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


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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.

______________________________________________________________________

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).


5.6. Results of multinomial logistic regression

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)
Place of residence

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)*

______________________________________________________________________________________

Note - *-Significant at p<0.05, **- significant at p<0.01, *** significant at p<0.001


5.7. Public health service knowledge


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

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