Assessment of Modern Maternal Health Care Usage of Urban Women

See discussions, stats, and author profiles for this publication at: https://www.researchgate.
net/publication/327155569
ASSESSMENT OF MODERN MATERNAL HEALTH CARE USAGE OF URBAN

WOMEN
Thesis · June 2014
CITATIONS READS
0 1,055
1 author:
Addisu Tesfaw Zinabu

St. Mary University College
3 PUBLICATIONS 3 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
ASSESSMENT OF MODERN MATERNAL HEALTH CARE USAGE OF URBAN WOMEN View project
ASSESSMENT OF MODERN MATERNAL HEALTH CARE USAGE OF URBAN WOMEN View project
All content following this page was uploaded by Addisu Tesfaw Zinabu on 24 September 2018.
The user has requested enhancement of the downloaded file.

ASSESSMENT OF MODERN MATERNAL HEALTH CARE USAGE OF URBAN
WOMEN
(IN CASE OF NECH SAR SUB-TOWN, ARBA MINCH TOWN)
A SENIOR RESEARCH
BY
ADDISU TESFAW
ID: RNS/059/04
ADVISOR: TARIKU TESFAYE (M.SC)
SUBMITTED TO DEPARTMENT OF STATISTICS, COLLEGE OF NATURAL
SCIENCES, ARBAMINCH UNIVERSITY
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE BSC DEGREE
IN STATISTICS
ARBAMINCH, ETHIOPIA
JUNE, 2014
a
Table of Contents
Acknowledgement........................................................................................................................................ iv
ABSTRACT .................................................................................................................................................. v
Abbreviation................................................................................................................................................. vi
CHAPTER ONE ........................................................................................................................................... 1
1. INTRODUCTION..................................................................................................................................... 1
1.1 Background of the Study ..................................................................................................................... 1
1.2 Statement of Problem .......................................................................................................................... 2
1.3 Objectives of the Study ....................................................................................................................... 3
1.4 Significance of the Study .................................................................................................................... 4
1.5 Limitation of the Study ....................................................................................................................... 4
CHAPTER TWO .......................................................................................................................................... 5
2. LITERATURE REVIEW.......................................................................................................................... 5
2.1 Definition and Concept of Maternal Health Care ............................................................................... 5
2.2 Impact of Maternal Mortality and Morbidity ...................................................................................... 5
2.3 The Dimension of Maternal Health Care Services .............................................................................. 6
2.4 Factors that Influence Maternal Health Care ...................................................................................... 8
CHAPTER THREE..................................................................................................................................... 11
3 METHODOLOGY ................................................................................................................................... 11
3.1 Population and Study Area................................................................................................................ 11
3.2 Target Population .............................................................................................................................. 11
3.3 Method of Data Collection ................................................................................................................ 11
3.4.1 Sampling Technique................................................................................................................... 12
3.3.2 Sample Size Determination ........................................................................................................ 12
3.4 The Study Variables .......................................................................................................................... 13
3.5 Method of Statistical Data Analysis .................................................................................................. 15
3. 6 Logistic Regression Model .............................................................................................................. 16
i
3. 7 Binary Logistic Regression .............................................................................................................. 16
3 .7.1 Odds Ratio ................................................................................................................................. 18
3.7.2 Parameter Estimation for Logistic Regression ........................................................................... 18
3.7.3 Assessment of Model Adequacy ................................................................................................ 20
CHAPTER FOUR ....................................................................................................................................... 24
STATISTICAL DATA ANALYSIS AND DISCUSSION......................................................................... 24
4.1 Summary of Descriptive Statistics .................................................................................................... 24
4.2 Bi-variate Analysis of ANC, delivery care and PNC ........................................................................ 26
4.3 Assessment of Model Adequacy ....................................................................................................... 27
4.3.1 Test of Model Adequacy for ANC ............................................................................................. 28
4.3.2 Test of Model Adequacy for Delivery Care ............................................................................... 29
4.3.3 Test of Model Adequacy for PNC.............................................................................................. 31
4.4 Binary Logistic Regression Analysis ................................................................................................ 33
4.4.1 Binary logistic regression result for ANC .................................................................................. 33
4.4.2 Binary Logistic Regression Result for Delivery Care ................................................................ 35
