Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
BMC Int Health Hum Rights. 2013 Apr 15;13:20. doi: 10.1186/1472-698X-13-20.
The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider.
A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve "kebeles" of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization.
About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services.
Factors operating at individual and "kebele" levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.
评估所有潜在的低技能产妇护理利用来源对埃塞俄比亚至关重要。以前的研究在很大程度上忽略了不同层次的贡献。这项研究旨在评估个人、社区和医疗机构特征对利用熟练提供者进行产前、分娩和产后护理的影响。
在 2012 年 1 月至 3 月的三个月内，在阿姆哈拉地区北贡德尔区的 12 个“kebeles”进行了一项关联设施和基于人群的调查。共有 1668 名在调查前一年分娩的妇女被选中进行分析。使用多水平模型，我们检查了集群变化以及许多个人、社区（kebele）和与设施相关的变量对熟练产妇护理利用的影响。
约 32.3%、13.8%和 6.3%的妇女有机会获得熟练提供者进行产前、分娩和产后护理。在每个熟练产妇护理利用指标方面，观察到集群之间存在显著的异质性。在个人层面上，与意识和认知相关的变量被发现对熟练产妇服务利用更为相关。对熟练提供者的偏好和以前的产前护理经验是所有熟练产妇保健服务利用指标的一致强预测因素。出生顺序、母亲教育和对获得熟练专业人员的卫生设施的认识一直是熟练产前和分娩护理使用的强有力预测因素。社区因素与分娩和产后护理都有关，而医疗机构的特征对熟练分娩护理的使用比对其他产妇服务更为相关。
在个人和“kebele”层面运作的因素在决定熟练产妇保健服务的利用方面发挥着重要作用。为了改善研究区域的熟练产妇服务，已经考虑到创造更好的社区对熟练提供者及其护理的认识和认知，并确保医疗机构的无缝运作的干预措施至关重要。这些干预措施应该针对贫困妇女。
