Predictors of skilled assistance seeking behavior to pregnancy complications among women at southwest Ethiopia: a cross-sectional community based study

Abstract

BackgroundIn Ethiopia, about 20,000 women die each year from complications of pregnancy and child birth with many more maternal morbidities occurring for each maternal deaths. This makes Ethiopia one of the highest countries for maternal deaths in the developing world. This study attempted to assess women’s skilled assistance seeking behaviour for pregnancy complications among those who gave birth.MethodA cross-sectional community based study was conducted among women who gave birth within one year regardless of their delivery place. The study was carried out in fifteen randomly selected villages at Arba Minch Zuria district, south west Ethiopia. Data was collected house-to-house using a pretested Amharic questionnaire. During the survey, 798 women were interviewed. Logistic regression model was applied to control confounders.ResultsOut of the total sample, 344 (43.1 %) respondents reported at least any one of the pregnancy complications faced in the recent pregnancy. The most common complications reported were malaria (57 %), nausea/vomiting (47.1 %) and severe head ache (29.1 %). of those women who faced complications, around 254 (73.8 %) sought assistance from a skilled provider. Ninety (26.2 %) of the respondents sought assistance either from unskilled provider or home based self-care. Unable to understand the seriousness of the complications, thought as unnecessary, and family disapproval were the major reasons for not seeking care from skilled providers. Belonging to monthly household income $US25- 100 (AOR = 3.4, 95 % CI; 1.04, 11.4), getting antenatal care from a skilled provider (AOR = 10.6, 95 % CI; 3.3, 34.5), Women in the age 20–34 years old (AOR = 3.8; 95 % CI, 1.2, 12.3), Availability of transport access (AOR = 72.2; 95 % CI; 17.2, 303.5) were significantly associated with seeking assistance from a skilled provider.ConclusionsNearly half (43.1 %) of the women had faced pregnancy complications to the recent birth of last one year. Majority (2/3rd) of the women who reported complications sought skilled assistance. Family, income, transport issue and antenatal care use were independent predictors for skilled assistance from skilled provider.

Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review

“…Studies which identified demand-side affordability as a barrier reported primarily on household resources and willingness to pay rather than cash flow within society [22, 23, 25, 26, 31, 32, 34, 36–38, 40, 41, 46–48, 50, 52, 61, 66–71, 73–75, 78, 79, 83, 85–112]. Some studies cited reports by pregnant women of being too busy or having no time as reasons for non-use of maternity care services [22, 26, 63, 86, 100, 113, 114], which represent opportunity costs.…”

“…Household expectations included service users’ minimal expectations of cleanliness and non-interference during labour and delivery at health facilities, ability to meet cultural expectations [30] and a perception that health workers were too busy [91]. Social problems related to women’s low self-esteem and assertiveness were highly reported and manifested in various forms such as the husband’s denial of permission, the need for the husband’s/relative’s permission, women’s low decision-making power/autonomy [22, 23, 27–29, 33, 39, 46, 49, 51, 60, 62, 64, 66, 68, 69, 71, 73, 78–80, 94, 97, 104, 110, 111, 114–122] and delayed/ineffective decision-making within the family [47, 56, 65, 123, 124]. Shyness, fear or shame were also reported [28, 113], particularly among sub-groups like teenagers who were possibly afraid of being reprimanded.…”

“…Community and cultural preferences [59, 121] covers a range of issues and include the following: home delivery being usual practice or feeling more comfortable at home [25, 27, 33, 46, 48, 54, 59, 80, 85, 113, 114]; cultural beliefs/customs [23, 36, 49–51, 59, 62, 64, 67–69, 71, 75, 78, 108–111, 125]; having relatives nearby to provide closer attention [22, 27, 80]; ethnicity [75, 90, 92, 126, 127]; unwillingness to see a male doctor [23, 57, 128] and not being afforded the freedom to assume preferred birthing positions [43, 51, 66, 104, 110, 129]. …”

Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

“…Earlier studies that examined factors associated with care seeking found that women belonging to wealthier households were more likely to seek skilled care for antepartum complications [11, 13]. Factors associated with skilled birth attendants during intrapartum period included mothers’ occupation, higher parity, complications during antepartum period, having antenatal care [14], and closer distance to a health facility [13, 15, 16]. In addition, access to skilled attendants, availability of quality care and associated medical cost remained major barriers to seeking care [11].…”

Clinical Complications In Pregnancy And The Relationship With Low Birth Weight And Prematurity Of The Newborn

“…Most intercurrences can lead to serious complications and the best way to avoid such complications is through an appropriate and qualified health care [8]. Some studies have identified factors and behaviors that can minimize the effects of pregnancy complications, such as increased educational level, ease of access to the health facility, the availability of the transport system, family support, experience of a previous pregnancy, favorable economic conditions and qualified health care [9,10] In fact, one highlights the importance of ensuring those users a qualified prenatal care, since, through that service, health professionals can perform the monitoring of the main pregnancy complications seeking to avoid major complications for mother and child [2].…”