4.4.3 Binary Logistic Regression Result for PNC............................................................................... 37
4.5 Discussion ......................................................................................................................................... 37
CHAPTER FIVE ......................................................................................................................................... 40
Conclusion and Recommendation............................................................................................................... 40
5.1 Conclusion......................................................................................................................................... 40
5.2 Recommendation............................................................................................................................... 40
6. References ............................................................................................................................................... 42
APPENDIX ................................................................................................................................................. 44
ii
List of Tables
Table 4.1 Summary of Descriptive Statistics ................................................................................ 25
Table 4.2 The results of bi-variate statistical data analysis of ANC, Delivery Care and PNC
usage. ............................................................................................................................................ 27
Table 4.3 Omnibus Tests of Model Coefficients for ANC ........................................................... 28
Table 4.4 Classification Table for ANC ....................................................................................... 28
Table 4.5 Model Summary for ANC ............................................................................................ 29
Table 4.6 Hosmer and Lemeshow Test for ANC ......................................................................... 29
Table 4.7 Classification Table for Delivery Care ......................................................................... 30
Table 4. 8 Model Summary for Delivery Care ............................................................................. 30
Table 4.9 Omnibus Tests of Model Coefficients for Delivery Care ............................................. 30
Table 4.10 Hosmer and Lemeshow Test for Delivery Care ......................................................... 31
Table 4.11 Classification Table for PNC ...................................................................................... 31
Table 4.12 Model Summary for PNC ........................................................................................... 32
Table 4.13 Omnibus Tests of Model Coefficients for PNC.......................................................... 32
Table 4.14 Hosmer and Lemeshow Test for PNC ........................................................................ 32
Table 4.15 Variables in the Equation for ANC............................................................................. 33
Table 4.16 Variables in the Equation for Delivery care ............................................................... 35
Table 4.17 Variables in the Equation for PNC ............................................................................. 37
iii
Acknowledgement
I would like to thanks to all the staff in statistics department for their assistance during my
study. I am grateful to my advisor Ato Tariku Tesfaye, for his unreserved guidance and
support. This could not be attained, without his support. I would like to thanks to Nech sar
sub-town women’s for providing me with all the relevant data used in this study. I would like
to thank my family, relatives and friends who supported me in one way or another to possess
my studies and this research. I thanks to my God who has never left me alone even at the time
of challenges and controversy.
iv
ABSTRACT
The main objective of this study was to assess the awareness and usage of modern maternal
health care and to identify the determinant factors affecting utilization of modern maternal
healthcare services in Nech sar sub-town. The Survey was conducted in Nech sar sub-town in
2006 E.C (2013/14). In this study, sample 240 mothers selected by using simple random
sampling technique and the data collected by using administered questionnaire. The collected
data analyzed by Chi-square test and Logistic regression using SPSS software. The result of
the study revealed that antenatal care; delivery care and postnatal care service utilization in
the study area were 38.3%, 37.9% and 24.6% respectively. Household income, awareness of
mothers’ about maternal health care, access of health care services, attended birth order
were major predictors of Antenatal care service utilization in the study area at 5% level of
significance. Religion, husband occupation, attended birth order and quality of antenatal
care were major predictors of delivery care service utilization in the study area at 5% level of
significance. Ability of delivery, place of birth and professional ethics were major predictors
of postnatal care service utilization in the study area at 5% level of significance. To
increasing maternal health care services utilization (i.e. antenatal care, delivery care and
postnatal care); expanding access of health care services, improve the quality of antenatal
care services, awareness raising promotions and providing training for health workers for
increasing their skill and professional ethics.
Key words:-Maternal health care, Antenatal care, Delivery care, Postnatal care, Logistic
regression
v
Abbreviation
ANC …………………….Antenatal care
DHS ………………………Demographic and Health Survey
EDHS……………………...Ethiopian Demographic and Health Survey
HIV ……………………….Human immune deficiency virus
HSDP……………………...Health Sector Development Program
ICPD………………………International Conference on Population and Development
MDG…………………….. .Millennium development goal
MHC…………………….. .Maternal health care
MMR……………………. Maternal Mortality Ratio
NFHS…………………….. Nepal Family Health Survey
PMTCT……………………Prevention of mother to child transmission
PNC ……………………… Postnatal care
SNNPR………………… Southern nation nationalities and peoples in the region
SPSS ………………….... Statistical Package for Social Science
UNFPA………………….. United Nations Population Fund
UNICEF………………… United Nations Children’s Fund
WHO……………………. World Health Organization
vi
CHAPTER ONE
1. INTRODUCTION
1.1 Background of the Study
Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period. The importance of maternal health care services in reducing maternal
and infant morbidity and mortality has received increasing recognition since the
International Conference on Population and Development (ICPD) in Cairo. The
utilization of maternal health care is one of the important factors to reduce the incidence
of maternal mortality (Mehari, 2012).
