Inequities in maternal health services utilization in Ethiopia 2000-2016: magnitude, trends, and determinants.
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ABSTRACT:
SUBMITTER: Gebre E
PROVIDER: S-EPMC6031117 | biostudies-literature | 2018 Jul
REPOSITORIES: biostudies-literature
Publications
Inequities in maternal health services utilization in Ethiopia 2000-2016: magnitude, trends, and determinants.
Gebre Emebet E Worku Alemayehu A Bukola Fawole F
Reproductive health 20180704 1
<h4>Background</h4>Inequities in maternal health services utilization constitute a major challenge in maternal mortality reduction in Ethiopia. We sought to assess magnitude, trends, and determinants of inequities in maternal health services utilization in Ethiopia from 2000 to 2016.<h4>Methods</h4>The study utilized data from the 2000 and 2016 Ethiopia Demographic and Health Surveys, which were done based on a cross sectional survey design. The wealth-related inequities were assessed by concent ...[more]
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Project description:BackgroundAt the national level in Ethiopia, there is limited knowledge of trends and factors associated with early initiation of breastfeeding and exclusive breastfeeding (EBF), particularly during the Millenium Development Goal (MDG) era (2000-2015). The study aimed to examine the trends and determinants of early initiation of breastfeeding and EBF in Ethiopia between 2000 and 2016.MethodsUsing the Ethiopia Demographic and Health Survey (EDHS) data for the years: 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037) and 2016 (n = 3861), trends in early initiation of breastfeeding and EBF were estimated. Multivariate logistic regression models that adjusted for confounders, sampling weight, clustering and stratification were used to examine the association between socioeconomic, demographic, health service and community level factors with early initiation of breastfeeding and EBF from 2000 to 2016.ResultsThe prevalence of early initiation of breastfeeding increased from 48.8% in 2000 to 75.7% in 2016 in Ethiopia. Improvement in EBF prevalence was not statistically significant (from 54.5% in 2000 to 59.9% in 2016). Over the study period, informal maternal employment (Adjusted Odds Ratio [aOR] 0.75; 95% Confidence Interval [CI] 0.68, 0.83), frequent antenatal care visits (aOR 0.74; 95% CI 0.65, 0.85), and cesarean birthing (aOR 0.22; 95% CI 0.17, 0.30) were associated with delayed initiation of breastfeeding. Birthing in the health facility (aOR 1.35; 95% CI 1.05, 1.75) and residing in the metropolis region (aOR 1.95; 95% CI 1.65, 2.32) were associated with timely initiation of breastfeeding. In a similar period, informally employed mothers (aOR 1.37; 95% CI 1.15, 1.63) and those with six or more family size (aOR 1.46; 95% CI 1.10, 1.93) were more likely to exclusively breastfeed their babies.ConclusionEarly initiation of breastfeeding improved in Ethiopia during the MDG era but it is still below the national target; progress in EBF remained slow. To improve breastfeeding outcomes and meet the global breastfeeding targets in Ethiopia, infant feeding efforts should focus on improving key modifiable factors, including place and mode of birthing and socioeconomic status of mothers.
| S-EPMC6740001 | biostudies-literature
Project description:BackgroundMortality from preventable pregnancy-related complications remains high in Ethiopia. Antenatal care remains a major public health intervention that prevents maternal and neonatal mortality. Thus, this study aimed to assess the magnitude and determinants of adequate antenatal care utilization in Southern Ethiopia.MethodsA community-based cross-sectional study was conducted between November and December 2019. A systematic random sampling technique was used to select 670 women. Data were collected using a pre-tested structured questionnaire administered with a digital survey tool (open data kit) and directly exported to STATA version 15 for analysis. Descriptive statistics followed by a multivariable logistic regression analysis were performed. Both crude and adjusted odds ratios (ORs) with 95% confidence intervals were reported.ResultsThe magnitude of adequate antenatal care utilization was 23.13%. Tertiary and above education (AOR,4.15;95%CI: 1.95, 8.83), having the best friend who used maternal care (AOR,2.01;95%CI: 1.18,3.41), husband support (AOR,3.84; 95%CI: 1.05, 14.08), high wealth index (AOR,3.61; 95%CI: 1.86, 6.99), follow-up in private health facilities (AOR, 2.27;95% CI:1.33, 3.88), having a history of risky pregnancy (AOR,2.59; 95%CI: 1.55, 4.35), and planned pregnancy (AOR,2.60;95% CI: 1.35, 4.99) were significant determinants of overall adequate ANC service utilization.ConclusionThe utilization of adequate antenatal care services is quite low. The study findings suggest that interventions should be in place to improve husband's support, social networks, and women's education. There is also a need to counsel women to utilize family planning.
