Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study

Abstract

Background: Maternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions. Methods: A cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13-49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*. Results: Of the 6321women included in the study, 714 had a live birth in the 12 months before the survey. Onethird of the women (30, 95% CI 26-34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43-51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40-57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37-45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron's I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron's I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women's age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone. Conclusions: This study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage.

Factors associating different antenatal care contacts of women: A cross-sectional analysis of Bangladesh demographic and health survey 2014 data

“…The regional and residential variations in ANC contact, however, are not exclusive in Bangladesh as studies from other parts of the world also present similar findings. Studies in Africa suggest regional and residential, urban and rural, variations in accessing ANC [30][31][32][33][34]. Likewise, studies from neighbouring countries of Bangladesh confirm similar results [19,22,[35][36][37][38].…”

Regional Differences in Postnatal Care Service Utilisation and Child Morbidity in Nigeria: Evidence from 2018 Nigeria Demographic and Health Survey (NDHS)

“…Earlier studies have shown that there are variations in the use of PNC services by regions [12] based on sociocultural differences and some factors affecting PNC service utilization in some facilities [4,11,14].…”

“…Meanwhile, Defar et al [12] have argued that maternal and child health (MCH) care utilisation often varies with geographic location. As such, there is a need for an empirical study examining analysing regional differences in the use of postnatal care services and child morbidity using the recent data from the 2018 NDHS in Nigeria.…”

Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods

“…Similarly, an estimated 30% of children under five years of age received oral rehydration salts treatment for diarrhoea from an appropriate health provider in 2016, as compared to 25% in 2011 [4,5]. Studies have reported that lack of geographic and financial access to services, caregivers' limited knowledge of child health danger signs, and poor quality of care at health facilities were some of the reasons for this low utilisation of services [6][7][8][9][10].…”

“…This activity was not planned to be implemented in 4 districts 6. Community includes AEWs, schoolteachers, WDAs, and HEWs 7. This activity was not planned to be implemented in 8 districts where no budget was allocated for the activity.…”