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Hunegnaw BM, Goddard FGB, Bekele D, Haneuse S, Pons-Duran C, Zeleke M, Mohammed Y, Bekele C, Chan GJ. Estimates and determinants of health facility delivery in the Birhan cohort in Ethiopia. PLoS One 2024; 19:e0306581. [PMID: 39058714 PMCID: PMC11280242 DOI: 10.1371/journal.pone.0306581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aimed to measure the prevalence and determinants of health facility delivery in the Amhara region in Ethiopia. From December 2018 to November 2020, we conducted a longitudinal study from a cohort of 2801 pregnant women and described the location of delivery and the association with determinants. We interviewed a subset of women who delivered in the community and analyzed responses using the three delays model to understand reasons for not using health facility services. A multivariable poisson regression model with robust error variance was used to estimate the presence and magnitude of association between location of delivery and the determinants. Of the 2,482 pregnant women followed through to birth, 73.6% (n = 1,826) gave birth in health facilities, 24.3% (n = 604) gave birth at home and 2.1% (n = 52) delivered on the way to a health facility. Determinants associated with increased likelihood of delivery at a health facility included formal maternal education, shorter travel times to health facilities, primiparity, higher wealth index and having attended at least one ANC visit. Most common reasons mothers gave for not delivering in a health facility were delays in individual/family decision to seek care. The proportion of deliveries occurring in health facilities is increasing but falls below targets. Interventions that focus on the identified social-demographic determinants and delays are warranted.
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Affiliation(s)
- Bezawit M. Hunegnaw
- Department of Pediatrics and Child Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Frederick G. B. Goddard
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Clara Pons-Duran
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Mesfin Zeleke
- Birhan HDSS, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yahya Mohammed
- Birhan HDSS, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Chalachew Bekele
- Birhan HDSS, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Grace J. Chan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School Boston, Boston, MA, United States of America
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Shibre G. Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory. BMJ Open 2024; 14:e077532. [PMID: 39043587 PMCID: PMC11268060 DOI: 10.1136/bmjopen-2023-077532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia. DESIGN Data for the study came from a series of the Ethiopia Demographic and Health Surveys. Four major surveys were taken place between 2000 and 2016 and all were included in the study. 9867, 9075, 10 592 and 9915 live births born 5 years preceding the surveys that were attended by skilled health workers in 2000, 2005, 2011 and 2016, respectively, were included in the study. For the postnatal care, only the 2016 survey was used due to sample size issues in the other surveys, and 3843 women having live births 2 years preceding the survey had complete data, allowing for fitting of a model. Since the outcome measures are binary, the logit model was used. Intersectionality was analysed by entering interactions into models. SETTINGS Population-based representative surveys encompassing all areas of Ethiopia. PARTICIPANTS The study subjects are women of reproductive age who had live births 2 years preceding the 2016 survey (for postnatal care) and live births born 5 years preceding the respective surveys (for birth care). OUTCOME MEASURES The outcome measures are skilled birth and postnatal care services. The postnatal care was for mothers within the first 2 days of giving birth and did not include care for the newborn. Competent maternal health care services are those that are provided by competent health workers: doctors, nurses, midwives and health officers. RESULTS It was observed that women at the crossroads of multiple axes of advantage and disadvantage had better and worse utilisation, respectively. For example, maternal education and residence intersected and predicted coverage of birth care was the highest among secondary schooling women who dwelt in urban settings with the values of 0.255; 95% CI 0.113 to 0.397 in 2000 and 0.589; 95% CI 0.359 to 0.819 in 2016 but was the lowest among non-educated women who lived in rural areas with the values of 0.0236; 95% CI 0.0154 to 0.0317 in 2000 and 0.203; 95% CI 0.177 to 0.229 in 2016. CONCLUSIONS It appeared that some women who were at the intersections of multiple axes of disadvantage had the lowest predicted coverage for maternal health care services. The study suggests that targeted interventions be developed for women who are at the intersection of multiple axes of marginalisation and that multiple sectors work in their sphere of resposibility to tackle social determinants of maternity care inequality. Policymakers may consider using intersectionality to inform development of targeted policies and or strategies. Further, future studies include structural drivers in the analysis of intersectionality to gain a better insight into the causes of disparities.
