Maternal and newborn health services utilization in Jimma Zone, Southwest Ethiopia: a community based cross-sectional study

Sex Disparities: Couple's Knowledge and Attitude Towards Obstetric Danger Signs and Maternal Health Care: in Rural Jimma Zone of Ethiopia

Purpose

This study aimed to compare knowledge and attitudes towards obstetric danger signs and care between females receiving maternal care and their male partners.

Methods and Materials

A community-based comparative cross-sectional study was conducted in the rural setting of Jimma, Ethiopia. Female and their male partners were selected randomly. The number of participants included from each sex was 3235 totaling 6470. Face-to-face data collection was employed using open data kit (ODK) software. A pre-test was performed before the data collection. Descriptive and analytical statistical analysis was used to compare knowledge and attitudes regarding obstetric danger signs and care. Predictor variables were declared considering a 95% confidence interval, adjusted odds ratio (AOR) and P-value less than 0.05.

Results

On average, male and female participants identified at least two obstetric danger signs. More females could mention more antenatal, childbirth, and postnatal danger signs than their male partners. Both females and their male partners who listened to the radio at least once per week had a statistically significant positive attitude towards obstetric care. Nonetheless, both had an almost similar magnitude of attitude towards obstetric care irrespective of belonging to different occupational, educational, and other social strata. Males' knowledge of danger signs during pregnancy (95% CI = (1.07-1.62), AOR = 1.32, P < 0.008) and postnatal care (95% CI = (1.16-1.89), AOR = 1.48, P < 0.002) had a statistically significant association with the females utilization antenatal care (ANC) service, though not delivery care (DC) or postnatal (PNC).

Conclusion

There were inequalities in obstetric danger signs knowledge between females and their male partners. Male partners' knowledge of obstetric danger signs is not only significant during pregnancy and delivery but also has a lasting impact on post-natal service utilization, which underscores the importance of their involvement in maternal healthcare.

Early Postnatal Care Utilization and Associated Factors Among Women Who Give Birth in the Last Six Weeks in Hosanna Town, Southern Ethiopia, 2022

Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7-30.0). No formal and primary educational level of husband (AOR = 0.05, 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13, 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (AOR = 0.3, 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08, 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Understanding Gender-Based Perception During Pregnancy: A Qualitative Study

Purpose

Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy.

Methods

A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category.

Results

Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond.

Conclusion

This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.

Essential Health Services Delivery Status During COVID-19 Pandemic in Ethiopia: A National Mixed-Methods Survey of Primary Healthcare Units

Background

Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19.

Methods

A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically.

Results

The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities.

Conclusion

The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

Availability of Maternal, Newborn care and Child Health Services at Primary Health Care Unit during COVID-19 Outbreak in Ethiopia

Background

The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak.

Methods

A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection.

Result

During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale.

Conclusion

Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

Health care seeking behaviors of pregnant women in rural Amhara, Ethiopia: a qualitative study of perceptions of pregnant women, community members, and health care providers

Introduction

in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia.

Methods

the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from October 3rd through October 14th, 2018. A phenomenological qualitative study design was used to understand participants' perceptions and experiences about pregnant women's health care seeking behaviors.

Results

early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers.

Conclusion

despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women's health care seeking practices.

Uptake of, barriers and enablers to the utilization of postnatal care services in Thyolo, Malawi

BACKGROUND

Postnatal care (PNC) ensures early assessments for danger signs during the postpartum period and is to be provided within 24 h of birth, 48-72 h, 7-14 days, and six weeks after birth. This study assessed the uptake of and the barriers and facilitators to receiving PNC care among mothers and babies.

METHODS

A concurrent mixed-method study employing a retrospective register review and a qualitative descriptive study was conducted in Thyolo from July to December 2020. Postnatal registers of 2019 were reviewed to estimate the proportion of mothers and newborns that received PNC respectively. Focus Group Discussions (FGDs) among postnatal mothers, men, health care workers, and elderly women and in-depth interviews with midwives, and key health care workers were conducted to explore the barriers and enablers to PNC. Observations of the services that mothers and babies received within 24 h of birth, at 48-72 h, 7-14 days, and six weeks after birth were conducted. Descriptive statistics were tabulated for the quantitative data using Stata while the qualitative data were managed using NVivo and analysed following a thematic approach.

