Pregnant Women's Intentions to Deliver at a Health Facility in the Pastoralist Communities of Afar, Ethiopia: An Application of the Health Belief Model.

Znabu Kahsay,Reda Shamie,Yordanos Tadesse,Alessandra Bazzano,Molla Hiluf

doi:10.3390/ijerph16050888

Abstract

Despite the significant benefits of giving birth at a health facility to improve maternal and child health, the practice remains lower than expected in pastoralist communities of Ethiopia. Understanding the intentions of pregnant women to use health facilities for delivery predicts the adoption of the behavior, yet documented evidence of intention in the context of pastoralist populations remains scarce. The current study aimed to assess pregnant women’s intentions to use a health facility for delivery in the Afar region of Ethiopia using the framework of the health belief model (HBM). A community-based, cross sectional survey was conducted from April 1 to April 30 2016 among 357 randomly sampled pregnant women using an interviewer-administered, semi-structured questionnaire. Data were entered into EpiData and exported to SPSS version 20.0 for analysis. Principal component factor analysis was done to extract relevant constructs of the model, and the reliability of items in each construct was assessed for acceptability. Multivariate logistic regressions were applied to identify predictors of pregnant women’s intentions to give birth at a health facility. The odds ratio was reported, and statistical significance was declared at 95% CI and 0.05 p value. Three hundred fifty seven pregnant women participated in the study (104.6% response rate indicating above the minimum sample size required). Among the respondents, only 108 (30.3%) participants intended to use a health facility for the delivery for their current pregnancy. Higher household average monthly income [AOR = 1.23, 95% CI = (1.10 − 2.90), antenatal clinic (ANC) attendance for their current pregnancy [AOR = 1.41, 95% CI = (1.31 − 2.10), perceived susceptibility to delivery-related complications [AOR = 1.52, 95% CI = (1.30 − 2.70), and perceived severity of the delivery complications [AOR = 1.66, 95% CI = (1.12 − 2.31) were positively associated with pregnant women’s intentions to deliver at a health facility. Intention was negatively associated with participants’ perceived barriers to accessing a health facility [AOR = 0.62, 95% CI = (0.36 − 0.85). Conclusions: A low proportion of pregnant women in the sampled community intended to deliver at a health facility. Pastoralist communities may have special needs in this regard, with household income, antenatal care attendance, perceived risk of complications, and perceived barriers to accessing a health facility largely explaining the variance in intention. Community-based interventions providing counseling and messaging on danger signs in the perinatal period and emphasizing benefits of delivering at a facility are recommended, alongside improving access.

Highlights

While maternal mortality has declined globally over recent decades, women continue to die of complications during pregnancy and childbirth
A low proportion of pregnant women in the sampled community intended to deliver at a health facility
Pastoralist communities may have special needs in this regard, with household income, antenatal care attendance, perceived risk of complications, and perceived barriers to accessing a health facility largely explaining the variance in intention

Summary

Introduction

While maternal mortality has declined globally over recent decades, women continue to die of complications during pregnancy and childbirth. The most recent maternal mortality ratio for Ethiopia was 353 deaths per 100,000 live births in 2015 [1,2]. Evidence exists for giving birth at a health facility as a prominent strategy to reduce maternal and child mortality if quality emergency and obstetric care is in place by skilled attendants [3,4]. It could prevent 13% to 33% of maternal deaths, which may rise to 75% or more if care starts during labor and continues to the early postpartum period [4,5,6]. The need to promote giving birth at health facility is reflected in many national health programs, including the most recent Health Sector Development Plans [7] and health sector transformation plan [8]

Objectives

Methods

Discussion

Conclusion