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Determinants of postnatal care utilization in Ethiopia: a multilevel analysis.

ABSTRACT: BACKGROUND:The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas. METHODS:The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12?months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care. RESULTS:This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05-1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28-3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57-13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04-2.12), birth notification (AOR: 2.66; 95% CI: 2.15-3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58-2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03-1.57). CONCLUSION:This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

SUBMITTER: Tiruneh GT

PROVIDER: S-EPMC7507276 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Determinants of postnatal care utilization in Ethiopia: a multilevel analysis.

Tiruneh Gizachew Tadele GT Worku Alemayehu A Berhane Yemane Y Betemariam Wuleta W Demissie Meaza M

BMC pregnancy and childbirth 20200921 1

<h4>Background</h4>The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government an ...[more]

PMID: 32957950

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Project description:BackgroundThe days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia.MethodsA community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively.ResultsThe study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization.Conclusion and recommendationThe study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.

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.

Project description:BACKGROUND:Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. METHODS:A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. RESULTS:The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. CONCLUSIONS:Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Project description:BACKGROUND:Maternal and neonatal mortality remain a significant problem across much of the developing world, especially in sub-Saharan Africa countries. In Ethiopia, most maternal and neonatal deaths occur during the postpartum period; this is a critical time for monitoring the health of women and newborns, but the most neglected period for care. In rural communities of Ethiopia, the utilization of postnatal care service is very low and evidence on which factors contribute to the non-utilization of postnatal care (PNC) is insufficient. Consequently, this study was designed to identify the determinants of postnatal service non-utilization among women who gave birth in Demba Gofa rural district, Southern Ethiopia. METHODS:A community-based unmatched case-control study was conducted among 186 cases (postnatal care non-utilizers) and 186 controls (postnatal care utilizers) in Demba Gofa rural district from March 1 to April 10, 2019. A previously tested interviewer-administered structured questionnaire was used for data collection. Binary logistic regression analysis was performed. In the final multivariable logistic regression analysis model, a p-value of less than 0.05 and an Adjusted Odd Ratio (AOR) with a 95% confidence interval (CI) was used to determine variables for postnatal care non-utilization. RESULTS:In this study, women who delivered recently were incorporated within 186 cases and 186 controls. Not knowing the availability of PNC services (AOR: 4.33, 95% CI: 1.71-10.99), having a home delivery (AOR: 7.06, 95% CI: 3.71-13.44), ANC non-attendance (AOR: 6.14, 95% CI: 3.01-12.50), unable to make an independent decision (AOR: 9.31, 95% CI: 3.29-26.35), and not participating in the Women's Development Army (WDA) (AOR: 5.09, 95% CI: 2.73-9.53) comprised the determinants which were assessed for non-utilization of postnatal care services. CONCLUSIONS:Encouraging institutional delivery along with integrated health education about postnatal care and postnatal danger signs, empowering women to execute independent decisions, accessing PNC services and strengthening participation in the Model Families will likely improve postnatal care service utilization in the district of Ethiopia.

Project description:IntroductionLack of sanitation is a major global problem mainly for the poor and disadvantaged. According to the 2016 Ethiopian Demographic and Health Surveys (EDHS) report, one out of every three households lack a toilet in Ethiopia and about 56% of rural households use unimproved toilet facilities. We aimed to determine the magnitude of improved household latrine utilization and its determinants in Ethiopia using the mini-Ethiopian Demographic Health Survey (EDHS) 2019 data set.MethodA secondary data analysis was conducted based on the mini 2019 EDHS data set. A total weighted sample of 8663 households were involved in analysis. After selecting the relevant variables for the outcome variable, we have fitted four different models. The null (empty) model with no independent variables and the second model contained the effects of the individual-level factors on the outcome variable. The third model included the influence of the community-level factors on the response variable, and the final multilevel multivariable logistic regression model examined the effects of individual-level and community-level variables on the outcome variable. The measure of variation was quantified using Intra-Class Correlation (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV). The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was used to show the strength of association and statistical significance was declared at p value < 0.05.ResultsThe magnitude of improved latrine utilization in Ethiopia was 19.5% with 95% CI (18.6%, 20.3%). The factors: educational status (AOR = 1.67; 95% CI: (1.10, 2.55), highest wealth index (AOR = 3.73; 95% CI: (2.73, 5.12), urban residence (AOR = 3.09; 95% CI: (1.68, 5.67), living in Addis Ababa (AOR = 4.08; 95% CI: (1.03, 16.2) and Dire Dawa (AOR = 8.22; 95% CI: (2.46, 27.42) and Somali regions (AOR = 3.11; 95% CI: (1.15, 8.42) were significantly associated to improved latrine utilization in Ethiopia.ConclusionThe magnitude of improved latrine utilization was quite low in Ethiopia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

Project description:BACKGROUND:Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. METHODS:Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. RESULTS:Household iodized salt utilization was spatially clustered in Ethiopia (Moran's Index?=?0.076, p-value?=?0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14-1.93), high community level education (AOR?=?1.51, 95% CI?=?1.03-2.20), middle wealth index (AOR?=?1.31, 95% CI?=?1.04-1.65) and high community media exposure (AOR?=?1.52, 95% CI?=?1.07-2.17) had higher odds of iodized salt utilization. CONCLUSIONS:Household iodized salt utilization had significant spatial variation across the country. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.

Dataset Information

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis.

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Determinants of postnatal care utilization in Ethiopia: a multilevel analysis.

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