RESULTS

The uptake of PNC services was at 90.5%, 30.2%, and 6.1% among women and 96.5%, 78.8%, and 13.7% among babies within 48 h of birth, 3 to 7 and 8 to 42 days respectively. The barriers to PNC services included the absence of a baby or mother, limited understanding of PNC services, lack of male involvement, and economic challenges. Cultural and religious beliefs, advice from community members, community activities, distance, lack of resources, and poor attitude of health care workers also impeded the utilisation of PNC services. The enablers included the mother's level of education, awareness of the services, economic resources, community-based health support, adequacy and attitude of health workers, seeking treatment for other conditions, and other clinic activities.

CONCLUSION

Optimisation of uptake and utilization of PNC services for mothers and neonates will require the involvement of all stakeholders. The success of PNC services lies in the communities, health services, and mothers understanding the relevance, time points, and services that need to be delivered to create demand for the services. There is a need to assess the contextual factors for a better response in improving the uptake of PNC services and in turn inform the development of strategies for optimizing the uptake of PNC services.

Mapping evidence on postpartum modern family planning service uptake among women in Ethiopia: A scoping review

Background

In Ethiopia, different fragmented studies have been conducted to assess the determinants and uptake of postpartum modern family planning services. There is discrepancy and inconsistency among reported studies on postpartum modern family planning service uptake. The scoping review aimed to collect evidence on postnatal birth control service use and supply a chance to spot key ideas and gaps to research, policy revision, and changes in strategies.

Methods

There were different process steps in this scoping review which included analysis questions, distinctive relevant studies, study choice, charting the information, and eventually collating, summarizing, and reporting the results. A search was conducted through scientific databases like PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Hinari, and Google Scholar. The first outcome of this scoping review was postpartum family planning service uptake after childbirth in Ethiopia. The Preferable Reporting Information in Systematic Review and Meta-Analysis (PRISMA) flow diagram was used to select and summarize the selection procedure of the articles. The information of the chosen studies was sorted using the subsequent categories: authors, year of publication, study location, main study objective, and method employed for information analyses.

Results

A total of 1,607 records were reclaimed from the database searches and reference list review. A total of 596 articles were identified in PubMed, 375 in CINAHL, 576 in Hinari, and 60 records in Google Scholar. A total of 1,607 literature studies were checked for replication, and 840 records were excluded. The bulk of articles (n = 420) were excluded because they did not focus on postpartum family planning service, and 322 articles were excluded due to study setting discrepancy. The remaining 28 full-text articles were read in full using the preidentified inclusion criteria and included in the scoping review for analysis.

Conclusion

Generally, this scoping review identified different fragmented and inconsistent research findings on the uptake of postpartum modern family planning in Ethiopia. Almost all studies were observational studies that lack interventional study designs to provide evidence-based interventions to improve postpartum family planning uptake. There is a definite need for further interventional and qualitative research to improve early postpartum family planning service uptake that improves maternal and child health.

Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey

Background

Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia.

Methods

A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05.

Results

In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care.

Conclusion

Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.

Factors Associated with Underutilization of Maternity Health Care Cascade in Mozambique: Analysis of the 2015 National Health Survey

Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.

Knowledge of Malaria and Its Uncomplicated Treatment with Argemone mexicana L. in Selected Districts of Jimma Zone, Oromia Regional State, Ethiopia: A Community-Based Cross Sectional Survey

Background

With the problems of increasing levels of drug resistance and difficulties to afford and access effective antimalarial drugs in poor and remote areas, herbal medicines could be an important and sustainable source of treatment. Argemone mexicana L. (AM) is a medicinal plant known long ago in several countries for treatment of numerous diseases including malaria. The aim of this study was to conduct a survey on the use of AM in the prevention and treatment of uncomplicated malaria in selected districts of Jimma Zone, Oromia Regional state, Ethiopia.

