Browsing by Author "Tigist Shumet"

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    Inequalities in maternal and child health service utilization and health related quality of life in four emerging regions of Ethiopia: Implications for fertility and child survival
    (Addis Ababa University, 2024-03) Tigist Shumet; Negatu Regassa (PhD)
    Background: According to the 2021 UN Sustainable Development Report, Ethiopia ranks 136 out of 165 countries in terms of performance of the SDG 3.2, with a statistical performance index of 53.6 in a scale of 0 (Worst) to 100 (best). The 2016 Ethiopian Demographic and Health Survey (2016 EDHS) shows an increase in the coverage of maternal health services that includes antenatal care (ANC), delivery care, and postnatal care for the mother. However, such improvements are accompanied by a substantial increase in geographic and social inequalities in the utilization of the services. The inequalities are visible and unacceptably high between geographically bordering emerging regions of Ethiopia (Afar, Somali, Gambela and Benishangul) and other regions of the country. Therefore, this study aimed to examine the levels of inequalities in key maternal and child health service utilization in four emerging regions of Ethiopia: namely Afar, Somali, Benishangul Gumuz, and Gambela Regions, and its implications for fertility and child survival. Methods: This study used data extracted from the 2016 Ethiopian Demographic and Health Survey, which was collected at the national level from January 18, 2016, to June 27, 2016, using a stratified twostage cluster sampling method. The study focused on women aged 15-49 years living in those emerging regions of Ethiopia: However, in addressing the fourth objective of the study, a scoping review and qualitative primary data were collected from the two emerging regions of Ethiopia (i.e., Afar and Somali regions). This research had six objectives, and except for the 4th objective of this study, the remaining used univariate analysis to describe the characteristics of the women included in this study. The study used various analysis techniques that matched its specific objectives, based on the relevant literature. For the quantitative data, multivariate mixed effect logistic regression, Blinder-Oaxaca decomposition, partial ecological approach, and Population Attributable Fraction (PAF) were used to examine the associations, inequalities, predictors, and impacts of maternal health service utilization in Ethiopia. For the qualitative data, thematic analysis was conducted to explore experiences and practice of women and health workers regarding barriers in contraceptive utilization. Results: This study found that women living in rural areas had a lower quality of life than those who are living in urban areas. Two socioeconomic factors, wealth index and educational attainment, explained a larger part of this inequality. The study also showed that there was a huge inequality in the demand and unmet need for contraception among women of age 15 to 49 years in the four regions. Several factors, such as women‘s and husband‘s education status, household wealth index, age of husband, husband‘s working status, region, and residence, were important predictors of the demand for contraception and xviii unmet needs for contraception. The study revealed that there were significant urban-rural inequalities in the utilization of maternal health care services, such as antenatal care (ANC), place of delivery, and postnatal care (PNC), in the four regions. The study demonstrated that key maternal health services, such as place of delivery and current contraceptive use, and socioeconomic factors, such as religion, type of place of residence, and wealth index, influenced the inequalities in fertility preference among high-parity women in the four regions. In addition, the study also indicated that Current contraceptive use and place of delivery accounted for 117% of the conventional risk factors for fertility preference in those emerging regions. Finally, the study also indicated that ANC and place of delivery accounted for 49% of the conventional risk factors for child survival in those emerging regions. Conclusion: The study examined the inequalities in MCH service utilization and HRQoL in four emerging regions of Ethiopia, and their effects on fertility and child survival. The study found significant urban-rural and socioeconomic inequalities in the quality of life, demand and unmet need for contraception, maternal health care services, fertility preference, and child survival among women and children in the four regions. The key factors that influenced these inequalities and outcomes were wealth index, education level, region, residence, religion, husband‘s working status, age of husband, ANC utilization, place of delivery, and current contraceptive use. The study also identified key maternal health services, such as place of delivery and current contraceptive use that accounted for half of the conventional risk factors that raised women‘s fertility preferences and reduced child survival in the study population. Recommendation: The study recommends that policymakers, stockholders, and researchers consider the following. Policymakers and local administrators should pay more attention to interventions that promote education and reduce the wealth gap among households in emerging regions of Ethiopia. Additionally, the government should enhance access to maternal health services, improve and reinforce existing fertility control programs and strategies, and advocate the benefits of using maternal health services in those regions. This would decrease inequalities in the use of key maternal health services and their impact on fertility and child survival in these four emerging regions. Finally, the study suggests that the government should prioritize improving service access and utilization by providing more budget and other resources to the respective disadvantaged regions and this will also help the desired decrease for existing inequalities. For future research, researchers may need to consider adopting a longitudinal design to track changes. They should also include other relevant variables that were omitted from this study, such as husband‘s perception, attitude, and influence on contraception use and unmet need, availability of service, and distance to the health facility.