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Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis.
- Source :
- BMC Health Services Research; 5/12/2021, Vol. 21 Issue 1, p1-14, 14p, 4 Charts, 2 Graphs, 1 Map
- Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>Persisting within-country disparities in maternal health service access are significant barriers to attaining the Sustainable Development Goals aimed at reducing inequalities and ensuring good health for all. Sub-national decision-makers mandated to deliver health services play a central role in advancing equity but require appropriate evidence to craft effective responses. We use spatial analyses to identify locally-relevant barriers to access using sub-national data from rural areas in Jimma Zone, Ethiopia.<bold>Methods: </bold>Cross-sectional data from 3727 households, in three districts, collected at baseline in a cluster randomized controlled trial were analysed using geographically-weighted regressions. These models help to quantify associations within women's proximal contexts by generating local parameter estimates. Data subsets, representing an empirically-identified scale for neighbourhood, were used. Local associations between outcomes (antenatal, delivery, and postnatal care use) and potential explanatory factors at individual-level (ex: health information source), interpersonal-level (ex: companion support availability) and health service-levels (ex: nearby health facility type) were modelled. Statistically significant local odds ratios were mapped to demonstrate how relevance and magnitude of associations between various explanatory factors and service outcomes change depending on locality.<bold>Results: </bold>Significant spatial variability in relationships between all services and their explanatory factors (pā<ā0.001) was detected, apart from the association between delivery care and women's decision-making involvement (pā=ā0.124). Local models helped to pinpoint factors, such as danger sign awareness, that were relevant for some localities but not others. Among factors with more widespread influence, such as that of prior service use, variation in estimate magnitudes between localities was uncovered. Prominence of factors also differed between services; companion support, for example, had wider influence for delivery than postnatal care. No significant local associations with postnatal care use were detected for some factors, including wealth and decision involvement, at the selected neighbourhood scale.<bold>Conclusions: </bold>Spatial variability in service use associations means that the relative importance of explanatory factors changes with locality. These differences have important implications for the design of equity-oriented and responsive health systems. Reductions in within-country disparities are also unlikely if uniform solutions are applied to heterogeneous contexts. Multi-scale models, accommodating factor-specific neighbourhood scaling, may help to improve estimated local associations. [ABSTRACT FROM AUTHOR]
- Subjects :
- MATERNAL health services
CLUSTER randomized controlled trials
REGRESSION analysis
POSTNATAL care
HEALTH facilities
RESEARCH
HEALTH services accessibility
CROSS-sectional method
RESEARCH methodology
MEDICAL cooperation
EVALUATION research
SOCIOECONOMIC factors
COMPARATIVE studies
RANDOMIZED controlled trials
PRENATAL care
DELIVERY (Obstetrics)
Subjects
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 21
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Health Services Research
- Publication Type :
- Academic Journal
- Accession number :
- 150301562
- Full Text :
- https://doi.org/10.1186/s12913-021-06379-3