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Social Determinants of Antenatal Care Service Use in Ethiopia: Changes Over a 15-Year Span.

ABSTRACT: Background: Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time. Methods: The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro International, USA in 2005, 2011, and 2016. A negative binomial with random effects at cluster level was used to model the number of ANC visits whereas a multilevel binary logistic regression modeled binary responses relating to whether a woman had at least 4 ANC visits or not. The model estimates were obtained with the statistical software Stata SE 15 using the restricted maximum likelihood method. Results: Although the median number of ANC visits significantly increased between 2005 and 2016, the majority of the women do not obtain the four ANC visits during pregnancy as recommended. The odds of having at least four ANC visits were significantly lower among women: below 20 years, those living in the rural areas, having higher birth order, or Muslim. In contrast, higher educational attainment, higher socio-economic status, exposure to mass media, and self-reporting decision empowerment were significantly associated with having at least four ANC visits. Conclusion: The use of ANC visits is driven mostly by the social determinants of health rather than individual health risk. The importance of the various SDHs needs to be recognized by Ministry of Health policy and program managers as a key driving force behind the country's challenges with reaching targets in the health agenda related to maternal health, particularly related to the recommended number of ANC visits.

SUBMITTER: Ousman SK

PROVIDER: S-EPMC6603173 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Social Determinants of Antenatal Care Service Use in Ethiopia: Changes Over a 15-Year Span.

Ousman Seman Kedir SK Mdala Ibrahimu I Thorsen Viva Combs VC Sundby Johanne J Magnus Jeanette H JH

Frontiers in public health 20190625

<b>Background:</b> Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time. <b>Methods:</b> The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro Internation ...[more]

PMID: 31294012

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Project description:BackgroundAntenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. Thus, this systematic review and meta-analysis aims to identify factors that determine antenatal care service satisfaction among women in Ethiopia.MethodsPubMed, Hinari, and Google Scholar were systematically searched for eligible studies. In addition, national university digital libraries were also searched. The Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included articles. The Cochrane Q-statistics and I2 tests were used to assess heterogeneity among the included studies. Publication bias was assessed using Egger's test. Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The extracted data were analyzed using STATA version 14 software and the results were presented using the forest plot.ResultsOf the 274 articles identified through the systematic search of the literature, 13 studies fulfilling the inclusion criteria were included in this meta-analysis. First antenatal care visit (AOR: 0.62 and 95% CI: 0.40, 0.96), women waited <60 min (AOR: 1.87 and 95% CI: 1.40-2.50), women whose privacy was maintained (AOR: 3.91 and 95% CI: 1.97-7.77), women treated respectfully (AOR: 5.07 and 95% CI: 2.34-10.96), and unplanned pregnancies (AOR = 0.28 and 95% CI: 0.10-0.77) were significantly associated with antenatal care service satisfaction.ConclusionThe study assessed the determinants of antenatal care service satisfaction in Ethiopia. First antenatal care visit, waiting time (<60 min) to see the care provider, maintenance of privacy, respectful treatment, and pregnancy unplanned were found to be determinants of antenatal care service satisfaction. Counseling a woman to comply with a minimum required antenatal care visits and compassionate and respectful maternity care will increase maternal satisfaction with the antenatal care services.

Project description:Background:Male partner involvement is an important and crucial determinant of prevention of mother to child transmission (PMTCT) of HIV. It creates an opportunity to reverse the transmission of HIV during pregnancy, labor, and breastfeeding. Thus, involving male partners during HIV screening of pregnant mothers at ANC is the key to fight against MTCT of HIV. Objective:This study was designed to assess the magnitude and factors associated with male partner's involvement on PMTCT service utilization among pregnant women who attended focused antenatal care (FANC) in Southern Ethiopia. Methods:An institutional-based cross-sectional study was conducted among 420 randomly selected pregnant women who enrolled in PMTCT service at ANC clinics. Pre-tested and structured self-administered questionnaires were used to collect the data. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables with a p-value less than 0.05. Results:A total of 409 pregnant women who had ANC follow-up have participated in this study. The majority 160 (39.1%) of the participants were in the age group of 25-29 years. The magnitude of male involvement in PMTCT service was 129 (29.8%). Number of ANC visits (3rd visit (AOR=2.36, CI=1.09, 5.10), 4th visit (AOR=3.49, CI=1.65, 7.38), birthplace interest (AOR=3.01, CI=1.16, 7.84), awareness about partner monthly income (AOR=2.17, CI=1.15, 4.11), source of family saving scheme (partner (AOR=2.99, CI=1.39, 6.43), self (AOR=8.59, CI=3.92, 18.82), both (AOR=5.13, CI=2.21, 11.92), maternal perception about the importance of consulting partner before HIV testing (AOR=9.30, CI=2.65, 32.64), and kinds of partner support (psychological (AOR=0.08, CI=0.02, 0.29), financial (AOR=0.33, CI=0.17, 0.68) were found to be significantly associated with male involvement in PMTCT. Conclusion:This study found out that male partner involvement in PMTCT is low. Therefore, improving male partner involvement in PMTCT is recommended for improving maternal FANC service utilization and adherence with notification of their partner and provision of psychological and financial support.

