Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia

Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.

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The Extent of Universal Health Coverage for Maternal Health Services in Eastern Uganda: A Cross Sectional Study

Maternal and Child Health Journal ◽

10.1007/s10995-021-03357-3 ◽

2021 ◽

Author(s):

Clara Lindberg ◽

Tryphena Nareeba ◽

Dan Kajungu ◽

Atsumi Hirose

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Postnatal Care ◽

Institutional Delivery ◽

Skilled Birth Attendance ◽

Health Coverage ◽

Birth Attendance ◽

Out Of Pocket Payments ◽

Eastern Uganda

Abstract Objective Monitoring essential health services coverage is important to inform resource allocation for the attainment of the Sustainable Development Goal 3. The objective was to assess service, effective and financial coverages of maternal healthcare services and their equity, using health and demographic surveillance site data in eastern Uganda. Methods Between Nov 2018 and Feb 2019, 638 resident women giving birth in 2017 were surveyed. Among them, 386 were randomly sampled in a follow-up survey (Feb 2019) on pregnancy and delivery payments and contents of care. Service coverage (antenatal care visits, skilled birth attendance, institutional delivery and one postnatal visit), effective coverage (antenatal and postnatal care content) and financial coverage (out-of-pocket payments for antenatal and delivery care and health insurance coverage) were measured, stratified by socio-economic status, education level and place of residence. Results Coverage of skilled birth attendance and institutional delivery was both high (88%), while coverage of postnatal visit was low (51%). Effective antenatal care was lower than effective postnatal care (38% vs 76%). Financial coverage was low: 91% of women made out-of-pocket payments for delivery services. Equity analysis showed coverage of institutional delivery was higher for wealthier and peri-urban women and these women made higher out-of-pocket payments. In contrast, coverage of a postnatal visit was higher for rural women and poorest women. Conclusion Maternal health coverage in eastern Uganda is not universal and particularly low for postnatal visit, effective antenatal care and financial coverage. Analysing healthcare payments and quality by healthcare provider sector is potential future research.

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Knowledge on Intrapartum Danger Sign Influences Place of Delivery: The Case of Raya Kobo District, Northeastern Ethiopia

International Journal of Child Health and Nutrition ◽

10.6000/1929-4247.2021.10.02.1 ◽

2021 ◽

Vol 10 (2) ◽

pp. 44-50

Author(s):

Nigus Bililign Yimer ◽

◽

Misgan Legesse Liben

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Institutional Delivery ◽

Maternal Health Services ◽

District Health ◽

Delivery Service ◽

Danger Signs ◽

Study Participants ◽

Institutional Delivery Service

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.

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Knowledge on Intrapartum Danger Sign Influences Place of Delivery: The Case of Raya Kobo District, Northeastern Ethiopia

International Journal of Child Health and Nutrition ◽

10.6000/1929-4247.2021.10.01.6 ◽

2020 ◽

Vol 10 (1) ◽

pp. 44-50

Author(s):

Nigus Bililign Yimer ◽

Misgan Legesse Liben ◽

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Institutional Delivery ◽

Maternal Health Services ◽

District Health ◽

Delivery Service ◽

Danger Signs ◽

Study Participants ◽

Institutional Delivery Service

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Determinants of utilization of antenatal and postnatal care services in Telangana

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173264 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3352

Author(s):

Neelima Singh ◽

Satyendra Nath Ponna ◽

Venkata Prasad Upadrasta ◽

Shankar Reddy Dudala ◽

Renuka Sadasivuni

Keyword(s):

Public Health ◽

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Postnatal Care ◽

Maternal Health Services ◽

Geographical Region ◽

System Level ◽

Care Services ◽

Antenatal And Postnatal Care

Background: Variation exists in utilization of antenatal and postnatal care services in public health facilities of developing countries. Provision of antenatal and postnatal care services is the major function of public health delivery system of India to improve maternal health outcomes. The objective of this study is to estimate the determinants of utilization of antenatal and postnatal care services stratified by geographical region in Telangana.Methods: It is a cross-sectional study of District Level Health and Facility Survey-4 of the state of Telangana. Multistage, stratified, probability proportional to size sample with replacement was used. 3065 women, who delivered after the year 2008, were considered for analysis. Descriptive analysis of components of antenatal and postnatal care services stratified by geographical region was carried out. Binomial logistic regression was carried out to determine association of demographic, system level variables with adequate antenatal care.Results: Study reveals variation exists across four regions of Telangana in utilization of maternal health services. Reception of adequate antenatal care is low in South region (20.6%) and high in East region (31.5%). Pregnant women with secondary education were 66% more likely to receive adequate antenatal care services compared to illiterate.Conclusions: Short term and long-term goals to be adopted and implemented by government to address the demand-supply imbalance such as public health infrastructure and quality of services in underperforming districts of Telangana to increase utilization of maternal health services by training health staff and engaging local communities to seek health care services.

