Utilization of institutional delivery service at Wukro and Butajera districts in the Northern and South Central Ethiopia

BMC Pregnancy and Childbirth

Saifuddin Ahmed³  Mesganaw Fantahun Afework²  Alemayehu Mekonnen²  Meselech Assegid²  Debebe Shaweno¹  Seifu Hagos² 

[1] School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia;Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;Bill & Melinda Gates Institute for Population and Reproductive Health, Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public health, Baltimore, MD, USA

关键词: Ethiopia;    Institutional delivery;    Skilled attendance birth;   

Others  :  1127279
DOI  :  10.1186/1471-2393-14-178

 received in 2013-05-14, accepted in 2014-05-19,  发布年份 2014

【 摘 要 】

Background

Ethiopia has one of the highest maternal mortality in the world. Institutional delivery is the key intervention in reducing maternal mortality and complications. However, the uptake of the service has remained low and the factors which contribute to this low uptake appear to vary widely. Our study aims to determine the magnitude and identify factors affecting delivery at health institution in two districts in Ethiopia.

Methods

A community based cross sectional household survey was conducted from January to February 2012 in 12 randomly selected villages of Wukro and Butajera districts in the northern and south central parts of Ethiopia, respectively. Data were collected using a pretested questionnaire from 4949 women who delivered in the two years preceding the survey.

Results

One in four women delivered the index child at a health facility. Among women who delivered at health facility, 16.1% deliveries were in government hospitals and 7.8% were in health centers. The factors that significantly affected institutional delivery in this study were district in which the women lived (AOR: 2.21, 95% CI: 1.28, 3.82), women age at interview (AOR: 1.96, 95% CI: 1.05, 3.62), women’s education (AOR: 3.53, 95% CI: 1.22, 10.20), wealth status (AOR: 16.82, 95% CI: 7.96, 35.54), women’s occupation (AOR: 1.50, 95% CI: 1.01, 2.24), antenatal care (4+) use (AOR: 1.77, 95% CI: 1.42, 2.20), and number of pregnancies (AOR: 0.25, 95% CI: 0.18,0.35). We found that women who were autonomous in decision making about place of delivery were less likely to deliver in health facility (AOR: 0.38, 95% CI: 0.23,0.63).

Conclusions

Institutional delivery is still low in the Ethiopia. The most important factors that determine use of institutional delivery appear to be women education and household economic status.

Women’s autonomy in decision making on place of delivery did not improve health facility delivery in our study population.

Actions targeting the disadvantaged, improving quality of services and service availability in the area are likely to significantly increase institutional delivery.

