Factors associated with women’s autonomy regarding maternal and child health care utilization in Bale Zone: a community based cross-sectional study

Background Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women’s autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women’s autonomy and identify associated factors in Southeast Ethiopia. Method A community based cross-sectional study was conducted from March 19th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women’s autonomy for health care utilization. Result Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children’s health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women’s autonomy. Conclusion Socio-demographic and maternal factors (knowledge and attitude) were found to influence women’s autonomy. Interventions targeting women’s autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status

The Prevalence of Anaemia Among Children Age 6 to 59 Months and Association Factors in Central Highland Region of Ethiopia, Community Based Cross Sectional Design, Initial Assessment for BCC Intervention

Behavioral change communication (BCC) to prevent iron deficiency anaemia had lacked attention in our country. Considerably, children are the most vulnerably group for iron deficiency anaemia (IDA). This study aimed to assess prevalence of anaemia and associated factors among children age 6 to 59 months. Methods: Community based Cross sectional study design was used for initial assessment for BCC intervention in Central Highland of Ethiopia. Multistage sampling method was used to select 8 districts, 16 clustered Kebeles (smallest unit of administration) and 1012 mothers/care givers and their pair children age 6 to 59 months by considering feature BCC intervention. Dietary behaviour, anthropometric measurements and blood samples data were collected. Binary and linear logistic regressions were analysed using IBM SPSS Statistics software version 21. Results: The prevalence of anaemia among study subjects was 184 (18.4 %.), but higher (24.1%) among group of age 6 to <24 months. The mean Hb concentration was 12.55+ 1.73 and stunted growth (411 (40.6%)). Being consuming cow milk as major complementary food (Adjusted Odds Ratio (AOR) =4.54, 95% CI =3.14, 6.56), age 6 to <24 months (AOR=1.4, CI=1.10, 2.94) were considered as independent predictors of risk for having anaemia among children. In linear logistic regression analysis, being increasing age (Bcoefficient ((B) = 0.172, CI=0.01, 0.33) and increasing height (B=0.170, CI=0.14, 0.329) were potentially increase haemoglobin concentration by 0.170 mg/dl. Also, Height for age (HAZ) (B =0.105, CI=0.02, 0.144) change Hb concentration by 0.105mg/dl. Conclusions: The magnitude of anaemia was moderate among young children. Cow milk consumption and young children related to poor dietary intake behaviour increased the risk of anaemia and high proportion of inadequate growth (stunting) among study subjects considerable for BCC intervention to improve iron intake for children growth

Modern Contraceptive Use and Associated Factors among Women within the Extended Postpartum Period in Gomma District,Jimma Zone, Oromia, Southwest Ethiopia,2022.

Background;- The extended postpartum period is a one-year time after giving birth during which women must have safe birth intervals. Many women’s are unaware that they are at risk for pregnancy during this time. As a result, many postpartum women did not begin using any form of contraception methods. As a result, there is a higher chance of an undesired pregnancy that leads mothers to pregnancy related complication. It is vital to have clear understanding of postpartum family planning services utilization and associated factors to achieve the desired health outcome for mother, neonate and children of the country. Objective; The aim of the study was to assess modern contraceptive use and associated factors among women’s within the extended postpartum period in Gomma, district, Jimma zone, Oromia, Ethiopia,2022. Method: Institutional based Quantitative cross sectional study design was conducted among 347 women within the extended postpartum period from May10 – June 20/2022. The study subject was selected by using systematic random sampling technique. Data was collected by using a structured and pretested interviewer administered questionnaire and the data was entered to Epi data version 4.6 and exported to SPSS version 25.0. Both bivariate and multivariate logistic regression model were performed to identify factors associated with outcome variable. Significance of association was decided by using the 95% Confidence level of AOR at p-value of <0.05. Result: Out of 347 sampled postpartum women, 337 of them responded with the response rate of 97.1%. The magnitude of postpartum contraceptive utilization was 30% (95% CI: 25.5-34.7). birth interval of ≤ 2 yrs (AOR =0.47, 95% CI: 0.19,0.90) was statistically negatively associated with modern PPFP use and Resumption of menses (AOR=4.34, 95% CI: 2.99-8.95), discussion with husband (AOR = 3.75, 95% CI: 1.76-7.97), ANC follow up (AOR=2.42,CI: 1.76-7.97), PNC follow up (AOR= 3.39, 95% CI: 1.73-6.68) and counseling during their child immunization (AOR=6.95, 95% CI:3.42-14.09) was statistically positively associated with postpartum modern contraceptive utilization among women within the extended postpartum period. Conclusion: The magnitude of postpartum modern contraceptive use during the extended postpartum period was low 30% (95% CI: 25.5- 34.7). Birth interval of ≤ 2 yrs, Resumption of menses, discussion with husband, ANC follow up, PNC follow up and counseling during their child immunization was statistically associated with postpartum contraceptive utilization among women within the extended postpartum period. Policy makers, program managers and health care providers need to focus on counseling and integration of postpartum family planning service and maternal and child health care service multiple contacts with health care professionals

