Evaluation of cervical cancer screening program in Gondar city administration public health facilities, Northwest Ethiopia, 2021: mixed method approach

BACKGROUND

Cervical cancer is one of the most malignancies in women all over the world. Over 90% of cases occurred in low and middle-income countries with limited resources. Even though cervical cancer is preventable, the Sub-Saharan countries are the most burdened. In Ethiopia 27.19 million women are at risk of acquiring cervical cancer. Although the prevalence of cervical cancer screening among women aged 18 to 69 was around 14%, due to COVID 19 and internal conflict the screening prevalence was lowered to 0.2% by 2022.

OBJECTIVE

This study aimed to evaluate cervical cancer screening program implementation at Gondar city administration public health facilities, Northwest Ethiopia.

METHODS

Single case study design with mixed method evaluation was employed in eight public health facilities of Gondar city administration from March 29 to May 30, 2021. The quantitative data were collected through exit interviews and resources inventory observations. While qualitative data were collected through Key informant interviews, non-participatory observation and document review. A total of 310 clients, 14 key informants, 30 non-participatory observations and six months retrospective document reviews were included in this evaluation. Quantitative data were entered into EPI-data version 4.6 and exported into SPSS version 20 for analysis. For qualitative data; records were transcribed, translated and analyzed in themes. Variables with P-value < 0.05 at 95% confidence interval and adjusted odds ratio were used to declare associated variables with client satisfaction.

RESULTS

The overall implementation of cervical cancer screening program with visual inspection with acetic acid was 64.5%. The availability of program resources, compliance of healthcare providers and satisfaction of mothers were 52.3%, 64.3% and 77.1% respectively. Being educated, having information on cervical cancer screening and the number of lifetime sexual partners were positively associated variables with client satisfaction.

CONCLUSION

The cervical cancer screening program was judged as partially-implemented and needs urgent improvement based on pre-determined judgment parameters. To implement the program properly and serve more women; human and material resources should be available, providers shall be trained and the health facilities should equip with full infrastructures like electric power supply and separate procedure rooms.

Willingness to pay for hepatitis B virus vaccine and associated factors among households in Bahir Dar City, northwest Ethiopia: using contingent valuation method

Background

The prevention of disease burden and death through vaccination is one of the most cost-effective methods. Even though the Hepatitis B Virus (HBV) has significant public health problems in Ethiopia, there is no compulsory HBV vaccination program for adults and the vaccine's market value was not yet estimated in the Ethiopia context. Therefore, this study aimed to assess the willingness to pay (WTP) for the HBV vaccine and its associated factors among households in Bahir Dar City, northwest Ethiopia.

Methods

A cross-sectional study was conducted among 620 households from March 1 to 30, 2020. A systematic random sampling technique was employed to select the required number of households. An interviewer-administered questionnaire was used to collect the necessary information. The contingent valuation method was conducted to measure WTP for the HBV vaccine. A Tobit regression model was employed to investigate significantly associated factors, and variables with a p-value of <0.05 were considered statistically significant.

Results

In this study, 62.17% of households were willing to pay for the HBV vaccine with an average cost of ETB174.24 (US$5.25). Male household heads (P = 0.014), favorable attitude (P = 0.017), and good knowledge (P < 0.001) toward the vaccine were positively associated with WTP, whereas age (P < 0.001), single marital status (P = 0.012) and divorced/widowed (P = 0.018) marital status were negatively associated with WTP.

Conclusions

Overall, most households were willing to pay for the HBV vaccine with an average demand of ETB174.24 (US$5.25). Therefore, a national-level HBV vaccine strategy should be designed considering the households' willingness to pay. In addition, working on attitudes and knowledge toward the vaccine could potentially increase the household's willingness to pay for the HBV vaccine.

Prevalence and Predictors of Depression Among Eritrean Refugees in Ethiopia: A Cross-Sectional Survey

Background

Depressive disorders place an enormous burden on society and ranked fourth in the global disease burden accounting for 4.4% of the total disability-adjusted life years and 11.9% of total years lived with disability. Depression is associated with high level of morbidity and it is the most common contributor to suicide. Refugees have higher rates of mental disorders, in particular depression than those usually found in the non-war affected general population. There is a dearth of evidence in Ethiopia regarding the mental health of refugees.

