Care Services In Ethiopia Research Articles

Spatial patterns and associated factors of HIV testing and counselling (HTC) as a component of antenatal care services in Ethiopia

Background While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia. Methods A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value < 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised. Results In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran’s I = 0.138, p-value <0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors. Conclusion The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women’s knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia.

Challenges and coping strategies for providing maternal health care services among health care professionals in rural health facilities in Wolaita Zone, Southern Ethiopia: a qualitative study

BackgroundMany factors can decrease job productivity and cause physical and psychological complications for health care professionals providing maternal care. Information on challenges and coping strategies among healthcare professionals providing maternal healthcare services in rural communities is crucial. However, there needs to be more studies, especially qualitative research, to explore challenges and coping strategies for providing maternal health care services in Ethiopia among health care professionals, particularly in the Wolaita zone.ObjectiveTo explore the challenges and coping strategies of professionals providing maternal health care in rural health facilities in Wolaita Zone, Southern Ethiopia, in 2023.MethodA phenomenological qualitative study design was applied from May 20 to June 20, 2023. The study was conducted in rural areas of the Wolaita Zone, southern Ethiopia. Healthcare professionals from rural areas were selected using purposive sampling, and in-depth interviews were conducted. A qualitative thematic analysis was employed to analyze the data. Field notes were read, recordings were listened to, and each participant’s interview was written word for word and analyzed using ATLAS.ti 7 software.ResultFive main themes emerged from the data analysis. These themes included inadequate funding from the government, societal barriers to health and access to health care, professionals’ personal life struggles, infrastructure related challenges and health system responsiveness, and coping strategies. Reporting to responsible bodies, teaching mothers about maternal health care services, and helping poor mothers from their pockets were listed among their coping strategies.ConclusionHealthcare professionals have a crucial role in supporting women in delivering babies safely. This study revealed that they are working under challenging conditions. So, if women’s lives matter, then this situation requires a call to action.

Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory

ObjectiveTo investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia.DesignData for the study came from a series of...

Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study

BackgroundAntenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia.MethodsA two-stage cluster sampling method was used and included 2714 women aged 15–49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services.ResultsOf all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively.ConclusionThe overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women’s awareness.

Perceived Impact of COVID-19 and Strategies for effective Implementation of Maternal and Child Health Care Services in Ethiopia: A Qualitative Study

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care. Children and women of reproductive age groups might be disproportionately affected by the disruption of routine health services, particularly in low and middle-income countries (LMICs). The aim of this study was to see the potential effects of the COVID-19 pandemic on maternal and child health (MCH) care service utilization and strategies for effective service implementation. A phenomenological qualitative inquiry was used. For the collection of the data, an in-depth interview was employed among women and informants from all levels of the health system including the health development army in July and September 2020. The data were analyzed thematically using framework analysis. The study identified a range of COVID-19 impacts on maternal and child health service utilization in Ethiopia. Namely, reduction in accessibility and quality of routine health services, low maternal and child health service utilization, challenges in the commitment of health workers, shortage in the supply of routine resources for maternal and child health services; and enduring strategies designed for effective maternal and child health service implementation. The impact of the COVID-19 pandemic on maternal and child health service utilization was identified in a clear thematic area. The findings of this study provide evidence on bases at the local level; will help the policymakers and local administrators to develop strategies for early preparedness in the context of pandemics.

Less than one in four mothers get quality intrapartum health care services in Ethiopia

