Maternal deaths in Ethiopia are mainly due to complications of pregnancy and delivery. The socio-cultural contexts under which these pregnancies and deliveries occur that pave the way for these complications and mortality. In Ethiopia, the maternal mortality ratio had been 353/100,000 live births in 2015. Therefore, the purposes of this study were to examine, and describe the socio-cultural determinants and missed opportunities of maternal health care in Eastern Ethiopia. The study was conducted in selected districts of Grawa, Chelenko and Haramaya Woreda, East Hararghe, Oromia National Regional State, Ethiopia. A community-based survey involving pregnant women in their third trimester and women who gave birth in the last five years, husbands, mothers-in-law, sisters-in-law, health workers, religious and community leaders were conducted between September up to December 2017. A systematic sampling technique was used to get a total of 422 study participants for quantitative and 24 FGD participants to qualitative study were adopted using triangulation of data collection. Pre-tested and structured questionnaire was used to collect relevant data. The main instrument used for quantitative data collection was the structured questionnaire, specifically in-depth interview methods. Bivariate and Multivariate data analysis were performed using SPSS version 25.0 and focus group discussion (FGD) was used to collect qualitative information and the information was analysed using thematic analysis method based on Atlas.ti version 8.2 statistical software packages. The study revealed that among 359 (85%) pregnant women who planned for ANC visit, 16 (4.5%) received ANC four or more times during their last pregnancies, the respondents (81.3%) claimed that they were taken care of by skilled delivery attendant during delivery, 18.5% of them said that they delivered at home and 71.1% of them received medical care after delivery (missed opportunity). Women in the age group 15-24 years [AOR: 1.18, 95%CI: 1.18 (0.37, 3.74)], primary school [AOR: 4.09, 95%CI: 4.09(0.96, 15.50)], women intended their last pregnancy [AOR: 3.1, 95% CI: 0.32(0.11, 0.94)], and women living in urban residences [AOR: 1.2, 95%CI: 0.86(0.25, 2.95)] were significant predictors of unplanned home delivery. For optimal and effective interventions of maternal health services utilization, provisions should be made for better women‘s education, family planning, community-based health insurance, health facilities access, job opportunity and women empowerment; provisions should also be made for creating income generating activities to women. Strengthening village women‘s army wing, refreshing and enabling health extension workers and traditional birth attendants. What is more, optimal measures should be taken to discourage traditional practices such as female genital mutilation, polygamy, violence against women and teenage marriage. Finally, free maternal and child health services should be advocated for so that the gap in maternal healthcare services is bridged. / 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)

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

PURPOSE: The main aim of this study was to systematically assess the factors that influence maternal health care services utilization by women in Awash Fentale woreda (district), Ethiopia. DESIGN: A quantitative, descriptive, and cross-sectional design was selected as the methodology for this study. METHOD: Data were collected using a structured questionnaire administered to 422 women aged 15 to 49 years through a stratified sampling technique. Data was entered, analyzed and interpreted using SPSS computer program. Binary logistic regression model was used to identify the factors that influence maternal health care services utilization. RESULTS: The findings of this research indicated that not attending school, not watching television, and not owning a Bajaj (three-tire motorbike) significantly influenced low utilization of antenatal care (ANC) visits, while exposure to media, including reading newspapers, was positively associated with the adequacy of ANC visits. Similarly, factors such as not attending school and not watching television at all influenced delivery care (DC) services utilization negatively, while husbands’ low income and not watching television at all were negatively associated with postnatal care (PNC) service utilization. This research study found that 80 (19%) of the respondents preferred to give birth at home and the remaining 342 (81%) preferred a health facility for their delivery services. In addition, 43% of the respondents were not satisfied with the care and attention given by the health care provider and approximately 52% of the respondents were not satisfied with the cleanliness of the health facilities. It was also illustrated in this study that family members’ influence was one of the major barriers identified for DC services utilization. Conclusion: Policy making, planning, and implementation should focus on factors that influence maternal health care services utilization and barriers to DC services. In order to increase the utilization of maternal health care services by women with low levels of educational status, husbands ’low income or wealth quintile, and low media exposure, strategies were developed by the researcher. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

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)

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)

This study aimed to assess the magnitude, trends and determinants of intrapartum stillbirths in the public health facilities in Addis Ababa. A case-control study design was used along with quantitative data collection methods. Obstetric care data on key variables were collected from medical records of 728 cases and 1551 controls in the public health facilities during July 1, 2010 and June 30, 2015. Data were analysed using SPSS version 24 to determine associations and risk factors against intrapartum stillbirth. HMIS data from different sources were further analysed for the same period to determine trends of stillbirth in the public health facilities of Addis Ababa. Findings from this study showed a staggering high prevalence of stillbirth at an average rate of 28 per 1000 births during the period 2010-2015. This figure was comparable with the population level prevalence of prenatal death in Addis Ababa which was 30 per 1000 birth (Central Statistical Agency 2011:115). No statistically significant associations were revealed against the effects of maternal medical conditions including diabetes, hypertension, cardiac and renal diseases and key socio-demographic variables including age, parity and marital status, and intrapartum stillbirth. On the contrary, HIV and syphilis infections, foetal presentations, multiple pregnancy and the frequency of ANC visits during the index pregnancy had statistically significant associations with intrapartum stillbirth. Furthermore, low FHR, non-vertex foetal presentations and ruptured cervical membrane on admission to labour were among risk factors for intrapartum stillbirth. Similarly, women in the stillbirth group received substandard care regarding the timely assessment of foetal decent, cervical dilatation, labour induction, and episiotomy care compared to women in the livebirth group. Obstetrical complications including obstructed labour, eclampsia and preeclampsia were more common among women in the intrapartum stillbirth group indicating that the above variables were key determinant of intrapartum stillbirth. These findings suggest that poor quality of obstetric care during labour and childbirth were the underlying risk factors for intrapartum stillbirth. In conclusion, strategies to overhaul the obstetric care practices in the public health facilities through skills building, accurate use of labour monitoring tools, close supervisions, accurate classification of stillbirth, proper documentation, and ongoing research efforts. / Health Studies / D. Litt. et Phil. (Health Studies)

This study aimed to identify factors affecting women’s utilisation of the prevention of mother-to-child transmission (PMTCT) of HIV, evaluate the quality of PMTCT services, describe health outcomes of mothers and infants and to identify factors that influence mother-to-child transmission (MTCT) of HIV. Structured interviews were conducted with 384 women who had utilised PMTCT services. Information was also obtained from the health records of these women and of their infants. Better educated women, who had male partners and were self-employed were more likely to use PMTCT services. Being unmarried, poor and feeling stigmatised made it difficult for women to use these services. Respondents were satisfied with PMTCT services except that clinics sometimes had no medications. The health care workers followed the Ethiopian guidelines during HIV testing and counseling but not when prescribing treatment. Although the respondents’ CD4 cell counts improved, their clinical conditions did not improve. The MTCT rate was significantly higher if infants did not receive ARVs, had APGAR scores below seven, weighed less than 2.5kg at birth, were born prematurely, and if their mothers had nipple fissures. PMTCT services could be improved if more women used these services, health care workers followed the national guidelines when prescribing ARVs, clinics had adequate supplies of medicines, all infants received ARVs, and mothers’ nipple fissures could be prevented. Antenatal care should help to avoid premature births of infants weighing less than 2.5kg and having APGAR scores below 7. Future research should compare formula feeding versus breastfeeding of infants with HIV-positive mothers / Health Studies / D. Litt. et Phil. (Health Studies)