Objective

This study aimed to assess the prevalence of depression and associated factors among Eritrean refugees in Tigray North Ethiopia.

Methods

A cross-sectional study was conducted at Maiayni refugee camp. A total of 800 participants were interviewed using systematic random sampling method. Pretested, structured and interviewer administered questionnaire that included socio demographic, clinical, behavioral, Harvard trauma questionnaire, and the patient health questionnaire (PHQ-9) was used. Descriptive statistics and binary logistic regression analyses were carried out.

Results

With 786 (98.3%) of response rate, the prevalence of depression was found to be 37.8%, 95% confidence interval (34.2, 41.2). The odds of depression was higher in females [(AOR=8.92 95% CI (5.21, 15.25)], older age [(AOR=2.72 95% CI (1.03-7.16)], those who never attended school [(AOR=3.09 95% CI (1.16-8.24)], among the unemployed [(AOR=2.36 95% CI (1.16-4.83)], those with poor social support [(AOR=8.67 95% CI (4.24-17.77)], past psychiatric history [(AOR=4.76 95% CI (1.94-11.67)], family history of a psychiatric disorder [(AOR=3.96 95% CI (1.93-8.13)], those who were using substances [(AOR=4.08 95% CI (2.51-6.65)], and among those who stayed for longer than a year at the camp [(AOR=4.18 95% CI (2.47-7.08))].

Conclusion

The study revealed that depression is a major mental health and public health problem among Eritrean refugees in Ethiopia. Several socio-demographic, psychosocial, behavioral and clinical factors were significant predictors of depression among the study participants. Mental health service provision for the refugees needs to be part of the support.

Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia

Background

A strong health information system (HIS) is one of the essential building blocks for a resilient health system. The Ministry of Health (MOH) of Ethiopia is working on different initiatives to strengthen the national HIS. Among these is the Capacity-Building and Mentorship Partnership (CBMP) Programme in collaboration with public universities in Ethiopia since November 2017. This study aims to evaluate the outcomes and share experiences of the country in working with universities to strengthen the national HIS.

Methods

The study employed a mixed-methods approach that included 247 health organizations (health offices and facilities) of CBMP-implementing woredas (districts) and 23 key informant interviews. The programme focused on capacity-building and mentoring facilities and woreda health offices. The status of HIS was measured using a connected woreda checklist before and after the intervention. The checklist consists of items related to HIS infrastructure, data quality and administrative use. The organizations were classified as emerging, candidate or model based on the score. The findings were triangulated with qualitative data collected through key informant interviews.

Results

The results showed that the overall score of the HIS implementation was 46.3 before and 74.2 after implementation of the programme. The proportion of model organizations increased from 1.2% before to 31.8% after the programme implementation. The health system–university partnership has provided an opportunity for higher education institutions to understand the health system and tune their curricula to address real-world challenges. The partnership brought opportunities to conduct and produce local- and national-level evidence to improve the HIS. Weak ownership, poor responsiveness and poor perceptions of the programme were mentioned as major challenges in programme implementation.

Conclusion

The overall HIS has shown substantial progress in CBMP implementation woredas. A number of facilities became models in a short period of time after the implementation of the programme. The health system–university partnership was found to be a promising approach to improve the national HIS and to share the on-the-ground experiences with the university academicians. However, weak ownership and poor responsiveness to feedback were the major challenges identified as needing more attention in future programme implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00787-x.

Mothers' Acceptance and Willingness to Pay an Out-of-Pocket Payment for Maternal and Child Nutritional Services in Northwest Ethiopia

BACKGROUND

Around $3.5 trillion globally and up to $2.78 billion in Ethiopia, losses are reported annually due to malnutrition. Even if in Ethiopia nutrition services are delivered free of charge, specific public health programs may start to charge users of services that include maternal and child health services. Therefore, this study was aimed to assess mothers' willingness to pay an out-of-pocket payment for maternal and child nutritional services and associated factors in Northwest Ethiopia.

METHODS

A community-based cross-sectional study design was conducted at Yilmana Densa district from March to May 2017. The sample size was 569, and a systematic random sampling technique was used. Bi-variate, multivariable logistic regression, and Tobit econometric analysis models were done. Adjusted odds ratio (AOR) and B-coefficient with 95% confidence interval (CI) and p-value were used.

