Ahmed Ahmed Fentaw, Ejigu Amare Genetu, Yeshiwas Almaw Genet, Bayeh Gashaw Melkie, Mekonnen Berhanu Abebaw, Alemayehu Meron Asmamaw, Tsega Tilahun Degu, Tsega Sintayehu Simie, Gebeyehu Asaye Alamneh, Asmare Zufan Alamrie, Yigzaw Zeamanuel Anteneh, Temesgen Abathun, Enawgaw Anley Shiferaw, Yirdaw Getasew, Yenew Chalachew, Molla Abebaw, Mekonen Habitamu, Anteneh Rahel Mulatie
Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
Sci Rep. 2025 Aug 23;15(1):31053. doi: 10.1038/s41598-025-15720-3.
Antenatal Care, use of skilled delivery attendants, Institutional delivery and postnatal care services are key maternal health services that can significantly reduce maternal mortality. The objective of this study was to identify spatial distribution and factors that affect full package utilization of maternal health services in Ethiopia. Sampling weights were applied, and analyses were conducted using STATA version 17. Spatial statistics, including Moran's I and Getis-Ord Gi*, were performed in ArcGIS to assess spatial autocorrelation and identify FPMHSU clusters. SaTScan software detected purely spatial clusters. Multilevel binary logistic regression identified individual- and community-level factors. Model selection was based on a significant log-likelihood ratio test and Variables with p < 0.05 were deemed significant, with adjusted odds ratios and 95% confidence intervals quantifying associations. The prevalence of in Ethiopia was 56.96% (95% CI: 55.41%, 58.51%) and exhibited significant spatial clustering (Moran's Index = 0.686, P < 0.001). Women aged 20-24 years [AOR = 0.65, 95% CI: 0.44-0.97], high parity [AOR = 0.52, 95% CI: 0.40-0.69] and urban residents [AOR = 0.53, 95% CI: 0.31-0.89] reduce the outcome, while being married [AOR = 1.54, 95% CI: 1.04-2.30], Muslim religion [AOR = 2.25, 95% CI: 1.45-3.48], primary education [AOR = 2.04, 95% CI: 1.65-2.52], secondary education [AOR = 2.30, 95% CI: 1.53-3.45], higher education [AOR = 6.10, 95% CI: 2.43-15.07], awareness of pregnancy complications [AOR = 3.62, 95% CI: 3.00-4.36], poorer households [AOR = 1.77, 95% CI: 1.32-2.37], middle wealth category [AOR = 1.56, 95% CI: 1.13-2.14], richer households [AOR = 2.61, 95% CI: 1.84-2.71], and the richest households [AOR = 6.70, 95% CI: 3.96-11.56] increase the outcome. This study revealed significant disparities in in Ethiopia, with spatial clustering (Moran's I = 0.686) and hotspots in Addis Ababa, Dire Dawa, Harari, and East Gojam. Women with higher education (primary, secondary, and higher), Muslim religion, awareness of pregnancy complications, better economic status (poorer, middle, richer, and richest wealth categories), and urban residence were more likely to utilize maternal health services. Addressing these disparities is crucial for improving maternal health outcomes and ensuring equitable access.
产前保健、熟练接生员的使用、机构分娩和产后护理服务是关键的孕产妇保健服务，可显著降低孕产妇死亡率。本研究的目的是确定埃塞俄比亚孕产妇保健服务综合套餐利用情况的空间分布及影响因素。应用抽样权重，并使用STATA 17版进行分析。在ArcGIS中进行了包括莫兰指数（Moran's I）和Getis-Ord Gi*在内的空间统计，以评估空间自相关性并识别孕产妇保健服务综合套餐充分利用情况（FPMHSU）的聚类。SaTScan软件检测到了纯空间聚类。多水平二元逻辑回归确定了个体和社区层面的因素。模型选择基于显著的对数似然比检验，p<0.05的变量被视为显著变量，调整后的比值比和95%置信区间量化了关联。埃塞俄比亚的利用率为56.96%（95%置信区间：55.41%，58.51%），并呈现出显著的空间聚类（莫兰指数=0.686，P<0.001）。20-24岁的女性[AOR=0.65，95%置信区间：0.44-0.97]、高胎次[AOR=0.52，95%置信区间：0.40-0.69]和城市居民[AOR=0.53，95%置信区间：0.31-0.89]会降低该结果，而已婚[AOR=1.54，95%置信区间：1.04-2.30]、穆斯林宗教信仰[AOR=2.25，95%置信区间：1.45-3.48]、小学教育程度[AOR=2.04，95%置信区间：1.65-2.52]、中学教育程度[AOR=2.30，95%置信区间：1.53-3.45]、高等教育程度[AOR=6.10，95%置信区间：2.43-15.07]、知晓妊娠并发症[AOR=3.62，95%置信区间：3.00-4.36]、较贫困家庭[AOR=1.77，95%置信区间：1.32-2.37]、中等财富类别[AOR=1.56，95%置信区间：1.13-2.14]、较富裕家庭[AOR=2.61，95%置信区间：1.84-2.71]和最富裕家庭[AOR=6.70，95%置信区间：3.96-11.56]会增加该结果。本研究揭示了埃塞俄比亚在这方面存在显著差异，存在空间聚类（莫兰指数I=0.686），亚的斯亚贝巴、德雷达瓦、哈拉里和东戈贾姆存在热点地区。受过高等教育（小学、中学和高等）、有穆斯林宗教信仰、知晓妊娠并发症、经济状况较好（较贫困、中等、较富裕和最富裕财富类别）以及居住在城市的女性更有可能利用孕产妇保健服务。解决这些差异对于改善孕产妇健康结果和确保公平可及性至关重要。
