Dataset Information

Perceived physical accessibility, mother's perception of quality of care, and utilization of skilled delivery service in rural Ethiopia.

ABSTRACT:

Objective

Despite 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.

Methods

A 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.

Result

In 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.

Conclusion

Although 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.

SUBMITTER: Hailemariam S

PROVIDER: S-EPMC8326625 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundEthiopia has been striving to promote institutional delivery through community wide programs. However, home is still the preferred place of delivery for most women encouraged by the community`s perception that delivery is a normal process and home is the ideal environment. The proportion of women using institutional delivery service is below the expected level. Therefore, we examined the impact of perception on institutional delivery service use by using the health belief model.MethodsA community-based cross-sectional study was conducted among 1,394 women who gave birth during the past 1 year from September to December 2019. A multistage sampling technique was used to select the study participants. Data were collected by using health belief model constructs, and structured and pretested questionnaire. Binary logistic regression was performed to identify factors associated with the outcome variable at 95% confidence level.ResultsInstitutional delivery service was used by 58.17% (95% CI: 55.57- 60.77%) of women. The study showed that high perceived susceptibility (AOR = 1.87; 95% CI 1.19-2.92), high cues to action (AOR = 1.57; 95% CI: 1.04-2.36), husbands with primary school education (AOR = 1.43; 95% CI 1.06-1.94), multiparty(5 or more) (AOR = 2.96; 95% CI 1.85-4.72), discussion on institutional delivery at home (AOR = 4.25; 95% CI 2.85-6.35), no close follow-up by health workers (AOR = 0.59;95% CI 0.39-0.88), regular antenatal care follow-up (AOR = 1.77;95% CI 1.23,2.58), health professionals lack of respect to clients (AOR = 2.32; 95% CI 1.45-3.79), and lack of health workers (AOR = 0.43;95% CI 0.29-0.61) were significantly associated with the utilization health behavior of institutional delivery service.ConclusionThe prevalence of institutional delivery in the study area was low. The current study revealed that among the health belief model construct perceived susceptibility and cues to action were significantly associated with the utilization behavior of institutional delivery service. On top of that strong follow-up of the community and home based discussion was a significant factor for the utilization behavior of institutional delivery service.

Project description:Background:There are wide differences in the uptake of skilled delivery services between urban and rural women in the northern region of Ghana. This study assessed the rural-urban differences in the prevalence of and factors associated with uptake of skilled delivery in the northern region of Ghana. Methods:The study population comprised postpartum women who had delivered within the last three months prior to the study. The dataset was analyzed using the chi-square test and multivariable logistic regression. Results:The odds of skilled birth attendance (SBA) adjusted for confounding variables in urban areas were higher compared with their rural counterparts (AOR?=?1.59; CI: 1. 07-2.37; p=0.02). The determinants of skilled delivery were similar but of different levels and strength in rural and urban areas. The main drivers that explained the relatively high skilled delivery coverage in the urban areas were higher frequency of antenatal care (ANC) attendance, proximity (physical access) to health facility, and greater proportion of women attaining higher educational level of at least secondary school. Distance from health facility less than 4 km was the greatest independent contributor to the variance in skilled delivery in the urban areas, whereas frequency of ANC attendance was the greatest independent contributor in the rural areas. Conclusions:This study identified underlying determinants accounting for rural-urban differences in skilled delivery, and covariate effect was more dominant than coefficient effect. Therefore, urban-rural differences in SBA outcomes were primarily due to differences in the levels of critical determinants rather than the nature of the determinants themselves. Therefore, improving skilled delivery outcomes in this study population and other similar settings will not require different policy frameworks and interventions in dealing with rural-urban disparities in SBA outcomes. However, context-specific tailored approaches and strategies including targeting mechanisms have to be designed differently to reduce the rural-urban differences.

