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).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). 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. In the study, 79.8% and 248 (71.5%) of the women who delivered within 12 months prior to this study received ANC and skilled birth attendance respectively from SBA. Fifty five (15.8%) mothers and 131 (38%) babies received Postnatal care from SBA with in 45 days after delivery. 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. 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- ervice 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)

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)