Utilization and factors associated with antenatal, delivery and postnatal Care Services in Tigray Region, Ethiopia: a community-based cross-sectional study.

BACKGROUND: This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. METHODS: A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May-June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. RESULTS: Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic media, and having 2-5 children were factors associated with an ANC 4+ visit. Whereas, partner involvement in ANC visit (AOR = 2.4, 95% of CI: 1.37, 4.35) and content of ANC discussed (AOR = 4.0, 95% of CI: 1.08, 14.93), having birth preparedness (AOR = 2.6, 95% of CI: 1.44, 4.97), residing within a distance of less than a 30-min walk to the nearest health facility (AOR = 2.0, 95% of CI: 1.16, 3.64), and having ANC 4+ visits (AOR = 2.4, 95% of CI: 1.39, 4.31) were the factors that were found to be associated with institutional delivery. As regards to PNC visits within 42 days of birth, age of 40-45 years, having 2-5 children, and ANC 4+ visits were found to be significant factors associated with it. CONCLUSION: The proportion of women who attended antenatal care and gave birth in a health facility was high. However, the proportion of women who attended antenatal and postnatal care was low. Residing in urban areas, having an electronic media, living near a health facility, having partner involvement in decision making, receiving appropriate ANC counseling, having birth preparedness, age of the woman, and number of children could potentially influence maternal health services utilization.

Factors associated with contraceptive use in Tigray, North Ethiopia.

BACKGROUND: Family planning interventions are cost-effective and have several cross-cutting benefits. Despite these benefits of family planning, progress in ensuring universal access to family planning to women in developing countries has been slow. In light of this; this study investigated the prevalence and factors associated with contraceptive use in Tigray Region, Northern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 1966 women of reproductive age group (15-49) in 13 districts (3 urban and 10 rural) from May-June 2015. Multistage sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the effect of independent variables on utilization of contraceptive use. RESULTS: Out of total 1966 women, 1879 (95.6%) have ever heard about family planning. Depo-Provera (depot medroxyprogesterone acetate, or DMPA) was the most popular contractive method as mentioned by 1757 (93.5%) of the participants. The overall contraceptive prevalence rate among all women was 623 (35.6%) while the contraceptive prevalence rate among married women was 543 (41.0%). Seven-in-ten women had ever used short acting contraceptive. In fact Depo-Provera was the most common type of contraceptive used as mentioned by 402 (64.5%) of the women. The odds of using family planning by married women living in urban areas was two times more than their counterparts (AOR = 2.0, 95% of CI: 1.33, 3.06). Similarly, the odds of using family planning among mothers with primary education was 1.3 times more as compared with no education (AOR = 1.3, 95% of CI: 1.02,1.93). However, as regards to long acting contraceptive methods, the odds of using long acting contraceptive methods use among married women in urban areas was 50% less when compared to rural married women (AOR = 0.5, 95% of CI: 0.3, 0.88). CONCLUSION: Contraceptive prevalence rate in Tigray region increased almost four fold in just 15 years. However, the increase is not yet enough to meet national and global targets. Further interventions are needed to narrow disparities in contraceptive use among different population groups and increase long acting contraceptive users. Moreover, improving quality of family planning in terms of the content of information provided to clients is crucial.

Undertaking cause-specific mortality measurement in an unregistered population: an example from Tigray Region, Ethiopia.

BACKGROUND: The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death) have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype. SAMPLING: Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected. IMPLEMENTATION: The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews. DISCUSSION: This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation.