Determinants of Conventional Health Services Utilization Among Pastoralists in Afar Region, Northeast Ethiopia
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Date
2005-05
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Addis Ababa University
Abstract
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).
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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
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Keywords
Health Services