Expanding Maternity Waiting Homes as an Approach to Improve Institutional Delivery in Southwest Ethiopia: A Community-Based Case-Control Study.

With the promising efforts in increasing institutional delivery yet, maternal and child mortality is high in Ethiopia. One of the strategies used to minimize this problem was the introduction of Maternity Waiting Homes (MWH). MWHs are residential facilities for pregnant women near a qualified medical facility. The introduction of MWHs has improved institutional delivery in many countries. In Ethiopia however, the contribution of MWHs was rarely studied. To fill this gap, we have conducted a community-based unmatched case-control study from March 1 to April 20, 2016, in Southwestern Ethiopia. Mothers who delivered at a health facility within 1 year were considered as cases while mothers delivered at home were controls. We used simple random sampling to identify study participants from the pool of cases and controls who were identified by census. Data were analyzed using SPSS Version 20. Binary logistic regression was used to identify significant predictors. A total of 140 cases and 273 controls were included in the study. Among the case, 86 (61.4%) used MWHs during their last delivery. Variables like educational status of the mothers [AOR = 2.96, 95% CI: 1.41, 6.23], educational status of the husband [AOR = 5.19, 95% CI: 1.52, 17.76], and having antenatal care follow up [AOR = 3.22, 95% CI: 1.59, 6.54]. This study remarks, accessing MWHs, creating better awareness in utilizing them, and practicing antenatal follow-up have a crucial role in improving institutional delivery. Therefore, strengthening the existing and establishing new MWHs to deliver quality services is a good strategy in reducing home delivery.

Are we too far from being client centered?

BACKGROUND: Quality of service provision in health facilities is fundamental to ensure effective care. However, women's actual experience of care is often neglected. OBJECTIVE: To assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia. METHOD: Community based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions. RESULTS: Perceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (ß: -0.331, 95% CI: -0.523, -0.140), urban residence (ß: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (ß: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (ß: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (ß: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (ß: -0.689, 95% CI: -0.907,-0.472). Urban residence (ß: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (ß: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure. CONCLUSION: Overall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.

Level and Factors Associated with Professional Commitment of Health Professionals Providing Institutional Delivery Services in Public Health Facilities, Southwest Ethiopia.

BACKGROUND: Professional commitment is beyond a commitment for a particular organization and implies the individuals' perspective towards their profession and the motivation that they have to stay in their job with willingness to strive and uphold the values and goals of the profession. In Ethiopia, uptake of institutional delivery services is low. However, the level and factors associated with professional commitment is not known so far. Hence, our objective is to assess the level and factors associated with commitment of health professionals providing institutional delivery services in public health facilities of Jimma Zone, Southwest Ethiopia. METHODS: A facility-based cross-sectional study design was conducted from March 01-20, 2016. A total of 442 eligible health professionals were included from randomly selected 7 districts and 47 respective health facilities. Health professionals were requested to fill self-administered questionnaire. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 20 for statistical analysis. Factor analysis was conducted. Simple and multiple linear regression were done using 95%CI and significance was declared at P<0.05. All assumptions of linear regression and principal component analysis were checked. RESULTS: The percentage mean score of professional commitment was 72.71% (SD21.88). The percentage mean score for perceived maternal health goal scale was 68.37% with the total variance explained being 69.68%. Perceived staff interaction, work-life balance, affective organizational commitment, normative organizational commitment, personal characteristics and perceived maternal health goal were independent predictors of professional commitment. CONCLUSION: The percentages mean score of professional commitment was medium. Hence, Health professionals should foster their level of professional commitment to increase uptake of institutional delivery services.