Utilization of institutional delivery and associated factors among mothers in Hosanna Town, Hadiya Zone, Southern Ethiopia: A community-based cross-sectional study

Healthcare-Seeking Behavior and Associated Factors for Newborn Danger Signs among Mothers Who Gave Birth in the Last 12 Months in Anlemo District

Background. Healthcare-seeking behavior is referred to as any action taken by individuals who believe they have a health problem or are ill in order to find an appropriate remedy. The aim of this is to assess healthcare-seeking behavior on newborn danger signs and associated factors among mothers who gave birth in the last 12 months in the Anlemo district. Methods. A community-based cross-sectional study was conducted in the Anlemo district from June 15th, 2019 to July 16th, 2019. Data were collected from 421 randomly selected mothers through a face-to-face interview. Data were cleaned and entered into Epi-Data version 3.1, and then, exported to SPSS version 22.0 for analysis. Binary logistic regression with $p$ values less than 0.25 was entered into a multivariable logistic regression for analysis. Finally, adjusted odds ratios (AOR) with 95% confidence intervals at a $p$ value of <0.05 were considered as a statistically significant association with the outcome variable. Results. Among mothers whose newborns faced newborn danger signs, 34.5% (95% CI: 28.7, 40.5%) sought medical attention for newborn danger signs. When mothers were faced with neonatal danger signs, the multivariable logistic regression model identified three independent variables that were associated with their healthcare-seeking behavior. Mothers who had a college degree or above were 6.34 times more likely than mothers who could not read or write to seek medical care (AOR = 6.34, 95% CI: 1.23–32.69). Mothers or healthcare seekers who did not travel a long distance (less than 5 kilometers) to acquire healthcare were 2.53 times more likely than mothers who traveled a long distance (AOR = 2.53, 95% CI: 1.05–6.08), which had a significant association with the dependent variable. Conclusions. In this study, the proportion of mothers seeking care for newborn danger signs was low, and the mothers’ education, time to reach the nearest health facility, and place of delivery were factors of statistical significance with the dependent variable.

Intention to give birth in the health institutions and associated factors among women who gave birth in the last 6 months in Debre Berhan town, North Showa zone, Ethiopia: A community-based cross-sectional study

Background

Institutional delivery is a proxy for skilled birth attendance, which is an important intervention to reduce maternal and neonatal mortality. Even though institutional delivery has such importance, significant numbers of women in Ethiopia do not prefer to give birth in health institutions. This study aimed to assess women’s intention to give birth in health institutions and associated factors among women who gave birth in the last 6 months in Debre Berhan town, North Showa Zone, Ethiopia, 2020.

Materials and methods

A community-based cross-sectional study was conducted among women who gave birth in the last 6 months in Debre Berhan town from October 30 to November 30, 2020. A cluster sampling technique was used to select study participants. Pretested semi-structured interviewer-administered questionnaires were administered. A logistic regression model was performed, and adjusted odds ratios with a 95% confidence interval based on p &lt; 0.05 were used to identify statistically significant variables.

Result

This study found that a total of 689 (88.8%) (95% CI: 86.6, 91%) respondents intended to deliver in the health facility. Being multiparous [AOR = 0.18 (95% CI: 0.08, 0.36)], having planned pregnancy [AOR = 3.1 (95% CI: 1.6, 5.9)], had no complications during previous delivery (AOR = 6.0 (95% CI: 3.5, 10.4)], and received respectful maternity care (RMC) during preceding delivery [AOD = 1.8 (95% CI: 1.05, 3.10)] are significantly associated with women’s intention to give birth in the health institution.

Conclusion

Childbirth is a special event that requires the safest place to save the lives of both the mother and newborn. In this study, the number of women who do not have the intention to give birth in the health institution is still high. Strategies to promote planned pregnancy, reduce complications during childbirth and provide RMC during childbirth should be designed and interventions should be implemented for all childbearing women.