Intrapartum care is a platform of comprehensive healthcare for pregnant women that is designed to improve birth outcomes for mother and child. However, complications during the intrapartum period continued to be the leading cause of death for women of reproductive age and newborns. Therefore, the aim of this study was to assess the prevalence of quality of intrapartum care and its associated factors among mothers in Ethiopia. A community based cross sectional study was conducted among 4469 mothers who gave birth in the last 2 years. Quality of intrapartum care was analyzed based on the assessment of health facility delivery, skilled birth attendants and early initiations of breast-feeding. Stata version 14 software was used for data cleaning and analysis. A mixed effect multilevel logistic regression was conducted to determine factors associated with quality of intrapartum care. An adjusted odds ratio with 95% confidence interval and a P value of less than or equal to 0.05 was used for the identification of both individual and community level factors. Overall, the prevalence of quality intrapartum care in Ethiopia was 23.8% (95% CI 22.6, 25.13). Primary education (AOR = 1.46, 95% CI = 1.14, 1.88), rich household class (AOR = 1.48, 95% CI = 1.10, 1.98), history of ANC (AOR = 2.91, 95% CI = 2.18, 3.86), perceived distance to the health facility as not a big issue (AOR = 1.63, 95% CI = 1.30, 2.05), urban residence (AOR = 2.97, 95% CI = 1.93, 5.09), Tigray region (AOR = 5.01, 95% CI = 1.25, 20.59), community level poverty (AOR = 0.63, 95% CI = 0.41, 0.97), and having 2–4 children (AOR = 0.74, 95% CI = 0.56, 0.97) were significantly associated with quality of intrapartum care. The finding conclude that less than one in four mothers received good quality intrapartum care. In order to optimize the quality of intrapartum care, the government should empower women through extensive education. It is also recommended for the Ministry of Health to evaluate the health facilities and community health workers to increase coverage of ANC and provide financial assistance to rural residents and the poor household class.

An Action Plan to Improve Postnatal Care in Ethiopia: A Mixed Methods Research

Despite the efforts made in Ethiopia to decrease maternal mortality by increasing postnatal care and other maternal health care services, neither significant reduction in maternal mortality nor an increase in postnatal care utilization. The objective of this study was to develop an action plan to improve postnatal care services in the Ethiopian context. Sequential mixed-methods research, was conducted over three phases. In the first phase of the study, background information on postnatal care services in Ethiopia was assessed and described. During the second phase of the study, an action plan for postnatal care improvement was developed, and the third phase concentrated on the validation of the developed action plan. For phase 1 one of the study 422 respondents were randomly selected and participated in the study from November 1 to 30, 2020. A self-administered structured questionnaire was used for quantitative data collection. The collected data were checked for completeness, cleaned, coded, and then entered into Statistical Package for Social Sciences (SPSS) software program version 21. For the thrird phase of the study a delphi technique was used to validate the developed action plan . For all phases of the study, the open-ended questions were open-coded and thematically analyzed. A validated action plan for the improvements of postnatal care was developed using the inputs from respondents during Phase 1, available literature as well as the three-round Delphi technique. The findings revealed that the developed action plan is applicable in the Ethiopian context and is crucial for improvement of postnatal care. The study revealed that the developed and validated action plan will improve postnatal care in Ethiopia. Follow-up studies to assess the limitations of the action plan can be conducted to adapt and improve the action plan. Further studies on possible challenges associated with the implementation can enhance the success of the implementation of the action plan.

The Acute Needs for Palliative Care Services in Ethiopia (Editorial Message)

Editorial message

Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data

ObjectiveThis study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future.MethodsData from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design.ResultsThirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20–49.ConclusionsWe recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.

Decomposition analysis of women's empowerment-based inequalities in the use of maternal health care services in Ethiopia: Evidence from Demographic and Health Surveys.

