The objectives of this study are to provide a comprehensive assessment of inequalities in infant and under-five years¿ child survival, access to and utilisations of child health services among different socio-economic groups in Ethiopia; and identify issues for policies and programmes at national and sub-national levels. This thesis examines the effect of parental socioeconomic status, maternal and delivery care services, mothers¿ bio-demographic and background characteristics on the level of differences in infant and under-five years¿ child survival and access to and utilisation of child health services. Descriptive and multivariate analyses were carried out for selected variables in the literature which were consider as the major determinants of infant mortality rate (IMR) and under-five years¿ child mortality rate (U5MR); access to and utilisations of child health services based on data from Ethiopian demographic and health survey (EDHS), covering the years 2000-2005. In the multivariate analysis a logit regression model was used to estimates inequalities in infant and under-five years¿ child survival, and inequalities in access to and utilisation of child health services. In Ethiopia, little was known about inequalities in IMR and U5MR, and inequalities in access to and utilisation of child health services. Besides, there is no systematic analysis of health inequalities and into its determinants using logistic regression. According to the available literature, this is the first comprehensive and systematic analysis of inequality of health in Ethiopia. The findings show that compared to under-five years¿ children of mothers¿ partners¿ with no work, mothers¿ partners¿ in professional, technical and managerial occupations had 13 times more chance of under-five years¿ child survival for 2000 weighted observations. In addition, compared to infants of mothers who were gave birth to one child in last 5 years preceding the survey, infants of mothers who were gave birth to 2 children in last 5 years preceding the survey had 70% less chance of infant survival while infants of mothers who were gave birth to 3 or more children had 89% less chance of infant survival for 2000 weighted observations. Moreover, this study finding also indicates that inequalities increased significantly in the five years period between 2000 and 2005 among mothers with different birth interval. Most of the relations between birth interval and receiving childhood immunisation for vaccine-preventable diseases were statistically significant. Moreover compared to non-educated mothers, mothers who completed secondary and higher education were nearly 10 times more likely to receive DPT3 immunisation for their young children. This study concludes that policy measures that tackle health inequalities will have a positive impact in the implementation of health sector strategy of Ethiopia. Health inequalities studies in Ethiopia and Sub-Saharan Africa (SSA) countries should focus on systematic analysis of different socio-economic groups. The finding of this study support investing in the Ethiopia¿s health extension package (HEP) is a necessary but not sufficient condition for addressing rural poor health problem. HEP is successful in increasing primary health care coverage in rural Ethiopia to 89.6% (FMOH, 2009) but unable to reduce Ethiopia¿s higher level of IMR and U5MR. HEP is one of the success stories that address the rural poor health problem and can also be adapted to developing countries of SSA. The finding also shows that the success stories such as health insurance programs like Rwanda (World Bank, 2008a) and Ethiopia (FMOH, 2009/10) will play a key role in achieving country¿s health care financing goal of universal coverage. This can also be replicated in the developing SSA countries.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T12:30:27Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_SimoneBarbosaPereira.pdf: 1911161 bytes, checksum: 8274b42d34b16d295141ae46b63f2ed9 (MD5) / Made available in DSpace on 2018-08-22T12:30:27Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_SimoneBarbosaPereira.pdf: 1911161 bytes, checksum: 8274b42d34b16d295141ae46b63f2ed9 (MD5) Previous issue date: 2016-12-20 / Good practices in childbirth and birth care do not constitute a new theme. They have gained notoriety due to the excessive use of invasive technologies and a high number of cesarean sections, in which Brazil ranks first in the world scale. One of the drivers of these changes was the launch by the World Health Organization in 1985 of the document entitled "Appropriate technologies for childbirth and birth". This document has promoted the adoption of good practices in care delivery and birth, capable of breaking with traditional models of intervention at delivery and birth, through new methodologies and intervention technologies aimed at the humanization of childbirth. Based on this proposal, the present study aimed as its general objective: To implement the good practices of attention to childbirth and birth, recommended by the World Health Organization, in a medium-sized Hospital Obstetric Unit. As specific objectives, this study considered: Know the professionals' perception professionals of an obstetric hospital unit on the good practices of attention to childbirth and birth, recommended by the World Health Organization; and, Describe the construction and validation steps of a construct of good practices of attention to childbirth and birth, to be implemented in an Obstetric Unit of habitual risk. In order to meet the first specific objective, a qualitative research was carried out, using the focal group technique, with the participation of the multidisciplinary team of the Obstetric Unit of habitual risk, of a medium-sized institution, from April to June 2016. The second specific objective was taken from a methodological survey, carried out between August and October 2016, with the participation of 12 judges from the obstetric area, national level, between the first and