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Arega T, Mulatu T, Alemayehu A, Mussa I, Dheresa M. Institutional delivery and associated factors among women who gave birth in Benishangul Gumuz region, South West Ethiopia. Front Public Health 2022; 10:965524. [PMID: 36568776 PMCID: PMC9780484 DOI: 10.3389/fpubh.2022.965524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background Maternal mortality from pregnancy and childbirth remains a major public health problem. Increasing access to institutional delivery is one of the key strategies to reduce childbirth-related maternal mortality. Despite all the efforts, institutional deliveries in Ethiopia remain low. Understanding factors associated with institutional delivery is important to devise strategies to improve facility based child birth. Hence, this study assessed the prevalence of institutional delivery and associated factors to bridge the gap. Methods A community-based cross-sectional study was employed from March-April 2020. Multi-stage sampling was employed to select 500 mothers who gave birth within the last 12 months in Mandura district, Benishangul Gumuz Region, Ethiopia. Data were collected using pre tested structured questionnaire through face-to-face interview. Logistic regression models were fitted to assess the predictors of institutional delivery. Adjusted Odds ratios with 95% CI was used to show associations and statistical significance was set at a p < 0.05. Results This study indicated that the prevalence of institutional delivery was 28.8% CI (25-33.3%). Having a positive attitude (AOR = 9.6,95%CI:2.5-35.9), attending antenatal care (ANC) at least once (AOR = 16.1,95%CI:9.6-22), attending ANC more than three times (AOR = 17.2, 95% CI:13.5-43.8), having good knowledge (AOR = 11.1, 95%CI: 2.7-45.4), and facing complications during pregnancy (AOR = 4.04, 95%CI: 1.0-16.0) were significantly associated with institutional delivery. Conclusion The prevalence of institutional delivery in this study was low. Positive attitude toward institutional delivery, attending ANC, having good knowledge about institutional delivery, and facing complications during pregnancy were identified predictors of institutional delivery. Strategies with a focus on increasing ANC uptake, improving mothers' knowledge, and promoting institutional delivery at the community level are critical.
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Affiliation(s)
- Temesgen Arega
- Mandura District Health Office, Beneshangul Gumuz, Asosa, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia,*Correspondence: Teshale Mulatu
| | - Afework Alemayehu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Tarik YD, Nigussie AA, Balcha WF, Getu AA. Factors associated with institutional delivery among mothers who gave birth within 1 year prior to the study at Gilgelbelles town, Northwest Ethiopia: a mixed-methods study. BMJ Open 2022; 12:e061218. [PMID: 36424117 PMCID: PMC9693699 DOI: 10.1136/bmjopen-2022-061218] [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] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to assess factors associated with institutional delivery among mothers who had delivered within 1 year prior to the study at Gilgelbelles town, Northwest, Ethiopia. DESIGN A community-based mixed-methods study was conducted from 1 February 2020 to 2 March 2020. SETTING This study was conducted at Gilgelbelles town, Northwest Ethiopia. PARTICIPANTS Included 422 mothers who delivered 1 year prior to the study at Gilgelbelles town. OUTCOME MEASURES Utilisation of institutional delivery and factors associated with institutional delivery. METHODS The quantitative data were collected by the simple random sampling technique, entered into Epi data V.3.1, and analysed using SPSS V.23.0. The qualitative data were collected by using in-depth interviews and thematic analysis was done manually to supplement the quantitative result. RESULTS In this study, 39.6% (95% CI=34.8 to 44.3) of mothers were given childbirth at the health facility. In multivariable analysis maternal age group of 15-20 years, secondary and above educational level, good knowledge on danger signs of obstetric, antenatal care visits, good awareness of birth preparedness and complications readiness plan, getting married after the age of 18 years, faced at least one complication during pregnancy, less than two children, travelled <30 min to reach a nearby health facility, having decision making power and not practised traditional malpractice during labour were significantly associated with institutional delivery. The qualitative result shows that cultural factors of the society and the lack of adequate delivery material in the health facility were identified as the major reason for the low utilisation of institutional delivery services. CONCLUSION This study showed that the proportion of institutional delivery was low. Sociodemographic, reproductive and knowledge-related factors were associated with institutional delivery. This indicates a need of taking appropriate interventions by integrating other stakeholders to increase the utilisation of institutional delivery services.
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Affiliation(s)
| | - Azezu Asres Nigussie
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondu Feyisa Balcha
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Almaz Aklilu Getu
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Tariku M, Enyew DB, Tusa BS, Weldesenbet AB, Bahiru N. Home delivery among pregnant women with ANC follow-up in Ethiopia; Evidence from the 2019 Ethiopia mini demographic and health survey. Front Public Health 2022; 10:862616. [PMID: 36466499 PMCID: PMC9709139 DOI: 10.3389/fpubh.2022.862616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Maternal mortality has remained an international public health problem although it is decreasing in recent years. Developing countries particularly Sub-Saharan African countries bears the high burden of maternal deaths. There was no study conducted to assess prevalence and associated factors of home delivery among women in Ethiopia on antenatal care (ANC) follow up nationally. Therefore, this study was conducted to assess the magnitude and associated factors of home delivery in Ethiopia. Objectives To assess the magnitude of home delivery and associated factors among women who had ANC follow up in Ethiopia. Methods Secondary data analysis was carried out using Ethiopian Mini Demography and Health Survey (EMDHS 2019). A total weighted sample of 2,143 women who had ANC follow up during pregnancy was incorporated in the study. In a generalized linear mixed model (GLMM), Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and p < 0.05 were declared as associated factors of home delivery. Results The prevalence of home delivery was 31.27% [95% CI: 29.34%, 33.27%] among women who had ANC follow up in Ethiopia. Attended higher education [AOR = 0.27; 95% CI: (0.13, 0.54)], rural resident [AOR = 2.15; 95% CI: (1.19, 3.90)], richest in the wealth index [AOR = 0.18; 95% CI: (0.10, 0.32)], had adequate ANC follow up [AOR = 0.25; 95% CI: (0.13, 0.51)] and being in third trimesters [AOR = 0.64; 95% CI: (0.49, 0.83)] during first ANC visit were significantly associated factors of home delivery. Conclusion Near to one-third of women in Ethiopia have delivered their babies at home even if they had an ANC follow up. Educational status, place of residence, wealth index, timing of first antenatal check and adequate ANC visit has shown significant association with home delivery. Therefore, focused intervention packages need to be implemented at all levels of the health care system in Ethiopia to improve health seeking behaviors of women who have ANC follow up to have delivery in health care institutions. While doing so, special attention should be given for poor, uneducated and rural dweller women.
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Affiliation(s)
- Mandaras Tariku
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Mandaras Tariku
| | - Daniel Berhanie Enyew
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nebiyu Bahiru
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Gilano G, Hailegebreal S, Seboka BT. Determinants and spatial distribution of institutional delivery in Ethiopia: evidence from Ethiopian Mini Demographic and Health Surveys 2019. Arch Public Health 2022; 80:65. [PMID: 35189954 PMCID: PMC8862569 DOI: 10.1186/s13690-022-00825-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/04/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Girma Gilano
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Samuel Hailegebreal
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biniyam Tariku Seboka
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Hailemariam S, Gutema L, Asnake M, Agegnehu W, Endalkachew B, Molla W. Perceived physical accessibility, mother's perception of quality of care, and utilization of skilled delivery service in rural Ethiopia. SAGE Open Med 2021; 9:20503121211036794. [PMID: 34377478 PMCID: PMC8326625 DOI: 10.1177/20503121211036794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/14/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Despite the concerted effort to improve skilled delivery service utilization in Ethiopia, a considerable proportion of births still occur at home by traditional birth attendants, notably in a rural setting. Hence, the aim of this study was to investigate whether mother’s perceived service quality and physical accessibility affect skilled delivery service utilization. Methods: A community-based cross-sectional study was conducted from 1 July 2019 to 30 August 2019, among mothers who gave birth in the last 12 months before the study, in selected five districts of Kaffa Zone, Ethiopia. Result: In this study, 262 (70.1%) of mothers utilized skilled delivery service in their recent childbirth. Mothers regarding the nearby health facility’s physical environment as “Good” (adjusted odds ratio = 2.48, 95% confidence interval = 1.44, 4.25), mothers mentioning time to reach to the nearby health facility “<1 h” (adjusted odds ratio = 1.92, 95% confidence interval = 1.11, 3.34), and mothers regarding prompt transport service from home to the nearby health facility “Available” (adjusted odds ratio = 2.01, 95% confidence interval = 1.11, 3.63) were positively associated with skilled delivery services’ utilization. Furthermore, completing secondary education and above, attending three and more antenatal care visits, and having good knowledge of danger signs during pregnancy showed a significant association. Conclusion: Although the study evidenced statistically significant association between perceived physical accessibility and perceived service quality, further study is recommended to investigate the relationship between actual physical accessibility and actual service quality. Targeted health education program intended to improve skilled delivery service utilization should give due emphasis on enhancing antenatal care service uptake, and raising mothers’ awareness on danger signs during pregnancy, with particular focus on those mothers with low schooling.
