Maternal and Child Health in Jimma Zone, Ethiopia: Predictors, Barriers and Strategies for Improvement Mariame Oumar Ouedraogo A thesis submitted to the Faculty of Graduate and Postdoctoral Studies in partial fulfillment of the requirements for the MSc degree in Epidemiology School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Mariame Oumar Ouedraogo, Ottawa, Canada, 2018 Table of Contents Table of Contents .......................................................................................................................... ii Acknowledgements ........................................................................................................................ iv Abstract .......................................................................................................................................... vi List of Tables ............................................................................................................................... viii List of Figures ................................................................................................................................ xi List of Abbreviations .................................................................................................................. xiii Chapter 1: General Introduction .................................................................................................. 1 Global Status of Maternal and Child Health ........................................................................................ 1 Maternal and Child Health and Mortality in Ethiopia: Trends, Causes, and Progress ................... 3 1. Health Extension Program and the Health Management Information System .............................. 7 2. Health Extension Program and Antenatal Care Attendance ........................................................ 10 3. Health Extension Program and Malaria in Pregnancy................................................................. 12 Project Rationale and Objectives ........................................................................................................ 14 References .............................................................................................................................................. 19 Chapter 2 (Manuscript 1): A Quality Assessment of Health Management Information System Data for Maternal and Child Health in Jimma Zone, Ethiopia ................................. 24 Preface to Manuscript 1 ............................................................................................................... 24 A Quality Assessment of Health Management Information System Data for Maternal and Child Health in Jimma Zone, Ethiopia ...................................................................................... 25 Abstract .................................................................................................................................................. 25 Introduction ........................................................................................................................................... 27 Methods .................................................................................................................................................. 32 1. Study Site .................................................................................................................................... 32 2. Ethiopia Health Management Information System ..................................................................... 33 3. Data Sources ................................................................................................................................ 34 4. Maternal and Child Health Indicators ......................................................................................... 35 5. WHO Data Quality Report Card and Data Analysis ................................................................... 35 Ethics Approval ..................................................................................................................................... 42 Results .................................................................................................................................................... 42 Discussion ............................................................................................................................................... 57 1. Key Findings: Summary and Interpretation ................................................................................ 57 2. Strengths and Limitations ............................................................................................................ 60 3. Implications of Findings .............................................................................................................. 61 4. Recommendations for Health Workers and Researchers ............................................................ 63 Conclusions ............................................................................................................................................ 66 References ................................................................................................... Error! Bookmark not defined. References .............................................................................................................................................. 68 Bridge to chapter 3 ....................................................................................................................... 73 Chapter 3 (Manuscript 2): Utilization of Key Preventive Measures for Pregnancy Complications and Malaria Among Women in Jimma Zone, Ethiopia .................................. 74 Preface to Manuscript 2 ....................................................................................................................... 74 ii Utilization of Key Preventive Measures for Pregnancy Complications and Malaria Among Women in Jimma Zone, Ethiopia ............................................................................................... 75 Abstract .................................................................................................................................................. 75 Introduction ........................................................................................................................................... 77 Methods .................................................................................................................................................. 81 1. Study Setting ............................................................................................................................... 81 2. Data Sources ................................................................................................................................ 82 3. Study Variables ........................................................................................................................... 83 4. Wealth Index Creation................................................................................................................. 87 5. Data Analysis .............................................................................................................................. 92 Ethics Approval ..................................................................................................................................... 93 Results .................................................................................................................................................... 93 1. Participant’s Characteristics ........................................................................................................ 93 2. Participants’ Reproductive History ............................................................................................. 98 3. Antenatal Care Attendance .......................................................................................................... 99 4. Barriers to Antenatal Care Attendance ...................................................................................... 100 5. Determinants of Attending at least one Antenatal Care Visit (ANC1) ..................................... 101 6. Determinants of Attending four or more Antenatal Care Visits (ANC4) .................................. 106 7. Malaria Infection and Mosquito Net Ownership and Utilization During Pregnancy ................ 109 8. Association between Antenatal Care Attendance and Ownership and Use of Mosquito Net ... 110 9. Risk Factors of Malaria in Pregnancy ....................................................................................... 112 Discussion ............................................................................................................................................. 114 1. Summary of Findings and Interpretation ................................................................................... 114 2. Strengths and Limitations .......................................................................................................... 118 3. Recommendations for Health Extension Workers and Researchers ......................................... 120 Conclusions .......................................................................................................................................... 121 References ............................................................................................................................................ 123 Chapter 4: