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Skilled Delivery Care Utilization among Currently Married Women of Reproductive Age in Hossana, Southwest Ethiopia | OMICS International
ISSN: 2376-127X
Journal of Pregnancy and Child Health
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Skilled Delivery Care Utilization among Currently Married Women of Reproductive Age in Hossana, Southwest Ethiopia

Zeleke Dutamo*
College of medicine and health science, Department of clinical Nursing, Samara University, Samara Ethiopia
Corresponding Author : Zeleke Dutamo
College of medicine and health science
Department of clinical Nursing, Samara University, Samara, Ethiopia
Tel: +251-0910489741
E-mail: [email protected]
Received March 16, 2015; Accepted May 07, 2015; Published May 12, 2015
Citation: Dutamo Z (2015) Skilled Delivery Care Utilization among Currently Married Women of Reproductive Age in Hossana, Southwest Ethiopia. J Preg Child Health 2:162. doi: 10.4172/2376-127X.1000162
Copyright: © 2015 Dutamo Z. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Child birth is natural and continuous process in which many women are at risk for developing complication during child birth. The skilled care for all women during childbirth is a key approach for saving women’s lives and ensuring the best chance of delivering a healthy infant.

Methods: A community based cross-sectional study was conducted from January 1-31, 2014. Data were collected from a sample of 420 women in the town using structured interview questionnaire. Descriptive, bivariate and multivariate logistic regression analyses were conducted. Odds ratio with 95% CI was estimated to identify predictors of skilled delivery care utilization. Statistical - level of significance was declared at p < 0.05.

Results: The study revealed that 65.5 % of deliveries were assisted by skilled health professional during last child birth. About, 92% of the women attended at least one antenatal care for the recent pregnancy. Among the antenatal care users, 54.4% had less than four antenatal visits. Husband educational level, pregnancy intenion, awareness on danger signs of pregnancy durning pregnancy, antenatal care attendance and frequency were significantly associated(p<0.05) with with skilled delivery care utilization.

Conclusions: The utilization of skilled delivery care services is relatively higher in the study area but inadequate in general. Some Sociodemographic, socio-economic and obstetric factors influence the utilization of skilled delivery care. Expanding educational opportunities, strengthening promotion of safe motherhood, and awareness program with the focus on obstetric danger signs of pregnancy, family planning and child spacing are recommended to improve the skilled delivery care utilization.

