Determinants of use of health facility for childbirth in rural Hadiya zone, Southern Ethiopia

  • BMC Pregnancy and Childbirth, Volume 16, No. 1, Year 2016

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Study Justification:
– Maternal mortality is a global public health concern, and facility-based childbirth can help reduce maternal deaths.
– The study aimed to determine the proportion of facility delivery and identify factors influencing the utilization of health facilities for childbirth.
– The findings can inform efforts to improve institutional deliveries and address barriers to accessing healthcare services.
Highlights:
– The study was conducted in two rural districts of Hadiya zone, southern Ethiopia.
– Data from 751 participants showed that 26.9% of deliveries were attended in health facilities.
– Factors associated with facility delivery included maternal age, education, husband’s education, possession of a radio, antenatal care, wealth quintile, and distance from the nearest health facility.
– Efforts to improve institutional deliveries should focus on promoting female education, wealth creation, female empowerment, family planning, and addressing service-related barriers and cultural influences.
Recommendations:
– Strengthen initiatives that promote female education and empowerment.
– Increase opportunities for wealth creation among women.
– Improve access to antenatal care services.
– Address service-related barriers to facility-based childbirth.
– Promote family planning to reduce unplanned pregnancies.
– Evaluate and address cultural influences on the use of health facilities for childbirth.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Regional Health Bureau: Oversees healthcare services in the region.
– District Health Offices: Responsible for healthcare delivery at the district level.
– Health Facility Staff: Provide skilled attendance and emergency obstetric care services.
– Community Health Workers: Promote health education and awareness in the community.
– Non-Governmental Organizations: Support initiatives to improve maternal health.
Cost Items for Planning Recommendations:
– Education Programs: Funding for initiatives to promote female education.
– Economic Empowerment Programs: Investment in programs that create economic opportunities for women.
– Antenatal Care Services: Resources for improving access to quality antenatal care.
– Infrastructure Development: Investment in improving health facility infrastructure and accessibility.
– Family Planning Services: Funding for programs that promote family planning and contraceptive use.
– Cultural Sensitization Programs: Resources for addressing cultural influences on healthcare utilization.
– Training and Capacity Building: Investment in training healthcare providers and community health workers.
– Monitoring and Evaluation: Resources for monitoring and evaluating the impact of interventions.
Please note that the cost items provided are general categories and not actual cost estimates.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional study conducted in two rural districts of Hadiya zone, southern Ethiopia. The study used a stratified random sampling method and collected data from 751 participants. Bivariate analysis and logistic regression were employed to identify determinants of facility-based delivery. The study found that 26.9% of deliveries were attended in health facilities. Factors such as maternal age, education, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy, and place of recent ANC attended were identified as determinants of facility-based childbirth. The study concludes that efforts to improve institutional deliveries in the region should focus on initiatives that promote female education, wealth creation, female empowerment, and increased uptake of family planning. To improve the strength of the evidence, future studies could consider using a longitudinal design to establish causality and include a larger sample size to increase generalizability.

Background: Maternal mortality remains a major global public health concern despite many international efforts. Facility-based childbirth increases access to appropriate skilled attendance and emergency obstetric care services as the vast majority of obstetric complications occur during delivery. The purpose of the study was to determine the proportion of facility delivery and assess factors influencing utilization of health facility for childbirth. Methods: A cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. Participants who delivered within three years of the survey were selected by stratified random sampling. Trained interviewers administered a pre-tested semi-structured questionnaire. We employed bivariate analysis and logistic regression to identify determinants of facility-based delivery. Results: Data from 751 participants showed that 26.9% of deliveries were attended in health facilities. In bivariate analysis, maternal age, education, husband’s level of education, possession of radio, antenatal care, place of recent ANC attended, planned pregnancy, wealth quintile, parity, birth preparedness and complication readiness, being a model family and distance from the nearest health facility were associated with facility delivery. On multiple logistic regression, age, educational status, antenatal care, distance from the nearest health facility, wealth quintile, being a model family, planned pregnancy and place of recent ANC attended were the determinants of facility-based childbirth. Conclusion: Efforts to improve institutional deliveries in the region must strengthen initiatives that promote female education, opportunities for wealth creation, female empowerment and increased uptake of family planning among others. Service related barriers and cultural influences on the use of health facility for childbirth require further evaluation.

A community based cross-sectional study was conducted in two rural districts of Hadiya zone, southern Ethiopia. In the zone, there were 280 Health Posts (HPs), 60 rural Health Centres (HCs) and one hospital serving a population of nearly 1.2 million. Hadiya zone is divided into 11 districts for administrative purposes. The vast majority of the population are Hadiya in ethnic group and they earn their living through rain fed agriculture. The Lemo district has a population of 144, 244 with about 33,176 childbearing women whereas the population of Gombora district is 113, 004 with about 26,330 childbearing women. Lemo district has 7 HCs and 33 HPs while Gombora has 6 HCs and 23 HPs. In both districts each rural kebele (the lowest administrative unit in Ethiopia), has one HP. About 98% of Lemo district and 100% of Gombora district populations are rural dwellers [10, 11]. The study population comprised women who reside in the kebeles selected from the two rural districts (Lemo and Gombora) and had delivered in the last three years preceding the study. The sample size was calculated using single population proportion determination formula; by taking point estimates of institutional childbirth of southern region which was 6.2 [4] Other inputs considered for the sample size determination were: 95% confidence level, design effect (deff) of 2, precision of 2.5% and 5% non-response rate which makes a total of 756 respondents. Stratified random sampling was used to select the study units. Firstly the study areas were divided into two groups; six of which were far (>20 km) from and four that were close (within 5–20 km) to the zonal capital. In order to have a good representation, one district was selected from each group using lottery method. Then all kebeles in the selected districts were grouped into five based on geographical direction, afterwards one kebele was selected from each group. Then enumeration was done in the selected kebeles by going house to house in order to identify eligible mothers (women who had given birth in the last three years preceding the survey; regardless of the current pregnancy status or outcome of the previous pregnancy or place of delivery) and 2,474 women were found to be eligible and all houses were coded. Thereafter, 756 women were randomly selected for the interview using proportional allocation. Regarding weighting a simple balancing was done and each observation had a weight of 1 as all eligible mothers were identified by enumeration and sampling procedure was done carefully. A structured questionnaire was adopted after reviewing relevant studies done previously Additional file 1). The 50-item questionnaires had 5 sections. It was constructed in English language and then translated into Hadiyigna language. Before actual collection of data, a written informed consent was obtained from all respondents after explanation of the purpose, objective, risk and benefit of the study. Also a pre-test was done in similar district in 10% of the respondents which was 75 and necessary corrections were made. The interviews were conducted in a convenient, quiet and private place for the mother. It took 25–40 min to complete the questionnaire. Data were collected by ten trained female data collectors who were High School Teachers and had Bachelor degrees. The questionnaires were checked for consistency and completeness before being entered into EPI data version 3.1 software for cleaning and exploration, and analysed using SPSS version 20.0. The responses concerning the outcome variable, place of delivery were three: health facility, home and on their way to the health facility. We had only two (0.0027%) of respondents who gave birth on their way to the health facility, we found these to be very small to be analysed alone therefore we added them to the home deliveries. Finally, home births were coded zero and health facility deliveries were coded one. We used principal component analysis method to generate wealth quintiles. It was based on household assets, dwelling characteristics, any livestock, agricultural land and others. Planned (a pregnancy which the woman becomes pregnant after intending to be pregnant or a pregnancy which a woman and her partner had discussed and decided in advance) and unplanned pregnancies (a pregnancy which the woman becomes pregnant without intending to or a pregnancy a woman and her partner had not discussed and decided in advance) were among the factors. Summarization was done using percentage, tables, figures and summary statistics. Binary logistic regressions were used to calculate Crude Odds Ratios (COR) for birth in a health facility and 95% Confidence Intervals (CI). Variables which were statistically significant at p < 0.05 on bivariate analysis were entered into multiple logistic regression model. Variables having strong correlation were planned to be excluded from the final model. Parity and place ANC attended were not included in the final model as it had strong correlation with age and numbers of ANC attendances respectively. Odds ratio was adjusted for all other variables. The significance level was set at p-value less than 0.05. The Hosmer-Lemshow goodness-of-fit test was also checked. Ethical approval letter was obtained from South Regional Health Bureau Ethics Committee.

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote areas, providing maternal health services and education to women who may not have easy access to healthcare facilities.

2. Telemedicine: Utilizing telemedicine technology to connect pregnant women in rural areas with healthcare professionals, allowing them to receive prenatal care and consultations remotely.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and support to women in rural areas, bridging the gap between communities and healthcare facilities.

4. Transportation assistance: Establishing transportation programs or subsidies to help pregnant women in rural areas reach healthcare facilities for prenatal care and childbirth, addressing the issue of distance as a barrier to accessing care.

