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Utilization of decentralized health facilities and factors influencing women's choice of a delivery site in Gida Ayana Woreda, western Ethiopia.

ABSTRACT: INTRODUCTION:Despite the government's efforts to decentralize and expand health institutions to promote facility-based child delivery, home delivery and maternal mortality are still widespread problems in Ethiopia. Most mothers continue to give birth at home. This study aims at identifying the socio-cultural practices, perceived benefit or need, and accessibility factors influencing women's choice of health facilities for delivery services in Gida Ayana Woreda, western Ethiopia. METHODS:We conducted a cross-sectional survey to assess women's use of delivery care services in Gida Ayana Woreda, from November 2016 to January 2017; 459 women who were selected randomly participated in the study. We evaluated the socio-cultural, perceived benefit or need, and economic and physical accessibility factors in women's choice of delivery care and used adjusted logistic regression analysis to examine significant predictors of delivery site use decisions. RESULTS:Over half (56.6%) of the women self-reported using institutional delivery care; 80.9% gave birth at a health center. A socio-cultural variable, maternal education, significantly influenced women's choice of health facility for delivery care services (AOR 3.4; 95% CI 2.0-5.9). Mothers' knowledge level of obstetric complications and experience of complications during the last birth were the two perceived benefits or need factors associated with higher odds of receiving delivery care from decentralized local facilities. Utilization of health centers for maternal delivery care was significantly higher than of health posts (AOR 5.0; 95% CI 2.4-10.2). Availability of motorized transportation during labor to nearby delivery site was a significant predictor of institutional delivery. CONCLUSION:This study demonstrates the under-utilization of decentralized health facilities for maternal delivery care services in Gida Ayana Woreda, which was significantly influenced by socio-cultural, perceived need, and accessibility factors of women during childbirth. This suggests the need for tailored intervention to improve childbirth services use for mothers in this kind of rural settings.

SUBMITTER: Tolera H

PROVIDER: S-EPMC6524803 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Utilization of decentralized health facilities and factors influencing women's choice of a delivery site in Gida Ayana Woreda, western Ethiopia.

Tolera Habtamu H Gebre-Egziabher Tegegne T Kloos Helmut H

PloS one 20190517 5

<h4>Introduction</h4>Despite the government's efforts to decentralize and expand health institutions to promote facility-based child delivery, home delivery and maternal mortality are still widespread problems in Ethiopia. Most mothers continue to give birth at home. This study aims at identifying the socio-cultural practices, perceived benefit or need, and accessibility factors influencing women's choice of health facilities for delivery services in Gida Ayana Woreda, western Ethiopia.<h4>Metho ...[more]

PMID: 31100070

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Project description:Objective:Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia.Methods:In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services.Results:Over half (55.7%) of the women did not utilize postnatal care within 42?days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35?years or older (adjusted odds ratio?=?3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio?=?2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio?=?3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio?=?2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery.Conclusion:The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.

Project description:BackgroundThere is limited evidence of the linkage between contraceptive use, the range of methods available and level of contraceptive stocks at health facilities and distance to facility in developing countries. The present analysis aims at examining the influence of contraceptive method availability and distance to the nearby facilities on modern contraceptive utilization among married women in rural areas in Ethiopia using geo-referenced data.MethodsWe used data from the first round of surveys of the Performance Monitoring & Accountability 2020 project in Ethiopia (PMA2020/Ethiopia-2014). The survey was conducted in a sample of 200 enumeration areas (EAs) where for each EA, 35 households and up to 3 public or private health service delivery points (SDPs) were selected. The main outcome variable was individual use of a contraceptive method for married women in rural Ethiopia. Correlates of interest include distance to nearby health facilities, range of contraceptives available in facilities, household wealth index, and the woman's educational status, age, and parity and whether she recently visited a health facility. This analysis primarily focuses on stock provision at public SDPs.ResultsOverall complete information was collected from 1763 married rural women ages 15-49 years and 198 SDPs in rural areas (97.1% public). Most rural women (93.9%) live within 5 kilometers of their nearest health post while a much lower proportion (52.2%) live within the same distance to the nearest health centers and hospital (0.8%), respectively. The main sources of modern contraceptive methods for married rural women were health posts (48.8%) and health centers (39.0%). The mean number of the types of contraceptive methods offered by hospitals, health centers and health posts was 6.2, 5.4 and 3.7 respectively. Modern contraceptive use (mCPR) among rural married women was 27.3% (95% CI: 25.3, 29.5). The percentage of rural married women who use modern contraceptives decreased as distance from the nearest SDP increased; 41.2%, 27.5%, 22.0%, and 22.6% of women living less than 2 kilometers, 2 to 3.9kilometers, 4 to 5.9 kilometers and 6 or more kilometers, respectively (p-value<0.01). Additionally, women who live close to facilities that offer a wider range of contraceptive methods were significantly more likely to use modern contraceptives. The mCPR ranged from 42.3% among women who live within 2 kilometers of facilities offering 3 or more methods to 22.5% among women living more than 6 kilometers away from the nearest facility with the same number (3 or more methods) available after adjusting for observed covariates.ConclusionsAlthough the majority of the Ethiopian population lives within a relatively close distance to lower level facilities (health posts), the number and range of methods available (method choice) and proximity are independently associated with contraceptive utilization. By demonstrating the extent to which objective measures of distance (of relatively small magnitude) explain variation in contraceptive use among rural women, the study fills an important planning gap for family planning programs operating in resource limited settings.

