Ana səhifə

Assessment of equity in provision and utilization of maternal and child health programs in butajira, southern ethiopia


Yüklə 0.55 Mb.
səhifə3/16
tarix18.07.2016
ölçüsü0.55 Mb.
1   2   3   4   5   6   7   8   9   ...   16

2.2. Statement of the Problem


The health policy of Ethiopia emphasizes the importance of achieving a universal access, for all segments of population, to a basic package of quality primary health care, via a decentralized management system. Primary health care programs were planned to be delivered free of charge in the country to achieve access to 100% of the population (6). But the health service in Ethiopia is characterized by low coverage of 64%. The health facilities are more concentrated to urban area while 85% of populations are rural residents with poor access (7). A recent study in rural Ethiopia showed that, those in urban area, those with higher asset score, and males were significantly more likely to visit higher-level health facilities (8).
To date, few studies are available in Ethiopia regarding equity of health service distribution in general and these are limited to curative health service distribution. As equitable primary health service provision is a goal for the country, it is important to assess the degree and direction of basic health service provision inequality in benefiting the vulnerable groups of the society such as children and mothers and in a way that helps policy making.
Therefore, this study is aimed at assessing equity in the provision and utilization of primary maternal and child health care services across population of different demographic, socioeconomic, geographic characteristics. In addition, it assesses the determinants in the equitable distribution of Primary Health Care services within a rural community in southern Ethiopia.

III. Objectives

General Objective:


  • To assess the equity aspect of the distribution of primary maternal and child health services in Meskan and Mareko Woreda, southern Ethiopia.



Specific objectives:


  1. To describe the utilization of primary maternal and child health care services across population of different demographic groups in Meskan and Mareko woreda.

  2. To describe the utilization of primary maternal and child health services across population of different socioeconomic characteristics in Meskan and Mareko woreda.

  3. To describe the utilization of primary maternal and child health services across population of different geographic localities in Meskan and Mareko woreda.

  4. To assess the determinants in the equitable distribution of primary health care services in Meskan and Mareko woreda.



IV. Methodology

4.1. Study Area and Period


The study was conducted from November 2004 to January 2005, in ten selected kebeles/ peasant association of Butajira Rural Health Program sites and public health facilities of Meskan and Mareko District, Gurage Zone, southern Ethiopia. The district was divided into 82 peasant associations and 4 urban dwellers association; the total population estimated to be 285,900 (projected from reported 1997 population with Rate of Natural Increase of 2.7%), among which 21% are women of 15-44 years age group and 15% are under five children.
In the districts; there are 12 Health Posts, 3 Health Stations, 2 Malaria Control Centers, 2 Health Centers and 1 Hospital (37). Coverages of preventive maternal and child health service of the Meskan and Mareko according to the Woreda Health Office report for 1996 E.C. were 83.4% for DPT3, 64% for measles, 28.6% for TT2 pregnant, and contraceptive prevalence rate of 12.3%, ANC coverage of 26.4%, and attended delivery was 13% (38). Records of all government health facilities were reviewed for one-year service.
The Department of Community Health, Faculty of Medicine has a community based continuous demographic surveillance system of the Butajira Rural Health Program (BRHP), which maintained a “field population laboratory” or “study base” in ten villages. The base was established in this district in 1987 and covers a population of about 41,200,000 distributed within ten randomly sampled kebeles (villages) which were purposively taken (with estimated population of 44,973) from which households were randomly selected.
Reason for choosing the DSS site is the ease of getting sample frame for the study from ongoing vital event registration, which could otherwise be tedious and costly, as it needs to conduct census.

4.2. Study design


The study is comprised of two methods, the first is reviewing of one-year (1996 EC.) maternal and child health service charts of all health facility in the woreda to collect geographic and socio-demographic data of those who have used health service by trained data collectors using a study format designed for this purpose. This was done to determine the utilization of services across population of different geographic localities.
The second is community-based, case control study aimed at collecting basic socio-demographic and economic data as well as other possible determinants of accessing health services among randomly selected 190 cases [households with pregnant mothers who received ANC follow up services] and 191 controls [households with pregnant mothers who did not received ANC follow up services] among residents of Butajira Rural Health Program site during 1996 EC using structured questionnaires administered by trained data collectors.

4.3. Study population and Sampling

4.3.1. Study population


The source population was records and registers from all health facilities and all mothers living in the Woreda during 1996 EC (and at the time of study).

