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Klazura G, Wong LY, Ribiero LLPA, Kojo Anyomih TT, Ooi RYK, Berhane Fissha A, Alam SF, Daudu D, Nyalundja AD, Beltrano J, Patil PP, Wafford QE, Rapolti DI, Sullivan GA, Graf A, Veras P, Nico E, Sheth M, Shing SR, Mathur P, Langer M. Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 years, a Systematic Review. J Surg Res 2024; 299:163-171. [PMID: 38759332 DOI: 10.1016/j.jss.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.
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Affiliation(s)
- Greg Klazura
- University of Illinois at Chicago, Chicago, Illinois
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford Hospital, Stanford, California.
| | | | | | | | - Aemon Berhane Fissha
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Syeda Fatema Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
| | | | - Poorvaprabha P Patil
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Akua Graf
- University of Illinois at Chicago, Chicago, Illinois
| | - Perry Veras
- Loyola Stritch School of Medicine, Maywood, Illinois
| | - Elsa Nico
- University of Illinois at Chicago, Chicago, Illinois
| | - Monica Sheth
- Loyola Stritch School of Medicine, Oak Park, Illinois
| | - Samuel R Shing
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Priyanka Mathur
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Monica Langer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
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Marye DM, Debalkie Atnafu D, Belayneh M, Takele Alemu A. User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:775-785. [PMID: 38106643 PMCID: PMC10722901 DOI: 10.2147/ceor.s431488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Increasing free and skilled delivery is a top priority in the global effort to reduce maternal and newborn mortality. Reducing user-fees through exemption policy has contributed to universal health coverage. However, there is scant evidence regarding the effect of exempted maternal services on adherence to utilization in Ethiopia. Thus, this study aimed to assess the effect of fee exemption policy on adherence to maternal health service utilization and its predictors. Methods A community-based comparative cross-sectional study was conducted in Bahir Dar City. A two-stage multistage sampling was employed; 497 women participated. Data were collected by face-to-face interview; entered and cleaned using Epi-Data 3.1. SPSS version 25 was used for further analysis. Bivariable and multivariable logistic regression models were computed to assess the association between explanatory and outcome variables. An adjusted odds ratio with a 95% confidence interval was used to interpret the degree of association. The effect of fee exemption policy on adherence to maternal health service utilization was measured by propensity score matching. Results The overall adherence to maternal service utilization was 54.2%. Factors associated with adherence to maternal health service utilization were pregnancy complications [AOR: 4.1, 95% CI (2.32, 7.28)], secondary and above education [AOR: 4.6, 95% CI (1.38, 15.08)], early ANC1 booking [AOR: 3.1, 95% CI (1.83, 5.16)], autonomous women [AOR: 2.1, 95% CI (1.02, 4.39)], user fee exemption [AOR: 2.3, 95% CI (1.20, 4.47)] and high parity [AOR: 0.39, 95% CI (0.2, 0.75)]. User fee exemption induced a 22.7% increment in adherence to maternal service utilization (ATET=0.227, t=2.13). Conclusion User fee exemption policy significantly improved adherence to maternal health service utilization. Promoting a fee exemption policy through third-party financing can enhance maternal health service utilization adherence in hard-to-reach settings of Ethiopia by targeting mothers with higher pregnancies, no complications, no autonomy, and less education.
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Affiliation(s)
- Demlie Mekonnen Marye
- Department of Health System Management and Health Economics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desta Debalkie Atnafu
- Department of Health System Management and Health Economics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Melesse Belayneh
- Department of Health System Management and Health Economics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ayenew Takele Alemu
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Mekango DE, Moges S, Lajore BA, Buda AS, Ejajo T, Erkalo D. Decomposition Analysis of Antenatal Care Utilization Inequities in Kembata Tembaro Zone, Southern Ethiopia. Ann Glob Health 2023; 89:73. [PMID: 37868709 PMCID: PMC10588493 DOI: 10.5334/aogh.4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background Health equity has emerged as a global issue in the post-2015 Sustainable Development Goals, and Ethiopia is no exception. Despite positive improvements, inequities in maternal health service utilization among demographic groups continue to be one of Ethiopia's significant challenges in decreasing maternal mortality. This study focuses on antenatal care service discrimination among a local poor group known as the "golden hands" community in Ethiopia's Kembata Tembaro zone. The subgroup community consists of outcast artesian groups known as "golden hands," formerly known as "Fuga," who face discrimination in all aspects of life owing to their living conditions and ethnic background. Methods A community-based comparative cross-sectional study was conducted in Ethiopia's Kembata Tembaro, zone in the Southern Nations, Nationalities, and Peoples' Region (SNNPR), from January to February 2022. The study focused on two groups, "golden hands" and "non-golden hands," consisting of women aged 15-49 years. Using stratified and multistage cluster sampling, 1,210 participants were selected, with 440 from golden hand communities and 770 from non-golden hand communities. Data was collected through translated questionnaires, and data quality was rigorously monitored. The concentration curve and index, as well as logistic-based decomposition analysis, were used to examine inequality. The statistical significance threshold was set at p < 0.05 with a 95% confidence interval. Result This study comprised 1,210 eligible participants, 440 of whom were golden hand community members. Discrimination accounted for 60.23% of the decreased antenatal care (ANC) service use by the golden hand community. Age, urban residence, and wealth index were the most important independent factors with statistically significant contributions to changes owing to differences in effects (discriminated difference). Conclusion Since ANC service discrimination is prevalent, the government and nongovernmental organizations should take steps to ensure that marginalized groups in society, such as golden hand women, the poor, the uneducated, and rural people, have equal access to service utilization opportunities.
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Affiliation(s)
- Dejene Ermias Mekango
- Public Health Department, College of Medicine & Health Sciences, Wachemo University, Hosanna, ET
| | - Sisay Moges
- Department of Family Health, Hosanna College of Health Science, Hosanna, ET
| | | | - Alula Seyum Buda
- School of Nursing, College of Medicine & Health Sciences, Wachemo University, Hosanna, ET
| | - Tekle Ejajo
- Public Health Department, College of Medicine & Health Sciences, Wachemo University, Hosanna, ET
| | - Desta Erkalo
- Public Health Department, College of Medicine & Health Sciences, Wachemo University, Hosanna, ET
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Kiros S, Ibrahim IM, Ahmed KY. Growth Monitoring and Promotion Service Utilisation and Associated Factors among Children in Afar Region, Northeast Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105807. [PMID: 37239538 DOI: 10.3390/ijerph20105807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The use of growth monitoring and promotion (GMP) services in the first two years of life can facilitate the early identification of common childhood health issues such as malnutrition and infections. It also creates an opportunity to promote education and nutritional counselling. This study is the first to investigate the use of GMP and its influencing factors among mothers in Ethiopia's pastoralist regions, including the Afar National and Regional State, where childhood malnutrition is a significant cause of morbidity and mortality. Between May and June 2021, a cross-sectional study was conducted within the Semera-Logia city administration. The study used a random sampling technique to select 396 children under two, and data were gathered using an interviewer-administered questionnaire. Multivariable logistic regression was used to analyse the influence of explanatory variables, which included socio-demographic, health service, and health literacy factors, on the utilisation of GMP services. The overall utilisation of GMP services was 15.9% (95% confidence intervals [CI]: 12.0%, 19.5%). Children whose fathers had college or higher education were more likely to utilise GMP services (adjusted odd ratios [AOR] = 7.75; 95% CI: 3.01, 19.99), whereas children living in households with more children were less likely to utilise GMP services (AOR = 0.11; 95% CI: 0.04, 0.28 for households with 3-4 children and AOR = 0.23; 95% CI: 0.08, 0.67 for households with 4+ children). Children who received postnatal care had higher odds of GMP service use (AOR = 8.09; 95% CI: 3.19, 20.50). GMP services are not being fully utilised to decrease infant and child morbidity and mortality caused by malnutrition in Ethiopia. We recommend strengthening GMP services in Ethiopia and taking targeted action to address the low attainment of parental education and poor postnatal care utilisation. Public health initiatives such as the implementation of mobile health (mHealth) approaches and education of mothers by female community healthcare workers on the significance of GMP services could be effective in increasing GMP service utilisation.
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Affiliation(s)
- Semhal Kiros
- Afar Regional Health Office, Logiya Primary Hospital, Semera P.O. Box 28, Ethiopia
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, Semera P.O. Box 132, Ethiopia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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Seyoum H, Feleke Z, Bikila D, Yaregal A, Demisie A, Ali S, Fisseha S, Abebe Y, Battu A, Lam F, Bayisa R. Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13200.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
As a key partner of Ministry of Health (MOH) Ethiopia, The Clinton Health Access Initiative (CHAI) had been implementing the Child Survival Project (CSP) since October 2015. Strengthening DTC was one of its focuses to improve overall supply chain management (SCM). The objective of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major driving and hindering factors for their functionality. A descriptive mixed study design was employed. The study made use of qualitative data supplemented with quantitative data, generated from both primary and secondary sources through key informant interviews and desk review methods. DTCs were introduced in Ethiopia in the early 1980s. The mandate of DTCs has been given to four different government organizations during that time. As a result, due to a lack of coordination among these organizations, its implementation was lagging. Recently, the government and its partners have given attention to DTCs. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in health facilities improved from 85% to 98% between 2015 and 2019 during baseline and end-line assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63%. The CHAI/CSP regular supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same facility revealed a significant association between the two variables at p<0.0001. Conclusions: Providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating bodies for DTCs and similar structures at Regional Health Bureaus and woreda health offices should be established.
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Yalew AZ, Olayemi OO, Yalew AW. Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016. Front Med (Lausanne) 2023; 10:1151486. [PMID: 37153096 PMCID: PMC10155231 DOI: 10.3389/fmed.2023.1151486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce. Objective This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia. Methods This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant. Results Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits. Conclusion Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.
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Affiliation(s)
- Ayalnesh Zemene Yalew
- Pan African University for Life and Earth Science Institute (Including Agriculture and Health), University of Ibadan, Ibadan, Nigeria
- School of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- *Correspondence: Ayalnesh Zemene Yalew, ;
| | - Oladapo O. Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Abebe GF, Belachew DZ, Girma D, Aydiko A, Negesse Y. Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey. BMC Pregnancy Childbirth 2022; 22:691. [PMID: 36071407 PMCID: PMC9450293 DOI: 10.1186/s12884-022-05016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia. Methods A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05. Results In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care. Conclusion Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.
