Background
Methods
Study design and area
Study population and sampling
Data collection
Data analysis and modeling
Variables | Descriptions | Measurements |
---|---|---|
Dependent variables
| Women who received ANC at least once from a skilled provider, delivery attended by a skilled provider and Women who received PNC at least once from a skilled provider | For each indicator, ‘Yes’ responses are coded as ‘1’ otherwise as ‘0’ |
ANC, Birth attendance and PNC by a skilled provider (three dependent variables) | ||
Level-1 predictor variables
|
Individual and household characteristics
| |
Birth order | Birth order of women’s most recent birth (index birth) | It is divided in to four categories: first birth, 2nd- 3rd, 4th-5th and above 5th |
Maternal and husband educational status | Highest level of education attained by the respondent (mother) and her husband | For each variable, it is categorized in to three: illiterate, primary and secondary and above secondary |
Wealth quintile | Household wealth status is computed by principal component analysis from ten variables (presence of own farmland, own toilet facility, bank account, mobile phone, electricity, roof of house with corrugated iron sheet, number of cows/oxen, horses/ mules/donkeys goats/sheep and chicken) | The wealth status is categorized in to five groups and ranked from poorest to wealthiest quintile. |
Awareness on risk of pregnancy | Awareness of women on risk of pregnancy | When women mentioned at least one major risk factor, the value is ‘1’ if not it is ‘0’ |
Health professionals preferred by women | Women prefer health professionals for their maternity care | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Awareness on places to get skilled providers | Women know appropriate health facilities to get skilled providers | When appropriate facilities are known, the value is ‘1’ if not it is ‘0’. |
Pregnancy wontedness | Pregnancy wanted or not | Pregnancy wanted or miss-timed coded as ‘0’ and unwanted coded as ‘1’ |
ANC in previous pregnancy | Presence of at least one ANC visit in previous pregnancies | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Agreed on postnatal check up | Women agreed on the need of postnatal check up after normal delivery | When women agreed, the value is ‘1’ if not it is ‘0’. |
Level-2 predictor variables
|
Communal (kebele) characteristics
| |
Source of income | The kebele population main source of income | It is categorized in to two: Farming and mixed (farming and trading) |
Self sustained | Presence of enough production for feeding the population | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Average distance | Average distance (in Kilometer) of villages in each kebele to the nearest health center | Supervisors estimated the distances of villages from health centers. The average values were calculated and rounded to one decimal place. |
Health facility characteristics
| ||
Presence of signal functions | Presence of all the six signal functions in basic essential obstetric care facilities (health centers) | If all signal functions are present, the value is labeled as ‘1’ if one or more are missing, the value is labeled as ‘0’ |
