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BMC International Health and Human Rights
Published in: BMC International Health and Human Rights 1/2013

Open Access 01-12-2013 | Research article

Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis

Authors: Abebaw Gebeyehu Worku, Alemayehu Worku Yalew, Mesganaw Fantahun Afework

Published in: BMC International Health and Human Rights | Issue 1/2013

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Abstract

Background

The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider.

Methods

A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization.

Result

About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services.

Conclusion

Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.
Literature
1.
FDRE, MOH: National reproductive health strategy: 2006–2015. Edited by: Department of FH. 2006, Addis Ababa: Minstry of health
2.
3.
Ronsmans C, Graham WJ: Maternal mortality: who, when, where, and why. Lancet. 2006, 368 (9542): 1189-1200. 10.1016/S0140-6736(06)69380-X.CrossRefPubMed
4.
WHO: making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM, and FIGO. 2004, Geneva: Department of Reproductive Health and Research, World Health Organization
5.
Central Statistical Agency [Ethiopia], ICF international: Ethiopia demographic and health survey 2011. 2012, Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central statistical agency and ICF international
6.
Macro O, [Ethiopia] CSA: Ethiopia Demographic and Health Survey 2005. 2006, Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central statistical agency
7.
Carlough M, McCall M: Skilled birth attendance: what does it mean and how can it be measured? A clinical skills assessment of maternal and child health workers in Nepal. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2005, 89 (2): 200-208. 10.1016/j.ijgo.2004.12.044.CrossRef
8.
Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, McCaw-Binns A, Burkhalter BR: Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement. Int J Gynecol Obstet. 2004, 87 (2): 203-210. 10.1016/j.ijgo.2004.06.017.CrossRef
9.
Paxton A, Bailey P, Lobis S, Fry D: Global patterns in availability of emergency obstetric care. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2006, 93 (3): 300-307. 10.1016/j.ijgo.2006.01.030.CrossRef
10.
Harvey SA, Blandón YCW, McCaw-Binns A, Sandino I, Urbina L, Rodríguez C, Gómez I, Ayabaca P, Djibrinaf S, group tNmanhqi: Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward. Bull World Health Organ. 2007, 85: 783-790. 10.2471/BLT.06.038455.CrossRefPubMedPubMedCentral
11.
Olsen BE, Hinderaker SG, Bergsjø P, Lie RT, Olsen OHE, Gasheka P, Kvåle G: Causes and characteristics of maternal deaths in rural northern Tanzania. Acta Obstet Gynecol Scand. 2002, 81 (12): 1101-1109. 10.1034/j.1600-0412.2002.811202.x.CrossRefPubMed
12.
Sepehri A, Sarma S, Simpson W, Moshiri S: How important are individual, household and commune characteristics in explaining utilization of maternal health services in Vietnam?. Soc Sci Med. 2008, 67: 1009-1017. 10.1016/j.socscimed.2008.06.005.CrossRefPubMed
13.
Babalola S, Fatusi A: Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009, 9 (1): 43-10.1186/1471-2393-9-43.CrossRefPubMedPubMedCentral
14.
Tsui A, Ukwuani F, Guilkey D, Angeles G: A Comparative multi-level analysis of health program effects on individual use of reproductive and sexual health services. MEASURE Evaluation Bulletin. 2003, 6: 1-12.
15.
Kruk ME, Galea S, Prescott M, Freedman LP: Health care financing and utilization of maternal health services in developing countries. Health Policy Plan. 2007, 22 (5): 303-310. 10.1093/heapol/czm027.CrossRefPubMed
16.
Parkhurst JO, Penn-Kekana L, Blaauw D, Balabanova D, Danishevski K, Rahman SA, Onama V, Ssengooba F: Health systems factors influencing maternal health services: a four-country comparison. Health Policy. 2005, 73 (2): 127-138. 10.1016/j.healthpol.2004.11.001.CrossRefPubMed
17.
Turner AG, Angeles G, Tsui AO, Wilkinson M, Magnani R: Sampling Manual for Facility Surveys for Population, Maternal Health, Child Health and STD Programs in Developing Countries. Manual Series. 2001, Chapel Hill: Carolina Population Center, University of North Carolina, No. 3
18.
COMMISSION FPC: Statistical Report of the,: Population and Housing Census Results. 2007, Addis Ababa: UNFPA, 2008-
19.
Ethiopian Society of Population Studies: Maternal Health Care Seeking Behaviour in Ethiopia: In-depth Analysis of the Ethiopian Demographic and Health Survey 2005. 2008, Addis Ababa: Ethiopian Society of Population Studies
20.
Nigussie M, Mariam DH, Mitike G: Assessment of safe delivery service utilization among women of childbearing age in North Gondar Zone, North West Ethiopia. Ethiop J Heal Dev. 2004, 18 (3): 145-152.
21.
WHO: Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials: 1990–2001. 2003, : World Health Organization
22.
Chandhiok N, Dhillon BS, Kambo I, Saxena NC: Determinants of antenatal care utilization in rural areas of India: A cross-sectional study from 28 districts. The Journal of Obstetrics and Gynecology of India. 2006, 56 (1): 47-52.
23.
Karim A, Betemariam W, Yalew S, Alemu H, Carnell M, Mekonnen Y: Programmatic correlates of maternal healthcare seeking behaviors in Ethiopia. Ethiop J Heal Dev. 2010, 24 (1): 92-99.
24.
Wirth M, Sacks E, Delamonica E, Storeygard A, Minujin A, Balk D: “Delivering” on the MDGs? equity and maternal health in Ghana, Ethiopia and Kenya. East Afr J Public Health. 2008, 5 (3): 133-141.PubMedPubMedCentral
25.
Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH: Determinants of the use of maternal health services in rural Bangladesh. Health Promot Int. 2003, 18 (4): 327-337. 10.1093/heapro/dag414.CrossRefPubMed
26.
Stanton C, Blanc AK, Croft T, Choi Y: Skilled care at birth in the developing world: progress to date and strategies for expanding coverage. J Biosoc Sci. 2007, 39 (1): 109-120. 10.1017/S0021932006001271.CrossRefPubMed
27.
Prata N, Greig F, Walsh J, West A: Ability to pay for maternal health services: what will it take to meet who standards?. Health Policy. 2004, 70 (2): 163-174. 10.1016/j.healthpol.2004.02.011.CrossRefPubMed
Metadata
Title
Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis
Authors
Abebaw Gebeyehu Worku
Alemayehu Worku Yalew
Mesganaw Fantahun Afework
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC International Health and Human Rights / Issue 1/2013
Electronic ISSN: 1472-698X
DOI
https://doi.org/10.1186/1472-698X-13-20

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