second round Delphi. From the data resulting from the first specific objective and codified by content analysis, three thematic categories emerged: good practices and their meanings; from the biological character to the singular and multidimensional care; from the punctual and fragmented conception to the network of attention to childbirth and birth. It was concluded that good practices in childbirth care and birth, in addition to making it possible to rethink the obstetric model and contribute to the organization of the maternal and child health care network, stimulate the role of women in their multiple dimensions. In response to the second specific objective, was obtained, in the judges' analysis, a return of 12 instruments evaluated in the first round and seven instruments in the second round Delphi. In the first round, significant suggestions for changes were made in relation to the items of the dimensions of the construct, in which the judges presented convergences in relation to the mission, vision and values, but suggested changes in the item "assignments of each professional in the team". The construct was considered valid, both in content and appearance, and could contribute to subsidize good practices of attention to childbirth care and birth in local and national territory. It is concluded that, besides the governmental initiatives, it is necessary that the health professionals are responsible for and assume the good practices of attention to childbirth and birth as a possibility of transformation of the obstetric model. As a way of broadening the reflections and qualifying the good practices of attention to childbirth and birth at the Obstetric Unit, the origin institution of the principal researcher, she presented to the managers and multi professional team the validated construct, in days and at times previously scheduled. In addition, a graphical representation of the Construct of Good Practices of Attention to Childbirth and Birth, validated by the Judges of the obstetric area, was prepared, which will be exposed at the main entrance of the Obstetric Unit in question. / As boas práticas de atenção ao parto e ao nascimento não se constituem em temática nova. Elas ganharam notoriedade pelo uso excessivo das tecnologias invasivas e elevado número de cesarianas, nas quais o Brasil figura em primeiro lugar na escala mundial. Um dos propulsores dessas mudanças foi o lançamento, pela Organização Mundial da Saúde, no ano de 1985, do documento “Tecnologias apropriadas para o Parto e Nascimento”. Este documento impulsionou a adoção de boas práticas na atenção ao parto e ao nascimento, capazes de romper com modelos tradicionais de intervenção ao parto e ao nascimento, por meio de novas metodologias e tecnologias de intervenção voltadas para a humanização do parto. Com base nesta aposta, o presente estudo teve como objetivo geral: Implementar as boas práticas de atenção ao parto e ao nascimento, preconizadas pela Organização Mundial da Saúde, em uma Unidade Obstétrica Hospitalar de médio porte. Como objetivos específicos este estudo considerou: Conhecer a percepção dos profissionais de saúde de uma unidade hospitalar obstétrica sobre as boas práticas de atenção ao parto e ao nascimento, preconizadas pela Organização Mundial da Saúde; e, Descrever as etapas de construção e de validação de um construto de boas práticas de atenção ao parto e ao nascimento, a ser implementado em uma Unidade Obstétrica de risco habitual. Para atender ao primeiro objetivo específico foi realizada uma pesquisa qualitativa, por meio da técnica de grupo focal, com a participação da equipe multiprofissional da Unidade Obstétrica de risco habitual, de uma instituição de médio porte, no período de abril a junho de 2016. O segundo objetivo específico foi atendido a partir de uma pesquisa metodológica, realizada entre os meses de agosto e outubro de 2016, com a participação de 12 juízes da área obstétrica, de âmbito nacional, entre a primeira e a segunda rodada Delphi. Dos dados resultantes do primeiro objetivo específico e codificados pela análise de conteúdo resultaram três categorias temáticas: boas práticas e seus significados; do caráter biológico ao cuidado singular e multidimensional; da concepção pontual e fragmentada à rede de atenção ao parto e ao nascimento. Concluiu-se que as boas práticas de atenção ao parto e ao nascimento, além de possibilitarem o repensar do modelo obstétrico e contribuírem na organização da rede de atenção à saúde materno infantil, estimulam o protagonismo da mulher em suas múltiplas dimensões. Em resposta ao segundo objetivo específico obteve-se, na análise dos juízes, um retorno de 12 instrumentos avaliados na primeira rodada e sete instrumentos, na segunda rodada Delphi. Na primeira rodada foram realizadas sugestões significativas de mudanças em relação aos itens das dimensões do construto, nos quais os juízes apresentaram convergências em relação à missão, à visão e aos valores, mas, sugeriram mudanças no item “atribuições de cada profissional na equipe”. O construto foi considerado válido, tanto em conteúdo quanto em aparência, e poderá contribuir para subsidiar as boas práticas de atenção ao parto e ao nascimento em âmbito local e em território nacional. Considera-se que, para além das iniciativas governamentais, é preciso que os profissionais de saúde se corresponsabilizem e assumam as boas práticas de atenção ao parto e ao nascimento como possibilidade de transformação do modelo obstétrico. Como forma de ampliar as reflexões e qualificar as boas práticas de atenção ao parto e ao nascimento na Unidade Obstétrica, instituição de origem da pesquisadora principal, a mesma apresentou para os dirigentes e equipe multiprofissional o construto validado, em dias e horários previamente agendados. Salienta-se, enfim, que foi confeccionada uma representação gráfica do Construto de Boas Práticas de Atenção ao Parto e ao Nascimento, validado pelos Juízes da área obstétrica, o qual ficará exposto na entrada principal da Unidade Obstétrica em questão.

