Dataset Information

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia.

ABSTRACT:

Background

Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women's education levels were also assessed.

Methods

Using survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran's I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations.

Results

Significant global spatial autocorrelation was present in ANC use (Moran's I?=?0.15, p value?=?0.025), delivery care (Moran's I?=?0.17, p value?=?0.01) and PNC use (Moran's I?=?0.31, p value ConclusionsSub-national variation in maternal healthcare services exists in Jimma Zone. There was relatively higher poverty and lower education in areas where service use cold spots were identified. Re-directing resources to vulnerable sub-groups and locations lagging behind will be necessary to ensure equitable progress in maternal health.

SUBMITTER: Kurji J

PROVIDER: S-EPMC7394677 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia.

Kurji Jaameeta J Talbot Benoit B Bulcha Gebeyehu G Bedru Kunuz Haji KH Morankar Sudhakar S Gebretsadik Lakew Abebe LA Wordofa Muluemebet Abera MA Welch Vivian V Labonte Ronald R Kulkarni Manisha A MA

BMC health services research 20200731 1

<h4>Background</h4>Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with hous ...[more]

PMID: 32736622

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Project description:BackgroundPersisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia.MethodsCross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women's proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality.ResultsSignificant spatial variability in relationships between all services and their explanatory factors (p < 0.001) was detected, apart from the association between delivery care and women's decision-making involvement (p = 0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale.ConclusionsSpatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations.

Project description:BackgroundMajority of causes of maternal and newborn mortalities are preventable. However, poor access to and low utilization of health services remain major barriers to optimum health of the mothers and newborns. The objectives of this study were to assess maternal and newborn health services utilization and factors affecting mothers' health service utilization.MethodsA community based cross-sectional survey was carried out on randomly selected mothers who gave birth within a year preceding the survey. The survey was supplemented with key informant interviews of experts/health professionals. Multivariable logistic model was used to identify factors associated with service utilization. Adjusted odds ratios (AORs) were used to assess the strength of the associations at p-value ≤0.05. The qualitative data were summarized thematically.ResultsA total of 789 (99.1% response rate) mothers participated in the study. The proportion of the mothers who got at least one antennal care (ANC) visit, institutional delivery and postnatal care (PNC) were 93.3, 77.4 and 92.0%, respectively. Three-forth (74.2%) of the mothers started ANC lately and only 47.5% of them completed ANC4+ visits. Medium (4-6) family size (AOR: 2.3; 95% CI: 1.1, 4.9), decision on ANC visits with husband (AOR: 30.9; 95% CI: 8.3, 115.4) or husband only (AOR: 15.3; 95%CI: 3.8, 62.3) and listening to radio (AOR: 2.5; 95%CI: 1.1, 5.6) were associated with ANC attendance. Mothers whose husbands read/write (AOR: 1.6; 95% CI: 1.1, 2.), attended formal education (AOR: 2.8; 95% CI: 1.1, 6.8), have positive attitudes (AOR: 10.2; 95% CI: 25.9), living in small (AOR: 3.0; 95% CI: 1.2, 7.6) and medium size family (AOR: 2.3; 95% CI: 1.2, 4.1) were more likely to give birth in-health facilities. The proportion of PNC checkups among mothers who delivered in health facilities and at home were 92.0 and 32.5%, respectively. The key informants mentioned that home delivery, delayed arrival of the mothers, unsafe delivery settings, shortage of skilled personnel and supplies were major obstacles to maternal health services utilization.ConclusionsHealth information communication targeting husbands may improve maternal and newborn health services utilization. In service training of personnel and equipping health facilities with essential supplies can improve the provider side barriers.

Project description:BackgroundOptimal nutrition during lactation is essential for the well-being of the mother and the infant. Studies have shown that access to nutrient-rich foods during lactation is critical as minimal stores of nutrients can have adverse effects. This study aimed to investigate the diversity, composition, and nutrient adequacy of diets of lactating mothers in Southwest Ethiopia.MethodsA community-based cross-sectional survey was carried out in three districts of Jimma Zone, Southwest Ethiopia, in February 2014. A stratified multistage sampling technique was used to select 558 lactating mothers. Data were collected using a pre-tested and structured interviewer-administered questionnaire. Minimum dietary diversity for women (MDD-W) was computed from a single 24-h recall. A cut off value of 5 was used to classify the dietary diversity into achieving MDD-W or not. The proximate, mineral and anti-nutritional compositions of 12 commonly consumed foods were analysed using standard methods. Nutrient adequacy ratio (NAR) and Mean adequacy ratio (MAR) of these foods were estimated.ResultsThe mean (±SD) dietary diversity score (DDS) of the study participants was 3.73±1.03. Meeting MDD-W was positively associated with agricultural production diversity (P = 0.001) and educational level of the women (P = 0.04). Conversely, district of the study (P = 0.003) and place of residence (P = 0.019) were negatively associated with meeting MDD-W. The proximate composition (g/100g) of the sampled foods ranged between 24.8-65.6 for moisture, 7.6-19.8 for protein, 2.1-23.1 for crude fat, 2.0-27 for crude fibre, 1.0-21.2 for total ash, and 0.9-45.8 for total carbohydrate content. The calorific value ranged between 124.5-299.6 Kcal/100g. The mineral contents (mg/100g) ranged between 9.5-52.5 for iron, 2.2-4.2 for zinc, 42.6-318.2 for calcium, and 150.7-379.9 for phosphorus. The content of anti-nutritional factors (mg/100g) ranged between 11.1-178.9 for phytate and 3.7-315.9 for tannin. All the commonly consumed maternal foods were not sufficient to meet the energy, fat and protein requirements, (NAR<1). However, all diets provided adequate iron and most of the cereal-based foods provided adequate carbohydrate and minerals. The overall nutrient adequacy was below the cut-off point for all food types.ConclusionsThe diets of lactating mothers in Southwest Ethiopia lack diversity and nutrient adequacy. A community-based nutrition education program on the importance of diet diversity and nutrient intake during lactation based on a multi-sectoral approach is needed.

