Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the poorest households.

BackgroundThe progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005–11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities.MethodsData for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services.ResultsIn this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor.ConclusionThe challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus, addressing socioeconomic inequalities in accessing maternal health services is central to resolving challenges of maternal health. Furthermore, as Ethiopia moves forward with the sustainable development agenda, socioeconomic inequalities in uptake of maternal health services should also be continuously monitored.

No abstract

Little studies and analysis have been undertaken to investigate the housing determinants of under-five mortality in Ethiopia.This study, therefore, explores the impacts of urban housing variables on the levels and patterns of under-five mortality in the country based on the SPSS (Statistic Package for Social Science) file of the 2005 Ethiopian Demographic and Health Survey (EDHS). This survey covered a sample of about 4,420 households/housing units of urban Ethiopia. The under-five deaths are computed for women in the age group 15-49 by subtracting the number of children living from children ever born (CEB) and established the proportion dead by dividing deaths by CEB corresponding to the categorical variables of housing structure, facilities, and household durables. The analytical techniques of the study included univariate, bivariate, and multivariate data analysis of the proportional variations of childhood mortality patterns being manifested by "bar graphs" with respect to housing situations as well as household durables. Amongst the categorical variables of the housing structures, facilities, and household durables with the highest no prevalence of under-five mortality levels are found to be the units of unconventional walls, thatched/leaf/reed roofing, animal dung flooring, shared pit latrine/use of bucket/bush, using kerosene, firewood/straw/charcoal for cooking, unconventional lighting, unprotected water supply, households with no durables.

Definition: The final net live birth delivery from the mother's womb, with distinct male and female genetic traits, forms a ratio of male live births per 100 female live births, termed as Sex Ratio at Birth (SRB). Study areas and source of data: The study areas are Africa and major worldwide continents and countries. The basic data are compiled from the National Population and Housing Censuses, Demographic Sample Surveys, Demographic and Health Surveys, and Vital Registration Systems.Analytical approaches: The factors influencing the variations in SRB are identified by reviewing various documents, analysis of variance (ANOVA) techniques, and statistical measures of central tendency and dispersion. Results: The ratios are consistently higher for advanced countries than the developing countries, with highest for China and India. The ANOVA results show slight differences among the 50 African countries but show differences among the African regional states, whereas the standard deviation of the SRB among the advanced countries, including some Asian and Latin American countries shows non-significant variations. In conclusion, the mean SRB for African populations is 103 as against 106 for other countries.