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Open Access 01-12-2015 | Research

Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study

Authors: Calistus Wilunda, Gianluca Quaglio, Giovanni Putoto, Risa Takahashi, Federico Calia, Desalegn Abebe, Fabio Manenti, Donata Dalla Riva, Ana Pilar Betrán, Andrea Atzori

Published in: Reproductive Health | Issue 1/2015

Abstract

Background

Ethiopia has high maternal mortality ratio and poor access to maternal health services. Attendance of at least four antenatal care (ANC) visits and delivery by a skilled birth attendant (SBA) are important in preventing maternal deaths. Understanding the reasons behind the poor use of these services is important in designing strategies to address the problem. This study aimed to determine the coverage of at least four ANC visits and delivery by a SBA and to identify determinants of utilisation of these services in three districts in South West Shoa Zone, Ethiopia.

Methods

A cross-sectional survey of 500 women aged 15–49 years with a delivery in two years prior to the survey was conducted in Wolisso, Wonchi and Goro districts in February 2013. Data were collected using an interviewer administered questionnaire. Logistic regression models were used to explore determinants of ANC attendance and SBA at delivery.

Results

Coverage of at least four ANC visits and SBA at delivery were 45.5 and 28.6 %, respectively. Most institutional deliveries (69 %) occurred at the single hospital that serves the study districts. Attendance of at least four ANC visits was positively associated with wealth status, knowledge of the recommended number of ANC visits, and attitude towards maternal health care, but was negatively associated with woman’s age. SBA at delivery was negatively associated with parity and time to the health facility, but was positively associated with urban residence, wealth, knowledge of the recommended number of ANC visits, perceived good quality of maternal health services, experience of a pregnancy/delivery related problem, involvement of the partner/family in decision making on delivery place, and birth preparedness.

Conclusions

Raising awareness about the minimum recommended number of ANC visits, tackling geographical inaccessibility, improving the quality of care, encouraging pregnant women to have a birth and complication readiness plan and community mobilisation targeting women, husbands, and families for their involvement in maternal health care have the potential to increase use of maternal health services in this setting. Furthermore, supporting health centres to increase uptake of institutional delivery services may rapidly increase coverage of delivery by SBA and reduce inequity.

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WHO, UNICEF, UNFPA, World Bank, UN. Trends in maternal mortality: 1990 to 2013 Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO; 2014.

Central Statistical Agency [Ethiopia], ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.

Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, et al. Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done? Int J Gynaecol Obstet. 2009;109:S5–S19.CrossRef

The Partnership for Maternal Newborn and Child Health. Opportunities for Africa’s Newborns Practical data, policy and programmatic support for newborn care in Africa. Cape Town: PMNCH; 2006.

UNICEF. Tracking progress in child survival: The 2005 report. New York: UNICEF; 2005.

Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347–70.CrossRefPubMed

Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–200.CrossRefPubMed

Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012;206(4):331 e1–19. doi:10.1016/j.ajog.2012.02.026.CrossRefPubMed

Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. 2007;21(2):98–113. doi:10.1111/j.1365-3016.2007.00786.x.CrossRefPubMed

10.

Tesfay R, Accorsi S, Akalu T, Vella V, Mamo D. Assessing the performance of the health sector: achievements and challenges in EFY 2002. FMOH Quarterly Health Bull. 2010;3(2):3–18.

11.

Federal Ministry of Health. Ethiopia Health Sector Development Program III 2005/06–2010/11: Mid-Term Review. Addis Ababa: FMoH; 2008.

12.

Abebe F, Berhane Y, Girma B. Factors associated with home delivery in Bahirdar, Ethiopia: a case control study. BMC Res Notes. 2012;5:653. doi:10.1186/1756-0500-5-653.CrossRefPubMedPubMedCentral

13.