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Affiliation(s)
- Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia.
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Alemseged Aydiko
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Yilkal Negesse
- Department of Public health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Berhe ET, Gesesew HA, Ward PR, Gebremeskel TG. Neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia. BMC Pregnancy Childbirth 2022; 22:386. [PMID: 35505295 PMCID: PMC9066857 DOI: 10.1186/s12884-022-04662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to assess the magnitude and factors associated with neglected and non-consented care during childbirth in public health facilities in Central Tigray, Ethiopia. METHODS A health facility-based cross-sectional survey supplemented by a qualitative study was conducted from April to May 2020 among women giving birth. We included 415 participants and recruited via a systematic random sampling technique. To collect the data, a pre-tested, face-to-face exit interview using an interviewer-administered structured questionnaire was used. Neglected and non-consented care and its outcomes (yes and no) were the dependent variables, and Socio-demographic data such as (age, educational level, region, and income), and other variables associated with compassionate and respective maternity care were the independent variables. We applied bivariate and multivariate logistic regression to determine predictors for non-consented and non-confidential care components of disrespect or abuse. The in-depth interviews were analyzed using content analysis. RESULTS Among the participants, 82.4% and 78.6% had neglected care and non-consented care among women giving birth respectively. No formal education level (AOR: 0.37, 95%, CI (0.18-0.78)) and primary education level (AOR: 0.18, 95%, CI (0.05-0.57))., mode of delivery (AOR 3.79, 95% CI 1.42-10.09), sex of skilled healthcare providers (AOR: 0.56, 95%, CI (0.34-0.93)), number of deliveries in a health Centre (AOR: 1.89, 95% CI (1.03-3.47)) predicted non-consented care, and history ANC (AOR: 8.10, 95% CI (1.33-49.51)), and federal government employee (AOR: 0.24, 95% CI (0.07-0.78)) predicted neglected care during childbirth. In-depth interview result shows the mode of delivery and sex of healthcare providers were factor associated with non-consented care and women's stay at health facilities were factor associated with neglected care. CONCLUSION The level of neglected and non-consented care during delivery was high reflecting substantial mistreatment. Educational level, mode of delivery, sex of skilled healthcare providers, and the number of deliveries in a health Centre were associated with non-consented care, and history ANC and Federal Government employees were associated with neglected care during childbirth. These findings imply the urgent needs or intervention including strengthening of awareness of both patients and healthcare providers on patients' rights and responsibilities and training service providers in patient-centered care and interpersonal communication and relationships to minimize mistreatment.
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Affiliation(s)
- Elsa Tesfa Berhe
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia.
| | - Hailay Abrha Gesesew
- Department of Epidemiology, College of Health Sciences, Mekele University, Mekele, Ethiopia.,Centre for Research On Health Policy, Torrens University, Adelaide, South Australia, Australia
| | - Paul R Ward
- Centre for Research On Health Policy, Torrens University, Adelaide, South Australia, Australia
| | - Teferi Gebru Gebremeskel
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia. .,Discipline of Public Health, Flinders University, Adelaide, Australia.
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Quality disparity in terms of clients’ satisfaction with selected exempted health care services provided in Ethiopia: meta-analysis. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nassar AAH, Raja'a YA, Bahubaishi NS. Cost saving in primary versus tertiary level of reproductive health services in Sana'a, Yemen, 2013: a comparative cross-sectional study. BMJ Open 2022; 12:e056866. [PMID: 35351722 PMCID: PMC8961106 DOI: 10.1136/bmjopen-2021-056866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To estimate the cost saving for utilisation of vaginal delivery (VD), antenatal care (ANC) and an intrauterine device (IUD) services at primary health level facilities (PHLF) instead of tertiary health level facilities (THLF) in Sana'a. DESIGN A comparative cross-sectional study. SETTING Eight PHLF in Sana'a governorate and three THLF in Sana'a city. PARTICIPANTS A total of 180 women aged (15-45 years) were enrolled equally from PHLF and THLF. Sixty women attended for each reproductive health service (VD, ANC and IUD services). PRIMARY AND SECONDARY OUTCOME MEASURES The direct and indirect costs of services at PHLF and THLF, and the cost saving for utilisation of PHLF instead of THLF. RESULTS The median of direct medical cost (DMC) of VD, ANC and IUD services were US$43.86, US$14.77 and US$9.07 at THLF compared with US$19.54, US$0.93 and US$11.17 at PHLF, respectively. The DMC difference of VD, ANC and IUD services between THLF and PHLF was US$24.32, US$13.84 and US$-2.1, respectively. Regarding the direct non-medical costs (DNMC), the median of VD, ANC and IUD services were US$43.05, US$19.07 and US$17.27 at THLF compared with US$13.96, US$0.00 and US$0.00 at PHLF, respectively. The DNMC difference of VD, ANC and IUD service between THLF and PHLF was US$29.09, US$18.07 and US$16.27, respectively. Moreover, the median of indirect cost (INDC) for VD, ANC and IUD services were US$23.93, US$9.49 and US$10.44 at THLF compared with US$7.90, US$1.59 and US$1.06 at PHLF, respectively. The INDC difference of VD, ANC and IUD service between THLF and PHLF was US$16.03, US$7.90 and US$9.38, respectively. CONCLUSION The study found the utilisation of VD, ANC and IUD services at PHLF instead of THLF is a considerable cost saving for families. Therefore, shifting the utilisation of services from THLF to PHLF reduces the financial burden affecting individuals, families and their productivity.
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Affiliation(s)
- Abdulkareem Ali Hussein Nassar
- Directorate General for Disease Control and Epidemiological Surveillance, Supervisor of the COVIS-19 Hotline Operation, Yemen Ministry of Public Health and Population, Sana'a, Yemen
- TEPHINET - The Task Force for Global Health, Program Evaluation Consultant in Yemen, Sana'a, Yemen
| | - Yahia Ahmed Raja'a
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Umm Al-Qura University, Makkah, Saudi Arabia
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Borde MT, Kabthymer RH, Shaka MF, Abate SM. The burden of household out-of-pocket healthcare expenditures in Ethiopia: a systematic review and meta-analysis. Int J Equity Health 2022; 21:14. [PMID: 35101038 PMCID: PMC8802489 DOI: 10.1186/s12939-021-01610-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In Ethiopia, household Out-Of-Pocket healthcare expenditure accounts for one-third of total healthcare expenditure, is one of the highest in the world, and still creates barriers and difficulties for households to healthcare access and may delay or forgo needed healthcare use. Despite the presence of a few highly dispersed and inconsistent studies, no comprehensive study was conducted. Therefore, in this systematic review and meta-analysis, we aimed at estimating the pooled estimates of the burden of household Out-Of-Pocket healthcare expenditures among Ethiopian households and identifying its determinants. METHODS We systematically searched articles from PubMed / Medline and Google scholar databases and direct Google search engine without restriction on publication period. Cross-sectional and cohort articles and grey literature published in English were included. Data were extracted using Microsoft Excel. Two reviewers screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment. The third reviewer commented on the review. Articles with no abstracts or full texts, editorials, and qualitative in design were excluded. To assess quality, Joanna Briggs Critical Appraisal Tools was used. A Forest plot was used to present summary information on each article and pooled common effects. Potential heterogeneity was checked using Cochrane's Q test and I-squared statistic. We checked publication bias using a Funnel plot. Moreover, subgroup and sensitivity analyses were performed. Meta-analysis was used for the pooled estimates using RevMan statistical software Version 5.4.1. RESULTS In this review, a total of 27 primary articles were included (with a total sample size of 331,537 participants). Because of the presence of heterogeneity, we employed a random-effects model; therefore, the pooled burden household Out-Of-Pocket / catastrophic healthcare expenditure in Ethiopia was strongly positively associated with household economic status. The odds of facing Out-Of-Pocket / catastrophic healthcare expenditures among the poorest quintile was about three times that of the richest (AOR = 3.09, 95% CI: 1.63, 5.86) p-value < 0.001. In addition, on pooled analysis, the mean direct Out-Of-Pocket healthcare expenditures were $32 per month (95%CI: $11, $52) (SD = $45), and the mean indirect Out-of-Pocket healthcare expenditures were $15 per month (95%CI: $3, $28) (SD = $17). The mean catastrophic healthcare expenditure at 10% of threshold was also disproportionately higher: 40% (95%CI: 28, 52%) (SD = 20%). Moreover, the common coping mechanisms were a sale of household assets, support from family, or loan: 40% (95%CI: 28, 52%) (SD = 20%). CONCLUSION Our study revealed the evidence of inequity in financial hardship that the burden of household Out-Of-Pocket / catastrophic healthcare expenditures gap persists among Ethiopian households that is unfair and unjust. To reduce the detected disparities in seeking healthcare among Ethiopian households, national healthcare priorities should target poor households. This calls for the Ministry of Health to improve the challenges and their impact on equity and design better prepayment policies and strengthen financial protection strategies to protect more vulnerable Ethiopian households. PROTOCOL REGISTRATION The details of this protocol have been registered on the PROSPERO database with reference number ID: CRD42021255977 .
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Affiliation(s)
- Moges Tadesse Borde
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
- Hawassa, Ethiopia
| | - Robel Hussen Kabthymer
- Department of Nutrition, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Mohammed Feyisso Shaka
- Department of Reproductive Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Semagn Mekonnen Abate
- Department of Anaesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Weldegiorgis SK, Feyisa M. Why Women in Ethiopia Give Birth at Home? A Systematic Review of Literature. Int J Womens Health 2021; 13:1065-1079. [PMID: 34785958 PMCID: PMC8590518 DOI: 10.2147/ijwh.s326293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed at reviewing identifying reasons for home delivery preference, determining the status of homebirth in Ethiopia, and identifying socio-demographic factors predicting home delivery in Ethiopia. Methods A systematic literature review regarding the status of homebirth, reasons why women preferred homebirth and socio-demographic determinants of home deliveries was performed using CINAHL, MEDLINE, Google Scholar and Maternity and Infant Care. Keywords and phrases such as home birth, home delivery, childbirth, prevalence, determinants, predictors, women and Ethiopia were included in the search. Results A total of 10 studies were included in this review. The mean proportion of homebirth was 73.5%. Maternal age, ANC visits, maternal level of education, distance to facilities, and previous facility birth were significantly associated with homebirth. Perceived poor quality of service, distant location of facilities, homebirth as customary in the society and perceived normalness of labour were identified as reasons for choosing homebirth. Conclusion Despite the significance of skilled birth attendants in reducing maternal and newborn morbidity and mortality, unattended homebirth remains high. By identifying and addressing socio-demographic enablers of home deliveries, maternal health service uptake can be improved.