The use of maternal health care services tends to rise with women's empowerment. However, disparities in the use of maternal health care services in Ethiopia that are founded on women's empowerment are not sufficiently addressed. In light of women's empowerment equity stratifier, this study seeks to assess inequalities in the uptake of maternal health care services (early antenatal care, four or more antenatal care and postnatal care services). Drawing on data from the four rounds of Ethiopia Demographic and Health Surveys (EDHSs) conducted between 2000 and 2016, we conducted analysis of inequalities in utilization of maternal health care services using women's empowerment as equity stratifier. We utilized concentration index and concentration curve for assessing the inequalities. We used clorenz and conindex Stata modules to compute the index and curve. Decomposition of the Erreygers normalized concentration index was done to explain the inequalities in terms of other variables' percent contributions. Complex aspect of the EDHSs data was considered during analysis to produce findings consistent with the data generating process. All analyses were done using Stata v16. Utilization of maternal health care services was inequitably distributed between empowered and poorly empowered women, with women in the highly empowered category taking more of the services. For instance, the Erreygers index for quality ANC are 0.240 (95% CI 0.207, 0.273); 0.20 (95% CI 0.169, 0.231) and 0.122 (95% CI 0.087, 0.157), respectively, for the attitude towards violence, social independence and decision-making domains of women's empowerment. Inequalities in the distribution of other variables like wealth, education, place of residence and women's empowerment itself underpin the inequalities in the utilization of the services across the women's empowerment groups. Equity in maternal health care services can be improved through redistributive policies that attempt to fairly distribute the socioeconomic determinants of health such as wealth and education between highly and poorly empowered women.

Incidence and predictors of women’s place of delivery among pregnant women who received antenatal care in Southern Ethiopia: a prospective cohort study

Background Home delivery is responsible for a high number of maternal and newborn deaths due to the occurrence of obstetric complications during labour and delivery. Little is known about the incidence and predictors of women’s place of delivery after utilizing antenatal care services in Ethiopia and the study area. Therefore, the purpose of this study is to fill those gaps in the studies mentioned above by determining the incidence and predictors of women’s place of delivery. Methods An institutional-based prospective cohort study was conducted among pregnant women in public hospitals of Gedeo zone, Southern Ethiopia between May 1 and October 30, 2021. A total of 390 pregnant women receiving antenatal care at Gedeo zone public hospitals were enrolled using a systematic random sampling technique and followed up to delivery. Data were entered into Epidata version 3.1 and exported to SPSS version 25 for analysis. For both bivariate and multivariable analyses, a poison regression model was used to identify the association between the dependent and independent variables. A statistical significance level was declared at a p-value less than 0.05. Results In this study, the overall incidence of home delivery and institutional delivery among pregnant women was 37.4% (95% CI: (32.5, 41.9)) and 62.6% (95% CI: 58.1, 67.5)) respectively. Distance from home to nearest health facility(ARR = 1.17:95%:CI (1.01,1.36), poor quality of antenatal care service(ARR = 1.40;95%:CI (1.10,1.79), no formal maternal education(ARR = 1.49;95%:CI (1.21,1.83), previous home delivery history(ARR = 1.38;95%:CI(1.22,1.56), unplanned pregnancy(ARR = 1.23;95%:CI (1.10,1.37) and history of pregnancy-related complication at health facility(ARR = 1.16;95%:CI(1.02,1.33) were predictors of home delivery. Conclusions The study indicated a high incidence of home birth after utilizing antenatal care services. As a result, interventions targeting those identified factors during antenatal care services are critical to reducing home births.

Maternal satisfaction with emergency obstetric and newborn care services in Ethiopia and the associated factors: A systematic review and meta-analysis.

In approximately 15% of all pregnancies, a potentially fatal complication that necessitates medical attention arises, requiring a significant obstetrical intervention for the pregnant women to survive. Between 70% and 80% of maternal life-threating complication have been treated through emergency obstetric and newborn services. This study investigates women's satisfaction with emergency obstetric and newborn care services in Ethiopia and factors associated with their satisfaction. In this systematic review and meta-analysis, we searched electronic databases, such as PubMed, Google Scholar, HINARI, Scopus, and Web of Sciences for primary studies. A standardized data collection measurement tool was used to extract the data. STATA 11 statistical software was used to analyze the data, and I2 tests were used to evaluate heterogeneity. The pooled prevalence of maternal satisfaction was predicted using a random-effects model. Eight studies were included. The pooled prevalence of maternal satisfaction with emergency obstetric and neonatal care services was 63.15% (95% confidence interval: 49.48-76.82). Age (odds ratio = 2.88, 95% confidence interval: 1.62-5.12), presence of birth companion (odds ratio = 2.66, 95% confidence interval: 1.34-5.29), satisfaction with health workers' attitudes (odds ratio = 4.02, 95% confidence interval: 2.91-5.55), educational status (odds ratio = 3.59, 95% confidence interval: 1.42-9.08), length of stay at health facility (odds ratio = 3.71, 95% confidence interval: 2.79-4.94), and antenatal care visits (odds ratio = 2.22, 95% confidence interval: 1.52-3.24) were associated with maternal satisfaction with emergency obstetric and neonatal care service. This study found a low level of overall maternal satisfaction with emergency obstetric and neonatal care services. To increase maternal satisfaction and utilization, the government should focus on improving the standards of emergency maternal, obstetric, and newborn care by identifying gaps in maternal satisfaction regarding the services provided by healthcare professionals.

