Maternal health care seeking behaviour and preferences for places to give birth in Addis Ababa, Ethiopia

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously.Health StudiesD. Litt. et Phil. (Health Studies

Prevalence and determinants of unintended childbirth in Ethiopia

Background Ethiopia’s population policy specifically aims to reduce TFR from 7.7 to 4.0 and to increase contraceptive use from 4.0% to 44.0% between 1990 and 2015. In 2011, the use of contraceptive methods increased seven-fold from 4.0% to 27%; and the TFR declined by 38% to 4.8. The use of modern contraceptives is, however, much higher in the capital Addis Ababa (56%) and other urban areas but very low in rural areas (23%) far below the national average (27%). In 2011, one in four Ethiopian women had an unmet need for contraception. The main aim of this study was to assess the pattern and examine the socioeconomic and demographic correlates of unintended childbirth among women 15-49 years in Ethiopia. Methods Data from the 2011 nationally representative Ethiopia Demographic and Health Survey are used. It covered 16,515 women of which 7,759 had at least one birth and thus included for this study. Multivariate logistic regression is used to see the net effects of each explanatory variable over the outcome variable. Results The study found that nearly one in three (32%) births was unintended; and about two-thirds of these were mistimed. The regression model shows that the burden of unintended births in Ethiopia falls more heavily on young, unmarried, higher wealth, high parity, and ethnic majority women and those with less than secondary education and with large household size. These variables showed statistical significance with the outcome variable. Conclusion The study found a relatively high prevalence of unintended childbirth in Ethiopia and this implies high levels of unmet need for child spacing and limiting. There is much need for better targeted family planning programs and strategies to strengthen and improve access to contraceptive services, to raise educational levels, and related information and communication particularly for those affected groups including young, unmarried, multipara, and those with less than secondary level of education. Further quantitative and qualitative research on the consequences of unintended pregnancy and childbirth related to prenatal and perinatal outcomes are vital to document process of change in the problem overtime

Prevalence and determinants of unintended childbirth in Ethiopia

Background Ethiopia’s population policy specifically aims to reduce TFR from 7.7 to 4.0 and to increase contraceptive use from 4.0% to 44.0% between 1990 and 2015. In 2011, the use of contraceptive methods increased seven-fold from 4.0% to 27%; and the TFR declined by 38% to 4.8. The use of modern contraceptives is, however, much higher in the capital Addis Ababa (56%) and other urban areas but very low in rural areas (23%) far below the national average (27%). In 2011, one in four Ethiopian women had an unmet need for contraception. The main aim of this study was to assess the pattern and examine the socioeconomic and demographic correlates of unintended childbirth among women 15-49 years in Ethiopia. Methods Data from the 2011 nationally representative Ethiopia Demographic and Health Survey are used. It covered 16,515 women of which 7,759 had at least one birth and thus included for this study. Multivariate logistic regression is used to see the net effects of each explanatory variable over the outcome variable. Results The study found that nearly one in three (32%) births was unintended; and about two-thirds of these were mistimed. The regression model shows that the burden of unintended births in Ethiopia falls more heavily on young, unmarried, higher wealth, high parity, and ethnic majority women and those with less than secondary education and with large household size. These variables showed statistical significance with the outcome variable. Conclusion The study found a relatively high prevalence of unintended childbirth in Ethiopia and this implies high levels of unmet need for child spacing and limiting. There is much need for better targeted family planning programs and strategies to strengthen and improve access to contraceptive services, to raise educational levels, and related information and communication particularly for those affected groups including young, unmarried, multipara, and those with less than secondary level of education. Further quantitative and qualitative research on the consequences of unintended pregnancy and childbirth related to prenatal and perinatal outcomes are vital to document process of change in the problem overtime

Factors Influencing Women’s Preferences for Places to Give Birth in Addis Ababa, Ethiopia

The main aim of this study was to examine factors determining women’s preference for places to give birth in Addis Ababa, Ethiopia. A quantitative and cross-sectional community based study design was employed. Data was collected using structured questionnaire administered to 901 women aged 15–49 years through a stratified two-stage cluster sampling technique. Multinomial logistic regression model was employed to identify predictors of delivery care. More than three-fourth of slum women gave birth at public healthcare facilities compared to slightly more than half of the nonslum residents. Education, wealth quintile, the age of respondent, number of children, pregnancy intention, and cohabitation showed net effect on women’s preference for places to give birth. Despite the high number of ANC attendances, still many pregnant women especially among slum residents chose to deliver at home. Most respondents delivered in public healthcare institutions despite the general doubts about the quality of services in these institutions. Future studies should examine motivating factors for continued deliveries at home and whether there is real significant difference between the quality of maternal care service offered at public and private health facilities

