Predictors of institutional delivery in Sodo town, Southern Ethiopia

  • African Journal of Primary Health Care and Family Medicine, Volume 5, No. 1, Year 2013

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Study Justification:
– The study aims to investigate the prevalence and predictors of institutional delivery in Sodo town, Southern Ethiopia.
– This is important because women are more likely to die during or following delivery than during pregnancy, and the use of delivery services and post-partum care is low.
– Understanding the factors that influence institutional delivery can help inform interventions and policies to improve maternal healthcare and reduce maternal mortality.
Study Highlights:
– The prevalence of institutional delivery-service utilization in Sodo town was found to be 62.2%.
– Factors such as husband’s educational status, parity, number of antenatal clinic visits, perceived quality of care, and knowledge regarding pregnancy danger signs were identified as independent predictors of institutional delivery utilization.
– The study suggests that promoting antenatal care, involving men in maternal healthcare, providing health education on pregnancy danger signs, and improving service quality are recommended to sustain or improve the current level of utilization in the town.
Study Recommendations:
– Promote antenatal care: Encourage pregnant women to attend regular antenatal clinic visits to ensure proper monitoring of their health and the health of their unborn child.
– Involve men in maternal healthcare: Engage husbands and partners in the decision-making process and encourage their support and involvement in maternal healthcare.
– Provide health education on pregnancy danger signs: Educate women and their families about the signs and symptoms of potential complications during pregnancy and delivery, so they can seek timely medical care.
– Improve service quality: Enhance the quality of care provided at healthcare facilities by addressing issues such as staff training, infrastructure, and availability of necessary equipment and supplies.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies and programs related to maternal healthcare.
– Local government authorities: Involved in allocating resources and coordinating efforts to improve maternal healthcare services.
– Healthcare providers: Including doctors, nurses, midwives, and other healthcare professionals who play a crucial role in delivering quality maternal healthcare services.
– Community leaders and organizations: Engaged in raising awareness, advocating for improved maternal healthcare, and mobilizing community support.
Cost Items for Planning Recommendations:
– Training and capacity building: Budget for training healthcare providers on best practices in maternal healthcare and improving service quality.
– Infrastructure improvement: Allocate funds for renovating and equipping healthcare facilities to ensure they meet the necessary standards for safe delivery.
– Health education materials: Develop and distribute educational materials on pregnancy danger signs and the importance of antenatal care.
– Community outreach programs: Allocate resources for community engagement activities, such as awareness campaigns and community health workers.
– Monitoring and evaluation: Set aside funds for monitoring and evaluating the implementation and impact of the recommended interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study employed a cross-sectional design and a multistage sampling scheme, which increases the generalizability of the findings. The sample size of 844 participants is adequate for the study objectives. The study also used binary- and multiple logistic regressions to identify predictors of institutional delivery. However, the study does not provide information on the validity and reliability of the measurement tools used, and there is no mention of any ethical considerations or limitations of the study. To improve the strength of the evidence, future studies could consider including information on the validity and reliability of measurement tools, addressing ethical considerations, and discussing any limitations of the study.

Background: Women are more liable to die during or following delivery than during pregnancy but use of both delivery services and post-partum care is low. Objective: To find out the prevalence and predictors of institutional delivery in Wolaita Sodo (Sodo) town, southern Ethiopia. Methods: A cross-sectional study was used to look at 844 women who had given birth in the previous five years in Sodo town. The study employed a multistage-sampling scheme. Codes were given for all identified women in selected kebeles (neighbourhoods) and a simple randomsampling technique was used after generating random numbers using the Statistical Package for Social Sciences (SPSS). SPSS was then used to carry out binary- and multiple logistic regressions. A 95% CI for the odds ratio was applied to judge the presence of relationships between variables. Results: The prevalence of institutional delivery-service utilisation in Sodo town was 62.2%. Husband educational status, parity, number of antenatal clinic visits, perceived quality of care and knowledge regarding pregnancy danger signs were independent predictors of utilisation of institutional delivery services. Conclusion: Institutional delivery service utilisation in Sodo town was much higher than the national figure. Findings in this study showed that promotion of antenatal care, involvement of men in maternal healthcare, provision of health education regarding the danger signs of pregnancy and improvement of service quality are recommended in order to sustain or even improve the current level of utilisation in the town.

The source population was all women of child-bearing age who had given birth during the previous five years in Sodo town. The study population included selected women of reproductive age group who had given birth at least once during the previous five years. The number of study participants was estimated by applying a single population proportion formula with the following assumptions: α = the risk of rejecting the null hypothesis (0.05), d = degree of precision or margin of error, Z = the standard score corresponding to a 95% confidence interval and p = 50% (the proportion of institutional deliveries).8 The final sample size was obtained after adding 10% to compensate for possible non-response and multiplying the result by a factor of two for design effect, resulting in a sample size of 844. The study employed a multistage sampling scheme. First, approximately 40% (four out of 11 kebeles) of the town were selected randomly to conduct a census for the identification of mothers who met the study criteria. This generated a sample frame comprising 1573 women. The probability of being included in the sample was equal for all the women in the sample frame since random numbers generated using SPSS version 16 were applied in order to identify the study participants. The women who were included in the sample were interviewed at home, using a questionnaire administered in Wolaitigna (the local language). A cross-sectional study design was used in Sodo town, which is 327 km south of Addis Ababa, the capital city. In the town there are two hospitals (private and government), three health centres, seven private clinics, three pharmacies and eight drug vendors. A pre-tested interviewer-administered structured questionnaire adapted from the Ethiopian Demography and Health Survey (EDHS) tool and related theses was used.4, 9, 10 Scales combining multiple items were used in order to measure perceived access to and quality of care at the nearest health facility. Data were checked for completeness and then coded and entered in to EpiData version 3.5.3. The data were then exported into SPSS version 16 for further analysis. Variables with significant association during bivariate analyses were entered into multiple logistic-regression models so as to control for possible confounding effects of the variables and to identify the independent predictors of institutional delivery. The strength of association was estimated by calculating the odds ratios (OR) with 95% confidence intervals (CI). A p-value of < 0.05 was taken as being of statistical significance for all analyses.

