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Background: In rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia. Methods: A community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas. Results: MWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization. Conclusions: A low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Despite recent achievements in health targets, Ethiopia still faces challenges in health service delivery. Between 2012 and 2015, a non-governmental organisation (NGO), Doctors with Africa CUAMM, implemented a multifaceted project aimed at improving access to maternal and child health services in three districts in Ethiopia. This paper evaluates the performance of this project, based on four maternal health indicators. Methods: A before-and-after study utilising data collected through cross-sectional surveys involving 999 women was conducted. The date of delivery was used to stratify the intervention period as follows: pre-intervention, early intervention, and late intervention. Changes during the intervention in the coverage of four antenatal care (ANC) visits, receipt of three basic components of ANC, skilled birth attendant (SBA) at delivery, and postnatal care (PNC) in seven days were assessed using logistic regression, adjusting for socio-demographic factors. Results: There was an increase in the coverage of receipt of all three ANC components and SBA at delivery between the pre-intervention period and the late intervention period. The percent of health centre deliveries increased from 7.3 % in the pre-intervention period to 35.6 % in the late intervention period. The odds of receiving all three components of ANC were twice higher in the late intervention period than in the pre-intervention period (OR 2.09; 95 % CI 1.12-3.89). The odds of SBA at delivery were five times higher in the late intervention period than in the pre-intervention period (OR 5.04; 95 % CI 2.53-10.06). There was no significant change in the coverage of four ANC visits and PNC after accounting for sociodemographic factors. Conclusions: This NGO implemented maternal health project in three districts in Ethiopia was associated with increased likelihood that a pregnant woman would receive three basic components of ANC and be assisted by a SBA at delivery. Increase in skilled birth attendance was driven by increased utilisation of health centres. More efforts are needed to bolster the coverage of ANC and PNC. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. However, there is a paucity of studies which examined the associated factors of antenatal depression in low-income countries. This study aimed to determine the prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia. Methods: A cross-sectional study was employed among 393 pregnant women attending antenatal care service in Addis Ababa public health centers, Ethiopia from April 12-26, 2012. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms. Descriptive statistics and logistic regression were used in the statistical analysis. Results: Prevalence of antenatal depression was 24.94% (95% CI: 20.85-29.30%). In the final multivariable model, those pregnant women who have previous history of depression were nearly three times at higher odds of having antenatal depression as compared to pregnant women who have no history of depression [AOR = 2.57(95% CI: 1.48-4.48 )]. Those pregnant women having unplanned pregnancy were nearly three times at higher odds to develop depression as compared to pregnant women whose pregnancy was planned [AOR = 2.78(95% CI: 1.59-4.85)]. The odd of developing antenatal depression was 89% higher in those pregnant women who experienced lack of baby's father support [AOR = 1.89(95% CI: 1.06-3.36)]. Education level, community's support, and partner's feeling on current pregnancy were not significantly associated factors with antenatal depression in the final multivariable model. Conclusion: Although clinical confirmation for antenatal depression is not conducted, one quarter of the pregnant women attending antenatal care were depressed in Addis Ababa based on EPDS. Unplanned pregnancy, experiencing lack of baby's father support and previous history of depression were factors independently associated with antenatal depression. Promotion of family planning and integration of mental health service with existing maternal health care as well as strengthening the referral system among public health centers were the recalled interventions to prevent antenatal depression in Addis Ababa Public Health Centers. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization, Caesarean Section (CS) rate (percentage of births managed by CS) exceeding 15% lacks medical justification and it could be linked with adverse maternal and child health consequences. Nonetheless, the rate in Addis Ababa city is beyond the aforementioned level. The objectives of the study were to assess the trend and socio-demographic differentials of CS rate in the city. Methods: The study was made based on the three Ethiopia Demographic and Health Surveys (EDHS) data (EDHS 2000, 2005 and 2011). The trend over the period of 1995-2010 was assessed using simple linear regression analysis whereas the differentials of CS rate were identified based on DHS 2011 data. CS rates were compared across categories of various socioeconomic variables using chi-square test. Results: The CS rate increased significantly from 2.3% in 1995-1996 to 24.4% in 2009-2010. From 2003 onwards, it persisted above 15%. The rates among women with secondary (32.3%) or higher (33.3%) levels of education were nearly two times higher than the corresponding figures in the illiterates (14.8%) and women with primary education (15.8%) (P < 0.001). The level among women from the 'rich' households (28.6%) was higher than those from the 'poor' (16.4%) and 'middle' (19.5%) households (P = 0.016). The rate also significantly increased with rising parity (P = 0.023). The rate among women who delivered in private health institutions (41.7%) was twice higher than their counterparts who delivered in public institutions (20.6%). Conclusion: The CS rate in Addis Ababa has exceeded beyond the level recommended by the WHO. Accordingly, It should be maintained within the optimum 5-15% range by introducing medical audit for labor management both in the private and public health institutions. Further, during prenatal care pregnant women should be fully informed about the risks of medically unjustified CS. [ABSTRACT FROM AUTHOR]