Effectiveness of Interactive Mobile Health Intervention on Contraceptive Adoption and Neonatal Care during Early Postpartum In Northeast Ethiopia: a Cluster Randomized Controlled Trial

Background: Despite improvements in family planning services across sub-Saharan Africa, the uptake of modern contraceptive methods during the early postpartum period remains low, contributing to a high unmet need for contraception and increasing the risk of unintended pregnancies and short birth intervals. In Ethiopia, postpartum contraceptive use is particularly low, and existing studies present fragmented and inconsistent findings, with limited exploration of the underlying factors influencing adoption during this critical period. Although global neonatal mortality has declined, progress in Africa, including Ethiopia, has been slower, underscoring the need to strengthen neonatal care practices. Mobile health (mHealth) interventions, enabled by widespread mobile phone access, offer a promising strategy to improve postpartum family planning and neonatal care by enhancing communication between women and health providers. However, evidence on the effectiveness of such interventions in the Ethiopian context remains limited. This study sought to generate evidence on postpartum contraceptive use and neonatal care practices by identifying knowledge gaps, understanding contextual barriers and facilitators, and informing the development of targeted, culturally appropriate, and scalable mHealth interventions. Objectives: This study aimed to evaluate the effectiveness of an interactive mobile health intervention to improve early postpartum modern contraceptive adoption and community-based neonatal care practices, while also identifying the barriers, facilitators, intention levels, associated factors, and existing evidence related to postpartum family planning among women in Northeast Ethiopia. Methods: This study was conducted in Dessie and Kombolcha city zones in the Amhara Regional State, Northeast Ethiopia, using a sequential multi-method approach. A cluster randomized controlled trial served as the primary design to evaluate the effectiveness of an interactive mobile health (mHealth) intervention in improving early postpartum modern contraceptive uptake and neonatal care practices. The intervention package included educational text messages on family planning and neonatal care, automated reminders aligned with critical postpartum milestones, and two-way mobile communication between women and trained health professionals. To ensure the intervention was evidence-based, tailored the needs and realities and contextually appropriate, the cluster randomized controled trial was supported by a scoping review, a qualitative study, and a baseline cross-sectional survey. The scoping review synthesized literature on postpartum contraceptive use in Ethiopia to map evidences, identify information gaps and guide the intervention’s theoretical framework and content. A qualitative study involving 57 purposively selected participants from December 15, 2022 to January 15, 2023, including postpartum women, health care providers, and community members, further explored socio-cultural, individual, and health system-level factors. Data were collected through interviews and focus groups and VII analyzed thematically using Atlas.ti software, ensuring trustworthiness through triangulation and peer review. Insights from this phase guided the cultural and contextual tailoring of the intervention. A baseline cross-sectional survey was conducted from January 2 to 15, 2023, among 780 pregnant women selected using cluster sampling from 20 kebeles in Dessie and Kombolcha. Face to face interviews were administered through Open Data Kit (ODK), and the data were analyzed using STATA version 17. Multivariable logistic regression identified factors influencing intention to use postpartum contraception. The cluster randomized controled trial was implemented from January 15 to June 15, 2023, involving 764 pregnant women at 30 weeks gestation, followed until 45 days postpartum. Kebeles (clusters) were randomized into intervention (n=383) and control (n=381) groups. The intervention group received the mHealth package in addition to standard maternal and newborn care, while the control group received routine care alone. Endline data collection was conducted electronically, and Generalized Estimating Equations (GEE) model was used for analysis to account for clustering of the intervention on early postpartum contraceptive adoption. The main outcomes postpartum contraceptive uptake and neonatal care practices were analyzed using adjusted odds ratios with 95% confidence intervals, with statistical significance set at p<0.05. To investigate how the intervention influenced neonatal care, Structural Equation Modeling (SEM) was performed using data from 743 participants (376 in the intervention group and 367 in the control group). Structural equation modeling assessed both direct and indirect pathways through which the intervention affected neonatal care. Confirmatory Factor Analysis (CFA) validated the constructs, and model fit was assessed using indices such as the chi-square to degrees of freedom ratio (3), Root Mean Square Error of Approximation (RMSEA) (0.03), and Standardized Root Mean Square Residual (SRMR) (0.06). The results showed acceptable model fit and statistically significant pathways, supporting the theoretical model that guided the design of the mHealth intervention. Results: From an initial pool of 1,607 records identified through database searches and reference list screening, duplicates and ineligible studies were excluded, leaving 28 full-text articles for detailed review. The scoping review revealed a notable absence of controlled trials or longitudinal research targeting early postpartum contraceptive use. Instead, the majority of existing studies broadly addressed postpartum family planning without emphasizing the critical early postpartum period and its unique challenges. The barriers to early postpartum contraceptive uptake identified through the review were multifaceted. Knowledge barriers were prominent, with many women unaware of the timing and necessity for contraception soon after childbirth. Negative attitudes both among women and healthcare providers also posed challenges, often stemming from fears that contraceptive use could reduce breast milk production or misconceptions about the risk of pregnancy during the postpartum period. Health system barriers such as VIII insufficient follow-up care, inconsistent availability of family planning services, long waiting times, and sometimes unfavorable provider attitudes further limited uptake. Moreover, community and cultural influences played significant roles in discouraging early postpartum contraceptive use. Regarding intention to use contraception in the early postpartum period, the study found that approximately three-quarters (75.8%, 95% CI: 73%–79%) of pregnant women intended to adopt modern contraceptive methods soon after childbirth. After adjusting for confounding variables, several factors were significantly associated with this intention. Older maternal age (AOR = 6.2; 95% CI: 2.6–14.6). A longer preceding birth interval (AOR = 2.5; 95% CI: 1.6–3.7), employment status (AOR = 1.9; 95% CI: 1.3–2.8), closer proximity to health facilities (AOR = 2.6; 95% CI: 1.5–4.4), Public facility delivery in the last birth (AOR = 2.4; 95% CI: 1.1–5.7), better knowledge of contraception (AOR = 1.5; 95% CI: 1.1–2.1), and attendance at antenatal care (AOR = 1.9; 95% CI: 1.2–3.3) were significaltly associated factors to had intention. An interactive mobile health intervention demonstrated a significantly higher rate of early postpartum contraceptive uptake in the intervention group (51.6%) compared to the control group (38.0%). Women who received the intervention were 1.6 times more likely to use modern contraceptive methods early postpartum than those who did not (AOR: 1.6; 95% CI: 1.249–2.123). The mobile health intervention had also a significant direct positive effect on neonatal care practices (β = 0.393, p = 0.007). Improved knowledge of neonatal care, also fostered by the intervention, independently contributed to better neonatal care practices (β = 0.347, p = 0.012). No significant indirect effects were found, indicating that both the intervention and enhanced knowledge acted as key, direct predictors of improved neonatal care behaviors. The total effects of the intervention and increased knowledge on neonatal care practices were statistically significant, with β = 0.382 (p = 0.009) and β = 0.347 (p = 0.012), respectively. Conclussion: This study provides compelling evidence that digital health interventions (mHealth) can play a transformative role in improving early postpartum contraceptive uptake and neonatal care. However, the study also identified several barriers to the adoption of modern contraceptive methods, including individual factors, method-related concerns, misconceptions, facility-level limitations, and broader sociocultural influences. Despite these challenges, approximately three out of four pregnant women expressed an intention to use contraceptives postpartum, even if intention had no significant association in this study. Overall, integrating mobile health solutions into maternal and neonatal care programs offers a promising pathway to overcoming persistent barriers and improving reproductive health outcomes in resource-limited settings. Trial Registration: Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ClinicalTrials.gov ID: NCT05666050. Registered on December 23, 2022