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Affiliation(s)
| | - Lidya Gutema
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Molla Asnake
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Wubetu Agegnehu
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Biruk Endalkachew
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Wondwosen Molla
- College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Ayana A, Kassie A, Azale T. Intention to use institutional delivery service and its predictors among pregnant women, North West Ethiopia: Using theory of planned behavior. PLoS One 2021; 16:e0248697. [PMID: 33961637 PMCID: PMC8104421 DOI: 10.1371/journal.pone.0248697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improving institutional delivery service is the most crucial strategies to reduce maternal and neonatal mortalities. In developing countries, only 50% of pregnant women deliver in health facilities and in Ethiopia only 48% of pregnant women deliver in health facilities. Maternal mortality remains the highest in Ethiopia. This study assessed intention to use institutional delivery service and its predictors among pregnant women using theory of planned behavior. METHODS Community-based cross-sectional study was conducted among 645 Yilmana Densa District Pregnant women using multi-stage followed by cluster sampling technique. Data were entered into Epi Data version 4.6.0.2 and analyzed with STATA version 14. Binary logistic regression analysis was done to identify independent predictors of intention at 95% confidence level and P < 0.05 was used to determine statistically significant predictors. RESULTS Intention of pregnant women to use institutional delivery service was 74.3% (CI; 70.71%, 77.6%). In the multivariable logistic regression; those who had 1-3 and 4 &above antenatal care 2.85(1.41, 5.75) and 3.14(1.16, 8.45) respectively, those who had past experience of institutional delivery (AOR = 3.39, 95%CI: 1.72, 6.71), parity of 1-3 and 4 & above % (AOR = 0.37, 0.19, 0.71) and (AOR = 0.25, 95%CI: 0.12, 0.55) respectively, rural residence (AOR = 0.51, 95%CI: 0.27, 0.96), favorable attitude (AOR = 2.93, 95%CI: 1.56, 5.50), favorable perceived behavioral control (AOR = 2.60, 95%CI: 1.44, 4.69) were factors significantly associated with intention to use institutional delivery service. CONCLUSION AND RECOMMENDATION Majority of the pregnant women were intended to deliver in the institution. Good Knowledge on institutional delivery, antenatal care visit, past experience of institutional delivery, rural residence, parity, attitude and perceived behavioral control were identified factors significantly associated with intention to use institutional delivery service. So, strengthening awareness creation and behavioral change communication programs are required at all levels of health system to raise intention of residents towards institutional delivery.
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Affiliation(s)
- Abirham Ayana
- Amhara Regional State Health Bureau, Bahir Dar, Ethiopia
| | - Ayenew Kassie
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Ayenew AA, Nigussie AA, Zewdu BF. Childbirth at home and associated factors in Ethiopia: a systematic review and meta-analysis. Arch Public Health 2021; 79:48. [PMID: 33849638 PMCID: PMC8042927 DOI: 10.1186/s13690-021-00569-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Asteray Assmie Ayenew
- Department of Midwifery, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Azezu Asres Nigussie
- Department of Midwifery, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Biruk Ferede Zewdu
- Department of Orthopedics, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mitikie KA, Wassie GT, Beyene MB. Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia. PLoS One 2020; 15:e0243466. [PMID: 33326426 PMCID: PMC7743934 DOI: 10.1371/journal.pone.0243466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background The risk of death from complications relating to pregnancy and childbirth for women’s lifetime is higher in developing countries. Improving maternal and child health through a well-organized institutional delivery service is central to achieving reduced maternal and child mortality. Despite the efforts that have been made to improve maternal health outcomes in Ethiopia, institutional delivery is still unacceptably low. Objective This study was conducted to assess institutional delivery service utilization and associated factors in the study area. Methods A Community-based cross-sectional study was conducted. A multi-stage sampling technique was used to employ a total of 546 women. Data were collected using an interviewer-administered questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0. for analysis. Logistic regression models were used to determine factors associated with the outcome variable. Adjusted Odds ratios with 95% CI were computed to measure the strength of association and statistical significance was declared at p-value <0.05. Results The Prevalence of institutional delivery in the study area was 38% (34%-42%). Factors significantly associated with institutional delivery were ANC visit 1.80 (1.12–2.91), knowledge of danger sign during pregnancy 3.60 (2.25–5.76), urban residency 2.09 (1.15–3.81), Parity 0.49 (0.25–0.95) accessibility of health facility 4.60 (2.01–10.89), husbands educational level: primary 2.50 (1.27–4.91), secondary and above 2.36 (1.24–4.48), mothers occupation: governmental employee 2.05 (1.00–4.18), and Private employee 2.42 (1.09–5.35). Conclusions The prevalence of institutional delivery in the District was low. Antenatal visits, residency, knowledge of pregnancy danger signs, parity, and accessibility of health facilities, maternal occupation, and husband education were factors significantly associated with institutional delivery.
