BackgroundTiming of Antenatal care booking is one of the basic components of antenatal care services; that helps to early detection, managing, and prevention of problems during the pregnancy and helps the mother to receive full packages of antenatal care services. However, in the world including Ethiopia, significant numbers of pregnant mothers were not booking the follow up on the recommended time. The main aim of this study was to assess the prevalence and factors that associated with the early timing of antenatal care visit in Bahir Dar Zuria District, North West Ethiopia.MethodsA community-based cross-sectional study was conducted. A total of 410 mothers have participated. Data were collected through the interview from March 1 to 30/2018 using a structured and pre-tested questionnaire. Data were clear, code, and enter into Epi-info version 7.1 and export to SPSS for farther analysis. Both bivariate and multivariate analyses were used. On bivariate analysis p-value, less than 0.2 were used to select the candidate variable for multivariate analysis. P-value and confidence interval were used to measure the level of significance on multivariate analysis and those variables whose P-value < 0.05 were considered as statically significant.ResultsThe prevalence of early timing of ANC in the study area was 46.8%; with [95% CI 40.5, 51.8]. Distances [AOR 2.47, 95% CI; 1.4, 4.2], Knowledge on the timing of ANC [AOR 2.1; 95% CI; 1.2, 3.7], No under-five children [AOR 2.7; 95% CI; 1.3, 5.8], having one under-five children [AOR 2.2; 95% CI; 1.1, 4.5], and wanted pregnancy [AOR 2.4, 95% CI, 1.3, 4.7] were affects the early timing of ANC.ConclusionsThe prevalence of early timing of ANC was high when compared to the national figure and the Sub-Saharan country. Accessibility of health services, knowledge on the timing of ANC, under-five children, and desire for pregnancy were factors that affect the early timing of ANC.

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.

Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.

Objective: To identify the 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 to October 30,2016. To select the villages and households, stratified then simple random sampling method was employed respectively. 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 outcome variables. Results: A total of 296 respondents (148 cases and 148 controls) were employed. The mean age for both cases and controls were 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 enrollment decision in the community-based health insurance. While, being merchant (AOR = 0.07; 95% CI: 0.09, 0.6) decreased the enrollment decision. Conclusion: Societies' enrollment decision to community-based health insurance program was determined by demographic, social, economic and political factors. Households with large family sizes and farmers in the informal sector should be given maximal attention for intensifying enrollment decision in the insurance program.

The level of patient satisfaction is a direct or indirect measure of services delivered in healthcare institutions. Different primary studies in Ethiopia showed the proportion of satisfied patients toward health services. Patient satisfaction reflects a wide gap between the current experience and the expected services and pushes clients to go to farther located health care facilities and even to more expensive private health care facilities to find quality healthcare services. Inconsistent findings regarding the proportion of patients that are satisfied with the healthcare services in Ethiopia make generalizations difficult at the national level. We have accessed previous studies through an electronic web-based search strategy using PubMed, Cochrane Library, Google Scholar, Embase, and CINAHL and a combination of search terms. The quality of each included article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for windows, and meta-analysis was carried out using a random-effects method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for reporting results. Out of 188 records screened, 41 studies with 17 176 participants fulfilled the inclusion criteria and were included for proportion estimation. The pooled proportion of satisfied patients was 63.7%. Attending a health center (AOR = 2.68; 95% CI = 1.79, 2.85), being literate (AOR = 0.46; 95% CI = 0.28-0.64), being younger than 34 years old (AOR = 2.07; 95% CI = 1.28, 2.85), and being divorced (AOR = 0.58; 95% CI = 0.38, 0.88) were factors identified as being associated with patient satisfaction. The proportion of patient satisfaction in Ethiopia was high based on over 50% satisfaction scale. The Ministry of Health should give more emphasis to improve hospital health care services to further improve patient satisfaction.