Skilled delivery service utilization and its association with the establishment of Women's Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis

Factors Associated with Use of Traditional Birth Attendants for Child Delivery: A Cross-Sectional Study

Background

Even though the use of skilled birth attendants at birth reduces the risk of maternal mortality and associated complications, some pregnant women prefer to use either traditional birth attendants (TBAs) or deliver at home. Although the use of assisted delivery was reduced between 2014 and 2016 in North Tongu, the rate of TBA use among pregnant women in the district was increasing. There is, therefore, the need to establish the reason for this increase in TBA use. We conducted a study to assess factors that influence the use of TBAs in the North Tongu district.

Methods

A retrospective cross-sectional facility-based survey was conducted among 449 women who delivered within the past 12 months and were accessing postnatal care services in the North Tongu district. A simple random sampling method was used to select women who attend child welfare clinics. Bivariate and multivariate analyses were conducted to determine the factors that were significantly associated with use of TBAs. All statistical analyses were done at a 95% confidence level with statistical significance at p ≤ 0.05.

Results

The mean age of the respondents was 27.0 years ± 6.2 SD. The prevalence of use of TBA during childbirth among women was 26.5%. Factors that significantly influenced use of TBAs during childbirth were age, religion, educational status, and parity. Other significant factors included several antenatal care visits and the attitude of health workers toward pregnant women.

Conclusion

Use of TBA services at birth in the study district remains relatively high. Women who use antenatal and postnatal care services should be educated on the importance of skilled delivery. There is also a need to equip TBAs and reposition them as link agents to facilitate referrals of pregnant women to health facilities where there is a need for additional birth attendants.

Antenatal care booked rural residence women have home delivery during the era of COVID-19 pandemic in Gidan District, Ethiopia

BACKGROUND

World Health Organization (WHO) recommends that every pregnant woman receive quality care throughout pregnancy, childbirth, and the postnatal period. It is estimated that institutional delivery could reduce 16% to 33% of maternal deaths. Despite the importance of giving birth at a health institution, in Ethiopia, according to the Ethiopian Demographic Health Survey report, nearly half of the ANC-booked mothers gave birth at home. Therefore, this study aimed to determine the prevalence and associated factors of home delivery among antenatal care-booked women in their last pregnancy during the era of COVID-19.

METHODS

A community-based cross-sectional study was conducted from March 30 to April 29, 2021. A simple random technique was employed to select 770 participants among women booked for antenatal care. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted. Adjusted odds ratios with its respective 95% confidence interval were used to declare the associated factors.

RESULTS

The prevalence of home delivery was 28.8% (95% CI: 25.7, 32.2). Rural residence (AOR = 2.02, 95% CI: 1.23, 3.34), unmarried women (AOR = 11.16, 95% CI: 4.18, 29.79), husband education (AOR = 2.60, 95% CI: 1.72, 3.91), not being involved in the women's development army (AOR = 1.64, 95% CI: 1.01, 2.65), and fear of COVID-19 infection (AOR = 3.86, 95% CI: 2.31, 6.44) were significantly associated factors of home delivery.

CONCLUSION

Even though the government tried to lower the rate of home delivery by accessing health institutions in remote areas, implementing a women's development army, and introducing maternal waiting home utilization, nearly one in every three pregnant women gave birth at home among ANC booked women in their last pregnancy. Thus, improving the husband's educational status, providing information related to health institution delivery benefits during antenatal care, and strengthening the implementation of the women's development army, particularly among rural and unmarried women, would decrease home childbirth practices.

Early Postnatal Home Visit Coverage by Health Extension Workers and Associated Factors Among Postpartum Women in Gidan District, Northeast Ethiopia

Objectives: To determine the coverage and associated factors of early postnatal home visits (PNHVs) by health extension workers (HEWs) among postpartum women in Gidan district, Northeast Ethiopia.

