Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: A prospective cohort study

Autoři: Moges Tadesse Borde aff001;  Eskindir Loha aff001;  Kjell Arne Johansson aff005;  Bernt Lindtjorn aff001
Působiště autorů: School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia aff001;  Centre for International Health, University of Bergen, Bergen, Norway aff002;  School of Public Health, College of Medicine and Health Sciences, Dilla, Dilla University, Ethiopia aff003;  Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England, United Kingdom aff004;  Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0215195


Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.

Klíčová slova:

anémia – Antenatal care – Ethiopia – Hypertensive disorders in pregnancy – Pregnancy – Socioeconomic aspects of health – Stillbirths – Women's health


1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, et al. (2016) Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 387: 462–474. doi: 10.1016/S0140-6736(15)00838-7 26584737

2. Chou D, Tunçalp Ö, Firoz T, Barreix M, Filippi V, et al. (2016) Constructing maternal morbidity–towards a standard tool to measure and monitor maternal health beyond mortality. BMC Pregnancy and Childbirth 16: 45. doi: 10.1186/s12884-015-0789-4 26935070

3. Lee BX, Kjaerulf F, Turner S, Cohen L, Donnelly PD, et al. (2016) Transforming Our World: Implementing the 2030 Agenda Through Sustainable Development Goal Indicators. J Public Health Policy 37 Suppl 1: 13–31.

4. Wilson RE, HM. S (2007) The paradox of obstetric "near misses": converting maternal mortality into morbidity. Int J Fertil Womens Med 52: 121–127. 18320871

5. Ashford L (2002) Hidden suffering: disabilities from pregnancy and childbirth in less developed countries, Washington, D.C.

6. World Bank (1999) Safe Motherhood and The World Bank, Washington, DC: The World Bank.

7. Mekonnen A, Mahmoud E, Fantahun M, Hagos S, Assegid M (2013) Maternal morbidity in Butajira and Wukro districts, North and South central Ethiopia. Ethiop Med J 51: 239–248. 24696974

8. Qureshi RN, Sheikh S, Khowaja AR, Hoodbhoy Z, Zaidi S, et al. (2016) Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: a qualitative study. Reproductive health 13 34–34. doi: 10.1186/s12978-016-0140-1 27356863

9. Chakraborty N, Islam MA, Chowdhury RI, Bari W, Akhter HH (2003) Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International 18: 327–337. doi: 10.1093/heapro/dag414 14695364

10. Lindtjorn B, Mitiku D, Zidda Z, Yaya Y (2017) Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia. PLoS One 12: e0169304. doi: 10.1371/journal.pone.0169304 28046036

11. Lindtjorn B, Mitike D, Zidda Z, Yaya Y (2018) Reducing stillbirths in Ethiopia: Results of an intervention programme. PLoS One 13: e0197708. doi: 10.1371/journal.pone.0197708 29847607

12. Singh S et al (2018) Abortion Worldwide 2017: Uneven Progress and Unequal Access, New York: Guttmacher Institute.

13. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, et al. (2016) National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 4: e98–e108. doi: 10.1016/S2214-109X(15)00275-2 26795602

14. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV (2011) Anaemia in low-income and middle-income countries. Lancet 378: 2123–2135. doi: 10.1016/S0140-6736(10)62304-5 21813172

15. Asrie F (2017) Prevalence of anemia and its associated factors among pregnant women receiving antenatal care at Aymiba Health Center, northwest Ethiopia. J Blood Med 8: 35–40. doi: 10.2147/JBM.S134932 28442940

16. WHO (2002) Iron and folate supplementation: Integrated Management of Pregnancy And Childbirth.

17. Palacios C, Pena-Rosas JP (2010) Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems: RHL commentary The WHO Reproductive Health Library; Geneva.

18. Berhe AK, Kassa GM, Fekadu GA, Muche AA (2018) Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC Pregnancy and Childbirth 18: 34. doi: 10.1186/s12884-018-1667-7 29347927

19. CSA Central Statistical Agency of Ethiopia] and ICF (2016) Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF.

20. Haradhan M (2013) Ethiopia: A socio-economic study. Journal of Business Management and Administration 1: 59–74.

21. CSA (2012) The 2007 Population and Housing census of Ethiopia: Administrative report. Addis Ababa.

22. Wonago district Office of Finance and Economic Development (2016) Annual statistical report of Wonago district.

23. Hofmann B (2002) On the triad disease, illness and sickness. J Med Philos 27: 651–673. doi: 10.1076/jmep.27.6.651.13793 12607162

24. WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity, Vitamin and Mineral Nutrition Information System. Geneva, (http://www.who.int/vmnis/indicators/haemoglobin. accessed [10.29.2018]).

25. American College of Obstetricians and Gynecologists' Task Force (2013) Report on Hypertension in Pregnancy. Obstet Gynecol 122: 1122–1131. doi: 10.1097/01.AOG.0000437382.03963.88 24150027

26. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, et al. (2005) Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 111: 697–716. doi: 10.1161/01.CIR.0000154900.76284.F6 15699287

27. Ravallion, Martin; Chen; Shaohua; and Prem Sangraula (2009) “Dollar-a-Day Revisited”, World Bank Economic Review, Vol. 23, No. 2, pp. 163–184.

28. Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, et al. (2016) Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 34: 6057–6068. doi: 10.1016/j.vaccine.2016.03.044 27431422

29. Yang W, Jepson C, Xie D, Roy JA, Shou H, et al. (2017) Statistical Methods for Recurrent Event Analysis in Cohort Studies of CKD. Clin J Am Soc Nephrol 12: 2066–2073. doi: 10.2215/CJN.12841216 28716856

30. Amorim LD, Cai J (2015) Modelling recurrent events: a tutorial for analysis in epidemiology. Int J Epidemiol 44: 324–333. doi: 10.1093/ije/dyu222 25501468

31. Hosmer D. W. and Lemeshow S. (1999) Applied Survival Analysis Regression Modeling of Time to Event Data, New York, USA.

32. Bhatia JC (1995) Levels and determinants of maternal morbidity: results from a community-based study in southern India. Int J Gynaecol Obstet 50 (Suppl 2).

33. Midhet F (2007) Prevalence and Determinants of Self-reported Morbidity among Pregnant Women in Rural Areas of Pakistan. Int J Health Sci (Qassim) 1: 243–248.

34. Agampodi SB, Wickramasinghe ND, Horton J, Agampodi TC (2013) Minor ailments in pregnancy are not a minor concern for pregnant women: a morbidity assessment survey in rural Sri Lanka. PLoS One 8: e64214. doi: 10.1371/journal.pone.0064214 23675528

35. Mwilike B, Nalwadda G, Kagawa M, Malima K, Mselle L, et al. (2018) Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in Urban Tanzania: a cross-sectional study. BMC Pregnancy and Childbirth 18: 4. doi: 10.1186/s12884-017-1628-6 29295710

36. Eittah. HFA Pregnant woman's knowledge, reaction to danger signs of pregnancy and utilization of antenatal services. American Journal of Research Communication, 2017, 5(6): 14–35} www.usa-journals.com, ISSN: 2325-4076.

37. Lebso M, Anato A, Loha E (2017) Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLOS ONE 12: e0188783. doi: 10.1371/journal.pone.0188783 29228009

38. Getahun W, Belachew T, Wolide AD (2017) Burden and associated factors of anemia among pregnant women attending antenatal care in southern Ethiopia: cross sectional study. BMC research notes 10: 276–276. doi: 10.1186/s13104-017-2605-x 28705235

39. Harvey T, Zkik A, Auges M, Clavel T (2016) Assessment of iron deficiency and anemia in pregnant women: an observational French study. Women's health, London, England; 12: 95–102.

40. Yang J, Wang Y, Wang X-Y, Zhao Y-Y, Wang J, et al. (2017) Adverse Pregnancy Outcomes of Patients with History of First-Trimester Recurrent Spontaneous Abortion. BioMed research international 2017: 4359424–4359424. doi: 10.1155/2017/4359424 28798930

41. Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, et al. (2018) Anaemia in Pregnancy: Prevalence, Risk Factors, and Adverse Perinatal Outcomes in Northern Tanzania. Anemia 2018: 1846280–1846280. doi: 10.1155/2018/1846280 29854446

42. Koenig MA, Jamil K, Streatfield PK, Saha T, Al-Sabir A, et al. (2007) Maternal health and care-seeking behavior in Bangladesh: findings from a national survey. Int Fam Plan Perspect 33: 75–82. doi: 10.1363/3307507 17588851

43. Sibbritt D, Ladanyi S, Adams J (2016) Healthcare practitioner utilisation for back pain, neck pain and/or pelvic pain during pregnancy: an analysis of 1835 pregnant women in Australia. Int J Clin Pract 70: 825–831. doi: 10.1111/ijcp.12870 27620139

44. Runkle J, Flocks J, Economos J, Tovar-Aguilar JA, McCauley L (2014) Occupational risks and pregnancy and infant health outcomes in Florida farmworkers. International journal of environmental research and public health 11: 7820–7840. doi: 10.3390/ijerph110807820 25101767

45. Dalaba MA, Akweongo P, Aborigo RA, Saronga HP, Williams J, et al. (2015) Cost to households in treating maternal complications in northern Ghana: a cross sectional study. BMC health services research 15: 34–34. doi: 10.1186/s12913-014-0659-1 25608609

46. Yaya Y, Data T, Lindtjorn B (2015) Maternal mortality in rural south Ethiopia: outcomes of community-based birth registration by health extension workers. PLoS One 10: e0119321. doi: 10.1371/journal.pone.0119321 25799229

47. IDMC (2018) Internal Displacement Monitoring Centre NRC, 3 rue de Varembé, 1202 Geneva, Switzerland, www.internal-displacement.org accessed on 12/20/2018.

48. Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W (2019) Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services. Globalization and Health 15: 24. doi: 10.1186/s12992-019-0470-1 30914055

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2019 Číslo 12
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