Reproductive health service utilization and associated factors among adolescents (15-19 years old) in Gondar town, Northwest Ethiopia

BMC Health Services Research, Volume 13, No. 1, Year 2013

Interpretation

Background: The utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6. Methods. A community based cross-sectional study was conducted from April 5-19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15-19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization. Results: Out of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family-relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio AOR = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV-AIDS. Conclusions: The majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization. © 2013 Feleke et al.; licensee BioMed Central Ltd. A community based cross-sectional study was conducted in Gondar town, Northwest Ethiopia from April 5–19, 2012. Gondar town is found in North Gondar Zone of the Amhara Regional State, 750 km Northwest of Addis Ababa. According to the 2007 Ethiopian census report, Gondar had a total population of 206,987, and adolescents aged 15–19 years were estimated to be 12% (25,128) of the total population [9]. The town is divided into 12 administrative areas. The participants of this study were adolescents 15–19 years old who had lived in the area for at least six months. The sample size was determined by using the single population proportion formula with the following assumptions: 17.6% proportion [10], 95% confidence level, 3% margin of error and design effect of 2. Then five percent was added for the expected non-response, making the final sample size 1300. From the 12 administrative areas of Gondar town, 4 were randomly selected. The sample allocated was proportional to the household size of each administrative area. The first household from each administrative area was identified using the lottery method, and then the systematic random sampling technique was applied to identify the next household to be included. Adolescents who were found in the selected households were interviewed. In the case of more than one eligible participant in the household, the lottery method was used to select one. In households in which adolescents were not at home, but it was known that there were eligible adolescents for the study, the interviewers revisited the household at three different time intervals, and when interviewers failed to meet the adolescent, the household was excluded from the survey and replaced by the next household in a clockwise direction. A structured questionnaire was developed and administered to the participants. The questionnaire and consent documents were first developed in English, then translated into Amharic, and finally retranslated into English by another translator to check consistency. Before the actual work, data collectors and supervisors were given intensive training for two days about the aim of the study, procedures and data collection techniques by going through the questionnaire question by question. After the training, interviewers pre-tested the questionnaire on 78 (6%) people living in an administrative area not selected for the study. The following operational definitions were used: Reproductive health services particularly considered in this study were FP and VCT services. FP service utilization was defined as ever use of any modern contraceptives in life time, and VCT service utilization referred to ever utilization of VCT service for HIV testing. Duration of sexual relationship was defined as number of months from first sexual intercourse to the last sexual intercourse. Type of sexual relationship reflects whether adolescents ever had a romantic relationship in their sexual experience or not. Data were checked for completeness and entered into EPI INFO version 3.5.3 statistical software and then exported to SPSS version 20 for further analysis. Multiple logistic regression was used to identify variables independently associated with service utilization. The strength of association was interpreted using the adjusted odds ratio and 95% CI. The criterion for statistical significance was set at a p value of 0.05. Ethical clearance was obtained from the Institution Review Board of the Institute of Public Health, the University of Gondar. Formal letters of cooperation were written to different kebele administrators. Oral consent was obtained either from parents or surrogate and participants. Moreover, the adolescents were assured that neither the interviewer nor their parents would have access to their responses. Confidentiality was assured by using anonymous questions and by conducting the interviews privately throughout.

AI Digest

Study Justification:

– The utilization of reproductive health services is important in preventing adolescents from sexual and reproductive health problems.
– Ethiopia has a high proportion of new HIV infections and maternal and infant mortality ratios, making reproductive health service utilization crucial.
– Assessing adolescent reproductive health service utilization contributes to achieving national Millennium Development Goals.

Highlights:

– 79.5% of adolescents utilized family planning (FP) services and 72.2% utilized voluntary counseling and testing (VCT) services.
– Among sexually experienced adolescents, 68.1% utilized contraceptive methods and 88.4% utilized VCT services during their first sexual encounter.
– Factors associated with FP service utilization included educational status, discussion with family-relatives, peer groups, sexual partners, and teachers.
– Factors associated with VCT service utilization included secondary education and above, schooling attendance, co-residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV-AIDS.

Recommendations for Lay Reader and Policy Maker:

– Building life skills, facilitating parent-to-child communication, establishing and strengthening youth centers, and school reproductive health clubs are important steps to improve adolescents’ reproductive health service utilization.

