Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia

Figures & data

Figure 1 Conceptual framework of the factors affecting the use of skilled delivery service.

Notes: From the three delays for seeking care, only the first and second phases are relevant for receiving normal delivery care. Adapted from Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(9):1091–1110.¹⁶
Abbreviation: ANC, antenatal care.

Table 1 Sociodemographic characteristics of mothers who participated in the study in northern Ethiopia, 2015

Sociodemographic characteristics	Frequency	Percentage
Age (years)
≤20	225	12.5
21–29	928	51.7
30–38	571	31.8
≥39	72	4.0
Marital status
Single	66	3.6
Married	1,578	87.9
Widowed	21	1.2
Divorced	73	4.1
Separated	58	3.2
Religion
Orthodox Christian	1,620	90.2
Muslim	176	9.8
Educational status of mothers
No schooling	824	45.9
Junior (1–4 grades)	236	13.1
Elementary (5–8 grades)	392	21.8
Secondary (9–12 grades)	281	15.7
Diploma and above	63	3.5
Occupational status of mothers
Housewife	717	39.9
Merchant	314	17.5
Employed	148	8.2
Farmer	617	34.4
Wealth index
Very poor	360	20.0
Poor	371	20.7
Medium	347	19.3
Wealthy	359	19.0
Very wealthy	359	19.0

Table 2 Perception of mothers toward the accessibility and quality of maternity services in their catchment area in northern Ethiopia, 2015

Perception of mothers	Total (%)	Skilled delivery use		p-value
		Yes (%)	No (%)
Distance to the nearest health facility				<0.001
<30 min walking time	899 (50.1)	768 (85.4)	131 (14.6)
≥30 min walking time	897 (49.9)	643 (71.7)	254 (28.3)
Easy transport service from home to the nearest health facility				0.009
Yes	1,152 (64.1)	484 (75.2)	160 (24.8)
No	644 (35.9)	927 (80.5)	225 (19.5)
Service providers are capable of handling birth-related problems				<0.001
Yes	1,055 (58.7)	873 (82.7)	182 (17.3)
No	741 (41.3)	538 (70.1)	203 (29.9)
There is availability of adequate equipment in delivery service at the nearest facility				<0.001
Yes	856 (47.7)	720 (84.1)	136 (15.9)
No	940 (52.3)	691 (73.5)	249 (26.5)

Table 3 Factors associated with skilled delivery service utilization in northern Ethiopia, 2015

