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Yaya S, Bishwajit G, Ekholuenetale M, Shah V, Kadio B, Udenigwe O. Factors associated with maternal utilization of health facilities for delivery in Ethiopia. Int Health 2019; 10:310-317. [PMID: 29447358 DOI: 10.1093/inthealth/ihx073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 12/19/2017] [Indexed: 11/14/2022] Open
Abstract
Background As a signatory of the Millennium Development Goals, Ethiopia has made significant achievements towards meeting the maternal mortality related goals since 1990. Despite that, the country is still experiencing unacceptably high maternal mortality rates, and challenges to improving the coverage and utilisation of health facility delivery services which represent a key strategy to combat maternal mortality. Currently, there is limited evidence on the factors associated with health facility delivery in Ethiopia. Therefore, the objective of this study was to identify the correlates of facility delivery among urban and rural women in Ethiopia. Methods This was a cross-sectional study based on data from the 2011 Ethiopian Demographic and Health Survey. Participants were 7540 women aged between 15 and 49 years with a history of at least one birth. The outcome variable was place of delivery. Data were analyzed using bivariate and multivariable regression techniques. Results The overall prevalence of health facility delivery was 17.1% (1447/7540). In the multivariable regression analysis, education, wealth status, frequency of antenatal care visits and mother's age at first birth were found to be significantly associated with women's choice of place of delivery. Among urban women, those who had primary and secondary/higher level education had increased odds of delivering at a health facility compared with those without formal education. Those who were from the richest households had higher odds of delivering at a health facility compared with those in the lowest class. In urban and rural areas, compared with those who had no ANC visits, those who had at least four visits also had increased odds of delivering at a health facility. In the urban areas, those who were over 18 years old at their first childbirth had significantly higher odds of choosing to deliver at a health facility. Conclusion Findings show that the prevalence of healthy facility delivery in Ethiopia is remarkably low. Addressing the sociodemographic and wealth inequities can help promote the utilisation of facility delivery in both urban and rural areas. Policy-makers should consider improving access to education as a strategy to meet maternal health related goals and treat education as a multipronged strategy. Providing free healthcare access could be one strategy to achieve the universal coverage of essential maternal healthcare services.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Ghose Bishwajit
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Medicine and Health Management, Tongji Medical College. Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Vaibhav Shah
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Bernard Kadio
- Interdisciplinary School Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Jackson R, Tesfay FH, Godefay H, Gebrehiwot TG. Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia. PLoS One 2016; 11:e0150747. [PMID: 26963507 PMCID: PMC4786113 DOI: 10.1371/journal.pone.0150747] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs' and mother's attitudes to maternal health services in Adwa Woreda, Tigray Region. METHODS In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women's social status and mobility; and women's perceptions of skilled birth attendant's care. All data were analyzed thematically. FINDINGS There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women's Development Groups (WDGs), and referral by ambulance to health facilities either before a woman's Expected Due Date (EDD) or if labour started at home. CONCLUSION With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women's groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries.
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Affiliation(s)
- Ruth Jackson
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Geelong, Victoria, Australia
| | - Fisaha Haile Tesfay
- College of Health Sciences, Department of Public Health, Mekelle University, Mekelle, Tigray Region, Ethiopia
| | - Hagos Godefay
- Tigray Regional Health Bureau, Mekelle, Tigray Region, Ethiopia
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Laaser U, Brand H. Global health in the 21st century. Glob Health Action 2014; 7:23694. [PMID: 24560267 PMCID: PMC3926989 DOI: 10.3402/gha.v7.23694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 12/19/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction Since the end of the 1990s, globalization has become a common term, facilitated by the social media of today and the growing public awareness of life-threatening problems common to all people, such as global warming, global security and global divides. Review For the main parameters of health like the burden of disease, life expectancy and healthy life expectancy, extreme discrepancies are observed across the world. Infant mortality, malnutrition and high fertility go hand in hand. Civil society, as an indispensable activator of public health development, mainly represented by non-governmental organisations (NGOs), is characterised by a high degree of fragmentation and lack of public accountability. The World Federation of Public Health Associations is used as an example of an NGO with a global mission and fostering regional cooperation as an indispensable intermediate level. The lack of a globally valid terminology of basic public health functions is prohibitive for coordinated global and regional efforts. Attempts to harmonise essential public health functions, services and operations are under way to facilitate communication and mutual understanding. Recommendations 1) Given the limited effects of the Millennium Development Goal agenda, the Post-2015 Development Goals should focus on integrated regional development. 2) A code of conduct for NGOs should be urgently developed for the health sector, and NGOs should be registered and accredited. 3) The harmonisation of the basic terminology for global public health essentials should be enhanced.
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Affiliation(s)
- Ulrich Laaser
- World Federation of Public Health Associations, c/o IGH/CMU, University of Geneva, Geneva, Switzerland; Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany;
| | - Helmut Brand
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium; Department of International Health, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Cailhol J, Craveiro I, Madede T, Makoa E, Mathole T, Parsons AN, Van Leemput L, Biesma R, Brugha R, Chilundo B, Lehmann U, Dussault G, Van Damme W, Sanders D. Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities. Global Health 2013; 9:52. [PMID: 24160182 PMCID: PMC4016264 DOI: 10.1186/1744-8603-9-52] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/25/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. METHODS A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries' responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. RESULTS In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. CONCLUSION Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.
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Affiliation(s)
- Johann Cailhol
- School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Isabel Craveiro
- Unit of International Public Health and Biostatistics, Instituto de Higiene e Medicina Tropical, CMDT, WHO Collaborating Centre for Health Workforce Policy and Planning, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Elsie Makoa
- Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho
| | - Thubelihle Mathole
- School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Ann Neo Parsons
- School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Luc Van Leemput
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Regien Biesma
- Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Uta Lehmann
- School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Gilles Dussault
- Unit of International Public Health and Biostatistics, Instituto de Higiene e Medicina Tropical, CMDT, WHO Collaborating Centre for Health Workforce Policy and Planning, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - David Sanders
- School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
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