Dissertations / Theses on the topic 'Health facilities – Ethiopia'

Magister Public Health - MPH
Evaluation of health programmes is essential to assist programme managers in decision-making and accountability to the population they serve. Additionally, regular monitoring and evaluation of TB/HIV collaborative activities are used as a means to assess quality, effectiveness and coverage of services; yet little attention has been given to this in most developing countries. In the southern region of Ethiopia, since the inception of the TB/HIV collaborative activities in 2005, there has not been any formal evaluation pertaining to the implementation status of integrated TB/HIV services at routine program level. However, a series of TB/HIV reviews underlined many challenges that have adversely affected the implementation nationally. However, studies conducted on the quality of TB and HIV/AIDS services tend to be broad and not targeted to the integrated TB/HIV program and therefore, it was necessary to assess the implementation status in a more focused way with a vision to determine its adequacy or otherwise and make appropriate recommendations to improve integrated TB/HIV services in the town. Aim: To assess the implementation of integrated TB/HIV activities in the health facilities of Hawassa town administration Study design: Cross sectional study Study population: All health facilities, health managers, and records of TB and HIV patients in Hawassa town administration Sample population: The study population encompassed TB and HIV clinics, managers of each health facility, and sampled records of individual clients/patients enrolled in the HIV/AIDS/TB treatment and care program, from each health facility in the year 2009/10. Data collection: Face-to-face interviews with facility managers, observation of the rooms in which TB/HIV services are rendered and a review of patient records, were undertaken. Analysis: Descriptive statistics with frequencies and percentages were used for analysis of facility based resource inputs, TB case finding and management, and HIV case finding and management practices. Indicator variables extracted from the record review were transformed into scales (0 or 1) and weighted to reflect the levels of TB/HIV service quality, integration and resources input. After weighting, experts' opinion was used to set a cut off level (75%) to categorize the relative service quality received by individuals and the level of integrated care provided by facilities into "adequate" or "inadequate". Bivariate analysis was done to assess the effect of independent predictor variables on outcome variables. We used a– P value of 0.1 on bivariate analysis as the cut off point for inclusion of variables into the multivariate analysis. Prevalence ratios, adjusted prevalence odds ratios, and 95% confidence intervals were used to present outcomes. Results: Availability of resource inputs for HIV/AIDS care was inadequate in half of the facilities in Hawassa town whereas, laboratory infrastructure for TB/HIV care was adequate in all facilities. Most (91%) HIV/AIDS patients had their CD4 count and weight (96%) measured at baseline. However, the trend declined over time and the practice was better in hospitals than in health centres. HAART status was a strong predictor of CD4 count improvement and improvement in CD4 count was found to be a strong predictor of body weight gain. TB case finding and management practices in HIV/AIDS clinics were found to be adequate in the health facilities in Hawassa town. Ninety five percent and 86% of HIV positive patients were screened for TB at baseline and at the last clinical visit respectively, of which 98%, 93% and 81% of patients co infected with TB and HIV were provided with DOTS, CPT and ART respectively. However, only 11% of HIV positive patients without active TB were provided with IPT. Only HAART status was found to be a strong predictor of TB case finding. Quality of HIV/AIDS care in health facilities in Hawassa town was adequate. Availability of at least a minimum number of staff and being on HAART were found to be strong negative and positive predictors of quality respectively. Overall, 91% of patients on HAART were retained in care at the end of the year (alive and on treatment), 6% were retained and 3% died. Resources for the TB program were deficient in our study area. Three out of four facilities had inadequate overall input resources required for good quality TB care and the fourth barely managed to achieve adequate status. However, laboratory infrastructure and availability of forms and registers were adequate in all the facilities. There was a high degree of HIV case finding and a high prevalence (17%) of HIV among TB patients. Despite this, the overall HIV care provided was inadequate, with only 64% and 73% of TB/HIV co-infected patients being provided with HAART and co-trimoxazole respectively and 22% of TB/HIV co-infected patients not enrolled in HIV care. Among sputum positive TB patients good quality TB care was found to be a strong predictor of successful treatment outcome Our study also showed consistently very high quality TB service provision in the town despite the lack of required resources. Conclusion and Recommendations: The study showed that there was relatively good quality provision of TB and HIV services despite inadequate input resources and that quality of care was positively associated with good outcomes. The study also indicated that HAART benefited patients substantially and hence earlier initiation could be the way forward. We recommend that to further improve quality of care one stop shopping services (availing both anti-TB and HIV care at the same service point within a clinic) be established. In addition, we recommend improved patient monitoring, especially for Pre-ART patients, be established.

