Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia: a triangulated community-based cross-sectional study

  • Reproductive Health, Volume 14, No. 1, Year 2017

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Study Justification:
– Regular utilization of maternal health care services reduces maternal morbidity and mortality.
– Understanding the factors associated with maternal health care seeking behavior can help improve service utilization and outcomes.
– This study aimed to assess the maternal health care seeking behavior and associated factors among women in rural villages of Haramaya district, East Ethiopia.
Highlights:
– Maternal health care service seeking behavior was found to be low in the study area.
– Factors such as educational status, birth order, and knowledge about pregnancy complications were significantly associated with maternal health care service seeking behavior.
– Focused health education and supportive counseling from health care providers were recommended to improve maternal health care seeking behaviors.
Recommendations for Lay Reader:
– Women in rural villages of Haramaya district, East Ethiopia have low utilization of maternal health care services.
– Education, birth order, and knowledge about pregnancy complications were found to be important factors influencing maternal health care seeking behavior.
– Providing focused health education and supportive counseling can help improve maternal health care seeking behaviors.
Recommendations for Policy Maker:
– Develop and implement targeted health education programs to improve awareness and knowledge about maternal health care services among women in rural areas.
– Train health care providers to provide kind and supportive counseling to encourage women to seek maternal health care services.
– Strengthen the availability and accessibility of maternal health care services in rural villages of Haramaya district.
– Allocate resources for the implementation of the recommended interventions.
Key Role Players:
– Ministry of Health: Responsible for policy development and coordination of maternal health care services.
– District Health Bureau: Responsible for implementing and monitoring maternal health care services at the district level.
– Health care providers: Responsible for delivering maternal health care services and providing counseling to women.
– Community leaders and local organizations: Engage in community mobilization and awareness campaigns to promote maternal health care seeking behavior.
Cost Items for Planning Recommendations:
– Development and printing of educational materials: Brochures, posters, and pamphlets to be distributed to women in rural villages.
– Training programs for health care providers: Workshops and seminars to enhance their counseling skills.
– Infrastructure improvement: Upgrading health facilities and ensuring availability of necessary equipment and supplies.
– Community mobilization activities: Organizing community meetings, awareness campaigns, and outreach programs.
– Monitoring and evaluation: Establishing systems to monitor the implementation and impact of the interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides specific data on maternal health care service seeking behaviors and associated factors in a rural area of Eastern Ethiopia. The study design is a community-based cross-sectional study supplemented with qualitative data, which adds depth to the findings. The sample size is adequate, and statistical analysis was conducted to identify associated factors. However, the abstract could be improved by providing more details on the methodology, such as the sampling technique used and the specific data collection tools. Additionally, it would be helpful to include information on the limitations of the study and suggestions for future research.

Background: Regular utilization of maternal health care services reduces maternal morbidity and mortality. This study assessed the maternal health care seeking behavior and associated factors of reproductive age women in rural villages of Haramaya district, East Ethiopia. Methods: Community based cross sectional study supplemented with qualitative data was conducted in Haramaya district from November 15 to Decemeber 30, 2015. A total of 561 women in reproductive age group and who gave birth in the last 2 years were randomly included. Bivariate and multivariate logistic regressions model was used to identify the associated factors. Odds ratios with 95% CI were used to measure the strength of association. Result: Maternal health care service seeking of women was found as; antenatal care 74.3% (95% CI; 72.5, 76.14), attending institutional delivery 28.7% (95% CI; 26.8, 30.6) and postnatal care 22.6% (95% CI; 20.84, 24.36). Knowledge of pregnancy complications, Educational status, and religion of women were found to be significantly associated with antenatal health care, delivery and postnatal health care service seeking behaviours triangulated with individual, institutional and socio-cultural qualitative data. Conclusion: The maternal health care service seeking behavior of women in the study area was low. Educational status of the women, birth order and knowledge about pregnancy complications were the major factors associated with maternal health care service seeking behavior Focused health education with kind and supportive health care provider counseling will improve the maternal health care seeking behaviors of women.