Variables	Skilled delivery utilization		COR (95% CI)	AOR (95% CI)
	Yes (%)	No (%)
Age of the mother, years
≤20	203 (90.2)	22 (9.8)	1	1
21–29	771 (83.1)	157 (16.9)	0.53 (0.33, 0.85)a	0.94 (0.51, 1.71)
30–38	384 (67.3)	187 (32.7)	0.22 (0.14, 0.36)b	0.65 (0.32, 1.28)
≥39	53 (73.6)	19 (26.4)	0.30 (0.15, 0.60)b	0.93 (0.38, 2.26)
Marital status
Single	55 (83.3)	11 (16.7)	1	1
Married	1,243 (78.8)	335 (21.2)	0.74 (0.38, 1.43)	0.68 (0.33, 1.50)
Widowed/divorced/separated	113 (74.3)	39 (25.7)	0.58 (0.27, 1.22)	0.45 (0.20, 1.11)
Educational status of mother
No schooling	579 (70.3)	245 (29.7)	1	1
Junior (1–4 grades)	185 (78.4)	51 (21.6)	1.53 (1.09, 2.17)a	0.91 (0.59, 1.43)
Elementary (5–8 grades)	330 (84.2)	62 (15.8)	2.25 (1.65, 3.07)b	0.83 (0.54, 1.28)
Secondary (9–12 grades)	259 (92.2)	22 (7.8)	4.98 (3.14, 7.89)b	1.17 (0.64, 2.16)
Diploma and above	58 (92.1)	5 (7.9)	4.9 (1.95, 12.39)b	0.81 (0.24, 2.69)
Education of partner/husband
No schooling	494 (68.2)	230 (31.8)	1	1
Junior (1–4 grades)	159 (77.9)	45 (22.1)	1.65 (1.14, 2.37)a	1.26 (0.83, 1.93)
Elementary (5–8 grades)	297 (82.0)	65 (18.0)	2.13 (1.56, 2.90)b	1.68 (1.12, 2.51)a
Secondary school and above	461 (91.1)	45 (8.9)	4.77 (3.38, 6.73)b	2.15 (1.31, 3.52)a
Occupation of mother
Housewife	585 (81.9)	130 (18.1)	1	1
Merchant	263 (83.8)	51 (16.2)	1.41 (0.80, 1.63)	1.11 (0.74, 1.67)
Employed	130 (87.9)	18 (12.1)	1.6 (0.94, 2.71)	1.42 (0.72, 2.78)
Farmer	431 (69.9)	186 (30.1)	0.51 (0.40, 0.66)b	0.97 (0.70, 1.33)
Birth order
First	436 (92.4)	36 (7.6)	1	1
Second	296 (82.2)	64 (17.8)	0.38 (0.25, 0.59)b	0.40 (0.24, 0.68)b
Third	231 (78.6)	63 (21.4)	0.30 (0.19, 0.47)b	0.38 (0.22, 0.67)b
Fourth and above	448 (66.9)	222 (33.1)	0.17 (0.11, 0.24)b	0.29 (0.16, 0.51)b
Recent pregnancy
Wanted	1,311 (79.2)	344 (20.8)	1	1
Unwanted	100 (70.9)	41 (29.1)	0.64 (0.44, 0.94)a	0.74 (0.47, 1.18)
Antenatal care utilization for the recent birth
Yes	1,313 (83.1)	268 (16.9)	1	1
No	98 (45.6)	117 (54.4)	0.17 (0.13, 0.23)b	0.17 (0.12, 0.25)b
Mother experienced any complication during childbirth for recent pregnancy
No	1,018 (76.5)	313 (23.5)	1	1
Yes	393 (84.5)	72 (15.5)	1.68 (1.27, 2.22)b	1.98 (1.44, 2.71)b
Mother knows a place for delivery service
Yes	1,112 (80.3)	273 (19.7)	1	1
No	299 (72.7)	112 (27.3)	0.65 (0.51, 0.84)b	0.79 (0.57, 1.49)
Mothers were aware of the danger signs of pregnancy, labor and delivery
Yes	993 (80.7)	238 (19.3)	1	1
No	418 (74.0)	147 (26.0)	0.68 (0.54, 0.86)b	1.08 (0.79, 1.49)
Mothers perceived that service providers are capable of handling birth-related problems
No	538 (70.1)	203 (29.9)	1	1
Yes	873 (82.7)	182 (17.3)	1.81 (1.44, 2.27)b	1.32 (0.97, 1.80)
Mothers perceived that there is availability of adequate equipment in delivery service
No	691 (73.5)	249 (26.5)	1	1
Yes	720 (84.1)	136 (15.9)	1.91 (1.51, 2.41)b	1.54 (1.11, 2.13)a
Distance to the nearest health facility
<30 min walking time	768 (85.4)	131 (14.6)	1	1
≥30 min walking time	643 (71.7)	254 (28.3)	0.43 (0.34, 0.55)b	0.53 (0.39, 0.71)b
Easy transport service from home to the nearest health facility
No	484 (75.2)	160 (24.8)	1	1
Yes	927 (80.5)	225 (19.5)	1.36 (1.08, 1.71)a	0.57 (0.42, 0.77)b

Note:

a p<0.05,

b p≤0.001.

Abbreviations: CI, confidence interval; COR, crude odds ratio.

ThaddeusSMaineDToo far to walk: maternal mortality in contextSoc Sci Med1994389109111108042057

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