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Determinants of adolescents reproductive health service utilization in Ethiopia: a systematic review of quantitative evidence.

ABSTRACT: Purpose: Adolescents in Ethiopia face many health problems which emanate from low knowledge and awareness of their reproductive health (RH), though there are additional factors contributing to the problem. Provision of adequate, friendly, and quality RH services to this group of young people is vital to have healthy and productive generation. This systematic review aimed to assemble the top obtainable evidence for the determinants of adolescent RH services utilization in Ethiopia. Methods: Systematic review of literature searches in major databases, MEDLINE, CINAHL, EMBASE, and Popline was conducted. English language articles published from 2010 onwards were sought. Socio-demographic and behavioral related outcomes were our interest. Fixed effect model with mantel Haenszel method was used to conduct meta-analysis using Revman5 software. Records were assessed for eligibility by two independent reviewers, with a third reviewer resolving disagreements. Result: Four community-based cross-sectional studies were included in the review. Results of the meta-analysis showed that adolescents whose educational level was primary were 57% less likely to use RH services than adolescents whose educational level was secondary and above. In-school adolescents were 2.39 more likely to utilize Family Planning services than adolescents who were out-of-school. Moreover, adolescents who ever discussed on RH issues with relatives/family/health workers were 3.63 more likely to utilize the services than adolescents who did not discuss with anyone else. Conclusion: We found adolescents' educational level; schooling status and ever discussion on RH issues were associated with RH service utilization in Ethiopia. Health information/education should be given in a regular manner to adolescents in schools and out of school on the availability and need for RH services. Developing the culture of discussion on RH issues within the community may help adolescents to be aware and utilize the available services.

SUBMITTER: Abraham G

PROVIDER: S-EPMC6489626 | biostudies-other | 2019

REPOSITORIES: biostudies-other

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Determinants of adolescents reproductive health service utilization in Ethiopia: a systematic review of quantitative evidence.

Abraham Gelila G Yitbarek Kiddus K Morankar Sudhakar Narayan SN

Adolescent health, medicine and therapeutics 20190418

<b>Purpose:</b> Adolescents in Ethiopia face many health problems which emanate from low knowledge and awareness of their reproductive health (RH), though there are additional factors contributing to the problem. Provision of adequate, friendly, and quality RH services to this group of young people is vital to have healthy and productive generation. This systematic review aimed to assemble the top obtainable evidence for the determinants of adolescent RH services utilization in Ethiopia. <b>Meth ...[more]

PMID: 31114415

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Project description:BackgroundIn most developing countries, meeting young people's sexual and reproductive health (SRH) needs remains a problem. Despite policy initiatives and strategic measures aimed at increasing youth utilization of sexual and reproductive health services in Ethiopia, its utilization remains very low. Therefore, this study aimed to assess Ethiopia's youth-friendly sexual and reproductive health services' utilisation and determinants.MethodsScopus, Medline, Google Scholar, and CINAHL databases were searched for articles published until March 2021. The pooled prevalence and effect size of youth-friendly sexual and reproductive health service use and associated factors were estimated using a weighted DerSimonian-laird random effect model. The I2 statistics were used to determine the degree of heterogeneity. The funnel plot and Egger's regression test were used to examine publication bias. Subgroup analyses were performed to reduce underlying heterogeneity.ResultsOne thousand one hundred and ninety-one articles were generated from various databases, and a final 26 articles were included in the review, including 16246 participants. Ethiopia's pooled prevalence of youth-friendly sexual and reproductive health service utilization was 42.73 % (95% CI: 35.38-50.09). The findings of this study showed that grade level 11-12, grade level 9-10, close to home sexual and reproductive health services, male sex, and discussion of sexual and reproductive health service with family, friends, and groups, ever experience sexual activity were associated with utilization of youth-friendly sexual and reproductive health services. Maternal educational status secondary school and above, age 15-19 years, age 20-24 years, having ever experienced reproductive problems, living with a partner, living alone, knowing about sexual and reproductive health, having a convenient working hour for youth-friendly service, and participation in a school clubs were also associated with the utilization of youth-friendly sexual and reproductive health services.ConclusionWe found several determinant factors for adolescent and youth utilization of sexual and reproductive health services. The review highlights the importance of improving service usage through youth education and promotion and the scaling up and institutionalizing of youth-friendly services through extensive capacity building.

