Peer-reviewed article
Distance, difference in altitude and socioeconomic determinants of utilisation of maternal and child health services in Ethiopia: a geographic and multilevel modelling analysis
Atkure Defar, Yemisrach Behailu Okwaraji, Zemene Tigabu, Lars Åke Persson, Kassahun Alemu ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how geographic distance, altitude differences, and household wealth affect the use of maternal and child health services in rural Ethiopia. Researchers surveyed nearly 12,000 women and almost 6,000 children across four regions to measure antenatal care visits, facility deliveries, child immunisation, and health service use for sick children. Long distances and greater altitude differences between homes and health facilities were associated with lower facility delivery rates, while wealthier households were more likely to use maternal health services. Notably, these geographic and economic factors did not significantly affect child immunisation or care-seeking for sick children.
Key points
- Only 39% of women had four or more antenatal care visits and 55% delivered at health facilities
- Long distance to health facility reduced facility delivery likelihood (adjusted OR=0.57)
- Greater altitude difference reduced facility deliveries (adjusted OR=0.34) and antenatal care visits (adjusted OR=0.46)
- Higher household wealth was associated with more antenatal care visits (adjusted OR=1.67) and facility deliveries (adjusted OR=2.11)
- Distance, altitude, and wealth showed no significant association with child immunisation or care-seeking for sick children
Limitations
This cross-sectional study cannot establish causality or temporal relationships. The analysis does not explain why geographic and socioeconomic factors affect maternal services but not child immunisation or sick-child care, limiting understanding of the mechanisms behind these differential associations.
Abstract
OBJECTIVE: We assessed whether geographic distance and difference in altitude between home to health facility and household socioeconomic status were associated with utilisation of maternal and child health services in rural Ethiopia. DESIGN: Household and health facility surveys were conducted from December 2018 to February 2019. SETTING: Forty-six districts in the Ethiopian regions: Amhara, Oromia, Tigray and Southern Nations, Nationalities, and Peoples. PARTICIPANTS: A total of 11 877 women aged 13-49 years and 5786 children aged 2-59 months were included. OUTCOME MEASURES: The outcomes were four or more antenatal care visits, facility delivery, full child immunisation and utilisation of health services for sick children. A multilevel analysis was carried out with adjustments for potential confounding factors. RESULTS: Overall, 39% (95% CI: 35 to 42) women had attended four or more antenatal care visits, and 55% (95% CI: 51 to 58) women delivered at health facilities. One in three (36%, 95% CI: 33 to 39) of children had received full immunisations and 35% (95% CI: 31 to 39) of sick children used health services. A long distance (adjusted OR (AOR)=0.57; 95% CI: 0.34 to 0.96) and larger difference in altitude (AOR=0.34; 95% CI: 0.19 to 0.59) were associated with fewer facility deliveries. Larger difference in altitude was associated with a lower proportion of antenatal care visits (AOR=0.46; 95% CI: 0.29 to 0.74). A higher wealth index was associated with a higher proportion of antenatal care visits (AOR=1.67; 95% CI: 1.02 to 2.75) and health facility deliveries (AOR=2.11; 95% CI: 2.11 to 6.48). There was no association between distance, difference in altitude or wealth index and children being fully immunised or seeking care when they were sick. CONCLUSION: Achieving universal access to maternal and child health services will require not only strategies to increase coverage but also targeted efforts to address the geographic and socioeconomic differentials in care utilisation, especially for maternal health. TRIAL REGISTRATION NUMBER: ISRCTN12040912.