Delivery Site Preferences and Associated Factors among Married Women of Child Bearing Age in Bench Maji Zone, Ethiopia

Ethiopian journal of health sciences, Volume 26, No. 1, Year 2016

Interpretation

BACKGROUND: Efforts to reduce maternal mortality and morbidity must address societal and cultural factors that affect women’s health and their access to services. There was no research conducted previously on delivery site preferences and associated factors among married women of child bearing age in the study area. The aim of this study was to assess the delivery site preferences and associated factors among women of child bearing age in Bench Maji Zone, Southwest Ethiopia. Study area and design: A community based cross sectional quantitative study design supplemented by qualitative data was used to assess delivery site preferences among married women of reproductive age group in Bench Maji Zone from April 20 to May 20, 2013. Bench Maji Zone is located in Southern Nation Nationality Regional State (SNNP), Southwest Ethiopia, around 565km away from the capital city, Addis Ababa, with its center, Mizan Teferi Town. In this zone, there are one town administration and 10 rural districts. The zone’s total population is 781,006 out of which women of childbearing age are181, 974. In addition, there are one general hospital, 35 health centers, 182 Health posts, one university and one Health sciences college. Study participants: All currently married women between 15–49 years of age who were living in selected kebeles of the zone (kebele is the smallest administrative unit of Ethiopia consisting of at least 500 families).Mothers who have at least one child birth at the time of the survey were included. While, those who were critically ill, could not talk or listen were excluded. Sample size and sampling procedure: Sample size was determined using the formula for a single population proportion: Prevalence (p) of institutional delivery among child bearing women which is 18.2% was used (14) to calculate total sample of 458. Adding 10% allowance for non-response and refusal to participate, a total of 504 married women were selected. Among 10 districts and one administrative town in Bench Maji Zone, five districts were randomly selected from which 504 respondents were selected. Then, the sample for each selected district was allocated proportional to the population size. The districts were further classified into kebeles and the kebeles were randomly selected. Households in selected kebeles were selected using systematic random sampling technique to contact and interview eligible women. Regarding sampling frame, all of the households in the selected kebeles were enumerated. Closed households during data collection were revisited three times at different times. The next nearest households were included for unsuccessful visits. To supplement quantitative data, in-depth interview was conducted with a total of 20 individuals [health professionals, HEWs, model mothers and religious leaders] judgmentally selected from each of the five districts of the study. The interview was not intensive exploratory as it was simply intended to supplement the quantitative study. The interview guide was developed based on the predetermined specific quantitative research objectives. Data collection tools and procedure: Both the interviewers and supervisors were given a two days’ training before the actual work about the aim of study and data collection techniques by going through the questionnaire question by question. After pre-test had been made, data was collected by interviewing married women by interviewer using a structured questionnaire. The questionnaire incorporated questions addressing socio-demographic variables, preference of delivery site and factors affecting the preferences among married women who delivered at least one child in the study area. It was prepared in English and translated to Amharic, the official language of Ethiopia. Qualitative data was collected using unstructured interview guideline. Each interview was recorded using ape recorder. Data quality assurance: Data quality was assured by properly designing and pre-testing the questionnaire, training the interviewers and supervisors on data collection procedures and, categorizing and coding of the questionnaire. Questionnaire was checked everyday for completeness by the supervisors and the necessary feedback was offered to data collectors in the next morning before data collection. Qualitative data was directly collected by the principal investigators. Different categories of respondents were recruited to ensure credibility. Transcription and coding was done by two different individuals separately to check cridebility of the findings and interpretations. Also, in addition to triangulating the qualitative findings with the quantitative one, direct quotes of individual respondents were used Data processing and analysis: Data was entered using EPI INFO version 3.5 statistical packages. It was exported to statistical packages for social scientists (SPSS) software (v 16.0; IBM Corporation, Armonk, NY, USA), where coding, recoding and categorizing were done. Mean, standard deviation and percentage were used as descriptive statistics and summary measures. Using odds ratio (OR) with 95 % limit of confidence interval, the association of dependent and independent variables was assessed and their degree of associations was computed. P-value <5% was considered to show significant statistical association. Qualitative data was first reread and transcribed. Coding and categorization was done to form primary themes based on a predetermined concepts/objectives of the study. Besides, quotes of participants' expressions that exemplify key concepts were used directly during analysis and then, the concepts were developed into major themes under each discussion guides. Finally, the result was triangulated with that of the quantitative one. Ethical considerations: Ethical clearance was obtained from the Research Ethics Committee of the College of Health Sciences, Mizan-Tepi University, before data collection. Then, permission letter was obtained from each district administrators, and verbal consent was taken from each eligible woman in each selected kebele. Study participants were informed that the study would not have any risks. In addition, the objective and benefits of the study were explained to them. Items seeking personal information (name, phone number, etc) were not included in the questionnaire to ensure privacy and confidentiality.

