araya-thesis

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Chapter 2 health services is one element [22,23]. In consideration of these other social determinants of women’s health, this study looked at whether participating in IGAs had an association with utilization of maternal health services. Logistic regression analysis revealed women who have been participating in three and more income generating activities were 1.72 times more likely to have good utilization of comprehensive maternal health services. The regression analysis also identified women who were literate, listened to the radio, and had been working towards graduation or graduated as model families for HEP were more likely to have good utilization of maternal health services. Hence these potential social factors could be targets for future intervention and support, as a means of increasing health care utilization. Year of enrolment into the HEP was not associated with good utilization of maternal health services. This may be due to the effect of diffusion of the intervention. Households who were enrolled later into the program may have opportunities to learn and share experience on positive health behaviours and information from households that were enrolled earlier. Strength and limitation of the study Our study examined utilization of maternal health services among rural women who are difficult to reach. Our study is a cross sectional study and it may be difficult to attribute all the changes in utilization of maternal health services to the deployment of HEWs. Comparing our findings from a local sample with a national survey has its own limitation as the study population of our survey is small in size and from a specific region of the country while the national survey is large in size and representative for the whole country. Nevertheless, similar findings on improvements on utilization of family planning, antenatal care and HIV testing after the introduction of the HEP were observed by other studies conducted in other regions of the country. Thus the conclusions made in our study are most likely hold true not only for our study area but also for other areas in the country irrespective of the difference in socio‐demographic characteristics across the country. It is worthy considering the way the outcome index (maternal health service utilization) is constructed, the variables chosen to construct this index and its categorization into good and poor. Had we chosen different variables and categorization to construct this outcome index, the results might have been different. Recall bias might also influence some of the results such as information on whether a household had been working towards graduation or graduated as model family or not and women’s involvement in IGA or not, because we took women’s word for these variables. Some important determinants of maternal health services utilization, for example distance to health facility, timing and frequency of HEWs visits, and household‐decision making practices are not taken into account in our study. We recommend further study on the effect of these factors on utilization of maternal health services by rural women. 38
Role of HEWs in improving utilization of maternal health services Conclusions This study has shown HEWs have brought essential maternal health care closer to the rural population in Ethiopia. Nevertheless their success is not for all components of maternal health services. HEWs brought improvement in utilization of family planning, ANC and HIV testing but not in assisting births. The perception that HEWs’ may be less competent in assisting births, the huge workload they already have, poorly equipped health posts and strong cultural beliefs supporting home births, make it unreasonable at the present time to expect substantial change in where and how women give birth. These challenging factors call for innovative strategies to support the efforts of HEWs in identifying risky mothers, birth preparedness and to improve their referral to health centers where midwives and better facilities for assisting births are available. 39
Page 2 and 3: © Araya Abrha Medhanyie, Maastrich
Page 4 and 5: Promotor Prof. dr. G.J. Dinant Copr
Page 7 and 8: Abbreviations AIDS ANC AOR CBRHA CH
Page 9 and 10: Chapter 1 General introduction 9
Page 11 and 12: Introduction Maternal health and mo
Page 13 and 14: Introduction Map 1. Map of Ethiopia
Page 15 and 16: Introduction Map 2 The Tigray regio
Page 17 and 18: Introduction In 2010/2011, the Fede
Page 19 and 20: Introduction Cross‐sectional surv
Page 21 and 22: Introduction Outline of thesis In C
Page 23 and 24: Introduction References 1. Hogan MC
Page 25 and 26: Chapter 2 The role of health extens
Page 27 and 28: Role of HEWs in improving utilizati
Page 37: Role of HEWs in improving utilizati
Page 41 and 42: Chapter 3 Knowledge and performance
Page 43 and 44: Knowledge and performance of HEWs o
Page 57 and 58: Chapter 4 Meeting community health
Page 59 and 60: Health Workers Needs and Mobile Tec
Page 83 and 84: Chapter 5 Mobile health data collec
Page 85 and 86: Mobile health data collection Intro
Page 87 and 88: Mobile health data collection summa
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Mobile health data collection cente
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Mobile health data collection Discu
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Mobile health data collection that
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Mobile health data collection 21. M
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Chapter 6 Abstract Background Mobil
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Chapter 6 birth attendants increase
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Chapter 6 of mobile phone, motivati
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Chapter 6 Figure 6.1 Total number o
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Chapter 6 was also evident from the
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Chapter 6 Five (21.7%) of the healt
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Chapter 6 made approximately 163 mi
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Chapter 6 23. Mosa AS, Yoo I, Sheet
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Chapter 7 Abstract Background Mobil
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Chapter 7 settings [8,9,10]. The ve
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Chapter 7 Table 7.1 Selected variab
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Chapter 7 in electronic records wer
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Chapter 7 and forgetting decimal po
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Chapter 7 we compared two separate
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Chapter 8 General discussion 127
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General discussion General discussi
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General discussion birth attendant.
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General discussion treatment suppor
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General discussion would pose a dif
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General discussion Cost implication
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General discussion measure any sign
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General discussion References 1. Me
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Valorisation 143
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Valorisation Valorisation: Implicat
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Valorisation In this research we te
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expansion of the primary health car
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analytics and maternal‐newborn pr
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poor knowledge and performance of t
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ክ ፍ ል ለ ማዳ ረ ስ ና
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ነ ው፡ ፡ በ መቀ ጠል
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ምዕ ራፍ ሦስ ት፤ የ ጤ
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የ ህ ሙማን መመር መሪ
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ምእ ራፍ ስ ምን ት፤ ይ
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ተግባ ራዊ ይገ ብራ፡
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ኣብ ምምሕያሽ ግልጋሎ
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ም ዕ ራ ፍ ሰ ለ ስ ተ ፤
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ም ዕ ራ ፍ ሽ ዱ ሽ ተ ፤
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ም ዕ ራ ፍ ሸ ሞ ን ተ ፤
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HEWs para priorizar los casos de al
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prenatal, parto y postnatal. Median
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La escalabilidad en la introducció
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to express my heartfelt gratitude t
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Biography 195
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Biography Biography Araya Abrha Med
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