Antenatal care and women’s decision making power as determinants of institutional delivery in rural area of Western Ethiopia

BMC Research Notes, Volume 8, No. 1, Year 2015

Interpretação

Background: Delivery by skilled birth attendance serves as an indicator of progress towards reducing maternal mortality. In Ethiopia, the proportions of births attended by skilled personnel were very low 15 % and Oromia region 14.7 %. The current study identified factors associated with utilization of institutional delivery among married women in rural area of Western Ethiopia. Methods: A community based cross-sectional study was employed from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone. A multi-stage sampling procedure was used to select 798 study participants. A pre-tested structured questionnaire was used to collect data and female high school graduates data collectors were involved in the data collection process. Bivariate and multivariable logistic regression model was fit and statistical significance was determined through a 95 % confidence level. Results: The study revealed that 39.7 % of the mothers delivered in health facilities. Age 15-24 years (AOR 4.20, 95 % CI 2.07-8.55), 25-34 years (AOR 2.21, 95 % CI 1.32-3.69), women’s educational level (AOR 2.00, 95 % CI 1.19-3.34), women’s decision making power (AOR 2.11, 95 % CI 1.54-2.89), utilization of antenatal care (ANC) during the index pregnancy (AOR 1.56, 95 % CI 1.08-2.23) and parity one (AOR 2.20, 95 % CI 1.10-4.38) showed significant positive association with utilization of institutional delivery. Conclusion and recommendation: In this study proportion of institutional delivery were low (39.7 %). Age, women’s literacy status, women’s decision making power, ANC practice and numbers of live birth were found important predictors of institutional delivery. The findings of current study highlight the importance of boosting women involvement in formal education and decision making power. Moreover since ANC is big pillar for the remaining maternal health services effort should be there to increase ANC service utilization. A community-based cross-sectional study was carried out from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone, Oromia Region, West Ethiopia. East Wollega Zone is one of the zones of Oromia Regional state with a population of 1,230,402 among which 614,761 are males and 615,641 are females. Majority of the population live in rural areas 86 % (1,061,120). Nekemte is the capital city of the zone which is located 331 km west of Addis Ababa with a population of 76,817 (male 39,167 and female 37,650) [13]. The source population was all married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Study populations were randomly selected married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Women who were critically ill could not provide informed consent were excluded from the study. The sample size was determined using a formula for estimation of single population proportion with the assumption of 95 % confidence interval (CT), margin of error 5 % and taking 61.6 % institutional delivery prevalence of Holeta town, central Ethiopia [14] and a design effect of 2. To avoid the effect of the design that decreases the representativeness of the study we used design effect. To compensate the non-response rate, 10 % of the determined sample was added up on the calculated sample size and the final sample size was 801. A multi-stage sampling technique was employed for the selection of the sampling units. First, six districts were selected from 18 districts found in East Wollega Zone. Then 10 rural kebeles (lower administrative level) were randomly selected from a list of all kebeles found in the six districts. The calculated sample size was proportionally allocated to each kebeles based on the number of married women who gave birth in the past 2 years. Then picking a house randomly for the initial household from each kebele, the final households with married women were selected using systematic sampling from the existing sampling frame of households which were identified through census prior to data collection. Finally, eligible study subjects were interviewed from each selected households. Pre-tested structured questionnaires were adapted from different literature [3, 12, 14–18] (Additional file 1). The questionnaires were prepared in English, translated into Afan Oromo (regional language), and then retranslated back to English by people who are proficient in both languages to maintain the consistency of the questionnaires. To administer the structured questionnaires, 12 female high school graduates were selected from the study area. Training was given for 3 days about the objective, relevance of the study, confidentiality of information, respondent’s rights, informed consent and techniques of interview. Six supervisors who have second degree oversaw the data collection procedures. All field questionnaires were reviewed each night and issues that arose during data collection were addressed in morning sessions. Data were cleaned and entered into a computer using Epi-Info window version 6.5 statistical programs. The data were then exported to SPSS windows version 20.0 for further analysis. The descriptive analyses such as proportions, percentages, frequency distribution and measures of central tendency were conducted. Initially, bivariate analysis was performed between dependent variable and each of the independent variables, one at a time. Their odds ratios (OR) at 95 % CI and p-values were obtained. The findings at this stage helped us to identify important associations. Then all variables found to be significant at bivariate level (at p < 0.05) were entered into multivariate analysis using the logistic regression model to test the significance of the association. Skill birth attendant means having an accredited health professional, including a midwife, doctor, or nurse, who has been trained in the skills needed to needed to manage a normal or uncomplicated pregnancy and childbirth and to support the woman in the immediate postpartum period. Institutional delivery means women who gave birth at health facility (Hospital or health center). Home deliveries means delivery attended by non-skilled birth attendant in this study. Ethical clearance and permission was obtained from Wollega University Institutional Review Board. Permission was secured from all kebeles through a formal letter. Written informed consent was obtained from each respondent before their interview. The written informed consent was also includes study participants less than 18 years since they were married and minor mature and the consent procedure was approved by ethics committee of Wollega University. Confidentiality of individual client information was ensured by using unique identifiers for the study participants and also limiting access to respondents’ information to the principal investigator and research assistants by storing the completed questionnaires and all documents with participant information in a lockable cabinet.