【 授权许可】

   
2014 Hagos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Central Statistical Agency [Ethiopia] and ICF International: Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.
• [2]Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, Nampala PM, Lawn JE: Sub-Saharan Africa’s mothers, newborns, and children: where and why do they die? PLoS Med 2010, 7(6):e1000294.
• [3]Baral YR, Lyons K, Skinner J, Van Teijlingen ER: Determinants of skilled birth attendants for delivery in Nepal. Kathmandu Univ Med J (KUMJ) 2010, 8(31):325-332.
• [4]Federal Democratic Republic of Ethiopia. Ministry of Finance and Economic Development: Millenium Development Goals Report: Challenges and Prospectives for Ethiopia. Addis Ababa, Ethiopia: Ministry of Finance and Economic Development; 2004.
• [5]UNFPA: Master plans for development: Key actions for the further implementation of the programme of action of the ICPD -- ICPD + 5. [http://www.unfpa.org/public/home/sitemap/icpd/International-Conference-on-Population-and-Development/ICPD5-key-actions/ webcite]
• [6]WHO, ICM and FIGO: Making Pregnancy Safer: The Critical Role of the Skilled Attendant: A Joint Statement by WHO, ICM and FIGO. Geneva: WHO; 2004.
• [7]Kesterton AJ, Cleland J, Sloggett A, Ronsmans C: Institutional delivery in rural India: the relative importance of accessibility and economic status. BMC Pregnancy Childbirth 2010, 10:30. BioMed Central Full Text
• [8]Agha S, Carton TW: Determinants of institutional delivery in rural Jhang, Pakistan. Int J Equity Health 2011, 10:31. BioMed Central Full Text
• [9]Gabrysch S, Cousens S, Cox J, Campbell OM: The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 2011, 8(1):e1000394.
• [10]Adamson PC, Krupp K, Niranjankumar B, Freeman AH, Khan M, Madhivanan P: Are marginalized women being left behind? A population-based study of institutional deliveries in Karnataka, India. BMC Public Health 2012, 12:30. BioMed Central Full Text
• [11]Gabrysch S, Campbell OM: Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9:34. BioMed Central Full Text
• [12]Teferra AS, Alemu FM, Woldeyohannes SM: Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, north west of Ethiopia: a community-based cross sectional study. BMC Pregnancy Childbirth 2012, 12:74. BioMed Central Full Text
• [13]Wanjira C, Mwangi M, Mathenge E, Mbugua G, Ng’ang’a Z: Delivery practices and associated factors among mothers seeking child welfare services in selected health facilities in Nyandarua South District, Kenya. BMC Public Health 2011, 11:360. BioMed Central Full Text
• [14]Federal Democratic Republic of Ethiopia: Ministry of Health. National Reproductive Health Strategy, 2006–2015. Addis Ababa, Ethiopia: Federal Ministry of Health; 2006.
• [15]Worku AG, Yalew AW, Afework MF: Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int Health Hum Rights 2013, 13:20. BioMed Central Full Text
• [16]Fikre AA, Demissie M: Prevalence of institutional delivery and associated factors in Dodota Woreda (district), Oromia regional state, Ethiopia. Reprod Health 2012, 9:33. BioMed Central Full Text
• [17]Mengesha ZB, Biks GA, Ayele TA, Tessema GA, Koye DN: Determinants of skilled attendance for delivery in Northwest Ethiopia: a community based nested case control study. BMC Public Health 2013, 13:130. BioMed Central Full Text
• [18]Karim A, Betemariam W, Yalew S, Alemu H, Carnell M, Mekonnen Y: Programmatic correlates of maternal healthcare seeking behaviors in Ethiopia. Ethiop J Health Dev 2010, 24(1):92-99.
• [19]Introduction to SAS: UCLA: statistical consulting group. 2014. from http://www.ats.ucla.edu/stat/sas/notes2/ webcite (accessed NOvember 24, 2013)
• [20]Federal Democratic Republic of Ethiopia: Ministry of Health. HSDP IV. Addis Ababa, Ethiopia: Annual Performance Report EFY 2004 (2011/2012); 2013.
• [21]icddr,b: Inequity in utilization of maternal health services: a challenge for achieving Millennium Development Goal 5 in Bangldesh. Health Sci Bull 2012., 10(1) accessed from http://www.icddrb.org/ webcite
• [22]Abera M, Gebremariam A, Belachew T: Predictors of safe delivery service utilization in Arsi Zone, South-East Ethiopia. Ethiop J Health Sci 2011, 21(Suppl 1):95-106.
• [23]Kabakyenga JK, Ostergren PO, Turyakira E, Pettersson KO: Influence of birth preparedness, decision-making on location of birth and assistance by skilled birth attendants among women in south-western Uganda. PLoS One 2012, 7(4):e35747.
• [24]Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H: 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 Childbirth 2007, 7:29. BioMed Central Full Text
• [25]Ochako R, Fotso JC, Ikamari L, Khasakhala A: Utilization of maternal health services among young women in Kenya: insights from the Kenya Demographic and Health Survey, 2003. BMC Pregnancy Childbirth 2011, 11:1. BioMed Central Full Text