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Project description:ImportanceNasal endoscopy is the most highly reimbursed routine clinical procedure in otolaryngology by Medicare. To our knowledge, the economic and demographic characteristics of nasal endoscopy have not been characterized at a population level.ObjectiveTo quantify trends in use of nasal endoscopy among Medicare recipients at a national and state level.Design, setting, and participantsCross-sectional study of procedure and beneficiary data from January 1, 2000, to December 31, 2016, and available health care provider data from 2015 obtained from the Centers for Medicare & Medicaid Services for all diagnostic nasal endoscopies categorized as Current Procedural Terminology code 31231.ExposuresDiagnostic nasal endoscopy.Main outcomes and measuresNasal endoscopies were analyzed by state, medical or surgical specialty, mean reimbursement, health care provider density, and type of health care practitioner performing the procedure.ResultsThe Centers for Medicare & Medicaid Services reimbursed $86.3 million for 559 547 nasal endoscopies in 2016. The total number of nasal endoscopies increased 313%, from 135 494 in 2000 to 559 547 in 2016 (9.3% average annual rate of increase). The mean reimbursement rate per nasal endoscopy varied by state, from $114.25 in Puerto Rico to $189.53 in New York. The percentage of Medicare beneficiaries receiving nasal endoscopy per state ranged from 0.1% in Alaska to 1.7% in New York. Almost all nasal endoscopies were performed by physicians (97.3%), with otolaryngologists (97.2%) being the most common specialty. Reimbursement rates (r = 0.60) and density of health care providers (r = -0.56) were correlated with higher utilization in a state's Medicare population.Conclusions and relevanceUtilization of nasal endoscopy by otolaryngologists in the Medicare population appears to have increased substantially over the past 2 decades. Practice patterns and reimbursement appeared to vary across the United States.
| S-EPMC6439755 | biostudies-literature
Project description:BackgroundSubstantial inequality in neonatal mortality rates (NMR) remains in low- and middle-income countries to the detriment of disadvantaged subpopulations. In Ethiopia, there is a dearth of evidence on the extent and trends of disparity in NMR. This study assessed the socioeconomic, residence and sex-based inequalities in NMR, as well as examined its change over a sixteen year period in Ethiopia.MethodsUsing the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Ethiopia Demographic and Health Surveys (EDHS) were analyzed between 2000 and 2016. NMR was disaggregated by four equity stratifiers: education, wealth, residence and sex. In addition, absolute and relative inequality measures, namely Difference, Population Attributable Risk (PAR), Ratio, Relative Concentration Index (RCI) and Slope Index of Inequality (SII) were calculated to understand inequalities from different perspectives. Corresponding 95% Uncertainty Intervals (UIs) were computed to measure statistical significance.FindingsLarge educational inequalities in NMR were found in 2000, 2005, and 2011, while wealth-driven inequality occurred in 2011. Sex disparity was noted in all the surveys, and urban-rural differentials remained in all the surveys except in 2016. While socioeconomic and area-related inequalities decreased over time, sex related inequality did not change during the period of study.ConclusionsNMR appeared to be concentrated among male newborns, neonates born to illiterate and poor women and those living in rural settings. However, the inequality narrowed over time. Interventions appropriate for different subpopulations need to be designed.
| S-EPMC7286487 | biostudies-literature
Project description:BACKGROUND:Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016. METHODS:Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n?=?2559), 2005 (n?=?1112), 2011 (n?=?3569), and 2016 (n?=?3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity. RESULTS:The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively. CONCLUSION:The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.
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Project description:Karnataka State continues to have the highest rates of maternal mortality in south India at 144/100,000 live births, but lower than the national estimates of 190-220/100,000 live births. Various barriers exist to timely and appropriate utilization of services during pregnancy, childbirth and postpartum. This study aimed to describe the patterns and determinants of routine and emergency maternal health care utilization in rural Karnataka State, India.This study was conducted in Karnataka in 2012-2013. Purposive sampling was used to convene twenty three focus groups and twelve individual interviews with community and health system representatives: Auxiliary Nurse Midwives and Staff Nurses, Accredited Social Health Activists, community leaders, male decision-makers, female decision-makers, women of reproductive age, medical officers, private health care providers, senior health administrators, District health officers, and obstetricians. Local researchers familiar with the setting and language conducted all focus groups and interviews, these researchers were not known to community participants. All discussions were audio recorded, transcribed, and translated to English for analysis. A thematic analysis approach was taken utilizing an a priori thematic framework as well as inductive identification of themes.Most women in the focus groups reported regular antenatal care attendance, for an average of four visits, and more often for high-risk pregnancies. Antenatal care was typically delivered at the periphery by non-specialised providers. Participants reported that sought was care women experienced danger signs of complications. Postpartum care was reportedly rare, and mainly sought for the purpose of neonatal care. Factors that influenced women's care-seeking included their limited autonomy, poor access to and funding for transport for non-emergent conditions, perceived poor quality of health care facilities, and the costs of care.Rural south Indian communities reported regular use of health care services during pregnancy and for delivery. Uptake of maternity care services was attributed to new government programmes and increased availability of maternity services; nevertheless, some women delayed disclosure of pregnancy and first antenatal visit. Community-based initiatives should be enhanced to encourage early disclosure of pregnancies and to provide the community information regarding the importance of facility-based care. Health facility infrastructure in rural Karnataka should also be enhanced to ensure a consistent power supply and improved cleanliness on the wards.NCT01911494.