Methods: A community-based, cross-sectional study was conducted between 30 March and 29 April 2021 in the Gidan district, Northeast Ethiopia. A multistage sampling technique was employed to select 767 postpartum women participants. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted to identify factors associated with early PNHVs by HEWs.

Results: The coverage of early postnatal home visits was 15.13% [95% confidence interval (CI): 12.75, 17.87]. Women’s education, institutional delivery, time to reach health posts, and participation in pregnant women forums were significantly associated with early PNHVs by HEWs.

Conclusion: In the current study, the coverage of early postnatal home visits by HEWs remains low in the study area. The concerned bodies should consider interventions that promote women’s education and institutional delivery, and more efforts should be made to improve community-based participation and links with HEWs.

Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana

Background

Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana.

Methodology

A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills.

Findings

We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant.

Conclusion

The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

“We Beat Them to Help Them Push”: Midwives’ Perceptions on Obstetric Violence in the Ashante and Western Regions of Ghana

Obstetric violence has been recognized as a major impediment to facility-based delivery, increasing the risk of preventable complications and maternal mortality. In Ghana, studies on women’s birth experiences reveal enormous and brutal acts of violence during delivery; however, inquiries into why midwives abuse women have not been extensively studied. This study explored the perspectives of midwives on the drivers of obstetric violence in the Western and Ashante Regions of Ghana. A qualitative study was conducted involving 30 in-depth interviews with midwives in eight health facilities. The data were analyzed thematically using NVivo 12. The results of the study reveal a normalization of violence in the delivery room and the intensity of violence is heightened during the second stage of labor. Midwives reported perpetrating or witnessing physical violence, abandonment of women, stigmatization of HIV women, verbal abuses such as shouting, and the detention of women in the health facilities. Midwives abuse women as a result of the pressures of the midwifery profession, poor maternal efforts of women, disrespect of midwives, women’s disobedience, and uncooperative attitudes. The culture of acceptability of obstetric violence is a major driver, contributing to its normalization. Midwives do not consider obstetric violence as abuse, but rather, as a delivery strategy which aids a successful delivery. It is therefore justified and viewed as a necessary part of the delivery process. There is a critical need for retraining midwives on alternative birthing strategies devoid of violence.

Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district

Background

Skilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia.

Methods

A community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model.

Results

This study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance.

Conclusions

This study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.

Exploring the Influence of Sociodemographic Characteristics on the Utilization of Maternal Health Services: A Study on Community Health Centers Setting in Province of Jambi, Indonesia

The Maternal Mortality Ratio in Indonesia has remained high, making it a national priority. The low utilization of maternal health services at community health centers is considered to be one of the reasons for poor maternal health status. This study aims to assess the influence of sociodemographic factors on utilization of maternal health services. The analysis was completed using binary and logistic regression to examine the association between sociodemographic variables and maternal health services utilization. A total of 436 women participated in the survey. In the multivariable analysis, age, education, ethnicity, parity status, distance to health centers and insurance ownership were associated with the utilization of maternal health services. Ethnicity (OR, 2.1; 95% confidence interval, 1.4–3.3) and distance to the CHC (OR, 0.5; 95% confidence interval, 0.3–0.8) were significantly associated with ANC visits. The association between parity and place of delivery was statistically significant (OR, 0.8; 95% confidence interval, 0.5–1.4). A positive association between basic health insurance ownership and PNC services was reported (OR, 0.3; 95% confidence interval, 0.1–0.6). Several sociodemographic factors were positively associated with the utilization of maternal health services at the CHCs. The required measures to improve the utilization of maternal health services at the CHCs level have to take into consideration the sociodemographic factors of reproductive age women.