Methods

A community-based cross-sectional study was conducted in two selected districts in Jimma Zone, southwest Ethiopia. In total, 552 participants from 17 kebeles (villages/communities) and 18 traditional healers of the districts were interviewed. Data collection was conducted from April 27 to May 18, 2020 using pre-tested structured questionnaires. The data were analyzed using Epi Info 7.0 and the descriptive statistics were used to summarize the results.

Results

The study indicated that AM is available, known by 39.8% of the respondents and used for prevention and treatment of malaria by 5.7% of the population. All traditional healers interviewed knew the plant, and 44.4% use it for treatment of malaria. In addition, AM is especially used to treat malaria, amoebiasis, diarrhea, cough, and tuberculosis.

Conclusion

The availability and use of AM to treat malaria was verified in both community and traditional healers. AM, which was found effective as antimalarial plant in high Plasmodium falciparum endemicity in Mali, is also well known and accepted in these areas of Ethiopia for the treatment of malaria. Further research is needed to assess wether AM is also effective against malaria in Ethiopia where P. vivax and P. falciparum coexist.

An Analysis of Utilization of Maternal Health Services with Respect to Information Received and Impact of Demographics in Punjab, India

The value information leads to effective utilisation of services. The study identifies the gap in information about maternal health services and their utilisation. The information which has led to utilisation of services can be assiduously labelled as value information or value awareness. The relationship has been explored between awareness about maternal health services and service utilisation among Janani Suraksha Yojana (JSY) beneficiaries in Punjab, a high-performing state in India as per NRHM. Further, an assessment of impact of demographics on beneficiaries with information and those who utilised the services has been explored. Information received and utilisation of ante-natal checkups (ANC), delivery care and post-natal checkups (PNC) services have been studied for two districts in the state of Punjab, India. Chi-square test has been applied to know the association between the maternal health services and the select districts with respect to information and services utilised. Impact of demographic variables such as age, education, income and caste have been evaluated for information and utilisation of maternal health services. The dispersed information that has not triggered in utilisation of services by JSY beneficiaries have been used as an ingredient to explore and understand the deterring factors in non-utilisation of maternal care services in the rural areas of developing country like India. Results highlight that a significant association exists between the utilisation of maternal health services among the select districts in the state of Punjab ( χ2 = 8.73, p-value = 0.0127); however, there is no association between the informed beneficiaries and the districts for the maternal health services. No impact of demographic variables has been found on the beneficiaries with information about maternal health services and those who utilised the services. The gap in awareness and utilisation of services throws light on the lurking concerns of unrecognised benefits, uncaring attitude towards health, prejudices about institutional delivery and PNC being considered an unimportant service among the beneficiaries.

Factors Associated with Post-Natal Care Utilization among the Women of Reproductive age Group: Evidence from Bangladesh Demographic and Health Survey 2017–18

Introduction

Postnatal period is a crucial stage of illness for mothers and their newborn children. Lack of post-natal care (PNC) services during this period is lifethreatening for both the mother and the babies. This study aims at examining the associated factors of PNC utilization among the mothers to explore the opportunities to accelerate it.

Methods

This study utilized the latest data from Bangladesh Demographic and Health Survey (BDHS) 2017–18, a nationally representative survey. A weighted sample of 5043 Bangladeshi women who gave birth three years prior to the survey was studied. Bivariate and multivariate analyses were performed to identify the underlying factors associated with the utilization of PNC.

Results

Around 63% women sought PNC from any kind of provider within 24 h to 42 days of the delivery among whom more than 48% received it from medically trained providers. Together with several sociodemographic factors- administrative division, place of residence, educational level, employment status, wealth status, some maternal factors such as- antenatal care (ANC) visits, place and mode of delivery- played a significant role in utilizing PNC services from trained providers.

