背景:世界卫生组织的全球卫生观察站将孕产妇死亡率定义为每年女性死亡人数,无论怀孕的时期或地点,在妊娠和分娩期间或终止妊娠后42天内,与妊娠或其管理相关或由妊娠或其管理引起的任何原因(意外或偶然原因除外),在2016年至2020年期间,全球估计有287,000名妇女因孕产妇原因去世,每天约800例死亡或每两分钟约1例。
方法:使用了14个SSA国家的最新2018-2023年DHS数据集,总共89,489名加权母亲在调查前3年出生,进行了多层次分析。在多变量分析中包括p值≤0.20的双变量分析变量,在多变量分析中,p值小于≤0.05的变量被认为是与8次及以上ANC访视相关的显著因素.
结果:在14个撒哈拉以南非洲国家进行8次及以上ANC访问的幅度为8.9%(95%CI:8.76-9.13),范围从加蓬的3.66%(95%CI:3.54-3.79)到尼日利亚的18.92%(95%CI:18.67-19.17)。多水平分析表明,孕产妇年龄(40-44,AOR;2.09,95CI:1.75-2.53),产妇职业状况(AOR;1.14,95CI;1.07-1.22),孕产妇教育水平(中等及以上,AOR;1.26,95CI;1.16-1.38),财富状况(AOR;1.65,95CI;1.50-1.82),媒体暴露(AOR;1.20,95CI;1.11-1.31),妊娠意向(AOR;1.12,95CI;1.05-1.20),曾经终止妊娠(AOR;1.1695CI;1.07-1.25),及时开始第一次ANC访问(AOR;4.79,95CI;4.49-5.10),对受访者医疗保健的赋权(AOR;1.43,95CI;1.30-1.56),城市居住地(AOR;1.33,95CI;1.22-1.44)是严重影响AN利用的因素。另一方面,较高的出生顺序(AOR;0.54,95CI;0.53-0.66),不使用避孕药(AOR;0.80,95CI;0.75-0.86)和调查年份(AOR;0.47,95CI;0.34-0.65)是与8次或更多ANC就诊呈负相关的因素.
结论:在本研究纳入的14个SSA中,8次和更多的ANC访问对世卫组织准则的遵守程度较低。受过教育,有工作,从农村居民和富裕财富群体获得媒体的访问有助于八次或更多的非国大访问,因此,我们强烈建议政策实施者倡导这种做法。
BACKGROUND: The world health organization\'s global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes.
METHODS: The most recent 2018-2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers
who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits.
RESULTS: The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76-9.13) ranging from 3.66% (95% CI: 3.54-3.79) in Gabon to 18.92% (95% CI: 18.67-19.17) in Nigeria. The multilevel analysis shows that maternal age (40-44, AOR;2.09, 95%CI: 1.75-2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07-1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16-1.38), wealth status(AOR;1.65, 95%CI; 1.50-1.82), media exposure (AOR;1.20, 95%CI; 1.11-1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05-1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07-1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49-5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30-1.56), urban place of residence (AOR;1.33, 95%CI; 1.22-1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53-0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75-0.86) and survey year (AOR;0.47, 95%CI; 0.34-0.65) were factors negatively associated with having eight and more ANC visits.
CONCLUSIONS: In the 14 SSA included in this study, there is low adherence to
WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.