Key Role Players:

– Government health departments
– Non-governmental organizations (NGOs)
– Schools and educational institutions
– Parents and guardians
– Health workers and counselors
– Peer educators

Cost Items for Planning Recommendations:

– Training and capacity building for health workers and counselors
– Development and distribution of educational materials
– Establishment and maintenance of youth centers and school reproductive health clubs
– Awareness campaigns and community outreach programs
– Monitoring and evaluation activities
– Research and data collection
– Collaboration and coordination efforts between stakeholders

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study conducted in Gondar town, Northwest Ethiopia. The study used a structured questionnaire and interviewed 1290 adolescents aged 15-19. The data was analyzed using statistical software and logistic regression was done to identify factors associated with family planning (FP) and voluntary counseling and testing (VCT) service utilization. The study found that 79.5% and 72.2% of the participants utilized FP and VCT services, respectively. The study also identified several factors associated with service utilization. However, the evidence is limited to a specific population and time period, and the study design does not allow for causal conclusions. To improve the evidence, future research could consider using a longitudinal design to assess changes in service utilization over time and include a more diverse sample to enhance generalizability.

Abstract

A community based cross-sectional study was conducted in Gondar town, Northwest Ethiopia from April 5–19, 2012. Gondar town is found in North Gondar Zone of the Amhara Regional State, 750 km Northwest of Addis Ababa. According to the 2007 Ethiopian census report, Gondar had a total population of 206,987, and adolescents aged 15–19 years were estimated to be 12% (25,128) of the total population [9]. The town is divided into 12 administrative areas. The participants of this study were adolescents 15–19 years old who had lived in the area for at least six months. The sample size was determined by using the single population proportion formula with the following assumptions: 17.6% proportion [10], 95% confidence level, 3% margin of error and design effect of 2. Then five percent was added for the expected non-response, making the final sample size 1300. From the 12 administrative areas of Gondar town, 4 were randomly selected. The sample allocated was proportional to the household size of each administrative area. The first household from each administrative area was identified using the lottery method, and then the systematic random sampling technique was applied to identify the next household to be included. Adolescents who were found in the selected households were interviewed. In the case of more than one eligible participant in the household, the lottery method was used to select one. In households in which adolescents were not at home, but it was known that there were eligible adolescents for the study, the interviewers revisited the household at three different time intervals, and when interviewers failed to meet the adolescent, the household was excluded from the survey and replaced by the next household in a clockwise direction. A structured questionnaire was developed and administered to the participants. The questionnaire and consent documents were first developed in English, then translated into Amharic, and finally retranslated into English by another translator to check consistency. Before the actual work, data collectors and supervisors were given intensive training for two days about the aim of the study, procedures and data collection techniques by going through the questionnaire question by question. After the training, interviewers pre-tested the questionnaire on 78 (6%) people living in an administrative area not selected for the study. The following operational definitions were used: Reproductive health services particularly considered in this study were FP and VCT services. FP service utilization was defined as ever use of any modern contraceptives in life time, and VCT service utilization referred to ever utilization of VCT service for HIV testing. Duration of sexual relationship was defined as number of months from first sexual intercourse to the last sexual intercourse. Type of sexual relationship reflects whether adolescents ever had a romantic relationship in their sexual experience or not. Data were checked for completeness and entered into EPI INFO version 3.5.3 statistical software and then exported to SPSS version 20 for further analysis. Multiple logistic regression was used to identify variables independently associated with service utilization. The strength of association was interpreted using the adjusted odds ratio and 95% CI. The criterion for statistical significance was set at a p value of 0.05. Ethical clearance was obtained from the Institution Review Board of the Institute of Public Health, the University of Gondar. Formal letters of cooperation were written to different kebele administrators. Oral consent was obtained either from parents or surrogate and participants. Moreover, the adolescents were assured that neither the interviewer nor their parents would have access to their responses. Confidentiality was assured by using anonymous questions and by conducting the interviews privately throughout.

Materials

N/A

Innovations

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

1. Mobile health (mHealth) interventions: Utilize mobile phones and other digital technologies to provide information, reminders, and support to pregnant women and new mothers. This could include text message reminders for prenatal appointments, educational videos or apps on maternal health topics, and virtual consultations with healthcare providers.

2. Community health worker programs: Train and deploy community health workers to provide maternal health services and education in remote or underserved areas. These workers can provide antenatal care, assist with deliveries, and offer postnatal support and counseling.

