Search

Abstract Providing adequate and equal access health care is a key goal towards universal health coverage (UHC), but women continue to confront considerable inequities in accessing healthcare, particularly in the emerging regions of Ethiopia. Therefore, we identified the contributing factors to the problems in accessing health care among women of reproductive age in emerging regions of Ethiopia. Data from the 2016 Ethiopia Demographic and Health Survey were used. A total of 4680 women in reproductive age were included in the final analysis and a multilevel mixed-effect binary logistic regression analysis was done to identify the contributing factors to the problems in accessing health care. In the final model, a p-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant factors. We found that 71.0% (95% CI 69.64–72.24%) of women in reproductive age had problems in accessing health care. Unmarried women (AOR = 1.30 95% CI 1.06–1.59), uneducated (AOR = 2.21 95% CI 1.48–3.30) and attended primary school (AOR = 1.58 95% 1.07–2.32), rural resident (AOR = 2.16 95% CI 1.40–2.02), poor (AOR = 2.95 95% CI 2.25–3.86) and middle wealth status (AOR = 1.74 95% CI 1.27–2.40), women who gave two births (AOR = 1.29 95% CI: 1.02–1.64) and not working (AOR = 1.33 95% CI 1.06, − 1.68) and working in agriculture (AOR = 1.88 95% CI 1.35–2.61) were factors that contributed for the problems in accessing health care. A significant proportion of women of reproductive age in emerging regions of Ethiopia face challenges in accessing healthcare, which places the country far from achieving its UHC targets. This issue is particularly prominent among unmarried, poor and middle wealth status, uneducated, non-working, and rural women of reproductive age. The government should develop strategies to improve women’s education, household wealth status, and occupational opportunities which would help to alleviate the barriers hindering healthcare access for women residing in emerging regions of Ethiopia.

BackgroundCommunity-based outpatient therapeutic feeding program (C-OTP) in Ethiopia has been launched to manage uncomplicated severe acute malnutrition (SAM) by trained Health Extension Workers (HEWs). This program is believed to be the most effective strategy for reaching a large group of children suffering from SAM in rural and disadvantaged communities. Nonetheless, poor treatment outcomes, notably mortality and prolonged recovery time, become pressing public health problems, which could be a result of suboptimal implementation and poor service quality.ObjectivesTo evaluate the implementation of C-OTP for managing uncomplicated severe acute malnutrition in the Central Gondar Zone.MethodsMultiple studies involving both qualitative and quantitative will be conducted. Availability of essential drugs and equipment, acceptability of the program by mothers/caregivers, health extension workers' compliance to the treatment protocol, and treatment outcome will be assessed employing different methods. Likewise, knowledge of health extension workers about SAM diagnosis and management and their skills to diagnose and manage uncomplicated malnutrition will be determined. Health extension workers, mothers/caregivers, supervisors, and healthcare administrators will be enrolled in the study. Besides, children's medical records registered between 2017 and 2020 will be reviewed to determine the treatment outcome. The data will be collected using pretested self-administered and face-to-face interviewer-administered questionnaires. Similarly, focus group discussions (FGDs), in-depth interviews, and observation checklists will be applied. Binary logistic regression analysis will be conducted, while the qualitative data will be analyzed using thematic content analysis.DiscussionSevere acute malnutrition is a public health problem that remains the underlying cause for over half of under-five mortality in Ethiopia. As a result, community-based therapeutic care has been launched in the country to address these problems and maximize population-level impact by improving treatment coverage, access, and cost-effectiveness. Despite its achievement, the program has been threatened with unfavourable treatment outcomes and a shortfall of resources. Hence, this implementation evaluation study will also identify gaps between healthcare systems and service users. The output will help programmers pass evidence-based and sound decisions to tackle the key barriers.

Background Community-based outpatient therapeutic feeding program (C-OTP) in Ethiopia has been launched to manage uncomplicated severe acute malnutrition (SAM) by trained Health Extension Workers (HEWs). This program is believed to be the most effective strategy for reaching a large group of children suffering from SAM in rural and disadvantaged communities. Nonetheless, poor treatment outcomes, notably mortality and prolonged recovery time, become pressing public health problems, which could be a result of suboptimal implementation and poor service quality. Objectives To evaluate the implementation of C-OTP for managing uncomplicated severe acute malnutrition in the Central Gondar Zone. Methods Multiple studies involving both qualitative and quantitative will be conducted. Availability of essential drugs and equipment, acceptability of the program by mothers/caregivers, health extension workers’ compliance to the treatment protocol, and treatment outcome will be assessed employing different methods. Likewise, knowledge of health extension workers about SAM diagnosis and management and their skills to diagnose and manage uncomplicated malnutrition will be determined. Health extension workers, mothers/caregivers, supervisors, and healthcare administrators will be enrolled in the study. Besides, children’s medical records registered between 2017 and 2020 will be reviewed to determine the treatment outcome. The data will be collected using pretested self-administered and face-to-face interviewer-administered questionnaires. Similarly, focus group discussions (FGDs), in-depth interviews, and observation checklists will be applied. Binary logistic regression analysis will be conducted, while the qualitative data will be analyzed using thematic content analysis. Discussion Severe acute malnutrition is a public health problem that remains the underlying cause for over half of under-five mortality in Ethiopia. As a result, community-based therapeutic care has been launched in the country to address these problems and maximize population-level impact by improving treatment coverage, access, and cost-effectiveness. Despite its achievement, the program has been threatened with unfavourable treatment outcomes and a shortfall of resources. Hence, this implementation evaluation study will also identify gaps between healthcare systems and service users. The output will help programmers pass evidence-based and sound decisions to tackle the key barriers.