5.5. Access, information and decision pattern as determinants of health service utilization
To compare access and knowledge factors as determinants of health service utilization, variables were categorized and recoded as: nearest HF HC=1, else=0; walking distance from a health institutions if less than an hour =1, else=0; Type of transport walking =1, else=0; Source of health information if health workers =1, else=0; Decision making in the family, if mother involved=1, else=0.
Table 5. Access, information source and decision making pattern as determinant for utilization of Public health programs, Meskan and Mareko District, Ethiopia 2004.
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Variables Cases (n=190) Cont (n=191) OR (95% CI)
Type of nearest HI
HC 104 100
Others 86 91 1.1 (0.74, 1.64)
Walking distance
< 1 hour 98 86
>1 hour 62 98 1.8(1.17, 2.77)*
Frequent mode of transport
Walking on foot 150 164
Others 40 27 0.62 (0.36, 1.05)
Source of health information
Health workers 148 160
Others 42 31 0.68(0.41, 1.14)
Decision maker
Mother involved 107 98
Not 83 93 1.22(0.8, 1.79)
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Note - *-Significant at p<0.05.
Accordingly, walking distance <1hour showed statistically significant association with service use (OR=1.8, 95% CI: 1.17-2.77). Involvement of mother in family decision-making was also associated with service use but not statistically significant (OR=1.22, 95% CI: 0.8-1.79).
Factors, that showed significant differences, were tested by multinomial logistic regression. Accordingly, only place of residence being an urban (X2=9.96, p<0.01), average annual income level of more than 1000 birr (X2=6.67, p<0.05), mothers having some education (X2=8.57, p<0.05), and walking distance from a health facility <1hour (X2=4.96, p<0.05), remains to be significantly different among cases and controls.
Table 6. Multinomial logistic regression of socio-demographic, economic and health service factors, Meskan and Mareko District, Ethiopia 2004.
Variables Cases (n=190) Cont (n=191) Crude OR (95% CI) Adj.OR (95%CI)
Urban 47 15
Rural 143 176 3.86 (2.07, 7.19) *** 3.05 (1.53, 6.12) **
Mother’s Educational status
Some schooling 47 20
No school 143 171 2.81 (1.59, 4.96) *** 2.45 (1.27, 3.89) *
Father’s Educational status
Some schooling 91 60
No schooling 99 130 1.99 (1.31, 3.02) ** 1.27 (0.78, 2.1)
Occupation
Non-farmer 47 18
Farmer 142 171 2.89 (1.64, 5.1) *** 1.64 (0.57, 4.77)
Annual Income
1000 or more 63 35
Less than 1000 78 102 2.35 (1.42, 3.91) ** 2.02 (1.18, 3.43) *
Own house
Has own house 166 182
No own house 24 9 0.34 (0.15, 0.76) * 0.92 (0.29, 2.94)
Own land
Has own land 151 175
No own land 39 16 0.35 (0.19, 0.65) ** 0.78 (0.22, 2.69)
Walking Distance
< 1 hour 98 86
>1 hour 62 98 1.8(1.17, 2.77)* 1.65 (1.06, 2.55)*
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Note - *-Significant at p<0.05, **- significant at p<0.01, *** significant at p<0.001
To assess knowledge and attitude of mothers concerning preventive maternal and child health services, mothers were inquired if they have ever heard of these services, their use and importance, the proper time of services and their cost as summarized in Table 7.
Accordingly, Cases were more likely than controls to know use and importance of ANC (OR= 4.44, 95% CI: 2.26-8.7), to know proper ANC service time (OR= 1.65, 95% CI: 1.1-2.5) and cost (OR= 22.7, 95% CI: 6.9-74.3). Additionally cases were more likely than controls to know use and importance of PNC (OR= 4.1, 95% CI: 2.1-8.1), and to know PNC service cost (OR=5.14, 95% CI: 2.5-10.6).
Furthermore, cases were more likely to know more than three contraceptive methods (OR= 2.9, 95% CI: 1.26-6.66).
To assess attitude of mothers concerning institutional delivery, mothers were inquired where was their chosen place for pregnant mothers to give birth. Accordingly, 24% of the cases but only 9.5% of the controls preferred health facility as place of delivery. Cases were more likely than controls to prefer health facility as place of delivery (OR=3.1, 95% CI: 1.71-5.53)
Table 7. Factors in utilization of Public health programs, Meskan and Mareko District, Ethiopia 2004.
Variables Utilization
Cases (n=190) Control (n=191) OR 95%CI
Ever heard
ANC yes 190 158 @
No 0 33
PNC yes* 47 15 3.86(2.1, 7.2)
No 143 176
Know use & importance of services
ANC yes* 178 147 4.44(2.26, 8.7)
No 12 44
PNC yes* 41 12 4.1(2.1, 8.1)
No 149 179
Know proper service time
ANC yes* 113 90 1.65(1.1, 2.5)
NO 77 101
Know service cost
ANC yes* 187 140 22.7(6.9, 74.3)
No 4 51
PNC yes* 42 10 5.14(2.5 10.6)
No 148 181
Know modern contraception
No method 68 71 1.00 1-2 methods 97 111 0.91(0.59, 1.4) >3 methods 25 9 2.9(1.26, 6.66)
Preferred Place of delivery
Health Facility * 46 18 Home 144 173 3.1(1.71, 5.53)
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Note *-significant at p<0.05,
@-Test not applied
1hour>1hour> |