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Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data

PLoS ONE ◽

10.1371/journal.pone.0243071 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243071

Author(s):

Achamyeleh Birhanu Teshale ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Multilevel Analysis ◽

Multivariable Analysis ◽

Media Exposure ◽

Maternal Health Services ◽

Reproductive Age ◽

Neonatal Tetanus ◽

P Value

Background Even though there is low coverage of maternal health services such as antenatal care and skilled birth attendant delivery as well as poor sanitary practice during delivery in Ethiopia, the proportion of births protected by the tetanus vaccine is low. Thus, this study aimed to investigate the determinants of births protected against neonatal tetanus in Ethiopia. Objective To assess the determinants of births protected against neonatal tetanus in Ethiopia. Method The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A weighted sample of 7590 women who gave birth within five years preceding the survey was used for analysis. We conducted a multilevel analysis, due to the hierarchical nature of the data. Variables with p-value <0.05 in the multivariable analysis were declared to be significantly associated with having births protected against neonatal tetanus. Result In this study, mothers with primary education [adjusted odds ratio (AOR) = 1.23; 95%CI: 1.04, 1.44] and secondary and above education [AOR = 1.36; 95%CI: 1.06, 1.73], media exposure [AOR = 1.35; 95%CI: 1.15, 1.58], not perceiving distance from the health facility as a big problem [AOR = 1.24; 95%CI: 1.08,1.42], one antenatal care (ANC) visit [AOR = 1.56; 95%CI: 2.71, 4.68], two to three ANC visit [AOR = 11.82; 95%CI: 9.94,14.06], and four and more ANC visit [AOR = 15.25; 95%CI: 12.74, 18.26], being in Amhara [AOR = 0.59; 95%CI: 0.38,0.92], Afar [AO = 0.41; 95%CI: 0.25,0.66], and Harari [AOR = 1.88; 95%CI: 1.15,3.07] regions, being in communities with higher level of women education [AOR = 1.25; 95%CI: 1.03,1.52], and higher level of media exposure [AOR = 1.22; 95%CI: 1.01,1.48] were significant predictors of having a protected birth against neonatal tetanus. Conclusion In this study, both individual level and community level factors were associated with having protected birth against neonatal tetanus. Therefore, strengthening maternal health services such as ANC visits and interventions related to increasing media campaigns regarding tetanus could increase the immunization against tetanus among reproductive-age women. In addition, it is also better to give attention to those reproductive age group women from remote areas and also better to distribute maternal services fairly and equally between regions.

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Factors Associated with Use of Maternal Health Services in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i3.1525 ◽

2019 ◽

Vol 17 (3) ◽

pp. 301-307

Author(s):

Prithutam Bhattarai

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Survey ◽

Institutional Delivery ◽

Maternal Health Services ◽

Demographic And Health Survey ◽

Maternal Health Service ◽

Health Institution ◽

Delivery Services

Background: Timely access and use of health services are critical for improving maternal health services. The objective of present study is to identify key factors related to antenatal care and institutional delivery services in Nepal.Methods: Data from the Nepal Demographic Health Survey 2016 was analyzed. Women who have taken four or more antenatal checkup (ANC4+), and who delivered at a health Institution were considered outcome variables. Logistic regression analysis was used to compute odds ratio. Women (15-49) having most recent birth in 5 years preceding the survey were included in the study.Results: 69.4% women had taken four or more ANC and 60.6 % had given delivery at a health institution. Age of mother at birth of child, birth order, residence, and ethnicity were significantly associated with use of maternal health service. Educated were 3.79(CI2.83-5.08) times likely to take ANC4+ and 2.71 (CI 2.05-3.57) times likely to give birth at health institution. Richest women were 2.25(CI2.83-5.08) times likely to utilize the ANC4+ service and 9.48(CI6.46-13.91) times likely to give birth at health institution. Women in Province 7 were 3.16(CI2.14-4.67) times likely to utilize ANC4+ service and 2.71(CI 1.83-4.05) times likely to give delivery in health institution compared to women in Province 6.Conclusions: Higher educated and richest women were using antenatal care and institutional delivery compared to less educated. The finding reinforces importance of empowering women with education and improving economic situation.Keywords: Antenatal care; demographic and health survey; institutional delivery; maternal health; Nepal.

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Determinants of maternal health services utilization in Uganda

BMC Health Services Research ◽

10.1186/s12913-015-0943-8 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 32

Author(s):

Gideon Rutaremwa ◽

Stephen Ojiambo Wandera ◽

Tapiwa Jhamba ◽

Edith Akiror ◽

Angela Kiconco

Keyword(s):

Maternal Health ◽

Health Services ◽

Health Services Utilization ◽

Maternal Health Services ◽

Services Utilization

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Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

10.21203/rs.2.17266/v1 ◽

2019 ◽

Author(s):

Ruth Atuhaire

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Structural Equation ◽

First Trimester ◽

Maternal Health Services ◽

Facility Delivery ◽

Health Facility Delivery ◽

Mediating Factor

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

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Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia

International Journal for Equity in Health ◽

10.1186/s12939-019-1111-2 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Alem Desta Wuneh ◽

Araya Abrha Medhanyie ◽

Afework Mulugeta Bezabih ◽

Lars Åke Persson ◽

Joanna Schellenberg ◽

...

Keyword(s):

Maternal Health ◽

Child Health ◽

Health Services ◽

Wealth Index ◽

Skilled Birth Attendance ◽

Maternal Health Services ◽

Child Health Services ◽

Services Utilization ◽

Birth Attendance ◽

And Child Health

Abstract Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

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Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-036211 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036211

Author(s):

Clara C Natai ◽

Neema Gervas ◽

Frybert M Sikira ◽

Beatrice J Leyaro ◽

Juma Mfanga ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Male Involvement ◽

Maternal Health Services ◽

Cross Sectional Study ◽

Growth Monitoring ◽

Sectional Study ◽

Cross Sectional ◽

Mwanza City

BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services.ObjectivesTo determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania.DesignA cross-sectional study conducted from June to July 2019.SettingThis study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City.ParticipantsIncluded 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care).Outcome measures4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery.MethodsInterviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS.ResultsThe mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with SBA use or PNC utilisation.ConclusionMale involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.

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