Browsing by Author "Berhane, Yemane (PhD)"

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    Assessment of Barriers To Emergency Contraception Use Among Antenatal care Seekers of Addis Ababa Health Centers
    (Addis Abeba Universty, 2007-01) Dinku, Etalemahu; Berhane, Yemane (PhD)
    Background; - In Ethiopia where maternal mortality is one of the highest and induced abortion secondary to unwanted pregnancies contributing the highest proportion of maternal deaths using emergency contraception as a back up method can contribute to reduce unwanted pregnancy secondary to method failure, contraception non use and also rape. Objectives; -the study is designed to assess the knowledge and practice to emergency contraception & also barriers to its use among the antenatal care attendees of Addis Ababa health centers. Methodology;-cross sectional institution based descriptive study was conducted in ten health centers of Addis Ababa from September to October 2006. One health center from each ten sub cities of Addis Ababa were included in the study after selecting by simple random sampling technique from each sub city .By using systematic random sampling technique 636 Ante natal care attendees were interviewed with a response rate of 97.8%. Pretested and structured questionnaire was used to collect the data & the data entered to EPI6 and SPSS version 11 used for analysis. Result Of the 636 women included in the study 148(23.3%) of the women reported that the current pregnancy is mistimed, 90(14.2%) is unwanted and 60(9.4%) reported that they had induced abortion in the last two years. Of the study participants 65(10.2%) had ever heard of emergency contraception. Where as, only 12(1.9%) of the women had actually used emergency contraception. The preferred places for the provision of emergency contraception were public hospitals 331(52%), health centers 214(33.6%), private clinics 34(5.3%), &pharmacies 33(5.2%). Conclusion This study showed that the major barrier to the use of emergency contraception is lack of awareness of this contraceptive method & also there is demand for education and provision of emergency contraception methods.
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    Assessment of Factors influencing Utilization of Post abortion Care in Public Facility in Agaro Town Jimma Zone,Oromiya Regional State, Southwest Ethiopia
    (Addis Abeba Universty, 2006-06) Wube, Medhanit; Berhane, Yemane (PhD)
    Background-: Unsafe abortion is one of the five major causes of maternal mortality in Ethiopia. It is estimated that between 10 and 50% of the women who undergo unsafe abortions need medical care for complications. The use of post abortion care services is believed to low. Objective: The objective of this study is to determine factors associated with utilization of post abortion care service in public health facility in Agaro town administration, Jimma zone, Oromiya Regional State. Methods: - Across sectional comparative study is conducted from January to February 2006. Study subjects were women drawn childbearing age (15-49 years) in Agaro town. Women had history of abortion in the last 5 years were identified by household census. Sample of women were drawn from all Kebele proportional to population size. Relevant data were collected using face to face interviewing of women in their home Results: - Abortion was reported by 310 (17%) of those pregnant in the last five years. Maternal education and marital status were significantly associated with PAC service utilization in public facility. Women with at least read and write are more likely utilize post abortion care service in public facility compared to those illiterate.{(OR(95%CI)=3.55(1.2,9.75)} But the association is decreased as educational level increases. Married women are more likely to utilize post abortion care in public facility compared to those unmarried women {(OR(95%CI)= 2.21(1.08, 4.17)}.Women with induced abortion are less likely utilize post abortion care in public facility compared to those with spontaneous abortion {(OR(95%CI)=0.46(0.27,0.97)}. Women’s attitude to wards general and post abortion care in public health facility has shown significant difference between women utilized post abortion care in public facility compared to not utilized {(OR(95%CI)= 2.23 (1.15, 4.13) Vs 3.36 (1.77, 6.38)}. Conclusion: Socio-demographic factors such as education and marital status of women, stigma attached to induced abortion morbidity, poor attitude of women towards general and post abortion care in public facility are preventing women from utilizing PAC in public facility. Empowerment of women, improving health management system, training programs in order to sensitize health care providers about the context and realities of women who obtain unsafe abortions are recommended.
