The Journal of Korean Society for School & Community Health Education (한국학교ㆍ지역보건교육학회지)

The Korean Society for School & Community Health Education (한국학교ㆍ지역보건교육학회)
권호 표지

Determinants of Utilization of Postnatal Care in Kapchorwa District, Eastern Uganda

산후건강관리서비스 이용의 결정요인에 관한 연구 -우간다 동부 카프초르와 구를 중심으로-

  • Chelangat, Irene Kapsawani (The Graduate School of Government and Business, Yonsei University, Wonju campus) ;
  • Jin, Ki-Nam (Department of Health Administration, Yonsei University, Wonju campus) ;
  • Kim, Sunmi (Department of Health Administration, Yonsei University, Wonju campus) ;
  • Um, Tae Rim (Department of Health Administration, Yonsei University, Wonju campus) ;
  • Kim, Jinjoo (Institute of Health & Welfare Institute, Yonsei University, Wonju campus)
  • Received : 2015.03.11
  • Accepted : 2015.04.20
  • Published : 2015.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

목적: 사하라 이남 아프리카 지역 중저소득국가 모성보건지표의 더딘 개선율은 MDG 5(모자보건향상) 미달성의 주요 원인 중 하나로 꼽힌다. 따라서 본 연구는 우간다 동부 카프초르와 구의 모성사망과 밀접한 산후건강관리(PNC, Postnatal care)서비스 이용결정요인을 파악하는데 있다. 이를 통해 지역건강관리자들에게 PNC 서비스 이용 개선을 위한 정책 수립 및 방안 마련에 기초자료를 제공하고, 궁극적으로는 MDG 5 지표 개선에 일조하고자 한다. 방법: 표본 집단은 카프초르와 구의 15세~49세 여성들 중 최근 1년 내에 출산을 경험한 자들을 대상으로 편의추출 되었다. 조사기간은 2014년 7월부터 10월까지였으며, 구조화된 설문에 총 171명이 응답하였고, 19명의 주요 정보제공자와의 심층면담도 실시하였다. 응답자의 사회인구학적 특성 및 PNC 이용행태를 알아보기 위해 빈도분석을 실시하였으며, 각 독립변수가 PNC 이용에 어떤 영향을 미치는지 파악하기 위해 로지스틱 회귀분석을 실시하였다. 결과: 응답자의 55%만이 의료시설의 PNC 서비스를 받은 것으로 나타났다. 로지스틱 회귀분석을 통해서는 응답자의 연령과 사회적 네트워크, 인지된 건강상태, 산전관리서비스 이용이 PNC 서비스 이용에 긍정적인 영향을 미치는 것으로 나타났으며 의료시설과의 거리, 가족의 규모는 부정적인 영향을 미치는 것으로 나타났다. 결론: PNC 서비스 이용개선을 위해서는 먼저 여성의 사회적 자본 확충 및 개선을 위한 모성보건교육인 소프트 인프라 지원이 지자체 차원에서 실시되어야 할 것이며, 서비스 이용을 가능케 하고 접근성을 높이는 응급후송체계 구축과 같은 물리적 인프라 지원도 도입되어야할 것이다. 또한 가족계획 서비스를 제공하는 등 모성보건관리에 대한 지자체의 민감성을 높이는 것도 필요하겠다.