• [26]Zere E, Tumusiime P, Walker O, Kirigia J, Mwikisa C, Mbeeli T: Inequities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets. Int J Equity Health 2010, 9:16. BioMed Central Full Text
• [27]van den Heuvel OA, De Mey WG, Buddingh H, Bots ML: Use of maternal care in a rural area of Zimbabwe: a population-based study. Acta Obstet Gynecol Scand 1999, 78(10):838-846.
• [28]Ibor UW, Anjorin OA, Ita AE, Otu MA, Bassey TI: Utilization of antenatal care in Ibadan North Local Government Area, Oyo State, Nigeria. Trends Med Res 2011, 6(4):273-280.
• [29]Raatikainen K, Heiskanen N, Heinonen S: Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 2007, 7:268. BioMed Central Full Text
• [30]Warren C: Care seeking for maternal health: challenges remain for poor women. Ethiop J Health Dev 2010, 24:100-104.
• [31]Ethiopian Society of Population Studies: Maternal Health Care Seeking Behaviour in Ethiopia: In-depth Analysis of the Ethiopian Demographic and Health Survey 2005. Addis Ababa, Ethiopia: Ethiopian Society of Population Studies; 2008.
• [32]Babalola S, Fatusi A: Determinants of use of maternal health services in Nigeria–looking beyond individual and household factors. BMC Pregnancy Childbirth 2009, 9:43. BioMed Central Full Text
• [33]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.
• [34]Cotter K, Hawken M, Temmerman M: Low use of skilled attendants’ delivery services in rural Kenya. J Health Popul Nutr 2006, 24(4):467-471.
• [35]Fotso JC, Ezeh AC, Essendi H: Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services? Reprod Health 2009, 6:9. BioMed Central Full Text
• [36]Mahabub-Ul-Anwar M, Rob U, Talukder MN: Inequalities in maternal health care utilization in rural Bangladesh. Int Q Community Health Educ 2006, 27(4):281-297.
• [37]Mayhew M, Hansen PM, Peters DH, Edward A, Singh LP, Dwivedi V, Mashkoor A, Burnham B: Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study. Am J Public Health 2008, 98(10):1849-1856.
• [38]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.
• [39]Say L, Raine R: A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ 2007, 85(10):812-819.
• [40]Some TD, Sombie I, Meda N: Women’s perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study. Reprod Health 2011, 8:3. BioMed Central Full Text
• [41]Van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Alindblade K: Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health 2006, 3:2. BioMed Central Full Text
• [42]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.
• [43]Federal Democratic Republic of Ethiopia: Ministry of Health. Essential Health Service package for Ethiopia.2005. Addis Ababa, Ethiopia: Federal Ministry of Health; 2005.
• [44]Tibebe A, Amarech G, Melese T, Damen HM: Examining out of pocket payments for maternal health in rural Ethiopia: paradox of free health care un-affordability. Ethiop J Health Dev 2012, (1):251-257.
• [45]Fabine R, Sophie W, Vincent DW: Innovative approaches to reducing financial barriers to obstetric care in Low-income countries. Am J Public Health 2010, 100(10):1845-1852.
• [46]Maluka SO: Why are pro-poor exemption policies in Tanzania better implemented in some districts than in others? Int J Equity Health 2013, 12:80. BioMed Central Full Text
• [47]Ministerial Leadership Initiative, Aspen Global Health and Development. Reducing Financial Barriers to Reproductive Health care: Experiences With Free Care and Health Insurance. Ministerial Leadership Initiative for Global Health: USA; 2010. [http://www.aspeninstitute.org/ webcite]
• [48]Sophie W, Margaret A, Thierno D: National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal, 2008. [http://core.kmi.open.ac.uk/display/2835520/ webcite]
• [49]USAID: Maternal Health in Ghana: Investigating the Impact of the National Health Insurance Scheme on Maternal Health Indicators. 2009. [http://www.who.int/pmnch/topics/maternal/app_maternal_health_english.pdf/ webcite]
• [50]Charlemagne O, Fabienne R, Juliette C, Cyril W, Dominique P, Fatoumata O, Gruénais ME, DeBrouwere V: Cost sharing scheme for emergency obstetric care in Secteur 30 health district, Ouagadougou, Burkina Faso. Stud Health Serv Org Policy 2008, 24:49-82.
• [51]Ridde V, Kouanda S, Bado A, Haddad S: Reducing the medical cost of deliveries in Burkina Faso is good for everyone, including the poor. PLoS One 2012, 7(3):e33082. doi:10.1371/journal.pone.0033082
• [52]Narayanan D, Maya AE, Denny J, Shishir G, Lalnuntlangi R: A conditional cash assistance programme for promoting institutional deliveries among the poor in India: process evaluation results. Stud Health Serv Org Policy 2008, 24:257-273.
• [53]Van Damme W: Improving access to safe delivery for poor pregnant women: a case study of vouchers plus health equity funds in three health districts in Cambodia. Stud Health Serv Org Policy 2008, 24:225-255.