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    Assessment of Obstetric Needs in Emergency obstetric Services, Addis Ababa 2006
    (Addis Abeba Universty, 2007-07) Nadew, Mesrak; Berhane, Yemane (PhD)
    Introduction: Obstetric needs are health problems that necessitate EmOC services or interventions. The sum of incidence of pathologies (obstetric emergencies and complications) is taken as an indicator of obstetric need. The assessment of UON has never been articulated in studies conducted on EmOC in Ethiopia. This study identifies gaps and deficits in MOI for AMI in comparison to the existing need. Objective: To assess UON in Emergency Obstetric services in hospitals of Addis Ababa. Methodology: A Cross-sectional study was conducted from July-September 2006 on 625 mothers who delivered with Absolute Maternal Indication (AMI), Major Obstetric Intervention (MOI) and non-AMI in 19 hospitals of Addis Ababa 6 Public and 13 Private. The data collectors were Midwives working in the Obstetric units of the hospitals. They were trained on pre-tested structured formats. Data quality was ensured through continuous supervision. Results: A total of 666 MOI were conducted and Caesarean section took the largest share 531(80.5%). The C/S rate per 100 births was 5.3%. The number of women with AMI was 367 where majority had Obstructed Labour 145(39.5%) The number of MOI done without AMI was 354 where majority were done for previous C/S 143 (40.4%) and foetal distress 127(35.9%). The odds of C/S in Private hospital 1.77 (1.09, 2.90) and daytime admission 1.61 (1.01, 2.57) was significantly higher than in public hospitals and night time admissions. The results of the new born showed that 538(92.4%) were born alive and discharged alive. Some of the mothers 39(5.4%) had complication after delivery mainly sepsis and haemorrhage with 4 resulted in maternal deaths which occurred in public hospitals. The vi average hospital stay in days was 3.9 and 7.1 for private and public respectively where the difference of means was statistically significant (p=0.000). Nearly 9 out of 100 births which needed major obstetric intervention in Addis Ababa during the period of data collection (July17-September 17, 2006) did not receive it. In other words the deficit of MOI/AMI per 100 births is 9.46%. Conclusion: The UON in Addis Ababa was higher than urban figures of other countries that underwent the UON exercise. The rural situation is expected to be worse than the capital where better socioeconomic indicators and several health facilities exist. If purely preventive measures are out of favor, the move towards managing maternal health through a hospital network still seems in its infancy. Finally, this study should not remain one more theoretical study, but should pave a way for practical and effective decisions to be taken which will through advocacy and resource mobilization allow the country to move out of the poverty of the maternal health services. Words used: Unmet Obstetric Needs, Major Obstetric Intervention (MOI), Absolute Maternal Indication (AMI), non Absolute Maternal Indication (non AMI), Caesarean Section (C/S), Emergency Obstetric services.
