Dataset Information

Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis.

ABSTRACT:

Background

Access to and utilization of facility delivery services is low in Ethiopia. The government of Ethiopia introduced a free delivery service policy in all public health facilities in 2013 to encourage mothers to deliver in health facilities. Examining the effect of this intervention on the utilization of delivery services is very important.

Objective

In this study, we assessed the effect of provisions of free maternity care services on facility-based delivery service utilization in central Ethiopia.

Methods

Data on 108 time points were collected on facility-based delivery service utilization (72 pre- and 36 postintervention) for a period of nine years from July 2007 to June 2016. Routine monthly data were extracted from the District Health Information System and verified using data from the delivery ward logbooks across the study facilities. An interrupted time-series analysis was conducted to assess the effect of the intervention.

Results

The implementation of the free delivery services policy has significantly increased facility deliveries. During the study period, there was a statistically significant increase in the number of facility-based deliveries after the 24^th and 36^th months of intervention (p < 0.05). Program effects on the use of public facilities for deliveries were persisted over a longer exposure period.

Conclusion

The findings suggested that the provision of free delivery services at public health facilities increased facility delivery use. The improved utilization of facility delivery services was more marked over a longer exposure period. Policy-makers may consider mobilizing the communities aware of the program at its instigation.

SUBMITTER: Demissie A

PROVIDER: S-EPMC7752279 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis.

Demissie Ayalneh A Worku Alemayehu A Berhane Yemane Y

Journal of pregnancy 20201212

<h4>Background</h4>Access to and utilization of facility delivery services is low in Ethiopia. The government of Ethiopia introduced a free delivery service policy in all public health facilities in 2013 to encourage mothers to deliver in health facilities. Examining the effect of this intervention on the utilization of delivery services is very important.<h4>Objective</h4>In this study, we assessed the effect of provisions of free maternity care services on facility-based delivery service utili ...[more]

PMID: 33414963

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Project description:BackgroundTelehealth using telephones or online communication is being promoted as a policy initiative in several countries. However, there is a lack of research on telehealth utilization in a country such as Japan that offers free access to medical care and regulates telehealth provision-particularly with respect to COVID-19.ObjectiveThe present study aimed to clarify telehealth utilization, the characteristics of patients and medical institutions using telehealth, and the changes to telehealth in Japan in order to support the formulation of policy strategies for telehealth provision.MethodsUsing a medical administrative claim database of the National Health Insurance and Advanced Elderly Medical Service System in Mie Prefecture, we investigated patients who used telehealth from January 2017 to September 2021. We examined telehealth utilization with respect to both patients and medical institutions, and we determined their characteristics. Using April 2020 as the reference time point for COVID-19, we conducted an interrupted time-series analysis (ITSA) to assess changes in the monthly proportion of telehealth users to beneficiaries.ResultsThe number of telehealth users before the reference time point was 13,618, and after the reference time point, it was 28,853. Several diseases and conditions were associated with an increase in telehealth utilization. Telehealth consultations were mostly conducted by telephone and for prescriptions. The ITSA results showed a sharp increase in the proportion of telehealth use to beneficiaries after the reference time point (rate ratio 2.97; 95% CI 2.14-2.31). However, no apparent change in the trend of increasing or decreasing telehealth use was evident after the reference time point (rate ratio 1.00; 95% CI 1.00-1.01).ConclusionsWe observed a sharp increase in telehealth utilization after April 2020, but no change in the trend of telehealth use was evident. We identified changes in the characteristics of patients and providers using telehealth.

Project description:BackgroundThere is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia.MethodsStudies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger's regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors.ResultTwenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I2 =?0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR)?=?2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR?=?3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR?=?3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR?=?2.91;95% 1.88,4.52) in 5 studies, availability of information source (AOR?=?1.80;95% CI 1.16,2.78) in 6 studies, ANC follow-up (AOR?=?2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR?=?4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR?=?3.04;95% CI 1.76,5.24) in 11 studies and place of birth of the elder child (AOR?=?8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization.ConclusionThis review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.

Project description:BackgroundGlobal strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited.ObjectiveThe study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility-delivery service among slums women, Addis Ababa, Ethiopia METHODS: Qualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18-49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge.ResultsThe FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

Project description:ObjectiveDespite the concerted effort to improve skilled delivery service utilization in Ethiopia, a considerable proportion of births still occur at home by traditional birth attendants, notably in a rural setting. Hence, the aim of this study was to investigate whether mother's perceived service quality and physical accessibility affect skilled delivery service utilization.MethodsA community-based cross-sectional study was conducted from 1 July 2019 to 30 August 2019, among mothers who gave birth in the last 12 months before the study, in selected five districts of Kaffa Zone, Ethiopia.ResultIn this study, 262 (70.1%) of mothers utilized skilled delivery service in their recent childbirth. Mothers regarding the nearby health facility's physical environment as "Good" (adjusted odds ratio = 2.48, 95% confidence interval = 1.44, 4.25), mothers mentioning time to reach to the nearby health facility "<1 h" (adjusted odds ratio = 1.92, 95% confidence interval = 1.11, 3.34), and mothers regarding prompt transport service from home to the nearby health facility "Available" (adjusted odds ratio = 2.01, 95% confidence interval = 1.11, 3.63) were positively associated with skilled delivery services' utilization. Furthermore, completing secondary education and above, attending three and more antenatal care visits, and having good knowledge of danger signs during pregnancy showed a significant association.ConclusionAlthough the study evidenced statistically significant association between perceived physical accessibility and perceived service quality, further study is recommended to investigate the relationship between actual physical accessibility and actual service quality. Targeted health education program intended to improve skilled delivery service utilization should give due emphasis on enhancing antenatal care service uptake, and raising mothers' awareness on danger signs during pregnancy, with particular focus on those mothers with low schooling.

Project description:IntroductionDespite 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.MethodsWe 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.ResultsOver 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.ConclusionThis 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.

Dataset Information

Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis.

Background

Objective

Methods

Results

Conclusion

Publications

Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis.

Similar Datasets

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