The death of the mother and her child keeps on bothering developing nations

Skilled delivery service utilization and its association with the establishment of Women's Health Development Army in Yeky district, South West Ethiopia: a multilevel analysis

Background

Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as “Women’s Health Development Army” (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known.

Methods

A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service.

Results

About 45% of women have received skilled delivery care. A significant heterogeneity was observed between “Women’s Health Development Teams (clusters)” for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization.

Conclusions

In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (− 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.

Skilled Antenatal Care Service Utilization and Its Association with the Characteristics of Women's Health Development Team in Yeky District, South-West Ethiopia: A Multilevel Analysis

BACKGROUND

In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was aimed to assess skilled antenatal care service utilization and its association with the characteristics of women's health development team (WHDT).

METHODS

A community based cross sectional study was conducted from January to February 2015. A multi-stage cluster sampling technique was applied, and a total of 748 women (15-49 years) who gave birth in one year preceding the study were included in the study. Data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Bivariate and multilevel mixed effects analysis techniques were applied to check for association of selected independent variables with utilization of skilled ANC.

RESULTS

About 71% women received skilled ANC service at least once. A significant heterogeneity was observed between WHDTs for skilled ANC utilization. Level-1 predictors of skilled ANC utilization were: preference of skilled personnel (AOR=11.0; 95%, CI, 3.02-40.04), awareness about places where to get skilled providers (AOR=51.6; 95% CI, 13.92-,190.97) and listening to radio (AOR=5.7; 95% CI, 1.46-21.94). Distance of WHDT within 2 km radius from the nearest health facility (HF) was the only level-2 significant predictor of skilled ANC service utilization (AOR=8.28; 95%CI, 1.08-62.20).

CONCLUSIONS

Skilled ANC service utilization is the joint effect of individual and WHDT characters. Awareness and perception creation towards skilled maternity service utilization need to be enhanced. Facilities and transport services should be more accessible towards WHDTs.