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Tiruye G, Shiferaw K, Tura AK, Debella A, Musa A. Prevalence of premature rupture of membrane and its associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2021; 9:20503121211053912. [PMID: 34733510 PMCID: PMC8558797 DOI: 10.1177/20503121211053912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Premature rupture of the membrane is a serious public health problem, especially in low- and middle-income countries with significant maternal and perinatal morbidity and mortality. Despite its substantial contributions to feto-maternal complications, the burden of premature rupture of the membrane was not systematically analyzed in Ethiopia. Hence, this review aimed to identify the burden of premature rupture of the membrane and associated factors among pregnant women in Ethiopia. Methods PubMed/Medline, Scopus, and African journal online databases and Google Scholar were searched for articles published in the English language. Independent review authors selected and screened studies. Appraisal for methodological quality of studies was conducted using the Joanna Briggs Institute assessment checklist. RevMan 5.3 software was used for meta-analysis. The I 2 statistical significance and Egger's test were used to assess heterogeneity and publication bias, respectively. Results The pooled prevalence of premature rupture of the membrane among pregnant women in Ethiopia was 9.2% (95% confidence interval = 5.0, 16.4). Factors significantly associated with premature rupture of the membrane were no antenatal care visit (odds ratio = 2.87, confidence interval = 1.34, 6.14), history of premature rupture of the membrane (odds ratio = 4.09, 95% confidence interval = 2.82, 5.91), history of abortion (odds ratio = 3.13, confidence interval = 1.63, 6.01), abnormal vaginal discharge (odds ratio = 6.78, confidence interval = 4.11, 11.16), and urinary tract infection (odds ratio = 3.04, confidence interval = 1.21, 7.63). Conclusion Nearly one in ten pregnancies in Ethiopia encounters premature rupture of the membrane complications. The finding highlights improving antenatal care utilization, thus preventing or treating urinary and reproductive tract infections, and tailored interventions for pregnant women with a history of premature rupture of the membrane or abortion contribute to reduced premature rupture of the membrane.
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Affiliation(s)
- Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kassiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulbasit Musa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Kebede E, Kekulawala M. Risk factors for stillbirth and early neonatal death: a case-control study in tertiary hospitals in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2021; 21:641. [PMID: 34548064 PMCID: PMC8456546 DOI: 10.1186/s12884-021-04025-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births. METHODS This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death. RESULTS During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098-2.780), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031). CONCLUSION Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.
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Affiliation(s)
- Eskinder Kebede
- Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Melani Kekulawala
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA.,College of Medicine and Life Sciences, University of Toledo, Toledo, USA
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Oyugi B, Kendall S, Peckham S. Effects of free maternal policies on quality and cost of care and outcomes: an integrative review. Prim Health Care Res Dev 2021; 22:e43. [PMID: 34521501 PMCID: PMC8444462 DOI: 10.1017/s1463423621000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/07/2022] Open
Abstract
AIM We conducted an integrative review of the global-free maternity (FM) policies and evaluated the quality of care (QoC) and cost and cost implications to provide lessons for universal health coverage (UHC). METHODOLOGY Using integrative review methods proposed by Whittemore and Knafl (2005), we searched through EBSCO Host, ArticleFirst, Cochrane Central Registry of Controlled Trials, Emerald Insight, JSTOR, PubMed, Springer Link, Electronic collections online, and Google Scholar databases guided by the preferred reporting item for systematic review and meta-analysis protocol (PRISMA) guideline. Only empirical studies that described FM policies with components of quality and cost were included. There were 43 papers included, and the data were analysed thematically. RESULTS Forty-three studies that met the criteria were all from developing countries and had implemented different approaches of FM policy. Review findings demonstrated that some of the quality issues hindering the policies were poor management of complications, worsened referral systems, overburdening of staff because of increased utilisation, lack of transport, and low supply of stock. There were some quality improvements on monitoring vital signs by nurses and some procedures met the recommended standards. Equally, mothers still bear the burden of some costs such as the purchase of drugs, transport, informal payments despite policies being 'free'. CONCLUSIONS FM policies can reduce the financial burden on the households if well implemented and sustainably funded. Besides, they may also contribute to a decline in inequity between the rich and poor though not independently. In order to achieve the SDG goal of UHC by 2030, there is a need to promote awareness of the policy to the poor and disadvantaged women in rural areas to help narrow the inequality gap on utilisation and provide a sustainable form of transport through collaboration with partners to help reduce impoverishment of households. Also, there is a need to address elements such as cultural barriers and the role of traditional birth attendants which hinder women from seeking skilled care even when they are freely available.
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Affiliation(s)
- Boniface Oyugi
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- The University of Nairobi, Nairobi, Kenya
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Geze S, Tura AK, Fage SG, van den Akker T. Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study. BMJ Open 2021; 11:e047206. [PMID: 34446486 PMCID: PMC8395281 DOI: 10.1136/bmjopen-2020-047206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia. DESIGN Cross-sectional study. SETTING Two major private hospitals in eastern Ethiopia. PARTICIPANTS All women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files. RESULTS Of 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%). CONCLUSION More than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.
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Affiliation(s)
- Shegaw Geze
- Department of Midwifery, College of Health and Medical Sciences, Wolkite University, Wolkite, Ethiopia
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of obstetrics and gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Enden MR, Tolla MT, Norheim OF. Providing universal access to modern contraceptive methods: An extended cost-effectiveness analysis of meeting the demand for modern contraception in Ethiopia. Soc Sci Med 2021; 281:114076. [PMID: 34116422 DOI: 10.1016/j.socscimed.2021.114076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
Despite recent advances in access to and use of modern contraception in Ethiopia, further improvement is needed, particularly among poorer women. This extended cost-effectiveness analysis investigated the health outcomes, their distribution, and financial risk protection associated with meeting the demand for modern contraception for all Ethiopian women. We developed five Markov models with wealth quintile-specific input data to investigate the effects of meeting this demand and followed a hypothetical cohort of 1,252,000 women through their reproductive lives from ages 15-49 years. The health outcomes are reported in quality-adjusted life years (QALYs) gained and in intermediate health outcomes, such as the total number of induced abortions, unintended pregnancies, and pregnancy-related deaths averted. The economic effect of meeting the demand for modern contraception was assessed by estimating the financial risk protection benefits in terms of averted out-of-pocket payments and the reduction in the number of cases of catastrophic health expenditure by quintile. Meeting the demand for modern contraception was deemed highly cost effective, with an incremental cost-effectiveness ratio of $96.60/QALY gained per woman. A total of 676,300 QALYs were gained, and approximately 1,900,000 unintended pregnancies, 250,000 induced abortions, and 9000 pregnancy-related deaths were averted over the 35-year period. Most of these gains were achieved among low-income groups. When the demand for modern contraception was met, almost 40,000 cases of catastrophic health expenditure were averted in the poorest quintile. The total governmental cost was higher in all quintiles when the demand for modern contraception was met compared to the baseline scenario, with the largest percentage increase in governmental spending in the poorest quintiles. Meeting the demand for modern contraception fulfills the priority-setting criteria established by the Ethiopian Ministry of Health and makes the Ethiopian health care system more equitable.
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Affiliation(s)
- M R Enden
- Bergen Centre for Ethics and Priority Setting, Institute of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5009, Bergen, Norway.
| | - M T Tolla
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States.
| | - O F Norheim
- Bergen Centre for Ethics and Priority Setting, Institute of Global Public Health and Primary Care, University of Bergen, Årstadveien 21, 5009, Bergen, Norway; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA, 02115, United States.
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Seyoum H, Feleke Z, Bikila D, Yaregal A, Demisie A, Ali S, Fisseha S, Abebe Y, Battu A, Lam F, Bayisa R. Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13200.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: As a key partner of Ministry of Health (MOH) Ethiopia, The Clinton Health Access Initiative (CHAI) had been implementing the Child Survival Project (CSP) since October 2015. Strengthening DTC was one of its focuses to improve overall supply chain management (SCM). The objectives of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major hindering factors for their functionality. Methods: A descriptive study design was employed with mainly qualitative data collection methods and analysis. The assessment made use of both qualitative and quantitative data, generated from primary sources through key informant interviews and from secondary sources through desk review methods. Results: DTCs were introduced in Ethiopia in the early 1980’s. The mandate of DTCs has been given to four different government organizations since this time. As a result, its implementation was lagging. Recently, the government and its partners have given attention to DTCs. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in health facilities (HFs) improved from 85% to 98% between 2015 and 2019 during baseline and endline assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63%. The CHAI/CSP regular supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same facility revealed significant association between the two variables at p<0.0001. Conclusions: Providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating bodies for DTCs and similar structures at Regional Health Bureaus and woreda health offices should be established.
