Browsing by Author "Dubale, Tewodros"

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    Determinants of Conventional Health Services Utilization Among Pastoralists in Afar Region, Northeast Ethiopia
    (Addis Ababa University, 2005-05) Dubale, Tewodros; Haile Mariam, Damen(PhD)
    Sub-Saharan African countries faced with different economic, social, political, organizational and management problems they are looking for different strategies and alternative resources for health service for the last decades. In our country the devastating health condition among pastoralists obliged us to have epidemiological evidence based information with holistic approach for informed decision making. This study was conducted with intention of weighing up and comparing the determinants of health services utilization and to develop health service utilization model for settled and mobile Afar pastoralists from August 2004 to March 2005. Different methodological approaches were used. Two independent case control studies were conducted after a survey. One on 276 mobile sub-community study subjects, of which 136 modern health utilizers and 140 non-utilizers and another on 262 settled sub-community study subjects, with 137 utilizers and 125 non-utilizers. These were triangulated with qualitative analysis (six steps of grounded theory) finding of five focus group discussions and supplemented with one year health care utilization assessment of outpatient and inpatient statistics of health facilities in Zone One of the Region. Data were collected with structured questionnaire, which fit the variables in the modified Andersen’s behavioural model and analyzed in SPSS V.10, with bivariate and multivariate logistic regression analysis of variables for the suggested model and backward step modeling of statistically significant factors for construction of the final models. The wide-ranging health facility based study shows distance decay degradation, great discrepancy of utilization rate between town, settled and mobile pastoralist community kebeles with ratio of 227: 39: 1, very low trained health workers to population ratio (1 physician for 110,584 populations). vi In the survey, mobility pattern was found to be statistically significant major determinant factor between mobile and settled communities with P value <0.01 and adjusted OR= 1.377 with 95%CI (1.138,1.667). With the case-control studies in the final analysis of stepwise logistic regression after adjusting the effects for all other variables with P value <0.05 at 95%CI with adjusted analysis for the mobile community family relation (for Daughter/son with (OR=2.425(1.032, 5.697), economic reason (OR= .263(.070, .996)), community (OR=50.254 (4.091, 617.346) and family (OR= 84.823 (8.969, 802.213)) as source of advice for decision become statistically significant. For the settled community, nearness or access (OR= 2.706(1.245, 5.882), and disability days before treatment (OR= 2.004(1.134, 3.540) become statistically significant. In the overall pastoralist community economic reason (OR= .432(.202, .922), mobility (OR= .242(.105, .557), family (OR= 5.841(2.986, 11.426)) and community leader (OR=6.545(2.278, 18.807) as source of advice for decision become statistically significant. After triangulating the quantitative findings with the qualitative study, mobility pattern, consultative decision making culture of the local kinship leaders, the communal way of contributing for health care service cost and "Daggu" traditional man-to-man communication, as new additive factors to the behavioural model particular from the pastoralists’ holistic view. These objective findings will supplement in the design of the health service of the area in the extension package and grounded hypothesis will give basic theories on health seeking behaviour in pastoralist context