RESULTS

A total of 545 (response rate of 95.8%) study participants were included in the study. The finding indicates that 88.8% of households were willing to pay for maternal and child nutrition services. The average amount of money to pay per visit was 19.6 ETB (CI = 18.8, 20.4) (0.84 USD). Mothers with good knowledge, good perceived family health status, medium and high perceived quality of services, and satisfaction with maternal and child nutritional services were significant variables to accept an out-of-pocket payment. In addition, the Tobit econometric model analysis reveals that knowledge, mothers' age, pregnancy status, mothers' educational status, wealth status, and self-reported satisfaction were identified as significant factors.

CONCLUSION

The majority of mothers were willing to accept out-of-pocket payments for maternal and child nutritional services with an average of 19.6 ETB. Therefore, strengthening awareness and improving the quality of nutritional services and maternal satisfaction may increase mothers' willingness to pay an out-of-pocket payment.

Cost of Illness of Epilepsy and Associated Factors in Patients Attending Adult Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia

Background

Epilepsy has significant economic implications on health care needs, premature death, and lost work productivity. Therefore, this study aimed to assess the cost of illness of epilepsy and its associated factors in the Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia.

Methods

We conducted an institution-based cross-sectional study from March 2018 to April 2018. A total of 442 adult epileptic patients were selected from the chronic follow-up clinic using a systematic sampling technique. We fitted binary logistic regression to identify the associated factors, and significant variables in the multivariable logistic regression analysis were determined using P-value <0.05 and 95% CI.

Results

The study revealed that the mean total cost illness of epilepsy per patient per year was US$ 166±61.6, and 30.3% of patients incurred high cost. Age (AOR = 1.06; 95% CI: 1.03, 1.09), sex (AOR = 3.66; 95% CI: 1.94, 6.89), educational (AOR = 0.15; 95% CI: 0.005, 0.047), polytherapy (AOR = 4.66; 95% CI: 2.29, 9.46), seizure frequency (AOR = 4.48; 95% CI: 1.56, 12.8), place where AEDs were bought (AOR = 6.23; 95% CI: 2.7, 14.03) and disease duration (AOR = 0.11; 95% CI: 0.05, 0.25) were predictors of the cost of illness of epilepsy.

Conclusion

The total annual cost of illness of epilepsy was high, taking into account the per capita income of the individuals. The age, sex, and educational status of the patients, and the number of AED, seizure frequency, places where patients buy drugs, and disease duration were factors significantly associated with the cost of illness of epilepsy. Hence, creating an alternative source of income, socio-economic support, and affordable health care service for patients, especially for female and elderly patients, and strengthening and equipping nearby clinics, increasing drug availability in governmental pharmacies.

Health-related quality of life and associated factors among patients with epilepsy at the University of Gondar comprehensive specialized hospital, northwest Ethiopia

PURPOSE

Epilepsy is a global public health problem that causes a profound physical, psychological and social consequences. However, as such evidence in our country is limited, this study aimed to assess the health-related quality of life (HRQOL) and associated factors among patients with epilepsy.

METHODS

An institution-based cross-sectional study was conducted on 370 patients with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31) was used to measure HRQOL. Multiple linear regression was fitted to assess the association between HRQOL and the independent variables, and a P-value < 0.05 and a 95% confidence interval were used to declare statistical significance.

RESULTS

More than 55% of the participants were male, and the mean age of the participants was 29.64 (11.09) years. The overall HRQOL score was 55.81 (14.00). The scale scores ranged from 46.50 (15.55) to 64.98 (19.43). Out of the seven scales, the energy scale score was the lowest. Frequency of seizure, anxiety, depression, perceived stigma and adverse drug event were negatively associated with HRQOL, whereas social support had a significant positive association.

CONCLUSION

This study revealed that the HRQOL of patients was low and that its energy and emotional scales were the most affected. The presence of depression, anxiety and stigma adversely affected patient HRQOL. Therefore, healthcare professionals should be aware of the emotional state of the role it plays for HRQOL. Interventions aimed at reducing psychosocial problems and stigmatization are also needed to improve the patient HRQOL.