Fikre AA, Demissie M. Prevalence of institutional delivery and associated factors in Dodota Woreda (district), Oromia regional state, Ethiopia. Reprod Health. 2012;9:33. doi:10.1186/1742-4755-9-33.CrossRefPubMedPubMedCentral

14.

Tsegay Y, Gebrehiwot T, Goicolea I, Edin K, Lemma H, Sebastian MS. Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study. Int J Equity Health. 2013;12:30. doi:10.1186/1475-9276-12-30.CrossRefPubMedPubMedCentral

15.

Birmeta K, Dibaba Y, Woldeyohannes D. Determinants of maternal health care utilization in Holeta town, central Ethiopia. BMC Health Serv Res. 2013;13:256. doi:10.1186/1472-6963-13-256.CrossRefPubMedPubMedCentral

16.

Mekonnen MG, Yalew KN, Umer JY, Melese M. Determinants of delivery practices among Afar pastoralists of Ethiopia. Pan Afr Med J. 2012;13 Suppl 1:17.PubMed

17.

Amano A, Gebeyehu A, Birhanu Z. Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2012;12:105. doi:10.1186/1471-2393-12-105.CrossRefPubMedPubMedCentral

18.

Tarekegn SM, Lieberman LS, Giedraitis V. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy Childbirth. 2014;14:161. doi:10.1186/1471-2393-14-161.CrossRefPubMedPubMedCentral

19.

Regassa N. Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. Afr Health Sci. 2011;11(3):390–7.PubMedPubMedCentral

20.

Fekede B, G/Mariam A. Antenatal care services utilization and factors associated in Jimma Town (south west Ethiopia). Ethiop Med J. 2007;45(2):123–33.PubMed

21.

Getahun H, Berhane Y. Abortion among rural women in north Ethiopia. Int J Gynaecol Obstet. 2000;71(3):265–6.CrossRefPubMed

22.

Bostoen K, Chalabi Z. Optimization of household survey sampling without sample frames. Int J Epidemiol. 2006;35(3):751–5. doi:10.1093/ije/dyl019.CrossRefPubMed

23.

JHPIEGO. Monitoring birth preparedness and complication readiness: tools and indicators for maternal and newborn health. JHPIEGO: Baltimore, Maryland; 2004.

24.

Rutstein S, Johnson K. The DHS Wealth Index. DHS Comparative Reports No. 6. ORC Macro: Calverton, Maryland; 2004.

25.

Filmer D, Pritchett LH. Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115–32.PubMed

26.

StataCorp. Stata survey reference manual release 13. College Station, TX: Stata Press; 2013.

27.

Kirkwood B, Sterne J. Essential Medical Statistics. 2nd ed. Oxford: Blackwell Publishing; 2003.

28.

Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–60. doi:10.1111/j.1365-2648.2007.04532.x.CrossRefPubMed

29.

Hodgins S. Achieving better maternal and newborn outcomes: coherent strategy and pragmatic, tailored implementation. Glob Health Sci Pract. 2013;1(2):146–53. doi:10.9745/ghsp-d-13-00030.CrossRefPubMedPubMedCentral

30.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed

31.

Pembe AB, Urassa DP, Carlstedt A, Lindmark G, Nystrom L, Darj E. Rural Tanzanian women’s awareness of danger signs of obstetric complications. BMC Pregnancy Childbirth. 2009;9:12. doi:10.1186/1471-2393-9-12.CrossRefPubMedPubMedCentral

32.

Hailu M, Gebremariam A, Alemseged F. Knowledge about obstetric danger signs among pregnant women in Aleta Wondo District, Sidama Zone, Southern Ethiopia. Ethiop J Health Sci. 2010;20(1):25–32.PubMedPubMedCentral

33.

Wilunda C, Putoto G, Dalla Riva D, Manenti F, Atzori A, Calia F, et al. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach. PLoS One. 2015;10(5), e0127827. doi:10.1371/journal.pone.0127827.CrossRefPubMedPubMedCentral

34.

