Pastoralism and antenatal care service utilization in Dubti District, Afar, Ethiopia, 2015: A cross-sectional study

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Study Justification:
– Health service utilization among pastoralists in Ethiopia is not well documented.
– Available data are very few and institution-based.
– Health services are inadequate, poorly equipped, scarce, inaccessible, and inappropriate to the pastoralist way of life.
– Effective antenatal care (ANC) use has been shown to influence women’s use of maternal health services, which is crucial in reducing maternal mortality.
– Studies on ANC service utilization among pastoralist women are almost negligible.
Study Highlights:
– A community cross-sectional study was conducted in Dubti District, Afar, Ethiopia.
– Data was collected through interviews using a questionnaire.
– Of the 788 women surveyed, 42.4% made at least one ANC visit, while only 19.5% had adequately utilized ANC (four or more visits).
– Only 9.7% of women visited an ANC center during the first trimester.
– Institutional delivery service utilization in the district was extremely low at 7.4%.
– Educational status of the mother had a significant association with institutional delivery.
– ANC utilization in peri-urban areas was two times higher than in rural areas.
– Factors positively associated with ANC service utilization were peri-urban residence and possession of radio/TV.
Recommendations for Lay Reader and Policy Maker:
– Every pregnant woman should receive at least four ANC visits, but only 20% of the respondents fulfilled this recommendation.
– Pastoralist lifestyles, access, demographic, and socio-cultural barriers affect proper utilization of maternal health services.
– Increasing service coverage and promotion of available services in the community is necessary.
– Accessible health services, transportation, and improved information, education, and communication on maternal health services must be intensified.
– Rigorous efforts are needed to reach disadvantaged groups and overcome health inequities between agrarian and disadvantaged pastoralist women.
Key Role Players:
– Ministry of Health
– Regional Health Bureau
– District Health Office
– Health Extension Workers
– Community Health Workers
– Non-Governmental Organizations (NGOs)
– Community leaders and elders
– Women’s associations and groups
Cost Items for Planning Recommendations:
– Training and capacity building for health workers
– Infrastructure development and improvement of health facilities
– Provision of medical equipment and supplies
– Outreach programs and mobile health services
– Transportation for pregnant women to access health services
– Information, education, and communication materials
– Community engagement and awareness campaigns
– Monitoring and evaluation of program implementation

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides quantitative data on the utilization of antenatal care (ANC) services among pastoralist women in Afar Region, Ethiopia. The study used a community cross-sectional design and collected data through interviews using a questionnaire. The sample size was relatively large (788 women). The study found that 42.4% of women made at least one ANC visit, while only 19.5% had adequately utilized ANC (four or more visits). The study also identified factors associated with ANC utilization, such as educational status and residence. However, the study did not provide information on the representativeness of the sample or the response rate. Additionally, the abstract does not mention the specific statistical analyses conducted or the limitations of the study. To improve the strength of the evidence, future research should aim for a more representative sample, report response rates, provide more details on statistical analyses, and acknowledge study limitations.

Health service utilization among pastoralists in Ethiopia is not well documented. Available data are very few and institution-based. Health services are particularly inadequate and poorly equipped, being scarce, inaccessible, and inappropriate to the pastoralist way of life. Effective antenatal care (ANC) use has been shown to influence women’s use of maternal health services, probably the most effective intervention in reducing maternal mortality in the developing world. Despite many studies done on ANC service utilization among agrarian women, the studies done on pastoralist women are almost negligible. Therefore, this study assesses utilization of ANC services among pastoralists of Afar Region, Ethiopia. A community cross-sectional study was carried out from 5 January to 5 February, 2015. The data was collected by interviews through a questionnaire. Statistical analyses were done to describe pertinent findings. Of 788 women, 42.4 % (334) made at least one ANC visit, while 19.5 % (65) had adequately utilized ANC (i.e. made four or more ANC visits). Only 9.7 % of women visited an ANC centre during the first trimester (12 weeks). Institutional delivery service utilization of the district was extremely low at 7.4 % (58). Educational status of the mother had a significant association with institutional delivery. Mothers who attended college/university were five times more likely to utilize delivery service than those mothers who are illiterate. ANC utilization in peri-urban areas was two times more than ANC utilization in rural areas with CI of 1.376, 3.595. Multivariate analyses, being in peri-urban residence (adjusted odds ratio (AOR) = 2.224; 95 % CI 1.38, 3.60), possessing radio/TV (AOR = 3.134; 95 % CI 2.204, 4.457), were positively associated with ANC service utilization. Every pregnant woman should receive at least four ANC visits, but only 20 % of the respondents were able to fulfil the recommendation. Pastoralist lifestyles, access, demographic, and socio-cultural barriers affect proper utilization of maternal health services. Increasing service coverage and promotion of available services in the community, accessible health services, transportation and improving information, education, and communication on maternal health services must be intensified to reach women in pastoralist communities of the country. Rigorous efforts are needed to reach disadvantaged groups so as to overcome health inequities between agrarian and disadvantaged pastoralist women.

Based on the information provided, here are some potential innovations that could improve access to maternal health for pastoralist women in Afar, Ethiopia:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote pastoralist communities, providing antenatal care services directly to women in their own communities.

2. Telemedicine: Using telecommunication technology to connect pastoralist women with healthcare professionals, allowing them to receive antenatal care consultations and advice remotely.

3. Community health workers: Training and deploying community health workers who are familiar with the pastoralist way of life and can provide culturally appropriate antenatal care services within the communities.

4. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns specifically tailored to pastoralist women, addressing their unique cultural beliefs and practices related to maternal health.

5. Improving transportation infrastructure: Investing in transportation infrastructure to improve access to healthcare facilities for pastoralist women, ensuring they can easily reach ANC centers and delivery services.

6. Strengthening ANC centers: Upgrading and equipping ANC centers in pastoralist areas to provide comprehensive and high-quality antenatal care services, including necessary medical equipment and trained healthcare professionals.

7. Empowering women through education: Promoting education among pastoralist women, as studies have shown that higher educational status is associated with increased utilization of maternal health services.

8. Partnerships with local communities: Collaborating with local community leaders and traditional birth attendants to raise awareness about the importance of antenatal care and encourage women to seek these services.

9. Integrating traditional practices: Incorporating traditional practices and beliefs into the provision of antenatal care services, ensuring that they are culturally sensitive and acceptable to pastoralist women.

10. Strengthening referral systems: Establishing effective referral systems between pastoralist communities and higher-level healthcare facilities, ensuring that women can access emergency obstetric care when needed.

These innovations aim to address the specific challenges faced by pastoralist women in accessing maternal health services and promote equitable and effective care for this underserved population.
AI Innovations Description
Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Mobile Antenatal Care (ANC) Clinics: Develop and implement mobile ANC clinics that can reach pastoralist communities in remote areas. These clinics can be equipped with necessary medical equipment and staffed with healthcare professionals who can provide ANC services to pregnant women. By bringing the services closer to the communities, it will increase access and utilization of ANC services among pastoralist women.

2. Community Health Workers: Train and deploy community health workers within pastoralist communities to provide education and promote the importance of ANC services. These community health workers can conduct home visits, organize community meetings, and provide information on the benefits of ANC and institutional delivery. They can also assist in arranging transportation for pregnant women to access ANC centers.

3. Telemedicine and Teleconsultation: Utilize telemedicine and teleconsultation technologies to connect pregnant women in pastoralist communities with healthcare professionals in urban areas. This can enable remote consultations, advice, and monitoring of pregnant women’s health during the antenatal period. It can also facilitate referrals to appropriate healthcare facilities when necessary.

4. Health Education and Communication: Develop targeted health education and communication campaigns specifically tailored to the pastoralist communities. These campaigns should address the cultural and socio-economic barriers that hinder ANC utilization. Information should be provided in local languages and through various channels such as radio, television, and community gatherings.

5. Strengthening Health Infrastructure: Improve the availability and accessibility of health facilities in pastoralist areas by investing in infrastructure development. This includes constructing and equipping health centers and maternity clinics, ensuring a sufficient supply of essential medicines and equipment, and training healthcare professionals to provide quality ANC services.

6. Partnerships and Collaborations: Foster partnerships and collaborations between government agencies, non-governmental organizations, and community-based organizations to collectively address the challenges faced by pastoralist women in accessing maternal health services. This can involve joint initiatives to improve transportation systems, establish referral networks, and provide financial support for ANC services.

By implementing these recommendations, it is expected that access to maternal health services, particularly ANC, can be improved among pastoralist women in Ethiopia, ultimately reducing maternal mortality and improving maternal and child health outcomes.
AI Innovations Methodology
To improve access to maternal health for pastoralist women in Afar, Ethiopia, the following innovations and recommendations can be considered:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote pastoralist communities, providing antenatal care services directly to women in their own environment. These clinics can be equipped with necessary medical equipment and staffed by healthcare professionals who can provide essential antenatal care services.

2. Community health workers: Training and deploying community health workers within pastoralist communities to provide education, support, and basic antenatal care services. These community health workers can act as a bridge between the community and formal healthcare facilities, ensuring that women receive the necessary care and information.

3. Telemedicine: Utilizing telemedicine technology to connect pastoralist women with healthcare professionals remotely. This can include virtual consultations, remote monitoring of vital signs, and access to educational resources. Telemedicine can help overcome geographical barriers and improve access to specialized care.

4. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns within pastoralist communities to increase knowledge and understanding of the importance of antenatal care. These campaigns can address cultural beliefs, myths, and misconceptions surrounding maternal health, and promote the benefits of seeking timely and regular care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Baseline data collection: Gather data on the current utilization of antenatal care services among pastoralist women in the target area. This can include information on the number of ANC visits, institutional delivery rates, and demographic characteristics.

2. Intervention implementation: Implement the recommended innovations, such as mobile health clinics, community health workers, telemedicine, and health education campaigns, within the target area. Ensure proper training and resources are provided to support the interventions.

3. Data monitoring and collection: Continuously monitor and collect data on the utilization of antenatal care services after the implementation of the interventions. This can include tracking the number of ANC visits, institutional delivery rates, and changes in demographic characteristics.

4. Comparative analysis: Compare the data collected post-intervention with the baseline data to assess the impact of the recommendations on improving access to maternal health. Analyze the changes in ANC utilization rates, institutional delivery rates, and demographic characteristics to determine the effectiveness of the interventions.

5. Evaluation and adjustment: Evaluate the results of the simulation and make adjustments to the interventions as needed. Identify any barriers or challenges that may have affected the outcomes and develop strategies to address them.

By following this methodology, it will be possible to simulate the impact of the recommended innovations on improving access to maternal health for pastoralist women in Afar, Ethiopia. This will help inform future interventions and policies aimed at reducing maternal mortality and improving maternal health outcomes in the region.

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