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    Assessment of Quality of Voluntary HIV Counseling and Testing Services in Addis Ababa, Ethiopia
    (Addis Abeba Universty, 2006-07) Abraham, Dawit; Berhane, Yemane (PhD)
    Background: HIV testing and counseling are entry points to HIV-related care and prevention services, and provide opportunities for people to reduce their risk of acquiring or transmitting HIV. Very little has been done to assess the quality of VCT services in Addis Ababa. Objective: A cross sectional, facility based study was conducted in February 2006 to assess the quality of VCT services in Addis Ababa. Methodology: It used structured questionnaires adopted from standardized UNAIDS materials. The study involved 41 different VCT sites, 65 VCT counselors and 403 VCT clients for exit interview. Six clients per counselor for exit interview were selected systematically. Descriptive statistics were computed for most of the variables. A non parametric comparison was made for time variables among the three service provider sites. SPSS version 11.0 was used to enter, clean, and analyze the data. Results: Only 27 (69.2%) VCT sites provide follow up counseling for HIV positive individuals besides Pre- and Post-test counseling services. Twenty two VCT sites have a separate counseling room with adequate space. Out of 65 counselors, 61 (93.8%) were nurses and only 20 (30.8%) were self motivated to be one. In-service training was given for only 11(16.6%) counselors and only 24 (36.9%) attend counselors’ support group. Over 83% of the clients came self referred and 177 (43.9%) clients chose the specific VCT site because it was close to home. The median waiting time to see a counselor was longer in government sites and waiting time to get test results was longer in private VCT sites. Over 79% of the clients were generally satisfied by the service. Conclusions: Majority of the VCT sites in Addis Ababa fulfilled the minimum requirements recommended by the WHO. There seemed to be lack of ongoing counseling training and support for counselors. There was a high satisfaction viii rate by the clients. However, counseling session durations were found to be less than the recommended. Recommendations: The regional government should take measures to enhance quality VCT services within the already available sites and establish more free standing sites. A strong counselors’ support group should be formed and be able to enroll as many members as possible. Further studies should apply direct observation of counseling sessions.
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    A community based study of health Related problems among adolescents in Awassa Zuria Woreda, Southern Ethiopia
    (Addis Abeba Universty, 1995-05) Mengeste, Solomon; Berhane, Yemane (PhD)
    The prevalence and determinants of substance use (a lcohol, khat, cigarette), mental illness, s u icidal a t tempt, STDs and teenage pregnancy among adolescents aged 10-24 years have not been well documented in the country. A community based cross - sectional study was conducted in Awassa Zuria Woreda, southern Ethiopia from November to December 1994 G.C. A total of 1953 adolescents were included in the study . Data were collected using questionnaire by trained interviewers. The likelihood of substance (alcohol, Khat, Cigarette) use on average was at least two times higher (p<0.05) among adolescents who reported history of run away from their family and police arrest. Mental illness, suicidal attempt, STDs and teenage pregnancy were found to be more likely to occur among adolescents who use one or more of the substances than others. The older adolescents in general were found to be more likely to be exposed to all of the heal th related problems studied. Risk factors identified for substance use and association of substance use with the health related problems among adolescents were observed in this study. The level s and the interactions observed between the adolescent risk behaviours and hea lth related problems indicate the need to set an immediate intervention programmes .
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    Determinants and Causes of Adult Mortality in Butajira
    (Addis Abeba Universty, 2000-12) Lulu, Kidest; Berhane, Yemane (PhD)
    Information on adult mortality is essentially non-existent in Ethiopia as in the rest of subSaharan Africa. This nested case-control study was conducted with the aim of assessing sociodemographic and behavioural factors associated with adult death in Butajira, Ethiopia. All deaths in the age-group 15-49 years during 1995-99 were taken as cases and unmatched controls of age 15-49 years were selected randomly from the computerized demographic surveillance database. Data were collected by lay interviewers using a simpli fied verbal autopsy questionnaire. Crude and adjusted odds ratio with 95% confidence interval were calculated to determine associations. Causes of death were diagnosed using an "expert algorithm" programmed into a computer. A total of 515 deaths and 1507 controls were interviewed. The major determinants of mortality identified are age-groups 30-39 and 40-49 years (OR 2.99, 95%CI 1.91-4.71 and OR 4.01, 95%CI 2A9-6A6), male sex (OR 1 A6, 95%CI 1.09-1.95), living in a rural lowland area (OR 1.54, 95%CI 1.03-231), single marital status (OR 1.63, 95%CI 1.13-2.35), having no educated person in the family (OR 1.91 , 95%CI 1.11-3.29), being unemployed (OR 1 AO, 95%CI 1.01-1.82), and poor and very poor perceived economic status (OR 1.97, 95%CI IJ 1-2.94 and OR 2.98, 95%CI 173-5.13). The major causes of death observed were acute febri le illnesses (25.2%), liver diseases (11.3%), diarrhoeal diseases (11.1 %), tuberculosis (9.7%) and HIY/AIDS (7A%). Communicable diseases accounted for 60.8% of the deaths. The factors associated with mortality and the high level of mortality from communicable diseases reflect the poor socioeconomic development of the country and inadequate coverage VI as a whole in education, health and poverty allevi ation . Therefore, eff0I1s should be directed at planning and implementing cost-effective interventions to decrease morbidity and mortality particularly from communicable diseases. Emphasis needs to be given also to poverty alleviation programmes.