Conclusion

To further improve utilization of post-natal care, national and local level action plans should be introduced to promote health facility delivery irrespective of their place of residence. In the meantime, PNC awareness campaigns, intervention and economic empowerment programs targeting mothers from the poorest quintile needs to be implemented, particularly those who are unable to attend at least four ANC visits, and have accessibility issues to education.

Changes in attitudes and behaviors supportive of maternal and newborn health in Ethiopia: an evaluative case study

Background

Ethiopia’s high neonatal mortality rate led to the government’s 2013 introduction of Community-Based Newborn Care (CBNC) to bring critical prevention and treatment interventions closer to communities in need. However, complex behaviors that are deeply embedded in social and cultural norms continue to prevent women and newborns from getting the care they need. A demand creation strategy was designed to create an enabling environment to support appropriate maternal, newborn, and child health (MNCH) behaviors and CBNC. We explored the extent to which attitudes and behaviors during the prenatal and perinatal periods varied by the implementation strength of the Demand Creation Strategy for MNCH-CBNC.

Methods

Using an embedded, multiple case study design, we purposively selected four kebeles (villages) from two districts with different levels of implementation strength of demand creation activities. We collected information from a total of 150 key stakeholders across kebeles using multiple qualitative methods including in-depth interviews, focus group discussions, and illness narratives; sessions were transcribed into English and coded using NVivo 10.0. We developed case reports for each kebele and a final cross-case report to compare results from high and low implementation strength kebeles.

Results

We found that five MNCH attitudes and behaviors varied by implementation strength. In high implementation strength kebeles women felt more comfortable disclosing their pregnancy early, women sought antenatal care (ANC) in the first trimester, families did not have fatalistic ideas about newborn survival, mothers sought care for sick newborns in a timely manner, and newborns received care at the health facility in less than an hour. We also found changes across all kebeles that did not vary by implementation strength, including male engagement during pregnancy and a preference for giving birth at a health facility.

Conclusions

Findings suggest that a demand creation approach—combining participatory approaches with community empowering strategies—can promote shifts in behaviors and attitudes to support the health of mothers and newborns, including use of MNCH services. Future studies need to consider the most efficient level of intervention intensity to make the greatest impact on MNCH attitudes and behaviors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03865-8.

Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia

Background

Maternity continuum of care is a model of integrated components of maternal health service from pregnancy to the post-partum period to improve maternal, neonatal and child health. In Ethiopia, the magnitude of antenatal care, skilled delivery, and post-natal care have shown improvement. However, there is limited evidence of the woman who attends continuing from antenatal care to post-partum care.

Objective

To assess completion of maternity continuum of care and its associated factors among women, in Motta town and Hulet Eji Enese district, Northwest Ethiopia.

Methods

A community based cross-sectional study with a stratified cluster sampling technique was conducted among 819 women 6week-6month post-partum period in Motta town and Hulet Eji Enese district. The data were collected from March 12, 2019 to April1, 2019 by face to face interviews, using a pretested structured questionnaire. Binary logistic regression (bi-variable and multivariable) model was done. Adjusted odds ratio with respect to 95% confidence interval was employed in the strength and direction of the association between covariates and outcome variable. Besides, a P value<0.05 was used to declare statistical significance.

Results

A total of 819 women with100% response rate participated and Completion of maternity continuum of care was found to be 47% (43.2%-50.2%) in the study. Educational attainment of Secondary school and above (adjusted odds ratio(AOR) = 3.5; 1.9–6.3), urban residence (AOR = 4.6; 95%CI 2.5–8.5), women reach to a health facility within 30minute(AOR = 2.1; 95%CI 1.2–3.7), a woman was the primary decision maker for attending maternity continuum of care(AOR = 3.5;95%CI 1.9–6.3), index pregnancy-related complication(AOR = 2.4;95%CI 1.1–5.3), starting antenatal care within second trimester (AOR = 3.4;95%CI 2.1–5.6) and antenatal care visit 3–4 times(AOR = 2.1;95%CI 1.2–3.8) were statistically significant with completion of maternity continuum of care.