The World Health Organization (WHO) estimates that 580,000 women of reproductive
age die each year from complications arising from pregnancy, and a high proportion of
these deaths occur in sub-Saharan Africa. Women play a principal role in the rearing of
children and the management of family affairs, and their loss from maternity-related
causes is a significant social and personal tragedy.
The concepts which apply to maternal death and its determinants have been well
documented and the health care solutions for preventing and treating the complications
during pregnancy are available. The majority of maternal and prenatal deaths could be
avoided by access to basic maternity care which is supported by adequate medical and
surgical care. (Kwast, 1996).
Availability, quality and affordability of maternal health care services for sure influence
use of the services by women. But good supply doesn’t create demand by itself. Even
under same circumstances some women use the services more than the others. This
shows that there are factors other than the health care service characteristics that
influence the use of maternal health care services (Gubhaju, 2001).
1
As part of a global initiative the millennium development goal (MDG) has the aim of
reducing maternal mortality ratio by two third and achieving universal coverage of
reproductive health by 2015. This goal was proposed to address the existing burden of
maternal mortality which did not change significantly with the existing initiatives. As a
strategy to achieve these goals the initiative has emphasized on the key role that the
presence of skilled attendant at delivery has on improving maternal health outcomes
(Dagne, 2010).
In Ethiopia, the levels of maternal and infant mortality and morbidity are among the
highest in the world. One explanation for poor health outcomes among women and
children is the nonuse of modern health care services by a sizable proportion of women
in Ethiopia. Previous studies have clearly demonstrated that the utilization of available
maternal health services is very low in the country (Mekonnen and Asnaketch, 2002).
Responding to challenges in achieving Millennium Development Goals (MDG), the
Ethiopian government initiated the Health Extension Program in 2003 as part of the
Health Sector Development Program (HSDP) to improve equitable access to preventive,
primitive and select curative health interventions through paid community level health
extension workers (Marge K, et al, 2010).
1.2 Statement of Problem
Women are the most responsible body for the family welfare. Women’s health plays an
important role in determining the health of the future population, because woman’s
health has an intergenerational effect. One of the MDG was minimizing maternal and
child mortality by accessing modern maternal health care service to the community.
Meseret, G. et al. 2009, study showed that the utilization of the existing facilities for
delivery was also low, which is clearly inadequate to reduce maternal deaths and to
2
attain the MDG target in Gamo Gofa zone which indicates the service was not brought to
the desired level. So this study was designed to address the following basic questions
regarding modern maternal health care service.
 What are the factors affecting utilization of modern maternal health care
services?
 What is the level of awareness of women on modern maternal health care
services in Nech Sar sub-town?
 Which components of maternal health care services are more used by Nech Sar
sub-town women’s?
1.3 Objectives of the Study
General objective
The general objective of this study was to assess awareness and usage of modern
maternal health care and to identify the determinant factors affecting utilization of
modern maternal healthcare services in Nech sar sub-town.
Specific Objectives
 To assess the level of awareness about modern maternal health care in Nech sar
sub-town.
 To identify factors affecting utilization of modern maternal health care services.
 To compare the modern maternal healthcare service utilization among the three
components.
 To provide scientific information to the concerned body.
3
1.4 Significance of the Study
Awareness on usage of modern maternal health care service creates maternal morbidity
and mortality prevention activity among community. This study would be important to
contribute an input for plan of maternal health care to enhance the awareness of the
community toward modern maternal health care services in Nech sar sub-town. And also
it helps health professionals to improve their capacity on service delivery mode and care
providers to fulfill the necessary medical equipments. Besides, essential developing
evidence –based interference that would make the difference in justifying health
problems, promoting health and finally improving the quality of the maternal health care
in Nech sar.