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Mohammed T, Udoh RH, Kuupiel D. Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers' and managers' perceptions. BMC Pregnancy Childbirth 2021; 21:220. [PMID: 33740908 PMCID: PMC7977170 DOI: 10.1186/s12884-021-03701-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers' and providers' perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers' and providers' perspectives of free maternal healthcare and the quality of care in SSA. METHODS We used Askey and O'Malley's framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. RESULTS In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers' and providers' perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. CONCLUSION This study established evidence of existing literature on the quality of care based on healthcare providers' and managers' perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- The University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Tahiru Mohammed
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Roseline H. Udoh
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
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Abadi T, Mebratie AD. Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia. Risk Manag Healthc Policy 2021; 14:87-95. [PMID: 33447112 PMCID: PMC7802893 DOI: 10.2147/rmhp.s285793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background The government of Ethiopia introduced an exemption policy that guarantees free maternal healthcare services from public providers. This policy aims to ensure financial protection and enhance utilization of services especially for low-income people. However, patients in most cases incur health expenditure when seeking health care. This paper aims to assess direct and indirect medical costs of treating maternal complications and associated factors at a public hospital in Northern Ethiopia. Methods An institution-based cross-sectional study design was carried on 267 mothers with complications. A multivariate linear regression model at 5% level of significance was used to analyze factors driving the outcome. Results The median cost was more than seven times the monthly minimum wage, and this may cause severe financial consequences for the poor. Direct medical costs accounted for the major share (68%) of total cost, and this was mainly driven by lack of diagnostic services at public facilities and paying for private providers. Expenditure for treatment of maternal complications is positively associated with income, absence from work, travel time to the facility and being diagnosed at a private facility. Conclusion The overall evidence in this study poses a concern about the context in which fee exemption reforms are being implemented.
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Affiliation(s)
- Teamir Abadi
- Health Bureau Health Care Financing Reform Case Team, Tigray Regional Health Bureau, Mekelle, Ethiopia
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Mekonnen T, Dune T, Perz J, Ogbo FA. Postnatal Care Service Utilisation in Ethiopia: Reflecting on 20 Years of Demographic and Health Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010193. [PMID: 33383822 PMCID: PMC7794721 DOI: 10.3390/ijerph18010193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Background: Most maternal deaths in the world occur during the postpartum period, especially within the first two days following delivery. This makes postnatal care (PNC) critical to improving the chances of maternal and child survival. Over the past 20 years, the proportion of women receiving antenatal care (ANC) in Ethiopia has increased while the proportion of those receiving PNC has remained low. This study aimed to understand the trends, determinants and urban–rural variations of PNC service utilisation. Methods: This study draws on the Ethiopian Demographic and Health Survey (EDHS) data for the years 2000 (n = 4552), 2005 (n = 4467), 2011 (n = 4445) and 2016 (n = 4275) to estimate the trends and determinants of PNC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent factors, the study factors and PNC service utilisation. Results: Over the twenty-year period of the EDHS, the proportion of Ethiopian women who received PNC services increased from 5.6% (95% CI: 4.6–6.9%) in 2000 to 18.5% (95% CI: 16.4–20.7%) in 2016. Similarly, women who received PNC services in urban areas increased from 15.2% (95% CI: 23.6–30.7%) in 2000 to 47% (95% CI: 60.4–67.3%) in 2016. Women who were in the wealthy quintile, had ANC visits, delivered in a health facility, and delivered by caesarean section were most likely to have PNC. The present study also showed that whilst birth spacing was a significant factor among urban women, wealth index, ANC visits, and perception of health facility distance were significant factors among rural women. Conclusions: The study suggests low levels of utilisation of PNC among Ethiopian women from rural districts. Geographically targeted interventions with a focus on low-socioeconomic rural women, and those with no previous contacts with the health system during pregnancy, are needed to improve PNC in Ethiopia.
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Affiliation(s)
- Tensae Mekonnen
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith NSW 2751, Australia; (T.D.); (J.P.); (F.A.O.)
- Correspondence:
| | - Tinashe Dune
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith NSW 2751, Australia; (T.D.); (J.P.); (F.A.O.)
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith NSW 2751, Australia; (T.D.); (J.P.); (F.A.O.)
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith NSW 2751, Australia; (T.D.); (J.P.); (F.A.O.)
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Tura AK, Aboul-Ela Y, Fage SG, Ahmed SS, Scherjon S, van Roosmalen J, Stekelenburg J, Zwart J, van den Akker T. Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9281. [PMID: 33322495 PMCID: PMC7764538 DOI: 10.3390/ijerph17249281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023]
Abstract
With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.
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Affiliation(s)
- Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Yasmin Aboul-Ela
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235 Harar, Ethiopia;
| | - Semir Sultan Ahmed
- Department of Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, P.O. Box 235 Harar, Ethiopia;
| | - Sicco Scherjon
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, 9700 AD Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
| | - Joost Zwart
- Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands;
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; (Y.A.-E.); (J.v.R.); (T.v.d.A.)
- Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Abayneh K, Mengistie B, Oljira L, Tiruye G. Clients' Satisfaction with Services for Prevention of Mother-to-Child Transmission of HIV in Public Health Facilities in Diredawa City, Eastern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:611-620. [PMID: 33116923 PMCID: PMC7585811 DOI: 10.2147/hiv.s264854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
Background Ethiopia has a very high burden of HIV infection among children, contracted from their mothers, and nearly two-thirds of pregnant women do not receive prevention of mother-to-child transmission (PMTCT) services. Ensuring clients’ satisfaction with PMTCT services is one of the bases to scale up service utilization and mitigate MTCT of HIV. However, in Ethiopia, particularly in the study area, evidence related to clients’ satisfaction with PMTCT services is scanty. Methods A facility-based cross-sectional study was conducted among women attending antenatal care in Diredawa city. Systematic random sampling was used to select 517 study participants. Interviewer-administered structured and pretested questionnaires were used to collect data. Statistical significance was regarded as P≤0.05 with a 95% CI. Results Client satisfaction with PMTCT services was 82.2% (95% CI 66.4%–94.3). Receiving the service from a hospital (AOR 2.34; 95% CI 1.5, 3.98), no formal education (AOR 2.53, 95% CI 1.52–4.2), primary education (AOR 2.17 95% CI 1.17–4.04), receiving pre- and post-HIV test counseling from the same provider (AOR 4.93, 95% CI 2.98–7.17), gestational age above first trimester (AOR 1.74, 95% CI 1.12–2.71), and waiting time ≤15 minutes (AOR 2.31, 95% CI 1.28–4.16) were positively associated with client satisfaction with PMTCT services. Conclusion Client satisfaction with PMTCT services is relatively high. Receiving the service from a hospital, no formal education or only primary education, gestational age above first trimester, getting pre- and post-HIV test counseling from the same provider, and waiting time ≤15 minutes to receive services were factors associated with client satisfaction. A greater number of skilled PMTCT-service providers would improve service quality and hasten its delivery. Furthermore, providing mentoring and supportive supervision of health centers with PMTCT programs and keeping the same provider in posttest counseling is also mandatory.
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Affiliation(s)
- Kinfe Abayneh
- Department of Management and Health Policy, Sofi Health Center, Harar, Ethiopia
| | - Bizatu Mengistie
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Kuupiel D. Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Serv Res 2020; 20:911. [PMID: 33004029 PMCID: PMC7528345 DOI: 10.1186/s12913-020-05755-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. METHODS We employed the Arskey and O'Malley's framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. CONCLUSION This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick I. Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- St. John of God College of Health, Duayaw Nkwanta, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Faculty of Business and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
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Mori AT, Binyaruka P, Hangoma P, Robberstad B, Sandoy I. Patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa: a systematic review. HEALTH ECONOMICS REVIEW 2020; 10:26. [PMID: 32803373 PMCID: PMC7429732 DOI: 10.1186/s13561-020-00283-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 08/05/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND Morbidity and mortality due to pregnancy and childbearing are high in developing countries. This study aims to estimate patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa. METHODS A systematic review of the literature was conducted to identify costing studies published and unpublished, from January 2000 to May 2019. The search was done in Pubmed, EMBASE, Cinahl, and Web of Science databases and grey literature. The study was registered in PROSPERO with registration No. CRD42019119316. All costs were converted to 2018 US dollars using relevant Consumer Price Indices. RESULTS Out of 1652 studies identified, 48 fulfilled the inclusion criteria. The included studies were of moderate to high quality. Spontaneous vaginal delivery cost patients and health systems between USD 6-52 and USD 8-73, but cesarean section costs between USD 56-377 and USD 80-562, respectively. Patient and health system costs of abortion range between USD 11-66 and USD 40-298, while post-abortion care costs between USD 21-158 and USD 46-151, respectively. The patient and health system costs for managing a case of eclampsia range between USD 52-231 and USD 123-186, while for maternal hemorrhage they range between USD 65-196 and USD 30-127, respectively. Patient cost for caring low-birth weight babies ranges between USD 38-489 while the health system cost was estimated to be USD 514. CONCLUSION This is the first systematic review to compile comprehensive up-to-date patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa. It indicates that these costs are relatively high in this region and that patient costs were largely catastrophic relative to a 10 % of average national per capita income.
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Affiliation(s)
- Amani Thomas Mori
- Centre for International Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
- Department of Global Public Health and Primary Care, Section for Ethics and Health Economics, University of Bergen, Bergen, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bjarne Robberstad
- Centre for International Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Department of Global Public Health and Primary Care, Section for Ethics and Health Economics, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Ingvild Sandoy
- Centre for International Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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Carvalho N, Hoque ME, Oliver VL, Byrne A, Kermode M, Lambert P, McIntosh MP, Morgan A. Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings. BMC Med 2020; 18:201. [PMID: 32718336 PMCID: PMC7385867 DOI: 10.1186/s12916-020-01658-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to oxytocin for prevention of postpartum haemorrhage (PPH) in resource-poor settings is limited by the requirement for a consistent cold chain and for a skilled attendant to administer the injection. To overcome these barriers, heat-stable, non-injectable formulations of oxytocin are under development, including oxytocin for inhalation. This study modelled the cost-effectiveness of an inhaled oxytocin product (IHO) in Bangladesh and Ethiopia. METHODS A decision analytic model was developed to assess the cost-effectiveness of IHO for the prevention of PPH compared to the standard of care in Bangladesh and Ethiopia. In Bangladesh, introduction of IHO was modelled in all public facilities and home deliveries with or without a skilled attendant. In Ethiopia, IHO was modelled in all public facilities and home deliveries with health extension workers. Costs (costs of introduction, PPH prevention and PPH treatment) and effects (PPH cases averted, deaths averted) were modelled over a 12-month program. Life years gained were modelled over a lifetime horizon (discounted at 3%). Cost of maintaining the cold chain or effects of compromised oxytocin quality (in the absence of a cold chain) were not modelled. RESULTS In Bangladesh, IHO was estimated to avert 18,644 cases of PPH, 76 maternal deaths and 1954 maternal life years lost. This also yielded a cost-saving, with the majority of gains occurring among home deliveries where IHO would replace misoprostol. In Ethiopia, IHO averted 3111 PPH cases, 30 maternal deaths and 767 maternal life years lost. The full IHO introduction program bears an incremental cost-effectiveness ratio (ICER) of between 2 and 3 times the per-capita Gross Domestic Product (GDP) ($1880 USD per maternal life year lost) and thus is unlikely to be considered cost-effective in Ethiopia. However, the ICER of routine IHO administration considering recurring cost alone falls under 25% of per-capita GDP ($175 USD per maternal life-year saved). CONCLUSIONS IHO has the potential to expand access to uterotonics and reduce PPH-associated morbidity and mortality in high burden settings. This can facilitate reduced spending on PPH management, making the product highly cost-effective in settings where coverage of institutional delivery is lagging.
