Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study

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

Interpretation

Background: Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Regional State, Ethiopia. Methods: A community-based cross-sectional study design was employed among 703 randomly identified mothers of Abuna Gindeberet district in March, 2013. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were used to determine prevalence and to identify associated factors with institutional delivery and postnatal care, considering p-value of less than 0.05 as significant. The results were presented in a narrative forms, tables and graphs. Results: One hundred one (14.4 %) of mothers gave birth to their last baby in health institutions. From 556 (79.1 %) of respondents who heard about postnatal care services, only 223 (31.7 %) of them utilized postnatal care services for their recent childbirth. From the total postnatal care users, 204 (91.5 %) of them took the services from health extension workers. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were found to be statistically significant with both institutional delivery and postnatal care services utilizations. But educational status of husbands was statistically significant with only postnatal care services utilizations. Conclusions: Both institutional delivery and postnatal care services utilizations from health institutions were low. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were the common factors that affect institutional delivery and postnatal care services utilizations from health institutions. Therefore, giving attention to the identified factors could improve and sustain institutional delivery and postnatal care services utilizations from health institutions. A community-based cross-sectional study was conducted among 703 women who gave birth in the last 12 months in Abuna Gindeberet district, West Shewa Zone, Oromiya Regional State in March 2013. The district had 42 rural sub-districts from which 14 of them randomly selected. The rationale behind selecting 14 sub-districts over 42 is to include representative sample which mean in some literature of world health organization (WHO), the sample must be between 30 and 50 % of total population. Therefore, we tried to include one-third of the total population [7]. In each selected sub-districts, households with under 1-year children identified through census and sampling frame was developed. Finally, study subjects were addressed through simple random sampling by using sampling frame developed from conducted census data [8]. The sample was determined using single population proportion formula with an assumption of level of confidence of the study 95 %, sampling error tolerated 5 % and proportion of institutional delivery care services utilization (P) 50 % used. Design effect of 1.7 and a non-response rate of 10 % were also considered. Design effect 1.5 to 2 is enough in cross sectional study which done in multistage sampling. Depending on the population under study whether the community is homogeneous or heterogeneous we can use starting from 1.5 to 2 design effect. If we consider the community is heterogeneous, we can use design effect 2. Again, if we consider the community is homogeneous, we can use design effect 1.5 [9, 10]. According to this, in this study the rural dispersed population is our study. Even though, they are dispersed population, all of them are rural. Two things considered in this condition, being all of them rural makes them homogeneous population and being dispersed population makes them heterogeneous population. Therefore, since these two conditions were present, we used design effect averagely or in middle of the range (because we can use starting from 1.5 up to 2 depending on condition of the population). Postnatal care: the services given to a mother for a period of 6 weeks from the time of delivery in their previous delivery from health institutions. Decision making style: It is the ways of determining and control over resources when women should seek health care services. The style may be both husband and wife decides together or separately by individual. Model family: is a family that applied all health extension packages at their home and got certificates of appreciations from health extension workers. Structured questionnaires, which address the objectives of the study, were adapted from pertinent literatures [11–13, 15–17, 18–20]. The questionnaires translated into the local language – Afan Oromo and retranslated to English. Pre-test was done on 5 % of the sample size in sub districts (kebeles) different from those selected sub-districts for the study before actual data collections. House to house, data collection was made through interviewer-administered questionnaires. Data entered into Epidata version 3.1 and exported to SPSS version 16.0 for analysis. Descriptive analysis was done to determine the prevalence of institutional delivery care services and postnatal care services utilizations. Binary and multiple logistic regression analyses by backward conditional method were used to identify associated factors with institutional delivery care services and postnatal care services utilizations. Variables that had p-value of less than 0.05 by binary logistic regression were included in the multiple logistic regression analysis. A p-value of 0.05 was used as cutoff point to identify statistically significant variables.

AI Digest

Study Justification:

– Delivery at health institutions and utilization of postnatal care services are important for promoting child survival and reducing maternal mortality.
– More than 80% of maternal deaths can be prevented with access to essential maternity care services.
– This study aimed to assess the utilization of institutional delivery and postnatal care services in Abuna Gindeberet District, Ethiopia.

Highlights:

– Only 14.4% of mothers gave birth to their last baby in health institutions.
– Among those who heard about postnatal care services, only 31.7% utilized them for their recent childbirth.
– The majority of postnatal care users (91.5%) received services from health extension workers.
– Factors such as decision-making styles, household distances from health institutions, household being a model family, and ANC services utilization were found to be statistically significant for both institutional delivery and postnatal care services utilization.

