Changes in Levels and Determinants of Maternal Health Service Utilization in Ethiopia: Comparative Analysis of Two Rounds Ethiopian Demographic and Health Surveys.
Antenatal care
Delivery care
Determinants
Ethiopia
Maternal health service
Postnatal care
Journal
Maternal and child health journal
ISSN: 1573-6628
Titre abrégé: Matern Child Health J
Pays: United States
ID NLM: 9715672
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
accepted:
09
06
2021
pubmed:
13
6
2021
medline:
16
10
2021
entrez:
12
6
2021
Statut:
ppublish
Résumé
Antenatal care (ANC), delivery by skilled birth attendants, and postnatal care (PNC) are critical components of maternal health services for reducing maternal mortality. The study aimed to compare the utilization of maternal health services in the two most recent rounds of Ethiopia Demographic and Health Surveys (EDHS) and identify the factors influencing the utilization of these services using the 2016 EDHS. Two rounds of EDHS data in 2011 and 2016 were used to estimate the proportion of women who had ANC, delivered by skilled birth attendants, and had a postnatal checkup and other characteristics of the surveyed population. The most recent round of data-the 2016 EDHS-was used to examine the socio-cultural and reproductive health factors associated with the three maternal health services utilization. Chi-square tests and multivariate logistic regression analyses with adjusted Odds Ratios (AOR) were conducted using Stata 15.0. The use of ANC services and skilled birth attendants increased significantly between 2011 and 2016 EDHS, utilization of ANC services increased from 34.0 to 65.5%, and use of skilled birth attendants increased from 11.7 to 35.9%, respectively. The use of postnatal care decreased from 9.3 to 6.9%. Utilization of maternal health service was significantly associated with urban residence, Protestant religion, Oromo ethnicity, more education, more household wealth, and less parity. Furthermore, women who had ANC visits during pregnancy were more likely to subsequently use skilled birth attendants (AOR 5.5, p < 0.001) and PNC (AOR 2.9, p < 0.001). The study highlighted the inequalities in the utilization of maternal health services between rural and urban areas, and the need of addressing the social, economic, and physical barriers that prevent women from using these services. Further, programs should be targeted at promoting the use of professional birth and postnatal services in Ethiopia.
Sections du résumé
BACKGROUND
BACKGROUND
Antenatal care (ANC), delivery by skilled birth attendants, and postnatal care (PNC) are critical components of maternal health services for reducing maternal mortality. The study aimed to compare the utilization of maternal health services in the two most recent rounds of Ethiopia Demographic and Health Surveys (EDHS) and identify the factors influencing the utilization of these services using the 2016 EDHS.
METHODS
METHODS
Two rounds of EDHS data in 2011 and 2016 were used to estimate the proportion of women who had ANC, delivered by skilled birth attendants, and had a postnatal checkup and other characteristics of the surveyed population. The most recent round of data-the 2016 EDHS-was used to examine the socio-cultural and reproductive health factors associated with the three maternal health services utilization. Chi-square tests and multivariate logistic regression analyses with adjusted Odds Ratios (AOR) were conducted using Stata 15.0.
RESULTS
RESULTS
The use of ANC services and skilled birth attendants increased significantly between 2011 and 2016 EDHS, utilization of ANC services increased from 34.0 to 65.5%, and use of skilled birth attendants increased from 11.7 to 35.9%, respectively. The use of postnatal care decreased from 9.3 to 6.9%. Utilization of maternal health service was significantly associated with urban residence, Protestant religion, Oromo ethnicity, more education, more household wealth, and less parity. Furthermore, women who had ANC visits during pregnancy were more likely to subsequently use skilled birth attendants (AOR 5.5, p < 0.001) and PNC (AOR 2.9, p < 0.001).
CONCLUSION
CONCLUSIONS
The study highlighted the inequalities in the utilization of maternal health services between rural and urban areas, and the need of addressing the social, economic, and physical barriers that prevent women from using these services. Further, programs should be targeted at promoting the use of professional birth and postnatal services in Ethiopia.
