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Addis Ababa University College of Health Sciences ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES SCHOOL OF PUBLIC HEALTH ASSESSMENT OF UTILIZATION AND FACTORS OF SKILLED BIRTH ATTENDANCE AMONG WOMEN OF CHILDBEARING AGE IN ANKASHA GUAGUSA WOREDA, AWI ZONE, AMHARA REGIONAL STATE, NORTHWEST ETHIOPIA. BY: MULUNESH ALEMAYEHU (B.Sc.) ADVISOR: WUBEGZIER MEKONNEN (PhD) A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES OF ADDIS ABABA UNIVERSITY FOR THE PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE MASTERS DEGREE IN PUBLIC HEALTH May, 2014 ADISS ABEBA, ETHIOPIA i ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES SCHOOL OF PUBLIC HEALTH Assessment of Utilization and Factors of Skilled Birth Attendance among Women of Childbearing Age in Ankasha Guagusa Woreda, Awi Zone, Amhara Regional State, Northwest Ethiopia, 2014 Submitted by: Signature Date Mulunesh Alemayehu ________ _______ Approved by the Examining Board Chairman Dep. Graduate Committee _______________________________ ________ _________ Advisor: Dr Wubegzier Mekonnen ________ ___________ Examiner: Dr Demeke Asefa ________ __________ Examiner: Dr Mulugeta Betre ________ __________ ii ACKNOWLEDGMENT It is a great pleasure for me to express my heart-felt appreciation to my advisor Dr Wubegzier Mekonnen for his tireless and timeless support, valuable advises, directions, suggestions, timely and constructive comments, and thoroughly reading of the materials, generally the way he has been helping me throughout the whole process, from the beginning to the end is unique and I heartly grateful. Thank you! In addition I would like to thank all the staffs of Addis Ababa University School of Public health, for providing me this opportunity to apply my theoretical knowledge in to practice and for the cooperation to the successful accomplishment of this research and John Hopkins University who was funding to accomplish this thesis work. My deepest gratitude also goes to my dear husband; Mulugeta Melaku, my lovely kids Meron and Metshet Mulugeta for their all rounded support throughout the study period and also to Mekonnen Melaku who dedicated his precious time to help and encourage during data analysis. My special thanks goes to Ato wallegn Bellay and Berlew Bellay from Ankasha Guagusa woreda staff members and Agew Awi Zonal Health Department respectively who had had kindly cooperated in providing me the information required for my thesis I will extend my thanks to all the officers of Ankasha Guagusa Woreda Health Department, who kindly facilitated and cooperated in all the data collection process; and provided the required support during the whole process of the research. And to the last, but not at least, my special thanks goes to my lovely father Agumas Mekete, mother Aleganesh Alemayehu, Brother Getahun Agumas and the rest brothers, sisters who were dedicated to support in all aspects during data collection. Finally, I am grateful to all the data collectors, supervisors and study participants who took part in the study and who showed greatest effort in acquiring and giving appropriate information. iii LIST OF ACRONYMS AAU: Addis Ababa University ANC: Antenatal Care AOR: Adjusted odds ratio COR: Crude odds ratio CI: Confidence Interval CSA: Central Statistics Agency DHS: Demographic and Health Survey EOC: Emergency Obstetric Care HSEW: Health Services Extension Workers HF: Health Facility IMCC: International Mother and Child Care IDI: In-Depth Interview MCH: Maternal and Child Health MDGs: Millennium Development Goals MMR: Maternal Mortality Ratio MS word: Micro Soft Word PID: Pelvic Inflammatory Disease SPSS: Statistical Package for Social Sciences TBA: Traditional Birth Attendance UNFPA: United Nation Population Fund WHO: World Health Organization iv TABLE OF CONTENTS PAGE ACKNOWLEDGMENT……………………………………………………………………...iii LIST OF ACRONYMS………………………………………………………………………iv 1.INTRODUCTION………………………………………………………………………….1 1.1 Backgrounds .............................................................................................. 1 1.2 Statements of the Problem ........................................................................ 2 1.3 Rationale of the Study ................................................................................ 3 2. LITRATURE REVIEW……………………………………………………………………4 2.1 Magnitude of Skilled Delivery Attendance .................................................. 4 2.2 Barriers on Skilled Delivery Attendance ..................................................... 4 2.2.1 Personal Factors .................................................................................... 4 2.2.2 Community and Cultural Barriers ............................................................ 7 2.2.3 Health Service Related Factors .............................................................. 