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Affiliation(s)
- Natalie Carvalho
- Centre for Health Policy & Global Burden of Disease Group, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Mohammad Enamul Hoque
- Agency for Clinical Innovation, NSW Ministry of Health, Sydney, NSW, 2067, Australia
| | - Victoria L Oliver
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Abbey Byrne
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Pete Lambert
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Michelle P McIntosh
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Women's retention on the continuum of maternal care pathway in west Gojjam zone, Ethiopia: multilevel analysis. BMC Pregnancy Childbirth 2020; 20:258. [PMID: 32349687 PMCID: PMC7191802 DOI: 10.1186/s12884-020-02953-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women’s service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. Methods A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval. Results The study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. Conclusions The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.
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Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082696. [PMID: 32295233 PMCID: PMC7216179 DOI: 10.3390/ijerph17082696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/04/2022]
Abstract
A previous study in Ethiopia reported significant variation in rotavirus vaccine uptake across socioeconomic strata. This study aims to quantify socioeconomic inequality of rotavirus vaccine uptake in Ethiopia and to identify the contributing factors for the inequality. The concentration curve (CC) and the Erreygers Normalized Concentration Index (ECI) were used to assess the socioeconomic related inequality in rotavirus vaccine uptake using data from the 2016 Ethiopian Demographic and Health Survey. Decomposition analysis was conducted to identify the drivers of inequalities. The CC for rotavirus vaccine uptake lay below the line of equality and the ECI was 0.270 (p < 0.001) indicating that uptake of rotavirus vaccine in Ethiopia was significantly concentrated among children from families with better socioeconomic status. The decomposition analysis showed that underlining inequalities in maternal health care services utilization, including antenatal care use (18.4%) and institutional delivery (8.1%), exposure to media (12.8%), and maternal educational level (9.7%) were responsible for the majority of observed inequalities in the uptake of rotavirus vaccine. The findings suggested that there is significant socioeconomic inequality in rotavirus vaccine uptake in Ethiopia. Multi-sectoral actions are required to reduce the inequalities, inclusive increasing maternal health care services, and educational attainments among economically disadvantaged mothers.
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Tesema GA, Gezie LD, Nigatu SG. Trends of stillbirth among reproductive-age women in Ethiopia based on Ethiopian demographic and health surveys: a multivariate decomposition analysis. BMC Pregnancy Childbirth 2020; 20:193. [PMID: 32228496 PMCID: PMC7106701 DOI: 10.1186/s12884-020-02880-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Despite the effort to reduce stillbirth, Ethiopia remains one of the countries with the highest rate in the world. Therefore, this study aimed to analyze the trends of stillbirth among births from reproductive age women over time based on Ethiopian Demographic and Health Surveys (EDHSs). Methods Secondary data analysis was conducted based on the Ethiopian Demographic Health Surveys (EDHSs) conducted in 2005, 2011 and 2016. A total weighted sample of 12,037, 10,588, and 11,375 in 2005, 2011 and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of stillbirth over time and factors contributing to the change in stillbirth rate. STATA 14 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance. Results Among women of reproductive age, the stillbirth rate declined from 13.3/1000 births in 2005 to 9.2 per 1000 births in 2016 with the annual rate of reduction of 3.1%. The study found that the stillbirth rate has been declined over time concerning the place of residence, region, antenatal care, education and place of delivery. The decomposition analysis indicated that about 82.3% of the overall change stillbirth rate was due to the difference in women’s composition. Particularly, an increase in women’s urban place of residence, health facility delivery, and cesarean delivery were significant predictors for the decline in stillbirth rate over the surveys. Conclusions The stillbirth rate has been declined over time. More than 3/4th of the decrease in stillbirth rate was due to the difference in characteristics of women over the surveys. The increase in women’s urban place of residence, an increase in cesarean delivery and health facility delivery significantly contributed to the decrease in stillbirth rate over time. Public health interventions targeting rural resident women, strengthening emergency obstetric services and health facility delivery would help to maintain the decreasing trend of stillbirth rate in Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ajayi AI, Akpan W. Maternal health care services utilisation in the context of 'Abiye' (safe motherhood) programme in Ondo State, Nigeria. BMC Public Health 2020; 20:362. [PMID: 32192429 PMCID: PMC7082975 DOI: 10.1186/s12889-020-08512-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nigeria Demographic and Health Survey (NDHS) of 2008 show that Ondo State had the worst maternal outcomes in the South Western region of Nigeria. To address this problem, the "Abiye" (safe motherhood) programme-which included community engagement, health system strengthening and user fee removal- was implemented by the state government. We assessed the use of maternal health care services and its determinants at 5 years after the implementation of this programme using a population-based survey. We also compared the results of our survey to the NDHS 2013 to assess improvement in maternal health care services utilisation. METHODS We conducted a population-based survey in 2016 among representative sample of 409 women who had given birth between 2011 and 2015, which were selected using cluster random sampling. We compared the findings of this 2016 survey to the 2013 NDHS, which contains maternal health care services utilisation information of a total of 434 women who gave birth between 2009 and 2013 to assess progress in the use of maternal health care services. We used descriptive and inferential statistics for our data analysis. RESULTS In the 2013 NDHS survey, about 80% of women received antenatal care compared to 98% in the 2016 survey. Our survey shows that the majority of births (85.6%) took place in health facilities compared to only 56.5% in NDHS 2013 survey, which represents a 29.1 percentage points increase. In both surveys, women with primary level of education or less had lower odds of delivering their babies in health facilities. However, while the 2013 NDHS survey shows that women who resided in urban areas were twice more likely to deliver their babies in health facilities compared to those living in rural areas, the 2016 survey shows that urban residence was no longer significantly associated with a higher odds of facility-based child delivery. CONCLUSION Maternal health services utilisation has improved considerably following the implementation of the "Abiye" initiative. The findings of this study suggest that with community engagement, health system strengthening and user fee removal for the most vulnerable, universal access to and utilisation of maternal health services is possible.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100, Kenya.
| | - Wilson Akpan
- Research and Innovation, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
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Horiuchi S, Nakdouangma B, Khongsavat T, Kubota S, Yamaoka K. Potential factors associated with institutional childbirth among women in rural villages of Lao People's Democratic Republic: a preliminary study. BMC Pregnancy Childbirth 2020; 20:89. [PMID: 32041566 PMCID: PMC7011605 DOI: 10.1186/s12884-020-2776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 01/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background The provision of quality health services has been a global priority to reduce neonatal and maternal deaths. In Lao People’s Democratic Republic (Lao PDR), the coverage of institutional childbirth stayed at a low level regardless of a sharp increase in the coverage of antenatal care (ANC) and fee exemption. The aim of the present study was to preliminary explore factors associated with increased institutional childbirth and the association between ANC attendance and maternal knowledge among women in rural villages of Lao PDR. Methods A secondary data analysis was conducted using data collected through a pilot survey in Sekong province in Lao PDR. The study participants were women with children under 5 years of age in villages within 10 km (km) from health centers staffed with skilled birth attendants. Data were collected via a face-to-face interview using a semi-structured questionnaire and were analysed using logistic regression models to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for having institutional childbirth in relation to potential factors. Results A total of 302 women, 203 (67.2%) of whom gave birth at a health facility. 277 (91.7%) attended ANC at least once. Sixty-nine women (22.9%) had received no formal education, 272 (90.1%) were of an ethnic minority, 174 (57.6%) were unwaged and 99 (32.8%) lived more than 6 km from the nearest health facility. 51 (16.6%) did not know about birth complications at interview. Institutional childbirth was negatively associated with a lack of maternal knowledge about birth complications (OR, 0.27; 95% Cl, 0.14–0.54) after adjusting for covariates. Although there were few women who did not received ANC, the results suggested ANC might not be associated with maternal knowledge about birth complications (OR, 1.87; 95% Cl, 0.43–8.12). Conclusions The present study suggests that maternal knowledge about birth complications is an important factor in increasing the institutional childbirth in rural villages of Lao PDR where majority of residents were ethnic minority. Improving quality of ANC and attitude among health care providers may be key to increasing health-seeking behavior. However, further research is needed to understand factors influencing choice of place of childbirth.
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Affiliation(s)
- Sayaka Horiuchi
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi, Tokyo, Japan. .,Center for Birth Cohort Studies, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, Japan.
| | | | | | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic
| | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi, Tokyo, Japan
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Merga M, Debela TF, Alaro T. Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia. J Prim Care Community Health 2019; 10:2150132719896447. [PMID: 31865840 PMCID: PMC6927202 DOI: 10.1177/2150132719896447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Ethiopian health care system since 2005 has encouraged safe enhanced obstetrical care. However, hospital delivery has remained expensive for poor households due to hidden costs. Hidden costs are the costs that are not accounted for in direct hospital costs. The aim of this study was to estimate the hidden costs of institutional delivery and to identify its associated factors. Methods: A health facility-based cross-sectional study was conducted in the Bale zone from August 13 to September 2, 2018. Exit interviews were conducted among women who gave birth at the selected hospitals. A total of 390 women from 1 referral hospital and 2 general hospitals were included into the study. Systematic sampling technique was used to select study participants. Multiple linear regression analysis was done to identify the predictors of the hidden cost of institutional delivery. Result: The median hidden cost of institutional delivery was 877.5 ETB (32.03 USD). The median of the direct medical cost of normal delivery was 280 ETB (10.21 USD) while the direct nonmedical cost was 230 ETB (8.40 USD). For cesarean section, the median direct medical cost was 292 ETB (10.66 USD) while indirect costs were 591 ETB (21.60 USD). For forceps delivery, the direct medical cost was 362 ETB (13.21 USD) while the direct medical cost was 360 (13.14 USD). Distance of household from the hospital (β = 0.165), length of stay at the hospital (β = 0.050), mode of delivery (β = -0.067), and family monthly income (β = 0.201) were the explanatory variables significantly associated with the hidden cost. Conclusion: This study showed hidden cost of facility-based delivery was high. Distance, length of stay, income, and mode of delivery were the predictor of hidden cost. Ethiopian health care system should consider the hidden costs for pregnant women and their families.