Identifiants
pubmed: 34117995
doi: 10.1007/s10995-021-03182-8
pii: 10.1007/s10995-021-03182-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1595-1606Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Akibu, M., Tsegaye, W., Megersa, T., & Nurgi, S. (2018). Prevalence and determinants of complete postnatal care service utilization in northern Shoa, Ethiopia. Journal of Pregnancy. https://doi.org/10.1155/2018/8625437
doi: 10.1155/2018/8625437
pubmed: 30186633
pmcid: 6112074
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A. B., Gemmill, A., Fat, D. M., Boerma, T., Temmerman, M., Mathers, C., & Say, L. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462–474. https://doi.org/10.1016/S0140-6736(15)00838-7
doi: 10.1016/S0140-6736(15)00838-7
Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly. https://doi.org/10.1111/j.1468-0009.2005.00428.x
doi: 10.1111/j.1468-0009.2005.00428.x
pmcid: 2690277
Assefa, Y., Damme, W. V., Williams, O. D., & Hill, P. S. (2017). Successes and challenges of the millennium development goals in Ethiopia: Lessons for the sustainable development goals. BMJ Global Health, 2(2), e000318. https://doi.org/10.1136/bmjgh-2017-000318
doi: 10.1136/bmjgh-2017-000318
pubmed: 29081999
pmcid: 5656143
Astatikie, G., Limenih, M. A., & Kebede, M. (2017). Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture. BMC Pregnancy and Childbirth, 17(1), 1–9.
doi: 10.1186/s12884-017-1302-z
Babalola, S., & Fatusi, A. (2009). Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. BMC Pregnancy and Childbirth, 9(1), 43. https://doi.org/10.1186/1471-2393-9-43
doi: 10.1186/1471-2393-9-43
pubmed: 19754941
pmcid: 2754433
Berhan, Y., & Endeshaw, G. (2015). Maternal mortality predictors in women with hypertensive disorders of pregnancy: A retrospective cohort study. Ethiopian Journal of Health Sciences, 25(1), 89–98.
doi: 10.4314/ejhs.v25i1.12
Bobo, F. T., Yesuf, E. A., & Woldie, M. (2017). Inequities in utilization of reproductive and maternal health services in Ethiopia. International Journal for Equity in Health, 16(1), 105. https://doi.org/10.1186/s12939-017-0602-2
doi: 10.1186/s12939-017-0602-2
pubmed: 28629358
pmcid: 5477250
Central Statistical, A. E., & International, I. C. F. (2012). Ethiopia Demographic and Health Survey 2011. Retrieved from Addis Ababa, Ethiopia: http://dhsprogram.com/pubs/pdf/FR255/FR255.pdf
Central Statistical Agency (CSA) [Ethiopia], I. (2016). Ethiopia Demographic and Health Survey 2016. Retrieved from https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf
Central Statistical Agency - CSA/Ethiopia, & ICF. (2017). Ethiopia Demographic and Health Survey 2016. Retrieved from Addis Ababa, Ethiopia. Retrieved from http://dhsprogram.com/pubs/pdf/FR328/FR328.pdf
Chernet, A. G., Dumga, K. T., & Cherie, K. T. (2019). Home delivery practices and associated factors in Ethiopia. Journal of Reproduction & Infertility, 20(2), 102.