Duty service | Maternity service for 24 hrs and 7 days | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Availability of obstetric guidelines | Obstetric guidelines available for reference by staff at all times | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Payment requirements | Maternity clients required to purchase/ provide supplies/drugs at time of delivery | Yes’ responses are coded as ‘1’ and no responses as ‘0’. |
Overall infrastructure | Infrastructures of the health facility (examination and delivery rooms, refrigerator, water source, power supply, toilet facilities, drainage system…) | Based on records of observation, the infrastructure of the health facility is categorized as not satisfactory (1) and satisfactory (2). |
Basic equipments | Presence of basic equipments (BP apparatus, stethoscope, fetal stethoscope, adult and baby weighing scales, delivery and episiotomy sets, sterilizers…) | Based on records of observation, the variable is categorized as not satisfactory (1) and satisfactory (2). |
Ethical considerations
Results
Characteristics | n | Number (percent) of women reporting skilled provider for: | |||
---|---|---|---|---|---|
ANC | Delivery care | PNC | |||
Birth order | 1 | 335 | 132 (39.4) | 77 (23.0) | 31 (9.3) |
2-3 | 657 | 215 (32.7) | 85 (12.9) | 47 (7.2) | |
4-5 | 439 | 116 (26.4) | 43 (9.8) | 17 (3.9) | |
6+ | 237 | 75 (31.6) | 26 (11.0) | 10 (4.2) | |
Mother's education | No education | 1183 | 339 (28.7) | 129 (10.9) | 56 (4.7) |
Primary | 327 | 117 (35.8) | 49 (15.0) | 24 (7.3) | |
Secondary and above | 158 | 82 (51.9) | 53 (33.5) | 25 (15.8) | |
Husband education | No education | 1057 | 286 (27.1) | 116 (11.0) | 50 (4.7) |
Primary | 430 | 172 (40.0) | 62 (14.4) | 33 (7.7) | |
Secondary and above | 181 | 80 (44.2 | 53 (29.3) | 22 (12.2) | |
Wealth quintile | Lowest | 331 | 81 (24.5) | 37 (11.2) | 13(3.9) |
Second | 340 | 107 (31.5) | 43 (12.6) | 15(4.4) | |
Middle | 306 | 112 (36.6) | 44 (14.4) | 30(9.8) | |
Fourth | 357 | 128 (35.9) | 60 (16.8) | 24(6.7) | |
Highest | 334 | 110 (32.9) | 47 (14.1) | 23(6.9) | |
Women have awareness on risk of pregnancy | No | 522 | 90 (17.2) | 52 (10.0) | 13 (2.5) |
Yes | 1146 | 448 (39.1) | 179 (15.6) | 92 (8.0) | |
Women preferred health professionals for the care | No | 713 | 142 (19.9) | 40 (5.6) | 15 (2.1) |
Yes | 955 | 396 (41.5) | 191 (20.0) | 90 (9.4) | |
Women have awareness on places to get skilled providers | No | 341 | 45 (13.2) | 14 (4.1) | 7 (2.1) |
Yes | 1327 | 493 (37.2) | 217(16.4) | 98 (7.4) | |
Pregnancy wontedness | Wanted/mistimed | 1511 | 495 (32.8) | 214 (14.2) | 96 (6.4) |
Unwanted | 157 | 43 (27.4) | 17 (10.8) | 9 ( 5.7) | |
ANC in previous pregnancy | No | 957 | 200 (20.9) | 107 (11.2) | 42 (4.4) |
Yes | 711 | 338 (47.5) | 124 (17.4) | 63 (8.9) | |
Women agree on planning health institutions as delivery place | No | 432 | 38 (8.8) | ||
Yes | 1236 | 193 (15.6) | |||
ANC for this pregnancy by a skilled provider | No | 1130 | 103 (9.1) | 56 (5.0) | |
Yes | 538 | 128 (23.8) | 49 (9.1) | ||
Women agree to have PNC after normal delivery | No | 767 | 26 (3.4) | ||
Yes | 901 | 79 (8.8) | |||
Total | 1668 | 538 (32.3) | 231 (13.8) | 105 (6.3) |
ANC by skilled provider | Birth attendance by skilled provider | PNC by skilled provider | |
---|---|---|---|
Random effects | |||
Level 2 variance | 1.52* (0.63, 3.71) | 0.45* (0.17, 1.18) | 1.09* (0.35,3.38) |
Rho - Intra-class correlation | 0.31 | 0.12 | 0.25 |
Deviance | 1832 | 1282 | 735 |
Antenatal care by a skilled provider