1.5 Limitation of the Study
There was not reduced maternal death related to delivery in Gamo Gofa zone. But, in
this study the researchers investigate only in Nech sar sub-town, due to shortage of
money and inadequate time given to do this paper. Most of variables in this study were
not significant. Because, some of the respondents was not willing to provide relevant
information and some respondents were a language problem.
4
CHAPTER TWO
2. LITERATURE REVIEW
2.1 Definition and Concept of Maternal Health Care
Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period. The importance of maternal health care services in reducing maternal
and infant morbidity and mortality has received increasing recognition since the (ICPD)
in Cairo (Mehari, 2012).
Maternal health care service utilization is believed to reduce maternal mortality and
morbidity directly through detection and treatment of pregnancy related illness or
indirectly through detection of woman at increased risk of complications of delivery in
ensuring that they delivered in suitable equipped facilities (Guillermo et al., 1992).
2.2 Impact of Maternal Mortality and Morbidity
According to WHO (2008) maternal death is defined as death of a woman while
pregnant or within 42 days of termination of pregnancy, irrespective of the duration and
site of the pregnancy, from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes.
Studies have shown that newborns whose mothers die are less likely to survive. A study
in Bangladesh showed that children under the 6 age of 10 years were up to 10 times
more likely to die following the death of their mothers were alive. Neonatal and infant
survivals are negatively impacted by maternal mortality (Frank W et al., 2007).
When a maternal death occurs, the women’s community loses a productive member and
her paid or unpaid labor. The country loses its investment in the women’s health and
education, forgoes her contributions to the economy (World Bank, 1994,
UNICF\FMOH, 1987-1998, Mahler H, 1997 .WHO, 1997).
5
When a mother dies, her family and community suffer, and surviving children often face
higher risks of poverty, neglect, and mortality (World bank, 1993).
2.3 The Dimension of Maternal Health Care Services
Maternal health care service utilization is believed to reduce maternal mortality and
morbidity directly through detection and treatment of pregnancy related illness or
indirectly through detection of woman at increased risk of complications of delivery in
ensuring that they delivered in suitable equipped facilities (Molla, 2011). The
dimensions of maternal health care covered in the survey are ANC, delivery care and
PNC.
1. Antenatal Care
WHO stated Antenatal care (ANC) the care that women receive during pregnancy, is a
unique opportunity to provide the pregnant woman with a vaccination to prevent tetanus,
an insecticide treated bed net to prevent malaria, screenings for anemia, and enrolling
woman in prevention of mother to child transmission of HIV (PMTCT), counseling for a
safe delivery & all factors that help ensure that the mother remains healthy through
childbirth and gives her child the best start in life (Molla, 2011). It is part of the primary
health care services for pregnant women and management of the fetus (Mehari, 2012)
According to World Health Organization (WHO, 2004) recommendation, for normal
pregnancy minimum of four antenatal visiting (at least 20 minutes duration for each) is
needed to accomplish the essential level of ANC.
Antenatal care can play an important role in improving maternal health, not by itself but
through encouraging women to use other services such as institutional delivery and
advice on pregnancy or delivery complications. ANC motivate pregnant woman facing
any pregnancy complication to seek advice for her problems. Level of ANC use does
6
make a difference to the chances of delivering in an institution. A study on rural Uttar
Pradesh shows the likelihood of women with high ANC use delivering in an institution
three times higher than for women with no ANC use (Fausdar & Abhishek, 2005).
2. Delivery Care
A skilled attendant of delivery is defined according to the WHO as an accredited health
professional – such as a midwife, doctor or nurse – who has been educated and trained to
proficiency in the skills needed to manage normal (uncomplicated) pregnancies,
childbirth and the immediate postnatal period, and in the identification, management and
referral of complications in women and newborns (WHO, 2010).
Skilled attendants at delivery are the most widely adopted process indicator that closely
correlated with maternal and prenatal mortalities (Talia M, 2004, WHO, UNCEF, and
UNFPA, 2001 and WHO, 1997). Many studies found that there is a strong correlation
between skilled care attendance at delivery and lower levels of maternal mortality
(WHO, 1994 and, .WHO, 1996). Regarding delivery care one third of births take place at
home without receiving assistance from a skilled birth attendant (WHO, 2010).
3. Postnatal Care
Postnatal Care (PNC) is healthcare provided following childbirth to both mother and
infant. The postnatal period is the time from immediately after birth up to 42 days
(Mehari, 2012). Risks of maternal and newborn deaths are greatest during the first 24 to
48 hours after birth. Therefore, Providing Postnatal Care (PNC) to recently delivered
mothers is quite essential during this period (UNICEF, 2009).