The Association Between Pregnancy-Related Factors and Health Status Before and After Childbirth With Satisfaction With Skilled Delivery in Multiple Dimensions Among Postpartum Mothers in the Akatsi South District, Ghana

Background

Skilled delivery has been a pronounced concern and has been investigated over the years in developing countries. An inclusive understanding of the satisfaction of postpartum mothers is vital in improving the quality of skilled delivery, which is beneath the standard in some parts of developing countries. This study assessed the association between pregnancy-related factors and health status before and after childbirth with satisfaction with skilled delivery in multiple dimensions among postpartum mothers in the Akatsi South District, Ghana.

Methods

A community-based, cross-sectional study was conducted among 538 postpartum mothers who participated through the systematic sampling method. Data collection was performed through a pretested and structured questionnaire developed from the WHO responsiveness concept and other prior studies. Questions on satisfaction were categorized into six dimensions. The associations were determined using bivariable and multivariable logistic regression analyses.

Results

The overall satisfaction of postpartum mothers with skilled delivery was 80.7%. The highest (89.6%) and the lowest (12.8%) satisfaction with skilled delivery were found in technical quality and financial dimensions. Analysis revealed that autonomously age and delivery procedure were significantly associated with the dimensions of communication and responsiveness. Postpartum mothers who delivered at private healthcare facilities [crude odds ratio (COR) = 1.70; (95% CI 1.00–2.90); p = 0.049] had preterm pregnancy before delivery [COR = 2.08; (95% CI 1.02–4.21); p = 0.043], had cesarean section [COR = 2.73; (95% CI 1.05–7.12); p = 0.040], and presented with complications after childbirth [COR = 2.63; (95% CI 1.09–6.35); p = 0.032] were more likely to be satisfied in the dimension of communication only compared to their counterparts. Regarding responsiveness, multiparous mothers [COR = 1.63; (95% CI 1.06–2.51); p = 0.007] were more likely to be satisfied than primiparous mothers. Overall satisfaction was significantly and positively correlated with the various dimensions of skilled delivery.

Conclusions

The majority were satisfied with five dimensions of satisfaction with skilled delivery except for the financial dimension. The District Health Directorate of Akatsi South should take into consideration these findings in their policy development for forward-looking skilled delivery.

Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice

Background

The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve?

Methods

We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis.

Results

One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps.

Conclusion

In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity.

Trial registration

PROSPERO registration number CRD42020177333.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01615-y.

Multivariate decomposition of trends, inequalities and predictors of skilled birth attendants utilisation in Nigeria (1990-2018): a cross-sectional analysis of change drivers

OBJECTIVES

Literature has assessed skilled birth attendants (SBAs) utilisation, but little is known about what contributes to the changes in SBA use. Multivariate decomposition analysis was thus applied in this study to examine; levels, trends, inequalities and drivers of changes in SBA utilisation.

DESIGN AND SETTING

A cross-sectional analysis of five-waves of NDHS-data (1990, 2003, 2008, 2013, and 2018), collected through similar multistage sampling across the 36 states and the federal-capital-territory of Nigeria.

PARTICIPANTS

Women of reproductive age (15-49 years), and with at least one birth in the last 5 years preceding each of the surveys.

MAIN OUTCOME MEASURE

SBA use is the response variable while explanatory variables were classified into; Demographics, Health, Economic and Corporal factors.

METHODS

Chi-square test for trends of proportions across the ordered survey years assessed trends in SBA use. MDA that quantifies and partition predictors effect into endowment and coefficient components evaluated contributors to changes in SBA use. Statistical analysis was carried out at a 95% confidence interval in Stata 16.

RESULTS

SBA use increased with significant (p<0.05) linear trends by 12% between 2003 and 2018. The decomposition analysis showed that differences in characteristics (endowment) accounted for 11.5% of the changes while the remaining 88.5% were due to differences in effects (coefficient). SBA utilisation rises by 61% when respondents decided on her health compared to when such decisions were made by the spouse. Utilisation of SBA, however, fell by 88% among women who reside in the states with high rural populations percentage.