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    The effect of maternal work on the nutritional status of mothers and children
    (Addis Abeba Universty, 1999-07) Negussie, Samrawit; Berhane, Yemane (PhD)
    Maternal work has been seen to have two contradictory effect on child nutrition-via increasing income and decreasing time available in the household . The net effect will depend on the decision making pattern of the household and the adequacy and quality of child care substitute . A sample of 422 mothers and their children were selected In the rural town of Butajira through household survey to exami ne the effect of working for profit/gain on nutritional status of both the mother and children. Result showed that children of working mothers had a better nutritional status [OR(95%CI) 0 . 38 (0 . 19,0.76] however working mothers themselves were at a risk of being malnourished compared to non-working mothers (95%CI): 1. 62 (1. 05, 2 . 5). The decision making pattern and the child care substitute did not show any effect on the overall result . In the attempt to improve the nutri tional status of children the encouragement of maternal involvement in income generating activities is indispensable. Working mothers in the informal work needs to be considered in any nutritional intervention programme as they are likely to be at risk of being malnourished . v
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    Exposure assessment to indoor smoke pollution in rural Ethiopia
    (Addis Abeba Universty, 1999-12) Eshete, Berhanu; Berhane, Yemane (PhD)
    Very little effort has been made in Ethiopia to assess the effect of indoor air p8l1ution at a community level . The aim of the study was to assess exposure to indoor air pollution at a household level and fi nd out the feasibility of using questionnaire in determining exposure level for indoor air pollution . Cross sectional study design was utilized . Data were collected using structured questionnaire , in-depth interview with key informants and child movement recording . Data entry and analysis was done using Epi Info version 6 statistical software . A total of 600 households from the three study areas (rural high land , rural lowland and town)were assessed . Three hundred thirty four(55 . 7%)of the households had high exposure level to indoor smoke . Rural households were less likely to have adequate smoke clearance compared to urban households (OR~O . 3 ; 95% CI~O . 16 , 0 . 54) . Being muslem , married , Mother illiterate and and low economi c status were less likely to De in the low exposure status with adjusted OR(95%CI) of 2 . 24(1.39 , 3 . 54) , 0 . 41(0 . 18 , 0 . 82) , 0 . 36(0 . 2 , 0 . 66)and 0 . 34(0 . 22 , 0 . 54) , respectively . The main source of indoor smoke was biomass fuel used by 98 . 5% for cooking and 29 . 6% for heating . The majority (94 . 9%) were using open type of stove without flue or chimney . The median (SO) of e xposure time by the interview and observation was found to be 180(202) and 125(148) minutes , respecti vely . From this we conclude and recommend that biomass fuels are the principal sources fo r the indoor smoke , the poor socio-demographic and environmental factors expose children to indoor smoke and collecting information about exposure time of under five children using interview and observation methods has no statistically significant difference . Using cleaner fuels , improving social , economic , cultu r al and environmenta l conditions could i mprove the exposure level to indoor smoke . 1
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    Health Problems and Service Preference of School Adolescents in Addis Ababa With Emphasis on Reproductive Health
    (Addis Abeba Universty, 2000-12) Berhane, Frehiwot; Berhane, Yemane (PhD)