Chol, C., Negin, J., Agho, K. E., & Cumming, R. G. (2019). Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: Results from the demographic and health surveys, 2010–2016. British Medical Journal Open, 9, e023128. https://doi.org/10.1136/bmjopen-2018-023128
doi: 10.1136/bmjopen-2018-023128
Corrine, W. R., Ruktanonchai, N. W., Nove, A., Lopes, S., Pezzulo, C., Bosco, C., Alegana, V. A., Burgert, C. R., Ayiko, R., Charles, A. S., & Lambert, N. (2016). Equality in maternal and newborn health: Modelling geographic disparities in utilisation of care in five east african countries. PLoS ONE, 8, e0162006. https://doi.org/10.1371/journal.pone.0162006
doi: 10.1371/journal.pone.0162006
Gabrysch, S., & Campbell, O. M. R. (2009). Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 9(1), 34. https://doi.org/10.1186/1471-2393-9-34
doi: 10.1186/1471-2393-9-34
pubmed: 19671156
pmcid: 2744662
Gebrehiwot, Y., & Tewolde, B. T. (2014). Improving maternity care in Ethiopia through facility based review of maternal deaths and near misses. International Journal of Gynecology & Obstetrics, 127, S29–S34.
doi: 10.1016/j.ijgo.2014.08.003
Griggs, D., Stafford-Smith, M., Gaffney, O., Rockström, J., Öhman, M. C., Shyamsundar, P., Steffen, W., Glaser, G., Kanie, N., & Noble, I. (2013). Policy: Sustainable development goals for people and planet. Nature, 495(7441), 305.
doi: 10.1038/495305a
Central Statistical Agency [Ethiopia], I. I. (2012). Ethiopia Demographic and Health Survey 2011. Retrieved from https://dhsprogram.com/pubs/pdf/FR255/FR255.pdf
Kerber, K. J., de Graft-Johnson, J. E., Bhutta, Z. A., Okong, P., Starrs, A., & Lawn, J. E. (2007). Continuum of care for maternal, newborn, and child health: From slogan to service delivery. The Lancet, 370(9595), 1358–1369. https://doi.org/10.1016/S0140-6736(07)61578-5
doi: 10.1016/S0140-6736(07)61578-5
Mezmur, M., Navaneetham, K., Letamo, G., & Bariagaber, H. (2017). Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia. BMC Health Services Research, 17(1), 367. https://doi.org/10.1186/s12913-017-2298-9
doi: 10.1186/s12913-017-2298-9
pubmed: 28532407
pmcid: 5441003
Mpembeni, R. N., Killewo, J. Z., Leshabari, M. T., Massawe, S. N., Jahn, A., Mushi, D., & Mwakipa, H. (2007). Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: Implications for achievement of MDG-5 targets. BMC Pregnancy and Childbirth, 7(1), 29. https://doi.org/10.1186/1471-2393-7-29
doi: 10.1186/1471-2393-7-29
pubmed: 18053268
pmcid: 2222241
Mullan, Z. (2016). Transforming health care in Ethiopia. The Lancet Global Health, 4(1), e1. https://doi.org/10.1016/S2214-109X(15)00300-9
doi: 10.1016/S2214-109X(15)00300-9
pubmed: 26718797
Shiferaw, S., Spigt, M., Godefrooij, M., Melkamu, Y., & Tekie, M. (2013). Why do women prefer home births in Ethiopia? BMC Pregnancy and Childbirth, 13(1), 5. https://doi.org/10.1186/1471-2393-13-5
doi: 10.1186/1471-2393-13-5
pubmed: 23324550
pmcid: 3562506
Simkhada, B., Teijlingen, E. R. V., Porter, M., & Simkhada, P. (2008). Factors affecting the utilization of antenatal care in developing countries: Systematic review of the literature. Journal of Advanced Nursing, 61(3), 244–260. https://doi.org/10.1111/j.1365-2648.2007.04532.x
doi: 10.1111/j.1365-2648.2007.04532.x
pubmed: 18197860
Sisay, M. M., Geremew, T. T., Demlie, Y. W., Alem, A. T., Beyene, D. K., Melak, M. F., Gelaye, K. A., Ayele, T. A., & Andargie, A. A. (2019). Spatial patterns and determinants of postnatal care use in Ethiopia: Findings from the 2016 demographic and health survey. British Medical Journal Open, 9(6), e025066. https://doi.org/10.1136/bmjopen-2018-025066
