背景:获得医疗保健的不平等导致社会群体之间的系统性健康差异。改善健康的干预措施并不总是考虑这些不平等。审查加纳和尼日利亚获得生殖保健服务的情况,探讨了这些国家妇女使用计划生育和孕产妇护理的模式。
方法:我们分别使用了来自2014年和2013年加纳和尼日利亚人口健康调查的人口水平数据。我们应用了两步聚类分析,然后进行了多项逻辑回归分析。
结果:与计划生育有关的初步两步聚类分析确定了加纳和尼日利亚的三个妇女群体:妇女高,获得计划生育服务的机会中等和贫困。随后与孕产妇护理相关的两步聚类分析确定了五个不同的聚类:较高,高,中等,加纳和尼日利亚获得孕产妇保健服务的机会很少。多元逻辑回归显示,与中等/高等教育的女性相比,在尼日利亚(OR=2.54,95%CI:1.90-3.39)和加纳(OR=1.257,95%CI:0.77-2.03),未受过教育的妇女获得计划生育服务的可能性较高.和白领相比,在尼日利亚,没有工作的女性获得孕产妇保健服务的可能性增加(OR=1.579,95%CI:1.081-2.307,p≤0.01).加纳没有观察到这种关联。在尼日利亚,家庭财富与获得计划生育服务和孕产妇保健服务密切相关。在加纳没有保险与获得计划生育服务的机会少有关,但尼日利亚的情况并非如此。在这两个国家,缺乏保险与无法获得孕产妇保健服务有关。
结论:这些差异证实了对生殖健康服务采取针对具体情况的重点方法的重要性。特别是减少社会经济地位造成的获取不平等。干预措施应侧重于根据需求评估将服务和人口群体分为优先类别。这样,它们可以帮助扩大自下而上的优质服务的覆盖面,以改善这些弱势群体的获取。
BACKGROUND: Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored.
METHODS: We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis.
RESULTS: The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90-3.39) and in Ghana (OR = 1.257, 95% CI: 0.77-2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081-2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services.
CONCLUSIONS: These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.