Conclusions

The completion of maternity continuum of care is low in the study area. Improving the educational status of women, engaging the rural community, physical accessibility of health facility, woman empowerment for decision making, emphasis on giving care for pregnancy-related complication, and early gestational age antenatal care at least 3 or more visits suggested to increase completion of maternity continuum of care.

Long-term trend in socioeconomic inequalities and geographic variation in the utilization of antenatal care service in India between 1998 and 2015

OBJECTIVE

To investigate the temporal trend of socioeconomic and rural-urban disparities and geographical variation in the utilization of antenatal care (ANC) services in India before and throughout the Millennium Development Goals era.

DATA SOURCES/STUDY SETTING

For this temporal analysis, secondary data from the Indian National Family Health Surveys between 1998 and 2015 (Waves 2, 3, and 4) were used.

STUDY DESIGN

We analyzed the trend in inequality for at least one and four ANC visits to a health care professional (ANC1+ and ANC4+, respectively) by education, wealth, and residence type. Multilevel logistic regression models were used to assess the temporal trend and the relative contribution of communities and states to the overall variation in ANC1+ and ANC4+.

DATA COLLECTION/EXTRACTION METHODS

Data on utilization of ANC services for the last birth of women aged 15-49 years during the three or five years preceding the survey (depending on the survey year) were used.

PRINCIPAL FINDINGS

Educational and wealth inequality in ANC1+ and ANC4+ worsened between 1998 and 2005 and improved between 2005 and 2015 (for ANC4+, OR [95% CI] = 0.22 [0.19-0.25] in Wave 2; OR [95% CI] = 0.19 [0.17-0.22] in Wave 3; and OR [95% CI] = 0.38 [0.36-0.40] in Wave 4 for the poorest). Rural-urban inequality showed a consistent decline (for ANC4+, OR [95% CI] = 0.59 [0.54-0.64] in Wave 2; OR [95% CI] = 0.63 [0.59-0.68] in Wave 3; and OR [95% CI] = 0.82 [0.79-0.85] in Wave 4 for rural area). The relative contribution of the community to the total geographic variation in the utilization of ANC services increased more than four times during the study period.

CONCLUSIONS

The use of ANC services remains disproportionately lower among women with low socioeconomic status. Efforts to directly target these women are necessary to tackle inequality in ANC utilization in India.

Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma Zone, Ethiopia

Background

In Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia.

Methods

We analyzed data from a community-based cross-sectional survey conducted in 2016 in three rural districts of Jimma Zone, Ethiopia, with 3784 women who had a pregnancy outcome in the year preceding the survey. We used multivariable logistic regression models accounting for clustering to identify the determinants of antenatal care (ANC) attendance and insecticide-treated net (ITN) ownership and use, and the prevalence and predictors of malaria infection among pregnant women.

Results

Eighty-four percent of interviewed women reported receiving at least one ANC visit during their last pregnancy, while 47% reported attending four or more ANC visits. Common reasons for not attending ANC included women’s lack of awareness of its importance (48%), distance to health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman’s ability to make healthcare decisions, and pregnancy intendedness. An estimated 48% of women reported owning an ITN during their last pregnancy. Of these, 55% reported to have always slept under it during their last pregnancy. Analysis revealed that the odds of owning and using ITNs were respectively 2.07 (95% CI: 1.62–2.63) and 1.73 (95% CI: 1.32–2.27) times higher among women who attended at least one ANC visit. The self-reported prevalence of malaria infection during pregnancy was low (1.4%) across the three districts. We found that young, uneducated, and unemployed women presented higher odds of malaria infection during their last pregnancy.

Conclusion

ANC and ITN uptake during pregnancy in Jimma Zone fall below the respective targets of 95 and 90% set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Reaching ANC non-users and ITN ownership and use as part of ANC services could be emphasized to address these gaps.