Poor linkages in maternal health care services-evidence on antenatal care and institutional delivery from a community-based longitudinal study in Tigray region, Ethiopia.

Yohannes Adama Melaku,Yihunie Lakew,Ashenafi Haile,Loko Abraham,Semaw Ferede Abera,Alemseged Aregay,Yemane Ashebir,Fisaha Haile Tesfay,Friehiwot Eshetu,John Kinsman,Berhe Weldearegawi

doi:10.1186/s12884-014-0418-7

Abstract

BackgroundProgress towards attaining the maternal mortality and maternal health targets set by Millennium Development Goal 5 has been slow in most African countries. Assessing antenatal care and institutional delivery service utilization and their determinants is an important step towards improving maternal health care services.MethodsData were drawn from the longitudinal database of Kilite-Awlaelo Health and Demographic Surveillance System. A total of 2361 mothers who were pregnant and who gave birth between September 2009 and August 2013 were included in the analysis. Potential variables to explain antenatal care and institutional delivery service utilization were extracted, and descriptive statistics and logistic regression were used to determine the magnitude of maternal health care service utilization and associated factors, respectively.ResultsMore than three-quarters, 76% [95% CI: 74.8%-78.2%] (n = 1806), of mothers had undergone at least one antenatal care visit during their previous pregnancy. However, only 27% [95% CI: 25.3%-28.9%] (n = 639) of mothers gave birth at a health institution. Older mothers, urban residents, mothers with higher education attainment, and farmer mothers were more likely to use antenatal care. Institutional delivery services were more likely to be used among older mothers, urban residents, women with secondary education, mothers who visited antenatal care, and mothers with lower parity.ConclusionsDespite a relatively high proportion of mothers attending antenatal care services at least once, we found low levels of institutional delivery service utilization. Health service providers in Kilite-Awlaelo should be particularly vigilant regarding the additional maternal health needs of rural and less educated women with high parity.

Highlights

Progress towards attaining the maternal mortality and maternal health targets set by Millennium Development Goal 5 has been slow in most African countries
Respondents? obstetrics history and maternal health care service utilization Twelve percent (n = 281) of birth outcomes were from the women? s first pregnancies
The large gap between the proportion of women who received at least some Antenatal Care (ANC) and the proportion of women who had an institutional delivery needs to be reduced

Summary

Introduction

Progress towards attaining the maternal mortality and maternal health targets set by Millennium Development Goal 5 has been slow in most African countries. Which established a global goal of reducing the maternal mortality ratio (the number of maternal deaths per 100,000 live births) by 75% between 1990 and 2015 ? Maternal mortality has remain stubbornly high throughout much of sub-Saharan Africa [1]. In the southern African region, the maternal mortality ratio has increased since 1990, by an annual rate of 2.7%, primarily because of HIV [1]. The number of maternal deaths annually remains unacceptably high, with over 15,000 Ethiopian women dying in childbirth in 2013 alone, by far the highest number of any country in the region [1]

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