The impact of perception on institutional delivery service utilization in Northwest Ethiopia: the health belief model

BACKGROUND

Ethiopia has been striving to promote institutional delivery through community wide programs. However, home is still the preferred place of delivery for most women encouraged by the community`s perception that delivery is a normal process and home is the ideal environment. The proportion of women using institutional delivery service is below the expected level. Therefore, we examined the impact of perception on institutional delivery service use by using the health belief model.

METHODS

A community-based cross-sectional study was conducted among 1,394 women who gave birth during the past 1 year from September to December 2019. A multistage sampling technique was used to select the study participants. Data were collected by using health belief model constructs, and structured and pretested questionnaire. Binary logistic regression was performed to identify factors associated with the outcome variable at 95% confidence level.

RESULTS

Institutional delivery service was used by 58.17% (95% CI: 55.57- 60.77%) of women. The study showed that high perceived susceptibility (AOR = 1.87; 95% CI 1.19-2.92), high cues to action (AOR = 1.57; 95% CI: 1.04-2.36), husbands with primary school education (AOR = 1.43; 95% CI 1.06-1.94), multiparty(5 or more) (AOR = 2.96; 95% CI 1.85-4.72), discussion on institutional delivery at home (AOR = 4.25; 95% CI 2.85-6.35), no close follow-up by health workers (AOR = 0.59;95% CI 0.39-0.88), regular antenatal care follow-up (AOR = 1.77;95% CI 1.23,2.58), health professionals lack of respect to clients (AOR = 2.32; 95% CI 1.45-3.79), and lack of health workers (AOR = 0.43;95% CI 0.29-0.61) were significantly associated with the utilization health behavior of institutional delivery service.

CONCLUSION

The prevalence of institutional delivery in the study area was low. The current study revealed that among the health belief model construct perceived susceptibility and cues to action were significantly associated with the utilization behavior of institutional delivery service. On top of that strong follow-up of the community and home based discussion was a significant factor for the utilization behavior of institutional delivery service.

Anaemia, anthropometric undernutrition and associated factors among mothers with children younger than 2 years of age in the rural Dale district, southern Ethiopia: A community‐based study

Mothers in resource‐poor settings are affected by different forms of undernutrition. However, the nutritional status of mothers in rural areas, particularly after delivery, is not well documented. This study assessed haemoglobin levels and body mass index (BMI) of mothers with children below 2 years of age in a rural district of southern Ethiopia. Factors associated with low haemoglobin levels and low BMI were analysed. A community‐based cross‐sectional study was conducted among 931 mother‐child pairs. Structured and standard questionnaires were used to collect data on background information, 24 h dietary recalls, and household food insecurity. Anthropometric and haemoglobin level assessments were performed. Anaemia was defined as haemoglobin levels below 12.0 g/dl, and anthropometric undernutrition was defined as a BMI <18.5 kg/m². Multilevel linear regression was used to determine associations. Out of 931 mothers, 12.8% were anaemic and 12.6% had a BMI <18.5 kg/m². The prevalence of minimum dietary diversity was 37.8%. The majority (78.5%) of the households were food insecure. Weight (β 0.02; 95% CI: 0.003−0.03), dietary diversity (β 0.08; 95% CI: 0.03−0.12) and secondary school attendance (β 0.34; 95% CI: 0.08−0.59) were associated with the mothers' haemoglobin level. Dietary diversity (β 0.08; 95% CI: 0.01−0.16) and household's wealth (β 0.6; 95% CI: 0.27−0.94) were associated with the mothers' BMI. Findings suggest that education and community‐based nutrition interventions must be strengthened to ensure household food security. Implementation of the national food‐based strategies should be considered, to improve the dietary diversity and nutritional status of mothers.

Anaemia and underweight were less prevalent among mothers with young children in the rural Dale district, southern Ethiopia, than the national report of the Ethiopian Demographic and Health Survey in 2016.

Dietary diversity is positively associated with haemoglobin level and body mass index among mothers with children younger than 2 years of age.

The existing nutrition interventions such as the Productive Safety Net Programme need strengthening, to improve the sustained food access to rural households.