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Project description:The novel coronavirus (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Despite strong efforts that have been taking place to control the pandemic globally, the virus is on the rise in many countries. Hence, this study assessed the maternal health care services utilization amidst the COVID-19 pandemic in West Shoa zone, Central Ethiopia. A community-based cross-sectional study was conducted among 844 pregnant women or those who gave birth in the last 6 months before the study. A multi-stage sampling technique was used to select the study participants. The data were collected through face-to-face interviews using a semi-structured questionnaire. Logistic regressions were performed to identify the presence of significant associations, and an adjusted odds ratio with 95%CI was employed for the strength and directions of association between the independent and outcome variables. A P-value of <0.05 was used to declare statistical significance. The prevalence of maternal health service utilization during the COVID-19 pandemic was 64.8%. The odds of maternal health service utilization was higher among mothers who had primary (AOR = 2.16, 95%CI: 1.29-3.60), secondary (AOR = 1.97, 95%CI: 1.13-3.44), and college and above education (AOR = 2.89, 95%CI: 1.34-6.22) than those who could not read and write. Besides, mothers who did travel 30-60 minutes (AOR = 0.37, 95%CI: 0.23-0.59) and 60-90minutes (AOR = 0.10, 95%CI: 0.05-0.19) to reach the health facility had a lower odds of maternal health service utilization than those who did travel <30 minutes. Moreover, mothers who earn 1000-2000 (AOR = 3.10, 95%CI: 1.73-5.55) and > 2000 birrs (AOR = 2.66 95%CI: 1.52-4.64) had higher odds of maternal health service utilization than those who earn <500 birrs. Similarly, the odds of utilizing maternal health service were higher among mothers who did not fear COVID-19 infection (AOR = 2.79, 95%CI: 1.85-4.20), who had not had to request permission from husband to visit the health facility (AOR = 7.24, 95%CI: 2.65-19.75), who had practicedCOVID-19 prevention measure (AOR = 5.82, 95%CI: 3.87-8.75), and used face mask (AOR = 2.06, 95% CI: 1.28-3.31) than their counterpart. Empowering mothers and creating awareness on COVID-19 preventionis recommended to improve maternal health service utilization during the COVID-19 pandemic.
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Project description:The prevalence of stunting in Ethiopia declined from 57% in 2000 to 44% in 2011, yet the factors producing this change are not fully understood. Data on 23,999 children 0-59 months of age from three Demographic and Health Surveys (DHS) from 2000, 2005, and 2011 were analyzed to assess the trends in stunting prevalence, mean height-for-age z-scores (HAZ) and the associations between potential factors and HAZ. Associations were determined separately using three separate generalized linear models for children age less than 6?months, 6-23 months, and 24-59 months of age. Significant variables were then analyzed to determine if they showed an overall trend between the 2000 and 2011 surveys. In children?<?6?months of age, only mother's height was both a significant predictor of HAZ and showed a progressive, albeit non-significant, increase from 2000 to 2011. In children 6-23 months of age, only mother's use of modern contraception showed substantial changes in a direction consistent with improving HAZ, but improvements in maternal nutrition status were observed from 2000 to 2005. For children 24-59 months of age a consistent and progressive change is seen in child's diarrhea, fever, mother's education, and the occurrence of open defecation. Our analysis demonstrated that factors associated with HAZ vary by child's age and the dominant livelihood practice in the community. Variables that could have contributed to the decline of stunting in Ethiopia in children less than 5?years of age include markers of child health, mother's nutritional status, mother's educational level, and environmental hygiene.
| S-EPMC6866086 | biostudies-literature
Project description:BackgroundThe fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia.MethodPopulation-based longitudinal study design was conducted by extracting data for nine consecutive years (2009-2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009-2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance.ResultsThe skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014-2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014-2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86-196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30-3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33-4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18-3.74).ConclusionRegardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women's attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.
| S-EPMC8428565 | biostudies-literature
Project description:BackgroundMaternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia.ObjectivesThis study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia.DesignA community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region.MethodsData were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization.ResultsUtilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73).ConclusionMaternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.
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