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: In recent years, much effort was made to improve access to sexual and reproductive health services (SRH) to adolescents and youths in Ethiopia particularly through establishment of youth friendly service (YFS) corners as part of the existing health care facilities. The existing evidences focused on investigating the utilization of SRH services at YFS established areas alone. There is a dearth of evidence which compares the SRH service use between the YFS implemented and non-implemented areas so that evidences can be drawn to suggest on the successes of the expansion of youth friendly corners.Methods: A school-based comparative cross-sectional study was conducted by employing a multistage cluster sampling method. A pre-tested self-administered questionnaire was used to collect data and the collected data were entered in to Epidata version 4.4.1 software and then exported to SPSS version 20 for analysis. ?2 test was used to see a significant difference in SRH service utilization among adolescents from YFS implemented and non-implanted areas. The association between the SRH services utilization and the independent variables were examined using binary logistic regression. Finally, variables having p-value less than or equal to 0.05 in the multivariable logistic regression model were considered as statistically significant.Results: There were a significant difference in the rate of SRH service utilization between YFS implemented (33.8%) and YFS non- implemented (9.9%) areas (?2?=?37.49, p?<?0.001). Higher educational status of mothers (AOR?=?2.588, 95% CI: 1.220, 5.491), having open discussion with family (AOR?=?3.175, 95%CI: 1.624, 6.206), having good knowledge (AOR?=?4.511, 95% CI: 2.458, 8.278) and having positive attitude (AOR?=?5.084, 95% CI: 2.764, 9.352) were factors positively associated with SRH services utilization.Conclusion: Compared with high schools from YFS implemented areas, the SRH service utilization was significantly lower among students from high schools where health facilities did not implement YFS. There is a need for enhancing efforts to establish YFS corners by the stakeholders at different hierarchies at places where the centers were not established so that SRH service uptake would be improved. In addition, it is better to promote open discussion with adolescents at the family level, and emphasis should be given for women education in the broad sense. Furthermore, wide-range awareness creation strategies should be used to address poor knowledge and negative attitude.

Project description:ObjectivesGlobally, twenty-three million adolescents aged 15-19 years have an unmet need for sexual and reproductive health services and are at risk of unintended pregnancy. In Sub-Saharan Africa, including Ethiopia, it might be difficult for adolescents to get access to sexual and reproductive health services that are acceptable to use. Privacy, a fear of sharing health concerns, a sociocultural environment, the unfriendliness of current services, and traditional taboos are some of the key reasons. This study aimed to explore the perspectives of service providers and adolescents on the use of sexual and reproductive health services.MethodologyA qualitative phenomenological study was conducted from January to February 2023 in the Tikur Anbessa specialized hospital. Purposive sampling was applied to select the study participants. A total of 17 in-depth interviews (with 7 adolescents and 10 health providers) were held. Instead of relying on the number of participants, data saturation was used. Thematic analysis was employed in analyzing the data.ResultThe findings indicate that obstacles to the use of sexual and reproductive health services include challenges related to the availability of resources and accessibility; resistance from religious beliefs, cultural beliefs, and customs; quality and institutional-related challenges; and stigma and discrimination in sexual and reproductive health services, which pose the biggest barrier to health professionals providing standardized sexual and reproductive health services.ConclusionA multi-pronged approach should be created to overcome these challenges, including community outreach for sexual and reproductive health and increasing awareness of the importance of early access to sexual and reproductive health through appropriate community forums. Existing sexual and reproductive health services are not promoted to adolescents and youth, and a lack of and difficulty getting resources for sexual and reproductive health services should be resolved.