Planing and implementing community‐based small‐scale activities, such as school gardening, and fish and poultry farming, to ensure the availability and affordability of nutritious foods.

Determinants and spatial distribution of institutional delivery in Ethiopia: evidence from Ethiopian Mini Demographic and Health Surveys 2019

BACKGROUND

Over the past few decades, maternal and child mortality had drawn the attention of governments and policymakers. Institutional delivery has been among the implementations needed to reduce maternal and child mortality. The fact that the problem was persisted intensified studies to research for more factors. Thus, the current study was intended for further analyses of EMDHS to identify the magnitude, spatial patterns, and predictors of institutional delivery.

METHODS

A cross-sectional survey data from EMDHS 2019 was analyzed involving 5488 reproductive-age women regarding institutional deliveries. We presented descriptive statistics using mean, standard deviations, and proportions. To check the nature of the distribution of institutional delivery, we applied the global Moran's I statistics. Getis-Ord Gi statistics was applied to detect spatial locations, and we applied spatial interpolation to predict unknown locations of institutional delivery using the Ordinary Kriging method. Kulldorff's SatScan was also applied to identify the specific local clustering nature of institutional delivery using the Bernoulli method. We applied multilevel binary logistic regression for the scrutiny of individual and community-level factors. We applied P < 0.25 to include variables in the model and P < 0.05 to declare associations. AOR with 95% CI was used to describe variables.

RESULTS

The prevalence of institution/facility delivery was 2666.45(48.58%) in the survey. The average number of children was 4.03 ± 2.47, and most women in this survey were in the age range of the 25-29 years (31.84%) and 30-34 years (21.61%). Women who learned primary education (AOR = 1.52; 95% CI 1.20-1.95), secondary education (AOR = 1.77; 95% CI 1.03-3.07), and higher education (AOR = 5.41; 95% 1.91-15.25), while those who can read and write sentences (AOR = 1.94; 95% 1.28-2.94), Rich (AOR = 2.40 95% CI 1.82-3.16), and those followed 1-2 ANC (AOR = 2.08; 95% CI 1.57-2.76), 3 ANCs (AOR = 3.24; 95% CI 2.51-418), and ≥ 4 ANCs (AOR = 4.91; 95% CI 3.93-6.15) had higher odds of delivering at health institutions.

CONCLUSION

The institutional delivery was unsatisfactory in Ethiopia, and there were various factors associated differently across the different regions. Pastoralist regions showed high home delivery than institutions which invites further interventions specific to those regions. Factors like age, highest education level achieved, preceding birth interval, literacy status, wealth status, birth order, regions, and rural residences were all affected institutional delivery so that interventions considering awareness, access, and availability of the services are vital.

Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

BACKGROUND

Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery.

METHOD

The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery.

RESULT

Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery.

CONCLUSION

The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03891030 , Retrospectively registered on 26 March, 2019.

Non-Institutional Childbirths and the Associated Socio-Demographic Factors in Gambella Regional State, Ethiopia

The decades-long global efforts to reduce maternal morbidity and mortality have shown overall progress, but most developing countries are still lagging significantly. This study aimed to assess the prevalence of non-institutional childbirths in the Gambella State and to identify socio-demographic factors responsible for non-institutional utilization of available birth services by reproductive-aged mothers. A community-based cross-sectional study design was adopted using a multi-stage random sampling technique. Binary logistic regression was used to identify factors associated with the selected place of birth. EpiData version 3.1 and SPSS version 13.0 were applied for data entry and analyses. All the 657 eligible mothers recruited for this study responded to the interview. 71% of the total respondents had non-institutional childbirths (NICB), and the rest had their most recent childbirth in an institution with skilled healthcare providers' assistance. Socio-demographic factors were significantly associated with NICB. Nuer (AOR = 2.12, 95% CI: 1.23-3.63) and Majang ethnic (AOR = 1.98, 95% CI: 1.02-3.83) groups had higher rates of NICB than the rest of the study population. The prevalence of non-institutional childbirths in Gambella remained two times higher than the institutional childbirths.