Health extension workers\u27 and mothers\u27 attitudes to maternal health service utilization and acceptance in Adwa Woreda, Tigray Region, Ethiopia

BACKGROUND: The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs\u27 and mother\u27s attitudes to maternal health services in Adwa Woreda, Tigray Region. METHODS: In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women\u27s social status and mobility; and women\u27s perceptions of skilled birth attendant\u27s care. All data were analyzed thematically. FINDINGS: There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women\u27s Development Groups (WDGs), and referral by ambulance to health facilities either before a woman\u27s Expected Due Date (EDD) or if labour started at home. CONCLUSION: With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women\u27s groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries

Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia

OBJECTIVES: To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia.METHODS: A key informant study was conducted with 44 Health Extension Workers in Afar Region, Kafa Zone (Southern Nation, Nationalities and Peoples\u27 Region), and Adwa Woreda (Tigray Region). Health Extension Workers were trained to interview women and ask for stories about their recent experiences of birth. We interviewed the Health Extension Workers about their experiences referring women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care. Data were analysed using thematic analysis.RESULTS: Themes related to reducing the first delay, such as the tradition of home birth, decision making, distance and unavailability of transport, did not differ between the three locations. Themes related to reducing the second delay differed substantially. Health Extension Workers in Adwa Woreda were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances as they were used for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they need to travel to health facilities for Emergency Obstetric and Newborn Care.CONCLUSIONS: Initiatives to reduce delays can improve access to maternal health services, especially when Health Extension Workers are supported by the Health Development Army and a functioning referral system, but district (woreda) health offices should ensure that ambulances are used as intended

The Health Extension Program and Its Association with Change in Utilization of Selected Maternal Health Services in Tigray Region, Ethiopia : A Segmented Linear Regression Analysis

BACKGROUND: In 2003, the Ethiopian Ministry of Health established the Health Extension Program (HEP), with the goal of improving access to health care and health promotion activities in rural areas of the country. This paper aims to assess the association of the HEP with improved utilization of maternal health services in Northern Ethiopia using institution-based retrospective data. METHODS: Average quarterly total attendances for antenatal care (ANC), delivery care (DC) and post-natal care (PNC) at health posts and health care centres were studied from 2002 to 2012. Regression analysis was applied to two models to assess whether trends were statistically significant. One model was used to estimate the level and trend changes associated with the immediate period of intervention, while changes related to the post-intervention period were estimated by the other. RESULTS: The total number of consultations for ANC, DC and PNC increased constantly, particularly after the late-intervention period. Increases were higher for ANC and PNC at health post level and for DC at health centres. A positive statistically significant upward trend was found for DC and PNC in all facilities (p<0.01). The positive trend was also present in ANC at health centres (p = 0.04), but not at health posts. CONCLUSION: Our findings revealed an increase in the use of antenatal, delivery and post-natal care after the introduction of the HEP. We are aware that other factors, that we could not control for, might be explaining that increase. The figures for DC and PNC are however low and more needs to be done in order to increase the access to the health care system as well as the demand for these services by the population. Strengthening of the health information system in the region needs also to be prioritized

Effect of health facility linkage with community using postnatal card on postnatal home visit coverage and newborn care practices in rural Ethiopia: A controlled quasi-experimental study design.

BackgroundPostnatal home visit has the potential to improve maternal and newborn health, but it remains as a missed opportunity in many low-and middle-income countries. This study examines the effect of health extension worker administered postnatal card combined with health facility strengthening intervention on postnatal home visit coverage, newborn care practices, and knowledge of newborn danger signs in rural Ethiopia.MethodsWe employed quasi-experimental design using controlled before-and-after study in intervention and comparison districts of rural Tigray, northern Ethiopia. Training of health extension workers (HEWs) on postnatal home visit (PNHV), training of healthcare providers on maternal and newborn care, and capacity building of healthcare authorities on leadership, management and governance together with health system strengthening were the implemented interventions. Baseline (n = 705) and end line (n = 980) data were collected from mothers who delivered a year before the commencement of the actual data collection in the respective surveys. We used difference-in-differences (DiD) analysis to assess the effect of the intervention on PNHV coverage, essential newborn care practices and maternal knowledge of newborn danger signs.ResultsA total of 1685 (100%) mothers participated in this study. In all districts, more than 1/3rd of the mothers 633(37.57%) were in the age of 30-39 years. The difference-in-differences estimator showed an average of 23.5% increase in coverage of PNHVs within three days (DiD, pConclusionWe conclude that the intervention package was effective in improving the coverage of PNHV, increase in knowledge of newborn danger sign and essential newborn care practices. Hence, further strengthening the linkages between health facilities and community is imperative to improve the coverage of essential lifesaving maternal and newborn care services by HEWs at home

Determinants of teenage pregnancy in Degua Tembien District, Tigray, Northern Ethiopia: A community-based case-control study

<div><p>Background</p><p>Approximately 16 million teenagers aged 15–19 years and 2 million teenagers under the age of 15 years give birth annually, with 95% of these births occurring in developing countries. Ethiopia has one of the highest teenage fertility rates in Sub-Saharan Africa; however determinants of teenage pregnancy are not well studied. Therefore, this study aimed to identify determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, in 2015.</p><p>Methods</p><p>A community-based case-control study was conducted in Degua' Tembien district from February 01, 2015 to March 15, 2015 with a randomly selected total sample size of 414 females (with a ratio of 1:2 case to control, 138 and 276 respectively). Data were entered in to Epi-Info and analyzed using SPSS software. Multivariable logistic regression was used to assess predictors of the outcome variable; variables with a p-value <0.25 in bivariable analysis were included in the model. Statistically significance was considered at a p-value ≤0.05 in both bivariable and multivariable logistic regression analyses.</p><p>Result</p><p>The mean ages (plus or minus standard deviation (±SD)) of cases and controls were 18.47 (0.72) and 17.09 (1.2) years, respectively. After adjustment for other variables, predictors of teenage pregnancy included: lower monthly income below ~$25 and ~$25–50 (adjusted odds ratio (AOR) = 23.96; 95% confidence interval (95%CI) 4.89–117.29 and AOR = 4.91; 95%CI 1.64–14.66, respectively); aged 18–19 years (AOR = 16.75; 95%CI 6.45–43.47); being married (AOR = 15.91; 95%CI 7.43–34.04); not communicating with parents on reproductive health issues (AOR = 6.52; 95%CI 3.12–13.64) and having a history of maternal teenage pregnancy (AOR = 4.14; 95%CI 1.84–9.33).</p><p>Conclusion</p><p>The factors associated with teenage pregnancy in our study were lower family monthly income, being married, being in the 18–19 year age group, not communicating with parents on reproductive health issues and having a maternal history of teenage pregnancy. Programs that encourage parent-teenage communication of reproductive health issues, starting from early adolescence, in order to build skills to prevent pregnancy in the late teenage years, are very important. In addition, multi-pronged activities across sectors that encourage delayed marriage and improve health service utilizations for girls are essential.</p></div

Socio-demographic and economic characteristics assessed as determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, 2015.

<p>(N = 414). . . . . . . . (continued).</p

Reproductive health characteristics assessed as determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, 2015.

<p>(N = 414).</p

Socio-demographic and economic characteristics assessed as determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, 2015. (N = 414).

<p>Socio-demographic and economic characteristics assessed as determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, 2015. (N = 414).</p

Sample size calculation for the predictors of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia based on significant factors from other studies.

<p>Sample size calculation for the predictors of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia based on significant factors from other studies.</p

Pregnancy knowledge of female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, 2015.

<p>(n = 414).</p