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Innovation 1: Mobile Antenatal Care Outreach Program
Develop a mobile antenatal care outreach program that brings healthcare services directly to pregnant women in rural areas. This program can include a mobile clinic equipped with medical professionals and necessary equipment to provide antenatal check-ups, education, and counseling. The mobile clinic can travel to different communities on a regular schedule, ensuring that pregnant women have access to quality antenatal care regardless of their location.

Innovation 2: Male Involvement Campaign
Create a targeted campaign to engage men in maternal healthcare. This can include community workshops, educational materials, and awareness campaigns that emphasize the importance of men’s involvement in supporting their partners during pregnancy and childbirth. The campaign can also provide information on the benefits of institutional delivery and encourage men to accompany their partners to healthcare facilities for antenatal check-ups and delivery.

Innovation 3: Pregnancy Danger Signs Mobile App
Develop a mobile application that provides information on pregnancy danger signs and when to seek immediate medical attention. The app can be easily accessible and user-friendly, providing clear and concise information in the local language. It can also include features such as reminders for antenatal check-ups and emergency contact numbers for healthcare providers. This innovation can empower women and their families with knowledge to recognize potential complications and seek timely medical care.

Innovation 4: Quality Improvement Program
Implement a quality improvement program in healthcare facilities to address gaps in infrastructure, equipment, and healthcare provider training. This program can involve regular monitoring and evaluation of healthcare services, feedback mechanisms from patients, and continuous professional development programs for healthcare providers. By improving the quality of care, women will be more likely to choose institutional delivery and have confidence in the healthcare system.

These innovations aim to improve access to maternal health services by addressing key predictors identified in the study. By promoting antenatal care, involving men, providing health education, and improving the quality of care, it is expected that the utilization of institutional delivery services will increase, leading to better maternal health outcomes in the community.
AI Innovations Description
Based on the research findings from the study titled “Predictors of institutional delivery in Sodo town, Southern Ethiopia,” the following recommendations can be developed into an innovation to improve access to maternal health:

1. Promote antenatal care: Increase awareness and encourage pregnant women to attend regular antenatal check-ups. This can be done through community outreach programs, health education campaigns, and partnerships with local healthcare providers.

2. Involve men in maternal healthcare: Engage men in the process of maternal healthcare by educating them about the importance of institutional delivery and encouraging their support and involvement. This can be achieved through targeted educational programs and community sensitization initiatives.

3. Provide health education regarding pregnancy danger signs: Educate women and their families about the warning signs and symptoms during pregnancy that require immediate medical attention. This can be done through the distribution of informational materials, community workshops, and training sessions for healthcare providers.

4. Improve the quality of care: Enhance the quality of maternal healthcare services by addressing gaps in infrastructure, equipment, and healthcare provider training. This can be achieved through investments in healthcare facilities, regular monitoring and evaluation, and continuous professional development programs for healthcare providers.

By implementing these recommendations, it is expected that the utilization of institutional delivery services will be sustained or even improved, leading to better access to maternal health services and ultimately reducing maternal mortality rates in the community.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Identify the target population: Define the population of interest, which in this case would be women of child-bearing age who have given birth in the previous five years in Sodo town, Southern Ethiopia.

2. Determine the sample size: Calculate the required sample size using appropriate statistical methods, taking into account the desired level of confidence, margin of error, and expected proportion of institutional deliveries.

3. Sampling technique: Use a multistage sampling scheme to randomly select a representative sample of women from the target population. This can involve selecting kebeles (neighborhoods) within Sodo town and randomly selecting women from each kebele.

4. Data collection: Develop a structured questionnaire based on the recommendations identified in the study. The questionnaire should include questions related to antenatal care attendance, involvement of men in maternal healthcare, knowledge of pregnancy danger signs, and perceived quality of care. Administer the questionnaire to the selected women through face-to-face interviews conducted in the local language.

5. Data analysis: Code and enter the collected data into a statistical software program, such as SPSS. Conduct descriptive analysis to summarize the characteristics of the study population and calculate the prevalence of institutional delivery utilization. Perform bivariate analysis to identify associations between the predictors and institutional delivery utilization. Enter significant variables into multiple logistic regression models to determine the independent predictors of institutional delivery utilization.

6. Simulate the impact: Based on the identified independent predictors, develop scenarios that simulate the impact of implementing the recommendations on improving access to maternal health. For example, simulate the increase in institutional delivery utilization by promoting antenatal care, involving men in maternal healthcare, providing health education on pregnancy danger signs, and improving service quality. Calculate the expected changes in utilization rates and compare them to the baseline prevalence.

7. Evaluate the results: Analyze the simulated impact and assess the effectiveness of the recommendations in improving access to maternal health. Compare the simulated results with the findings from the original study to validate the impact of the recommendations.

By following this methodology, researchers can simulate the potential impact of the recommendations on improving access to maternal health in Sodo town, Southern Ethiopia. This can help inform policymakers and healthcare providers about the potential benefits of implementing these recommendations and guide decision-making for improving maternal healthcare services.


Statistics:
Citations: 20
Identifiers:
DOI: 10.4102/phcfm.v5i1.544
ISSN: 20712928
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Ethiopia
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Male & Female
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