Distance, difference in altitude and socioeconomic determinants of utilisation of maternal and child health services in Ethiopia: a geographic and multilevel modelling analysis.
BMJ Open
; 11(2): e042095, 2021 02 18.
Article
em En
| MEDLINE
| ID: mdl-33602705
ABSTRACT
OBJECTIVE:
We assessed whether geographic distance and difference in altitude between home to health facility and household socioeconomic status were associated with utilisation of maternal and child health services in rural Ethiopia.DESIGN:
Household and health facility surveys were conducted from December 2018 to February 2019.SETTING:
Forty-six districts in the Ethiopian regions Amhara, Oromia, Tigray and Southern Nations, Nationalities, and Peoples.PARTICIPANTS:
A total of 11 877 women aged 13-49 years and 5786 children aged 2-59 months were included. OUTCOMEMEASURES:
The outcomes were four or more antenatal care visits, facility delivery, full child immunisation and utilisation of health services for sick children. A multilevel analysis was carried out with adjustments for potential confounding factors.RESULTS:
Overall, 39% (95% CI 35 to 42) women had attended four or more antenatal care visits, and 55% (95% CI 51 to 58) women delivered at health facilities. One in three (36%, 95% CI 33 to 39) of children had received full immunisations and 35% (95% CI 31 to 39) of sick children used health services. A long distance (adjusted OR (AOR)=0.57; 95% CI 0.34 to 0.96) and larger difference in altitude (AOR=0.34; 95% CI 0.19 to 0.59) were associated with fewer facility deliveries. Larger difference in altitude was associated with a lower proportion of antenatal care visits (AOR=0.46; 95% CI 0.29 to 0.74). A higher wealth index was associated with a higher proportion of antenatal care visits (AOR=1.67; 95% CI 1.02 to 2.75) and health facility deliveries (AOR=2.11; 95% CI 2.11 to 6.48). There was no association between distance, difference in altitude or wealth index and children being fully immunised or seeking care when they were sick.CONCLUSION:
Achieving universal access to maternal and child health services will require not only strategies to increase coverage but also targeted efforts to address the geographic and socioeconomic differentials in care utilisation, especially for maternal health. TRIAL REGISTRATION NUMBER ISRCTN12040912.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Serviços de Saúde da Criança
/
Serviços de Saúde Materna
Tipo de estudo:
Observational_studies
/
Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Adult
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Child
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Child, preschool
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Female
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Humans
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Infant
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Middle aged
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Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article