Determinants of Access to Health Care Among Women in East African Countries: A Multilevel Analysis of Recent Demographic and Health Surveys from 2008 to 2017

BACKGROUND

Access to essential health care is one of the major factors associated with maternal mortality. In developing countries, improving women's access to health care has significantly reduced maternal death. Therefore, this study aimed to identify the determinants of access to health care among women in East African countries based on 2008 to 2017 Demographic and Health Surveys (DHSs).

METHODS

This study used secondary data from 2008 to 2017 DHSs of 12 East African countries. A two-level mixed-effects logistic regression analysis was employed to determine the variables associated with women's access to maternal health care. The adjusted odds ratios (AORs), 95% CI, and P-value were computed. Variables with P<0.05 were considered as determinants of access to maternal health care.

RESULTS

A total of 148,483 study participants were included in this study. Women who accessed health care were 64,218 (42.91%) in the region. The study revealed that access to women's health care was positively associated with factors; being educated women, having an educated husband, being from households with middle and richest wealth status, and living in different countries compared to Comoros. The study also revealed that living in a rural setting and having unplanned pregnancy were barriers to access to health care.

CONCLUSION AND RECOMMENDATION

Women in East Africa countries have poor access to maternal health care. Residence, maternal education, husband education, income, and planned pregnancy were the predictors of access to health care. Therefore, there should be a common strategy to enhance the accessibility of health service utilization among women in the region and financial support for the poor that enables women to use health services. For better health care access, increasing the awareness of women and their partners about the significance of utilization of healthcare service focusing on uneducated persons are crucial activities.

Acceptance of Human Papillomavirus Vaccination and Associated Factors Among Parents of Daughters in Gondar Town, Northwest Ethiopia

Background

Cervical cancer is one of the profound threats to women’s lives and the fourth most common cancer among women. Ethiopia launched the human papilloma vaccination for the first time, with the support of the Global Alliance for Vaccine and Immunization (GAVI) in 2018. Therefore, the aim of this study was to assess the acceptability of the human papillomavirus vaccine and associated factors among parents of daughters in Gondar town, Northwest Ethiopia.

Methods

A community-based cross-sectional study with a total sample of 946 study participants was conducted in Gondar town from April to May 2019. The study participants were selected using a multistage sampling technique from parents having a daughter of 9−17 years age. Data were collected using an interviewer-administered questionnaire. The data were entered into EpiData version 4.2 and exported to STATA version 14 for analysis. Variables having a p-value of <0.2 and <0.05 in the bivariable and multivariable logistic regression were considered as a statistically significant factor for the acceptance of HPV vaccination.

Results

A total of 899 study participants with a response rate of 95% were included in the study. Among participants in this study, 81.3% with 95% CI (78.6, 83.7) accepted to vaccinate their daughters for HPV vaccination. The acceptance to vaccinate daughters for HPV vaccination was affected by being from the richest household [AOR= 3.44, 95% CI = (1.97, 6.01)], good knowledge about cervical cancer [AOR=5.49, 95% CI= (2.62, 11.52)], and positive attitude towards HPV vaccination [AOR=21.53, 95% CI= (11.60, 39.96)].

Conclusion

The study revealed that the acceptance to human papillomavirus vaccination is high and was significantly associated with the level of knowledge about cervical cancer, the attitude towards HPV vaccination, and the wealth status of the households. Therefore, community education on cervical cancer and its prevention is crucial to increase awareness and acceptance as well.

Self-reported fall and associated factors among adult people with visual impairment in Gondar, Ethiopia: a cross-sectional study

Background

Fall is a major public health problem and potentially disabling issue. A vast burden of visually impaired live in low-middle income countries particularly in Sub-Saharan Africa. Limited ability to detect environmental hazards puts visually impaired at a greater risk of falls and unintentional injuries. Falls among visually impaired is associated with considerable disability, health care cost, loss of independence, and socio-economic consequences. Ethiopia lacked estimates of fall among any vulnerable population, particularly among visually impaired people. Therefore, this study aimed to estimate the prevalence of falls and factors associated among adult people with medically diagnosed visual impairment in Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among visually impaired adults who attended the ophthalmology clinic at the University of Gondar comprehensive specialized hospital during the study period. Data were collected by interview method using structured questionnaires, patient medical record reviews, and physical measurements. Bivariate and multivariable binary logistic regression model analysis was used to identify factors associated with falls. Adjusted odds ratio with corresponding 95% confidence intervals were computed to show the strength of association.

