Menu
Menu
Menu
Menu
Background: Ethiopia is one of the six countries that contributes’ to more than 50 % of worldwide maternal deaths. While it is revealed that delivery attended by skilled provider at health facility reduced maternal deaths, more than half of all births in Ethiopia takes place at home. According to EDHS 2011 report nine women in every ten deliver at home in Ethiopia. The situation is much worse in southern region. The aim of our study is to measure the prevalence and to identify factors associated with institutional delivery service utilization among childbearing mothers in Cheha District, SNNPR, Ethiopia. Methods: A community based cross sectional survey was conducted in Cheha District from Dec 22, 2012 to Jan 11, 2013. Multistage sampling method was employed and 816 women who gave birth within the past 2years and lived in Cheha district for minimum of one year prior to the survey were involved in the study. Data was entered and analyzed using Epi Info Version 7 and SPSS Version 16. Frequencies and binary logistic regression were done. Factors affecting institutional delivery were determined using multivariate logistic regression. Results: A total of 31 % of women gave birth to their last child at health facility. Place of residence, ability to afford for the whole process to get delivery service at health facility, traveling time that takes to reach to health institution which provides delivery service, husband’s attitude towards institutional delivery, counseling about where to deliver during ANC visit and place of birth of the 2nd youngest child were found to have statistically significant association with institutional delivery. Conclusion: Institutional delivery is low in the study area. Access to health service was found to be the most important predictor of institutional delivery among others. Accessing health facility within reasonable travel time; providing health education and BCC services to husbands and the community at large on importance of using health institution for delivery service; working to improve women’s economic status; counseling women to give birth at health institution during their ANC visit and exploring the overall quality of ANC service are some of the areas where much work is needed to improve institutional delivery.
Cheha District is located in Gurage Zone, Southern Nations Nationalities and Peoples Region (SNNPR)-Ethiopia. Emdebir town the capital city of Cheha District is located 182 Km south west to Addis Ababa. The district has 2 small towns, of which one is the capital city, and 39 rural “kebeles” (smallest administrative units). It has a population of 138,054 out of which 67,094 of them are male and 70, 960 are female. Out of the total population childbearing mothers comprises 23.3 % (32,167). Most people are economically dependent on Agriculture. There is 1 hospital (owned by Faith Based Organization), 6 health centers, 7 clinics and 38 health posts in the district. Initial assessment of health institutions was done in collaboration with the District Health Office; then those institutions that can actually provide safe delivery service, out of the aforementioned health institutions, were identified. Community based cross sectional survey was conducted in Cheha District from December 22, 2012 to January 11, 2013. The source populations were all women of childbearing age (15–49 years) in Cheha District who had experience of at least one birth. The actual study populations were a randomly selected women who had given birth in the past 2 years in Cheha District prior to the survey and who lived at least 1 year in the district prior to the survey. Women who were mentally or physically ill and not capable to be interviewed were excluded from the study. The sample size was calculated using Epi Info version 7. A sample size of 845 was calculated using formula for single population proportion, taking the largest p value, prevalence (P) of delivery attended by skilled personnel which is 10 % for the country, assuming a design effect of 2, a margin of error of 3 % at 95 % confidence interval, and a non-response rate of 10 %. Multistage sampling method with stratification of the district into rural and urban areas was used. From the district’s 39 rural kebeles, 8 rural kebeles were selected randomly and from the two urban areas having 3 kebeles, 2 kebeles’ were randomly selected and included in the study. In the selected kebeles, households having the target were identified by house to house visit (i.e. by census) using 30 health extension workers (high school graduates who undergo one year training program to deliver mainly packages of preventive and health promotion services and few basic curative services). In the census women who gave birth within the past 2 years in Cheha district, and lived a minimum of 1 year in the district, prior to the survey were identified and this was used to randomly select the study subjects. Then sample size was allocated to each urban and rural area proportional to size of the target households, and simple random sampling was applied to get the required households from households having the target. Whenever two or more eligible women were found in the same household only one of them was selected randomly and included in the study. Interviewer administered pre-tested structured questionnaire which was used in previous studies and adapted according to the facts obtained from literature review was employed to collect data. The questionnaire was translated to local languages (Amharic and Guragigna) to facilitate the interview. The data was collected by female nurses who can read and fluently speak both Amharic and Guragigna languages after providing them with a three days of training on objective of the study, techniques of survey interviewing using the questionnaire and on the overall data collection procedures by the principal investigator. Care was taken not to assign the nurse in the catchment kebele of the health institution where they work. In addition, six male supervisors (BSc nurses and BSc in Public Health) were trained on supervision techniques in addition to training on data collection procedures. The training was complemented by practical session. Moreover, Pre – testing of the questionnaire had been conducted in one rural kebele of Eza district which is neighbor to Cheha district, before the actual data collection date, and accordingly correction, such us adjustment of skip points, improvement in translation to local lanquage and other improvements had been made on the final version of the questionnaire. The data was collected in mothers own home at their convenient time. A strong supervision of the data collection process had been carried out by principal investigator and all supervisors. Information were pre coded, the data was checked for errors, and missing values had been dealt with. Categorization was made for those data that were not pre-categorized. Coded data was entered using Epi Info version 7 and was exported to SPSS for Windows version 16 for analysis. Data cleaning, recoding and verification were done accordingly. Frequency and measure of variations were used to describe the study population. Bivariate analysis using logistic regression technique was done to see the association of each independent variables with the outcome variable and crude odds ratio with 95 % CI were computed. Those variables which had a significant association (with p value of less than 0.05) with the outcome variable including the well known confounders were included in multivariate logistic regression model. In doing multivariate logistic regression each independent variables having p value of less than 0.05 in bivariate analysis and the well known confounders were grouped (Group of independent variables include: Socio-demographic variables including access related factors, health care behaviours and cultural factors; obstetric variables including characteristics of ANC service; knowledge and attitude of respondents) and each of these group of independent variables were entered in different blocks in SPSS covariate box and we ran SPSS to see whether or not all those variables which had statistically significant association with the outcome variable in bivariate analysis, maintained their association in the multivariate logistic regression. Adjusted odds ratio with 95 % confidence interval (statistical significance was declared at P < 0.05) was used to show the significance of the association. The results were presented using absolute numbers, proportions, medians, mean, standard deviation, odds ratio and confidence intervals. Tables, figures and graphs were produced. The study was conducted after getting approval of the proposal from ethical review committee of Hawassa University. Written consent was obtained from Gurage Zone Health Department. Involvement into the study was on the basis of an informed consent that was obtained from each respondent, and for those age less than 18 the consent was obtained from the guardian or parents accordingly. Confidentiality was assured by avoiding personal identifier of the data and the data was kept in a secure place by the principal investigator.
N/A
