Factors in maternal healthcare service utilization in Ethiopia

다국어 초록 (Multilingual Abstract)

Background: Ethiopia is among the sub-Saharan African countries with the highest maternal mortalities. According to a study by Tiruneh et al. (2022) the maternal mortality ratio (MMR) was 401/100,000 LBs in 2017. The most maternal deaths result from preventable causes and modifiable factors. The Optimal utilization of antenatal-care, institutional delivery and postnatal care services is a pivotal intervention in substantially reducing these deaths through early problem identification and management, the promotion of health-seeking behavior, preparation of pregnant women for birth, provision of safe and clean delivery, and monitoring of maternal health during 42 days after delivery. The aim of this study was to assess the prevalence of the three major maternal healthcare services utilization and associated factors among Ethiopian mothers in the child-bearing age in 2019.
Method: Secondary data analysis was performed based on the Ethiopian mini-demographic and health survey 2019. The survey design was stratified, two-stage cluster sampling. The analysis was restricted to antenatal care, institutional delivery and postnatal care service utilization among women in the age group15-49 years who delivered at least one live child in the previous five years at the survey date. Descriptive statistics, Chi-square tests and binomial logistic regression were performed. Odds ratios with 95% confidence interval was calculated, while p-value less than 0.05 was used to determine statistically significant associations among the independent and outcome variables.
Result: Prevalence of Antenatal Care, Institutional Delivery and Postnatal Care services utilization rates were: 73.8% [95% CI: 72.4, 75.1], 11.7% [95% CI: 10.7, 12.8], and 53.7% [95% CI: 52.12, 55.24], respectively. The utilization of Antenatal Care, Institutional Delivery and Postnatal Care services were significantly associated with the educational status, media exposure (Radio, Television), region of residence, and skilled healthcare providers. Age of the woman, religion and residence type (urban/rural) are shared determinants of Antenatal Care and Institutional Delivery service utilization, whereas Antenatal Care attendance and frequency of Antenatal Care visits are common significant influencers of Institutional Delivery and Postnatal Care service utilization among the study participants.
Conclusion: The utilization rates for Antenatal Care, Institutional Delivery and Postnatal Care services were substantially low. Educational status, media exposure (Radio, Television), region of residence, and skilled healthcare provider were factors significantly associated with all the three components of maternal and child health. Therefore, maternal health-related, policies, strategies, and plans should be designed and approached in a comprehensive, integrated, multi-sectorial and collaborative manner. The common factors associated with the main maternity-services utilization and socioeconomically less privileged regions should be accorded first priority in maternal-healthcare intervention plans in Ethiopia.
Key Words: Maternal Mortality Ratio, Antenatal Care, Institutional Delivery, Postnatal Care, Service Utilization, Ethiopia, Associated Factors.

목차 (Table of Contents)

• Acknowledgements
• List of tables
• List of Figures
• Acronyms and Abbreviations
• Abstract
• CHAPTER 1. INTRODUCTION
• 1.1 Background/ Statement of the Problem
• 1.2 Purpose of the Study
• 1.3 Definition of Terms
• CHAPTER 2. LITERATURE REVIEW
• 2.1 Overview of Maternal Healthcare Service in Ethiopia
• 2.2 Individual (Maternal) Factors in Maternity Healthcare Service Utilization
• 2.3 Environmental Factors in Maternity Healthcare Service Utilization
• 2.4 Health-System Factors (Healthcare Providers)
• CHAPTER 3. CONCEPTUAL FRAMEWORK
• CHAPTER 4. METHODS
• 4.1 Study Design
• 4.2 Research Period
• 4.3 Study Participants
• 4.4 Inclusion Criteria
• 4.5 Exclusion Criteria
• 4.6 Study Setting
• 4.7 Data Source and Collecting Process
• 4.8 Statistical Analysis and calculations
• 4.9 Ethical Approval
• 4.10 Expected Benefits
• 4.11 Potential Risks
• CHAPTER 5. RESULTS
• 5.1 General Characteristics of the Study Participants
• 5.2 Individual/Maternal Factors
• 5.3 Environmental Factors
• 5.4 Health-System Factors
• 5.5 ANC-, PNC-, and FD-/ID-Services Utilization Rates
• 5.6 The Differences by Maternal, Environmental and Health-System Variables of the Three Major Maternity Healthcare Service Utilization
• 5.6.1 Maternity Healthcare Service Utilization Differences by Maternal Factors
• 5.6.2 Service Utilization Differences by Environmental Factors
• 5.6.3 Differences in Service Utilization by Health-System Factors
• 5.7 The Association between Maternal, Environmental and Health-System Factors and Maternity service Utilization
• 5.7.1 Maternal Factors and Maternity service utilization
• 5.7.2 Environmental Factors and Maternity Healthcare service Use
• 5.7.3 Health-System Factors (Healthcare Provider)
• CHAPTER 6. DISCUSSION
• 6.1 Maternity Healthcare-Service Utilization Rates
• 6.2 Maternal Factors in Maternity Healthcare Service Utilization
• 6.3 Environmental Factors in Maternal Health Service Utilization
• 6.4 Health-System Factors Associated with Maternity Health service Utilization
• CHAPTER 7. CONCLUSION AND RECOMMENDATION
• 7.1 Key Findings
• 7.2 Strengths and Limitations of the study
• 7.2.1 Strengths
• 7.2.2 Limitations
• 7.3 Recommendations
• 7.4 Conclusion
• References
• Appendix 1 Table of Evidence (TOE)
• Appendix 2 Letter of Data Access Approval