AI Digest

Study Justification:

– The study aimed to assess the delivery site preferences and associated factors among women of childbearing age in Bench Maji Zone, Southwest Ethiopia.
– This research was important because efforts to reduce maternal mortality and morbidity must address societal and cultural factors that affect women’s health and their access to services.
– There was no previous research conducted on delivery site preferences and associated factors in the study area, highlighting the need for this study.

Study Highlights:

– The study used a community-based cross-sectional quantitative study design supplemented by qualitative data.
– The study was conducted in Bench Maji Zone, located in Southern Nation Nationality Regional State (SNNP), Southwest Ethiopia.
– The study included all currently married women between 15-49 years of age who were living in selected kebeles of the zone.
– A total of 504 married women were selected as study participants, and in-depth interviews were conducted with 20 individuals including health professionals, HEWs, model mothers, and religious leaders.
– Data collection tools included a structured questionnaire and an unstructured interview guideline.
– Data quality assurance measures were implemented to ensure the accuracy and reliability of the data.
– Data processing and analysis were conducted using EPI INFO and SPSS software.
– Ethical clearance was obtained, and informed consent was obtained from study participants.

Recommendations for Lay Reader and Policy Maker:

– Based on the study findings, it is recommended to increase awareness and education about the importance of institutional delivery among married women of childbearing age in Bench Maji Zone.
– Efforts should be made to address the factors that influence delivery site preferences, such as cultural beliefs and perceptions.
– Improving access to quality healthcare services, including the availability of health centers and trained healthcare professionals, is crucial to encourage institutional delivery.
– Collaboration between healthcare providers, community leaders, and religious leaders is recommended to promote the importance of institutional delivery and address any cultural barriers.

Key Role Players Needed to Address Recommendations:

– Healthcare providers: Including doctors, nurses, midwives, and other healthcare professionals who can provide quality maternal healthcare services.
– Community leaders: Such as local government officials, community elders, and community health workers who can help raise awareness and promote the importance of institutional delivery.
– Religious leaders: Who can play a role in addressing cultural beliefs and perceptions related to delivery site preferences.
– Non-governmental organizations (NGOs): Organizations that can provide support and resources to improve access to healthcare services and promote institutional delivery.

Cost Items to Include in Planning the Recommendations:

– Training programs: To educate healthcare providers and community leaders on the importance of institutional delivery and how to address cultural barriers.
– Infrastructure development: To improve the availability and quality of healthcare facilities, including health centers and hospitals.
– Outreach and awareness campaigns: To raise awareness among the community about the benefits of institutional delivery and address any misconceptions or cultural barriers.
– Support for healthcare professionals: Including incentives and resources to attract and retain skilled healthcare professionals in the study area.
– Monitoring and evaluation: To assess the effectiveness of the implemented recommendations and make necessary adjustments.

Strength of Evidence

The strength of evidence for this abstract is 6 out of 10.
The evidence in the abstract is based on a community-based cross-sectional quantitative study design supplemented by qualitative data. The study area and design are clearly described, and the sample size and sampling procedure are provided. The data collection tools and procedure, as well as data processing and analysis, are also explained. However, the abstract lacks information on the specific findings and results of the study. To improve the evidence, the abstract should include a summary of the key findings and their implications for addressing delivery site preferences among married women of childbearing age in Bench Maji Zone, Ethiopia.

