Assessment of equity in provision and utilization of maternal and child health programs in butajira, southern ethiopia
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5.8. Geographic locality and health service utilizationTo describe the geographic distribution of service users, One-year services users were reviewed from health facility records. Out of the existing 26 health institutions in the study districts, i.e. 23 health posts/stations, 2 health centers, and 1 hospital, preventive maternal and child health services were provided only in three facilities (one hospital and two health centers). From these, records of 2501 Expanded Program of Immunization users, 4172 Antenatal care users, 765 delivery users, and 2428 Family Planning users were reviewed while Post natal care service was not provided in all facilities. In this service users are all individuals registered on respective service records and received the service e.g. EPI. As shown in table 8, the urban residents, which are less than 20% of total population of the district, accounts for significant proportion of all FP, ANC, delivery and EPI service users. Additionally, peasant associations located within a walking distance of less than an hour from health facilities received services more than those located in far distances. Further categorizing children into fully immunized (those who received all antigens i.e. BCG, three doses of DPT and OPV, and measles), and partially immunized (those who received some antigens but not all), from all fully immunized children, 58% were from urban and 73% were from peasant associations/kebeles located within a walking distance of less than an hour (Table 8). Table 8. Distributions of maternal health and EPI service users by place of residence and distance from health facility, Meskan and Mareko District, Ethiopia 2004.Place of resident MCH services Urban N (%) Rural N (%) Total N (%)* FP 1280 (54) 1088 (46) 2428 (100) ANC 950 (23) 3179 (77) 4172 (100) Delivery 336 (45) 414 (55) 765 (100) EPI 921 (38) 1533 (62) 2501 (100) Fully immu. 519 (58) 381 (42) 900 (100) Partially immu. 391 (25) 1141 (75) 1532 (100)
FP 1598 (68) 738 (32) 2428 (100) ANC 1431 (36) 2585 (64) 4172 (100) Delivery 349 (49) 361 (51) 765 (100) EPI 1364 (56) 1057 (44) 2501 (100) Fully immu. ** 655 (73) 245 (27) 900 (100) Partially immu. ** 742 (49) 762 (51) 1504 (100) _____________________________________________________________________ * Total Numbers and percentages may not equal to the numbers and percents in their respective rows due to exclusion of subjects with unknown information. Data of mothers who had delivered in the health facility were further tabulated by ANC attendance status versus place of residence and living distance from health facility, as well as outcome of delivered baby versus place of residence, living distance from health facility, and ANC status. Accordingly, 12.1% of urban and 35.3% of rural mothers had no recorded history of ANC attendance, 14.3% of mothers who resides within a distance of 6km but 34.2% of mothers who resides in a distance of more than 6km from health facilities had no history of ANC. This shows significance association between using ANC service and being urban resident (X2=40.1, p<0.001), and living within a distance of 6km (X2=29.3, p<0.001). Concerning birth outcome, 2.56% of urban but 7.7% of rural mothers gave birth to dead baby, the stillbirth rate was 1.7% for those who resides within a distance of less than 6 km, but 8.8% for who resides in a distance of more than 6km from health facilities, the stillbirth rate was 3.3% for those who attended ANC, but 11.2% for non-attendants. Giving birth to live baby was associated with being urban resident (X2=6.46, p<0.05), living within a distance of 6km from health facilities (X2=12.83, p<0.001), and attending ANC (X2=11.37, p<0.01). Furthermore, children who received EPI service were categorized as fully immunized and partially immunized and compared by their place of residence and living distance from health facility. Accordingly, fully immunized children were 3.88 times more likely to be from urban (X2=238.7, p<0.001), and 2.75 times more likely to be living within a distance of 6km from health facilities (X2=126.2, p<0.001). As shown in Table 9, factors that showed significance association were further tested using Multinomial logistic regression. Accordingly, ANC attendance remains to be significantly associated with being from urban area (X2=12.17, p<0.001), and giving birth to live baby remains to be significantly associated with living within a distance of 6km from health facilities (X2=7.25, p<0.01), and attending ANC (X2=6.6, p<0.05). Furthermore, full immunization for EPI remains to be significantly associated with being from urban area (X2=103.61, p<0.001).Table 9. Distribution of mothers' ANC status, birth outcome, and children's EPI status by place of residence and distance from health facility, Meskan and Mareko District, Ethiopia 2004.ANC attendance Crude OR Adjusted OR Yes no (95% CI) (95% CI)ResidenceUrban 240 33 3.98 (2.56, 6.13)*** 3.69 (1.77, 7.69) **Rural 185 101Distance<6km 246 41 3.12 (2.06, 4.7) *** 1.09 (0.538, 2.21)>6km 179 93 ^Baby Outcome Crude OR Adjusted ORLive birth Stillbirth (95% CI) (95% CI) ResidenceUrban 266 7 3.16 (1.33, 7.52) * 2.02 (0.52, 7.7)Rural 264 22Distance<6km 282 5 5.46 (2.05, 14.5) *** 7.69 (1.74, 33.96) *>6km 248 24 ANC attendance Yes 411 14 3.7 (1.74, 7.88) ** 2.8 (1.28, 6.13) ** No 119 15 Immunization for EPI Crude OR Adjusted OR Fully immu. Partial immu. (95% CI) (95% CI)ResidenceUrban 519 391 3.88 (3.26, 4.63) *** 3.41 (2.69, 4.32) ***Rural 381 1113Distance<6km 655 742 2.75 (2.3, 3.28) *** 1.22 (0.95, 1.55)>6km 245 762 ____________________________________________________________________________________________________________________________________ Note -*- significant at p<0.05, **- significant at p<0.01, ***- significant at p<0.001. |