Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Faculty of Medicine and Health Sciences, Global Health Institute, University of Antwerp, Wilrijk, Belgium.
BMC Pregnancy Childbirth. 2023 Feb 4;23(1):96. doi: 10.1186/s12884-023-05414-x.
Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia.
The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance.
Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service.
Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.
尽管埃塞俄比亚农村地区努力提供孕产妇保健服务，但利用率仍然很低。因此，本研究旨在评估埃塞俄比亚农村地区孕产妇保健服务的现状和决定因素。
本研究使用准实验前后比较基线数据。使用经过预测试的半结构式访谈式问卷收集数据。采用多水平混合效应逻辑回归模型来确定与产前护理 (ANC)、熟练分娩护理 (SBA) 和产后护理 (PNC) 利用相关的个体和社区水平因素。采用调整后的优势比 (AOR) 和相应的 95%置信区间 (CI) 进行估计，p 值小于 0.05 表示具有统计学意义。
共有 727 名孕妇参与，应答率为 99.3%。其中 461 名（63.4%）孕妇接受了 ANC 服务，而 46.5%（CI：42-50%）的分娩由 SBA 接生，33.4%（CI：30-36%）的孕妇接受了 PNC。报告其妊娠计划（AOR=3.9；95%CI：1.8-8.3）和意识到妊娠危险信号（AOR=6.8；95%CI：3.8-12）的女性更有可能接受 ANC 服务。在社区层面因素中，居住在低地（AOR=4.1；95%CI：1.1-14）和交通便利（AOR=1.9；95%CI：1.1-3.7）的女性更有可能接受 ANC 服务。此外，就业（AOR=3.1；95%CI：1.3-7.3）和接受 ANC（AOR=3.3；95%CI：1.8-5.9）的女性更有可能在分娩时获得 SBA。分娩时接受 SBA 的可能性与较短的旅行距离（AOR=2.9；95%CI：1.4-5.8）和更容易获得交通工具（AOR=10；95%CI：3.6-29）到最近的医疗机构呈正相关。居住在中地（AOR=4.7；95%CI：1.7-13）和分娩时接受 SBA（AOR=2.1；95%CI：1.2-3.50）会增加接受 PNC 服务的可能性。
与推荐标准相比，研究地区的孕产妇保健服务利用率总体较低。妇女的教育程度、对危险信号的认识以及妊娠规划等个体层面因素，以及居住在低地、前往医疗机构的旅行距离较短等社区层面因素，在利用孕产妇保健服务方面发挥着重要作用。建议增强妇女权能，推广避孕方法以避免意外怀孕，并改善医疗保健服务的获取，特别是在高地地区，以提高孕产妇保健服务的利用率。