Abstract

Study area and design: A community based cross sectional quantitative study design supplemented by qualitative data was used to assess delivery site preferences among married women of reproductive age group in Bench Maji Zone from April 20 to May 20, 2013. Bench Maji Zone is located in Southern Nation Nationality Regional State (SNNP), Southwest Ethiopia, around 565km away from the capital city, Addis Ababa, with its center, Mizan Teferi Town. In this zone, there are one town administration and 10 rural districts. The zone’s total population is 781,006 out of which women of childbearing age are181, 974. In addition, there are one general hospital, 35 health centers, 182 Health posts, one university and one Health sciences college. Study participants: All currently married women between 15–49 years of age who were living in selected kebeles of the zone (kebele is the smallest administrative unit of Ethiopia consisting of at least 500 families).Mothers who have at least one child birth at the time of the survey were included. While, those who were critically ill, could not talk or listen were excluded. Sample size and sampling procedure: Sample size was determined using the formula for a single population proportion: Prevalence (p) of institutional delivery among child bearing women which is 18.2% was used (14) to calculate total sample of 458. Adding 10% allowance for non-response and refusal to participate, a total of 504 married women were selected. Among 10 districts and one administrative town in Bench Maji Zone, five districts were randomly selected from which 504 respondents were selected. Then, the sample for each selected district was allocated proportional to the population size. The districts were further classified into kebeles and the kebeles were randomly selected. Households in selected kebeles were selected using systematic random sampling technique to contact and interview eligible women. Regarding sampling frame, all of the households in the selected kebeles were enumerated. Closed households during data collection were revisited three times at different times. The next nearest households were included for unsuccessful visits. To supplement quantitative data, in-depth interview was conducted with a total of 20 individuals [health professionals, HEWs, model mothers and religious leaders] judgmentally selected from each of the five districts of the study. The interview was not intensive exploratory as it was simply intended to supplement the quantitative study. The interview guide was developed based on the predetermined specific quantitative research objectives. Data collection tools and procedure: Both the interviewers and supervisors were given a two days’ training before the actual work about the aim of study and data collection techniques by going through the questionnaire question by question. After pre-test had been made, data was collected by interviewing married women by interviewer using a structured questionnaire. The questionnaire incorporated questions addressing socio-demographic variables, preference of delivery site and factors affecting the preferences among married women who delivered at least one child in the study area. It was prepared in English and translated to Amharic, the official language of Ethiopia. Qualitative data was collected using unstructured interview guideline. Each interview was recorded using ape recorder. Data quality assurance: Data quality was assured by properly designing and pre-testing the questionnaire, training the interviewers and supervisors on data collection procedures and, categorizing and coding of the questionnaire. Questionnaire was checked everyday for completeness by the supervisors and the necessary feedback was offered to data collectors in the next morning before data collection. Qualitative data was directly collected by the principal investigators. Different categories of respondents were recruited to ensure credibility. Transcription and coding was done by two different individuals separately to check cridebility of the findings and interpretations. Also, in addition to triangulating the qualitative findings with the quantitative one, direct quotes of individual respondents were used Data processing and analysis: Data was entered using EPI INFO version 3.5 statistical packages. It was exported to statistical packages for social scientists (SPSS) software (v 16.0; IBM Corporation, Armonk, NY, USA), where coding, recoding and categorizing were done. Mean, standard deviation and percentage were used as descriptive statistics and summary measures. Using odds ratio (OR) with 95 % limit of confidence interval, the association of dependent and independent variables was assessed and their degree of associations was computed. P-value <5% was considered to show significant statistical association. Qualitative data was first reread and transcribed. Coding and categorization was done to form primary themes based on a predetermined concepts/objectives of the study. Besides, quotes of participants' expressions that exemplify key concepts were used directly during analysis and then, the concepts were developed into major themes under each discussion guides. Finally, the result was triangulated with that of the quantitative one. Ethical considerations: Ethical clearance was obtained from the Research Ethics Committee of the College of Health Sciences, Mizan-Tepi University, before data collection. Then, permission letter was obtained from each district administrators, and verbal consent was taken from each eligible woman in each selected kebele. Study participants were informed that the study would not have any risks. In addition, the objective and benefits of the study were explained to them. Items seeking personal information (name, phone number, etc) were not included in the questionnaire to ensure privacy and confidentiality.

Materials

N/A

Innovations

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

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide pregnant women with information on prenatal care, delivery options, and postnatal care. These apps could also include features such as appointment reminders, medication reminders, and emergency contact information.

2. Telemedicine: Establish telemedicine services that allow pregnant women in remote areas to consult with healthcare professionals via video calls. This would enable them to receive medical advice, guidance, and support without having to travel long distances.

3. Community Health Workers (CHWs): Train and deploy CHWs to provide education, counseling, and basic healthcare services to pregnant women in rural areas. CHWs can conduct regular home visits, monitor the health of pregnant women, and refer them to healthcare facilities when necessary.

4. Transportation Support: Develop transportation systems or programs that provide pregnant women with affordable and reliable transportation to healthcare facilities for prenatal care, delivery, and postnatal care. This could involve partnerships with local transportation providers or the use of community-owned vehicles.

5. Maternal Waiting Homes: Establish maternal waiting homes near healthcare facilities to accommodate pregnant women who live far away. These homes would provide a safe and comfortable place for women to stay during the final weeks of pregnancy, ensuring that they are close to the facility when it’s time to deliver.

6. Financial Incentives: Implement financial incentive programs that provide pregnant women with financial support for accessing maternal healthcare services. This could involve cash transfers, vouchers, or subsidies for transportation, medications, and other related expenses.

7. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of maternal healthcare and encourage women to seek prenatal care and deliver in healthcare facilities. These campaigns could use various media channels, community events, and local influencers to reach the target audience.