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Affiliation(s)
- Melese Merga
- Bale Zonal Health Department, Oromia Regional State, Robe, Ethiopia
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Tesfaye G, Chojenta C, Smith R, Loxton D. Predisposing, enabling and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia. Reprod Health 2019; 16:167. [PMID: 31729986 PMCID: PMC6858740 DOI: 10.1186/s12978-019-0829-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Skilled delivery care utilization in Ethiopia is still very low compared with the goal set by the global community for countries with the highest maternal mortality. As a result, the country is overburdened with high maternal morbidity and mortality. We aimed to explore the predisposing, enabling, and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia. Methods A community-based cross-sectional study was conducted with a total of 1294 women. The participants were selected using systematic sampling techniques. An interviewer-administered structured questionnaire aided by an electronic survey tool was used to collect data. Univariate analyses were conducted to describe the study sample. Bivariate and multivariate logistic regression analyses were carried out to elicit the association of predisposing, enabling, and need factors associated with skilled delivery care utilization. Separate multivariate models were fitted for primiparous and multiparous women categories. Odds ratios with 95% confidence intervals were used to assess statistical significance. Results More than a quarter (30.8%) of the women surveyed used skilled delivery care for their most recent birth. Significant predisposing factors were as follows: presence of educated family member; receiving education on maternal health; previous use of skilled delivery care; and best friend’s use of maternal care. Place of residence was the enabling factor that predicted skilled delivery care use. Antenatal care attendance and pregnancy intention were significant need factors associated with skilled delivery care utilization. Conclusion The findings of the study highlight the need for a concerted effort to establish community-based peer education programs; improve access to family planning services (to reduce unintended pregnancies); increase antenatal care uptake; and facilitate access to skilled delivery care in rural areas.
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Affiliation(s)
- Gezahegn Tesfaye
- School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O Box: 235, Harar, Ethiopia. .,Research Centre for Generational Health and Ageing, Faculty of Health and Medicine University of Newcastle, Newcastle upon Tyne, NSW, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine University of Newcastle, Newcastle upon Tyne, NSW, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine University of Newcastle, Newcastle upon Tyne, NSW, Australia
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Tesfaye G, Chojenta C, Smith R, Loxton D. Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study. Women Birth 2019; 33:e216-e226. [PMID: 31060984 DOI: 10.1016/j.wombi.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Ethiopia, maternal health service utilization is still unacceptably low. The societal and cultural factors that constrain women from attending these services have not yet been sufficiently explored. Using qualitative methods, we aimed to explore the factors that delay maternal health service utilization in eastern Ethiopia. METHOD A total of 13 audio-recorded focus group discussions were conducted comprising 88 participants. We conducted separate group discussions with reproductive aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers to capture their knowledge, practices, feelings, thoughts and attitudes towards maternal health service utilization. The recorded sessions were transcribed into the local language and then translated into English for analysis. RESULT The study identified a number of factors that may delay maternal health service utilization. Factors were grouped using the Three Delays model as a framework. Low level of awareness regarding need, poor involvement of husband, perceived absence of health problems, social power, community misperceptions and cultural restrictions, negative attitudes towards male midwives, acceptance of traditional birth attendants and poor social networking were Delay One factors. Lack of physical accessibility and high transportation costs were categorised as Delay Two factors for skilled birth care attendance. Perceived or experienced poor quality of care were categorised as Delay Three factors for both skilled birth and postnatal care utilization. CONCLUSION Despite the ongoing government measures to improve maternal health service utilization in Ethiopia, numerous factors continue to contribute to delays in service use, which in turn contribute to high maternal mortality.
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Affiliation(s)
- Gezahegn Tesfaye
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Roger Smith
- Mothers and Babies Research Centre, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
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Azeze GA, Mokonnon TM, Kercho MW. Birth preparedness and complication readiness practice and influencing factors among women in Sodo town, Wolaita zone, Southern Ethiopia, 2018; community based cross-sectional study. Reprod Health 2019; 16:39. [PMID: 30925883 PMCID: PMC6441218 DOI: 10.1186/s12978-019-0703-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Birth preparedness and complication readiness (BPCR) is a strategy that helps women to consider all available maternal health care services during pregnancy and prepare for potential complications. Though global annual number of maternal deaths decreased to an estimated 303,000 in 2015, avoidable morbidity and mortality remains a formidable challenge in many developing countries which account for approximately 99% (302,000) of the global maternal deaths in 2015. This study aims to assess the practice and factors associated with birth preparedness and complication readiness among women in Sodo town, Wolaita zone, Southern Ethiopia; 2018. Methods Community-based cross-sectional study was carried out from June 1–30, 2018. A total of 495 (pregnant and recently delivered women), were randomly selected and interviewed using pretested structured questionnaire. The data were entered using EPI Data version 3.1 and analyzed using SPSS version 20. Descriptive statistics were reported and bivariate and multivariable logistic regression was carried out to see the effect of each independent variable on the dependent variable. Result Of 506 sampled participants, 495 (49.5% pregnant and 50.5% recently delivered) participated, which made a response rate of 97.8%. 48.5% of women were prepared for birth and ready for its complication in the study area. From multivariable analysis, women in the age group of 15–24 (AOR = 2.39, 95% C. I = 1.19, 4.46) and 25–34 years (AOR = 1.89, 95% C. I = 1.10, 3.25); women who attended college and above level of education (AOR = 2.07, C. I = 1.11, 3.88); women counseled to prepare potential blood donors (AOR = 1.90, 95% C. I = 1.15, 3.12) and to identify skilled birth attendants prior to birth (AOR = 1.59, 95% C. I = 1.05, 2.39) and women whose partners and/or families were counseled (AOR = 2.16, 95%C.I = 1.25, 3.74) were factors positively associated with birth preparedness and complication readiness practice. Conclusion Although not satisfactory in view of expectations, a relatively higher practice of birth preparedness and complication readiness had been observed in the study area compared with the previous reports. Healthcare workers at the grassroots should be encouraged to involve women’s partners and/or family members while explaining birth preparedness and complication readiness with a special emphasis on older (> 35 years) and uneducated women in order to improve the practice in the study area.
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Affiliation(s)
- Gedion Asnake Azeze
- Department of Midwifery, College of Health Science, Wolaita Sodo University, P.O.Box 138, Sodo, Ethiopia.
| | - Taklu Marama Mokonnon
- Department of Midwifery, College of Health Science, Wolaita Sodo University, P.O.Box 138, Sodo, Ethiopia
| | - Melkamu Worku Kercho
- Department of Midwifery, College of Health Science, Wolaita Sodo University, P.O.Box 138, Sodo, Ethiopia
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Getachew B, Liabsuetrakul T. Health care expenditure for delivery care between maternity waiting home users and nonusers in Ethiopia. Int J Health Plann Manage 2019; 34:e1334-e1345. [PMID: 30924204 DOI: 10.1002/hpm.2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare the health care expenditures between maternity waiting home (MWH) users and nonusers in Ethiopia. METHODS A cross-sectional study was done in Ethiopia between December 2017 and June 2018. The study setting included eight health facilities in the Gurage zone of Ethiopia. Health expenditure for delivery care was the outcome variable that was then classified into out-of-pocket (OOP) payments, women's costs, total costs, and overall costs. Those health expenditures were then compared among MWH users and nonusers. OOP payments were further analyzed using quantile regression to explore associated factors. RESULTS A total of 812 postpartum women were included in this study of whom half were MWH users. Significantly higher OOP payment, women's costs, total costs, and overall cost were found among MWH users compared with nonusers regardless of duration of MWH stay. The MWH users were more likely to have higher OOP payment compared with MWH nonusers in linear and quantile regressions for both unadjusted and adjusted analyses. Higher OOP payments were observed for longer distance traveled and cesarean section (CS) delivery women at the 75th and 90th quantiles of expenditure. Using public transportation was significantly associated with higher OOP payment in all quantile levels. CONCLUSION Utilization of MWH incurred higher OOP payments, total costs, women's costs, and overall costs compared with MWH nonusers. Higher OOP payments for delivery care among MWH users were observed in all quantiles of expenditure.
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Affiliation(s)
- Biniam Getachew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Tama E, Molyneux S, Waweru E, Tsofa B, Chuma J, Barasa E. Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation. Int J Health Policy Manag 2018; 7:603-613. [PMID: 29996580 PMCID: PMC6037504 DOI: 10.15171/ijhpm.2017.135] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Kenya introduced a free maternity policy in 2013 to address the cost barrier associated with accessing maternal health services. We carried out a mixed methods process evaluation of the policy to examine the extent to which the policy had been implemented according to design, and positive experiences and challenges encountered during implementation.
Methods: We conducted a mixed methods study in 3 purposely selected counties in Kenya. Data were collected through in-depth interviews (IDIs) with policy-makers at the national level, health managers at the county level, and frontline staff at the health facility level (n=60), focus group discussions (FGDs) with community representatives (n=10), facility records, and document reviews. We analysed the data using a framework approach.
Results: Rapid implementation led to inadequate stakeholder engagement and confusion about the policy. While the policy was meant to cover antenatal visits, deliveries, and post-natal visits, in practice the policy only covered deliveries. While the policy led to a rapid increase in facility deliveries, this was not matched by an increase in health facility capacity and hence compromised quality of care. The policy led to an improvement in the level of revenues for facilities. However, in all three counties, reimbursements were not made on time. The policy did not have a system of verifying health facility reports on utilization of services.
