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影响坦桑尼亚设施交付需求的供应侧因素:多层次分析
Peter Binyaruka1, Anna Foss2, Abdullah Alibrahim3
1Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania. pbinyaruka@ihi.or.tz.
Health economics review
|November 6, 2023
概括
在坦桑尼亚,改善获得以设施为基础的分娩护理的机会对于减少产妇和新生儿死亡至关重要. 需求方面的因素,如教育和产前护理访问,显著影响妇女分娩的地点.
科学领域:
- 孕产妇和生殖健康 孕产妇和生殖健康
- 医疗保健服务研究 医疗服务研究
- 全球卫生平等全球卫生平等
背景情况:
- 获得以设施为基础的分娩护理对于减少孕产妇和新生儿死亡率至关重要,特别是在低收入环境中.
- 尽管具有重要意义,但在许多低收入地区,在医疗机构中获得熟练分娩助理仍然是一个挑战.
- 了解需求和供应方面的因素对于开发有效的干预措施来改善以设施为基础的分娩护理至关重要.
研究的目的:
- 调查坦桑尼亚基于设施的分娩护理的决定因素.
- 分析需求侧和供应侧因素对选择交付地点的影响.
- 为有针对性的干预提供证据,以增加医疗机构的熟练分娩出席率.
主要方法:
- 2012年进行了一项横截面调查,包括坦桑尼亚的150个卫生设施,1494名患者和2846个家庭.
- 收集了调查前12个月内分娩的妇女的数据.
- 采用多层混合效应物流回归模型来分析基于设施的交付的决定因素,并考虑层次数据结构和需求变化.
主要成果:
- 86%的妇女在医疗机构分娩.
- 需求侧因素 (76%) 在确定设施分娩时比供应侧因素 (24%) 有更大的影响.
- 设施分娩与妇女的教育,穆斯林信仰,更高的财富,第一次分娩和足够的产前护理访问有关. 相反,更长的等待和旅行时间,以及潜在的分娩费用与更少的设施分娩有关.
结论:
- 政策干预应侧重于通过健康教育提高需求,特别是对受教育程度较低的妇女和具有较高平等程度的妇女.
- 降低获得护理的财务和时间方面的障碍对于改善设施为基础的分娩率至关重要.
- 改善设施内人际关怀的质量是鼓励基于设施的分娩的关键策略.
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