Background: In spite of the promotion of institutional delivery in Ethiopia, home delivery is still common primarily in hard-to-reach areas. Institutional delivery supported to achieve the goal of reducing maternal and neonatal mortality in Ethiopia. The objective of this study is to assess the determinants of institutional delivery in Ethiopia. Methods: Cross sectional survey was conducted in 11 administrative regions of Ethiopia. The Ethiopian demographic and health survey data collection took place from January 18, 2016, to June 27, 2016. The study subjects were 11,023 women (15-49 years old) who gave birth in the preceding 5 years before 2016 Ethiopian demographic health survey. This representative data was downloaded from Demographic Health Survey after getting permission. The Primary outcome variable was institutional delivery. The data was transferred and analyzed with SPSS Version 20 statistical software package. Results: Of 11,023 mothers, 2892 (26.2%) delivered at a health facility and 8131 (73.8%) at home. Women with secondary education were 4.36 times more likely to have an institutional delivery (OR: 4.36; 95% CI: 3.12-6.09). Institutional delivery was higher among women who were resided in urban areas by three fold (OR: 3.26; 95% CI: 2.19-4.35). Women who visited ANC (Antenatal care) were about two times more likely to choose institutional delivery (OR: 1.81; 95% CI: 1.58-2.07). Respondents who watch television at least once a week was two times more likely to experience institutional delivery than those who did not watch at all (0R: 1.90; 95% CI: 1.35-2.66). The wealthiest women were 2.61 times more likely to deliver in an institution compared with the women in the poorest category (OR: 2.61; 95% CI: 1.95-3.50). Conclusion: Women having higher educational level, being richest, residing in urban area, visiting antenatal care at least once, and frequent exposure to mass media were factors associated with institutional delivery. Improving access to education and health promotion about obstetrics and delivery through mass media will increase the uptake of institutional delivery.
Objective: - To identify determinants for enrollment decision in the community based health insurance program among informal economic sector engaged societies, North West Ethiopia.Method:-Unmatched case control study was conducted on 148 cases (member to insurance) and 148 controls (not member to insurance program) from September 1- October 30 2016. Stratified then simple random sampling method was employed. The data were entered in to Epi-info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multi-variable logistic regression analyses were computed to describe the study objectives and identify the determinants of enrolment decision for the insurance program. Odds ratio at 95 % CI was used to describe the association between the independent and the outcome variables. Result: - A total of 296 respondents (148 cases and 148 controls) were employed. A mean age for cases and controls was 42 ± 11.73 and 40 ± 11.37 years respectively. Majority of respondents were males (87.2 % for cases and 79 % for controls). Family size between 4 and 6 (AOR=2.26; 95% CI: 1.04, 4.89), history of illness by household (AOR=3.24; 95% CI: 1.68, 6.24), perceived amount of membership contribution was medium (AOR=2.3; 95% CI: 1.23, 4.26), being married (AOR=6; 95% CI:1.43, 10.18) and trust on program (AOR=4.79; 95% CI: 2.40, 9.55) were independent determinants for increased enrolment decision in the CBHI. While, being merchant (AOR=0.07; 95% CI: 0.09, 0.6) decreased the enrolment decision. Conclusion: - Societies enrollment decision to community based health insurance program was determined by demographic, social, economic and political factors. Households with large family size and farmers in the informal sector should be given maximal attention for escalating enrolment decision in the insurance program.
Background Community-Based Health Insurance (CBHI) is an evolving program for delivering financial protection against the cost of illness and enhancing access to quality health services for low-income informal households. Objective The study aimed to identify determinants of household dropout from a CBHI program in Mecha district, North West Ethiopia, 2019. Methods A community-based case-control study was conducted in the Mecha district from March 10 to June 10, 2018. The final sample was 634 (317 cases and 317 controls) determined by the two-population proportion formula, and these samples were selected using a multi-stage sampling technique. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value < 0.05) to identify the determinants for the dropout from CBHI. Results Poor perceived quality of care (AOR = 3.66; 95%CI: 2.35, 5.69), low knowledge of community-based health insurance (AOR = 6.02; 95%CI: 2.97, 12.26), no active community communication (AOR = 5.41; 95%CI: 3.29, 8.90) no chronic illness (AOR = 10.82; 95%CI: 5.52, 21.21) premium fee is not affordable (AOR = 2.35; 95%CI: 1.47, 3.77), and out of pocket money not reimbursed (AOR = 9.37; 95%CI: 4.44, 19.77) were the determinants for the dropout from CBHI. Conclusions Poor perceived quality of care, low knowledge of CBHI, no active community participation, no chronic illness, premium fees are not affordable, and out-of-pocket money not reimbursed were the determinants for the dropout from CBHI.
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