Spatial variations of women's home delivery after antenatal care visits at lay Gayint District, Northwest Ethiopia.

BACKGROUND: Home delivery is the most frequent childbirth practice in Ethiopia and brings health risks for many mothers and their babies which in turn affecting the whole families. Characterizing the spatial variations and the associated factors of home deliveries after antenatal care visit is necessary to prioritize risks and facilitate geographically based interventions. METHOD: A community-based cross-sectional study design was carried out between February and March 2016. A total of 528 women who had just given birth were interviewed face-to-face using a questionnaire. Geo-referenced data were collected using a handheld global positioning system (GPS). The Bernoulli model was applied using the SatScan ™ software to analyze the purely spatial clusters of home deliveries. ArcGIS version 10.1 was used to visualize clusters of home delivery. RESULTS: The overall proportion of home deliveries was 278(52.7%), and home deliveries had spatial variations. A primary cluster [LLR = 14.54, p < 0.001] was detected in village of Safida Giorgis. Secondary clusters were detected in Checheho [LLR = 9.17, p < 0.05] and ZurAmba [LLR = 8.51, p < 0.05]. Predictors for home delivery included the distance between the health extension worker's and mother's house [AOR = 2.2, 95% CI: 1.1, 4.3], residence [AOR = 3.8, 95% CI: 1.3, 10.9], source of information for ANC [AOR = 0.3, 95% CI: 0.13, 0.7], ANC visits [AOR = 6.1, 95% CI:1.9, 19.3], health education [AOR = 3.4, 95% CI: 1.5, 7.4], decision on place of delivery [AOR = 0.3, 95% CI: 0.1, 0.8], and knowledge on place of delivery [AOR = 0.04, 95% CI: 0.0, 0.1]. CONCLUSION: The proportion of home delivery after ANC visit was decreasing compared to other studies conducted in the region. In addition, spatial variations of home delivery were observed in the study area. Promoting women's education and behavioral change communication at the grass root level, provision of the services both at home and health facilities and improving the quality and capacity of the health providers are some of the recommendations forwarded.

Spatial patterns of childhood diarrhea in Ethiopia: data from Ethiopian demographic and health surveys (2000, 2005, and 2011).

BACKGROUND: Childhood diarrhea is a major public health problem, especially in developing countries, including Ethiopia. Exploring the spatial pattern of childhood diarrhea is important to monitor and design effective intervention programs. Therefore, this study aimed to explore the spatial patterns of childhood diarrhea in Ethiopia over the past one decade. METHODS: A total of 29,358 under-five children were retrieved from three consecutive Ethiopian demographic and health surveys (2000, 2005, and 2011) and included into the study. Spatial cluster and autocorrelation analysis was done to explore the patterns of childhood diarrhea. RESULTS: Childhood diarrhea clustered spatially at a national level in all survey periods (Moran's I: 0.3830-1.3296, p < 0.05). Significant spatial clusters were found in different survey periods across the regions. The most likely spatial clusters were found in Southern Nations Nationalities and people, West Oromia, Gambella, Benshangul-Gumuz, and Somali regions. Childhood diarrhea also clustered at the border areas of Southern Nations Nationalities and People and Tigray, Central Somali and Western Oromia, Gambella and Amhara (West Gojam, Awi, Oromia, and Wag Himra) regions. In 2000, the most likely clusters were found in Southern Nations Nationalities and People, West Oromia, and Gambella regions (LLR = 55.37, p < 0.001); in 2005, at Southern Nations Nationalities and People (LLR: 45.69, p < 0.001); and in 2011, at Gambella, West Southern Nations Nationalities and People and Oromia, and Benshangul-Gumuz regions (LLR: 51.09, p < 0.001). CONCLUSION: In this study, childhood diarrhea remains public health problem and had a spatial variation across the regions. Identifying the risk areas would help in designing effective interventions to reduce childhood diarrhea in these areas.