Keywords

References

  1. Addai I. Determinants of use of maternal-child health services in rural Ghana. Journal of Biosocial Science 2000;32(1):1-15.
  2. Aday LA, Andersen RM. A framework for the study of access to medical care. Health Services Research 1974;9(3):208.
  3. Andersen RM. Behavioral Model of Families' Use of Health Services. Research Series No. 25. Chicago, IL: Center for Health Administration Studies, University of Chicago, 1968.
  4. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly 1973 Winter;51(1):95-124. https://doi.org/10.2307/3349613
  5. Amooti-Kaguna B, Nuwaha F. Factors influencing choice of delivery sites in Rakai district of Uganda. Social Science & Medicine 2000;50(2):203-213. https://doi.org/10.1016/S0277-9536(99)00275-0
  6. Celik Y, Hotchkiss DR. The socio-economic determinants of maternal health care utilization in Turkey. Social Science & Medicine 2000;50(12): 1797-1806. https://doi.org/10.1016/S0277-9536(99)00418-9
  7. Chakraborty N, Islam MA, Chowdhury RI, Bari WW, Akhter HH. Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International 2003;18(4):327-337. https://doi.org/10.1093/heapro/dag414
  8. Elo IT. Utilization of maternal health-care services in Peru: the role of women's education. Health Transition Review 1992;49-69.
  9. Fiedler JL. A review of the literature on access and utilization of medical care with special emphasis on rural primary care. Social Science and Medicine 1981;15:129-142.
  10. Fosu GB. Childhood morbidity and health services utilization: cross-national comparisons of user-related factors from DHS data. Social Science & Medicine 1994; 38(9):1209-1220. https://doi.org/10.1016/0277-9536(94)90186-4
  11. Gage AJ. Barriers to the utilization of maternal health care in rural Mali. Social Science & Medicine 2007;65(8):1666-1682. https://doi.org/10.1016/j.socscimed.2007.06.001
  12. Ikamari LD. Maternal health care utilisation in Teso District. African Journal of Health Sciences 2005;11(1):21-32.
  13. Karkee R, LEE AH, Khanal V. Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey 2011. BMJ open 2014;4(3):e004372. https://doi.org/10.1136/bmjopen-2013-004372
  14. Mekonnen Y, Jegou R, Coutinho RA, Nokes J, Fontanet A. Demographic impact of AIDS in a low-fertility urban African setting: projection for Addis Ababa, Ethiopia. Journal of Health, Population and Nutrition 2002;120-129.
  15. Mekonnen Y, Mekonnen A. Utilization of Maternal Health Care Services in Ethiopia. Calverton, ML: ORC Macro, 2002.
  16. Mekonnen Y, Mekonnen A. Factors influencing the use of maternal healthcare services in Ethiopia. Journal of Health, Population and Nutrition 2003;374-382.
  17. Ministry of Health. Health Sector Strategic Plan iii 2010/11-2014/15. Government of Uganda, Kampala: Ministry of Health, 2010.
  18. Ministry of Health. Strategic Plan, Maternal Perinatal and Child Death Review 2009/10-2014/15. Government of Uganda, Kampala: Ministry of Health, 2009
  19. Navaneetham K, Dharmalingam A. Utilization of maternal health care services in Southern India. Social Science & Medicine 2002;55(10):1849-1869. https://doi.org/10.1016/S0277-9536(01)00313-6
  20. Nhindiri P, Munjanja S, Zhanda I, Lindmark G, Nystrom L. A community-based study on utilisation of maternity services in rural Zimbabwe. African Journal of Health Sciences 1996;3(4):120-125.
  21. Nwakoby BN. Use of obstetric services in rural Nigeria. The Journal of the Royal Society for the Promotion of Health 1994;114(3):132-136. https://doi.org/10.1177/146642409411400304
  22. Obermeyer CM, Potter JE. Maternal health care utilization in Jordan: a study of patterns and determinants. Studies in Family Planning 1991;177-187.
  23. Parkhurst J, Ssengooba F. Access to and Utilisation of Professional Child Delivery Services in Uganda and Bangladesh. Health Systems Development Programme, London School of Hygiene and Tropical Medicine, 2005.
  24. Prata N, Mbaruku G, Campbell M, Potts M, Vahidnia F. Controlling postpartum hemorrhage after home births in Tanzania. International Journal of Gynecology & Obstetrics 2005;90(1):51-55. https://doi.org/10.1016/j.ijgo.2005.03.007
  25. Raghupathy S. Education and the use of maternal health care in Thailand. Social Science & Medicine 1996;43(4):459-471. https://doi.org/10.1016/0277-9536(95)00411-4
  26. Ronsmans C, Graham WJ, Lancet Maternal Survival Series steering group. Maternal mortality: Who, When, Where, and Why. The Lancet 2006;368(9542):1189-1200. https://doi.org/10.1016/S0140-6736(06)69380-X
  27. Singh PK, Rai RK, Alagarajan M, Singh L. Determinants of maternity care services utilization among married adolescents in rural India. PloS One, 2012;7(2):e31666. https://doi.org/10.1371/journal.pone.0031666
  28. Uganda Bureau of Statistics(UBOS) and Macro International Inc. Uganda Demographic and Health Survey 2006. Calverton, ML: UBOS and Macro International Inc, 2007.
  29. Wong EL, Popkin BM, Guilkey DK, Akin JS. Accessibility, quality of care and prenatal care use in the Philippines. Social Science & Medicine 1987;24(11):927-944. https://doi.org/10.1016/0277-9536(87)90286-3
  30. World Health Organization, Department of Reproductive Health and Research. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: World Health Organization. 2007.