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Affiliation(s)
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Melkamu Bedemo Beyene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Tesema GA, Mekonnen TH, Teshale AB. Individual and community-level determinants, and spatial distribution of institutional delivery in Ethiopia, 2016: Spatial and multilevel analysis. PLoS One 2020; 15:e0242242. [PMID: 33180845 PMCID: PMC7660564 DOI: 10.1371/journal.pone.0242242] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Institutional delivery is an important indicator in monitoring the progress towards Sustainable Development Goal 3.1 to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Despite the international focus on reducing maternal mortality, progress has been low, particularly in Sub-Saharan Africa (SSA), with more than 295,000 mothers still dying during pregnancy and childbirth every year. Institutional delivery has been varied across and within the country. Therefore, this study aimed to investigate the individual and community level determinants, and spatial distribution of institutional delivery in Ethiopia. Methods A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 women was included in this study. For spatial analysis, ArcGIS version 10.6 statistical software was used to explore the spatial distribution of institutional delivery, and SaTScan version 9.6 software was used to identify significant hotspot areas of institutional delivery. For the determinants, a multilevel binary logistic regression analysis was fitted to take to account the hierarchical nature of EDHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p-values<0.2 in the bi-variable analysis were fitted in the multivariable multilevel model. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) were used to declare significant determinant of institutional delivery. Results The spatial analysis showed that the spatial distribution of institutional delivery was significantly varied across the country [global Moran’s I = 0.04 (p<0.05)]. The SaTScan analysis identified significant hotspot areas of poor institutional delivery in Harari, south Oromia and most parts of Somali regions. In the multivariable multilevel analysis; having 2–4 births (AOR = 0.48; 95% CI: 0.34–0.68) and >4 births (AOR = 0.48; 95% CI: 0.32–0.74), preceding birth interval ≥ 48 months (AOR = 1.51; 95% CI: 1.03–2.20), being poorer (AOR = 1.59; 95% CI: 1.10–2.30) and richest wealth status (AOR = 2.44; 95% CI: 1.54–3.87), having primary education (AOR = 1.47; 95% CI: 1.16–1.87), secondary and higher education (AOR = 3.44; 95% CI: 2.19–5.42), having 1–3 ANC visits (AOR = 3.88; 95% CI: 2.77–5.43) and >4 ANC visits (AOR = 6.53; 95% CI: 4.69–9.10) were significant individual-level determinants of institutional delivery while being living in Addis Ababa city (AOR = 3.13; 95% CI: 1.77–5.55), higher community media exposure (AOR = 2.01; 95% CI: 1.44–2.79) and being living in urban area (AOR = 4.70; 95% CI: 2.70–8.01) were significant community-level determinants of institutional delivery. Conclusions Institutional delivery was low in Ethiopia. The spatial distribution of institutional delivery was significantly varied across the country. Residence, region, maternal education, wealth status, ANC visit, preceding birth interval, and community media exposure were found to be significant determinants of institutional delivery. Therefore, public health interventions should be designed in the hotspot areas where institutional delivery was low to reduce maternal and newborn mortality by enhancing maternal education, ANC visit, and community media exposure.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Tesfaye Hambisa Mekonnen
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yosef T. Magnitude and Associated Factors of Institutional Delivery Among Reproductive Age Women in Southwest Ethiopia. Int J Womens Health 2020; 12:1005-1011. [PMID: 33192103 PMCID: PMC7654524 DOI: 10.2147/ijwh.s278508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the global maternal mortality ratio (MMR) fallen by nearly 44% from 1990 to 2015, however, maternal mortality remains a global problem. Reducing maternal morbidity and mortality is a global priority, which is particularly relevant for developing countries like Ethiopia. A good strategy for reducing maternal morbidity and mortality is increasing institutional delivery service utilization. This study aimed to assess the magnitude and associated factors of institutional delivery among reproductive-age women in southwest Ethiopia. METHODS A community-based cross-sectional study was conducted among 526 women at Mizan-Aman town from January 1 to 30, 2019. The data were collected through face-to-face interviews, and a structured questionnaire was used to assess the prevalence and associated factors of institutional delivery among reproductive-age women who delivered in the past one year. The collected data were entered into the Epi Data