Keywords
Skilled Delivery Care; Hossana; Unintended Pregnancy
Abbreviations
ANC: Antenatal Care; AOR: Adjusted Odds Ratio; CI: Confidence Interval; DC: Delivery Care; WHO: World Health Organization
Introduction
Maternal and child healthcare is one of the eight basic components of primary healthcare in the Declaration of Alma-Ata. It includes health services during pregnancy, birth and early period of postdelivery [1,2]. Child birth is natural and continuous process in which many women are at risk for developing complication during child birth. In (2010), an estimated 287,000 women died around the world from largely preventable and treatable pregnancy and childbirthrelated causes. From this, developing countries shares 99 percent of the burden in which around 56 percent of these maternal deaths took place in sub-Saharan Africa. The maternal mortality ratio is estimated 676 per 100,000 live births according 2011 EDHS compared to 16 per 100,000 live births in developed countries, 500 per 100,000 live births in Sub-Saharan countries [3-5].
Skilled care for all women during child birth is a key approach for saving women’s lives and ensuring the best chance of delivering a healthy infant [6]. According to EDHS 2011 report, about 10 percent of births are assisted by skilled provider. This is also varied 50.8% of women in urban and 4% of women in rural areas assisted during delivery by skilled health care providers [5].
A few studies carried out in some parts of Ethiopia to identify factors associated with delivery care utilization among women of reproductive age, particularly no study was conducted in the study setting [7-11]. Understanding the factors that determine delivery care utilization is important in designing and implementing interventions that increase the utilization of the care services. It benefits the individuals, family, community and the nation at large. Therefore, this study was aimed to identify the level of skilled delivery care utilization and associated factors among currently married women of reproductive age in Hosanna, South west Ethiopia.
Methods
Study design and area
A cross-sectional study was conducted to assess the level of skilled delivery care utilization and associated factors among currently married women of reproductive age who gave birth in the last 12 months in Hossana town from January1-31, 2014. Hosanna town is situated 232kms Southwest of Addis Ababa (Capital city of Ethiopia). There are about 84,433 people live in the town; of these 49.2% are females. The town has the three former sub administrative units called kefle ketema (districts) consisting eight kebelesa under it. There is one government owned hospital and there are three health centers, eight health posts and five private clinics. The hospital, all the three health centers and three private clinics provide maternal health care services including antenatal care, delivery care and postnatal care services with routinely staffed senior and junior skilled health care providers.
Sample size and sampling procedure
The sample size was determined by using single population proportion formula. Prevalence(p) of 51% (0.51) women living in urban received delivery care from skilled health professionals according to EDHS 2011 with 5% margin of error, 95% (Z α/2=1.96) confidence level of certainty, 10% of non-response rate to obtain the sample size of 422 currently married women who gave birth in the last 12 months.
Multi-stage sampling technique was selected to select study participants. The town was divided into three former higher administrative unit kefle ketema (districts) the first two of the kefle ketema (districts) consists of six kebeles (lowest administrative unit) and the third kefle ketema (district) consists of two kebeles. We identified two Kebeles from Sech duna district, two kebele from Gofer meda and one kebele from Addis kifle ketema district, using simple random sampling method. Pre survey was conducted to identify the households with eligible (currently married women who gave births in the last 12 months) in five kebeles included in the sample. Then sampling fraction was determined for each of the selected kebeles by probability proportional sampling method. Then we employed simple random sampling method to select the total households in each kebele to be interviewed by using systematic random sampling. Whenever more than one eligible respondent is present in the same selected household, only one respondent chosen by lottery method (simple random sampling). Revisits of three times was made in case where eligible respondents were not available at the time of the survey.
Data collection
Twelve grade complete female data collectors were used to collect the data. The principal investigator trained intensively data collectors and supervisors for three days on the purpose and procedures of the survey, problems that might arise during the survey and art of interviewing. Data collectors and supervisors practiced a role-play. Then feedbacks and comments were given to each interviewer. Care was given on questionnaire design and pretest was among currently married women of reproductive age who gave birth in the last 12 months prior to the survey residing in adjacent kebeles not included in the principal survey. Closely supervised the data collection process was closely supervised by field supervisors and principal investigator.
Ethical consideration
Firstly, ethical approval was obtained from Institutional Research Ethics committee (IREC) of Haramaya University College of Health and Medical Sciences. Then Haramaya University college of Health and Medical sciences, school of graduate study wrote formal supporting letter to the study area. Then permission was obtained from perspective kebeles in included in the study’ the data collectors explained carefully purpose of the study and the right of the respondents not to participate, not to answer the question for which they didn’t want. Assurance of confidentiality was employed before asking informed and written consent to conduct interview.
Data processing and analysis
After completion of data collection, checking of questionnaire for completeness and coding, data were entered into EPI-DATA version 3.02 and exported to the SPSS (version 20.0) for the analysis. Descriptive analysis like percentages, proportions, mean and standard deviation were used to describe study population. Bivariate analysis was employed to calculate the crudes odds ratio (OR) and with 95% CI to assess the association between dependent and independent variables. Further, multivariate logistic regression analysis was performed to calculate adjusted odds ratio (AOR) for all the variables that p<0.3 in bivariate analysis as the crude odds ratio do not show the effect of confounders. Skilled delivery care was defined as if the women was attended by skilled health professional (Nurses, midwives, doctors and health officers) during the recent child birth.
Results
Socio demographic and economic profile
From all eligible respondents in the selected sample, 420 women responded to the questionnaire with the response rate of 99.5%. Most of the study respondents (88.6%) were in the age group of 20-34 with the mean age of 28.11 ±4.91 years. More than half (64.8%) of the respondents were protestants followed by 20.7% were Orthodox religion followers. Regarding to women’s literacy, 36.4% of women attended elementary education and, 67.6% of women attended secondary and above education whereas, 13.3 % of the respondents never attended formal school. More than half (56.2%) of the respondents were unemployed while, 43.8% were employed (Table 1).
