Data from: Social capital as a determinant of pregnant mother’s place of delivery: experience from Kongwa District in central Tanzania

Introduction: Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery. Methods: We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12. Results: Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4–6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3–13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9–11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4–13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001). Conclusion: Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.

引言：孕产妇健康不良是包括坦桑尼亚在内的撒哈拉以南非洲各国疾病全球负担的重要构成因素。确保所有分娩均在医疗机构进行并由熟练卫生人员助产，是包括千年发展目标（Millennium Development Goals, MDGs）在内的全球及各国政策倡导的策略之一。然而，尽管已实施多项干预措施，撒哈拉以南非洲地区由熟练卫生人员助产的分娩比例仍处于较低水平。本研究旨在探究社会资本（social capital）对促进医疗机构分娩的作用。方法：我们从坦桑尼亚农村地区两个随机抽取的行政村中，选取了744户拥有5岁以下儿童的家庭，向这些家庭的产妇询问其末次分娩的地点。采用经改良的涵盖社会资本结构维度与认知维度的问卷，通过面对面访谈对研究对象的社会资本进行评估。采用主成分分析（Principal Component Analysis, PCA）构建社会资本指数。使用STATA 12统计软件构建单变量与多变量回归模型。结果：85.9%的产妇表示其末次分娩在医疗机构完成。与社会资本最低五分位组相比，医疗机构分娩的比例随社会资本水平提升呈显著升高趋势：低社会资本组（校正比值比（Adjusted Odds Ratio, AOR）=2.9，置信区间（Confidence Interval, CI）：1.4~6.1，p=0.004）；中社会资本组（AOR=5.5，CI：2.3~13.3，p<0.001）；高社会资本组（AOR=4.7，CI：1.9~11.6，p<0.001）；最高社会资本组（AOR=5.6，CI：2.4~13.4，p<0.001），且趋势卡方检验具有统计学意义（χ²=17.21，p<0.001）。结论：总体而言，社会资本在促进医疗机构分娩方面发挥着重要作用，而这一作用可进一步改善孕产妇与儿童的健康状况。未来应协同发力，推广并支持有效的社会资本建设，尤其应侧重认知型社会资本的培育。