manager and analyzed using SPSS version 21. Binary logistic regression was done to determine the association between dependent and expected independent variables. Statistical significance was declared at p < 0.05 in the multivariable logistic regression analysis. RESULTS Of the 526 mothers interviewed, the proportion of institutional delivery was 76%, 95% CI (72.4%-79.7%). The study also found maternal age 25-34 years (AOR=1.89, 95% CI [1.42-3.26]) and 35 years and above (AOR=3.51, 95% CI [1.52-7.85]), monthly income ≥36 USD (AOR=2.22, 95% CI [1.12-4.13]), being multiparity (AOR=1.98, 95% CI [1.08-3.62]), having ANC visit (AOR=10.5, 95% CI [6.76-28.3]), knowledge of pregnancy danger signs (AOR=5.51, 95% CI [3.46-10.2]) and experience of pregnancy danger signs (AOR=3.86, 95% CI [2.67-7.29]) were significantly associated with institutional delivery. CONCLUSION The utilization of institutional delivery service among mothers in the study area was good. But, more effort is needed to increase service utilization to 100%. The provision of the continuous house to house health education regarding institutional delivery is an important segment of intervention that can be done through health extension workers. Besides, counseling mothers on the importance of institutional delivery by health professionals at each ANC follow-up visit plays paramount importance.
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Affiliation(s)
- Tewodros Yosef
- Department of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
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11
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Kurji J, Gebretsadik LA, Wordofa MA, Morankar S, Bedru KH, Bulcha G, Bergen N, Kiros G, Asefa Y, Asfaw S, Mamo A, Endale E, Thavorn K, Labonte R, Taljaard M, Kulkarni MA. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia. BMC Public Health 2020; 20:1593. [PMID: 33092565 PMCID: PMC7583173 DOI: 10.1186/s12889-020-09692-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Lakew Abebe Gebretsadik
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | | | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Getachew Kiros
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management & Policy, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Shifera Asfaw
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Erko Endale
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute General Campus, University of Ottawa, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute Civic Campus, University of Ottawa, Ottawa, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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Dile M, Demelash H, Meseret L, Abebe F, Adefris M, Goshu YA, Ayele AS, Liyeh TM. Determinants of obstructed labor among women attending intrapartum care in Amhara Region, Northwest Ethiopia: A hospital-based unmatched case-control study. ACTA ACUST UNITED AC 2020; 16:1745506520949727. [PMID: 32842920 PMCID: PMC7453442 DOI: 10.1177/1745506520949727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives: maternal and neonatal mortality in Ethiopia is a major reproductive health problem. Obstructed labor is one of the leading causes of maternal, fetal, and neonatal morbidity in developing countries. The evidence regarding its determinants at the tertiary level of care is sparse. Therefore, this study aimed to study the determinants of obstructed labor among women attending intrapartum care in Amhara region referral hospitals. Methods: A Hospital-based unmatched case-control study was conducted from March 1stto August 30, 2017. Cases were women whose labor was obstructed (n = 270), and controls were women whose labor was not obstructed (n = 540). Both cases and controls were selected randomly, and a proportional to size allocation was made to the referral hospitals selected for the study. A binary and a multivariable logistic regression model was computed to identify the determinant factors at 95% CI. Results: The mean age of the study participants was 27.66 years (27.4 ± 5.44 for cases and 28.15 ± 6.16 for controls), ranging between 16 and 45 years. Relatively, higher proportions of cases than controls were unable to read and write (58.5%) and were urban residents (53.7%). Distance from hospital, distance from health center, mothers inability to read and write, mothers primary level of education, more than 28 weeks of gestation at the first visit of antenatal care, 37 to 42 weeks at admission, above 42 weeks at admission, women of a merchant spouse, and history of pregnancy-related complications were the positive determinants of obstructed labor. However, mothers whose gestational age was 16 to 28 weeks at the first antenatal care visit were 62% less likely to be exposed to obstructed labor. Conclusions: Obstetric, service-related, and system factors were predictors of obstructed labor. Improving women’s literacy status, health service access, and utilization will help reduce obstructed labor.