Community based cross sectional study supplemented with qualitative data was carried out from November 15 to Decemeber 30, 2015 in Haramaya district, Eastern Ethiopia. The study was conducted rural part of Haramaya district. The disrtict is found 505 km east of Addis Ababa, the capital of Ethiopia (Fig. 1). According to the information obtained from the district health bureau, the total population of the district was 271,394 of whom 138,376 were men and 133,018 were female. Among all the residents, 50,986 of them live in urban whereas the remaining 220,408 are residing in rural part of the district [21]. There were 34 Kebeles (the smallest administrative units) and of these 33 of the kebeles are rural. As to the health service facilities in the district; there were one district hospital, seven health centers, 34 health posts providing health care services. Rural districts of Haramaya, 2015 The study population included all women who gave birth in the last 2 years and residing in the rural villages of Haramaya district for at least 6 months. The sample size was 561 women which were determined by single population proportion formula considering the multistage sampling technique. A two stage sampling technique was employed to select respondents for the study. First, eight rural kebeles were selected randomly from 33 rural kebeles. The number of women who gave birth in the last 2 years was obtained from health posts record in each kebele. Then, proportional to number of mothers who gave birth in the last 2 years, the respondents were chosen from each kebele using random sampling method for the quantitative data. To supplement the quantitative data, FGD was conducted with three groups each consisting of 9–12 rural women and in-depth interview was done with ten maternal health care service providers. Purposive sampling was used to select discussant women considering variability in age, time gave birth and social status. All women in FGD were not part of the quantitative study. Key informants for the in-depth interview were selected purposefully based on their involvement in maternal health care service provision. The outcome variable was maternal health care seeking behaviour (antenatal, delivery and postnatal care). Whereas, Socio-economic and demographic related characteristics, access to maternal health care services, perceived quality of maternal health care services were taken as independent variables. Maternal health- health of women during pregnancy, childbirth and the postpartum period. Maternal death- death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Maternal morbidity- any injury, condition or symptom on women that resulted from or worsened by pregnancy. Maternal health care seeking behaviour- utilization of maternal health care services (antenatal, delivery and postnatal care). Antenatal care- the care received from healthcare professionals during pregnancy at least once. Institutional delivery -delivery in public or private hospitals, clinics and health centers, attended by skilled attendants (midwifery, nurses, doctors, health officers). Postnatal care- health care for the mother from immediately after the birth until around 6 weeks by health professionals. A structured and pretested questionnaire was used to collect the quantitative data via face to face interview technique. The questionnaire was adopted after reviewing different literature. The questionnaire was prepared in English and translated to the local language, Oromiffa, and then back to English by two different individuals to check the consistency. Twelve diploma holder nurses who were fluent in speaking Afan Oromo supervised by two BSc nurse and the investigator were involved in the data collection. Data collectors interview women at their households using structured questionnaires and interview guide. Focus group discussions were conducted at nearby village gathering areas with FGD checklist and tape recorder. In order to ensure the quality of the data training was given to the data collectors and supervisors on basic skills, ways of obtaining consents and objectives of the study by the principal invigilator. Pretest was done for 5% of sample size in unselected kebeles. Definition of concepts and terms were made clear with a common language of the district to avoid ambiguity. The principal investigator did on-site supervision during the data collection period and review all filled questionnaires during the next morning of each data collection so as to identify incomplete and incoherent responses. Each completed questionnaire was checked for completeness before data entry. Then the data were coded and entered in to a computer by using EPI Info version 7 and then data were exported to SPSS version 20 for analysis. Descriptive statistics were carried out to describe the study participants according to different characteristics and proportions were also computed. Binary logistic regression models were fitted to each; ANC, place of delivery and PNC to identify associated factors. Odds ratios with their 95% confidence interval (CI) were used to determine the strength and significance of association. P value less than 0.05 was considered as a level of significance. The qualitative data were analyzed with thematic analysis.

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

1. Mobile health clinics: Implementing mobile health clinics that travel to rural villages in Haramaya district could provide convenient access to maternal health care services for women who may have limited transportation options.

2. Telemedicine: Introducing telemedicine services could allow women in rural areas to consult with healthcare professionals remotely, reducing the need for them to travel long distances to access maternal health care.

3. Community health workers: Training and deploying community health workers in rural villages could help increase awareness about the importance of maternal health care and provide basic services such as antenatal and postnatal care.

4. Health education programs: Developing and implementing targeted health education programs that focus on maternal health could help improve knowledge and understanding among women in rural areas, encouraging them to seek appropriate care during pregnancy and childbirth.

5. Financial incentives: Introducing financial incentives, such as subsidies or cash transfers, for women who utilize maternal health care services could help overcome financial barriers and encourage more women to seek care.

