Length of Stay After Childbirth in 92 Countries and Associated Factors in 30 Low- and Middle-Income Countries: Compilation of Reported Data and a Cross-sectional Analysis from Nationally Representative Surveys

BackgroundFollowing childbirth, women need to stay sufficiently long in health facilities to receive adequate care. Little is known about length of stay following childbirth in low- and middle-income countries or its determinants.Methods and FindingsWe described length of stay after facility delivery in 92 countries. We then created a conceptual framework of the main drivers of length of stay, and explored factors associated with length of stay in 30 countries using multivariable linear regression. Finally, we used multivariable logistic regression to examine the factors associated with stays that were “too short” (Across countries, the mean length of stay ranged from 1.3 to 6.6 d: 0.5 to 6.2 d for singleton vaginal deliveries and 2.5 to 9.3 d for cesarean-section deliveries. The percentage of women staying too short ranged from 0.2% to 83% for vaginal deliveries and from 1% to 75% for cesarean-section deliveries.Our conceptual framework identified three broad categories of factors that influenced length of stay: need-related determinants that required an indicated extension of stay, and health-system and woman/family dimensions that were drivers of inappropriately short or long stays. The factors identified as independently important in our regression analyses included cesarean-section delivery, birthweight, multiple birth, and infant survival status. Older women and women whose infants were delivered by doctors had extended lengths of stay, as did poorer women. Reliance on factors captured in secondary data that were self-reported by women up to 5 y after a live birth was the main limitation.ConclusionsLength of stay after childbirth is very variable between countries. Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these. The challenge is to commit to achieving adequate lengths of stay in low- and middle-income countries, while ensuring any additional time is used to provide high-quality and respectful care.

【背景】分娩后，女性需在医疗卫生机构留院足够时长以获得充足的产后照护（postnatal care）。目前针对中低收入国家（low- and middle-income countries）产妇产后留院时长及其影响因素的相关研究仍较为匮乏。
【方法与结果】本研究首先描述了92个国家的机构分娩（facility delivery）后留院时长情况。随后本研究构建了留院时长主要影响因素的概念框架，并针对30个国家的数据，采用多变量线性回归（multivariable linear regression）分析与留院时长相关的影响因素。最后，本研究使用多变量逻辑回归（multivariable logistic regression）探究了与"过短留院"相关的影响因素。研究结果显示：各国产妇产后平均留院时长介于1.3~6.6天之间：单胎阴道分娩（singleton vaginal deliveries）产妇的留院时长为0.5~6.2天，剖宫产（cesarean-section）产妇则为2.5~9.3天。阴道分娩产妇中留院时长过短的占比介于0.2%~83%之间，剖宫产产妇则为1%~75%。
本研究构建的概念框架将影响留院时长的因素划分为三大类别：与医疗需求相关的决定因素（此类因素需延长必要的留院时长），以及医疗卫生系统与产妇/家庭层面的因素（此类因素会导致留院时长过长或过短）。回归分析中被证实具有独立显著影响的因素包括剖宫产分娩、出生体重、多胎妊娠以及婴儿存活状态。高龄产妇、由医生接生的产妇，以及经济状况较差的产妇，其留院时长往往更长。本研究的主要局限性在于：所用的二手数据为产妇在活产分娩后最长5年内的自我报告信息。
【结论】不同国家的产妇产后留院时长差异极大。相当比例的产妇留院时长过短，无法获得充足的产后照护。我们需确保医疗卫生机构配备合格的接生人员并提供有效的照护服务，同时保障产妇留院时长足够长以从中获益。当前的挑战在于：在中低收入国家中，既要确保产妇达到充足的留院时长，又要确保额外的留院时间被用于提供高质量且尊重产妇权益的照护服务。