doi: 10.1136/bmjopen-2018-025066
Tarekegn, S. M., Lieberman, L. S., & Giedraitis, V. (2014). Determinants of maternal health service utilization in Ethiopia: Analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy and Childbirth, 14(1), 161. https://doi.org/10.1186/1471-2393-14-161
doi: 10.1186/1471-2393-14-161
pubmed: 24886529
pmcid: 4022978
Tekelab, T., Chojenta, C., Smith, R., & Loxton, D. (2019). Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis. PLoS ONE, 14(4), e0214848–e0214848. https://doi.org/10.1371/journal.pone.0214848
doi: 10.1371/journal.pone.0214848
pubmed: 30973889
pmcid: 6459485
Tesfahun, F., Worku, W., Mazengiya, F., & Kifle, M. (2014). Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District, Ethiopia: A cross-sectional study. Maternal and Child Health Journal, 18(10), 2341–2351. https://doi.org/10.1007/s10995-014-1474-3
doi: 10.1007/s10995-014-1474-3
pubmed: 24770953
pmcid: 4220106
Tesfaye, S., Barry, D., Gobezayehu, A. G., Frew, A. H., Stover, K. E., Tessema, H., Alamineh, L., & Sibley, L. M. (2014). Improving coverage of postnatal care in rural Ethiopia using a community-based, collaborative quality improvement approach. Journal of Midwifery & Women’s Health, 59(s1), S55–S64. https://doi.org/10.1111/jmwh.12168
doi: 10.1111/jmwh.12168
Teshale, A. B., Alem, A. Z., Yeshaw, Y., Kebede, S. A., Liyew, A. M., Tesema, G. A., & Agegnehu, C. D. (2020). Exploring spatial variations and factors associated with skilled birth attendant delivery in Ethiopia: Geographically weighted regression and multilevel analysis. BMC Public Health, 20(1), 1444. https://doi.org/10.1186/s12889-020-09550-3
doi: 10.1186/s12889-020-09550-3
pubmed: 32977789
pmcid: 7519489
Wado, Y. D. (2018). Women’s autonomy and reproductive health-care-seeking behavior in Ethiopia. Women & Health, 58(7), 729–743. https://doi.org/10.1080/03630242.2017.1353573
doi: 10.1080/03630242.2017.1353573
Wang, H., Tesfaye, R., NV Ramana, G., & Chekagn, C.T. (2016). Ethiopia health extension program: An institutionalized community approach for universal health coverage. World Bank Studies.
Warren, C. (2010). Care seeking for maternal health: Challenges remain for poor women. Ethiopian Journal of Health Development. https://doi.org/10.4314/ejhd.v24i1.62950
doi: 10.4314/ejhd.v24i1.62950
WHO. (2016). Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/249155/9789241511216-eng.pdf?sequence=1
WHO. (2019). Fact Sheets of Maternal Mortality. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Woldemicael, G., & Tenkorang, E. Y. (2010a). Women’s autonomy and maternal health-seeking behavior in Ethiopia. Maternal and Child Health Journal, 14, 988. https://doi.org/10.1007/s10995-009-0535-5
doi: 10.1007/s10995-009-0535-5
pubmed: 19882240
Woldemicael, G., & Tenkorang, E. Y. (2010b). Women’s autonomy and maternal health-seeking behavior in Ethiopia. Maternal and Child Health Journal, 14(6), 988–998. https://doi.org/10.1007/s10995-009-0535-5
doi: 10.1007/s10995-009-0535-5
pubmed: 19882240
Yaya, S., Bishwajit, G., Ekholuenetale, M., Shah, V., Kadio, B., & Udenigwe, O. (2017). Timing and adequate attendance of antenatal care visits among women in Ethiopia. PLoS ONE, 12(9), e0184934. https://doi.org/10.1371/journal.pone.0184934
doi: 10.1371/journal.pone.0184934
pubmed: 28922383
pmcid: 5602662