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Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, southern Ethiopia.

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Kea, Aschenaki Z, Tulloch, Olivia, Datiko, Daniel, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X and Kok, Maryse C (2018) 'Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, southern Ethiopia.'. BMC Pregnancy and Childbirth, Vol 18, Issue 1, p. 96.

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Abstract

In 2015 the maternal mortality ratio for Ethiopia was 353 per 100,000 live births. Large numbers of women do not use maternal health services. This study aimed to identify factors influencing the use of maternal health services at the primary health care unit (PHCU) level in rural communities in Sidama zone, south Ethiopia in order to design quality improvement interventions. We conducted a qualitative study in six woredas in 2013: 14 focus group discussions (FGDs) and 44 in-depth interviews with purposefully selected community members (women, male, traditional birth attendants, local kebele administrators), health professionals and health extension workers (HEWs) at PHCUs. We digitally recorded, transcribed and thematically analysed the interviews and FGDs using Nvivo. The 'three delay model' informed the analytical process and discussion of barriers to the use of maternal health services. Lack of knowledge on danger signs and benefits of maternal health services; cultural and traditional beliefs; trust in TBAs; lack of decision making power of women, previous negative experiences with health facilities; fear of going to an unfamiliar setting; lack of privacy and perceived costs of maternal health services were the main factors causing the first delay in deciding to seek care. Transport problems in inaccessible areas were the main contributing factor for the second delay on reaching care facilities. Lack of logistic supplies and equipment, insufficient knowledge and skills and unprofessional behaviour of health workers were key factors for the third delay in accessing quality care. Use of maternal health services at the PHCU level in Sidama zone is influenced by complex factors within the community and health system. PHCUs should continue to implement awareness creation activities to improve knowledge of the community on complications of pregnancy and benefits of maternal health services. The health system has to be responsive to community's cultural norms and practices. The mangers of the woreda health office and health centres should take into account the available budgets; work on ensuring the necessary logistics and supplies to be in place at PHCU.

Item Type: Article
Uncontrolled Keywords: Ethiopia, Health extension workers, Maternal health, Quality improvement, Service utilization, Three delays
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WQ Obstetrics > Childbirth. Prenatal Care > WQ 155 Home childbirth
WQ Obstetrics > Childbirth. Prenatal Care > WQ 160 Midwifery
WQ Obstetrics > WQ 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12884-018-1721-5
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 30 Apr 2018 14:41
Last Modified: 30 Apr 2018 14:41
URI: http://archive.lstmed.ac.uk/id/eprint/8523

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