Magister Public Health - MPH
The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of 'acceptable' waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests.
South Africa

The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed.
Health Studies
D. Litt. et Phil. (Health Studies)

Health Management Information System (HMIS) in developing countries lags seriously behind as compared to the developed countries; and the existing HMIS in many countries is insufficient to support health management functions. The purpose of this study was to describe the implementation of Anti-retroviral Therapy (ART) pharmacy management information system in public health facilities. Quantitative, descriptive research was conducted at 38 public health facilities. The participants of the study were Pharmacists and Druggists those are working at ART Pharmacy. Data collection was done by using structure questionnaire. 76 respondents were recruited to participate in the study. The participants ages ranged from 26-50 years and all had more than 2 years’ work experience. The study indicated that even if there is a system at most health facilities their utilization of information technology (IT) for pharmacy practice were not appreciated. The findings indicated that the need for creating awareness among professionals in giving more skill oriented and also a formal in-service information technology related trainings for the professionals. To achieve better utilization of information technology at health care delivery system particularly pharmacy practice, government and stakeholder should consider capacity building activities through proper training and it should also viewed as a long term socio-cultural and technical development process.
Health Studies
M.A. (Public Health with specialization in Medical Informatics)

Healthcare waste management is very important due to its hazardous nature that can cause risk to human health and the environment. The study wished to determine the amount of healthcare waste generated in 15 public health centres and 3 hospitals and evaluate the healthcare waste management practices in Addis Ababa City Administration. The aim of the study was to develop a manual for healthcare facilities based on the findings on healthcare waste management practice, quantification and intervention. Data was obtained from questionnaires distributed to 636 randomly selected healthcare professionals, ancillary staff and managers and by means of surveying the facilities. The mean HCW generation rate was 10.64 + 5.79 kg/day, of which 37.26% (3.96 + 2.017kg/day) was general waste and 62.74% (6.68 + 4.293 kg/day) was hazardous waste from the surveyed health centres. HCW generation and quantification was not measured and documented in any of the HCFs. Quantifying HCW would help determine the type of waste as well as the HCFs that generate the highest and lowest HCW, which could have implications for resource allocation in managing HCW. Segregation of different types of wastes was not regularly done. Some HCFs had separate storage areas for HCW and separate containers for hazardous and nonhazardous waste. In some instances, however, the containers were not clearly marked. Regarding storage, some of the HCFs had interim storage sites and HCW disposal sites. Several interim storage facilities lacked security and surveillance and were not cleaned after collection. In addition, HCW remained at the interim storage facilities for more than 48 hours before final disposal. The main forms of on-site treatment of HCW before disposal were burning, crushing sharps, sterilisation and chemical disinfection. The most common treatment method used for HCW was incineration. Most HCW handlers had not received adequate training; did not wear PPE, and did not take precautionary measures, such as washing their hands and heavy duty gloves after handling HCW. The researcher developed a manual for effective HCW management and training of HCW handlers. Based on the findings, the study makes recommendations for policy, education, HCW management, including generation, segregation, storage, transportation and disposal, and further research.
Health Studies
D. Litt. et Phil. (Health Studies)