Clinical ethical practice and associated factors in healthcare facilities in Ethiopia: a cross-sectional study

BackgroundClinical ethical practice (CEP) is required for healthcare workers (HCWs) to improve health-care delivery. However, there are gaps between accepted ethical standards and CEP in Ethiopia. There have been limited studies conducted on CEP in the country. Therefore, this study aimed to determine the magnitude and associated factors of CEP among healthcare workers in healthcare facilities in Ethiopia.MethodFrom February to April 2021, a mixed-method study was conducted in 24 health facilities, combining quantitative and qualitative methods. Quantitative (survey questionnaire) and qualitative (semi-structured interviews) data were collected. For quantitative and qualitative data analysis, Stata version 14 and Atlas.ti version 7 were utilized. Multiple logistic regression and thematic analysis for quantative and qualitative respectively used.ResultsFrom a total of 432 study participants, 407 HCWs were involved in the quantitative analysis, 36 participants were involved in five focus group discussions (FGDs), and eleven key informant interviews (KIIs) were involved in the qualitative analysis. The score of good CEP was 32.68%. Similarly, the scores of good knowledge and attitude were 33.50% and 25.31%, respectively. In the multiple logistic regression models, satisfaction with the current profession, availability of functional CECs, compassionate leaders, previously thought clinical ethics in pre-service education and good attitude were significant factors associated with CEP. Among these significant factors, knowledge, compassionate leaders, poor infrastructure, a conducive environment and positive attitudes were also determinants of CEP according to qualitative findings.ConclusionsThe CEP in health care services in Ethiopia is low. Satisfaction with the current profession, functional CECs, positive attitude, compassionate leaders and previously thought clinical ethics were significant factors associated with CEP. The Ministry of Health (MoH) should integrate interventions by considering CECs, compassionate leadership, and positive attitudes and enhance the knowledge of health professionals. Additionally, digitalization, intersectoral collaboration and institutionalization are important for promoting CEP.

Geographical accessibility of emergency neonatal care services in Ethiopia: analysis using the 2016 Ethiopian Emergency Obstetric and Neonatal Care Survey

IntroductionAccess to emergency neonatal health services has not been explored widely in the Ethiopian context. Accessibility to health services is a function of the distribution and location of services, including...

Quality disparity in terms of clients’ satisfaction with selected exempted health care services provided in Ethiopia: Meta-analysis