    A cross-sectional descriptive survey to assess adolescents health related problems and service utilization pattern and preferences was conducted from January to December 2000 in randomly selected school adolescents in Addis Ababa. Data were collected using an anonymous self-administered questionnaire. A total of 2647 high school students from 13 schools participated in the study. Of theses 1177(44.5%) were males and 1470(55.5%) were females. Five hundred fifty eight (21.9%) adolescent reported to be sexually active. Condom use during the last intercourse among the sexually active was 72.9%. Forty-four (7.9%) of the sexually active adolescents claimed to have had symptoms of STD in the past three months. Among the sexually active female, 32 (5 .7%) claimed to have been pregnant out of which 22 (68.8%) ended up in abortion. Overall 1045 (39.5%) of the students reported the use of at least one of the substa nces (alcohol, cigarette, kaht or cannabis); 1229(51.6%) had mental distress, and 284(10.9%) had attempted suicide in the past. Seven hundred eighty three (32. 3%),523(24.5%) and 610(25.9%) of the adolescents claimed that the existing reproductive health services are inaccessible, unaffordable or unacceptable respectively for adolescents. For 1852(72.0%) of the adolescents feeling of embarrassment at seeking reproductive health service was the reason for not utilizing existing service while 1738 (67.8%) claimed it was for fear of being seen by parents or others. The majority 1402 (57.0%) claimed that service fees are unaffordable for adolescents. Five hundred fifty two (21.6%) preferred to have ARHS with in the existing system but with special approch to adolescents by service providers, while 1070(41 .9%) in separate setting outside of the existing service including youth centers. It was concluded that adolescents have specific health problems, risk taking and care seeking behavior that have not been well addressed by the existing health services. Hence recommended that organizing youth friendly RHS be given an urgent attention by decision makers, public health planners and health care providers at all levels. VI I
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    Infertility in Rural Ethiopia
    (Addis Abeba Universty, 1999-12) Hailemariam, Ashenafi; Berhane, Yemane (PhD)
    Infertili ty is a ",.:arld- wide problem affecting 8- 12 % of married couples. The prevalence of infertility i n some areas of the s u b- Sahara region reaches as high as 30%. Muc h of the literature on i nfertility deals with the problems of infertility for women i n the western countries and little is known as to what puts women in sub- Sahara Africa vulnerable to infertility and as to how perceive t he causes of i nfertility. A cross- sectional s urvey was cond ucted i n r ural Butajira, Ethiopia , i n t he period between t he 1 3 th of May a nd 23'" of June , 1 999 t o determi ne the magnitude a nd potential r i sk factors of i nfertili ty. A total of 901 women in t he age gro up 20 to 29 years were enrol led into the study from surveil lance register. The prevalence of primary a nd secondary i nferti l ity was 2. 9~ and 16 .1 % respectively . Comparison was made between cases of secondary infertility and fertile women about potential risk factors. Pregnancy wastage, age at first marriage lenD than 16 years, STDs occ urring after the last pregnancy, polygamous marriage, a nd low level education of t he husba nds were fo und significa ntly associated with secondary i nfert ility . Most women with the problem of infertility i n t he area visit t he witc h-craft , more often t han the health institutions. It is recommended t hat public health officials must i ncrease t he access to and strengthe n programs aiming at t he reduction of post- partum a nd post- abortal i nfections a nd STDs . Due attention should be given for developing and implementing protocols for evaluating and managing infertility .
