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Using Andersen’s behavioral model of health care utilization in a decentralized program to examine the use of antenatal care in rural western Ethiopia

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  • Habtamu Tolera
  • Tegegne Gebre-Egziabher
  • Helmut Kloos

Abstract

Background: In Ethiopia, most women do not make the minimum number of antenatal care (ANC) visits recommended by WHO. This study modeled predisposing, enabling, need, and external environmental factors in the utilization of decentralized health facilities for ANC services in rural western Ethiopian communities. Methods: A community-based, cross-sectional study was conducted in Gida Ayana Woreda (District) among 454 women. Data were collected through structured questionnaires. Multinomial logistic regression was used to model the association between the explanatory variables and the use of recommended and fewer than recommended visits for ANC with reference to the base model, no ANC visits. Results: Only 15.2% of women made the recommended minimum number of ANC visits. Women with fewer than 2 children (AOR 10.7; 95% CI 3.0–8.4) were 10.7 times more likely received ANC service as recommended. Women with a delivery of 2 or more (AOR 9.7; 95% CI 3.7–5.2) home visits by health extension workers (HEWS) were 9.7 times more likely receiving minimum ANC services. Involvement in gainful activities had 4 times higher log odds of seeking recommended ANC (AOR 4.0; 95% CI 1.4–11.7). Women who experienced high fever were more likely to obtain the recommended ANC services (AOR 7.1; 95% CI 2.9–7.5). Residents of Ayana Kebele decentralization entity were 60% more likely to make the recommended number of visits to ANC (AOR 24.6; 95% CI 4.8–15.2). Conclusions: Number of children, home visits, gainful activities, monthly income, high fever, and decentralized administrative kebele were strongly linked with recommended ANC schedule. The need for a program intervention aimed at meeting WHO recommendations for ANC visits include economizing birth size and spacing; improving home attendance by HEWs, knowledge of pregnancy complications and benefits of minimum ANC visits, local socio-economic development measures targeting poor women/households; further decentralization of health system improving proximity to ANC in rural western Ethiopia.

Suggested Citation

  • Habtamu Tolera & Tegegne Gebre-Egziabher & Helmut Kloos, 2020. "Using Andersen’s behavioral model of health care utilization in a decentralized program to examine the use of antenatal care in rural western Ethiopia," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.
    • Handle: RePEc:plo:pone00:0228282
    DOI: 10.1371/journal.pone.0228282
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    1. Saifuddin Ahmed & Andreea A Creanga & Duff G Gillespie & Amy O Tsui, 2010. "Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-6, June.
    2. Ruth Jackson, 2016. "Changing the place of birth from home to health facilities in Kafa Zone, Ethiopia," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 8(3), pages 423-435, July.
    3. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
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    2. Feleke Hailemichael Astawesegn & Virginia Stulz & Kingsley E. Agho & Haider Mannan & Elizabeth Conroy & Felix Akpojene Ogbo, 2021. "Prenatal HIV Test Uptake and Its Associated Factors for Prevention of Mother to Child Transmission of HIV in East Africa," IJERPH, MDPI, vol. 18(10), pages 1-17, May.

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