Project description:BackgroundUtilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. As a result, the extent of their service utilization should be determined before implementing any kind of interventions. Therefore, this study was aimed at assessing the level of reproductive health services utilization and its associated factors among adolescents who live in Debre Berhan town.MethodsA community-based cross-sectional method was employed in this study from April 5-May 1, 2016. A multi-stage systematic sampling technique was applied to select a total of 648 adolescents living in 5 randomly selected kebeles of Debre Berhan town. Moreover, a logistic regression was done to identify independent predictors of reproductive health service utilization.ResultsAccordingly, the major findings of this study reveals that about one-third (33.8%) of adolescents utilized at least one of reproductive health services. Adolescents who had discussed sexual and reproductive health issues with their sexual partner and peers were two times more likely to use reproductive health services than their counter parts (AOR?=?2.368, 95% CI: 1.168-4.802 and AOR?=?2.360, 95% CI: 1.155-4.820 respectively). Adolescents who weren't co-resided with both their parents were also about two times more likely to utilize reproductive health service than those who were living together (AOR?=?2.570, 95% CI?=?1.155-4.820). Positive perception of oneself towards acquisition of Human Immunodeficiency Virus urged the adolescents to use RH services twice than those who didn't perceive themselves as risky (AOR?=?2.231, 95%CI: 1.001-4.975).ConclusionSuccinctly speaking, the analysis of the major finding suggests that the utilization of reproductive health services among adolescents in the study area was low. Discussion with sexual partner and peers, risk perception of oneself towards the acquisition of human immune-deficiency virus was among the predictors of reproductive health services usage.

Project description:BackgroundAlthough studies on the uptake of Adolescent sexual and reproductive health (ASRH) services in Ethiopia have been conducted they have failed to show the disparity in service uptake among rural and urban settings. Once the extent and determinants of ASRH service uptake in urban and rural contexts are known, it will be crucial to provide evidence-based information and recommendations for potential interventions to reduce the burden of disease and disability among adolescents. This study aimed at determining the level of SRH service utilization among urban and rural adolescents in the Guraghe zone, Southern Ethiopia.MethodsA community-based comparative cross-sectional study was undertaken from November 1 -30, 2020. A multi-stage sampling technique was employed and a total of 1083 adolescents (361 from the urban and 722 from the rural areas) were selected randomly to take part in the study. Pre-tested, interviewer-administered, structured questionnaires were used to collect the data. The data were encoded and entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. χ2 test was computed to see a significant difference in SRH service utilization among urban and rural adolescents. In a bivariable logistic regression analysis, a variable with a p-value less than 0.25 has been selected for a multivariable logistic regression model. Variables with p-values less than 0.05 were declared statistically significant in multivariate logistic regression.ResultsA total of 1,075 adolescents (358 from urban and 717 from rural) took part in the study, yielding a response rate of 99.3%. The overall SRH service utilization among the whole adolescents was 39.5% (95%CI: 36.5, 42.4). There was a significant difference in SRH service utilization between urban 56.9% (95%CI: 51.8, 62.1) and rural 30.8% (95%CI: 27.4, 34.2) adolescents (χ2 = 68.3, p < 0.001). Residence[AOR = 2.62; 95%CI:1.63,3.41], availability of youth clubs [AOR = 4.73; 95%CI:3.43,6.53], taking part in peer education [AOR = 2.06; 95%CI:1.48,3.88], having parental discussion [AOR = 3.29; 95%CI:1.73,3.33], and being knowledgeable on SRH issues [AOR = 2.01; 95%CI: 1.45,3.03] were identified as a significant determinants of SRH service uptake. Having parental discussion, geographical accessibility, and knowledge on SRH were significant predictors of SRH service uptake among rural adolescents.ConclusionOverall, ASRH service utilization in the study area was low, despite urban adolescent service uptake becoming higher than rural adolescents. Since the majority of adolescents were enrolled in schools, schools should be an area of intervention to improve adolescents' knowledge of SRH services through mass media, community networks, and interpersonal/group communication. Furthermore, promoting parent-adolescent discussions, as well as peer-to-peer discussions at the family and school level, should be emphasized. Stakeholders in the education and health sectors need to strengthen their efforts to establish youth clubs in places where they do not yet exist, especially in rural schools.

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.

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Determinants of adolescents reproductive health service utilization in Ethiopia: a systematic review of quantitative evidence.

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Determinants of adolescents reproductive health service utilization in Ethiopia: a systematic review of quantitative evidence.

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