Association between health insurance enrolment and maternal health care service utilization among women in Ethiopia

Background Health insurance was considered as the third global health transition which can increase access to health care services by eliminating monetary obstacles to maternal health care use, particularly in emerging nations. Hence, this study aimed to assess the association between health insurance enrolment and maternal health care service utilization among women in Ethiopia. Methods A cross-sectional study was conducted using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set. About 4278 mothers who had delivered at least one child in the last five years of the survey were selected in the study. Multivariate logistic regression analysis was performed to measure the relationship between health insurance enrolment and maternal health care service utilization by controlling confounders An adjusted odds ratio with a 95% confidence interval and p-values < 0.05 were well-thought-out to state the imperative association. Results The overall health insurance coverage among the women was 4.7%. About, 18.1% of women from households in the poorest wealth quantile had no health insurance coverage for maternal health care services. Moreover, 84% of women lived in a rural area did not enclose by health insurance. According to multivariate logistic regression, the likelihoods of ANC utilization were 1.54 times (AOR: 1.54; 95% CI: 1.06–2.25) higher among mothers who were enrolled in health insurance compared to their counterparts. In the same vein, the likelihoods of been attended by a skilled birth attendant were 1.84 times (AOR: 1.84; 95% CI: 1.1–3.08) higher among mothers who were enrolled in health insurance. Conclusions This study has shown that women enrolled in health insurance were associated with skilled delivery and recommended ANC utilization than women who did not enroll in health insurance. Health insurance enrolment enterprises must be available to all pregnant women, particularly those of poorer socioeconomic rank.

CULTURAL COMPETENCE OF HEALTH CARE WORKERS ON MATERNAL HEALTH CARE SERVICE UTILIZATION AMONG MOTHERS OF MOUNT ELGON CONSTITUENCY BUNGOMA, KENYA

Purpose: To determine cultural competence of health care workers on maternal health care service utilization among mothers of Mt. Elgon Constituency in Bungoma County. Methodology: A descriptive-analytical cross-sectional study design was adopted using mixed methods for data collection. Cultural competence tool was used to assess health care workers cultural competence. Qualitative data was collected using key informant interviews (KII) and focus group discussion (FGD). Data entry and analysis was done using SPSS Version 25 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and odds ratio used to determine the strength of association. A p-value of ≤ 0.05 was considered as statistical significance threshold. Findings: Unemployment (OR: 0.6; 95% CI: 0.4 – 0.9; p = 0.02); lack of mobile clinic (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.06 ); use of interpreter (OR: 0.2; 95% CI: 0.01 – 0.81; p = 0.02); service provided in public facilities (OR: 0.5; 95% CI: 0.3 – 0.8; p = 0.004); being too busy (OR: 0.5; 95% CI: 0.3 – 0.9; p = 0.02); consulting health care workers (OR: 0.5; 95% CI: 0.2 – 0.9; p = 0.03); not consulting elders (OR: 0.7; 95% CI: 0.4 – 1.0; p = 0.08) and culturally incompetent ( 100%) were significantly associated with utilization of maternal and child health services. The determinants of maternal health care service utilization in Mt. Elgon Sub-County are women who are employed (OR: 2.8; 95% CI: 1.1 – 7.3; p=0.03) and cultural incompetence of health care workers (100%). A unique contribution to theory, practice, and policy: The study findings have identified cultural competence gaps among health care workers which need to be addressed by policy makers to increase utilization in the study area and other similar environment

Obstetric violence and its associated factors among postnatal women in a Specialized Comprehensive Hospital, Amhara Region, Northwest Ethiopia

Objective Obstetric violence is an often overlooked obstacle to quality maternal health care service utilization. In the study setting, there was limited evidence on obstetric violence. Hence, this study aimed at assessing the prevalence and associated factors of obstetric violence among women who gave birth in Gondar University Specialized Comprehensive Hospital, Northwest Ethiopia. Results A total of 409 women had been participated in the study with a response rate of 100%. Three in four (75.1%) women reported that they had been subjected to at least one form of obstetric violence during labor and delivery with 95% CI (70.9–79.0). The reported forms of obstetric violence include non-consented care—260 (63.6%), non-dignified care—226 (55.3%), physical abuse—192 (46.9%), non-confidential care—132 (32.3%, neglected care—52 (12.7%) and discriminated care—38 (9.3%). On the contrary, none of the respondent had reported detention for failure to pay in the hospital. The multivariable logistic regression analysis demonstrated that urban residents (AOR = 1.89; 95% CI 1.11, 3.22) and primary school attendants (AOR = 0.49; 95% CI 0.27, 0.91) were significantly associated with experiencing obstetric violence. This study indicated the high prevalence of obstetric violence. Thus, interventions need to be undertaken by taking the reported forms of obstetric violence and participants’ sociodemographic status in to account.