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Affiliation(s)
- Gebretsadik Shibre
- Addis Ababa University, College of Health Sciences, School of Public Health, Department of Reproductive, Family and Population Health, Addis Ababa, Ethiopia
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Shibre G, Mekonnen W, Haile Mariam D. Explaining changes in educational disparities in competent maternal health care services in urban and rural areas in Ethiopia. Front Public Health 2024; 12:1332801. [PMID: 38680926 PMCID: PMC11045905 DOI: 10.3389/fpubh.2024.1332801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Aggregate statistics of maternal health care services have improved in Ethiopia. Nevertheless, the country has one of the lowest Universal Health Coverage (UHC) service coverage indices, with slight improvement between 2000 and 2019. There are disparity studies that focus on a single dimension of inequality. However, studies that combine multiple dimensions of inequality simultaneously may have important policy implications for closing inequalities. In this study, we investigated education inequalities in the receipt of maternal health care services in rural and urban areas separately, and we examined whether these inequalities decreased, increased, or remained unchanged. Methods The data for the study came from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Using women's education as a dimension of inequality, we separately analyzed inequalities in maternal health care services in urban and rural settings. Inequalities were measured through the Erreygers concentration index, second differences, and Relative Index of Inequality (RII). Whether inequalities changed over time was analyzed by relative and absolute measures. An Oaxaca-type decomposition approach was applied to explain changes in absolute disparities over time. Results There were glaring educational disparities in maternal health care services in urban and rural areas, where the services were more concentrated among women with better schooling. The disparities were more severe in urban than in rural areas. In urban areas, skilled birth service was the most unequal in both periods. Disparities in rural places were roughly similar for all services except that in 2011, postnatal care was the least unequal, and in 2016, skilled birth was the most unequal services. Trend analyses revealed that disparities significantly dropped in urban by absolute and relative measures. Conversely, in rural regions, the disparities grew by the concentration index measure for most services. The RII and second differences presented conflicting results regarding whether the gaps were increasing, shrinking, or remaining the same. Conclusion Substantial disparities in maternal health care services remained and even increased, as in rural areas. Different and targeted strategies are needed for urban and rural places to close the observed educational inequalities in these areas.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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George F, Rajeev LN, Bandyopadhyay S, Baby J, Sinha S, Sachdev HS, Kurpad AV, Thomas T. The role of dairy consumption in the relationship between wealth and early life physical growth in India: evidence from multiple national surveys. BMC Public Health 2024; 24:96. [PMID: 38183073 PMCID: PMC10768164 DOI: 10.1186/s12889-023-17520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Prevalence of undernutrition continues to be high in India and low household wealth is consistently associated with undernutrition. This association could be modified through improved dietary intake, including dairy consumption in young children. The beneficial effect of dairy on child growth has not been explored at a national level in India. The present analyses aimed to evaluate the direct and indirect (modifying association of household level per adult female equivalent milk and milk product consumption) associations between household wealth index on height for age (HAZ) and weight for age (WAZ) in 6-59 months old Indian children using data from of nationally representative surveys. METHODS Two triangulated datasets of two rounds of National Family Health Survey, (NFHS-3 and 4) and food expenditure (National Sample Survey, NSS61 and 68) surveys, were produced by statistical matching of households using Non-Iterative Bayesian Approach to Statistical Matching technique. A Directed Acyclic Graph was constructed to map the pathways in the relationship of household wealth with HAZ and WAZ based on literature. The direct association of wealth index and its indirect association through per adult female equivalent dairy consumption on HAZ and WAZ were estimated using separate path models for each round of the surveys. RESULTS Wealth index was directly associated with HAZ and WAZ in both the rounds, but the association decreased from NFHS-3 (βHAZ: 0.145; 95% CI: 0.129, 0.16) to NFHS-4 (βHAZ: 0.102; 95%CI: 0.093, 0.11). Adult female equivalent milk intake (increase of 10gm/day) was associated with higher HAZ (β_NFHS-3=0.001;95% CI: 0, 0.002; β_NFHS-4=0.002;95% CI: 0.002, 0.003) but had no association with WAZ. The indirect association of wealth with HAZ through dairy consumption was 2-fold higher in NFHS-4 compared to NFHS-3. CONCLUSIONS The analysis of triangulated survey data shows that household level per- adult female equivalent dairy consumption positively modified the association between wealth index and HAZ, suggesting that regular inclusion of milk and milk products in the diets of children from households across all wealth quintiles could improve linear growth in this population.
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Affiliation(s)
- Franciosalgeo George
- Division of Epidemiology, Biostatistics, and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - L Naga Rajeev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Sulagna Bandyopadhyay
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Jeswin Baby
- Division of Epidemiology, Biostatistics, and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
- Department of Statistical Sciences, Kannur University, Kerala, India
- Research and Development Cell, Caritas Hospital and Institute of Health Sciences, Kottayam, India
| | - Srishti Sinha
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, India.
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Abdo R, Demelash M, Seid AM, Mussema A. First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors. BMC Pregnancy Childbirth 2023; 23:742. [PMID: 37858033 PMCID: PMC10585910 DOI: 10.1186/s12884-023-06034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa. METHODS Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger's test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis. RESULTS A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3-41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5-3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2-1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4-2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2-2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5-2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7-2.1; I2 = 94.4%). CONCLUSION Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).
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Affiliation(s)
- Ritbano Abdo
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
| | - Minychil Demelash
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abdulrezak Mohammed Seid
- Department of Medical Laboratory, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Abdulhakim Mussema
- Department of Medical Laboratory, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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Jana A, Dey D, Ghosh R. Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021. BMC Public Health 2023; 23:1336. [PMID: 37438769 DOI: 10.1186/s12889-023-16160-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.
