| ObjectiveTo study the influence factors about maternal hospital delivery in Weixi county and find out the major ones, explore the bottlenecks of local hospital delivery, in order to provide decision-making basis for maternal and child work in Weixi.MethodsQuantitative study including community-based case-control study matching at 1:3 was used to investigate the maternal basic information, hospital delivery condition, not hospital delivery condition, accessibility of health service etc. Pregnant women whose delivery outcomes were not hospital delivery in Weixi county between 2012 and 2013 were chosen as case group, while those whose fetal times were same, age ± 1 and delivery outcomes were hospital delivery in the same county and same years were chosen as control group.Qualitative research including semi-structured in depth interview was used to investigate relevant staff for maternal and child health service in Weixi county.Statistical analysis methods including statistical description, chi-square test and single factor logistic regression analysis were used.Results1 Comparison of maternal basic information between case and control groups: average age of 150 pregnant women in case group was (23.93 ± 5.01) years old, while it was (24.34±5.10) years old of 450 pregnant women in control group, which was no statistical significance between two groups through t test(t=0.840, P=0.401). There was no statistical significance of age stratification and fetal times between two groups through chi-square test(x2=0.902, P=0.924; x2=6.530, P=0.090).2 Comparison of maternal hospital delivery influence factors between case and control groups:taking whether hospital delivery or not as dependent variable,1 for case group(not hospital delivery) and 0 for control group(hospital delivery), while 19 factors was selected as independent variables. Single factor logistic regression analysis was used, taking backward method, and level of significance α=0.05. Factors whose OR>1 were risk factors and OR<1 were protective factors.2.1 Comparison of individual factors between case and control groups:single factor logistic regression analysis was used and education level(OR1=0.414, OR2=0.078) and economic situation(ORl=0.372) were the protective factors for maternal hospital delivery. It was used and nation Lisu(OR=9.811) were the risk factors for maternal hospital delivery.2.2 Comparison of pregnancy history between case and control groups:logistic regression analysis was used and parity≥ 3(OR=5.751), number of children ≥ 3 (OR=3.425) were the risk factors for maternal hospital delivery.It was birth hospital of first child (OR=0.071) were the protective factors for maternal hospital delivery.2.3 Comparison of health knowledge level between case and control groups: logistic regression analysis was used and prenatal examination times(ORl=0.031, OR2=0.003) and basic health knowledge(OR=0.372) were the protective factors for maternal hospital delivery.2.4 Comparison of health awareness between case and control groups:logistic regression analysis was used and hearing about maternal death(OR=0.225), knowing that hospital delivery was free in Wei Xi(OR=0.116) and awareness of expected date of childbirth(OR=0.078) were the protective factors for maternal hospital delivery.2.5 Comparison of traffic accessibility between case and control groups:logistic regression analysis was used and, distance from home to regular hospital(OR1=6.706, OR2=7.302, OR3=17.103), time for going to hospital (OR1=4.405, OR2=6.273, OR3=21.437), self-feeling about distance from home to hospital(ORl=5.795, OR2=15.900) were the risk factors for maternal hospital delivery. It was prenatal examination place of county hospital(OR=0.434), road conditions (OR1=0.335, OR2=0.385) to hospital and regular transportation(OR=0.451) to hospital were the protective factors for maternal hospital delivery.3 Principal component analysis about maternal hospital delivery influence factors:component1 was mainly influenced by nation, education level of mother, distance from home to hospital, time for going to hospital and self-feeling about distance from home to hospital, which reflected the maternal individual characteristics and traffic accessibility situation. Component2 was mainly influenced by whether hearing about maternal death or not, whether knowing that hospital delivery was free in Wei Xi or not and whether knowing expected date of childbirth or not, which reflected the health awareness level of pregnant women. Component3 was mainly influenced by parity, number of children and birth place of first child, which reflected the pregnancy history. Component4 was mainly influenced by traffic condition and transportation ways, which reflected the traffic convenience. Component5 was mainly influenced by economic condition, which reflected the economic influence. Component6 was mainly influenced by prenatal examination place, which reflected the accessibility of community health care service. Component? was mainly influenced by prenatal examination times and basic knowledge level, which reflected the health knowledge level of pregnant women.ConclusionsFactors affecting the choice of maternal hospital delivery can be summarized as individual characteristics, pregnancy history, knowledge and awareness of health level, traffic factors, family economic conditions, prenatal examination utilizations, community health services accessibility and other factors. Individual characteristics, traffic factors, prenatal examination, knowledge and awareness of health level are main ones that restrict the development of maternal and child health care work in Weixi county, which is also the bottleneck to break through currently. Family economic condition is no longer the most important factor that restrict choosing maternal hospital delivery and it is only exist in several poor households.Suggestions1 Government should formulate appropriate tilt policies. Exploring the labor service model actively and promoting the establishment of free labor policy. Carrying out mid wifery skills training and making the identity of staff legalization.2 Strengthening the construction of health sevice institution and staff especially the ob stetrics department and human capacity in township hospitals. While taking the constr uction of lechodochium in remote villages. Qualitied obstetrics and gynecology docto rs can change the practice mode and conduct outreach and door-to-door services.3 Continuing building "one to one" assistance system and gathering multi-force to joi n in propaganda with the assistanc and participation of community. |
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