5. Maternal health education programs: Developing and implementing educational programs that focus on maternal health, including topics such as prenatal care, birth preparedness, and recognizing signs of complications, to empower women with knowledge and improve their decision-making regarding healthcare.

6. Financial incentives: Introducing financial incentives, such as cash transfers or vouchers, to encourage pregnant women in rural areas to seek maternal healthcare services, reducing financial barriers to accessing care.

7. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities in rural areas, ensuring they are equipped with the necessary resources and skilled healthcare professionals to provide quality maternal health services.

It is important to note that the specific context and needs of the community should be taken into consideration when implementing any innovation to improve access to maternal health.
AI Innovations Description
Based on the study conducted in rural Hadiya zone, Southern Ethiopia, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Strengthen initiatives that promote female education: Providing education to women can empower them to make informed decisions about their health and seek appropriate maternal healthcare services. This can be done through community-based education programs, scholarships, and awareness campaigns.

2. Create opportunities for wealth creation: Poverty can be a barrier to accessing maternal healthcare services. By creating opportunities for income generation, such as vocational training programs or microfinance initiatives, women can have the financial means to seek healthcare when needed.

3. Empower women: Empowering women to make decisions about their reproductive health can lead to increased uptake of family planning and improved access to maternal healthcare. This can be achieved through women’s empowerment programs, which focus on building self-confidence, decision-making skills, and providing support networks.

4. Improve antenatal care services: Antenatal care plays a crucial role in ensuring a safe and healthy pregnancy. Efforts should be made to improve the quality and accessibility of antenatal care services, including increasing the number of health facilities offering these services, training healthcare providers, and promoting early and regular attendance.

5. Reduce distance barriers: Distance from the nearest health facility was found to be a determinant of facility-based childbirth. Innovations such as mobile health clinics or telemedicine can help overcome geographical barriers and provide access to maternal healthcare services in remote areas.

6. Address cultural influences: Cultural beliefs and practices can influence the use of health facilities for childbirth. It is important to engage with communities and address cultural norms and misconceptions through culturally sensitive health education programs and community dialogues.

By implementing these recommendations, it is possible to develop innovative solutions that improve access to maternal health services in rural areas, ultimately reducing maternal mortality rates and improving the overall health outcomes of women and their children.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Strengthening female education: Promote and invest in educational opportunities for women, as studies have shown that higher levels of education are associated with increased utilization of health facilities for childbirth.

2. Empowering women: Implement programs that empower women and promote gender equality, as empowered women are more likely to make decisions regarding their own healthcare, including choosing to deliver in a health facility.

3. Increasing access to family planning: Improve access to and awareness of family planning services, as planned pregnancies are more likely to result in facility-based deliveries.

4. Enhancing antenatal care services: Strengthen antenatal care services, including increasing the number of visits and improving the quality of care provided, as women who receive adequate antenatal care are more likely to deliver in a health facility.

5. Addressing service-related barriers: Identify and address barriers that prevent women from accessing health facilities for childbirth, such as long distances, lack of transportation, and inadequate infrastructure.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Collect data on the current utilization of health facilities for childbirth, as well as relevant demographic and socioeconomic factors that may influence access to maternal health services.

2. Modeling: Use statistical modeling techniques, such as logistic regression, to identify the determinants of facility-based childbirth. This will help understand the factors that have the greatest impact on access to maternal health services.

3. Scenario development: Based on the identified determinants, develop different scenarios that represent the potential impact of the recommendations. For example, simulate the effect of increasing female education by a certain percentage or improving access to family planning services in specific areas.

4. Data analysis: Analyze the simulated scenarios to estimate the potential increase in facility-based deliveries and assess the impact on access to maternal health services. This can be done by comparing the proportion of facility deliveries in the current situation to the proportion in the simulated scenarios.

5. Evaluation: Evaluate the results of the simulations to determine the most effective recommendations for improving access to maternal health. Consider factors such as feasibility, cost-effectiveness, and sustainability.

6. Implementation: Based on the evaluation, prioritize and implement the recommendations that are most likely to have a significant impact on improving access to maternal health. Monitor and evaluate the implementation to assess the actual impact on access to maternal health services.

By following this methodology, policymakers and healthcare providers can make informed decisions and take targeted actions to improve access to maternal health services in rural areas.

Statistics:
Citations: 21
Authors: 3
Identifiers:
DOI: 10.1186/s12884-016-1151-1
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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