Conclusion: The Kenyan Ministry of Health (MoH) should develop a formal policy on the free maternity services, and provide clear guidelines on its content and implementation arrangements, engage with and effectively communicate the policy to stakeholders, ensure timeliness of payment disbursement to healthcare facilities, and introduce a mechanism for verifying utilization reports prepared by healthcare providers. User fee removal policies such as free maternity programmes should be accompanied by supply side capacity strengthening.
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Affiliation(s)
- Eric Tama
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.,Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | | | - Evelyn Waweru
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Jane Chuma
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.,The World Bank, Kenya Country Office, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dalinjong PA, Wang AY, Homer CSE. The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt. BMC Res Notes 2018; 11:341. [PMID: 29843780 PMCID: PMC5975462 DOI: 10.1186/s13104-018-3452-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/24/2018] [Indexed: 01/15/2023] Open
Abstract
Objective A free maternal health policy was implemented under Ghana’s National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications). Results Reasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.
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Affiliation(s)
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
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Chol C, Negin J, Garcia-Basteiro A, Gebrehiwot TG, Debru B, Chimpolo M, Agho K, Cumming RG, Abimbola S. Health system reforms in five sub-Saharan African countries that experienced major armed conflicts (wars) during 1990-2015: a literature review. Glob Health Action 2018; 11:1517931. [PMID: 30270772 PMCID: PMC7011843 DOI: 10.1080/16549716.2018.1517931] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/23/2018] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has had more major armed conflicts (wars) in the past two decades - including 13 wars during 1990-2015 - than any other part of the world, and this has had an adverse effect on health systems in the region. OBJECTIVE To understand the best health system practices in five SSA countries that experienced wars during 1990-2015, and yet managed to achieve a maternal mortality reduction - equal to or greater than 50% during the same period - according to the Maternal Mortality Estimation Inter-Agency Group (MMEIG). Maternal mortality is a death of a woman during pregnancy, or within 42 days after childbirth - measured as maternal mortality ratio (MMR) per 100,000 live births. DESIGN We conducted a selective literature review based on a framework that drew upon the World Health Organisation's (WHO) six health system building blocks. We searched seven databases, Google Scholar as well as conducting a manual search of sources in articles' reference lists - restricting our search to articles published in English. We searched for terms related to maternal healthcare, the WHO six health system building blocks, and names of the five countries. RESULTS Our study showed three general health system reforms across all five countries that could explain MMR reduction: health systems decentralisation, the innovation related to the WHO workforce health system building block such as training of community healthcare workers, and governments-financing reforms. CONCLUSION Restoring health systems after disasters is an urgent concern, especially in countries that have experienced wars. Our findings provide insight from five war-affected SSA countries which could inform policy. However, since few studies have been conducted concerning this topic, our findings require further research to inform policy, and to help countries rebuild and maintain their health systems resilience.
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Affiliation(s)
- Chol Chol
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Joel Negin
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | | | | | - Berhane Debru
- Research and Human Resource Development, Ministry of Health, Asmara, The State of Eritrea
| | - Maria Chimpolo
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Kingsley Agho
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
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Mezmur M, Navaneetham K, Letamo G, Bariagaber H. Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys. PLoS One 2017; 12:e0184688. [PMID: 28910341 PMCID: PMC5598994 DOI: 10.1371/journal.pone.0184688] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022] Open
Abstract
Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the poorest households.
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Affiliation(s)
- Markos Mezmur
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Gobopamang Letamo
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Hadgu Bariagaber
- Department of Population Studies, University of Botswana, Gaborone, Botswana
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Zegeye EA, Mbonigaba J, Kaye SB. HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings. PSYCHOL HEALTH MED 2017; 23:525-531. [PMID: 28760009 DOI: 10.1080/13548506.2017.1360469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman-infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman-infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.
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Affiliation(s)
- Elias Asfaw Zegeye
- a Economics Department , University of KwaZulu Natal , Durban , South Africa.,b Clinton Health Access Initiative, Federal Ministry of Health, Health Economics and Financing Analysis Team , Addis Ababa , Ethiopia
| | - Josue Mbonigaba
- a Economics Department , University of KwaZulu Natal , Durban , South Africa
| | - Sylvia Blanche Kaye
- c Public Administration and Economics Department , Durban University of Technology , Durban , South Africa
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Bobo FT, Yesuf EA, Woldie M. Inequities in utilization of reproductive and maternal health services in Ethiopia. Int J Equity Health 2017; 16:105. [PMID: 28629358 PMCID: PMC5477250 DOI: 10.1186/s12939-017-0602-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. METHOD Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. RESULTS Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. CONCLUSION Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, College of Health sciences; Wollega University, Nekemte, Ethiopia
| | - Elias Ali Yesuf
- Department of Health Economics, Management, and Policy, Faculty of Public Health; Jimma University, Jimma, Ethiopia
- CIH-LMU Center for International Health, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mirkuzie Woldie
- Department of Health Economics, Management, and Policy, Faculty of Public Health; Jimma University, Jimma, Ethiopia
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Mezmur M, Navaneetham K, Letamo G, Bariagaber H. Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia. BMC Health Serv Res 2017; 17:367. [PMID: 28532407 PMCID: PMC5441003 DOI: 10.1186/s12913-017-2298-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/08/2017] [Indexed: 11/26/2022] Open
Abstract
Background The progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005–11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities. Methods Data for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services. Results In this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor. Conclusion The challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus, addressing socioeconomic inequalities in accessing maternal health services is central to resolving challenges of maternal health. Furthermore, as Ethiopia moves forward with the sustainable development agenda, socioeconomic inequalities in uptake of maternal health services should also be continuously monitored.
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Affiliation(s)
- Markos Mezmur
- Department of Population Studies, University of Botswana, Private Bag: UB 705, Gaborone, Botswana.
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Private Bag: UB 705, Gaborone, Botswana
| | - Gobopamang Letamo
- Department of Population Studies, University of Botswana, Private Bag: UB 705, Gaborone, Botswana
| | - Hadgu Bariagaber
- Department of Population Studies, University of Botswana, Private Bag: UB 705, Gaborone, Botswana
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Tesfaye B, Mathewos T, Kebede M. Skilled delivery inequality in Ethiopia: to what extent are the poorest and uneducated mothers benefiting? Int J Equity Health 2017; 16:82. [PMID: 28511657 PMCID: PMC5434546 DOI: 10.1186/s12939-017-0579-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The fifth Millennium Development Goal (MDG) targeted at improving maternal health. In this regard, Ethiopia has shown substantial progresses in the past two decades. Nonetheless, these impressive gains are unevenly distributed among Ethiopian women with different socio-economic characteristics. This study aimed at investigating levels and trends of skilled delivery service, and wealth and education related inequalities from 2000 to 16. METHODS Longitudinal data analysis was conducted on Ethiopian Demographic and Health Survey (EDHS) data of 2000, 2005, 2011 and 2016. The outcome variable was skilled delivery, while data on economic status and education level were used as dimensions of inequality. Rate Ratio (RR) and Rate Difference (RD) inequality measures were applied. STATA for windows version 10.1 statistical software was utilized for data analysis and presentation. The strength of association of inequality dimensions with the outcome variable was assessed using a 95% confidence interval. RESULTS From total deliveries, 5.62%, 6.3%, 10.8% and 28% of them were attended by skilled birth attendant in 2000, 2005, 2011 and 2016 respectively. In the most recent survey (EDHS 2016), proportion of births attended by skilled birth attendance among women who completed secondary and above education was about 5.42 [95% CI (4.53, 6.09)] times more when compared to women with no formal education. Proportion of births attended by skilled birth attendance among women in the richest quintile was about 5.11 [95% CI (3.98, 6.12)] times higher than that of women in the poorest quintile. Moreover, gap of inequality on receiving skilled delivery service has increased substantially from 24.2 (2000) to 53.8 (2016) percentage points between women in the richest and poorest quintiles; and from 44.9 (2000) to 76.0 (2016) percentage points between women who completed secondary and above education and women with no formal education. CONCLUSIONS Skilled birth attendance remained low and virtually unchanged during the period 2000-2011, but increased substantially in 2016. Gap on wealth and education related inequalities increased linearly during 2000-16. Most pronounced inequalities were observed in women's level of education revealing women with no formal education were the most underserved subgroups. Encouraging women in education and economic development programs should be strengthened as part of the effort to attain Universal Health Coverage (UHC) of Sustainable Development Goals (SDGs) in Ethiopia.
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Affiliation(s)
- Brook Tesfaye
- Health Policy and Planning Directorate, Ethiopian Federal Ministry of Health, Sudan Street, Lideta Sub-city, Addis Ababa, Ethiopia
| | - Tsedeke Mathewos
- John Snow Incorporated Research and Training Institute, Health Management Information System Scale-up Project, Addis Ababa, Ethiopia
- Technical Assistant to Director of Health Policy and Planning Directorate, Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mihiretu Kebede
- Department of Health Informatics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, Bremen, Germany
- University of Bremen, Health Sciences, Bremen, Germany
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Shifraw T, Berhane Y, Gulema H, Kendall T, Austin A. A qualitative study on factors that influence women's choice of delivery in health facilities in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2016; 16:307. [PMID: 27733138 PMCID: PMC5062812 DOI: 10.1186/s12884-016-1105-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/11/2016] [Indexed: 11/14/2022] Open
Abstract
Background Facility based delivery for mothers is one of the proven interventions to reduce maternal and neonatal morbidity and mortality. This study identified women’s reasons for seeking to give birth in a health facility and captured their perceptions of the quality of care they received during their most recent birth, in a population with high utilization of facility based deliveries. Methods This qualitative study was conducted in eight health centers in Addis Ababa. Women bringing their index child for first vaccinations were invited to participate in an in-depth interview about their last delivery. Sixteen in-depth interviews were conducted. Interviews were conducted by trained researchers using a semi-structured interview guide. The data were transcribed verbatim in Amharic and translated into English. A thematic analysis was conducted to answer specific study questions. Results All research participants expressed a preference for facility based delivery because of their awareness of obstetric complications, and related perceptions that facility-birth is safer for the mother and child. Dimensions of quality of care and the cost of services were identified as influencing decisions about whether to seek care in the public or private sector. Media campaigns, information from social networks and women’s experiences with healthcare providers and facilities influenced care-seeking decisions. Conclusions The universal preference for facility-based birth by women in this study indicates that, in Addis Ababa, facility based delivery has become a preferred norm. Sources of information for decision-making and the dimensions of quality prioritized by women should be taken into account to develop interventions to promote facility-based births in other settings.