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Affiliation(s)
- Mulugeta Dile
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Demelash
- Department of Social and Public Health, Debre Tabor University, Debre Tabor, Ethiopia
| | - Lealem Meseret
- Department of Gynecology and Obstetrics, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Mulat Adefris
- Department of Gynecology and Obstetrics, University of Gondar, Gondar, Ethiopia
| | - Yitayal Ayalew Goshu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche Liyeh
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Haile D, Kondale M, Andarge E, Tunje A, Fikadu T, Boti N. Level of completion along continuum of care for maternal and newborn health services and factors associated with it among women in Arba Minch Zuria woreda, Gamo zone, Southern Ethiopia: A community based cross-sectional study. PLoS One 2020; 15:e0221670. [PMID: 32511230 PMCID: PMC7279583 DOI: 10.1371/journal.pone.0221670] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Completion along continuum of care for maternal and newborn health (MNH) services like antenatal care, skilled birth attendance and postnatal care services is advantageous over each segment of services. It is one of the currently recommended strategies to reduce both maternal and neonatal mortality and achieve the global target of ending preventable maternal and under-five children’s mortality. Although studies on factors affecting each segment of MNH services have been well documented in Ethiopia, there is a dearth of evidence about the level of continuum of care and factors associated with it. This study was intended to fill this gap in evidence in the study area so that interventions could be taken to improve maternal and newborn health. Methods A community-basedcross-sectional study was conducted among 432 postnatal women who gave birth in the previous year in Arba Minch Health and Demographic Surveillance System (HDSS) site. Women were selected by computer generated random numbers from a list of women who stayed at least 6 weeks after birth. A pre-tested, structured, and interviewer-administered questionnaire was used for data collection. Data were entered and coded in Epi-data and analyzed using SPSS software version 23. Binary logistic regression model was fitted to identify factors associated with the dependent variable. Bivariate and multivariable analyses were fitted in steps to select candidate variables for multivariable analysis and to control for potential confounding effect respectively. Results The overall completion along the continuum of care was 42(9.7%). The factors significantly associated with completion of care along the continuumwere timely initiation of antenatalcare (before16weeks) [AOR: 10.7, CI (5.1, 22.7], birth preparedness and complication readiness [AOR: 2.9, CI (1.4, 6.1), pre-pregnancy contraception utilization [AOR: 3.9, CI: 1.4, 11.0], being employed [AOR: 2.6 CI:(1.3, 5.4)], and having a planned pregnancy [AOR:3.5 CI: (1.1, 11.4)]. Conclusion and recommendation Completion along the continuum of care for MNH services was low in the study area. Thus, efforts to improve the completion of care should focus on interventions that enhance early initiation of antenatal care, planned pregnancy, and birth preparedness and complication readiness.
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Affiliation(s)
- Dereje Haile
- Wolaita Zone Health Department, Duguna Fango Health office, Wolaita Sodo, Wolaita Zone, Ethiopia
| | - Mekdes Kondale
- Reproductive Health Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Eshetu Andarge
- Reproductive Health Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Abayneh Tunje
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Teshale Fikadu
- Epidemiology and Biostatistics Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nigussie Boti
- Reproductive Health Unit, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Asresie MB, Dagnew GW. Effect of attending pregnant women's conference on institutional delivery, Northwest Ethiopia: comparative cross-sectional study. BMC Pregnancy Childbirth 2019; 19:353. [PMID: 31606054 PMCID: PMC6790024 DOI: 10.1186/s12884-019-2537-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Institutional delivery is the cornerstone reducing maternal mortality. Community-based behavioral change interventions are increasing institutional delivery in developing countries. Yet, there is a dearth of information on the effect of attending pregnant women’s conferences in improving institutional delivery in Ethiopian. Therefore, this study was aimed to assess the effect of attending pregnant women’s conference on institutional delivery, Northwest Ethiopia. Methods Community-based comparative cross-sectional study was conducted in 2017 among 871 women who gave birth within the last 12 months (435: pregnant women’s conference attendants and 436: pregnant women’s conference non-attendants). Participants were selected by using a multistage-simple random sampling technique and a structured interviewer-administered questionnaire was used for data collection. Both descriptive and logistic regression analyses were performed using SPSS V.23. A P-value less than or equal to 0.05 at 95% confidence interval was set to test statistical significance. Results Institutional delivery among women who attended pregnant women’s conferences was 54.3%, higher compared with 39.9% of women who didn’t attend the conference. Likewise, the level of well-preparedness for birth was higher among women who attended the conference (38.9%) compared with their counterparts (25.7%). Being knowledgeable on childbirth (AOR = 1.7, 95%CI: 1.2, 2.8) and postpartum danger signs (AOR = 14.0, 95%CI: 4.6, 40.0), and discussed with partners/families about the place of birth (AOR = 7.7, 