Results

A total of 328 adults medically diagnosed with visual impairment participated in the study (97.3% response rate). The age of the participants ranged from 25 to 89 years with a mean age of (56.46 ± 14.2 years). The overall cumulative prevalence of self-reported falls among adults with visual impairment was 26.8% with 95%CI (22.7, 32.4%). The major associated factors of fall identified by multivariate analysis were; visual impairment in both eye (AOR 3.21, 95% CI 1.11, 9.29), fear of falling: some concerned: (AOR, 4.12; 95%CI, 1.44, 11.76), very concerned fear (AOR 10.03; 95% CI, 3.03, 33.21), medications: (AOR 4.63; 95% CI 2.14, 10.00) and self-reported depression: (AOR 3.46; 95% CI 1.11, 10.79).

Conclusion

The result of this study indicates a moderate self-reported prevalence of fall among adult people with medically diagnosed visual impairment. Identifying sub-groups at risk of falls among visually impaired, modifiable risk factors, implementation of precaution measures to avoid fall and fall-related injuries, and most importantly measures that would reduce the fear of falls in visually impaired people deserves immediate attention.

Fertility Desire And Associated Factors Among HIV Positive Women Attending ART Clinics In Amhara Region Referral Hospitals In Northwest Ethiopia, 2017

Background

“Fertility desire” is the intention of people to have more children despite being diagnosed with HIV, whereas intentions denote a commitment to implement that desire. Despite the overwhelming effects of HIV on a fetus, there is a desire for fertility among people positive for the virus/disease worldwide.  Therefore, this study aimed to assess fertility desires and factors associated with sexually active HIV positive reproductive-age women attending ART clinics at Amhara region referral hospitals, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted on reproductive-age women attending the clinics at the hospitals. A total of 427 eligible women were systematically included in the study. A semi-structured questionnaire was used to collect data via interviewer-administered techniques. EpiInfo7 and STATA 14 software was used for data entry and analysis, respectively. The logistic regression analysis method was used to identify factors associated with fertility desire. Factors that had p-values of ≤0.05 were considered statistically significant.

Results

The findings indicated that 40.3% (95% CI; 35.7%, 45.0%) of the participants reported they had the desire to have children in the future. Variables such as women in the age group of 25–34 years (AOR= 2.80, 95% CI; 1.68, 4.68), participating with their sexual partner (AOR=3.52, 95% CI; 1.36, 9.13) and married women (AOR=2.32, 95% CI; 1.05, 5.10) had a positive association with the outcome variable, whereas having one or more live children (AOR=0.19, 95% CI; 0.09, 0.39) and having no formal education (AOR= 0.51, 95% CI; 0.29, 0.89) had a negative association with fertility desire.

Conclusion

The proportion of sexually active HIV-positive women with desire for children was high among women visiting referral hospitals. Therefore, programmers and policymakers need to expand new PMTCT services throughout the region and consider the effects of these factors on HIV-positive women, as they develop interventions.

Self-care practice and associated factors among patients with diabetes mellitus on follow up at University of Gondar Referral Hospital, Gondar, Northwest Ethiopia

OBJECTIVE

Diabetes, a rising global health problem, requires continuous self-care practice. There are limited studies about self-care practice, and most of the studies conducted in Ethiopia focused on some parts of the recommended self-care practices. Therefore, this study aimed to assess diabetes self-care practice and associated factors among diabetic patients attending at University of Gondar Referral Hospital, Gondar, Northwest Ethiopia.

RESULTS

The study revealed that 51.86% (95% CI 46.95-56.72%) of the patients have poor self-care practice. Unable to read and write (AOR = 3.36; 95% CI 1.42-7.90), primary level of education (AOR = 2.62; 95% CI 1.20-5.70), living in rural area (AOR = 3.33; 95% CI 1.61-6.88), having strong social support (AOR = 0.31; 95% CI 0.15-0.62), having diabetes related complication (AOR = 2.20; 95% CI 1.12-4.30), and poor socio-economic status (AOR = 2.16; 95% CI 1.17-3.98) were factors significantly associated with poor self-care practice of patients with diabetes. The study indicates that the prevalence of poor self-care practice was high. Education, residence, socio-economic status, complication and social support were significantly associated with poor self-care practice. Therefore, strategies should be developed to support patients with information, glucometer, and enhance patient's social support.