The study was conducted to describe how socio-economic characteristics (SEC) of women affect their utilization of maternal healthcare services in Abuja Municipal Areas Council (AMAC) in Abuja Nigeria. A non-experimental, facility-based cross-sectional survey was done. Data was collected using structured interviewer administered questionnaire in 5 district hospitals in AMAC. Sample size of 384 was calculated a priori based on the assumption that 50% of the target population utilized maternal healthcare services during their last pregnancy. Equal allocation of samples per facility was done. The ANC register was used as the sampling frame and proportionate allocation of samples per clinic days was undertaken in each facility. Data analysis included descriptive statistics, cross tabulations and measures of inequality. Logistic regression analysis was used to test the hypothesized relationship between socioeconomic characteristics (predictors) and maternal healthcare service utilization. Other than birth order that showed consistent effect, the results of this study indicated that the predictive effect (predisposing and enabling factors) of the SEC of women included in this study (age, education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilization were not consistent when considered independently (bivariate analysis) as opposed to when considered together through logistic regression. In addition, the study revealed that there was inequality in the utilization of maternal healthcare services (ante-natal care - ANC, delivery care and post natal care - PNC, and contraceptive services) among women with different SEC, and the payment system for maternal healthcare services was regressive. Addressing these predictors in the natural co-existing state (as indicated by the logistic regression) is essential for equitable access and utilization of healthcare during pregnancy, delivery and the postnatal period, and for contraceptive services in AMAC, Abuja Nigeria. Targeted policy measures and programme actions guided by these findings are recommended to optimise returns on investment towards achieving national and global goals on maternal health in Nigeria / Health Studies / D. Litt. et Phil. (Health Studies)

The study was conducted to describe how socio-economic characteristics (SEC) of women affect their utilization of maternal healthcare services in Abuja Municipal Areas Council (AMAC) in Abuja Nigeria. A non-experimental, facility-based cross-sectional survey was done. Data was collected using structured interviewer administered questionnaire in 5 district hospitals in AMAC. Sample size of 384 was calculated a priori based on the assumption that 50% of the target population utilized maternal healthcare services during their last pregnancy. Equal allocation of samples per facility was done. The ANC register was used as the sampling frame and proportionate allocation of samples per clinic days was undertaken in each facility. Data analysis included descriptive statistics, cross tabulations and measures of inequality. Logistic regression analysis was used to test the hypothesized relationship between socioeconomic characteristics (predictors) and maternal healthcare service utilization. Other than birth order that showed consistent effect, the results of this study indicated that the predictive effect (predisposing and enabling factors) of the SEC of women included in this study (age, education, birth order, location of residence, income group and coverage by health insurance) on maternal healthcare service utilization were not consistent when considered independently (bivariate analysis) as opposed to when considered together through logistic regression. In addition, the study revealed that there was inequality in the utilization of maternal healthcare services (ante-natal care - ANC, delivery care and post natal care - PNC, and contraceptive services) among women with different SEC, and the payment system for maternal healthcare services was regressive. Addressing these predictors in the natural co-existing state (as indicated by the logistic regression) is essential for equitable access and utilization of healthcare during pregnancy, delivery and the postnatal period, and for contraceptive services in AMAC, Abuja Nigeria. Targeted policy measures and programme actions guided by these findings are recommended to optimise returns on investment towards achieving national and global goals on maternal health in Nigeria / Health Studies / D. Litt. et Phil. (Health Studies)