Utilization of Post-Abortion Care Services in Three Regional States of Ethiopia

Background: In Ethiopia; utilization of post-abortion care service is minimal and it seems that the expanding services are underutilized. The purpose of this study was to assess factors which influence decisions for utilization of abortion related services at community level. Methodology: The study was carried out in six selected districts (woredas) within the three big regions of the country; namely Amhara; Oromiya and SNNPR. The study employed a descriptive cross-sectional design. Both quantitative and qualitative study techniques; including structured interview questionnaires; focus group discussions (FGDs); and in-depth interviews. The study population comprised randomly selected 1;492 women of reproductive age; service providers; and key informants of the sampled districts. Results: Majority of respondents said that they prefer public health facilities. According to the respondents; the reason why women do not visit health facility for PAC services include lack of community support; unavailability of services; services are expensive; facilities are distantly located and lack of means of transportation. From the multivariate analysis it appears that public health facilities are preferred by younger respondents; those with no education; those with no history of unwanted pregnancy and those with better income. The qualitative study indicated that women do not go to health facilities for PAC mainly because of inappropriate treatment by providers at the health facilities. Conclusion: Public health facilities especially health centers are the most preferred but there are barriers that should improve. Introduction of supportive supervision should be considered as a tool for improving quality of care. A mechanism should be in place to obtain community opinion regularly and use it to continuously improve services. To correct some misconceptions and improve community awareness on abortion related issues community providers; including reproductive health agents and health extension workers can teach about availability of services and about abortion related complications

Previous Utilization of Service does not Improve Timely Booking in Antenatal Care: Cross Sectional Study on Timing of Ababa

Background: Antenatal care is more beneficial in preventing adverse pregnancy outcomes when it is sought early in pregnancy. However; existing evidence from developing countries including Ethiopia indicate that few women seek antenatal care at early stage of their pregnancy. Objective: The objective of this study was to assess the timing of ANC booking and impact of previous antenatal care utilization on timing of first antenatal care booking in Addis Ababa governmental health institutions. Methods: A cross sectional study was conducted to collect data from 630 pregnant women who were attending antenatal care service at 10 governmental health centers in Addis Ababa from March 1 to 30; 2008. Results: Past experience on antenatal care service utilization did not come out as a predictor for timely booking of antenatal care (OR=1.40; 95CI: 0.91; 2.15). Multivariate analysis revealed that respondents who received advice on recommended time of booking; their pregnancy was planned and first pregnancy; were more likely to book timely compared to others (AOR=10.10; 95CI: 4.54; 22.40; AOR=1.87; 95CI:1.11; 3.23; (AOR= 1.86; 95CI: 1.01; 3.44) respectively. Conclusions: Past utilization of antenatal care service did not come as a predictor for timely booking of the service; provided that advice on timely booking is the main factor. In order to improve the situation; strengthening of focused antenatal care; availing of clear service delivery guidelines and training of service providers are important. [Ethiop. J. Health Dev. 2010;24(3):226-233]

Quality of Post-Abortion Care in Public Health Facilities in Ethiopia

Background: Comprehensive quality Post Abortion Care (PAC) is one of the important strategies to save lives where access to safe abortion is restricted by Law and services are inaccessible. Objective: The objective of the study was to assess the status of quality of PAC in health facilities of Amhara and Oromiya regional states. Methods: The study was cross-sectional by design and was conducted from November 2002 to March 2003. Patient interview; provider interview and direct service delivery observation were utilized to capture different aspects of care. Eleven health facilities (five in Oromiya and six in Amhara Regions); 103 post-abortion patients and 87 health service providers were included in the study. Results: although facilities were found to be prepared to manage abortion complications; some patients were delayed from receiving services because of require- ment to pay before getting services; and to buy drugs and supplies from other sources. Patient-provider interaction was generally satisfactory as viewed by the respondents. Majority (88.3) of patients felt that PAC services maintained confidentiality. Patients were not informed about the steps of each procedure. Nearly two-third of service providers informed the patients about the cause of their problem; but only 50.5of them told the outcome of treatment. Information provision regarding important precautions and warning signs was uniformly very low in all study facilities. Only 53.4of patients left the facilities counseled about family planning and 44.7with contraceptives. But; 84.5of women do not plan pregnancy within three months following the abortion. Great majority of the patients responded that they were satisfied with services they have obtained. Dissatisfaction included maltreatment by service providers; and inconvenient setup of service delivery. Patient assessment was principally based on last menstrual period and bimanual pelvic examination in most of the facilities. Service providers do not usually stick to infection prevention and universal precautions. Conclusion: the study has shown areas of improvement for better services to respond to various needs of the postabortion patients

Linkage between VCT and Reproductive Health Services (FP; ANC and delivery) in two Public Facilities of Rural Ethiopia

Background: Linking of related health services or delivering services in an integrated setup is an indispensable undertaking to optimize utilization of scarce resources in developing countries like Ethiopia. However; very related services such as HIV/AIDS and reproductive health are mostly delivered not in an integrated setup and a lot of missedopportunities are observed. Method: A cross-sectional study was conducted to describe the linkage between VCT and reproductive health services in two public health facilities of rural Ethiopia. A total of 405 women who were attending family planning (FP); antenatal and delivery care services were interviewed with structured questionnaire. Moreover; using qualitative technique; service provider interview and direct service delivery observation were conducted. Results: It was found that almost half of the women coming to attend ANC; delivery and family planning services have sufficient knowledge about VCT. Overall; 80have favorable attitude towards VCT. Family planning (FP) clients have less favorable attitude and less knowledge compared to ANC and delivery care attendees. Only 46.9of women reported that they were informed about VCT during their current visit. About 32.4of FP; 62.8of ANC were informed by providers about VCT (P0.001). Similarly; 22.4of FP; 57.9of ANC attendees were advised to get tested by the providers (P0.001). Majority of ANC attendees were referred to the VCT sites as compared to FP clients which were found to be due to the existence of formal referral between the ANC and VCT clinics for PMTCT services. Use of IE/BCC materials to disseminate messages in different service delivery sites was very limited. FP counse- ling and contraceptives are not provided at the VCT sites and there is no referral to FP clinics for those who may need the services. Conclusion: The study revealed weak linkage between VCT and FP which was mainly due to shortage of trained manpower; lack of time to counsel clients; negligence; absence of clear guidelines and referral system and lack of follow up and supervision. Therefore; orientation of providers; development of clear referral guideline and supportive supervision are recommended to minimize such missed opportunities