The burden of underweight and overweight among women in Addis Ababa, Ethiopia

Background Obesity and overweight are rising worldwide while underweight rates persist in low-income countries. The aim of this study was to examine changes in the prevalence of underweight and overweight/obesity among non-pregnant women aged 15-49 years, and its socio-demographic correlates in Addis Ababa, Ethiopia. Methods The data are from 2000, 2005 and 2011 nationally representative Ethiopian Demographic and Health Surveys in Addis Ababa. The dependent variable was women’s nutritional status measured in terms of body mass index coded in binary outcomes to examine risk of being underweight (\u3c18.5 kg/m2 vs. ≥18.5 kg/m2) or overweight/obese (\u3e25 kg/m2 vs. ≤25 kg/m2). Logistic regression models were used to estimate the strength of associations. Results The prevalence of overweight/obesity increased significantly by 28%; while underweight decreased by 21% between 2000 and 2011. Specifically, the prevalence of urban obesity increased by 43.3% i.e., from 3.0% to 4.3% in about 15 years. Overall, more than one-third (34.7%) of women in Addis Ababa were either under or overweight. Women’s age and proxies for high socio-economic status (i.e. household wealth quintile, educational attainment, access to improved source of drinking water, and television watching) were positively associated with being overweight. The correlates of underweight were young age and proxies for low socio-economic status (i.e. low wealth quintile, limited access to improved source of water or toilet facility). Conclusions There is a need for policies to recognize the simultaneous public health problems of under and overnutrition, and for programs to target the distinct populations that suffer from these nutrition problems in this urban area

Ethiopia’s urban primary health care reform: Practices, lessons, and the way forward

AbstractBackground: At present there is remarkable expansion of urbanization in Ethiopia. By 2050, 38% of the population in Ethiopia is expected to reside in urban settings. The majority of this future urban population is believed to live in slums. In response to this daunting health challenge, the Ministry of Health launched urban health extension program in 2009. The outcome of this initiative, however, is still uncertain - Urban Health Extension Professionals seem to have failed to meet the desired end. To improve the situation, experiences were drawn from middle-income countries and piloted in Addis Ababa in 2014. This is a report of the study conducted to assess the implementation of the pilot initiatives. In the assessment of the implementation, attempts were also made to identify lessons and challenges encountered.Methods: Qualitative data were collected from purposively selected individuals involved in the design, implementation, and use of the pilot initiative. Checklists developed on the basis of the objective of the study were used for data collection.Findings: The findings indicated that the initiative had a team of health professionals - people who had the skills needed to work as a team and implement the pilot activities. The health team improved linkages and collaboration between the health system and the community. Through the team, identification of the most neglected sections of the population was ensured and this section has accessed health services. For example, the disabled, the sick, the elderly, persons with chronic health problems, girls and women were identified as social sectors that had either no or very little access to health care. The health team created a strong sense of collaboration between itself and the community level structures. This has been recognized to have an important role in improving service delivery to community. However, the level of the team’s recognition of local community set up and structures as facilitators of health services needs improvement. Furthermore, a shortage of transportation to distant places in the catchment areas and a lack of timely provision of supplies and drugs to address some basic health problems at household and community levels were identified as major problems.Conclusions: Ensuring proper urban health care requires multifaceted and multi-sectoral responses. Defining strategies of enhancing the engagement of different sectors in achieving the objectives of the initiative is an important point to be noted. Ways to provide continuous supplies to the health teams need to be sought. An equally important point that needs to be noted to ensure further successes of the initiative is empowering and enabling community level structures to focus more on health-related activities. [Ethiop. J. Health Dev. 2018; 32(1):4-9

Implementing the Urban Community Health Information System in Ethiopia: Lessons from the pilot-tests in Addis Ababa, Bishoftu and Hawassa

Background: The Strengthening Ethiopia’s Urban Health Program (SEUHP), supported by the United States Agency for International Development (USAID), initiated the pilot testing of the Urban Community Health Information System (UCHIS) in three sites (Addis Ababa, Bishoftu and Hawassa) to support the Ethiopian Federal Ministry Health (FMOH) in its efforts to standardize and expand the Health Management Information System (HMIS) to urban areas. This paper aimed to document the lessons learned and the challenges encountered in the implementation process of UCHIS. Methods: UCHIS implementation guidelines, service delivery cards, monitoring tools, registers, data quality assessment, and progress reports were reviewed. To further understand the UCHIS implementation process, five key informant interviews and four focus group discussions were held between March and April 2018. Results and Discussion: The pilot program identified improvements in data quality and use at the urban health extension professional (UHE-p) level for decision-making and for reporting to city/town health offices and health centers. The prioritization of households according to their economic status and health needs helped UHE-ps to target health services and perform activities optimally. The development and standardization of health service cards for various communicable and non-communicable diseases and maternal, neonatal, and child health services enabled UHE-ps to provide health services in a comprehensive manner. Conclusions: The initiation of UCHIS as a pilot test enabled the UHE-ps to collect high-quality data and report to city/town health offices and health centers. Additionally, UCHIS helped UHE-ps to comprehensively focus on the 15 health service packages and target the neediest sections of the population. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):49-53] Keywords: Urban community health, information system, pilot testing