This study aimed to assess the magnitude, trends and determinants of intrapartum stillbirths in the public health facilities in Addis Ababa. A case-control study design was used along with quantitative data collection methods. Obstetric care data on key variables were collected from medical records of 728 cases and 1551 controls in the public health facilities during July 1, 2010 and June 30, 2015. Data were analysed using SPSS version 24 to determine associations and risk factors against intrapartum stillbirth. HMIS data from different sources were further analysed for the same period to determine trends of stillbirth in the public health facilities of Addis Ababa. Findings from this study showed a staggering high prevalence of stillbirth at an average rate of 28 per 1000 births during the period 2010-2015. This figure was comparable with the population level prevalence of prenatal death in Addis Ababa which was 30 per 1000 birth (Central Statistical Agency 2011:115). No statistically significant associations were revealed against the effects of maternal medical conditions including diabetes, hypertension, cardiac and renal diseases and key socio-demographic variables including age, parity and marital status, and intrapartum stillbirth. On the contrary, HIV and syphilis infections, foetal presentations, multiple pregnancy and the frequency of ANC visits during the index pregnancy had statistically significant associations with intrapartum stillbirth. Furthermore, low FHR, non-vertex foetal presentations and ruptured cervical membrane on admission to labour were among risk factors for intrapartum stillbirth. Similarly, women in the stillbirth group received substandard care regarding the timely assessment of foetal decent, cervical dilatation, labour induction, and episiotomy care compared to women in the livebirth group. Obstetrical complications including obstructed labour, eclampsia and preeclampsia were more common among women in the intrapartum stillbirth group indicating that the above variables were key determinant of intrapartum stillbirth. These findings suggest that poor quality of obstetric care during labour and childbirth were the underlying risk factors for intrapartum stillbirth. In conclusion, strategies to overhaul the obstetric care practices in the public health facilities through skills building, accurate use of labour monitoring tools, close supervisions, accurate classification of stillbirth, proper documentation, and ongoing research efforts.
Health Studies
D. Litt. et Phil. (Health Studies)

The purpose of this study was to investigate the health service delivery by private health sector and develop guidelines to enhance provision of health service so as to increase their contribution in the country’s health system. Interviews with 1112 participants were conducted in phase I. Descriptive statistics, chi square tests and logistic regression analysis were used for analysis. Private health facilities (30.5%) were providing healthcare services in their own buildings that were constructed for that purpose while others work in a rented houses built for residence or others. Some facilities (11.7%) received loan services from financial institutions in the region. A significant association was found between obtaining loan and owning building for healthcare services delivery (x2=13.99, p<0.001). Private health facilities were mainly engaged in profit driven and curative services while their participation in the promotive and preventive services like FP, ANC HIV test, TB and malaria prevention and control was not minimal. Majority, 247 (96.5%) provide services for extended hours out of normal working time such as evening, weekends and holidays. Physicians, more than other professionals were found practicing part time work (dual practice). Service consumers of the private health sector were urban dwellers 417 (71.6%) and 165 (28.4%) rural residents. Nearly three-fourth (73.0%) of study participants had a history of multiple visits to both public and private health facilities for current medical condition. Median payment of patients in a single visit including diagnosis and medicine was 860 birr ($30.85) (IQR = 993 ($35.62). Only 2.1% have paid through insurance services while others through out of pocket payments. Price of services delivered in private health facilities were set mainly by owners’ will (91.4%) while others with established team. Satisfaction on the fairness of prices to services obtained from each facility were reported by 63.1% service consumers. Those patients without any companion (AOR=1.83, 95% CI=1.16-2.91) and no history of visit to other facilities (AOR=1.97, 95% CI=1.24-3.12) were more likely to be satisfied than those coming with companions and those with history of visit. In addition, as age of consumers increase, satisfaction to services prices tend to decline (AOR=0.97, 95% CI=0.96-0.99). Uncomplimentary regulatory system to private health facilities, lack of training and continuing education for health professionals, unavailability of enough health workforce in the market and shortage of supplies to private facilities were among main gaps disclosed. Based on findings, five guidelines were developed to enhance health services delivery in the private health sector, namely, increase facilitation for financial access to actors in the sector, increase facilitation to access regular updating trainings and continuing education for healthcare workers, enhance and scale up the capability of existing association in the private health sector, strengthen and support working for extended hours to promote user friendly services and accessibility of healthcare services for the poor through community based health insurance and exemption. Therefore, these recommendations to help enhance the private health sector for better performance and contribution.
Health Studies
D.Lit.Phil (Health Studies