A one year activity (1996 EC.) records and registers of all the health facilities and a randomly selected sample of 381 households with eligible mothers were used as study population.


4.3.2. Sample size calculation


The sample size calculation for the household survey were based on a report by Tesema and Assefa that showed among 48% of mothers who didn't attended ANC, proportion of urban mothers were 27% (19).
Assumptions:

1. Proportion of exposure among controls to be Po= proportion of urban mothers in non users=27%

2. OR worth detecting = 2

3. 95% confidence level; =. 05

4. Power =80%;  =0.20

5. Case: control ratio =1: 1

N=[Z2pq + Zp1q1+Poqo]2/(p1-po)2
Sample Size Calculation for equal case control ratio; the target to be included is 160 cases and 160 controls. Adding 20% allowance for losses and refusals, the sample size of 192 cases and 192 controls were used as study population.

4.3.3. Identification and Selection of case and controls, and Sampling procedures

Three weeks prior to actual data collection time, ten interviewers contacted a total of 763 mothers in the ten Peasant Associations, and asked whether they used ANC during this pregnancy or not. These mothers were identified from the ongoing Demographic Surveillance System of Butajira Rural Health Program, which continuously register all vital events in the ten PAs'.


Accordingly, 439 mothers had attended ANC (eligible cases) and 324 mothers did not attended ANC (eligible controls). Then the principal investigator selected a random sample of 192 cases from 439 ANC users (eligible cases) and a random sample of 192 controls from 324 ANC non-users (eligible controls). Printed lists of these selected households were given to 10 trained data collectors who administered the interview using structured questionnaires.

4.3.4. Operational definitions


Outcome: utilization of ANC services among all pregnant mothers living in Butajira Rural Health Program site during 1996 EC.

Exposure: socio-demographic, socio economic and geographic variables

Cases: are households with pregnant mothers who received ANC follow up, during 1996 EC among Butajira Rural Health Program site residents.

Controls: are households with pregnant mothers who did not received ANC follow up, during 1996 EC among Butajira Rural Health Program site residents. (Both cases and controls were identified after conducting the by a household survey).

Equity/inequity: The primary determinant in the use of services should be the need for them. As the need for basic preventive service such as ANC follow up among all pregnant women is equally distributed, any variation in the utilization of this service by income, ethnicity, religion, education, sex, age, location of residence etc will be considered as inequity. For the health facility users any significant variation of service users by place of residence and distance will also be considered as inequity.
Educational status of study subjects: subjects who have some years of formal education assumed to have some schooling and those who have no some years of formal education assumed to have no schooling.

4.3.5. Investigator's Field work experience


During the development of study proposal, the outcome variable, and definition of cases and controls were as follows:




  • Outcome: utilization of ANC service and EPI services among pregnant mothers and under one children living in Butajira Rural Health Project site in 1996 EC.

  • Case: household with both pregnant mother and under one child if both of them received their respective services (ANC and EPI).

  • Control: household with both pregnant mother and under one child if both of them do not received their respective services.

Three weeks prior to the actual data collection time, 1261 newborn babies were identified from the ongoing DSS during the year, Hamle 1/1995- Sene 30/1996; from which deaths, out-migrations, and in-migrates were excluded. The remaining 1049 households with alive newborn children were listed by their address i.e. their PAs and household numbers and provided to data collectors, who interviewed mothers: Whether they used ANC during this pregnancy or not; and if used asked to show ANC follow up card and whether their children were immunized for EPI.


The questionnaires were analyzed by the principal investigator with the following results.

  • Households with properly filled information for both mothers and children = 763

  • Total number of mothers who attended ANC = 439

  • Total number of children vaccinated for EPI = 692

  • Households with both the mother and child received service=416

  • Households with both the mother and child didn't received service=48

  • Households with the mother didn't received but the child receive service=276

  • Households with the mother received but the child didn't received service=23

  • Mothers did not attend ANC in 324 households and children did not vaccinated in 71 households.

Based on this case definition; eligible cases, i.e. households with both the mother and child received service, were 416 while eligible controls, households with both the mother and child didn't received service, were only 48 which is not sufficient for the calculated sample size. Accordingly, the definition of cases and controls were changed to households with the mother who used ANC and households with mother who did not use ANC.

1   2   3   4   5   6   7   8   9   ...   16


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©atelim.com 2016
rəhbərliyinə müraciət