Ethiopia is one of the five nations that bear the global burden of nearly 50% maternal mortalities and newborn deaths. Cause-specific maternal mortality and newborn death information are vitally important for prevention, but little is known about the causes of deaths. Many maternal mortalities and newborn deaths occur at home, outside the formal health sector, and few are attended by qualified medical professionals. Despite the fact that, non-medical factors are often more important in determining whether a woman/newborn lives or dies than the medical cause of death itself. This study determines and explores factors contributing to maternal mortalities and newborn deaths in Ethiopia with the aim of developing a community-based model for averting maternal mortalities and newborn deaths in Ethiopia. The study was organised in three phases. In Phase 1, a community-based-retrospective approach using explorative, descriptive and contextual study design, combining both qualitative and quantitative methods (mixed methods) were used to make an in-depth investigation and analysis of the circumstances and events surrounding individual cases of maternal mortality and newborn deaths. The result of the study revealed various direct and indirect as well as possible contributing factors to maternal mortalities and newborn deaths which outlined bases for forwarding Phase 2 of the study called concept analysis. In Phase 3, a prototype model was developed according to Chinn and Kramer’s approach to theory generation: initially, based on the empirical perspectives of the study, concept analysis was conducted. The structure and process of a model to avert maternal mortality and newborn death were described; and, six survey list; namely, agent, recipient, context, procedure, dynamic and terminus of Dickoff, James and Wiedenbach (1968) form the basis for development and description of a model for averting maternal mortality and newborn deaths in Ethiopia. Impediment in receiving prompt, adequate and appropriate care were common problems encountered even after reaching an appropriate medical facility. For any attempt to attain a significant reduction in maternal mortality and newborn death, the health care system in Ethiopia must assume its tasks to institute critical changes in both the structure and process of health care delivery services. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to determine factors influencing skilled delivery service utilisation in order to develop strategies to improve utilisation of skilled birth attendance service in North West Ethiopia. The objectives were to explore and describe the perceptions and experiences of the community regarding skilled utilisation of the birth attendance service; explore reasons for non-utilisation of skilled birth attendance service; asses the health system experience of provision of skilled birth attendance service; and formulate strategies to improve utilisation of skilled birth attendance service. The study employed a qualitative, descriptive, and explorative research design to address the research questions formulated by the researcher. The study used focus group discussion guide to obtain information from pregnant women and women who gave birth recently. Furthermore, the study used an interview guide to gather information from health extension workers, midwives, health centre heads, district health office technical experts and heads. It also employed and inductive thematic analysis approach to analyse the qualitative data. The study further used the Atlas ti version 7 for the data analysis. The steps followed for the analysis were data immersion, coding, displaying, reduction, and interpretation. Overall, nine themes emerged from the analysis of the data. Consequently, the researcher used the findings of the study to develop strategies to improve the utilisation of skilled birth attendance service. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English, with Annexures in English and Amharic / Annexure 5 and Annexure 7 "Questionnaire for qualitative study" in English and Amharic / The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC). PURPOSE The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). METHODOLOGY The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. RESULTS In the study, 79.8% of the women who delivered within 12 months prior to this study received ANC from SBA. Baby care and PNC for the mother and baby received from SBA were at 248 (71.5%), 55 (15.8%), and 131 (38%) respectively. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. CONCLUSION To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health-service utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework. / Health Studies / D. Litt. et Phil. (Health Studies)