CONCLUSIONS

SBA use remained low in Nigeria, and slowly increase at the rate of <1% yearly. Women health decision-making power contributed most to positive changes. Residing in states with high rural populations has a negative impact on SBA use. Maternal health programmes that strengthen women's health autonomy and capacity building in rural communities should be encouraged.

Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia

Background:

The maternal mortality rate in poor nations remains unacceptably high. The purpose of this study was to identify factors associated with institutional delivery usage.

Methods:

The data came from the Ethiopian mini demographic and health survey, which was conducted in 2019. This study comprised 3978 women of reproductive age who had given birth within the previous 5 years. To uncover significantly linked parameters associated with institutional delivery, we used a multilevel logistic regression model. Statistical significance was declared at p < 0.05, and we assessed the strength of association using adjusted odds ratios with 95% confidence intervals.

Results:

More than half of the women (53.67%) among 3978 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, women in age group 45–49 (AOR = 2.43, 95% CI: 1.280, 4.591), primary educational level (AOR = 2.21, 95% CI: 1.864, 2.625, secondary and above education level (AOR = 6.37, 95% CI: 4.600, 8.837), being Muslim (AOR = 2.57, 95% CI: 1.245, 2.166), women who visited ANC service four up to seven times (AOR = 2.75, 95% CI: 2.175, 3.473), women visited ANC service eight times and above (AOR = 3.295% CI: 1.685, 6.050), women who reside in middle wealth index (AOR = 1.57, 95% CI: 1.273, 1.950), and rich wealth index (AOR = 3.43, 95% CI: 2.782, 4.225) were more likely to give birth at health institution compared to their counterparts. Furthermore, women being in rural area (AOR = 0.34, 95% CI:- 0.283, 0.474) and protestant women (AOR = 0.1.57, 95% CI: 0.479, 0.852) were less likely to deliver at health institution.

Conclusions:

Ethiopia still has a low level of institutionalized delivery. Institutional delivery in Ethiopia should be improved through context-specific and personalized programs, such as educating women and enhancing access to ANC services.

Trend and decomposition analysis of risk factors of childbirths with no one present in Nigeria, 1990-2018

OBJECTIVES

To assess the trend and decompose the determinants of delivery with no one present (NOP) at birth with an in-depth subnational analysis in Nigeria.

DESIGN

Cross-sectional.

SETTING

Nigeria, with five waves of nationally representative data in 1990, 2003, 2008, 2013 and 2018.

PARTICIPANTS

Women with at least one childbirth within 5 years preceding each wave of data collection.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome of interest is giving birth with NOP at delivery defined as childbirth assisted by no one. Data were analysed using Χ² and multivariate decomposition analyses at a 5% significance level.

RESULTS

The prevalence of having NOP at delivery was 15% over the studied period, ranges from 27% in 1990 to 11% in 2018. Overall, the prevalence of having NOP at delivery reduced significantly by 35% and 61% within 2003-2018 and 1990-2018, respectively (p<0.001). We found wide variations in NOP across the states in Nigeria. The highest NOP practice was in Zamfara (44%), Kano (40%) and Katsina (35%); while the practice was 0.1% in Bayelsa, 0.8% in Enugu, 0.9% in Osun and 1.1% in Imo state. The decomposition analysis of the changes in having NOP at delivery showed that 85.4% and 14.6% were due to differences in women's characteristics (endowment) and effects (coefficient), respectively. The most significant contributions to the changes were the decision-maker of healthcare utilisation (49%) and women educational status (24%). Only Gombe experienced a significant increase (p<0.05) in the level of having NOP between 2003 and 2018.

CONCLUSION

A long-term decreasing secular trend of NOP at delivery was found in Nigeria. NOP is more prevalent in the northern states than in the south. Achieving zero prevalence of NOP at delivery in Nigeria would require a special focus on healthcare utilisation, enhancing maternal education and healthcare utilisation decision-making power.

