Appropriateness and timeliness of care-seeking for complications of pregnancy and childbirth in rural Ethiopia: a case study of the Maternal and Newborn Health in Ethiopia Partnership|
Sibley, Lynn M.; Amare, Yared; Abebe, Solomon Tesfaye; Belew, Mulusew Lijalem; Shiffra, Kemeredin & Barry, Danika
Background: In 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating
Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition
and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving
descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including
Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study.
Methods: Methods included secondary analysis of data from MaNHEP’s 2010 baseline and 2012 end line surveys,
health program inventory and facility mapping to contextualize care-seeking, and illness narratives to identify factors
influencing illness recognition and care-seeking. Analyses used descriptive statistics, bivariate tests, multivariate logistic
regression, and thematic content analysis.
Results: Maternal illness awareness increased between 2010 and 2012 for major obstetric complications. In 2012, 45%
of women who experienced a major complication sought biomedical care. Factors associated with care-seeking were
MaNHEP CMNH Family Meetings, health facility birth, birth with a skilled provider, or health extension worker. Between
2012 and 2014, the Ministry of Health introduced nationwide initiatives including performance review, ambulance
service, increased posting of midwives, pregnant women’s conferences, user-friendly services, and maternal death
surveillance. By 2014, most facilities were able to provide emergency obstetric and newborn care. Yet in 2014,
biomedical care-seeking for perceived maternal illness occurred more often compared with care-seeking for newborn
illness—a difference notable in cases in which the mother or newborn died. Most families sought care within 1 day of
illness recognition. Facilitating factors were health extension worker advice and ability to refer upward, and health
facility proximity; impeding factors were time of day, weather, road conditions, distance, poor cell phone connectivity
(to call for an ambulance), lack of transportation or money for transport, perceived spiritual or physical vulnerability of
the mother and newborn and associated culturally determined postnatal restrictions on the mother or newborn’s
movement outside of the home, and preference for traditional care. Some families sought care despite disrespectful,
poor quality care.
Conclusions: Improvements in illness recognition and care-seeking observed during MaNHEP have been reinforced
since that time and appear to be successful. There is still need for a concerted effort focusing on reducing identified
barriers, improve quality of care and provider counseling, and contextualize messaging behavior change
communications and provider counseling.
Illness recognition; Care-seeking; Maternal and newborn complications; Community-oriented interventions