Menu
Menu
Menu
Menu
Objective This study aimed to analyse the prevalence and factors associated with continuum of maternal healthcare services among women who gave birth in Siyadebirena Wayu district, Central Ethiopia. Design Community-based cross-sectional study. Setting At eight Kebeles in Central Ethiopia. Participants The study was done on 614women aged 15–49 years using interviewer-administered structured questionnaire. Following proportional allocation of the sample, we used simple random sampling technique to select study participants. Methods Binary logistic regression model was fitted to identify the factors associated with the outcome. Variables with p<0.2 in the bivariable analysis were the candidates for multivariable analysis. A p<0.05 and adjusted OR (AOR) with 95% CI were taken to declare the factors and the strengths of association with continuum of maternal healthcare utilisation. Outcome Continuum of maternal healthcare utilisation. Results Only 16.1% (95% CI 13.3% to 19.0%) of the women had used a complete continuum of maternal health services. Variables, such as contraceptive use (AOR 4.95; 95%CI 1.61 to 15.20), autonomy (AOR 4.45; 95%CI 1.69 to 11.60), urban residence (AOR 3.91; 95%CI 1.06 to 14.39), educated women (AOR 5.36; 95%CI 1.15 to 25.06), took less than 30min to reach a health facility (AOR 3.17; 95%CI 1.38 to 7.25), use public transportation (AOR 2.48; 95%CI 1.12 to 5.52) and good knowledge (AOR 9.88; 95%CI 3.89 to 25.0) were positively associated with continuum of maternal healthcare. In the contrary, women who had third child birth order (AOR 0.22; 95%CI 0.06 to 0.8) was negatively associated. Conclusions Overall, the level of the continuum of maternal healthcare services utilisation was low compared with the national and global targets. Therefore, programme planners and implementer had better conduct health education to enhance the awareness of women about continuum of maternal healthcare services. Healthcare sector policy-makers and managers shall also scale up healthcare facilities to improve access to maternal healthcare services.
A community-based cross-sectional study was conducted from 1 February 2020 to 10 March 2020 in Siyadebirena Wayu district which is located in Central Ethiopia. This district borders surrounded by the Oromia Region in the South, Ensaro in the West, Moretna Jiru in the North, and Basona Werana in the East. Based on the 2007 national census conducted by the Central Statistical Agency of Ethiopia, this district has a total population of 61,046, of whom, 31 322 were men and 7.41% were urban inhabitants.25 There are one urban and thirteen rural kebeles in the district. There are 18 healthcare facilities:1 primary hospital, 3 health centres and 14 health posts that provide outpatient service, inpatient service and maternal health service to their catchment population.26 All reproductive age women (15–49 years) in Siyadebirena Wayu district who gave birth 1 year ago from the data collection period were the source population while those women in the selected kebeles of the district were the study population. Those seriously ill women and women who lived less than 6 months in the district during the data collection period were excluded from the study. The sample size was determined using single population proportion formula: n=(Za/2)2P(1−P)d2. Proportion (p=9.7%) of mothers had continuum of maternal healthcare service utilisation in Arbaminch, Ethiopia18; 3% margin of error; 95% confidence level at Z⍺/2 (α=0.05)=1.96; 10% non-response rate and 1.5 design effect were considered for sample size determination. As a result, the final sample size was 620. In the study area, there are one urban and thirteen rural Kebeles. After stratifying into urban and rural areas, 1 and 7 sample kebeles were drawn from urban and rural kebele in the district, respectively, by lottery method (simple random sampling). We used the lists of all eligible women including mothers who gave birth at home from the health posts’ community health information system (CHIS) maternal data on women who gave births from January 2019 to January 2020. In order not to miss women who gave birth at home or those who delivered at health facility but not found in that selected kebeles, health development army leaders were used to identify those mothers in each selected kebeles. Then, simple random sampling technique was used to select the participants after proportional allocation of women to each selected kebele had been made. Continuum of maternal healthcare utilisation was the dependent variable. The independent variables included sociodemographic factors (women’s age, marital status, women’s educational status, husband’s educational status, women’s employment status, husband’s employment status, religion, residence and monthly income), health service accessibility-related factors (membership of health insurance, perceived required time to reach a health facility, perceived distance from the health facility, perceived quality of care, media exposure, autonomy and means of transport), obstetric