Neural Tube Defect: Burden, Determinants, Dietary practice and Effect of Picture Based Nutrition Education toward women’s Adherence to Preconception Iron-Folic Acid Supplementation in Eastern Ethiopia

Introduction: Globally, neural tube defects (NTDs) are the top five causes of infant mortality, morbidity, and disability. NTDs are invisible to policy-makers yet have a significant emotional, economical psychological, impact on families and society while also contributing to the loss of human potential and associated with substantial mortality, morbidity, disability problems. Due to the sheer number of its population, Ethiopia is one of the four sub-Saharan African countries with the largest number of NTDs cases. However, the burden and determinants of NTDs are not sufficiently studied and the data is largely remains unknown. In addition, there is no data has been found the linkage between maternal dietary practice and developing NTDs. Furthermore, there is a lack of evidence about the practice of preconception folate supplementation to reduce the risk of NTDs among women planning to get pregnant in the existing health care system. Despite the fact that numerous evidence-based studies have been conducted to investigate the effects of preconception folic acid supplementation on reducing the risk of NTDs. However, no or a few studies has been conducted in Ethiopia to examine the effect of preconception picture based health education on the adherence of iron folic acid supplementation to reduce the risk of NTDs among women planning to become pregnant. Objectives: To assess the burden, determinants, dietary practice and to examine the effect of pictured based nutrition education knowledge and adherence to preconception iron-folic acid supplementation among women planning to be pregnant in Eastern Ethiopia. This study also aimed to explore the practice of preconception folate supplementation among women planning to get pregnant in the Ethiopian health care system. Methods: The study is used both quantitative and qualitative components. The quantitative study included retrospective cohort study, matched case control, comparative and parallel randomized controlled trail. A structured checklist questionnaire with open and close-ended questions were used for data collection. Data were collected by interviewing mothers/caretakers and reviewing retrospective medical records. The study subjects were recruited in purposively selected hospitals from Eastern Ethiopia based on caseloads. Data retrieving form was used to collect the data from neonates and terminated with neural tube defects medical records of the period 2017-2019. Data collectors were trained midwives nurses, health extension workers and other health professionals working at the selected study hospitals. For matched case control and 14 comparative cross sectional study, cases were ascertained using a prospective study approach, whereas controls were randomly selected from the same selected health facilities. For the case control and comparative cross sectional study, 276 pregnant women (138 cases who delivered or terminated the pregnancy due to NTDs and 138 women who gave birth apparently healthy neonate) were studied. For parallel RCT, 244 women (122 interventional and 122 control groups) who have a plan to pregnancy were included. The incidence (burden) of each case is calculated by dividing the number of cases per year by the total number of births in each hospital. A linear trend of NTDs over time and Extended Mantel-Haenszel chi-square was performed. The dietary practice was assessed using modified food frequency questionnaire (FFQ). The dietary practice of women was determined by using meal frequency, dietary diversity score (DDS), food variety score (FVS), and animal food source (ASF). Statistical procedures, such as frequency, percentage, chi-square, bivariate, and multivariate were used to analyze the data and