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Affiliation(s)
- Arup Jana
- Research Scholar, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Deepshikha Dey
- MPhil., International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Ranjita Ghosh
- PhD Scholar, Institute for Social and Economic Change, Karnataka, 560072, India.
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Misu F, Alam K. Comparison of inequality in utilization of maternal healthcare services between Bangladesh and Pakistan: evidence from the demographic health survey 2017-2018. Reprod Health 2023; 20:43. [PMID: 36915151 PMCID: PMC10009948 DOI: 10.1186/s12978-023-01595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Inequality in maternal health has remained a challenge in many low-income countries, like Bangladesh and Pakistan. The study examines within-country and between-country inequality in utilization of maternal healthcare services for Bangladesh and Pakistan. METHODS The study used the latest Demographic Health Surveys (DHS, 2017-2018) datasets of Bangladesh and Pakistan for women aged 15-49 years who had given at least one live birth in three years preceding the survey. Equity strata were identified from the literature and conformed by binary logistic regressions. For ordered equity strata with more than two categories, the relative concentration index (RCI), absolute concentration index (ACI) and the slope index of inequality (SII) were calculated to measure inequalities in the utilization of four maternal healthcare services. For two-categories equity strata, rate ratio (RR), and rate difference (RD) were calculated. Concentration curves and equiplots were constructed to visually demonstrate inequality in maternal healthcare services. RESULTS In Bangladesh, there was greater inequality in skilled birth attendance (SBA) based on wealth (RCI: 0.424, ACI: 0.423, and SII: 0.612), women's education (RCI: 0.380, ACI: 0.379 and SII: 0.591), husband's education (RCI: 0.375, ACI: 0.373 and SII: 0.554) and birth order (RCI: - 0.242, ACI: - 0.241, and SII: -0.393). According to RCI, ACI, and SII, there was inequality in Pakistan for at least four ANC visits by the skilled provider based on wealth (RCI: 0.516, ACI: 0.516 and SII: 0.738), women's education (RCI: 0.470, ACI: 0.470 and SII: 0.757), and husband's education (RCI: 0.380, ACI: 0.379 and SII: 0.572). For Bangladesh, the RR (1.422) and RD (0.201) imply more significant urban-rural inequality in SBA. In Pakistan, urban-rural inequality was greater for at least four ANC visits by the skilled provider (RR: 1.650 and RD 0.279). CONCLUSION Inequality in maternal healthcare is greater among the underprivileged group in Pakistan than in Bangladesh. In Bangladesh, the SBA is the most inequitable maternal healthcare, while for Pakistan it is at least four ANC visits by the skilled provider. Customized policies based on country context would be more effective in bridging the gap between the privileged and underprivileged groups.
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Affiliation(s)
- Farjana Misu
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Department of Statistics, Jagannath University, Dhaka-1100, Bangladesh.
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Gebregizabher FA, Medhanyie AA, Bezabih AM, Persson LÅ, Abegaz DB. Is Women's Engagement in Women's Development Groups Associated with Enhanced Utilization of Maternal and Neonatal Health Services? A Cross-Sectional Study in Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1351. [PMID: 36674107 PMCID: PMC9858998 DOI: 10.3390/ijerph20021351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In Ethiopia, the Women Development Group program is a community mobilization initiative aimed at enhancing Universal Health Coverage through supporting the primary healthcare services for mothers and newborns. This study aimed to assess the association between engagement in women's groups and the utilization of maternal and neonatal health services. METHOD A cluster-sampled community-based survey was conducted in Oromia, Amhara, Southern Nations, Nationalities and Peoples, and Tigray regions of Ethiopia from mid-December 2018 to mid-February 2019. Descriptive and logistic regression analyses were performed, considering the cluster character of the sample. RESULTS A total of 6296 women (13 to 49 years) from 181 clusters were interviewed. Of these, 896 women delivered in the 12 months prior to the survey. Only 79 (9%) of these women including Women Development Group leaders reported contact with Women Development Groups in the last 12 months preceding the survey. Women who had educations and greater economic status had more frequent contact with Women Development Group leaders. Women who had contact with Women Development Groups had better knowledge on pregnancy danger signs. Being a Women Development Group leader or having contact with Women Development Groups in the last 12 months were associated with antenatal care utilization (AOR 2.82, 95% CI (1.23, 6.45)) but not with the use of facility delivery and utilization of postnatal care services. CONCLUSIONS There is a need to improve the organization and management of the Women Development Group program as well as a need to strengthen the Women Development Group leaders' engagement in group activities to promote the utilization of maternal and neonatal health services.
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Affiliation(s)
- Fisseha Ashebir Gebregizabher
- Tigray Regional Health Bureau, Mekelle P.O. Box 07, Ethiopia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia
| | - Lars Åke Persson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Della Berhanu Abegaz
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
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