Global dominance of non-institutional delivery and the risky impact on maternal mortality spike in 25 Sub-Saharan African Countries.

IF 4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Oyewole K Oyedele, Temitayo V Lawal
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引用次数: 0

Abstract

Background: Despite 70% of global maternal death occurring in Sub-Saharan Africa (SSA) and the high rate of non-institutional delivery (NID), studies that inspect the connections are needed but lacking. Thus, we investigated the urban-rural burden and risk factors of NID and the correlate with maternal mortality to extend strategies for sinking the mortality spike towards sustainable development goal (SDG-3.1) in SSA.

Methods: Secondary analysis of recent (2014-2021) cross-sectional demographic-health-survey (DHS) were conducted across 25-countries in SSA. Primary outcome was institutional versus non-institutional delivery and secondary outcome was maternal-mortality-ratio (MMR) per 100,000 livebirths and the lifetime risk (LTR), while predictors were grouped by socio-economic, obstetrics and country-level factors. Data were weighted to adjust for heterogeneity and descriptive analysis was performed. Pearson chi-square, correlation, and simple linear regression anlyses were performed to assess relationships. Multivariable logistic regression further evaluated the predictor likelihood and significance at alpha = 5% (95% confidence-interval 'CI').

Results: Prevalence of NID was highest in Chad (78.6%), Madagascar (60.6%), then Nigeria (60.4%) and Angola (54.3%), with rural SSA dominating NID rate by about 85%. Odds of NID were significantly lower by 60% and 98% among women who had at least four antenatal care (ANC) visits (aOR = 0.40, 95%CI = 0.38-0.41) and utilized skilled birth attendants (SBA) at delivery (aOR = 0.02, 95%CI = 0.01-0.02), respectively. The odds of NID reduces by women age, educational-level, and wealth-quintiles. Positive and significant linear relationship exist between NID and MMR (ρ = 0.5453), and NID and LTR (ρ = 0.6136). Consequently, 1% increase in NID will lead to about 248/100000 and 8.2/1000 increase in MMR and LTR in SSA respectively.

Conclusions: Only South Africa, Rwanda and Malawi had achieved the WHO 90% coverage for healthcare delivery. ANC and SBA use reduced NID likelihood but, MMR is significantly influenced by NID. Hence, strategic decline in NID will proportionately influence the sinking of MMR spike to attain SDG-3.1 in SSA.

非机构分娩在全球占主导地位,对25个撒哈拉以南非洲国家孕产妇死亡率激增的危险影响。
背景:尽管全球70%的孕产妇死亡发生在撒哈拉以南非洲(SSA),而且非机构分娩率(NID)很高,但检查这种联系的研究是必要的,但缺乏。因此,我们调查了NID的城乡负担和危险因素以及与孕产妇死亡率的相关性,以扩展SSA降低死亡率飙升的战略,以实现可持续发展目标(SDG-3.1)。方法:对SSA 25个国家近期(2014-2021年)的横断面人口健康调查(DHS)进行二次分析。主要结局是机构分娩与非机构分娩的比较,次要结局是每10万例活产的孕产妇死亡率(MMR)和终生风险(LTR),预测因子按社会经济、产科和国家级因素分组。对数据进行加权以调整异质性,并进行描述性分析。采用Pearson卡方分析、相关性分析和简单线性回归分析来评估相关性。多变量逻辑回归进一步评估了预测因子的似然性和显著性,alpha = 5%(95%置信区间CI)。结果:NID患病率最高的国家为乍得(78.6%)、马达加斯加(60.6%)、尼日利亚(60.4%)和安哥拉(54.3%),其中农村SSA占NID患病率的85%左右。在至少进行过四次产前保健(ANC)检查(aOR = 0.40, 95%CI = 0.38-0.41)和分娩时使用熟练助产士(aOR = 0.02, 95%CI = 0.01-0.02)的妇女中,NID的几率分别显著降低了60%和98%。NID的几率因女性年龄、教育水平和财富五分位数而降低。NID与MMR (ρ = 0.5453)、LTR (ρ = 0.6136)呈显著正线性关系。因此,NID增加1%将导致SSA的MMR和LTR分别增加约248/100000和8.2/1000。结论:只有南非、卢旺达和马拉维实现了世卫组织90%的卫生保健服务覆盖率。ANC和SBA的使用降低了NID的可能性,但MMR受NID的显著影响。因此,NID的战略性下降将成比例地影响MMR峰值的下降,以实现SSA的可持续发展目标3.1。
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来源期刊
Global Health Research and Policy
Global Health Research and Policy Social Sciences-Health (social science)
CiteScore
12.00
自引率
1.10%
发文量
43
审稿时长
5 weeks
期刊介绍: Global Health Research and Policy, an open-access, multidisciplinary journal, publishes research on various aspects of global health, addressing topics like health equity, health systems and policy, social determinants of health, disease burden, population health, and other urgent global health issues. It serves as a forum for high-quality research focused on regional and global health improvement, emphasizing solutions for health equity.
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