Text in English
INTRODUCTION: Late in HIV epidemic while HIV program is maturing studies in rich and resource limited setting have shown controversial results with regard to whether childbearing desire and intention are changed after the expansion of ART and PMTCT services. There are few studies in Ethiopia which tried to find out fertility preferences after the decentralized ART and PMTCT services. PURPOSE: The objective of the study is to determine the prevalence of fertility desire, intention and associated factors among HIV positive males and females at health facilities in Hawassa city with chronic HIV care. METHOD: The study used quantitative, observational, analytic and cross-sectional study design. It was structured on Trait-Desire-Intention-Behaviour theoretical frame work. A gender based stratification followed by random sampling method was applied. An interviewer-administered structured data collection approach using the pre-tested questionnaire was applied in the study. The Microsoft Office Excel 2007 and Epi-Info version 3.5.3 were utilized for data analysis. In addition to descriptive statistics, both bivariate and multivariable logistic regressions were used to analyse the data. RESULT: With a respondent rate of 93%, a total of 460 PLHIV participated in the study with equal number of males and females. The majority of the participants were from urban (85%), in relationship (70.9%), and on ART (80%). The reported fertility desire, 43.9% (45.2% in males; 42.6% in females), and fertility intention, 44.9% (46.4% in males; 43.4% in females), were high. The median number of intended children was 2. About 54% of PLHIV were using at least one of the contraceptives with 32.4% of unmet need of family planning. Participants with overall experinece of 2 births or less (AOR: 2.4 95% CI 1.32-4.32; p-value=0.0042), without birth experience after HIV diagnosis (AOR:0.52 95% CI 0.28-0.98; p-value=0.0424) and whose partner also desired for childbearing (AOR: 19.73 95%CI 10.81-35.99; p-value=0.0000) were more likely to intend for a/another child.They wished and planned to get birth because; they did not have a/children before or fear of childless stigma (25.3%), ART could help to have negative child (21.8%), importance of parenthood (17.8%) and the desire of once partner (16.8%). The study participants had consulted health care workers (34.2%), approached their partner or their partner had already approached them (27.6%), tried to get a partner or married (17.6%) and stop using family planning (6%) to get pregnant. CONCLUSION: This study highlights high fertility desire and intention in the background of high unmet need for family planning among PLHIV. A development of comprehensive male partner-involved couple counseling protocol, improving the communication HCWs have with PLHIV to emphasize safer conception methods and strengthening all the components of PMCT integrating with other SRH services at chronic HIV clinic are critical.
Health Studies
M.A. (Public Health)

The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of &ldquo
acceptable&rdquo
waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests.

Text in English, with Annexures in English and Amharic
Annexure 5 and Annexure 7 "Questionnaire for qualitative study" in English and Amharic
The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC). PURPOSE The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). METHODOLOGY The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. RESULTS In the study, 79.8% of the women who delivered within 12 months prior to this study received ANC from SBA. Baby care and PNC for the mother and baby received from SBA were at 248 (71.5%), 55 (15.8%), and 131 (38%) respectively. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. CONCLUSION To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health-service utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework.
Health Studies
D. Litt. et Phil. (Health Studies)

Purpose: The purpose of this study is to assess risk factors associated with TB co-infection in HIV/AIDS patients taking antiretroviral therapy (ART). Methodology: An observational, analytic, case-control and quantitative study was conducted on a randomly selected 367 HIV and AIDS patients of whom 92 of them were TB co-infected. Data collection was done by using self-structured questionnaire. Result: In this study, educational status, waste disposal system, monthly income, contact history with a patient of active tuberculosis or presence of a family member with active tuberculosis, drug adherence, knowledge on tuberculosis prevention and history of exposure to substance were factors independently associated with the occurrence of active tuberculosis among HIV and Aids patients taking ART. Conclusion: The findings highlight the need for on-going educational, informational and other interventions to address the risk factors of tuberculosis in HIV and Aids patients in order to decrease the rate of TB co-infection
Health Studies
M.A. Public Health