AI Digest

Study Justification:

The study aimed to identify factors associated with the utilization of institutional delivery among married women in rural areas of Western Ethiopia. This is important because the proportions of births attended by skilled personnel in Ethiopia were very low, indicating a need for improvement in maternal healthcare. By understanding the factors influencing institutional delivery, interventions can be developed to increase access to skilled birth attendance and reduce maternal mortality.

Highlights:

– The study found that only 39.7% of mothers in the rural area delivered in health facilities, indicating a low utilization of institutional delivery.
– Factors such as age, women’s educational level, women’s decision-making power, utilization of antenatal care, and parity were found to be important predictors of institutional delivery.
– The findings highlight the importance of boosting women’s involvement in formal education and decision-making power, as well as increasing the utilization of antenatal care services.

Recommendations:

– Efforts should be made to increase women’s access to formal education, as this was found to be a significant predictor of institutional delivery.
– Programs and policies should focus on empowering women and increasing their decision-making power regarding their reproductive health.
– Strategies should be implemented to increase the utilization of antenatal care services, as this was also found to be a significant predictor of institutional delivery.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies and programs related to maternal healthcare.
– Local Health Authorities: Responsible for overseeing the delivery of healthcare services in the rural areas and implementing interventions to improve institutional delivery.
– Community Health Workers: Play a crucial role in educating and mobilizing communities to utilize institutional delivery services.
– Non-Governmental Organizations: Can provide support and resources to implement interventions aimed at increasing institutional delivery.

Cost Items for Planning Recommendations:

– Education Programs: Budget for initiatives aimed at increasing women’s access to formal education, such as scholarships, school infrastructure improvements, and teacher training.
– Empowerment Programs: Budget for programs that empower women and increase their decision-making power, such as training workshops and awareness campaigns.
– Antenatal Care Services: Budget for improving access to and utilization of antenatal care services, including training healthcare providers, improving infrastructure, and providing necessary equipment and supplies.
– Community Mobilization: Budget for community health workers and outreach programs to educate and mobilize communities to utilize institutional delivery services.
– Monitoring and Evaluation: Budget for monitoring and evaluating the effectiveness of interventions and making necessary adjustments.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used a community-based cross-sectional design and a relatively large sample size. The statistical analysis included bivariate and multivariable logistic regression models. However, the study did not provide information on the validity and reliability of the questionnaire used, and there is no mention of any measures taken to ensure data quality. To improve the strength of the evidence, future studies should consider using a longitudinal design to establish causality and should provide information on the validity and reliability of the data collection tools. Additionally, researchers should implement measures to ensure data quality, such as training data collectors and conducting regular data quality checks.