Preparedness of the Urban Health Extension Program to provide priority health services identified in its packages

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at a household level – is one of the three approaches of the national Health Extension Program (HEP).The UHEP is organized to deliver services within 16 packages. This study is aimed at assessing the preparedness of the program to provide priority health services identified in its packages. Methodology: The study covered sampled urban health extension facilities within five study regions, and included 26 facility assessments, and 330 urban health extension professionals’ (UHE-ps’) assessments. Results: According to the findings of the facility assessment, most items within the UHEP packages are available, even though very few facilities were found to stock delivery kits, dressing materials, and oxytocin. Adrenaline was also observed to be found in only a limited number of facilities. Regarding teaching aids and services guidelines, most of the facilities had health education materials, Health Management Information System (HMIS) recording and reporting formats, family health services guidelines, disease prevention guidelines, family planning guidelines, and environmental health guidelines. All of the facilities observed seemed to have most of the services that are prioritized within the UHEP packages. The items less available include HIV testing and counseling guidelines, first aid kits, and infant weighing scales. A knowledge assessment through a test of 327 UHE-ps using questions based on the guideline manual showed a mean score of 76.2% (32 out of 42), with a minimum of 33.3% (10 out of 42) and maximum of 90.5% (38 out of 42). Considering the mean score (76.2%) as the passing grade, only 43% of the UHE-ps scored above the average. Questions on controlling communicable diseases and postnatal care (PNC) were items on which the UHE-ps scored highest. Conclusions and Recommendations: The findings of the present survey show that there is an overall fair level of preparedness within the UHEP to provide the services identified within its various component packages. However, there are still a few services packages for which the UHE facilities do not seem to be well prepared. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):76-82] Keywords: Preparedness; Urban Health Extension Program; Urban Health Extension Professionals

Patterns of utilization, expectations, and satisfaction of the community to urban health extension services

Background: The Urban Health Extension Program (UHEP) – an innovative Ethiopian government plan to ensure health service equity by creating demand for essential health services through the provision of appropriate health information at the household level – is one of the three approaches of the national Health Extension Program (HEP). There are very few studies on the quality of health care provided by the UHEP in Ethiopia. This study is part of a comprehensive survey designed to assess the quality of health service delivered by the UHEP, and looks at the pattern of utilization, expectations, and satisfaction of the community in relation to services provided within the UHEP. Methodology: The study covered sampled households for a community-based cross-sectional survey using structured questionnaires among 589 households within five major regions (Amhara; Harari; Oromia; Southern Nations, Nationalities, and Peoples’ (SNNP); and Tigray), as well as the two city administrations of Addis Ababa and Dire Dawa. Results: According to the findings, about 88% of the respondents have heard about urban health extension services in general, and the majority (51.6%) of them have heard about the services from the urban health extension workers (UHEWs), while 28.4%, 10.6%, and 9.3% heard about it from mass media, health centers and neighbors, respectively. Service packages reported to have been used most include environmental health (75.7%), health education (56.5%), and immunization of children (39.2%). On the other hand, services such as first aid (2.2%), referral (3.1%), HIV/AIDS care and support (3.7%), postnatal care (7.8%) and nutritional screening of children (9.7%) seem to have very low rates of utilization. With regard to the overall satisfaction of respondents on their visits to UHE facilities, more than 40% of the survey households responded as being satisfied or very satisfied with most of the items, except for the availability of UHEPs for home visits, availability of medical supplies, and referrals for consultations. Conclusions: Beneficiary communities seem to have an overall positive impression of the services provided by the UHEP, even though knowledge about and utilization of some of the services seem to be minimal. There are tendencies among many community members of associating the program with kebele political activities. There are also instances where communities expect too much from the urban health extension professionals (UHE-ps), while some others tend to undermine the knowledge and skills of UHE-ps and do not consider them as health professionals. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):83-90] Keywords: Utilization of urban health extension; Urban Health Extension Program; Urban Health Extension Professionals