Willingness to pay for improved solid waste management and associated factors among households in Injibara town, Northwest Ethiopia

Objective

Globally, cities generate 1.3 billion tons of solid waste per year, amounting to a rate of 1.2 kg per person per day. Solid waste management is an important challenge to both the developed and developing countries. This study aimed to assess the willingness to pay for the improved solid waste management and associated factors among households in Injibara town, Ethiopia.

Results

A total of 903 household heads participated in the study. The finding indicated that 81.06% were willing to pay for the service. The average amount of money the participants would be willing to pay per month was 29.7 ETB ($1.07)). The study revealed that sex (β = 3.24, (95% CI 1.98, 4.50)), age (β = − 0.09: 95% CI − 0.19, − 0.01), educational status (β = 6.19: 95% CI 3.54, 8.84), occupation (β = 2.43: 95% CI 1.009, 3.86), amount of solid waste generated (β = 1.74: 95% CI 0.19, 3.29), distance from dump site (β = 1.58: 95% CI 0.45, 2.72), satisfaction with the existing service (β = 3.89, (95% CI 2.75, 5.06) and wealth status (β = 2.43: 95% CI 1.0, 3.86) were statistically significant. Therefore, the level of premium load should consider the amount of waste generated, wealth status and the distance from the dump site.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4433-7) contains supplementary material, which is available to authorized users.

Willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Northeast Ethiopia

OBJECTIVE

Community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Ethiopia.

RESULTS

A total of 532 study participants were included in the study. The finding indicated that 77.8% of the households were willing to pay for the community-based health insurance. The average amount of money the households were willing to pay per household per annum was 233 ETB ($11.12 USD). The result of the study also revealed that attending formal education[ß = 3.20; 95% CI = 1.87, 4.53], history of illness [ß = 2.52; 95% CI = 1.29, 3.75], household size [ß = 0.408; 95% CI = 0.092, 0.724], awareness about the scheme [ß = 2.96; 95% CI = 1.61, 4.30], and wealth status [ß = 5.55; 95% CI = 4.19, 6.90] were factors significantly associated with willingness to pay. Therefore, enhancing awareness of the community about the scheme, considering the amount of premium as per household family size and wealth status might increase household's willingness to pay for community-based health insurance.

Factors for healthcare utilization and effect of mutual health insurance on healthcare utilization in rural communities of South Achefer Woreda, North West, Ethiopia

OBJECTIVE

To identify factors for healthcare utilization and to describe effect of Mutual Health Insurance on health service utilization in rural community in South Achefer, North West Ethiopia.

METHODS

Across-sectional study was conducted. A total of 652 households consented to participate in the study (326 insured and 326 uninsured households). Propensity score matching was used to explain possible differences in the baseline variables between enrolled and un-enrolled households. Logistic regression analysis was used to identify factors for healthcare utilization.

RESULTS

Healthcare utilization among insured households was 50.5% (95% CI: 44.8%, 56.2%). Whilst among uninsured households, healthcare utilization was 29.3% (95% CI: 24.11, 34.47). In general, the overall healthcare utilization was 39.89% (95% CI: 35.7, 43.8). The overall increase in patient-attendance given illness among insured households was 25.2% higher compared with uninsured (t = 4.94, 95% CI: 0.145, 0.359). Educated (primary and above) (AOR = 1.84; 95% CI: 1.14, 2.98), chronic patient (AOR = 1.86; 95% CI: 1.13, 3.06), first choice was health facilities at the point of illness (AOR = 6.33; 95% CI: 2.97-13.51), rich (AOR = 2.1; 95%CI: 1.29, 3.43), and insured (AOR = 2.16; 95% CI: 1.45, 3.23) were independently associated with increased healthcare utilization.

CONCLUSION

Enrolment to mutual health insurance increases healthcare utilization. Presence of illness in the households, household earnings, educational status, first choice of treatment at point of illness, and membership to Mutual Health Insurance scheme should be targeted during escalating of healthcare utilization.