Resumo

A community-based cross-sectional study was carried out from January 2 to January 31, 2015 among mothers who gave birth in the last 2 years in rural area of East Wollega Zone, Oromia Region, West Ethiopia. East Wollega Zone is one of the zones of Oromia Regional state with a population of 1,230,402 among which 614,761 are males and 615,641 are females. Majority of the population live in rural areas 86 % (1,061,120). Nekemte is the capital city of the zone which is located 331 km west of Addis Ababa with a population of 76,817 (male 39,167 and female 37,650) [13]. The source population was all married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Study populations were randomly selected married women aged 15–49 years who gave at least one birth in the last 2 years preceding the survey. Women who were critically ill could not provide informed consent were excluded from the study. The sample size was determined using a formula for estimation of single population proportion with the assumption of 95 % confidence interval (CT), margin of error 5 % and taking 61.6 % institutional delivery prevalence of Holeta town, central Ethiopia [14] and a design effect of 2. To avoid the effect of the design that decreases the representativeness of the study we used design effect. To compensate the non-response rate, 10 % of the determined sample was added up on the calculated sample size and the final sample size was 801. A multi-stage sampling technique was employed for the selection of the sampling units. First, six districts were selected from 18 districts found in East Wollega Zone. Then 10 rural kebeles (lower administrative level) were randomly selected from a list of all kebeles found in the six districts. The calculated sample size was proportionally allocated to each kebeles based on the number of married women who gave birth in the past 2 years. Then picking a house randomly for the initial household from each kebele, the final households with married women were selected using systematic sampling from the existing sampling frame of households which were identified through census prior to data collection. Finally, eligible study subjects were interviewed from each selected households. Pre-tested structured questionnaires were adapted from different literature [3, 12, 14–18] (Additional file 1). The questionnaires were prepared in English, translated into Afan Oromo (regional language), and then retranslated back to English by people who are proficient in both languages to maintain the consistency of the questionnaires. To administer the structured questionnaires, 12 female high school graduates were selected from the study area. Training was given for 3 days about the objective, relevance of the study, confidentiality of information, respondent’s rights, informed consent and techniques of interview. Six supervisors who have second degree oversaw the data collection procedures. All field questionnaires were reviewed each night and issues that arose during data collection were addressed in morning sessions. Data were cleaned and entered into a computer using Epi-Info window version 6.5 statistical programs. The data were then exported to SPSS windows version 20.0 for further analysis. The descriptive analyses such as proportions, percentages, frequency distribution and measures of central tendency were conducted. Initially, bivariate analysis was performed between dependent variable and each of the independent variables, one at a time. Their odds ratios (OR) at 95 % CI and p-values were obtained. The findings at this stage helped us to identify important associations. Then all variables found to be significant at bivariate level (at p < 0.05) were entered into multivariate analysis using the logistic regression model to test the significance of the association. Skill birth attendant means having an accredited health professional, including a midwife, doctor, or nurse, who has been trained in the skills needed to needed to manage a normal or uncomplicated pregnancy and childbirth and to support the woman in the immediate postpartum period. Institutional delivery means women who gave birth at health facility (Hospital or health center). Home deliveries means delivery attended by non-skilled birth attendant in this study. Ethical clearance and permission was obtained from Wollega University Institutional Review Board. Permission was secured from all kebeles through a formal letter. Written informed consent was obtained from each respondent before their interview. The written informed consent was also includes study participants less than 18 years since they were married and minor mature and the consent procedure was approved by ethics committee of Wollega University. Confidentiality of individual client information was ensured by using unique identifiers for the study participants and also limiting access to respondents’ information to the principal investigator and research assistants by storing the completed questionnaires and all documents with participant information in a lockable cabinet.

Materiais

https://efashare.b-cdn.net/materials/d619fb9e09b457f8552e1f26591ff10eb93aa77e90efe0af4b704fb45fafd2dc/13104_2015_1708_MOESM1_ESM.docx

Inovações

Based on the study titled “Antenatal care and women’s decision making power as determinants of institutional delivery in rural area of Western Ethiopia,” the following recommendations can be developed into innovations to improve access to maternal health:

1. Increase women’s involvement in formal education: Develop innovative programs and initiatives that promote and support women’s education, such as scholarships, vocational training, and mentorship programs. This can help improve access to maternal health services by empowering women with knowledge and skills to make informed decisions about their reproductive health.

2. Empower women’s decision-making power: Implement innovative interventions that focus on empowering women to make informed decisions about their reproductive health and childbirth. This can be done through community-based workshops, support groups, and counseling services that provide information and resources to enhance women’s decision-making power.

3. Enhance antenatal care (ANC) utilization: Develop innovative strategies to increase the uptake of ANC services among pregnant women. This can include implementing community-based ANC programs, utilizing mobile health technologies to provide ANC information and reminders, and conducting targeted health education campaigns to raise awareness about the importance of ANC.