Project description:BackgroundMaternal depression is the most prevalent psychiatric disorder during pregnancy, can alter fetal development and have a lasting impact on the offspring's neurological and behavioral development. However, no review has been conducted to report the consolidated magnitude of antenatal depression (AND) in Ethiopia. Therefore, this review aimed to systematically summarize the existing evidence on the epidemiology of AND in Ethiopia.MethodsUsing PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of AND from three electronic databases (PubMed, EMBASE, and SCOPUS). We used predefined inclusion criteria to screen identified studies. A qualitative and quantitative analysis was employed. Heterogeneity across the studies was evaluated using Q and the I² test. Publication bias was assessed by funnel plot and Egger's regression test.ResultsIn this review, a total of 193 studies were initially identified and evaluated. Of these, five eligible articles were included in the final analysis. In our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96-27.78). The prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. The prevalence of AND was 26.48% and 18.28% as measured by Beck depression inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Moreover, the prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.77% for the studies conducted in the institution-based setting. In our qualitative synthesis, we found that those pregnant women who had a history of stillbirth, complications during pregnancy, previous history of depression, no ANC follow-up, irregular ANC follow-up, not satisfied by ANC follow-up, and monthly income <1500 Ethiopian birr were linked with a greater risk of developing ANC. We also found that those women who experienced partner violence during pregnancy, food insecurity, medium and low social support, and those who were unmarried, age group 20-29, house wives and farmers were associated with a higher risk of developing ANC.Conclusion and recommendationsOur meta-analysis found that the pooled prevalence of AND in Ethiopia was 21.28%. The prevalence of AND was high in the third trimester of pregnancy as compared to the first and second trimesters of pregnancy. The prevalence of AND was high in studies conducted using BDI than EPDS. Studies on the magnitude of AND as well as the possible determinants in each trimester of pregnancy with representative sample size are recommended. Screening of depression in a pregnant woman in perinatal setting might be considered backed by integration of family planning and mental health services. The use of validated and a standard instrument to assess AND is warranted.Systematic review registrationThe protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID=CRD42017076521, 06 December 2017).

Project description:BackgroundCataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services.MethodsConfidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected.ResultsCataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p?=?0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p?=?0.009). Several factors were associated with increased surgeon productivity (p?<?0.05): working for >2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6-312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major challenges.ConclusionsThe uneven distribution of infrastructure and personnel, underutilization by the community and inadequate attention and support from the government are limiting cataract surgery service delivery in Southern Ethiopia. Improved human resource management and implementing community-oriented strategies may help increase surgical output and achieve the "Vision 2020: The Right to Sight" targets for treating avoidable blindness.

Project description:AIMS/HYPOTHESIS:We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes. METHODS:We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes. RESULTS:The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 ± 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 ± 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p < 0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p < 0.0001), and these proportions increased with time for both groups (p < 0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 ± 1.34; p < 0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p < 0.001). Birthweight was also increased in type 2 diabetes (0.94 ± 1.34; p < 0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p < 0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p < 0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population. CONCLUSIONS/INTERPRETATION:Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.

Project description:IntroductionDespite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15-49 years in Tigray, Ethiopia.MethodsThe study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation.ResultsThe response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband's occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands' occupation.ConclusionsA relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.

Dataset Information

Social Determinants of Antenatal Care Service Use in Ethiopia: Changes Over a 15-Year Span.

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Social Determinants of Antenatal Care Service Use in Ethiopia: Changes Over a 15-Year Span.

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