BACKGROUND Achieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common. METHODS Guided by Andersen's Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions. RESULTS The analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women's household decision-making power, place of residence as important determinants of ANC visits and SBAs. CONCLUSIONS Based on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.

中文翻译：

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乌干达初产妇的孕产妇保健服务利用情况：千年发展目标实现了什么？


背景 实现可持续发展目标中的孕产妇健康成果需要实施更有针对性的政策和战略。虽然千年发展目标可能加深了我们在这方面的理解，但我们对初产妇使用孕产妇保健服务的趋势以及年龄和地理区域如何影响这些趋势知之甚少。在这项研究中，我们调查了乌干达初产妇对产前和熟练分娩服务的利用情况，乌干达是孕产妇死亡率最高的国家之一，早育及其随之而来的挑战也很常见。方法 在安德森行为模型的指导下，我们将多元回归模型拟合到 2006 年、2011 年和 2016 年乌干达人口和健康调查 (n = 3477) 的汇总数据集中，以了解产前护理 (ANC) 和熟练助产士 (SBA) 的动态初产妇中的利用。采用后估计裕度来进一步强调年龄和地理区域的影响。结果 分析显示，2006 年至 2016 年，初产妇获得孕产妇保健服务的情况有所改善。与 2006 年相比，2016 年初产妇进行早期 ANC、四次或以上 ANC 就诊和 SBA 的可能性分别增加了 48%、24% 和 2.98 倍， 分别。总体而言，2016 年初产妇达到所有三项孕产妇保健服务指标的可能性比 2006 年高出 42%。对年龄和地域差异的后估计裕度分析显示，年轻的初产妇获得孕产妇保健服务的概率较低，而东部地区（该国最贫困的地区之一）的初产妇获得孕产妇保健服务的概率最低。 此外，研究还发现，教育、财富、妇女的家庭决策权、居住地是 ANC 访问和 SBA 的重要决定因素。结论 根据我们的研究结果，解决初产妇（尤其是年轻个体）在早期接受 ANC 方面的脆弱性非常重要。乌干达应扩大当地社区孕产妇保健服务的权力下放和一体化，作为解决长期存在的地理差异的战略，并最终改善可持续发展目标期间的孕产妇保健成果。