4. Address age-related barriers: Develop innovative interventions that specifically target older women to ensure they have equal access to maternal health services. This can include providing age-appropriate health education materials, offering specialized support services for older women, and conducting outreach programs to reach this population.

5. Strengthen health facility infrastructure: Implement innovative approaches to strengthen the infrastructure and capacity of health facilities in rural areas. This can include improving transportation systems to ensure women can access health facilities, training and deploying skilled birth attendants to rural areas, and providing necessary equipment and supplies for safe deliveries.

By implementing these innovative interventions, access to maternal health services can be improved in rural areas of Ethiopia, ultimately reducing maternal mortality and improving the overall health outcomes for women and their children.

AI Innovations Description

1. Increase women’s involvement in formal education: The study found that women’s educational level was significantly associated with the utilization of institutional delivery. Therefore, developing innovative programs and initiatives that promote and support women’s education can help improve access to maternal health services.

2. Empower women’s decision-making power: The study also revealed that women’s decision-making power was positively associated with the utilization of institutional delivery. To improve access to maternal health, innovative interventions should focus on empowering women to make informed decisions about their reproductive health and childbirth.

3. Enhance antenatal care (ANC) utilization: The study identified ANC utilization as an important predictor of institutional delivery. Therefore, innovative strategies should be developed to increase the uptake of ANC services among pregnant women, such as community-based ANC programs, mobile health technologies, and targeted health education campaigns.

4. Address age-related barriers: The study found that younger age groups (15-24 years) were more likely to utilize institutional delivery. Innovative interventions should address age-related barriers and provide targeted support to older women to ensure they have equal access to maternal health services.

5. Strengthen health facility infrastructure: To improve access to institutional delivery, innovative approaches should focus on strengthening the infrastructure and capacity of health facilities in rural areas. This can include improving transportation systems, ensuring the availability of skilled birth attendants, and providing necessary equipment and supplies for safe deliveries.

Overall, the findings of the study highlight the importance of developing innovative interventions that address the socio-cultural, educational, and healthcare system-related factors influencing access to maternal health services in rural areas of Ethiopia.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Increase women’s involvement in formal education: Develop and implement innovative programs that focus on increasing women’s access to formal education. This can include initiatives such as scholarships, mentorship programs, and vocational training opportunities. Collect data on the number of women participating in these programs and track their educational progress over time.

2. Empower women’s decision-making power: Implement interventions that aim to empower women and improve their decision-making power regarding reproductive health and childbirth. This can include workshops, support groups, and community awareness campaigns. Collect data on women’s decision-making power before and after the interventions and assess any changes in their decision-making abilities.

3. Enhance antenatal care (ANC) utilization: Develop and implement innovative strategies to increase the uptake of ANC services among pregnant women in rural areas. This can include community-based ANC programs, mobile health technologies, and targeted health education campaigns. Collect data on ANC utilization rates before and after the implementation of these strategies and assess any improvements in access to maternal health services.

4. Address age-related barriers: Develop targeted interventions that address age-related barriers to accessing maternal health services. This can include providing support and resources specifically tailored to older women, such as transportation assistance and specialized healthcare services. Collect data on the utilization rates of older women before and after the interventions and assess any improvements in access to maternal health services.

5. Strengthen health facility infrastructure: Implement innovative approaches to strengthen the infrastructure and capacity of health facilities in rural areas. This can include improving transportation systems, ensuring the availability of skilled birth attendants, and providing necessary equipment and supplies for safe deliveries. Collect data on the availability and quality of health facility infrastructure before and after the interventions and assess any improvements in access to maternal health services.

To evaluate the impact of these recommendations, data should be collected before and after the implementation of the interventions. This can include data on utilization rates of institutional delivery, ANC services, and women’s decision-making power. Statistical analysis can be conducted to compare the data and determine the effectiveness of the interventions in improving access to maternal health services. Additionally, qualitative data such as interviews and focus group discussions can be conducted to gather feedback and insights from the women who have benefited from the interventions.

Autores & Coautores

Statistics:

Citations: 35

Authors: 3

Identifiers:

DOI: 10.1186/s13104-015-1708-5

Research Areas:

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

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male & Female

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