Project description:BACKGROUND:In Ethiopia, most women do not make the minimum number of antenatal care (ANC) visits recommended by WHO. This study modeled predisposing, enabling, need, and external environmental factors in the utilization of decentralized health facilities for ANC services in rural western Ethiopian communities. METHODS:A community-based, cross-sectional study was conducted in Gida Ayana Woreda (District) among 454 women. Data were collected through structured questionnaires. Multinomial logistic regression was used to model the association between the explanatory variables and the use of recommended and fewer than recommended visits for ANC with reference to the base model, no ANC visits. RESULTS:Only 15.2% of women made the recommended minimum number of ANC visits. Women with fewer than 2 children (AOR 10.7; 95% CI 3.0-8.4) were 10.7 times more likely received ANC service as recommended. Women with a delivery of 2 or more (AOR 9.7; 95% CI 3.7-5.2) home visits by health extension workers (HEWS) were 9.7 times more likely receiving minimum ANC services. Involvement in gainful activities had 4 times higher log odds of seeking recommended ANC (AOR 4.0; 95% CI 1.4-11.7). Women who experienced high fever were more likely to obtain the recommended ANC services (AOR 7.1; 95% CI 2.9-7.5). Residents of Ayana Kebele decentralization entity were 60% more likely to make the recommended number of visits to ANC (AOR 24.6; 95% CI 4.8-15.2). CONCLUSIONS:Number of children, home visits, gainful activities, monthly income, high fever, and decentralized administrative kebele were strongly linked with recommended ANC schedule. The need for a program intervention aimed at meeting WHO recommendations for ANC visits include economizing birth size and spacing; improving home attendance by HEWs, knowledge of pregnancy complications and benefits of minimum ANC visits, local socio-economic development measures targeting poor women/households; further decentralization of health system improving proximity to ANC in rural western Ethiopia.

Project description:BACKGROUND:Maternity Waiting Homes (MWHs) have been advocated to improve the utilization of skilled birth attendants. Nevertheless, delivery attended by skilled personnel is low in Ethiopia and may indicate that the utilization of MWH is also low. The aim of this study is to explore the factors influencing women's access to the MWHs in rural Southwest Ethiopia. METHODS:Qualitative data were collected through focus group discussions with MWHs users and in-depth interviews with MWHs non-users, health extension workers and the clinicians. Four focus group discussions and 18 in-depth interviews were conducted between May 1 and June 1, 2017. Furthermore, observations were made to assess the availability of basic facilities at selected MWHs. Data were thematically analyzed using NVivo version 7. The concept of access defined by Thiede et al was applied to guide the analysis. RESULTS:Women had interest on MWHs and are aware of the existence of MWHs in their immediate vicinity. Health information disseminations and referral linkages by frontline health workers enabled women to timely access the MWHs. However, Women didn't understand the aims and benefits of MWHs. At the facility level, there were attempts to improve the acceptability of MWHs by allowing women to choose their delivery positions. But, participants claimed lack of privacy and presence of disrespectful care. Physical barriers (long distance, unavailability of transport options & unfavorable roads) were considered as potential problems for women residing in remote areas. MWH users mentioned absences of sufficient basic facilities, poor quality and varieties of food. Because of insufficient facilities, the cost of living was high for most users. The communities try to overcome the indirect costs through contributions in-kind and in-cash. CONCLUSIONS:The factors influencing women's access to the MWHs were structural and individual and resonate with Thiede et al. dimensions of access. A better understanding of which factors are most influential in preventing women's access to the MWHs in rural Southwest Ethiopia is needed to appropriately target interventions.