IntroductionIn Ethiopia; even though utilization of health care services has been improved after the introduction of user fee exemption, little is known about the quality of the services. There are fragmented studies on the output dimension of quality of health care services particularly on clients’ satisfaction. Therefore this study aims to assess overall quality (in terms of clients’ satisfaction) and its disparity among users of selected exempted health care services provided in Ethiopia. MethodsThe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was used to undertake this study. Both published and unpublished articles conducted in Ethiopia on the quality of health care services in terms of clients’ satisfaction dimensions were searched. A total of 750 articles were retrieved through international databases (Scopus, MEDLINE/PubMed, Science Direct, Google Scholar and Cochrane Library) and national digital library repositories (Addis Ababa University’s digital library repository); 703 of which were excluded while only 47 articles were included in the meta-analysis. The search for articles was conducted during the period 03 December 2019 to 28 January 2020. For methodological qualities of the included articles assessment, a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies was used. R version 3.6.1 and stata version 14 soft wares were used for analysis. A random-effects model was used to calculate pooled estimates. The I2 tests were used to assess the heterogeneity of the studies. ResultsThe pooled overall prevalence of included 47 studies revealed that clients’ satisfaction among users of selected exempted health care services in Ethiopia was 70% (95% CI: 64, 74%). In subgroup analysis; the lowest prevalence of clients’ satisfaction was observed among users of obstetrics maternal health care services with the prevalence of 65.04% (95% CI: 57.50, 72.58). ConclusionThis study found that more than one-third of respondents; was not satisfied with exempted health care services. There is slight difference in satisfaction of clients across type of exempted health care services and regions. Policy and decision makers in Ethiopia shall design strategies to optimize quality of health care services besides exemption of its costs.it is also strongly recommend that a special emphasis shall be given to obstetric health care services provision. Moreover, concerned stakeholders’ (ministry of health, etc.) should strengthen compassionate respectful care provision in public health facilities; beside to removing user fees.

Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities

Unsafe abortion is a leading cause of global maternal mortality and morbidity. This study sought to estimate availability of essential postabortion care (PAC) services among publicly managed health facilities in Ethiopia. Data from public hospitals and health centers in Ethiopia were collected in 2020. Among facilities offering labor and delivery, we assessed the proportion that: (1) offered PAC, (2) were equipped for each PAC signal function, and (3) were equipped for all PAC signal functions falling within their scope of care by facility type. Our primary outcome was PAC service provision status. Descriptive statistics summarized the proportion of hospitals and health centers, respectively, categorized as each PAC status and with necessary equipment for individual signal functions. Per Federal Ministry of Health (FMOH) guidelines, hospitals are expected to provide comprehensive PAC, while health centers are expected to provide basic PAC. Altogether, 69.1% (n=94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (n=131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; n=114) and uterine evacuation among health centers (84.6%; n=170). Meaningful progress has been made toward achieving the Ethiopian FMOH's goal of universal PAC service availability at hospitals and health centers by 2020. Despite this, sizable gaps remain and may endanger maternal health in Ethiopia, underscoring a need for continued prioritization of PAC services. Ethiopia's commitment to PAC has fostered a service landscape that is stronger than many other low-resource settings; however, notable shortcomings are present. Further research is needed to understand the potential role of clinical training and supply-side interventions.

Barriers and Facilitators to Accessing Health Care Services among Married Women in Ethiopia: a Multi-level Analysis of the Ethiopia Demographic and Health Survey

Background and Objective: Access to health care services is a major challenge to women and children in many developing countries such as Ethiopia. In this study, we investigated the individual- and community-level factors associated with barriers to accessing health care services among married women in Ethiopia. Methods: Data from the 2016 Ethiopia demographic and health survey on 9,824 married women of reproductive age (15-49 years) were analyzed. Multilevel logistic regression models were used to assess individual- and community-level factors associated with barriers to access health care services. Regression analysis results revealed adjusted odds ratios at 95% confidence intervals. Results: Over two-thirds (71.8%) of married women in Ethiopia reported barriers to accessing health care services. Some of the individual-level factors that were associated with lower odds of reporting barriers to access health care services include: having secondary education (aOR=0.49, 95% CI: 0.32-0.77), being in the richest quintile (aOR=0.34, 95% CI: 0.22-0.54), and indicating wife-beating as unjustified (aOR=0.66, 95% CI:0.55-0.81). Among the community-level factors, high community-level literacy (aOR=0.56, 95% CI: 0.34-0.92) and moderate community socioeconomic status (aOR=0.62, 95% CI: 0.45-0.85) were significantly associated with lower odds of reporting barriers to access health care services. Conclusion and Implications for Translation: The findings revealed high barriers to access health care services, and both individual- and community-level factors were significant contributing predictors. Therefore, it is important to consider multidimensional strategies and interventions to facilitate access to health care services in Ethiopia. Copyright © Zegeye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Readiness of Primary Hospitals in Providing Neonatal Intensive Care Services in Ethiopia.