8 2.3 Research Questions .................................................................................. 9 2.4 Conceptual Frame Work………………………………………………………10 3. OBJECTIVE……………………………………………………………………………...11 3.1 General Objective .................................................................................... 11 3.2 Specific Objectives ................................................................................... 11 4. METHODS……………………………………………………………………………….12 4.1 Study Area ............................................................................................... 12 4.2 Study Design............................................................................................ 13 4.3 Study Period ............................................................................................ 13 4.4 Source Population.................................................................................... 13 4.5 Study Population ...................................................................................... 13 4.6 Inclusion Criteria ...................................................................................... 13 4.7 Exclusion Criteria ..................................................................................... 13 4.8 Sample Size Determination ..................................................................... 14 4.9 Sampling Procedure and Technique ........................................................ 14 4.10 Data Collection Tools ............................................................................... 16 4.11 Data Collection Procedure ....................................................................... 16 4.12 Variable .................................................................................................... 18 4.12.1 Dependent Variable:- ............................................................................ 18 4.12.2 Independent Variables .......................................................................... 18 4.13 Data Quality Control ................................................................................. 18 v 4.14 Data Analysis ........................................................................................... 19 4.15 Operational Definitions….…………………………………………………….19 4.16 Result Dissemination Plan ....................................................................... 20 4.17 Ethical Clearance ..................................................................................... 20 5. RESULTS…...…………………………………………………………………………...21 5.1 Quantitative .............................................................................................. 21 5.1.1 Socio Demographic Characteristics of the Respondents in Ankasha Guagusa District, Awi zone, Amhara region ............................................................................ 21 5.1.2 Obstetric Characteristics of the Respondents in Ankasha Guagusa District, Awi Zone, Amhara region................................................................................................ 24 5.1.3 Knowledge and Attitude of Respondents towards Skilled Birth Attendance Utilization in Ankasha Guagusa Woreda District, Awi Zone, Amhara region………………………………………………………………………………………..27 5.1.3.2. Attitude of Respondents on Skill Birth Attendance Utilization in Ankasha Guagusa District, Awi Zone, Amhara Region ........................................................... 30 5.1.4. Accessibility, Availability and Utilization of Health Facilities of Respondents in Ankasha Guagusa District, Awi Zone, Amhara region.............................................. 31 5.1.5. Community Based Factors towards Utilization of Skilled Birth Attendance in Ankasha Guagusa District, Awi Zone, Amhara region.............................................. 32 5.1.6. Factors Associated with Skilled Birth Attendance in Ankasha Guagusa District, Awi Zone, Amhara region ......................................................................................... 34 5.1.6.2. Obstetric, Attitude, Knowledge and other Related Factors Associated with Utilization of Skilled Birth Attendance in Ankasha Guagusa District, Awi Zone, Amhara region……………………………………………………………………………...36 5.2 Qualitative Study Findings ....................................................................... 40 5.2.1 Personal Barriers/Behavioral Barriers................................................... 41 5.2.2 Community related Barriers………………………………………………..44 5.2.3 Facility related Barriers …………………………………………………….47 6. DISCUSSION……………………………………………………………………………51 7. STRENGTHS…………………………………………………………………………….56 8. LIMITATIONS OF THE STUDY…………………………………………………….....56 9. CONCLUSION…………………………………………………………………………..57 10. RECOMMENDATIONS…….…………………………………………………………58 11. REFERENCE…….…………………………………………………………………....59 vi List of Tables Page Table
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