Maternal Health in Amhara Region, Ethiopia: Relationship between Continuum of Care and Perceived Maternal Trust of Frontline Healthcare Workers Open Access

Abstract

Background: There has been rising attention paid to maternal health and the need to provide women in reproductive age with a full continuum of care. Nevertheless, the literature examining the impact of maternal trust of Frontline Healthcare Workers on the continuum of maternal care in rural Ethiopia is sparse.

Objective: This study sought to examine the relationship between adherence to the World Health Organization (WHO) continuum of care model and perceived maternal trust of Frontline Healthcare Workers in Amhara region.

Methods: Bivariate analyses were conducted to examine the potential association between utilization of the continuum of care and maternal socioeconomic status, literacy, maternal trust of the Frontline Healthcare Workers for antenatal, labor/delivery and postpartum care. Moreover, bivariate analyses were conducted to examine the general attitude of mothers whom they think should provide antenatal, labor/delivery and postpartum care during pregnancy. Finally, ordinal logistic regression looked at (1) the predictive value of the various components of maternal trust and (2) to look at the predictive values of knowledge, access and utilization of Frontline Healthcare Workers on the reporting of maternal trust during pregnancy, delivery and postpartum.

Result: Less than 35% of pregnancies between 2009-2010 met WHO standards for antenatal, delivery and postpartum care. Meeting the WHO standards of care at one stage was significantly associated with meeting subsequent standard of care. About 61% of the women had heard of HEWs, 18% had heard of vCHWs and 79% had heard of TBAs. More than 50% of the women indicated not trained healthcare personnel should provide 61% antenatal care, 73% labor and deliver and 90% postpartum care. Greater maternal knowledge, easier access and prior utilization associated with at least two times higher odds of having more trust of FHWs.

Discussion: The Amhara region survey indicates many serious deficiencies in knowledge, access and utilization of care. However, it also points out providing women with a continuum of maternal health care presents an optimistic health outcome. This study found that subsequent antennal, delivery and postpartum care is positively associated with trust on the FHWs.

Table of Contents

Table of Contents
Chapter 1. Introduction...................................................................................................1
Addressing Reproductive Health in Ethiopia ...........................................................................1
Continuum of Maternal, Newborn and Child Health Care ..........................................................1
Reproductive Health in the Ethiopia Context ..........................................................................6
Study Rational .................................................................................................................8
Research Questions .........................................................................................................10
Chapter 2. Review of the Literature .................................................................................11
Maternal Morbidity and Mortality ........................................................................................11
Continuum of Care ...........................................................................................................12
Reproductive Health in Rural Amhara Region ........................................................................12
Ethiopia's Health Extension Program ...................................................................................17
Summary .......................................................................................................................19
Chapter 3. Methodology ..................................................................................................20
Study Population ..............................................................................................................20
Sample Size and Research Design ................................................................................ ......20
Procedures ......................................................................................................................21
Instrument.......................................................................................................................22
IRB and Confidentiality ................................................................................................ .....22
Data Analysis ...................................................................................................................23
Chapter 4. Results ...........................................................................................................26
Descriptive characteristics of the study population............................................................ ......26
Demographics Characteristics ......................................................................................... ....30
Continuum of Care and WHO Standards ................................................................................ 32
Knowledge, access and use of Front-Line Healthcare Workers .................................................. .36
General Attitude of Care Provide during Antenatal, Labor and Delivery and Postpartum Care .39
Perceived Maternal Trust of Frontline Healthcare Workers ................................................. ........44
Chapter5. Discussion .........................................................................................................50
Summary of findings ............................................................................................................50
Demographic characteristics ..................................................................................................50
Continuum of Care ...............................................................................................................51
Limitations of the Analysis .....................................................................................................54
Recommendations ................................................................................................................54
References ........................................................................................................................56
Annex A. WHO recommended Interventions for Improving Maternal Health .....................................59
Annex B. Questions Used in Analysis ........................................................................................60
Annex C. IRB Exemption .........................................................................................................76

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Maternal Health in Ethiopia
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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