Gender disparity in healthcare sector leadership positions is a major problem among female healthcare professionals in Southern Ethiopia. This study explored gender disparities among healthcare professionals in healthcare sector leadership positions. The findings would be used to develop guidelines to reduce gender disparities in healthcare leadership in healthcare sectors to a minimum in Ethiopia. This study used exploratory and descriptive cross-sectional research design incorporating a mixed methods research approach to collect both quantitative and qualitative data simultaneously which were analyzed during the same phase of the research process. The quantitative survey data was collected using piloted structured questionnaire while qualitative data was collected using semi-structured interview guide containing open questions. Quantitative data was collected from a random sample of 414 healthcare professionals and qualitative data from a purposive sample of 21 healthcare professionals from seven districts having the experiences of gender disparity in healthcare leadership positions. Quantitative data had a compliance rate of 98% and it was entered into EpiData version 3.1 and exported to SPSS (version 24) for further analysis, and the qualitative data was coded and analyzed manually into thematic content. Quantitative findings of the study revealed that only 26% (n=108) of the participants reported that representation of women in healthcare sector leadership positions in the past few years has been increased. The majority of leadership positions assumed by study participants were at department head level while only 1.3 % were on chief excutive officers and 2.3% medical director positions respectively. Of these none was a female and 67%, n=264 of the participants do not have leadership role in a health service facility. Study participants having bachelor degree level of education were 2.3 times more likely to be represented in healthcare sector leadership positions than those participants having master’s degree and diploma [AOR=2.3, (95% CI: 1.289, 4.252)]. Challenges experienced by women health professionals regarding gender disparity in leadership positions in health service facility included family responsibilities, lack of support, lack of self-esteem or self-confidence, lack of career advancement, and cultural bias. The conclusions derived from the study was that women need all the opportunities, encouragement and support to allow them access to and success in healthcare sector leadership positions through informal and formal leadership training.
Health Studies
D.Litt. Phil (Health Studies)

The Ministry of Health (MOH) and its partners are determined to prevent and manage preventable causes of morbidity and mortality in mothers, neonates and children. In the last decade, special emphasis has been given to increasing the number of health facilities that provide maternal and child health services (MNCH), huge production of skilled birth attendants (SBAs), and equipping the health facilities to improve the utilisation of quality services. This study investigated the community perspectives of health service utilisation and proposes a framework for improving the utilisation of the available SBA and postnatal care (PNC).The purpose of this study was to develop a framework for the utilisation of skilled care for delivery and postnatal care by women of childbearing age (15-45). The study used a Sequential explanatory Mixed Methods Approach to investigate the utilisation of SBA and PNC in a district in Ethiopia. The Delphi Technique helped to solicit input from maternal health care experts on the development of a Framework for utilisation of SBA and PNC. This study utilised the Anderson Health Utilisation Model. In the study, 79.8% and 248 (71.5%) of the women who delivered within 12 months prior to this study received ANC and skilled birth attendance respectively from SBA. Fifty five (15.8%) mothers and 131 (38%) babies received Postnatal care from SBA with in 45 days after delivery. The study further found that women who can read and write and were educated are more likely to utilise SBA and receive quality health care services. The study showed that certain factors such as disrespecting service users, abusing service users’ lack of trust on the SBA by service users, religion and superstition contribute negatively to the use of SBAs. None of the predisposing, enabling and need factors predicted the use of SBA for PNC by the mothers. Nevertheless, through the focus group discussions (FGDs) and individual interviews (IDI), it was revealed that there was a widespread knowledge and perception gaps in the community related to the importance of postnatal period and PNC. Religious sanctification also have imperative role in hampering PNC service use by the mothers. The Health care workers (HCWs) also lacked the keenness and orientation to provide the service. Babies born from families with monthly income equal to 500 or above USD were more likely to use PNC within 45 days. There was a widespread misconception in the community that Babies do not need PNC before 45 days of birth except for vaccination purpose. To examine their role in health service utilisation for SBA and PNC, researches can integrate social support and social network to the Andersen’s health- ervice utilisation model. A framework for utilisation of SBA and PNC is proposed. The researcher recommends developing an utilisation tool kit that specifies the detail operationalisation of the framework.
Health Studies
D. Litt. et Phil. (Health Studies)