characteristics (ANC initiation, history of contraceptive use, desire for pregnancy, and birth order), and women’s knowledge-related factors (knowledge towards maternal healthcare and attitude towards maternal healthcare). Continuum of maternal healthcare utilisation was assumed to be completed if a woman had at least four prenatal care visits, skilled delivery, and at least one PNC visit within 6 weeks by skilled health workers.14 18 19 27–29 Knowledge about maternal healthcare was measured by using 12 knowledge measuring items. Accordingly, each item contains (‘1=yes’ and ‘0=no’ alternatives) and those women who scored above 50% of the total knowledge measuring score were considered as having good knowledge.29 Attitude towards maternal healthcare was measured using six attitude measuring items, each containing a five point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree) and those women who scored above 75% of the total attitude measuring scores were considered as having a favourable attitude.29 Media exposure of the women was considered if they had a chance of getting maternal health-related information from any source, such as radio, television (TV), magazine, health professionals, etc.30 Perceived quality of maternal healthcare of the women was measured by using 11-item questions, each containing a five point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree), and those women who scored over 75% of the total quality perception measuring score were considered as having good perception.31 A woman was considered as having decision-making autonomy if she had a power to decide for healthcare needs by herself or with her husband.18 A structured interviewer administered questionnaire was developed through reviewing previous literatures14 16 18 29–34 (online supplemental file 1). The questionnaire was prepared in English and translated to Amharic and back to English to maintain its consistency. The English language questionnaire was translated into the Amharic language by the authors of this research with the help of a language expert. The back-translation of the Amharic version was performed by senior academic staff of the Department of Health Systems and Policy who were not members of the research group and had no information about the original questionnaire. Then, the authors, the language expert and the senior academic staff members met and discussed the translation and back-translation. Finally, the last Amharic version of the questionnaire was prepared for data collection. bmjopen-2021-051148supp001.pdf Seven diploma and seven BSc degree graduate nurses were employed as data collectors and supervisors, respectively. Different measures were taken in order to assure the quality of the data. A 2-day training was given for data collectors and supervisors on the basic techniques of data collection. Pretest was also done in Enewari district on 31 participants to assess the validity, reliability and the clarity of the tools. Necessary modification was also done on unclear questions after the pretest. The result of the reliability test (Cronbach’s alpha) for attitude towards maternal healthcare, knowledge about maternal healthcare, and perceived quality of healthcare was 0.72, 0.81 and 0.8, respectively. Regular monitoring and supervision of the overall activity was done by the supervisors and principal investigator to check the completeness and the quality of data. The data were checked for completeness, cleaned, coded and entered into EPI Data then exported to SPSS V.22 for analysis. Descriptive statistics were done and the result was presented with narrations, tables and graphs based on the nature of the variables. Both bivariable and multivariable logistic regression analyses were done. Model fitness was checked by Hosmer and Lemeshow goodness of test which was p=0.7. Variables having p<0.2 in the bivariable analysis were entered into the multivariable logistic regression analysis to identify the factors significantly associated with the outcome variable. Adjusted OR (AOR) with 95% CI and p<0.05 during the multivariable analysis were used to identify and measure the strength of the association with the outcome variables. The participants had got clear information about the procedures, risks and benefits of the study. In addition, it was also ensured that participants understood the information provided to decide voluntarily whether they want to participate or not. Written informed consent was obtained from each study participant to ensure their voluntariness for participation in this study. Assent from the parents/guardians were taken for participants aged below 18 years. The privacy and confidentiality of the participants were maintained by using anonymity. Before the data collection, we communicated with the district and kebele administrators about the nature of our study. Subsequently, we ensured the full collaboration and cooperation of the district and the local administration. We interviewed the participants after clarifying the benefits and risks of the study and obtaining their permission.