8. Strengthening Healthcare Infrastructure: Invest in improving the infrastructure of healthcare facilities, particularly in rural areas, to ensure that they have the necessary equipment, supplies, and skilled healthcare professionals to provide quality maternal healthcare services.

9. Partnerships and Collaboration: Foster partnerships and collaboration between government agencies, non-governmental organizations, healthcare providers, and community leaders to collectively address the barriers to accessing maternal healthcare. This could involve sharing resources, coordinating efforts, and leveraging each other’s expertise and networks.

10. Data Collection and Monitoring: Establish a robust data collection and monitoring system to track maternal health indicators, identify gaps in service delivery, and measure the impact of interventions. This data can inform evidence-based decision-making and help prioritize resources and interventions.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health in Bench Maji Zone, Ethiopia is to focus on addressing the factors that influence delivery site preferences among married women of childbearing age. This can be achieved through the following steps:

1. Conduct further research: Conduct additional research to gain a deeper understanding of the factors that influence delivery site preferences among married women in the study area. This will help identify specific barriers and facilitators to accessing maternal health services.

2. Increase awareness and education: Implement awareness campaigns and educational programs to increase knowledge and understanding of the importance of skilled delivery care and the available options for delivery sites. This can be done through community outreach programs, health education sessions, and the use of local media channels.

3. Improve infrastructure and resources: Invest in improving the infrastructure and resources of existing health facilities, including general hospitals, health centers, and health posts. This can involve upgrading facilities, ensuring the availability of necessary medical equipment and supplies, and training healthcare providers to deliver quality maternal health services.

4. Strengthen community engagement: Engage with community leaders, religious leaders, and other influential individuals to promote the importance of skilled delivery care and encourage community support for accessing maternal health services. This can be done through community meetings, workshops, and the establishment of community-based support groups.

5. Address cultural and societal factors: Develop culturally sensitive strategies to address societal and cultural factors that may influence delivery site preferences. This can involve working closely with local communities to understand and respect their beliefs and practices while promoting the importance of skilled delivery care.

6. Improve transportation and accessibility: Address transportation barriers by improving road infrastructure and increasing access to transportation services in rural areas. This can include providing transportation vouchers or subsidies for pregnant women to access health facilities for delivery.

7. Strengthen referral systems: Establish and strengthen referral systems between different levels of healthcare facilities to ensure seamless and timely access to appropriate maternal health services. This can involve training healthcare providers on referral protocols and improving communication channels between facilities.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to a reduction in maternal mortality and morbidity in Bench Maji Zone, Ethiopia.

AI Innovations Methodology

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

1. Increase the number of health facilities: One recommendation could be to increase the number of health facilities, such as health centers and hospitals, in the Bench Maji Zone. This would provide more options for women to access maternal health services closer to their homes.

2. Improve transportation infrastructure: Another recommendation could be to improve transportation infrastructure, such as roads and public transportation, in the area. This would make it easier for women to travel to health facilities, especially in rural areas where access to transportation is limited.

3. Increase awareness and education: It is important to increase awareness and education about the importance of maternal health and the available services. This could be done through community outreach programs, health education campaigns, and involving local leaders and influencers to spread the message.

4. Strengthen referral systems: Developing and strengthening referral systems between different levels of healthcare facilities is crucial. This would ensure that women who require specialized care can be referred and transported to higher-level facilities in a timely manner.

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

1. Collect baseline data: Gather data on the current state of maternal health access in the Bench Maji Zone, including the number of health facilities, transportation infrastructure, awareness levels, and referral systems.

2. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the number of women accessing maternal health services, travel time to the nearest health facility, awareness levels among the target population, and the effectiveness of referral systems.

3. Develop a simulation model: Create a simulation model that incorporates the baseline data and the potential impact of the recommendations. This model should consider factors such as population size, geographical distribution, and existing healthcare infrastructure.

4. Run simulations: Use the simulation model to run different scenarios that reflect the implementation of the recommendations. This could involve increasing the number of health facilities, improving transportation infrastructure, conducting awareness campaigns, and strengthening referral systems.

5. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health. This could include measuring changes in the indicators defined in step 2.

6. Refine and iterate: Based on the analysis of the simulation results, refine the recommendations and the simulation model if necessary. Repeat the simulation process to further assess the potential impact and make adjustments as needed.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health in the Bench Maji Zone. This can inform decision-making and help prioritize interventions that are most likely to have a positive impact.

Author

Dima Health

Statistics:

Citations: 15

Identifiers:

DOI: 10.4314/ejhs.v26i1.9

Research Areas:

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

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Exploratory Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female