Predictors | n | Adjusted odds ratio (95% CI) | |||
---|---|---|---|---|---|
Level-1predictor variables (Individual and household characteristics) | ANC | Delivery care | PNC | ||
Birth order | 1 | 335 | 1 | 1 | 1 |
2-3 | 657 | 0.75 (0.53, 1.07) | 0.60 (0.40, 0.90) | 0.98 (0.56, 1.71) | |
4-5 | 439 | 0.66 (0.44, 0.99) | 0.51 (0.32, 0.85) | 0.58 (0.28, 1.20) | |
6+ | 237 | 0.79 (0.50, 1.25) | 0.55 (0.31, 0.96) | 0.60 (0.26,1.38) | |
Mother's education | No education | 1183 | 1 | 1 | 1 |
Primary | 327 | 1.09 (0.80, 1.50) | 1.17 (0.79, 1.72) | 1.31 (0.76, 2.24) | |
Secondary and above | 158 | 1.68 (1.08, 2.60) | 1.94 (1.21, 3.10) | 1.72 (0.86, 3.47) | |
Husband education | No education | 1057 | 1 | 1 | 1 |
Primary | 430 | 1.34 (0.98, 1.82) | 0.83 (0.56, 1.22) | 0.83 (0.49, 1.39) | |
Secondary and above | 181 | 1.22 (0.77, 1.94) | 1.27 (0.77, 2.11) | 0.85 (0.43, 1.70) | |
Wealth quintile | Lowest | 331 | 1 | 1 | 1 |
Second | 340 | 1.02 (0.69,1.51) | 1.08 (0.66, 1.78) | 0.97 (0.44, 2.14) | |
Middle | 306 | 1.14 (0.75, 1.72) | 1.24 (0.74, 2.08) | 2.08 (1.01, 4.28) | |
Fourth | 357 | 1.03 (0.68, 1.56) | 1.51 (0.92, 2.46) | 1.35 (0.63, 2.86) | |
Highest | 334 | 0.83 (0.54, 1.27) | 1.21 (0.71, 2.05) | 1.44 (0.67, 3.13) | |
Awareness on risk of pregnancy | No | 522 | 1 | 1 | 1 |
Yes | 1146 | 1.35 (0.96, 1.89) | 1.10 (0.82, 1.75) | 1.52 (0.79, 2.93) | |
Health professionals preferred for the care | No | 713 | 1 | 1 | 1 |
Yes | 955 | 1.64 (1.14, 2.36) | 2.29 (1.50, 3.51) | 2.45 (1.31, 4.60) | |
Awareness on places to get skilled provider | No | 341 | 1 | 1 | 1 |
Yes | 1327 | 1.63 (1.07, 2.49) | 2.83 (1.54, 5.20) | 1.48 (0.64, 3.42) | |
Pregnancy wontedness | Wanted/mistimed | 1511 | 1 | 1 | 1 |
Unwanted | 157 | 0.79 (0.51, 1.22) | 0.59 (0.34, 1.03) | 0.67 (0.31, 1.42) | |
ANC in previous pregnancy | No | 957 | 1 | 1 | 1 |
Yes | 711 | 3.39 (1.98, 5.80) | 1.80 (1.31, 2.49) | 1.92 (1.20, 3.08) | |
Skilled ANC for this pregnancy | No | 1130 | 1 | 1 | |
Yes | 538 | 1.90 (1.37, 2.63) | 0.76 (0.48, 1.20) | ||
Level 2 predictor variables
| |||||
Communal (kebele) characteristics
| |||||
Main source of income | Farming | 1214 | 1 | 1 | 1 |
Mixed | 454 | 1.35 (0.47, 3.88) | 1.64 (1.18, 2.28) | 1.54 (1.03, 2.30) | |
Self sustained | No | 445 | 1 | 1 | 1 |
Yes | 1223 | 1.29 (0.21, 8.09) | |||
Average distance to the nearest health center | 0.83 (0.46, 1.48) | 0.84 (0.69, 1.03) | 0.80 (0.63, 1.02) | ||
Health facility characteristics
| |||||
Signal functions | One or more missed | 583 | 1 | 1 | 1 |
All present | 1085 | 1.14 (0.24, 5.51) | 1.96 (1.13, 3.40) | 1.16 (0.58, 2.35) | |
Availability of obstetric guidelines | No | 900 | 1 | ||
Yes | 768 | 1.13 (0.59, 2.18) | |||
Payment requirements during delivery | No | 1252 | 1 | ||
Yes | 416 | 0.53 (0.32, 0.88) | |||
Overall infrastructure | Not satisfactory | 1153 | 1 | 1 | 1 |
Satisfactory | 515 | 1.64 (0.39,6.92) | 0.98 (0.64, 1.51) | 1.51(0.74, 3.10) | |
Basic equipments | Not satisfactory | 878 | 1 | ||
Satisfactory | 790 | 1.12 (0.73, 1.72) | |||
Random part | |||||
Var (ANC in previous preg) | 0.62 (0.22, 1.80) | - | - | ||
Var (Preference of H. professionals for the care) | 0.07 (0.14, 4.05) | - | - | ||
Var(cons) i.e. level-2 variance | 0.76 (0 .41, 2.21) | 5.64e-19 | 2.13e-18 | ||
Rho - Intra-class correlation | 0.19 | Nearly 0 | Nearly 0 | ||
Deviance (G2) | 1652 | 1167 | 670 |