Wilunda C, Putoto G, Manenti F, Castiglioni M, Azzimonti G, Edessa W, et al. Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study. Int J Equity Health. 2013;12:27. doi:10.1186/1475-9276-12-27.CrossRefPubMedPubMedCentral

35.

Hosseinpoor AR, Bergen N, Koller T, Prasad A, Schlotheuber A, Valentine N, et al. Equity-oriented monitoring in the context of universal health coverage. PLoS Med. 2014;11(9), e1001727. doi:10.1371/journal.pmed.1001727.CrossRefPubMedPubMedCentral

36.

Boerma JT, Bryce J, Kinfu Y, Axelson H, Victora CG. Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet. 2008;371(9620):1259–67. doi:10.1016/s0140-6736(08)60560-7.CrossRefPubMed

37.

Barros AJ, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, Franca GV, et al. Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries. Lancet. 2012;379(9822):1225–33. doi:10.1016/s0140-6736(12)60113-5.CrossRefPubMed

38.

Bhutta AZ, Chopra M, Axelson H, Berman P, Boema T, Bryce J, et al. Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival. Lancet. 2010;375:2032–44.CrossRefPubMed

39.

Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9:34. doi:10.1186/1471-2393-9-34.CrossRefPubMedPubMedCentral

40.

Harborview Medical Center. Ethiopian cultural profile. Harborview Medical Center. 2008. https://ethnomed.org/culture/ethiopian/copy_of_ethiopian-cultural-profile. Accessed 26.07.2015.

41.

Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1):71. doi:10.1186/1742-4755-11-71.CrossRefPubMedPubMedCentral

42.

Adjiwanou V, Legrand T. Does antenatal care matter in the use of skilled birth attendance in rural Africa: a multi-country analysis. Soc Sci Med. 2013;86:26–34. doi:10.1016/j.socscimed.2013.02.047.CrossRefPubMed

43.

Mistry R, Galal O, Lu M. Women’s autonomy and pregnancy care in rural India: a contextual analysis. Soc Sci Med. 2009;69(6):926–33. doi:10.1016/j.socscimed.2009.07.008.CrossRefPubMed

44.

Woldemicael G, Tenkorang EY. Women’s autonomy and maternal health-seeking behavior in Ethiopia. Matern Child Health J. 2010;14(6):988–98. doi:10.1007/s10995-009-0535-5.CrossRefPubMed

45.

Magoma M, Requejo J, Campbell O, Cousens S, Merialdi M, Filippi V. The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial. Trop Med Int Health. 2013;18(4):435–43. doi:10.1111/tmi.12069.CrossRefPubMed

46.

Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS One. 2011;6(6), e21432. doi:10.1371/journal.pone.0021432.CrossRefPubMedPubMedCentral

47.

Hiluf M, Fantahun M. Birth preparedness and complication readiness among women in Adigrat town, north Ethiopia. Ethiop J Health Dev. 2008;22(1):14–20.CrossRef

48.

Amudhan S, Mani K, Rai SK, Pandav CS, Krishnan A. Effectiveness of demand and supply side interventions in promoting institutional deliveries--a quasi-experimental trial from rural north India. Int J Epidemiol. 2013;42(3):769–80. doi:10.1093/ije/dyt071.CrossRefPubMed

49.

Van de Poel E, Flores G, Ir P, O’Donnell O, Van Doorslaer E. Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia. Bull World Health Organ. 2014;92(5):331–9. doi:10.2471/blt.13.129122.CrossRefPubMedPubMedCentral

Title: Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study
Authors: Calistus Wilunda
Gianluca Quaglio
Giovanni Putoto
Risa Takahashi
Federico Calia
Desalegn Abebe
Fabio Manenti
Donata Dalla Riva
Ana Pilar Betrán
Andrea Atzori
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Reproductive Health / Issue 1/2015
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/s12978-015-0067-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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