6. Improving infrastructure: Investing in the improvement of healthcare infrastructure in rural areas, such as building more health centers and ensuring they are well-equipped, could enhance access to maternal health care services.

7. Partnerships with local organizations: Collaborating with local organizations, such as women’s groups or community-based organizations, could help raise awareness about maternal health and facilitate access to care through community outreach programs.

These are just a few potential innovations that could be considered to improve access to maternal health in the rural villages of Haramaya district. It is important to assess the feasibility and effectiveness of these innovations in the local context before implementing them.
AI Innovations Description
Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Implement targeted health education programs: Develop and implement focused health education programs that specifically target women in rural areas of Haramaya district. These programs should aim to increase awareness and knowledge about the importance of maternal health care services, including antenatal care, institutional delivery, and postnatal care. The education programs should be delivered by kind and supportive health care providers who can provide counseling and address any concerns or misconceptions.

2. Strengthen community-based maternal health care services: Improve access to maternal health care services by strengthening the existing community-based health care facilities in rural villages of Haramaya district. This can be done by increasing the number of health centers and health posts, as well as ensuring that these facilities are adequately staffed with skilled attendants, such as midwives, nurses, doctors, and health officers.

3. Enhance transportation infrastructure: Address the transportation challenges faced by women in rural areas by improving the transportation infrastructure. This can include building and maintaining roads, providing reliable public transportation options, and ensuring that ambulances are available for emergency situations. By improving transportation options, women will have better access to health care facilities for antenatal care, institutional delivery, and postnatal care.

4. Increase community engagement and involvement: Engage the community in the development and implementation of maternal health care programs. This can be done through community meetings, focus group discussions, and involvement of community leaders and influencers. By involving the community, there will be increased ownership and support for the programs, leading to improved access to maternal health care services.

5. Strengthen data collection and monitoring systems: Establish robust data collection and monitoring systems to track the utilization of maternal health care services and identify any gaps or challenges. This will enable health authorities to make informed decisions and allocate resources effectively to areas with the greatest need. Regular monitoring and evaluation of the programs will also help identify areas for improvement and ensure that the recommended innovations are having the desired impact.

By implementing these recommendations, it is expected that access to maternal health care services in rural villages of Haramaya district will be improved, leading to a reduction in maternal morbidity and mortality rates.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Strengthening Health Education: Implement focused health education programs that target women in rural areas, providing them with information about the importance of maternal health care services and the potential risks associated with not seeking care. This can be done through community health workers, local health centers, and mobile health clinics.

2. Improving Infrastructure: Invest in improving the infrastructure of health facilities in rural areas, including the construction and renovation of health centers and hospitals. This will ensure that women have access to quality maternal health care services closer to their homes, reducing the need for long and costly journeys.

3. Increasing Availability of Skilled Birth Attendants: Train and deploy more skilled birth attendants, such as midwives and nurses, to rural areas. This will ensure that women have access to skilled care during childbirth, reducing the risk of complications and improving maternal and neonatal outcomes.

4. Addressing Socio-cultural Barriers: Conduct community engagement activities to address socio-cultural barriers that prevent women from seeking maternal health care services. This can include working with community leaders, religious leaders, and traditional birth attendants to promote the importance of maternal health care and dispel myths and misconceptions.

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

1. Define the indicators: Identify key indicators that measure access to maternal health care, such as the percentage of women receiving antenatal care, institutional delivery, and postnatal care.

2. Collect baseline data: Gather data on the current status of access to maternal health care in the target area. This can be done through surveys, interviews, and data from health facilities.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should consider factors such as population size, geographical distribution, and existing health infrastructure.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to estimate the potential impact of the recommendations on improving access to maternal health care. This can be done by adjusting the parameters related to the recommendations, such as the number of health education sessions conducted or the increase in skilled birth attendants.

5. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on the selected indicators. This can be done by comparing the baseline data with the simulated data and calculating the percentage change or improvement.

6. Validate the model: Validate the simulation model by comparing the simulated results with real-world data, if available. This will help ensure the accuracy and reliability of the model.

7. Refine and iterate: Based on the results and feedback from stakeholders, refine the simulation model and iterate the process to further improve the accuracy and effectiveness of the recommendations.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health care and make informed decisions on resource allocation and implementation strategies.


Statistics:
Citations: 54
Identifiers:
DOI: 10.1186/s12978-016-0270-5
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Violence and Injury, Workforce
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Male & Female
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