Abstract
BackgroundBecause 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.MethodsA 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.ResultsAbout 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.ConclusionsIn 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.
Highlights
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)
The World Health Organization (WHO) has estimated that 289,000 women died during pregnancy and childbirth in 2013 globally, a majority of which were in developing countries with limited access to skilled maternity services [12, 13]
Study design and setting A community-based cross-sectional study was conducted over 2 months (January–February 2015) among women of reproductive age who gave birth 1 year preceding the study at Yeky district, Sheka Zone, Southwest Ethiopia
Summary
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). Despite the existence of proven interventions to prevent disability or death during pregnancy and childbirth; maternal and perinatal mortality still remains to be major public health problems among sub-Saharan African countries, including Ethiopia [2, 6,7,8,9,10,11]. According to Ethiopian Demographic and Health Survey (EDHS) 2011 and International Monetary Fund (IMF) consultation-staff report of 2014, the maternal mortality ratios in Ethiopia were 676/100,000 and 420/100,000 live births, respectively, which are still among the highest in the world and sub-Saharan African Countries [14, 15]. The EDHS 2011 and mini EDHS 2014 reported that only 10 and 15% of pregnant women in Ethiopia, respectively, received skilled delivery care which is among the lowest in the world and sub-Saharan African Countries [14, 24]. According to the-EDHS 2011, the reasons for not attending health facilities for delivery care were: “it was not important (61%)”, “not familiar (30%)”, and “health facilities were geographically inaccessible (14%)”, respectively, while the mini-EDHS 2014 revealed that similar reasons were given by 45, 33 and 22%, respectively of women who didn’t give their last birth at health facilities [14, 24]
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