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Knowledge, Attitudes, and Practices Surrounding Maternal and Newborn Health Among Community-based Health Workers in Amhara Region, Ethiopia

Hackett, Stephanie Frances Apuzzo (2012)
Master's Thesis (140 pages)
Committee Chair / Thesis Adviser: Stephenson, Robert
Committee Members:
Research Fields: Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: Maternal Health; Community-based Health Workers; Ethiopia
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url: http://pid.emory.edu/ark:/25593/cr3z2

Abstract

Background:

Ethiopia has a maternal mortality ratio of 673 per 100,000 live births and a 1 in 27 lifetime risk of maternal death1. The 2005 Ethiopia DHS reports 94% of births occur at home and a skilled attendant attends only 5.7% of births. The neonatal mortality rate also remains high, with 39 per 1,000 newborns dying within the first month of life. In a country where 85% of the population is classified as rural, access to health services presents an immense challenge in the provision of adequate healthcare2.

Objective:

This study aimed to understand factors associated with the delivery of maternal and newborn health services by community-based health workers in Amhara region Ethiopia.

Methods: A survey was conducted with 169 community-based health workers in Amhara region Ethiopia. The surveys collected data on knowledge, attitudes and practices surrounding 18 key maternal and newborn health practices as well as demographics and perceived trust and confidence during the antenatal, labor and delivery, and postpartum period.

Results:

HEWs are the most educated (p<.000), have received more Clean and Safe Birth training (p<.000), and have the greatest overall knowledge of 18 maternal and newborn health practices that reduce mortality (p<.000), however in practice only 71% of HEWs attend births and among those who do, TBAs are attending statistically more births each month (p<.000). While only a tenth of the vCHWs attend births they have higher overall knowledge of key maternal health practices as compared to TBAs.

Discussion:

While most community-based health worker attitudes and knowledge support the goals of the Ethiopian Health Extension Program, in practice, TBAs are still providing the most labor and delivery care. It is important to bridge the gap in knowledge and practices of community health workers programmatically in order to ensure community members receive the most effective maternal and newborn care.

Table of Contents

Table of Contents

List of Figures................. 9

List of Tables................. 9

Chapter One: Introduction................. 10

Objective:........... 11

Aims:........... 11

Background........... 11

Amhara Region........... 12

West Gojjam Zone..... 13

Woreda level descriptions..... 14

Governmental Involvement........... 16

Study population - FLW's........... 18

Summary........... 19

Chapter Two: Comprehensive Review of the Literature................. 20

Community Health Worker Programs........... 20

Implementation difficulties..... 21

Training deficiencies..... 22

Overburdened Workers..... 24

Program Oversight..... 25

Community Attitudes..... 25

Insufficient Governmental Policy..... 26

Poor Government Funding..... 28

CHW Profiles........... 29

Nepal- Female Community Health Volunteer Program..... 29

Brazil- Family Health Program..... 31

Traditional and Trained Traditional Birth Attendants........... 32

Ethiopia's Health Extension Program........... 34

HEWs relationship with other CHWs..... 37

Effectiveness of HEW work..... 38

Strengths of the HEW model..... 41

Weaknesses of the HEW model..... 42

Gaps in Knowledge........... 44

Chapter Three: Methodology and Results................. 45

Conceptualization of 18 MNH package items........... 45

Tool Development........... 47

Translation of tools........... 54

Training of Enumerators........... 54

Pilot testing........... 55

Sampling method........... 56

Data Entry & Data Analysis........... 56

Results................. 57

Demographics:........... 57

Key Demographic Results........... 57

General Job Perceptions:........... 59

Key General Job Perception Results........... 59

Maternal and Newborn Health Practices........... 61

Perceptions of Duties, Knowledge, and Trust among FLWs: Antenatal Care........... 63

Personal Attitudes Towards and Knowledge of Antenatal Care........... 66

Perceptions of Duties, Knowledge, and Trust among FLWs: Labor/Birth Care........... 68

Personal Knowledge and Attitudes Towards Labor and Birth Care........... 70

Perceptions of Duties, Knowledge, and Trust among FLWs: Postpartum Care........... 73

Personal Knowledge and Attitudes Towards Postpartum Care........... 75

Perceptions of Duties, Knowledge, and Trust among FLWs: Newborn Care........... 76

Personal Knowledge and Attitudes Towards Newborn Care........... 78

Knowledge of MNH Package Items Among All FLW........... 80

Differences in Knowledge of MNH Package Items by MNH Training........... 86

Differences in Knowledge of MNH Package Items by Location........... 88

FLW Perceptions of the Duty to Perform MNH Package Items........... 91

Practice of Skills At Last MNH Visit Among FLW with Ability to Perform Skill........... 96

Teamwork Among FLW........... 98

Chapter Four: Discussion, Conclusion, and Recommendations................. 98

References................. 110

Appendix 1: Survey................. 116

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