Project description:Health management information system (HMIS) data are important for guiding the attainment of health targets in low- and middle-income countries. However, the quality of HMIS data is often poor. High-quality information is especially important for populations experiencing high burdens of disease and mortality, such as pregnant women, newborns, and children. The purpose of this study was to assess the quality of maternal and child health (MCH) data collected through the Ethiopian Ministry of Health's HMIS in three districts of Jimma Zone, Oromiya Region, Ethiopia over a 12-month period from July 2014 to June 2015. Considering data quality constructs from the World Health Organization's data quality report card, we appraised the completeness, timeliness, and internal consistency of eight key MCH indicators collected for all the primary health care units (PHCUs) located within three districts of Jimma Zone (Gomma, Kersa and Seka Chekorsa). We further evaluated the agreement between MCH service coverage estimates from the HMIS and estimates obtained from a population-based cross-sectional survey conducted with 3,784 women who were pregnant in the year preceding the survey, using Pearson correlation coefficients, intraclass correlation coefficients (ICC), and Bland-Altman plots. We found that the completeness and timeliness of facility reporting were highest in Gomma (75% and 70%, respectively) and lowest in Kersa (34% and 32%, respectively), and observed very few zero/missing values and moderate/extreme outliers for each MCH indicator. We found that the reporting of MCH indicators improved over time for all PHCUs, however the internal consistency between MCH indicators was low for several PHCUs. We found poor agreement between MCH estimates obtained from the HMIS and the survey, indicating that the HMIS may over-report the coverage of key MCH services, namely, antenatal care, skilled birth attendance and postnatal care. The quality of MCH data within the HMIS at the zonal level in Jimma, Ethiopia, could be improved to inform MCH research and programmatic efforts.

Project description:BackgroundMalaria caused by Plasmodium vivax and Plasmodium falciparum is among the major public health problems in most endemic areas of the world. Artemisinin-based combination therapy (ACT) has been recommended as a first-line treatment for uncomplicated Plasmodium falciparum malaria almost in all endemic regions. Since ineffectively regulated medicines in resource limited settings could favour infiltration of poor quality anti-malarial medicines into pharmaceutical supply chain and jeopardize a positive treatment outcome, regular monitoring of the quality of anti-malarial medicines is critical. Thus, the aim of this study was to assess the quality of fixed dose combination (FDC) artemether (ART)/lumefantrine (LUM) tablets available in Jimma zone, Ethiopia.MethodsThis study was conducted in Jimma zone, Ethiopia. A total of 74 samples of FDC ART/LUM (20 mg ART/120 mg LUM) tablets were collected from 27 public facilities. All samples were subjected to visual inspection and the relevant information was recorded. The samples were transported to Jimma University Laboratory of Drug Quality (JuLaDQ) and stored at ambient temperature (20 °C to 25 °C) until analysis. The Pharmacopoeial conform/non-conform methods and the risk-based Derringer's desirability function approach were employed to assess the pharmaceutical quality of the investigated products.ResultsThe visual inspection results revealed that there were no signs of falsified in the investigated products. Identification test results of samples indicated that all samples contained the stated active pharmaceutical ingredients (APIs). The results of uniformity of mass indicated that all samples complied with International Pharmacopoeial specification limits. The assay results, expressed as percent label claim (%lc) of ART (89.8 to 108.8%, mean ± SD = 99.1 ± 3.9%) and LUM (90.0 to 111.9%, mean ± SD = 98.2 ± 3.8%) revealed that, all samples complied with International Pharmacopoeia acceptance specification limits (i.e. 90-110%lc), except one generic product (IPCA Laboratories Ltd., India) which contains excessive LUM (111.9 ± 1.7%lc). The risk priority number (RPN) results revealed that assay (RPN = 392) is relatively the most critical quality attribute followed by identity (RPN = 280) and mass uniformity (40). Quality evaluation based on psycho-physical Harrington's scale revealed that more than 96% of samples were within the acceptable ranges (D ≥ 0.7-1.0).ConclusionsBoth Pharmacopoeial and risk-based desirability function approaches to quality evaluation applied to the investigated products revealed that above 96% FDC ART/LUM tablets circulating in public settings of Jimma zone are of good quality.

Project description:BackgroundEthiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging-based message framing for maternal and newborn health.ObjectiveThis research aims to examine the effectiveness of mobile phone messaging-based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia.MethodsA 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone-based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials.ResultsRecruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024.ConclusionsThis trial was carried out to understand how mobile phone-based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health.Trial registrationPan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49.International registered report identifier (irrid)DERR1-10.2196/52395.

Dataset Information

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia.

Background

Methods

Results

Publications

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia.

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