Ayal Debie, Molla M Wassie, Claire T Roberts, Murthy N Mittinty, Annabelle Wilson, Jacqueline H Stephens
{"title":"埃塞俄比亚孕产妇保健服务完整连续利用的趋势和促成因素：多变量分解分析。","authors":"Ayal Debie, Molla M Wassie, Claire T Roberts, Murthy N Mittinty, Annabelle Wilson, Jacqueline H Stephens","doi":"10.1186/s12978-025-01945-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Most maternal deaths are preventable by accessing essential maternity healthcare services. However, maternal mortality rates remain high in Ethiopia partly due to only a few women using a complete Continuum of Maternal Healthcare Services (CMHS). This study aims to assess trends and contributors for complete CMHS utilization in Ethiopia.</p><p><strong>Methods: </strong>Ethiopian Demography and Health Survey (EDHS) 2011-2019 data were used to assess the trends of complete CMHS utilization. A total weighted sample of 10,768 women (3333 in 2011, 4590 in 2016, and 2845 in 2019) were included in the analysis. A logit-based multivariate decomposition analysis was undertaken to assess the change in the proportion of complete CMHS utilization and its contributors between 2011 and 2019.</p><p><strong>Results: </strong>In Ethiopia, trends of complete CMHS utilization among women increased from 9.6% (95% CI 8.4, 10.9) in 2011 to 29.9% (95% CI 27.3, 32.6) in 2019. In the decomposition analysis, 60.6% of the difference in the proportion of complete CMHS utilization was explained by the differences in the composition of women's characteristics, and 39.4% was attributed to coefficients of characteristics. As such, equalizing the number of women who attended school at secondary level or higher, had television, initiated antenatal care (ANC) visits in the first trimester, were aware of pregnancy-related complications, delivered by caesarean section for their most recent childbirth, were from poorer households, gave urine and blood samples during pregnancy in 2019-2011 levels, would reduce the differences between 2011 to 2019 in complete CMHS utilization. In contrast, equalizing the number of women from richer (higher) household wealth categories in 2019-2011 levels would increase the 2011-2019 gaps in complete CMHS utilization.</p><p><strong>Conclusion: </strong>While progress has been made, complete CMHS utilization was low in Ethiopia. Differences in the composition of characteristics and effect of coefficients had a substantial contribution to the change in complete CMHS utilization between 2011 and 2019. Adopting a multi-faceted approach that considers the unique challenges within the country, including women's education, wealth status, and quality of care, will improve CMHS utilization. Empowering women through education can enhance their decision-making ability regarding their own health.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":"22 1","pages":"9"},"PeriodicalIF":3.6000,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773735/pdf/","citationCount":"0","resultStr":"{\"title\":\"Trends and contributors of complete continuum of maternal healthcare service utilization in Ethiopia: a multivariate decomposition analyses.\",\"authors\":\"Ayal Debie, Molla M Wassie, Claire T Roberts, Murthy N Mittinty, Annabelle Wilson, Jacqueline H Stephens\",\"doi\":\"10.1186/s12978-025-01945-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Most maternal deaths are preventable by accessing essential maternity healthcare services. However, maternal mortality rates remain high in Ethiopia partly due to only a few women using a complete Continuum of Maternal Healthcare Services (CMHS). This study aims to assess trends and contributors for complete CMHS utilization in Ethiopia.</p><p><strong>Methods: </strong>Ethiopian Demography and Health Survey (EDHS) 2011-2019 data were used to assess the trends of complete CMHS utilization. A total weighted sample of 10,768 women (3333 in 2011, 4590 in 2016, and 2845 in 2019) were included in the analysis. A logit-based multivariate decomposition analysis was undertaken to assess the change in the proportion of complete CMHS utilization and its contributors between 2011 and 2019.