Vitamin A Supplementation Coverage and Ocular Signs among Children Aged 6-59 Months in Aleta Chuko Woreda, Sidama Zone, Southern Ethiopia

Background

Periodic vitamin A supplementation to children is a cost-effective strategy to avert vitamin A deficiency. However, few pieces of evidence are available about the coverage of vitamin A supplementation at the community level in the study area. Therefore, the aim of this study was to assess vitamin A supplementation coverage and prevalence of ocular signs of vitamin A deficiency among children aged 6-59 months.

Methods

Community-based cross-sectional study design was conducted using a two-stage stratified random sampling method. Data were collected from mothers with children aged 6-59 months using a structured pretested questionnaire. A total of 665 children aged 6 to 59 months were examined for clinical signs and symptoms of vitamin A deficiency by trained clinical health professionals. Descriptive statistics and logistic regression were done.

Result

Vitamin A supplementation coverage in the study area was 36.2% (95% CI: 32.6-39.9). Overall, the prevalence of xerophthalmia was 2.7%. Age group 6-23 months (AOR: 2.1, 95% CI: 1.4-2.9), good maternal knowledge (AOR: 1.5, 95% CI: 1.2-2.1), children with high wealth status (AOR: 2.3, 95% CI: 1.4-3.8), precampaign health education on vitamin A (AOR: 3.4,95% CI: 2.1-5.6), member of Health Development Army (AOR: 2.7, 95% CI: 1.7-4.2), and access to health facility within <30 minutes (AOR: 2.5, 95% CI: 1.6-3.8) were significantly associated with the receipt of vitamin A capsule.

Conclusion

Vitamin A supplementation coverage of the study area was low as compared to the UNICEF threshold of 70%. Vitamin A deficiency is a public health problem in the study area. Increasing maternal level of knowledge, precampaign health education on vitamin A supplementation, and strengthening Health Development Army are recommended to increase the vitamin A supplementation coverage.

Childbirth at home and associated factors in Ethiopia: a systematic review and meta-analysis

Background

Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Childbirth at home in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of home childbirth and its associated factors among women in Ethiopia at their last childbirth.

Method

For this review, we used the standard PRISMA checklist guideline. This search included all published and unpublished observational studies written only in English language and conducted in Ethiopia. PubMed/Medline, Hinari, EMBASE, Google Scholar, Science Direct, Scopus, Web of Science (WoS), ProQuest, Cochrane Library, African Journals Online, Ethiopian’s university research repository online library were used. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles from February 1–30, 2020. The overall selected search results were 40 studies. Microsoft Excel was used for data extraction and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) for data analysis. The quality of individual studies was appraised by using the Joanna Briggs Institute (JBI) quality appraisal checklist. The heterogeneity of the studies was assessed by the Cochrane Q and I2 test. With the evidence of heterogeneity, subgroup analysis and sensitivity analysis were computed. The pooled prevalence of childbirth at home and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.

Result

Seventy-one thousand seven hundred twenty-four (71, 724) mothers who gave at least one birth were recruited in this study. The estimated prevalence of childbirth at home in Ethiopia was 66.7% (95%CI: 61.56–71.92, I2 = 98.8%, p-value < 0.001). Being from a rural area (adjusted odds ratio (AOR) 6.48, 95% confidence interval (CI): 3.48–12.07), being uneducated (AOR = 5.90, 95% CI: 4.42–7.88), not pursuing antenatal (ANC) visits at all (AOR = 4.57(95% CI: 2.42–8.64), having 1–3 ANC visits only (AOR = 4.28, 95% CI: 3.8–8.26), no birth preparedness and complication readiness plan (AOR = 5.60, 95% CI: 6.68–8.25), no media access (AOR = 3.46, 95% CI: 2.27–5.27), having poor knowledge of obstetric complications (AOR = 4.16: 95% CI: 2.84–6.09), and walking distance more than 2 hours to reach the nearest health facility (AOR = 5.12, 95% CI: 2.94–8.93) were the factors associated with giving childbirth at home.