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    Pregnancy Outcome in Rural Ethiopia With Emphasis to Perinatal Mortality
    (Addis Abeba Universty, 1997-12) Wolde-Michael, Kifle; Berhane, Yemane (PhD)
    A prospective community-based study of pregnant women was conducted to assess pregnancy outcome with emphasis to perinatal mortal ity in rural communities of Meskan and Mareko district in Gurage zone in Southern Eth iop ia, between March 22 and August 2 1, 1997. Pregnant women were identified by trained enumerators through house - to - house visit and were followed month Iy till del ivery, after wh ich both the neonates and the mothers were visited at 7th and 28th days. Pretes ted standard questionnaires were used to obtain information on socio-demograph ic characteristics, past obstetric history, health problems during the index pregnancy and labour, and the condition of both the neonates and the mothers at the 7th and 28th days. Analysis made on 428 singleton births showed a perinatal mortality rate of 44.4 per 1000 births. The stillbirth and early neonatal mortality rates were 21.0 per 1000 births and 23.9 per 1000 live births, respectively. The rates were found to be relatively low as compared to figures reported for other sub- Saharan Africa. Both bivariate and multivariate analysis showed that maternal height and gestational age were significantly associated with perinatal ~ - -- mortality. The risk of death was signif icantly higher among neonates born to short statured mothers. Similarly the risk of perinatal death was higher in preterm babies than term babies. Establishment of emergency obstetric care (EOC) alongside with training of traditional birth attendants and educating mothers for appropriate utilization of MCH services are recommended.
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    Quality of Reproductive Health Services With Emphasis on Structural Aspects in South Central Ethiopia
    (Addis Abeba University, 1998-12) Wako, Getachew; Berhane, Yemane (PhD)
    Health care services in developing countries are reported to suffer from low quality. A descriptive cross-sectional study was conducted lO assess the quality of reproductive health care, with empbasis on the structural as aspects in two administrative zones in south central Ethiopia. Of the 79 health institut ions in tile study area, 74 were visited for a response rate of 94 %. Data were collected using a queStionnaire adopted from the WHO Safe Motherhood Need Assessmem and dl~ WHO training modules for EPI and STDs. Multip le stlu"tural defi ciencies were identitied in all components of reproductive healtl1 care. Absolute minimum equipmelll for maternity and ll-e:onatal care were found to be complete and adequate in 20(27 %) and 3(4.1 %) of the institu tions, respectively. Consumable snpplies were available adequately in 13( 17.6%), sterili zer in 13(17.6%). essemi al drugs in 16 (2 1.6 %), ergometrine injection in 49 (66.2 %). and alcohol in 22 (29.7 %) of the institutions. In the EPI sec tion, steam sterilizer was available in 45(60.8 %), and adequate vaccines in 57 (77 .0%) ohhe institut ions. Only 1(1.4%) health institution had a complete mix of comraceptives. Impr,rtatlt laboratory tes ts(syphilis test, hemoglobinometer, urine analys is) were available fully in on1)' one (1.4%) health institution. Only 9(11. 1 %) health it15tito tions had adequate IEC materials ,on aLi reproductive health components. More dIan hal f [44(59.4 % ) 1 of dIe health insti tutions had no water source in their compound . Only 8( I 0.8 %) were found to Itave a te lephone or two-way radio. A thi rd, 25(33.8%), of the health institutions had no means of transport It is concluded liar the .5tructurai setting for reproductive health servi;:.:es is very poor iu the maj ority of the health i:asti i.i.HioIlS. Recommendations include that besides cOllsuucting new beaJdl institutions, !'tl"Ong emphasis .sbould be given 011 revitalizing tbe ex isting health ilL')titutioilS by ronecting structural defidencies \I,ri rl!oul delay .