</p><p><strong>Results: </strong>In Ethiopia, trends of complete CMHS utilization among women increased from 9.6% (95% CI 8.4, 10.9) in 2011 to 29.9% (95% CI 27.3, 32.6) in 2019. In the decomposition analysis, 60.6% of the difference in the proportion of complete CMHS utilization was explained by the differences in the composition of women's characteristics, and 39.4% was attributed to coefficients of characteristics. As such, equalizing the number of women who attended school at secondary level or higher, had television, initiated antenatal care (ANC) visits in the first trimester, were aware of pregnancy-related complications, delivered by caesarean section for their most recent childbirth, were from poorer households, gave urine and blood samples during pregnancy in 2019-2011 levels, would reduce the differences between 2011 to 2019 in complete CMHS utilization. In contrast, equalizing the number of women from richer (higher) household wealth categories in 2019-2011 levels would increase the 2011-2019 gaps in complete CMHS utilization.</p><p><strong>Conclusion: </strong>While progress has been made, complete CMHS utilization was low in Ethiopia. Differences in the composition of characteristics and effect of coefficients had a substantial contribution to the change in complete CMHS utilization between 2011 and 2019. Adopting a multi-faceted approach that considers the unique challenges within the country, including women's education, wealth status, and quality of care, will improve CMHS utilization. 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引用次数: 0
摘要
背景：大多数孕产妇死亡是可以通过获得基本的孕产妇保健服务来预防的。然而，埃塞俄比亚的孕产妇死亡率仍然很高，部分原因是只有少数妇女使用完整的连续孕产妇保健服务。本研究旨在评估埃塞俄比亚全面利用CMHS的趋势和贡献者。方法：使用埃塞俄比亚2011-2019年人口与健康调查（EDHS）数据评估全面CMHS利用趋势。总加权样本10768名女性（2011年3333名，2016年4590名，2019年2845名）被纳入分析。采用logistic多元分解分析方法，评估2011 - 2019年CMHS完全利用率及其贡献率的变化情况。结果：在埃塞俄比亚，妇女完全使用CMHS的趋势从2011年的9.6% （95% CI 8.4, 10.9）增加到2019年的29.9% （95% CI 27.3, 32.6）。在分解分析中，60.6%的CMHS完全利用比例差异可归因于女性特征构成差异，39.4%归因于特征系数差异。因此，均衡以下妇女的人数：上过中学或更高水平的学校、有电视、在妊娠早期进行产前保健（ANC）检查、了解妊娠相关并发症、最近一次分娩时剖腹产、来自较贫困家庭、在2019-2011年期间提供了妊娠期间的尿液和血液样本，将减少2011年至2019年在全面利用CMHS方面的差异。相比之下，在2019-2011年的水平上，来自较富裕（较高）家庭财富类别的妇女人数相等，将扩大2011-2019年在全面利用CMHS方面的差距。结论：虽然取得了进展，但在埃塞俄比亚，CMHS的完全利用率很低。特征组成和系数效应的差异对2011 - 2019年CMHS完全利用率的变化有重要贡献。采取多方面的方法，考虑到国内的独特挑战，包括妇女的教育、财富状况和护理质量，将提高CMHS的利用率。通过教育赋予妇女权力可以提高她们对自身健康的决策能力。
Trends and contributors of complete continuum of maternal healthcare service utilization in Ethiopia: a multivariate decomposition analyses.
Background: Most maternal deaths are preventable by accessing essential maternity healthcare services. However, maternal mortality rates remain high in Ethiopia partly due to only a few women using a complete Continuum of Maternal Healthcare Services (CMHS). This study aims to assess trends and contributors for complete CMHS utilization in Ethiopia.
Methods: Ethiopian Demography and Health Survey (EDHS) 2011-2019 data were used to assess the trends of complete CMHS utilization. A total weighted sample of 10,768 women (3333 in 2011, 4590 in 2016, and 2845 in 2019) were included in the analysis. A logit-based multivariate decomposition analysis was undertaken to assess the change in the proportion of complete CMHS utilization and its contributors between 2011 and 2019.
Results: In Ethiopia, trends of complete CMHS utilization among women increased from 9.6% (95% CI 8.4, 10.9) in 2011 to 29.9% (95% CI 27.3, 32.6) in 2019. In the decomposition analysis, 60.6% of the difference in the proportion of complete CMHS utilization was explained by the differences in the composition of women's characteristics, and 39.4% was attributed to coefficients of characteristics. As such, equalizing the number of women who attended school at secondary level or higher, had television, initiated antenatal care (ANC) visits in the first trimester, were aware of pregnancy-related complications, delivered by caesarean section for their most recent childbirth, were from poorer households, gave urine and blood samples during pregnancy in 2019-2011 levels, would reduce the differences between 2011 to 2019 in complete CMHS utilization. In contrast, equalizing the number of women from richer (higher) household wealth categories in 2019-2011 levels would increase the 2011-2019 gaps in complete CMHS utilization.
Conclusion: While progress has been made, complete CMHS utilization was low in Ethiopia. Differences in the composition of characteristics and effect of coefficients had a substantial contribution to the change in complete CMHS utilization between 2011 and 2019. Adopting a multi-faceted approach that considers the unique challenges within the country, including women's education, wealth status, and quality of care, will improve CMHS utilization. Empowering women through education can enhance their decision-making ability regarding their own health.
期刊介绍：
Reproductive Health focuses on all aspects of human reproduction. The journal includes sections dedicated to adolescent health, female fertility and midwifery and all content is open access.
Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.
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