Conclusion

The pooled prevalence of childbirth at home was high in Ethiopia. Being from a rural area, being uneducated, not pursuing ANC visits at all, having 1–3 ANC visits only, no media access, having poor knowledge of obstetric complications, not having a birth preparedness and complication readiness plan, and walking time greater than 2 hours to reach the nearest health facility increased the probability of childbirth at home in Ethiopia.

Determinants of Health Facility Delivery in Northwest Ethiopia: A Community-Based Case-Control Study

BACKGROUND

Although Ethiopia has developed many strategies to promote health facility delivery, more than half of the women gave birth at home contributing to high maternal and neonatal mortality. Therefore, this study aimed to identify the determinants of health facility delivery in Northwest Ethiopia.

METHODS

A community-based unmatched case-control study was conducted in selected districts in Northwest Ethiopia. The sample included 885 infant mothers (295 cases and 590 controls) from April 6-16, 2019. Data were collected using a pretested interviewer-administered structured questionnaire. A multivariable logistic regression model was used to identify predictors, and STATA 14 statistical software was used to analyze the data.

RESULTS

The mean maternal age was 26.4 years (SD±6.7) for cases and 28.1 years (SD±6.8) for controls. The overall good newborn care qualities were 95.8% (206) for cases and 40.8% (262) for controls. Attending a formal education (AOR=2.1 (95% CI: 1.5, 2.9)), having first pregnancy from 18 to 25 (AOR=1.5 (95% CI: 1.1, 2.1)), living within 1 km distance from the nearest health center (AOR=2.5 (95% CI: 1.5, 4.0)), having ANC visits (AOR=3.9 (95% CI: 2.4, 6.5)), having a mobile (AOR=1.7 (95% CI: 1.3, 2.4)) were the determinants of health facility delivery.

CONCLUSION

Maternal education, not having pregnancy at early age, accessing health facilities to the nearby residents, attending antenatal care, and having a mobile were the determinants of health facility delivery. Therefore, strengthening education and health-seeking behavior of the mothers using a locally contextualized strategy is essential. Reaching mothers who are still far from health facility also deserves needs due attention.

Women's development group leaders' promotion of maternal, neonatal and child health care in Ethiopia: a cross-sectional study

Background

Women’s development group leaders are volunteer community health workers in Ethiopia who, among other duties, promote health and prevention of diseases. They link and extend essential health services from health posts to households.

Objective

To assess the characteristics, knowledge, and practice of women’s development group leaders in the field of maternal, neonatal, and child health care.

Method

This study used a cluster-sampled cross-sectional survey conducted from December 2016 to February 2017 in four regions of Ethiopia: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples. One of the volunteers, who was available at the time of the survey, was included from each cluster. A total of 187 women’s development group leaders participated in this quantitative study.

Result

Close to half of the women’s development group leaders were illiterate. The leaders had a wide variation in the number of women in their groups. Two-thirds had received some training during the last year, covering a broad range of health topics. Their knowledge of maternal, newborn, and child health was relatively low. Two-thirds had monthly contact with health extension workers. Around half had interacted with other local stakeholders on maternal and child health matters during the last three months. Two-thirds had visited pregnant women, and half had made home visits after delivery in the previous quarter. Activities regarding sick newborns and under-five children were less frequent.

Conclusion

The women leaders were given a wide range of tasks, despite having a low educational level and receiving training through brief orientations. They also showed limited knowledge but had a relatively high level of activities related to maternal health, while less so on neonatal and child health.

Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria

Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country - two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15-49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

Primary health care contributions to universal health coverage, Ethiopia

Many global health institutions, including the World Health Organization, consider primary health care as the path towards achieving universal health coverage (UHC). However, there remain concerns about the feasibility and effectiveness of this approach in low-resource countries. Ethiopia has been implementing the primary health-care approach since the mid-1970s, with primary health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a document review of publicly available qualitative and quantitative data. Using the framework of the Primary Health Care Performance Initiative we describe and analyse the practice of primary health care and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia has been possible through policies, strategies and programmes that are aligned with country priorities. There has been a diagonal approach to disease control programmes along with health-systems strengthening, community empowerment and multisectoral action. These strategies have enabled the country to increase health services coverage and improve the population’s health status. However, key challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow health-systems transition to provide services for noncommunicable diseases, inadequate quality of care, and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country needs to improve its domestic financing for health and target disadvantaged locations and populations through a precision public health approach. These challenges need to be addressed through the whole sustainable development agenda.

Exploring spatial variations and factors associated with skilled birth attendant delivery in Ethiopia: geographically weighted regression and multilevel analysis

BACKGROUND

Skilled birth attendant (SBA) delivery is vital for the health of mothers and newborns, as most maternal and newborn deaths occur at the time of childbirth or immediately after birth. This problem becomes worsen in Ethiopia in which only 28% of women give birth with the help of SBA. Therefore, this study aimed to explore the spatial variations of SBA delivery and its associated factors in Ethiopia.

METHODS

A secondary analysis was carried out using the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 11,023 women who had a live birth in the 5 years preceding the survey was included in the analysis. Arc-GIS software was used to explore the spatial distribution of SBA and a Bernoulli model was fitted using SaTScan software to identify significant clusters of non-SBA delivery. The Geographic Weighted Regression (GWR) was employed in modeling spatial relationships. Moreover, a multilevel binary logistic regression model was fitted to identify factors associated with SBA delivery.

RESULTS

In this study, SBA delivery had spatial variations across the country. The SaTScan spatial analysis identified the primary clusters' spatial window in southeastern Oromia and almost the entire Somalia. The GWR analysis identified different predictors of non- SBA delivery across regions of Ethiopia. In the multilevel analysis, mothers having primary and above educational status, health insurance coverage, and mothers from households with higher wealth status had higher odds of SBA delivery. Being multi and grand multiparous, perception of distance from the health facility as big problem, rural residence, women residing in communities with medium and higher poverty level, and women residing in communities with higher childcare burden had lower odds of SBA delivery.

CONCLUSION

Skilled birth attendant delivery had spatial variations across the country. Areas with non-skilled birth attendant delivery and mothers who had no formal education, not health insured, mothers from poor households and communities, Primiparous women, mothers from remote areas, and mothers from communities with higher childcare burden could get special attention in terms of allocation of resources including skilled human power, and improved access to health facilities.

Determinants of institutional delivery service utilization in Ethiopia: a population based cross sectional study

Background

The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia.

Methods

Data were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chi-square test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals.

Result

The level of institutional delivery was 38.9%. Women’s who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73–3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32–3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10–10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women’s without formal education, giving birth at health facility was more likely for women’s who had primary education level (AOR = 1.77, 95% CI: 1.49–2.10), secondary education level (AOR = 3.79, 95% CI: 2.72–5.30), and higher education level (AOR = 5.86, 95% CI: 3.25–10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86–3.06) and middle (AOR = 1.66, 95% CI: 1.36–2.03) household wealth index were more likely to deliver at health facility compared to women’s who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level.

Conclusion

The level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.