Recommendations:

– Improve access to and utilization of institutional delivery and postnatal care services.
– Address factors such as decision-making styles, household distances from health institutions, household being a model family, and ANC services utilization.
– Provide training and support for health extension workers to deliver postnatal care services effectively.

Key Role Players:

– Health extension workers
– Trained health-care providers
– Community health workers
– Local government authorities
– Non-governmental organizations (NGOs) working in maternal and child health

Cost Items for Planning Recommendations:

– Training programs for health extension workers and other health-care providers
– Infrastructure development to improve access to health institutions
– Outreach programs to raise awareness and educate communities about the importance of institutional delivery and postnatal care services
– Monitoring and evaluation activities to assess the impact of interventions and ensure quality of services

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which allows for the collection of data from a representative sample. The sample size of 703 women is relatively large, increasing the reliability of the findings. The study also used structured questionnaires adapted from relevant literature and conducted a pre-test to ensure data quality. However, the study was conducted in 2013, and the publication is from 2016, which may raise questions about the relevance of the findings to the current context. Additionally, the abstract does not provide information on the response rate, which could affect the generalizability of the results. To improve the strength of the evidence, future studies could consider conducting a more recent assessment and providing information on the response rate.

Abstract

A community-based cross-sectional study was conducted among 703 women who gave birth in the last 12 months in Abuna Gindeberet district, West Shewa Zone, Oromiya Regional State in March 2013. The district had 42 rural sub-districts from which 14 of them randomly selected. The rationale behind selecting 14 sub-districts over 42 is to include representative sample which mean in some literature of world health organization (WHO), the sample must be between 30 and 50 % of total population. Therefore, we tried to include one-third of the total population [7]. In each selected sub-districts, households with under 1-year children identified through census and sampling frame was developed. Finally, study subjects were addressed through simple random sampling by using sampling frame developed from conducted census data [8]. The sample was determined using single population proportion formula with an assumption of level of confidence of the study 95 %, sampling error tolerated 5 % and proportion of institutional delivery care services utilization (P) 50 % used. Design effect of 1.7 and a non-response rate of 10 % were also considered. Design effect 1.5 to 2 is enough in cross sectional study which done in multistage sampling. Depending on the population under study whether the community is homogeneous or heterogeneous we can use starting from 1.5 to 2 design effect. If we consider the community is heterogeneous, we can use design effect 2. Again, if we consider the community is homogeneous, we can use design effect 1.5 [9, 10]. According to this, in this study the rural dispersed population is our study. Even though, they are dispersed population, all of them are rural. Two things considered in this condition, being all of them rural makes them homogeneous population and being dispersed population makes them heterogeneous population. Therefore, since these two conditions were present, we used design effect averagely or in middle of the range (because we can use starting from 1.5 up to 2 depending on condition of the population). Postnatal care: the services given to a mother for a period of 6 weeks from the time of delivery in their previous delivery from health institutions. Decision making style: It is the ways of determining and control over resources when women should seek health care services. The style may be both husband and wife decides together or separately by individual. Model family: is a family that applied all health extension packages at their home and got certificates of appreciations from health extension workers. Structured questionnaires, which address the objectives of the study, were adapted from pertinent literatures [11–13, 15–17, 18–20]. The questionnaires translated into the local language – Afan Oromo and retranslated to English. Pre-test was done on 5 % of the sample size in sub districts (kebeles) different from those selected sub-districts for the study before actual data collections. House to house, data collection was made through interviewer-administered questionnaires. Data entered into Epidata version 3.1 and exported to SPSS version 16.0 for analysis. Descriptive analysis was done to determine the prevalence of institutional delivery care services and postnatal care services utilizations. Binary and multiple logistic regression analyses by backward conditional method were used to identify associated factors with institutional delivery care services and postnatal care services utilizations. Variables that had p-value of less than 0.05 by binary logistic regression were included in the multiple logistic regression analysis. A p-value of 0.05 was used as cutoff point to identify statistically significant variables.

Materials

N/A

Innovations

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 travel to rural areas, providing antenatal care, institutional delivery, and postnatal care services. This would help overcome the challenge of long distances to health institutions.

2. Telemedicine: Introducing telemedicine services that allow pregnant women in remote areas to consult with healthcare providers through video calls or phone calls. This would enable them to receive medical advice and guidance without having to travel long distances.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, including antenatal care and postnatal care, in rural areas. This would increase access to care for women who may not have easy access to health facilities.

4. Awareness campaigns: Conducting community-wide awareness campaigns to educate women and their families about the importance of institutional delivery and postnatal care services. This would help address any cultural or social barriers that may prevent women from seeking these services.