95%CI: 3.6, 16.4) were more likely to institutional delivery among women who attended pregnant women’s conference. Whereas, among women who didn’t attend the pregnant women’s conference, being knowledgeable about pregnancy danger signs (AOR = 3.6, 95%CI: 1.6, 8.1) were more likely to institutional delivery. In addition, the nearest health facility within 1 h of walking and well-preparedness for birth and its complication were found positively associated with institutional delivery in both groups. Conclusion Institutional delivery was low in both groups compared to the national plan, but was higher among women who attended the conference. Similarly, women’s knowledge of obstetric danger signs and preparation for birth and its complication was higher among women who attended the conference. Therefore, encouraging women to attend the pregnant women’s conference and discuss with their families about the place of delivery should be strengthened.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Tesfaw N, Gizachew A, Kassa GM, Abajobir AA. Skilled Delivery Service Utilization and Associated Factors among Mothers Who Gave Birth in the Last Two Years in Northwest Ethiopia. Ethiop J Health Sci 2019; 28:423-432. [PMID: 30607055 PMCID: PMC6308736 DOI: 10.4314/ejhs.v28i4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Giving birth in a medical institution, under the care and supervision of trained health-care providers, reduces the risk of maternal mortality and promotes child survival. Despite this, most mothers in Ethiopia are giving birth at home. Thus, this study was conducted to assess the level of skilled delivery service use and associated factors among mothers in Enarje Enawga District, Northwest Ethiopia. Materials and Methods A community-based cross-sectional study design was employed to recruit a total of 777 mothers who gave birth in the last two years. Data were collected using structured questionnaire. Bi-variable and multivariable logistic regression analyses were employed to assess factors associated with skilled delivery service use. Odds ratios with 95% confidence intervals were computed. Results Only 156 (20.1%) of the mothers had utilized skilled delivery service in the last two years. Mothers aged 15–24 years (AOR = 5.57), residing in urban areas (AOR = 1.80), and residing within a walking time of 16–30 minutes from health facility (AOR = 3.52) were more likely to use skilled delivery practice. Additionaly, mothers who had four and more antenatal care (ANC) visits (AOR = 4.94) and mothers who received health education (AOR = 5.04) were more likely to use skilled delivery service. Conclusion The level of skilled delivery service use among mothers was low. Age, residence, distance from health facility, number of ANC visits and health education were found to be associated with skilled delivery service use. Community-based health education programs regarding the risks of home delivery is necessary with a special focus on younger mothers residing in rural area.
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Affiliation(s)
- Nigus Tesfaw
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ayu Gizachew
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | | | - Amanuel Alemu Abajobir
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.,School of Public Health, The University of Queensland, Herston, Australia
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Bishanga DR, Drake M, Kim YM, Mwanamsangu AH, Makuwani AM, Zoungrana J, Lemwayi R, Rijken MJ, Stekelenburg J. Factors associated with institutional delivery: Findings from a cross-sectional study in Mara and Kagera regions in Tanzania. PLoS One 2018; 13:e0209672. [PMID: 30586467 PMCID: PMC6306247 DOI: 10.1371/journal.pone.0209672] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/09/2018] [Indexed: 11/18/2022] Open
Abstract
In Tanzania, maternal mortality has stagnated over the last 10 years, and some of the areas with the worst indicators are in the Lake and Western Zones. This study investigates the factors associated with institutional deliveries among women aged 15-49 years in two regions of the Lake Zone. Data were extracted from a cross-sectional household survey of 1,214 women aged 15-49 years who had given birth in the 2 years preceding the survey in Mara and Kagera regions. Logistic regression analyses were conducted to explore the influence of various factors on giving birth in a facility. About two-thirds (67.3%) of women gave birth at a health facility. After adjusting for possible confounders, six factors were significantly associated with institutional delivery: region (adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.54 [0.41-0.71]), number of children (aOR, 95% CI: 0.61 [0.42-0.91]), household wealth index (aOR, 95% CI: 1.47 [1.09-2.27]), four or more antenatal care visits (aOR, 95% CI: 1.97 [1.12-3.47]), knowing three or more pregnancy danger signs (aOR, 95% CI: 1.87 [1.27-2.76]), and number of birth preparations (aOR, 95% CI: 6.09 [3.32-11.18]). Another three factors related to antenatal care were also significant in the bivariate analysis, but these were not significantly associated with place of delivery after adjusting for all variables in an extended multivariable regression model. Giving birth in a health facility was associated both with socio-demographic factors and women's interactions with the health care system during pregnancy. The findings show that national policies and programs promoting institutional delivery in Tanzania should tailor interventions to specific regions and reach out to low-income and high-parity women. Efforts are needed not just to increase the number of antenatal care visits made by pregnant women, but also to improve the quality and content of the interaction between women and service providers.
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Affiliation(s)
- Dunstan R. Bishanga
- Jhpiego Tanzania, Dar es Salaam, Tanzania
- University of Groningen, University Medical Centre Groningen, Department of Global Health, Health Sciences, Groningen, the Netherlands
- * E-mail:
| | - Mary Drake
- Jhpiego Tanzania, Dar es Salaam, Tanzania
- University of Groningen, University Medical Centre Groningen, Department of Global Health, Health Sciences, Groningen, the Netherlands
| | - Young-Mi Kim
- Jhpiego, Baltimore, MD, United States of America
| | | | - Ahmad M. Makuwani
- Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Marcus J. Rijken
- Department of Obstetrics and Gynecology, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle Stekelenburg
- University of Groningen, University Medical Centre Groningen, Department of Global Health, Health Sciences, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
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Fekadu GA, Kassa GM, Berhe AK, Muche AA, Katiso NA. The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:577. [PMID: 30041655 PMCID: PMC6056996 DOI: 10.1186/s12913-018-3370-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. Methods Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger’s test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). Result A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). Conclusion Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | | | | | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of public health, University of Gondar, Gondar, Ethiopia
| | - Nuradin Abusha Katiso
- Department of Nursing, College of Health Sciences and Medicine, Woliata Sodo University, Woliata Sodo, Ethiopia
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Yaya S, Bishwajit G, Uthman OA, Amouzou A. Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria. PLoS One 2018; 13:e0196896. [PMID: 29723253 PMCID: PMC5933759 DOI: 10.1371/journal.pone.0196896] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women’s access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Methods Cross-sectional data on 37,086 community dwelling women aged between 15–49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don’t trust facility/poor service, 5) No female provider, 6) Husband/family didn’t allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. Results In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3–57.9) in Nigeria and 45.4% (42.0–47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Conclusion Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olalekan A. Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Agbessi Amouzou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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Mahato PK, van Teijlingen E, Simkhada P, Sheppard ZA, Silwal RC. Factors related to choice of place of birth in a district in Nepal. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:91-96. [PMID: 28844364 DOI: 10.1016/j.srhc.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/13/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Nepal, both percentage of women giving birth at health facility and proportion of birth assisted by skilled birth attendant is very low. The purpose of this research was to identify predictors for choice of place of birth: either at home, primary health care facility (including birthing centres) or at tertiary health care facilites (hospitals and clinics). METHODS A cross-sectional household survey was conducted in seven village development committee of a district lying in plain area of Nepal: Nawalparasi. A structured interview questionnaire was developed and administered face-to-face. Descriptive analysis along with chi-square test and multinomial logistic regression was used to identify the predictors of giving birth at a health care facility. RESULTS Women were significantly more likely to give birth at health care facilities compared to home if the distance was less than one hour, belonged to advantaged caste, had radio, television and motorbike/scooter, decision maker for place of birth was husband, reported their frequency of antenatal (ANC) visits at 4 or more and belonged to age group 15-19. CONCLUSION The analysis indicates that husbands of women giving birth influence the choice of place of birth. The findings highlight importance of having four or more ANC visits to the health institutions and that it should be located within one-hour walking distance. Inequity in utilisation of childbirth services at health institutions exists as showed by low utilisation of such services by disadvantaged caste.
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Affiliation(s)
- Preeti K Mahato
- Faculty of Health & Social Sciences, Bournemouth House, 19 Christchurch Road, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Edwin van Teijlingen
- Faculty of Health & Social Sciences, Bournemouth House, 19 Christchurch Road, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Padam Simkhada
- Public Health Institute, Henry Cotton Building, 15-21 Webster Street, Liverpool L3 2ET, UK.
| | - Zoe A Sheppard
- Faculty of Health and Social Sciences, Christchurch Road, Bournemouth University, Bournemouth BH1 3LT, UK.
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Tumwine JK. Updates on communicable and non-communicable diseases in LMICs. Afr Health Sci 2017. [PMID: 27358652 DOI: 10.4314/ahs.v16i1.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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