The impact of the Ethiopian health extension program and health development army on maternal mortality: A synthetic control approach

The Ethiopian government has implemented nationwide strategies to improve access to basic health services and enhance health outcomes. The Health Extension Program (HEP) launched in 2003, expanded basic health infrastructure and local human resources. In 2011, the government introduced the Health Development Army (HDA). HDA is a women-centered community movement inspired by military structures and discipline. Its special objective is to improve maternal health outcomes. This paper uses a synthetic control approach to assess the effects of HEP and HDA on maternal mortality ratios (MMR). The MMR data are from the Global Burden of Diseases (GBD) database. A pool of 42 Sub-Saharan African countries, covering the period 1990 to 2016, is used to construct a synthetic comparator which displays a mortality trajectory similar to Ethiopia prior to the interventions. On average, since 2004, maternal mortality in the control countries exhibits a moderate downward trend. In Ethiopia, the downward trend is considerably steeper as compared to its synthetic control. By 2016, maternal mortality in Ethiopia was lower by 171 (p-value 0.048) maternal deaths per 100,000 live births as compared to its synthetic control. Between 2003 and 2016, Ethiopia's maternal mortality ratio declined from 728 to 357. These estimates suggest that a substantial proportion of this decline may be attributed to HEP/HDA. The Ethiopian experience of enhancing nation-wide access to and use of maternal health services in a short time-span is remarkable. Whether such a model may be transplanted is an open question.

Contribution of women's development army to maternal and child health in Ethiopia: a systematic review of evidence

OBJECTIVE

The aim of this review was to identify, appraise and synthesise studies that reported on the contribution of women's development army (WDA) to maternal and child health development.

SETTING

Studies conducted in Ethiopia 2010 onwards and published in English were considered.

DATA SOURCES

Evidence were searched in MEDLINE, CINAHL and EBSCOhost from 25 March to 10 April 2018.

ELIGIBILITY CRITERIA

Both quantitative and qualitative studies assessing the contribution of WDA to maternal and child health were considered.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers have extracted data using pre-planned data extraction tool separately for each study design. Findings were synthesised using tables and narrative summary.

OUTCOME

Maternal and child health services; maternal and child mortality.

RESULTS

Nine studies met the inclusion criteria and were used for synthesis. The results revealed that participation and membership in women's development teams (WDTs) have a positive effect on minimising maternal death and improving child immunisation service use. Skilled delivery and antenatal care service use were higher in WDTs located within a radius of 2 km from health facilities. Women's development teams were also the main sources of information for mothers to prepare themselves for birth and related complications. Moreover, well-established groups have strengthened the linkage of the health facility to the community so that delays in maternal health service use were minimised; health extension workers could effectively refer women to a health facility for birth and utilisation of skilled birth service was improved.

CONCLUSION

Voluntary health service intervention in Ethiopia has improved maternal and child health services' outcome. A decrease in maternal deaths, increase in antenatal and delivery service use and improved child immunisation service uptake are attributable to this intervention. The linkage between community members and the primary healthcare system served as an effective and efficient mechanism to share information.

Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live?

BACKGROUND

Health facility delivery has been described as one of the major contributors to improved maternal and child health outcomes. In sub-Saharan Africa where 66% of the global maternal mortality occurred, only 56% of all births take place in health facility. This study examined the individual and contextual predictors of non-use of health service for delivery in Nigeria where less than 40% births occur in health facility.

METHODS

Data from 2013 Nigeria Demographic and Health Survey (DHS) involving 20,192 women who had delivery within 5 years of the survey were used in the study. Multilevel multivariable logistics regression models which had the structure of non-use of health service for delivery defined at individual, community and state levels were applied in the analysis. Spatial analysis was also used to capture the locations where the phenomenon is prevalent in the country.

RESULTS

About 62% of the women did not utilize health service during delivery. More than three-quarter of those with no education and 92% of those who did not attend antenatal clinic during pregnancy never utilized health service for delivery. The odds of non-use of health service during delivery increased for women who had no education, from poor households, aged 25-34 years, unmarried, never attended antenatal clinic, experienced difficulty getting to health facility and lived in the most socioeconomically disadvantaged communities and states.

CONCLUSIONS

This study has demonstrated that non-utilization of health service for delivery is influenced by individual, community and state level factors, with substantial proportions of women not utilizing such service residing in the northern region of Nigeria. Each level should be adequately considered in the design of the appropriate interventions.