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    The Role of Families and Communities in HIV/AIDS Prevention and Control
    (Addis Abeba Universty, 2004-04) Hailemichael, Aynalem; Berhane, Yemane (PhD)
    HIV/AIDS has seriously affected the well-being of adolescents in Ethiopia and has posed serious concern for their parents. However, parental and community involvement in HIV prevention and control activities has been limited due to top-down approach adapted in the program. To assess the role of families and communities in the prevention and control of HIV/AIDS among adolescents. A cross sectional community based study was conducted in Jimma town from January to February 2004 using a mixture of quantitative and qualitative research methods. A total of 602 parents were randomly included in the study. Majority of parents agreed to most of the questions used to assess the risk reduction potentials but only 121(48.4%) fathers and 149(42.6%) mothers agreed with regard to the role of parents in the promotion of condoms use among sexuality active young adults. On the other hand the responses of the study subjects were below 50% for most of the vulnerability and impact reduction potential questions. Education and family income were found to be determinant factors for the perceived risk, vulnerability and impact reduction potential (p <0.05). Four hundred and sixty two (76%) and 358(59.6%) of parents reported that they made discussion about HIV/AIDS and sexuality with their children respectively. Yet only 130(21.7%) of the parents reported that they had ever advice the use of condoms to their sexually active children. Scope of knowledge of modes of transmission and means of prevention of HIV/AIDS is still worrying. This study identified the presence of major misconceptions pertaining condom use. CBOs showed an encouraging commitment in participating in the HIV/AIDS prevention activities. They also have showed a sense of program ownership and believed that they can serve as a link between the policy makers and the community. Parents and community members are aware of their potentials contributions and are willing to actively participate in HIV/AIDS prevention and control activities. Therefore, parents and communities have to be given a chance to participate in HIV/AIDS prevention and control activities as they are at the front in bearing its burden. Key words: family ,CBOs and HIV/AIDS prevention
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    Treatment initiation and Compliance among TB patients in Addis Ababa
    (Addis Abeba Universty, 1997-12) Tadesse, Michael; Berhane, Yemane (PhD)
    A hospital based descriptive and longitudinal study with internal comparIson was carried out to describe the treatment initiation pattern and compliance rate among tuberculosis patients . All government health center providing tuberculosis treatment were part of the study, patients were interviewed by nurses in health center. The study was carried out in Addis Ababa between May 9 1997 to September 25 1997. A total of 765 newly diagnosed tuberculosis patients were enrolled in the study. The median time from the onset of the illness until the initial medical consultation was 2 months (patient's delay). This delay was longer in uneducated patients. Fifty percent of patients were put on treatment with correct diagnosis within 10 days of first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and mean number of consultations before diagnosis was two . Patients who first visited private clinic had shorter doctor's delay than those who first saw government health institutions. The median total delay was three months at the time of treatment initiation. Overall patients compliance during the intensive phase of DOTS was 97 %. The study concluded that the public should be educated about the early symptoms of tuberculosis and the need to seek early medical attention particularly, those with little or no formal education.
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    What Factors Determine Delivery Practices of Pregnant Women?
    (Addis Abeba Universty, 2005-05) Ayele, Binyam; Berhane, Yemane (PhD)
    Background:- Ensuring a skilled delivery attendant at each child birth is the most critical intervention in reducing maternal and neonatal mortality and morbidity. In Ethiopia the proportions of births attended by skilled personnel is very low and even for women who have access to the services. The proportion of birth occurring in health facilities is very low. Objective:- This study aims at identifying the factors that influence intention of pregnant women for their delivery and the factors that determine actual delivery service utilizations. Methods:- A prospective community based follow up study is conducted in Jimma town. Women in their child trimester were identified by a complete household survey. Subsequently relevant data were collected in two separated household survey. Results:- A total of 207 women were included in the study. Maternal age and educational status are significantly associated with place of delivery. Woman between 35-39 are less likely to deliver in HFs when compared to those between 15-39 ( OR = 0.06 and 95% CI=0.01 to 0.52) and those with formal education are more likely to deliver in HFs(OR=2.82 and 95%CI1.09 to 7.23). Women who attended ANC follow up ( OR = 2.63 and 95%CI= 1.11 to 6.23) women to whom their husbands and relatives prefer SDA ( OR = 4.78 and 95% CI=2.25 to 10.21) and those who can decide by themselves about getting ID services ( OR = 2.75 and 95 % CI = 1.3 to 5.78) are more likely to deliver in HFs. vii Conclusions:- Empowering disadvantaged women. Promoting ANC follow up and improving the information provision during the follow up. Interventions targeted at husbands and other relatives to direct their influence in favorable fashion and reaching out more women to provide relevant information about ID services are recommended