3. Telemedicine: Use telecommunication technologies to connect pregnant women in rural areas with healthcare providers in urban centers. This allows for remote consultations, monitoring, and diagnosis, reducing the need for travel and improving access to specialized care.

4. Maternal health clinics: Establish dedicated clinics or centers that focus specifically on maternal health services. These clinics can provide comprehensive antenatal care, delivery services, postnatal care, and family planning services in one location, making it easier for women to access the care they need.

5. Financial incentives: Implement financial incentives or subsidies to encourage pregnant women to seek and utilize maternal health services. This could include providing vouchers for free or discounted prenatal care visits, transportation allowances, or cash transfers for completing recommended antenatal and postnatal visits.

6. Public-private partnerships: Collaborate with private sector organizations, such as pharmaceutical companies or technology companies, to improve access to maternal health services. This could involve providing free or discounted medications, medical supplies, or technology solutions to healthcare facilities or community health workers.

7. Maternal health education programs: Develop and implement educational programs that focus on maternal health topics, targeting both adolescents and adults. These programs can provide information on pregnancy, childbirth, breastfeeding, and postnatal care, as well as promote healthy behaviors and practices.

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

The study conducted in Gondar town, Northwest Ethiopia aimed to assess the utilization of reproductive health services among adolescents aged 15-19 years old. The study found that the majority of adolescents in the area were utilizing family planning (FP) and voluntary counseling and testing (VCT) services. However, among sexually experienced adolescents, the utilization of FP at first sexual intercourse and VCT services was found to be low.

The study identified several factors associated with the utilization of FP and VCT services. These factors included educational status, schooling attendance, discussion of services with family, relatives, peer groups, sexual partners, and teachers. Additionally, adolescents who had a romantic sexual relationship and those whose last sexual relationship was long-term were more likely to utilize FP services.

Based on the findings of the study, the researchers recommended several strategies to improve adolescents’ reproductive health service utilization. These strategies include building life skills, facilitating parent-to-child communication, establishing and strengthening youth centers, and school reproductive health clubs.

It is important to note that the study was conducted in a specific area of Ethiopia and may not be generalizable to other contexts. However, the findings and recommendations can serve as a starting point for further research and the development of innovative approaches to improve access to maternal health services for adolescents.

AI Innovations Methodology

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

1. Increase awareness and education: Implement comprehensive reproductive health education programs targeting adolescents in schools and communities. This can include information on family planning, contraception, sexually transmitted infections, and the importance of prenatal care.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of reproductive health services by increasing the number of healthcare facilities, particularly in rural areas. This can involve establishing maternal health clinics, training healthcare providers, and ensuring the availability of essential medical supplies and equipment.

3. Enhance community engagement: Engage community leaders, parents, and other stakeholders to promote the importance of maternal health and encourage community support for pregnant women. This can involve community outreach programs, support groups, and partnerships with local organizations.

4. Improve affordability and financial support: Address financial barriers by implementing policies that provide financial support for maternal health services, such as subsidizing healthcare costs, providing health insurance coverage, or implementing conditional cash transfer programs for pregnant women.

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

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of pregnant women receiving prenatal care, the percentage of births attended by skilled healthcare providers, or the percentage of women using modern contraception.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, or analysis of existing data sources.

3. Introduce the recommendations: Implement the recommended interventions or policies aimed at improving access to maternal health services. This can be done gradually or in specific target areas to assess the impact.

4. Monitor and evaluate: Continuously monitor the selected indicators to assess any changes or improvements over time. This can involve collecting data at regular intervals, conducting surveys or interviews, and analyzing the data using statistical methods.

5. Compare and analyze data: Compare the baseline data with the data collected after implementing the recommendations to determine the impact on access to maternal health services. This can involve statistical analysis to identify any significant changes or trends.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any challenges or barriers that may have affected the outcomes and make recommendations for further improvements.

It is important to note that the specific methodology may vary depending on the context and resources available. It is recommended to involve relevant stakeholders, such as healthcare providers, policymakers, and community members, in the design and implementation of the methodology to ensure its relevance and effectiveness.

Author

Dima Health

Statistics:

Citations: 49

Identifiers:

DOI: 10.1186/1472-6963-13-294

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, 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, Grounded Theory

Study Approach:

Quantitative