Skilled delivery care utilization
The study revealed that 65.5 % of deliveries were assisted by skilled health care professionals. Out of 422 women included in the study, 65.5 % of the women attended at least one antenatal visit during their last pregnancy from skilled health professional in which 40.2% deliveries were assisted by midwifes followed by 13 % were by nurses (Figure 1) About, 92% of the women attended at least one antenatal care for the recent pregnancy. Among the antenatal care users, 54.4% had less than four antenatal visits.
In multivariate logistic regression analysis husband’s educational level, pregnancy intention, awareness to pregnancy danger signs, antenatal care attendance and frequency were significantly associated with skilled delivery care utilization. The utilization of skilled delivery care is higher whose husband’s educational level is elementary school and college or higher educational level (AOR=3.75, 95% CI=1.18, 11.85 and AOR=5.83 95%CI=1.82, 18.69) respectively. The probability of skilled delivery care utilization among women with intended pregnancy were about two times than that of the reference group (women with unintended pregnancy) (AOR=2.2095%CI=1.19, 4.04). Women who were aware at least one danger signs of pregnancy were 4.4 times more likely to utilize delivery care than that of the reference group (not aware) (AOR=3.37, 95% CI=1.96, 5.79). Women who attended ANC during recent pregnancy were about six times more likely to be assisted by skilled health worker during delivery compared to women who attended ANC at most three times (AOR=6.12, 95%CI=2.42, 15.45) (Table 2).
Discussion
The study revealed that delivery care utilization was 65.5%. Parity, pregnancy intension and awareness on obstetric danger signs were significantly associated with ANC utilization. Concerning to delivery care, women’s educational level, pregnancy intension, awareness on danger signs of pregnancy and frequency of ANC visit were significantly associted with delivery care utilization whereas, average family monthly income 450-1100 Birr, awareness on obstetric danger signs of pregnancy and frequency of ANC visit for the recent pregnancy are significantly associated with postnatal care utilization. Although study has contribution to literature on maternal health care, it has some limitations. First, age of respondent might have some miss reporting of age as no reliable parental birth records in Ethiopia. Although the study focused those women who gave birth in the last one year, there may be recall bias.
From the survey, it is learnt that 87.6% of women attended at least one ANC from skilled health care providers. The finding is in line with study conducted in Holeta town (87.1%) and Woldia (89%) [9,10]. It is inconsistent with a multilevel analysis conducted in North Gondar zone (32.3%) and Sidama zone (77.4 %) [10,12-14]. This might be the fact that studies were conducted in both rural and urban kebeles where the distance from health institution could be a major predictor of ANC utilization in rural areas. This study finding is also slightly higher compared with the DHS (2011) in Ethiopia showed that women living in urban received professionally assisted antenatal care about 76% [5]. This might be the fact that increase of the awareness among women due to recently started urban health extension program which is providing equitable access to promotive, preventive and selective curative health interventions through health extension workers. It is also important to note the time gap between the EDHS 2011 and the current study.
The study revealed that 65.5 % of the women were assisted by skilled health professional during delivery. These findings compare well with the study conducted in Holeta town (61.6%) but, slightly higher than study conducted in Woldia (48.3%) [9,10]. This could be the study was conducted in Woldia included women from both rural and urban part of the study area but current study was conducted in urban only where the distance from health institution could be a major predictor of delivery care utilization in rural areas. It is also, slightly higher compared to the DHS (2011) in Ethiopia showed that women living in urban received professionally assisted delivery care was about 51% [5]. This could be the fact that awareness creation among women about the benefit of skilled attendance at delivery through expansion of urban health extension workers and currently started free ambulance services in the community.
This study finding also revealed the odds of utilizing skilled DC among women whose pregnancy intended are higher compared to women whose pregnancy is unintended. The positive effect of intended pregnancy on maternal health care utilization was observed in different studies done elsewhere [9,10,13-18]. This might be due to the fact that women with unintended pregnancies may initially attempt to deny their pregnancies to themselves first. As the result women become less motivated to seek ANC and DC services. Recognition of obstetric danger signs of pregnancy by women and their family could prevent significant maternal morbidity and mortality and promptly seek health care [2,4]. Women who were aware at least one obstetric danger sign of pregnancy are more likely to utilize DC compared to the women who didn’t. Similar effect was observed in study conducted in Ethiopia and other developing countries [8-10,19,20]. Skilled attendance birth was significantly associated with the level of husband education. That is, women who had elementary educated and college/higher educated husbands are more likely to use safe delivery services than those with no education levels. Other studies agree with these findings [13,21].
This survey also revealed that women who attended antenatal visits at least four times were more likely to seek skilled delivery than women who attended at most three times. Similar findings were reported in Woldia and Southern Tanzania [9,20]. This may be due to the fact that women with more ANC visits also showed a higher satisfaction with the care quality and hence more likely to use health services for delivery. It is also a fact that many ANC visits expose the women to more health education and counseling which are both likely to increase service utilization.
Conclusion
More than half of the deliveries were attended by skilled health professional. Majority of women attended at least one antenatal visit from skilled health care providers during their recent pregnancy in the study area however; less than half of the women received the recommended four antenatal visits by WHO. Husband’s educational status, pregnancy intension, awareness on danger signs of pregnancy, ANC attendance and WHO recommended ANC visit were predictors of skilled delivery care utilization. Expanding educational opportunities, strengthening promotion of safe motherhood, and awareness program with the focus on obstetric danger signs of pregnancy, family planning and child spacing are recommended to improve the skilled delivery care utilization.
End Note
asmallest administrative unit in Ethiopia
Acknowledgements
The author would like to thank Haramaya University for initiating to conduct this work. The also would like to thank Hossana town administration, supervisors, data collectors and all study respondents.
References

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