Project description:BackgroundA minimum of one ultrasound scan is recommended for all pregnant women before the 24th week of gestation. In Ethiopia, there is a shortage of skilled manpower to provide these services. Currently, trained mid-level providers are providing the services at the primary healthcare level. The aims of this study were to compare antenatal care 1 (ANC1), antenatal care 4 (ANC4), skilled birth attendance (SBA), and postnatal care (PNC) service utilization before and after institutionalizing Vscan limited obstetric ultrasounds at semi-urban health centers in Ethiopia.MethodsA pre and post intervention observational study was conducted to investigate maternal and neonatal health service utilization rates before and after institutionalizing Vscan limited obstetric ultrasound services, between July 2016 and June 2020. The data were extracted from 1st August- 31st December 2020.ResultsThe observed monthly increase on the mean rank of first ANC visits after the introduction of Vscan limited obstetric ultrasound services showed a statistically significant difference at KW-ANOVA H (3) = 17.09, P = 0.001. The mean rank of fourth ANC utilization showed a statistically significant difference at KW- ANOVA H (3) = 16.24, P = 0.001. The observed mean rank in skilled birth attendance (SBA) showed a statistically significant positive difference using KW-ANOVA H (3) = 23.6, P<0.001. The mean rank of increased utilization in postnatal care showed a statistically significant difference using KW-ANOVA H (3) = 17.79, P<0.001.ConclusionThe introduction of limited obstetric ultrasound services by trained mid-level providers at the primary healthcare level was found to have improved the utilization of ANC, SBA, and postnatal care (PNC) services. It is recommended that the institutionalization of limited obstetric ultrasound services be scaled up and a further comparative study between facilities with and without ultrasound services be conducted to confirm causality and assess effects on maternal and perinatal outcomes.

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:BackgroundSkilled attendance at birth is considered key to accomplishing Sustainable Development Goal (SDG) 3.1 aimed at reducing maternal mortality. Many maternal deaths can be prevented if a woman receives care by skilled health personnel. Maternal utilization of skilled health delivery services in rural areas in low- and middle-income countries is 70% compared to 90% in urban areas. Previous studies have found community-based interventions may increase rural maternal uptake of skilled health delivery services, but evidence is lacking on which strategies are most effective.ObjectiveTo review the effectiveness of community-based strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low-and middle-income countries.MethodsWe conducted a narrative review. PubMed, CINAHL, Cochrane Library, and PsycINFO databases were searched for articles from database inception through 13 November 2019. Key search terms were pre-determined. Information was extracted on studies meeting our inclusion criteria: cluster and randomized trials, rural setting, reproductive aged women, community engagement, low- and middle-income countries. Studies were considered effective if statistically significant (p < 0.05). A narrative synthesis was conducted.ResultsTen cluster randomized trials out of 5,895 candidate citations met the inclusion criteria. Strategies included home-based visits, women's groups, and combined approaches. Out of the ten articles, only three studies were found to significantly increase maternal uptake of skilled health personnel for delivery, and each used a different strategy. The results are inconclusive as to which strategies are most effective. Limitations of this review include heterogeneity and generalizability of studies.ConclusionsThis research suggests that different strategies may be effective at improving maternal utilization of skilled health personnel for delivery in certain rural settings while ineffective in others. More research is warranted to better understand the context in which strategies may be effective and under what conditions.

Project description:BackgroundMaternal mortality continues to be a pressing concern in global health, presenting an enduring and unmet challenge for healthcare systems worldwide. Utilization of institutional delivery services has been established as a proven intervention to mitigate life-threatening risks for both mothers and newborns. Exploring the determinants of institutional delivery is crucial to improve and enhance maternal and newborn safety. This study aimed to assess the contextual and individual factors associated with institutional delivery in Nepal.MethodsThis study utilized that data form Nepal Multiple Indicator Survey 2019, which included a sample of 1,932 women who had given birth within the two years prior to the survey. A multilevel logistic regression analysis was performed to determine the significant external environment, contextual and individual predictors of institutional delivery.ResultsThe women from Madhesh province [Adjusted Odds Ratio (aOR): 0.32, 95% Confidence Interval (CI): 0.17-0.61], as compared to Bagmati province, women from rural areas (aOR: 0.55, 95% CI: 0.39-0.78) as compared to urban areas, and women from a relatively less-advantaged ethnic groups (aOR: 0.52, 95% CI: 0.35-0.76) as compared to the relatively advantaged ethnic groups were less likely to deliver in health institutions. Similarly, women from the poorest (aOR: 0.09, 95% CI: 0.04-0.22) and second wealth groups (aOR: 0.29, 95% CI: 0.13-0.64) were less likely to attend institute for delivery compared to women from the richest household. Women with formal education (aOR: 1.65, 95% CI: 1.16-2.35) were more likely to deliver in an institution over uneducated women. Moreover, the uptake of institutional delivery increased by 59% (aOR: 1.59, 95% CI: 1.43-1.75) for each additional ANC visit.ConclusionThe findings highlight the importance of stepping up efforts to achieve universal health care from the standpoint of long-term government investment, focusing particularly on illiterate women in rural areas, poorer households, and socially disadvantaged groups. Expanding the benefits of maternal benefit schemes targeting the women from the poorest households in the communities is recommended.