第3巻 第1号

要旨

序論

Young pregnant mothers experience heightened biological, social, and economic vulnerabilities that may compromise health-related quality of life (HRQoL), especially in low-resource settings. Although maternal healthcare service utilization (MHCSU) improves clinical outcomes, evidence linking it to HRQoL among young mothers in Uganda remains limited. This study examined determinants of HRQoL among young pregnant mothers aged 10–24 years in Eastern Uganda, with emphasis on MHCSU.

方法

A cross-sectional analytical study was conducted among 967 young pregnant mothers in selected districts of Eastern Uganda. The study used baseline data collected prior to randomization and implementation of any intervention. Although the WHOQOL-BREF instrument was administered in full, the present analysis utilized the global quality-of-life item (Question 1: "How would you rate your quality of life?") as the primary outcome measure. Responses ranged from very poor (1) to very good (5) and were analyzed as an ordinal outcome using ordered logistic regression. Data were analyzed using descriptive statistics, ANOVA for bivariate associations and ordered logistic regression models to assess predictors of HRQoL, all conducted at a 95% confidence level.

結果

Results from the bivariate analysis indicated that uptake of antenatal care (ANC), skilled birth attendance (SBA), and access to postnatal care (PNC) were associated with better health-related quality of life (HRQoL) among young pregnant mothers. Mothers who attended antenatal care reported higher mean HRQoL scores compared to those who did not (2.98 ± 1.12 vs. 2.66 ± 0.96, p = .001), demonstrating that ANC utilization is positively linked to maternal well-being. Similarly, mothers who delivered with the assistance of skilled birth attendants had higher HRQoL scores than those who did not (3.00 ± 1.11 vs. 2.65 ± 0.97, p < .001), indicating the importance of skilled delivery care in improving quality of life. Access to postnatal care also showed a positive association, with mothers who received PNC services reporting higher HRQoL scores compared to those who did not (2.97 ± 1.12 vs. 2.71 ± 1.10, p = .003). Overall, these findings suggest that increased utilization of maternal healthcare services is consistently associated with improved HRQoL among young pregnant mothers.

In the ordered logistic regression analysis, ANC uptake remained a statistically significant predictor of HRQoL (OR = 1.686, p < .001), indicating that mothers who accessed ANC services had approximately 1.69 times higher odds of being in better quality of life categories compared to those who did not. Similarly, skilled birth attendance was positively and significantly associated with HRQoL (OR = 1.761, p < .001), suggesting that mothers who delivered with skilled health personnel were more likely to report improved quality of life outcomes. Access to postnatal care also demonstrated a significant positive effect (OR = 1.552, p = .002), implying that mothers who received PNC services had higher odds of better HRQoL. In the multivariable model, immediate health-seeking behavior remained a significant predictor (OR = 1.411, p = .006), indicating that prompt care utilization increases the likelihood of improved well-being. Conversely, perceived quality of care was negatively associated with HRQoL; compared to mothers who perceived care as excellent, those who rated care as good (OR = 0.394, p < .001), fair (OR = 0.083, p < .001), and poor (OR = 0.077, p < .001) had significantly lower odds of reporting better quality of life. These findings highlight the critical importance of perceived care quality in shaping maternal well-being.

結論

Maternal healthcare service utilization and positive care experiences were significantly associated with better HRQoL among young pregnant mothers. Expanding access to ANC, SBA, and PNC alongside respectful, youth-responsive care is essential to improve maternal well-being in Eastern Uganda.

要旨

序論

Skilled birth attendance (SBA) is a proven intervention for reducing maternal and newborn morbidity and mortality through the prevention and management of childbirth complications. While its survival benefits are well established, less is known about its association with health-related quality of life (HRQoL), an important indicator of women’s physical, psychosocial and social well-being. Evidence on this relationship remains limited among young mothers in low resource settings such as Uganda. This study examined the association between SBA and HRQoL among young mothers aged 10-24years in Eastern Uganda.

方法

A cross-sectional study was conducted among 967 young mothers in Kamuli, Pallisa, and Ngora districts. Participants were young mothers aged 10–24 years who had delivered within the previous two years. Data were collected using structured interviewer-administered questionnaires. HRQoL was assessed using the WHOQOL-BREF tool on a five-category self-rated scale. Descriptive statistics summarized participant characteristics, chi-square tests and One way ANOVA explored bivariate associations, and ordered logistic regression estimated the relationship between SBA and HRQoL. Skilled birth attendance was defined as delivery assisted by a trained and accredited health professional (doctor, nurse or midwife) in accordance with WHO recommendations.

結果

Most respondents were aged 18–24 years (91.3%), married (75.8%), and had prior pregnancy experience (90.4%). Bivariate analysis demonstrated that skilled birth attendance (SBA) utilization was significantly associated with several key factors, including age (χ²(1)=5.75, p=0.017), religion (χ²(1)=18.09, p<0.001), knowledge of maternal healthcare services (χ²(1)=26.84, p<0.001), seeking care immediately (χ²(1)=38.82, p<0.001), perceived quality of care (χ²(3)=71.90, p<0.001), and previous pregnancy complications (χ²(1)=6.91, p=0.009). These findings indicate that younger mothers, those lacking awareness, and those reporting poorer care experiences were less likely to deliver with assistance of skilled birth attendant. An ordered logistic regression analysis further established that utilization of SBA was a significant predictor of health-related quality of life (HRQoL) (z = 4.12, p < 0.001). Young mothers who delivered with the assistance of a skilled birth attendant had significantly higher odds of reporting better HRQoL compared to those who did not (OR = 1.761, 95% CI 1.345 2.306), implying that SBA users were approximately 1.76 times more likely to fall into a higher HRQoL category. The overall model was statistically significant (LR χ² (1) = 17.01, p < 0.001), although the pseudo-R² of 0.006 suggests limited explanatory power. Nonetheless, the findings highlight the independent contribution of SBA to improved maternal well-being, underscoring its importance in enhancing quality of life among young mothers.

結論

Skilled birth attendance was positively associated with better HRQoL among young mothers in Eastern Uganda. Expanding equitable access to skilled delivery care may enhance physical safety, emotional well-being, and overall quality of life for this vulnerable population.