5. Financial incentives: Providing financial incentives, such as cash transfers or vouchers, to encourage women to seek institutional delivery and postnatal care services. This would help offset any financial barriers that may prevent women from accessing these services.

6. Improving infrastructure: Investing in the improvement of health facilities, including the availability of trained healthcare providers, medical equipment, and essential supplies for maternal health services. This would ensure that women receive quality care when they do access health institutions.

It is important to note that the specific context and needs of the community should be considered when implementing these innovations.

AI Innovations Description

The study conducted in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia aimed to assess the utilization of institutional delivery and postnatal care services. The results showed that both institutional delivery and postnatal care services utilization from health institutions were low. Factors such as decision-making styles, household distances from health institutions, household being a model family, and ANC services utilization were found to be statistically significant in affecting the utilization of both institutional delivery and postnatal care services.

Based on these findings, the following recommendations can be developed into innovations to improve access to maternal health:

1. Improve decision-making styles: Promote joint decision-making between husbands and wives regarding seeking health care services. This can be achieved through community education programs that emphasize the importance of involving both partners in maternal health decisions.

2. Increase accessibility of health institutions: Reduce the distance between households and health institutions by establishing more health facilities or mobile health clinics in rural areas. This will make it easier for pregnant women to access institutional delivery and postnatal care services.

3. Promote model families: Encourage households to become model families by implementing all health extension packages at their homes. This can be done through incentives and recognition programs that provide certificates of appreciation to families who adhere to recommended health practices.

4. Strengthen ANC services utilization: Enhance the utilization of antenatal care (ANC) services by raising awareness about the benefits of ANC visits and providing incentives for pregnant women to attend regular check-ups. This can be achieved through community outreach programs and collaborations with local health workers.

By implementing these recommendations, it is possible to improve and sustain the utilization of institutional delivery and postnatal care services, ultimately reducing maternal mortality and promoting child survival.

AI Innovations Methodology

To improve access to maternal health in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia, the following innovations and recommendations can be considered:

1. Mobile Health Clinics: Implementing mobile health clinics that travel to remote areas of the district can provide essential maternal health services, including antenatal care, institutional delivery, and postnatal care. These clinics can be equipped with trained health-care providers and necessary medical equipment to ensure quality care.

2. Telemedicine: Introducing telemedicine services can enable pregnant women in remote areas to access medical consultations and advice from healthcare professionals without the need for physical travel. This can help address the issue of long distances from health institutions and improve access to timely and accurate information.

3. Community Health Workers: Expanding the role of community health workers (CHWs) can help increase access to maternal health services. CHWs can be trained to provide basic antenatal and postnatal care, conduct health education sessions, and refer women to health institutions when necessary. This can help bridge the gap between communities and health facilities.

4. Awareness Campaigns: Conducting targeted awareness campaigns to educate women and their families about the importance of institutional delivery and postnatal care services can help increase utilization. These campaigns can address cultural beliefs, misconceptions, and barriers that prevent women from seeking 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: Collect data on the current utilization of institutional delivery and postnatal care services in the district. This can be done through surveys, interviews, or existing data sources.

2. Define Key Indicators: Identify key indicators that will be used to measure the impact of the recommendations. This can include the percentage of women accessing antenatal care, institutional delivery, and postnatal care services.

3. Develop a Simulation Model: Create a simulation model that incorporates the recommendations and their potential impact on the key indicators. This model can be based on historical data, expert opinions, and evidence from similar interventions in other settings.

4. Input Data and Parameters: Input relevant data and parameters into the simulation model, such as the number of mobile health clinics, the coverage of telemedicine services, the number of trained community health workers, and the reach of awareness campaigns.

5. Run Simulations: Run multiple simulations using different scenarios and assumptions to assess the potential impact of the recommendations on improving access to maternal health. This can help identify the most effective combination of interventions.

6. Analyze Results: Analyze the results of the simulations to determine the projected changes in the key indicators. This can include the percentage increase in institutional delivery and postnatal care service utilization.

7. Validate and Refine: Validate the simulation results by comparing them with real-world data and feedback from stakeholders. Refine the simulation model and assumptions based on this feedback.

8. Recommendations and Implementation: Use the simulation results to inform recommendations for improving access to maternal health. These recommendations can guide the implementation of the identified interventions and monitor their impact over time.

By following this methodology, policymakers and healthcare providers can make informed decisions on how to allocate resources and implement interventions that will have the greatest impact on improving access to maternal health in Abuna Gindeberet District.

Author

Dima Health

Statistics:

Citations: 31

Identifiers:

DOI: 10.1186/s12884-016-0940-x

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory, Narrative Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female