determine the frequency of NTDs, associated factors and Odds ratio. The qualitative study was aimed to explore the practice, challenges, and opportunities for preconception folate supplementation to reduce the risk of NTDs. In this study 45 participants included pregnant women who followed ANC, women who had a plan to be pregnant, health care providers who work at family planning service, gynecology ward and experts of maternal and child health care services (MCH). A purposive sampling method was used to select the study participants from health facilities. Content validation of the instruments was done by two experts after which the instruments were pretested and ambiguous questions were removed or revised. An in-depth interview was conducted. Field notes and audio recordings were transcribed verbatim, translated, and analyzed by inductive thematic analysis using Atlas ti.7.1. Result: For retrospective cohort study a total of 48,567 newborn were participated and 522 newborns with NTDs were identified. The linear trends of NTDs over the three years of 2017- 2019 were OR of 1 (base year), 4.3, and 8.3, respectively, [Extended Mantel-Haenszel chi-square for linear trend = 200.53 (P<0.0001)]. Thus the burden of NTDs showed that a statistically significant increased trend over the three years. For the case control study, Illiterate (AOR=0.34, 95% CI: 0.12-0.92, P=0.034), rural residents (AOR=3.4, 95% CI: 1.18-9.78, P=0.023), having a history of elective termination (AOR=2.95, 95% CI: 1.15-7.55, P=0.023), those who suffered severe anemia in pre or early pregnancy (AOR=3.4, 95% CI: 1.17-9.87, P=0.024), having history 15 of fever in pre or early pregnancy (AOR=2.75; 95% CI: 1.05-7.15, P=0.038), and mothers who had an exposure to various agrochemicals (AOR=3.39, 95% CI: 1.11-10.3, P=0.032) were significantly associated with occurrence of NTDs. For comparative cross sectional study, the prevalence of good dietary practice in the study population was 29% (95% CI = 23.6%–34.3%). Illiterate women were 84% less likely to adhere to good dietary practice than women with higher education (AOR=0.16, 95% CI, 0.03-0.8), and respondents in the comparison group are more likely to have a good dietary practice than compared to these case groups (AOR=2.1, 95% CI 1.07–4.1). For parallel RCT study, the intervention group (42.6%) had adherence to iron-folic acid supplements compared to the control group (3.3%); this difference was significant (P<0.0001). History of NTDs affecting pregnancy, history of spontaneous abortion, and knowledge was independently associated with adherence to iron-folic acid supplement (P<0.05). In the qualitative study, there was no provision of preconception folic acid supplementation for those who planned to be pregnant. The challenges for this disruption in the continuum of care include the absence of clear policy, program, and guidelines, lack of knowledge among caregivers and women, unfavorable attitude and belief, the high workload of providers, and poor adherence. Conclusion: NTDs is a significant public health burden in the study area, with the most common forms being anencephaly and Spinal bifida. Illiterate, rural residents, having a history of elective termination, those who suffered severe anemia in pre or early pregnancy, having history of fever in pre or early pregnancy, and mothers who had an exposure to various agrochemicals were significantly associated with occurrence of NTDs, history of NTDs affecting pregnancy, history of spontaneous abortion, and knowledge was independently associated. The findings suggest that primary preventative strategies should be strengthened by actively promoting preconception care services, such as preconception iron folic acid supplement, as well as food fortification and good dietary practices. This study highlighted the need for policy, program, guidelines, and a structure for preconception care services in the countr

Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia : a multilevel cross-sectional analysis

Maternity waiting homes (MWHs) are temporary residential spaces located within or close to health facilities, offering skilled obstetrical care. Data used in this analysis were collected from three districts in Jimma Zone in the southern part of Ethiopia. The survey targeted 3840 women. Qualitative research from this study setting and other areas in Ethiopia highlight the pivotal role of husbands and family support in enabling women’s use of MWHs. Findings have implications for achieving equity in access to maternal healthcare, as poorer women with little social support in the form of companions accompanying them for health facility visits, are among the more vulnerable groups

Effectiveness of Participatory Community Health Actors Intervention on Improving Health Facility Delivery in Jimma Zone, Ethiopia: A Cluster Randomized Controlled Trial

Introduction: In developing countries including Ethiopia, poor health status of citizens is one of the factors behind the low level of economic development. Ethiopia is working greatly with great progresses in maternal, neonatal and child health during the Millennium Development Goal period (1990-2015), mainly credited to the innovative community based program of health extension package into rural areas. However, successes were not grasped at all regions and urban-rural settings, as a result, the maternal health care utilization has remained low; especially health facility childbirth is very low. To close this gap, the Ethiopian government proposes multiple strategies including community based intervention at various levels including individual, family and community. However, there is a dearth of evidence on the effectiveness of community health actors through participatory community based intervention approach on improving health facility childbirth. Therefore, the aim of this study was to assess factors affecting health facility delivery and to evaluate the effects of community based participatory community health actor’s intervention in improving the utilization of health facility delivery over the study periods. Method: Various participatory training support, educational materials, and communication activities were implemented from May 2017 to June 2019 in three districts of Jimma zone to promote maternal and child health services. As this study also embedded under the main project, we employed both qualitative and quantitative studies enrolling different groups of participants based on different research questions. Accordingly, the study first tried to explore the actual roles and contribution of possible community health actors and credible sources of maternal health services through qualitative study that was conducted in May 2016. Further, to assess factors affecting health facility delivery including social support as main factor, and evaluate the effectiveness of participatory community health actors’ intervention on improving health facility childbirth, we used a community based cluster-randomized control trial in Jimma zone from 16 randomly selected health centers including a total of 5014 women (2394 in control and 2620 in intervention arms) were enrolled during baseline and endline phases of the study. So health facility delivery was compared at endline between intervention and control groups using a generalized linear mixed model analysis. The final differences during baseline and endline were constrained by including fixed effects for period and intervention by period. Data were analyzed using the SPSS version 20 software. Various regression modeling techniques including xiii multivariate general linear modeling were performed. Odds ratios with 95% confidence intervals and alpha of 0.05 were used to report comparisons between intervention and control groups. Result: The findings of qualitative study showed the most commonly cited roles identified by all participants were promotion of health care services, provision of continuous support during pregnancy, labour and post-natal care (PNC), and working as a link between communities and the health system. HEWs, WDA and religious leaders were identified as credible sources and best in passing different knowledge on to mothers, family members and members of the community during community meetings, women’s association meetings, antenatal outreach sessions, and coffee ceremony on topics like use of maternal and child health (MCH) services like anti-matal care (ANC) services, health facility delivery and related cares. According to the quantitative study (research question 2) result showed that despite the huge effort made to provide maternal health services free of charge, utilization remains low and only 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. Data from the final evaluation study (research question 3) were analyzed using intention-to-treat, and the result showed that in the unadjusted and adjusted analysis, women in the intervention group were 2 times and 12 times more likely to use health facility delivery than women in the control group OR 2.12; 95 CI 1.20-4.44), and (AOR 12.83; 95 CI 2.10-82.70); respectively; women in the intervention group were 2 times more likely to involve in deciding the final place of childbirth than women in the control group (OR =2.72; 95% CI 1.37–5.40). As of maternal social support outcomes, the women reported receiving different types of supports from three different sources, including family members, close friends and community health actors (CHAs). The result showed that from close ties the women received tangible supports (86.2% for intervention and 70% for control), emotional supports (80.8% for intervention and 64% for control), and xiv accompaniment supports (62% for intervention and 46% for control) and these received supports were increased across all groups between baseline and endline. Therefore, generalized linear mixed model analysis showed that significant increase were observed in intervention groups for tangible support (OR= 26.8, 95%CI: 5.4-113.0), emotional support (OR = 11.3, 95%CI: 6.0 to 23.0), accompaniment, (OR= 16.3, 95%CI: 5.0 to54.5). Further, a mean differences (MD) in received continuous advice and supports from CHAs (MD=3.8; 95 CI: 3.71 to 3.81; effect size (ES)=41%), in received continuous advice from close ties (MD=4.9; 95% CI: 4.85 to 5.00; ES=13%), density of ties (MD=14.3; 95 CI: 14.2 to 14.2; ES=8%), perception on benefits of MCH use (MD=3.8; 95 CI: 3.71 to 3.83; ES=93%), and attitude towards health facility delivery (MD=7.3; 95 CI: 7.2 to 7.5; ES=6%), were significant favoring the intervention group. Conclusion and recommendation: As the qualitative studies and baseline survey confirmed community health actors (HEWs, WDA, religious leaders) were identified as epicenter in providing different MCH promotion activities that can be positive to use for community based intervention in improving MCH cares including ANC, childbirth and early PNC services. Accordingly, given all the limitations the findings from our interventional study suggested that participatory CHAs intervention appears to be more effective not only in improving health facility childbirth but also in enhancing various social supports and creating positive attitudes and making shared decisions in using health facility delivery. Thus maternal health promotion programs need to leverage CHAs including families and faith-based organizations in addition to health professionals in disseminating information in relation to MCH use, particularly health facility delivery in rural settings. Future research may compensate for the limitations of the current study by conducting a process evaluation along with outcome evaluation to ensure that the intervention is delivered and implemented as planned to indicate the fidelity of the implementation