The purpose of this study was to propose women-centered guidelines to enhance the utilization of health facility-based delivery among attendees of FANC in Addis Ababa, Ethiopia. A qualitative exploratory and descriptive research design was used to achieve the aims and objectives of the study. The design was contextual in nature.The study was conducted in three phases, using purposively selected attendees of FANC who participated in individual and focus group interviews in phases I and II respectively. Data were analyzed by means of thematic analysis. In phase III of the study, the findings of the first two phases and literature were used as the basis for the development of guidelines to enhance the utilization of health facility-based delivery services among attendees of FANC in Addis Ababa, Ethiopia. From the analysis of individual interview data, four (4) themes emerged, namely, perceived benefits of home delivery, knowledge deficit about health facility-based delivery, poor access to health care facilities and inadequate resources. These themes were identified as rich and detailed account of the perspectives of facility-based and home delivery among attendees of FANC in Addis Ababa, Ethiopia. Two (2) themes emerged from the analysis of focus group interviews data, namely provision of quality, respectful and dignified midwifery care and increased awareness of FANC. These themes were identified as the rich and detailed account of the views of, and recommendations made by attendees of FANC on measures needed to enhance the development of women-centred guidelines to enhance the utilization of health facility-based delivery services. The recommended measures addressed the negative perceptions of health facility-based delivery among attendees of FANC, with the aim of decreasing home deliveries and increasing the number of institutional deliveries. The study recommends that the Ministry of Health, Addis Ababa Health Bureau and the health facilities use the proposed guidelines to enhance the utilization of health facility-based delivery.
Health Studies
D. Litt. et Phil. (Health Studies)

PURPOSE: The main aim of this study was to systematically assess women’s maternal health care seeking behaviour and its determinants in Addis Ababa, Ethiopia. DESIGN: A quantitative and cross-sectional community based study was the selected methodology for this study. METHOD: Data was collected using structured questionnaire administered to 903 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary and multinomial logistic regression models were employed to identify predictors of adequacy of antenatal care and delivery care. RESULTS: Most of the women (97.9%) visited health care facilities at least once for antenatal care follow up. About 86.5% of them had at least four visits during their last pregnancy; and only 51.1% started their first antenatal visit early. Further, only about one out of five of the antenatal care attendees received sufficient content of antenatal care services. Consequently, only about one out of ten women received overall adequate antenatal care mainly due to inadequate use of the basic components of antenatal services. Most of the women delivered in public health care institutions (76.3%) despite the general doubts about the quality of services in these facilities. Women of better socioeconomic status preferred to give birth at private health care facilities. Caesarean section delivery rate in Addis Ababa (19.1%) is higher than the maximum WHO recommended rate (15.0%); particularly among the non-slum residents (27.2%); clients of private health care facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women who belong to the highest wealth quintile (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery and about 9.0% of the caesarean section births had no medical indication. CONCLUSION: Disparities in maternal health care utilisation between the socio-economic groups was evident, requiring urgent attention from policy makers and other stakeholders to enable Ethiopia to meet its millennium development goal 5. Improving the quality of antenatal care in public health facilities which are the main provider of health care services to the majority of the Ethiopian population is urgent. The increase in the rate of caesarean section beyond the World Health Organization recommended upper limit has to be taken seriously.
Health Studies
D. Litt.. et Phil. (Health Studies)

The aim of this study was to identify factors affecting facility-based delivery with the purpose of developing a framework for the promotion of facility-based delivery among women living in rural Ethiopia. Explanatory mixed methods design, comprising of four phases-the descriptive (quantitative), explorative (qualitative), meta-inference and development phases was employed. The quantitative phase was conducted first using a structured questionnaire to identify the variables influencing facility-based delivery care seeking behaviour. A sample of 389 responses were used for data analysis using Structural Equation Modeling. The quantitative phase conducted next to explain the determinants that contributed to influencing facility-based delivery care seeking behaviour. Sixteen participants who were involved the first phase were involved in the follow-up second phase. As illustrated by the results of the study, the majority of women in the study areas continued to deliver at home, putting themselves at risk of dying from pregnancy related causes. As highlighted by the key findings from the quantitative and qualitative data of this study, the most influential factors in predicting and explaining delivery care seeking behaviour are response efficacy, attitude, subjective norm, and perceived behavioural control which are shaped by mothers’ confidence in the outcome, quality of care, interpersonal relations with family members, willingness to conform, access to services, and their decision making power. The way these findings emphasized the factors attitude, subjective norm and perceived behavioural control were consistent with the Theory of Planned Behaviour, while the significance of response efficacy was in line with Protection Motivation Theory. The study developed a framework to help promote facility-based delivery among mothers living in rural Ethiopia.
Health Studies
D. Litt. et Phil. (Health Studies)