Giving birth in Ethiopia: a spatial and multilevel analysis to determine availability and factors associated with healthcare facility births

Chojenta, Catherine; Getachew, Theodros; Smith, Roger; Loxton, Deborah

doi:10.1111/1471-0528.16275

Cited by 10 publications

(20 citation statements)

References 35 publications

(97 reference statements)

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“…Malawi, for example, has 82% of the country's administrative level-2 not meeting the target. Similarly, in Ethiopia, although the national average distance to EmONC facilities was 12.8 km, it varies from as long as 27.1 km in the Somali region to as short as a kilometre in bigger cities of Addis Ababa and Dire Dawa [ 32 , 38 ]. Similar phenomena were observed in Ghana, where 82% of women can access C-EmONC facilities within two hours in the metropolitan region of Greater Accra while only less than a quarter in the two predominantly rural Northern and Western regions [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the availability and accessibility of health facilities, the quality of the service at the facility strongly influenced maternal health care utilization. Studies in different countries of SSA confirmed that higher service quality at health facilities increases the odds of maternal health service utilization [ 38 , 46 , 51 ]. However, two studies in different parts of Ghana failed to find such an association [ 65 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…Inequality in maternal health care utilization was also identified at a national level. For instance, in Ethiopia, a relatively higher utilization was found in Addis Ababa [31][32][33][34][35][36][37], Dire Dawa [31,[34][35][36][37], Tigray [31,[33][34][35][36][37][38][39], and Harari [31,33,35,36]. A relatively low utilization was found in regions of Somali [31,33,34,36,37,39], Afar [31,[33][34][35]37], Oromia [32,33,35,36,39], most of Amhara [33][34][35]37,40], Gambela [32,33,37,39], Benishangul Gumuz…”

Section: Identifying Inequalities In Maternal Health Care Utilizationmentioning

confidence: 99%

“…Most studies examining the effect of distance on health care utilization found that the further a woman lives from a health facility, the less likely she is to receive necessary maternal health care [38,53,[65][66][67]. Some studies, however, found a threshold distance beyond which maternal health service utilization ceased to decline with additional distance [67,68].…”

Section: Highlighting the Effect Of Availability And Geographic Acces...mentioning

confidence: 99%

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How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

et al. 2022

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Background Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA. Methods A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review. Results We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data. Conclusions The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Identifying Inequalities In Maternal Health Care Utilizationmentioning

confidence: 99%

Section: Highlighting the Effect Of Availability And Geographic Acces...mentioning

confidence: 99%

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How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

et al. 2022

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“…In Ethiopia, only 48% of deliveries were assisted by skilled birth attendant [7]. Other studies conducted in different parts of Ethiopia also reported that institutional delivery ranges from 27 to 51% [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing place of delivery in Ethiopia: Linking individual, household, and health facility-level data

Belayneh

Shiferaw²,

Nega³

et al. 2022

PLOS Glob Public Health

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Introduction Maternal mortality remains high, especially in sub-Saharan Africa. Institutional delivery is one of the key intervention to reduce it. Despite service utilization reflects an interplay of demand- and supply-side factors, previous studies mainly focused on either sides due to methodological challenges and data availability. But, a more comprehensive understanding can be obtained by assessing both sides. The aim of this study is to assess individual, household, community, and health facility factors associated with deliveryplace in Ethiopia. Methods We have used the 2019 Performance Monitoring for Action survey data set, which is a nationally representative sample of women linked with national sample of health facilities in Ethiopia. A total of 2547 women who recently delivered were linked with 170 health centers and 41 hospitals. Facility readiness index was calculated based on previous study conducted by Stierman EK on similar data set. We applied survey weights for descriptive statistics. Multilevel mixed-effects logistic regression was used to identify factors influencing delivery place. Results Coverage of institutional delivery was 54.49%. Women aged 20–34 [AOR; 0.55 (0.32–0.85)] compared with those younger than 20 years; those with no formal education [AOR: 0.19 (10.05–0.76)] or attended only primary school [AOR: 0.20 (0.05–0.75)] compared with those attended above secondary; and women whose partners didn’t encourage antinatal visit [AOR; 0.57 (0.33–0.98)] all have decreased odd of institutional delivery. Attending at least one antenatal visit [AOR: 3.09 (1.87–5.10)] and increased availability of medicines in the closest facility [AOR: 17.33 (1.32–26.4)] increase odds of institutional deliver. Conclusion In Ethiopia, nearly half of the total deliveries take place outside health facilities. In addition to improving women’s education, utilization of antenatal care, and encouragement by partners, it is important to consider the availability of medicine and commodities in the nearby health facilities while designing and implementing programs to reduce home delivery.

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Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: evidence from national population and health facility data

Chojenta

Getachew

Smith

et al. 2022

Preprint

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Background: Caesarean section has a significant role in reducing maternal and neonatal mortality. A linked analysis of population and health facility data is valuable to map and identify caesarean section use and associated factors. This study aimed to identify geographic variation and associated factors of caesarean delivery in Ethiopia. Method: Linked data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) and the 2014 Ethiopian Service Provision Assessment Plus (ESPA+) survey was performed. Spatial analysis was conducted to identify geographic variations and factors associated with caesarean delivery. Hierarchical Bayesian analysis was also performed to identify factors associated with caesarean delivery using the SAS MCMC procedure. Results: Women's age and education, household wealth, parity, antenatal care (ANC) visits, and distance to caesarean section facility were associated with caesarean delivery use. Women who had 4 or more ANC visits were 4.67 (95% Credible Interval (CrI): 2.17, 9.43) times more likely to have caesarean delivery compared to those who had no ANC visits. Women who had education and were from rich households were also 2.80 (95% CrI: 1.83, 4.19) and 1.80 (95% CrI: 1.08, 2.84) times more likely to have caesarean deliveries relative to women who had no education and were from poor households, respectively. A one-kilometer increase in distance to a caesarean section facility was associated with an 88% reduction in the odds of caesarean delivery (Adjusted Odds Ratio (AOR) = 0.12, 95% CrI: 0.01, 0.78). Hotspots of high caesarean section rates were observed in Addis Ababa, Dire Dawa, and the Harari region. In addition, women's age at first childbirth and 4 or more ANC visits showed significant spatially varying relations between caesarean delivery use across Ethiopia. Conclusion: Caesarean section is a lifesaving procedure, and it is essential to narrow disparities to reduce maternal and neonatal mortality and avoid unnecessary procedures.

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Giving birth in Ethiopia: a spatial and multilevel analysis to determine availability and factors associated with healthcare facility births

Abstract: Objective To assess spatial variations in the use of healthcare facilities for birth and to identify associated factors. Design Cross-sectional analysis of population-and healthcare facility-based data.

Cited by 10 publications

References 35 publications

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

Factors influencing place of delivery in Ethiopia: Linking individual, household, and health facility-level data

Spatial and hierarchical Bayesian analysis to identify factors associated with caesarean delivery use in Ethiopia: evidence from national population and health facility data

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