Prospective study of determinants and costs of home births in Mumbai slums 英文参考文献.docVIP

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Prospective study of determinants and costs of home births in Mumbai slums 英文参考文献.doc

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Prospective study of determinants and costs of home births in Mumbai slums 英文参考文献

Dasetal.BMCPregnancyandChildbirth2010,10:38 /1471-2393/10/38 RESEARCH ARTICLE OpenAccess Prospectivestudyofdeterminantsandcostsof homebirthsinMumbaislums SushmitaDas1*,UjwalaBapat1,NeenaShahMore1,LatikaChordhekar1,WasundharaJoshi1,DavidOsrin2 Abstract Background:Around86%ofbirthsinMumbai,India,occurinhealthcareinstitutions,butthisaggregatefigure hidessubstantialvariationandlittleisknownabouturbanhomebirths.Weaimedtoexplorefactorsinfluencing thechoiceofhomedelivery,carepracticesandcosts,andtoidentifycharacteristicsofwomen,householdsand theenvironmentwhichmightincreasethelikelihoodofhomebirth. Methods:AspartoftheCityInitiativeforNewbornHealth,weusedakeyinformantsurveillancesystemtoidentify birthsprospectivelyin48slumcommunitiesinsixwardsofMumbai,coveringapopulationof280000.Birthsand outcomesweredocumentedprospectivelybylocalwomenandmotherswereinterviewedindetailatsixweeks afterdelivery.Weexaminedtheprevalenceofhomebirthsandtheirassociationswithpotentialdeterminants usingregressionmodels. Results:Wedescribed1708(16%)homedeliveriesamong10754birthsovertwoyears,2005-2007.Theproportion variedfrom6%to24%,dependingonarea.Themostcommonlycitedreasonsforhomebirthwerecustomandlack oftimetoreachahealthcarefacilityduringlabour.Seventypercentofhomedeliverieswereassistedbyatraditional birthattendant(dai),and6%byskilledhealthpersonnel.ThemediancostofahomedeliverywasUS$21,of institutionaldeliveryinthepublicsectorUS$32,andintheprivatesectorUS$118.Inanadjustedmultivariable regressionmodel,theoddsofhomedeliveryincreasedwithilliteracy,parity,socioeconomicpoverty,poorerhousing, lackofwatersupply,populationtransience,andhazardouslocation. Conclusions:Weestimate32000annualhomebirthstoresidentsofMumbai’sslums.Theseareunevenly distributedandclusterwithothermarkersofvulnerability.Sincecostdoesnotappeartobeadominant disincentivetoinstitutionaldelivery,effortsareneededtoimprovetheclientexperienceatpublicsector institutions.Itmightalsobeproductivetoconcentrateonintensiveoutreachinvulnerablearea