The Ethiopian neonatal mortality has not shown much progress over the years. In light of this, the country has introduced interventions such as the utilization of newborn corners and neonatal intensive care units to avert preventable neonatal deaths. This study was conducted to assess readiness of primary hospitals in providing neonatal intensive care services. A health facility based cross-sectional study design was employed where data were collected using both prospective and retrospective techniques using a format adapted from national documents. SPSS version 25 was used for data entry and analysis using descriptive statistics. Data were collected from 107 of 113 (94.7%) primary hospitals due to inaccessibility of some primary hospitals. The minimum national standard requirement of a level one neonatal intensive care unit for infrastructure was met by 63% (68/107) and 44% (47/107) had fulfilled the requirements for kangaroo mother care units. The average number of neonatal intensive care unit trained nurses per primary hospital was 2.6, 0.8 for general practitioners and 2.9 support staff; all of which is less than the minimum recommended national standard. The minimum national requirement for medical equipment and renewables for primary hospital level was fulfilled by 24% (26/107) of the hospitals, 65% (70/107) for essential laboratory tests, and 87% (93/107) for clinical services and procedures. The average number of admissions during the six months prior to the data collection was 87.2 sick newborns per facility with a 'discharged improved' rate of 71.5%, referral out rate of 18.4% and level one neonatal intensive care unit death rate of 6.6%. The remaining newborns had either left against medical advice or were still undergoing treatment during data collection. The overall readiness of primary hospitals to deliver neonatal intensive care services in terms of infrastructure, human resource, medical equipment, and laboratory tests was found to be low. There is a need to fill gaps in infrastructure, medical equipment, renewables, human resource, laboratory reagents, drugs and other supplies of neonatal intensive care units of primary hospitals to garner better quality of service delivery.

Determinants of postnatal care utilization in Ethiopia: a multilevel analysis

BackgroundThe expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas.MethodsThe study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care.ResultsThis study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05–1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28–3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57–13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04–2.12), birth notification (AOR: 2.66; 95% CI: 2.15–3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58–2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03–1.57).ConclusionThis study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.

Bayesian Multilevel Analysis of Utilization of Antenatal Care Services in Ethiopia.

In sub-Saharan Africa, 72% of pregnant women received an antenatal care visit at least once in their pregnancy period. Ethiopia has one of the highest rates of maternal mortality in sub-Saharan African countries. So, this high maternal mortality levels remain a major public health problem. According to EDHS, 2016, the antenatal care (ANC), delivery care (DC), and postnatal care (PNC) were 62%, 73%, and 13%, respectively, indicating that ANC is in a low level. The main objective of this study was to examine the factors that affect the utilization of antenatal care services in Ethiopia using Bayesian multilevel logistic regression models. The data used for this study comes from the 2016 Ethiopian Demographic and Health Survey which was conducted by the Central Statistical Agency (CSA). The statistical method of data analysis used for this study is the Bayesian multilevel binary logistic regression model in general and the Bayesian multilevel logistic regression for the random coefficient model in particular. The convergences of parameters are estimated by using Markov chain Monte-Carlo (MCMC) using SPSS and MLwiN software. The descriptive result revealed that out of the 7171 women who are supposed to use ANC services, 2479 (34.6%) women were not receiving ANC services, while 4692 (65.4%) women were receiving ANC services. Moreover, women in the Somali and Afar regions are the least users of ANC. Using the Bayesian multilevel binary logistic regression of random coefficient model factors, place of residence, religion, educational attainment of women, husband educational level, employment status of husband, beat, household wealth index, and birth order were found to be the significant factors for usage of ANC. Regional variation in the usage of ANC was significant.