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Affiliation(s)
- Tigest Shifraw
- Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia
| | - Hanna Gulema
- Addis Continental Institute of Public Health, P.O Box 26571/1000, Addis Ababa, Ethiopia
| | - Tamil Kendall
- Maternal Health Task Force, Harvard TH Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA
| | - Anne Austin
- Maternal Health Task Force, Harvard TH Chan School of Public Health, 651 Huntington Avenue, Boston, MA, 02115, USA
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Vallières F, Cassidy EL, McAuliffe E, Gilmore B, Bangura AS, Musa J. Can Sierra Leone maintain the equitable delivery of their Free Health Care Initiative? The case for more contextualised interventions: results of a cross-sectional survey. BMC Health Serv Res 2016; 16:258. [PMID: 27412299 PMCID: PMC4942899 DOI: 10.1186/s12913-016-1496-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 06/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by the same District Health Management Team (DHMT). METHODS We employed a cross-sectional household survey using a two-stage probability sampling method to obtain a sample of the population across two rural locations in Bonthe District: the riverine and the mainland. Overall, a total of 393 households across 121 villages were surveyed in the riverine and 397 households across 130 villages were sampled on the mainland. Maternal health, child health and sanitation indicators in Bonthe District were compared using Pearson Chi-Squared test with Yates' Continuity Correction across the two areas. RESULTS Women across the two regions self-reported significantly different uptake of family planning services. Children on the mainland had significantly greater rates of health facility based deliveries; being born in the presence of a skilled birth attendant; completed immunisation schedules; and higher rates of being brought to the health centre within 24 h of developing a fever or a suspected acute respiratory infection. Households on the mainland also reported significantly greater use of treated water and unrestricted access to a latrine. CONCLUSIONS If the government of Sierra Leone is going to deliver on their promise to free health care for pregnant women and their children, and do so in a way that reduces inequalities, greater attention must be paid to the existing service delivery gaps within each District. This is particularly relevant to health policy post-Ebola, as it highlights the need for more contextualised service delivery to ensure equitable access for women and children.
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Affiliation(s)
- Frédérique Vallières
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
- />School of Psychology, Trinity College Dublin, University of Dublin, 2 College Green, Dublin 2, Ireland
| | - Emma Louise Cassidy
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Eilish McAuliffe
- />School of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Brynne Gilmore
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Allieu S. Bangura
- />World Vision Sierra Leone, 35 Wilkinson Road, Freetown, Sierra Leone
| | - Joseph Musa
- />World Vision Sierra Leone, 35 Wilkinson Road, Freetown, Sierra Leone
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Ridde V. From institutionalization of user fees to their abolition in West Africa: a story of pilot projects and public policies. BMC Health Serv Res 2015; 15 Suppl 3:S6. [PMID: 26559564 PMCID: PMC4652517 DOI: 10.1186/1472-6963-15-s3-s6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This article analyzes the historical background of the institutionalization of user fees and their subsequent abolition in West Africa. Based on a narrative review, we present the context that frames the different articles in this supplement. We first show that a general consensus has emerged internationally against user fees, which were imposed widely in Africa in the 1980s and 1990s; at that time, the institutionalization of user fees was supported by evidence from pilot projects funded by international aid agencies. Since then there have been other pilot projects studying the abolition of user fees in the 2000s, but these have not yet had any real influence on public policies, which are often still chaotic. This perplexing situation might be explained more by ideologies and political will than by insufficient financial capacity of states.
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Affiliation(s)
- Valéry Ridde
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Québec, Canada
- University of Montreal Public Health Research Institute (IRSPUM), Montreal, Québec, Canada
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Okusanya BO, Roberts AA, Akinsola OJ, Oye-Adeniran BA. Birth plans and health insurance enrolment of pregnant women: a cross-sectional survey at two secondary health facilities in Lagos, Nigeria. J Matern Fetal Neonatal Med 2015; 29:2602-6. [PMID: 26482637 DOI: 10.3109/14767058.2015.1094790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We evaluated birth plans and health insurance enrolment of pregnant women at secondary health care level as a strategy for post-2015 goals. METHODS This was a cross-sectional study at two secondary health facilities in Lagos state, Nigeria. A pre-tested questionnaire was used to collect data that were analysed and results presented with frequencies. An overall estimate with 95% confidence interval was used at significant p values of less than 0.05. RESULTS Five hundred and twenty-four women, with a mean age of 3 0 ± 4.1 years, participated. Most women chose hospital delivery (84%) and had plan for transportation (86.3%) during labour. Few women were well prepared for birth (9.7%) and had health insurance (10.1%). Compared with women without insurance, more health-insured women had plans for transport in labour (p = 0.1383) and identified a place of birth (p = 0.2294), but did not have as much plan for someone to accompany them in the case of an emergency (p = 0.3855) and donate blood (p = 0.5065). Few health insured women saved money for delivery (p = 0.7439). CONCLUSION Health insured women did not have better birth plans and expanding pregnant women's access to health insurance may be an insufficient strategy to achieve post MDG 2015 goals.
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Affiliation(s)
| | - Alero A Roberts
- b Department of Community Health and Primary Care , Idi-Araba, College of Medicine, University of Lagos , Lagos , Nigeria
| | - Oluwatosin J Akinsola
- b Department of Community Health and Primary Care , Idi-Araba, College of Medicine, University of Lagos , Lagos , Nigeria
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Abrahim O, Linnander E, Mohammed H, Fetene N, Bradley E. A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Units. PLoS One 2015; 10:e0139024. [PMID: 26436759 PMCID: PMC4593586 DOI: 10.1371/journal.pone.0139024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022] Open
Abstract
Background Primary healthcare systems in sub-Saharan Africa have undergone substantial development in an effort to expand access to appropriate facilities through a well-functioning referral system. The objective of this study was to evaluate the current patterns of seeking prior care before arriving at a health center or a hospital as a key aspect of the referral system of the primary health care unit (PHCU) in three regions in Ethiopia. We examined what percentage of patients had either sought prior care or had been referred to the present facility and identified demographic and clinical factors associated with having sought prior care or having been referred. Methods and Findings We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in three primary health care units serving approximately 100,000 people each and reflecting regional and ethnic diversity; 53% (N = 418) of the sample was seeking care at hospital outpatient departments, and 47% of the sample was seeking care at health centers (N = 378). We used unadjusted and adjusted logistic regression to identify factors associated with having been referred or sought prior care. Our findings indicated that only 10% of all patients interviewed had been referred to their current place of care. Among those in the hospital population, 14% had been referred; among those in the health center population, only 6% had been referred. Of those who had been referred to the hospital, most (74%) had been referred by a health center. Among those who were referred to the health center, the plurality portion (32%) came from a nearby hospital (most commonly for continued HIV treatment or early childhood vaccinations); only 18% had come from a health post. Among patients who had not been formally referred, an additional 25% in the hospital sample and 10% in the health center sample had accessed some prior source of care for their present health concern. In the adjusted analysis, living a longer distance from the source of care and needing more specialized care were correlated with having sought prior care in the hospital sample. We found no factors significantly associated with having sought prior care in the health center sample. Conclusions The referral system among health facilities in Ethiopia is used by a minority of patients, suggesting that intended connections between health posts, health centers, and hospitals may need strengthening to increase the efficiency of primary care nationally.
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Affiliation(s)
- Orit Abrahim
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Erika Linnander
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Halima Mohammed
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Netsanet Fetene
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Elizabeth Bradley
- Yale University School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
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Onarheim KH, Taddesse M, Norheim OF, Abdullah M, Miljeteig I. Towards universal health coverage for reproductive health services in Ethiopia: two policy recommendations. Int J Equity Health 2015; 14:86. [PMID: 26419910 PMCID: PMC4588686 DOI: 10.1186/s12939-015-0218-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/17/2015] [Indexed: 11/30/2022] Open
Abstract
Reproductive health services are crucial for maternal and child health, but universal health coverage is still not within reach in most societies. Ethiopia's goal of universal health coverage promises access to all necessary services for everyone while providing protection against financial risk. When moving towards universal health coverage, health plans and policies require contextualized knowledge about baseline indicators and their distributions. To understand more about the factors that explain coverage, we study the relationship between socioeconomic and geographic factors and the use of reproductive health services in Ethiopia, and further explore inequalities in reproductive health coverage. Based on these findings, we discuss the normative implications of these findings for health policy. Using population-level data from the Ethiopian Demographic and Health Survey (2011) in a multivariate logistic model, we find that family planning and use of antenatal care are associated with higher wealth, higher education and being employed. Skilled attendance at birth is associated with higher wealth, higher education, and urban location. There is large variation between Addis Ababa (the capital) and other administrative regions. Concentration indices show substantial inequalities in the use of reproductive health services. Decomposition of the concentration indices indicates that difference in wealth is the most important explanatory factor for inequality in reproductive health coverage, but other factors, such as urban setting and previous health care use, are also associated with inequalities. When aiming for universal health coverage, this study shows that different socioeconomic factors as well as health-sector factors should be addressed. Our study re-confirms the importance of a broader approach to reproductive health, and in particular the importance of inequality in wealth and geography. Poor, non-educated, non-employed women in rural areas are multidimensionally worse off. The needs of these women should be addressed through elimination of out-of-pocket costs and revision of the formula for resource allocation between regions as Ethiopia moves towards universal health coverage.
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Affiliation(s)
- Kristine Husøy Onarheim
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Mieraf Taddesse
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.
| | - Muna Abdullah
- United Nations Population Fund, Country Office in Ethiopia, Addis Ababa, Ethiopia.
| | - Ingrid Miljeteig
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, N-5018, Bergen, Norway.
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