Project description:BackgroundMedicinal plants are the integral part of the variety of cultures in Ethiopia and have been used over many centuries. Hence, the aim of this study is to document the medicinal plants in the natural vegetation and home gardens in Wonago Woreda, Gedeo Zone, Southern Nations, Nationalities and Peoples Regional State (SNNPR).Materials and methodsThirty healers were selected to collect data on management of medicinal plants using semi-structured interview, group discussion, and field observation. The distribution of plant species in the study areas was surveyed, and preference ranking, direct matrix ranking, priority ranking of factors and Informant consensus factor (ICF) were calculated.ResultsThe informants categorized the vegetation into five community types based on plant density and associated landform: 'Raqqa', 'Hakka cadanaba', 'Mancchha', 'Bullukko', and 'Wodae gido'. 155 plant species were collected from the natural vegetation and 65 plant species from the home gardens ('Gattae Oduma'). Seventy-two plant species were documented as having medicinal value: Sixty-five (71%) from natural vegetation and 27 (29%) from home gardens. Forty-five (62%) were used for humans, 15(21%) for livestock and 13(18%) for treating both human and livestock ailments: 35 (43.2%) were Shrubs, 28(34.5%) herbs, 17 (20.9%) trees and 1(1.2%) climbers. The root (35.8%) was the most commonly used plant part. The category: malaria, fever and headache had the highest 0.82 ICF. Agricultural expansion (24.4%) in the area was found to be the main threat for medicinal plants followed by fire wood collection (18.8%). Peoples' culture and spiritual beliefs somehow helped in the conservation of medicinal plants.ConclusionTraditional healers still depend largely on naturally growing plant species and the important medicinal plants are under threat. The documented medicinal plants can serve as a basis for further studies on the regions medicinal plants knowledge and for future phytochemical and pharmacological studies.

Project description:BackgroundAlthough it is a preventable and treatable disease, tuberculosis remains a major medical and public health problem throughout the world. The control and elimination of tuberculosis is currently challenged by the development and spread of antituberculosis drug resistance. The resistance is often correlated to the absence of properly implemented control measures that lead to poor treatment outcomes. Therefore, the aim of the current study was to assess poor treatment outcomes and its determinants among tuberculosis patients in selected health facilities in East Wollega zone, Western Ethiopia.MethodA five-year retrospective cross-sectional study design was employed. Data were collected from patients' medical record from January to March 2017. Data were entered and analyzed using SPSS version 20. Descriptive statistics were used to generate and summarize frequencies. Univariate and multivariate logistic regression analysis were used to associate the potential determinants of poor treatment outcomes.ResultsFrom 995 patients with documented treatment outcomes, 58.9% were males with a mean age of 31.9±16.3 years and 58% lived in rural areas. Majorities of cases (95.7%) were newly treated ones. Nearly half of the cases had extrapulmonary tuberculosis and 6.8% were co-infected with HIV. Nearly three-quarter of patients had completed their treatment while 17.2%, 2.9%, 4.8%, 0.4% patients were cured, defaulted, died, and failed, respectively. The overall treatment success rate was 91.9%. Being treated in Anger Gute health center (adjusted odds ratio (AOR): 2.27; 95% confidence interval (CI): 1.18-4.38); male (AOR: 1.81; 95% CI: 1.06-3.10); lived in rural areas (AOR: 1.73; 95% CI: 1.02-2.91); previously treated (AOR: 2.72; 95% CI: 1.16-6.39) and unknown HIV status (AOR: 4.56; 95% CI: 1.98-10.50) were determinants of poor treatment outcomes.ConclusionThe current treatment success rate was exceeded the recommended target. However, special attention and strict follow up is required for tuberculosis patients with high risk of unsuccessful treatment outcomes including male, rural resident, previously treated and unknown in HIV status patients throughout their treatment periods.

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Utilization of decentralized health facilities and factors influencing women's choice of a delivery site in Gida Ayana Woreda, western Ethiopia.

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Utilization of decentralized health facilities and factors influencing women's choice of a delivery site in Gida Ayana Woreda, western Ethiopia.

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