Promoting antenatal care (ANC) and skilled attendance at birth is clearly not enough for
improving maternal and child health. Strategies that promote universal access to
7
postnatal care (PNC) have been recommended for some years and have potential to
contribute to sustained reductions in neonatal and maternal mortality (Abhishek S, 2001)
2.4 Factors that Influence Maternal Health Care
Previous empirical studies have found that the use of maternal health services is related
to demographic, cultural, and socio-economic factors, such as age of women, birth order,
women and husband education, wealth index, religious background, employment,
marital status, traditional belief and etc.
A study by Addai (2000) found that older mothers are more likely to use maternal health
care services than younger mothers. The result of this study is also consistent with
Chakraborty et al. (2003). In contrast, in a cross-sectional survey of 7005 pregnant
women from 28 districts in 14 states of India, reported that there is statistical
significance in reduction of ANC utilization as age increases (Chandiok N, 2006).
In Ethiopia, finding form analysis of EDHS, 2000, identified that, there is a little
difference among married and unmarried women on utilization of ANC in all nations but
married women uses ANC services two-times more than unmarried women in urban
areas.
(Masaki M. and Bina G., 2012) an using logistic regression model analysis that
education of women is the most important factor in determining increased utilization of
maternal health services. It is well recognized that mother’s education has a positive
impact on health care utilization. In a study in Peru using DHS data, using logistic
regression model found quantitatively important and statistically significant effect of
mother’s education on the use of prenatal care and delivery assistance.
8
Similar study conducted using EDHS data of 2005, by the Ethiopian Society of
Population Studies (2008), indicated female education retains a net effect on maternal
health service use, independent of other women’s background characteristics,
households’ socioeconomic status and access to health care services.
Kamal (2009) using regression model showed that husbands’ education is another factor
which affects utilization of maternal health care services. Husbands’ education is found
to have a significant positive association with maternity care service utilization. Elo
(1992) also found that husband’s education is found to have a significant positive association
with maternity care service utilization.
Several studies have found a strong association between birth order and use of health
care services (Wong et al., 1987; Elo, 1992; Kamal, 2009). Because of perceived risk
associated with first pregnancy, a woman is more likely to seek MHC services for first
birth than higher-order births. Having more children may also cause resource constraints,
which have a negative effect on health care utilization (Wong et al., 1987).
In Addis Ababa using logistic regression model study show that household wealth has
a very significant impact on the utilization of maternal healthcare services, with
wealthier families more likely to use the health service (Mehari, 2012).
In Addis Ababa using logistic regression model the result shows that mothers working
status as employee is positively associated with utilization of ANC, delivery care and
PNC services from health professionals (Mehari, 2012). McCaw-Binns et al (1995) also
found positive associations between ANC use and the work status of mothers. In
contrast, a study by the Ethiopian Society of Population Studies (2008), found that
9
mothers work status does not have any effect on utilization of maternal healthcare
services.
In Addis Ababa using logistic regression model religion is found to be significantly
related with use of delivery care and PNC services but not with use of ANC services
(Mehari, 2012). A study in Ethiopia by Yared and Asnaketch (2002) using logistic
regression model found that mothers who follow orthodox religion use ANC, delivery
care, and PNC more than mothers who follow any other religion. In contrast a result
obtained from the study by the Ethiopian Society of Population Studies (2008), showed
that mothers religious affiliations do not influence utilization of ANC and PNC, but have
significant effect on the delivery care services use. Another studies (Kamal, 2009) using
regression model indicate that religion is negatively associated with the use of some
maternal healthcare services but shows no significant difference for others.
According to EDHS, 2005, women with highest wealth quintiles use ANC five times
greater than women with lowest wealth quintiles. A study in over 50 countries showed
that on average more than 80% of births were attended for the richest women compared
with only 34% of the poorest women (Gill et al, 2007).
10
CHAPTER THREE
3 METHODOLOGY
3.1 Population and Study Area
Nech sar is one among four sub-towns in Arba Minch town, found in Southern Nation
Nationalities and Peoples Region (SNNPR). Arba Minch, located about 500 km south of
Addis Ababa (capital of the country) while 275 km south of Hawassa (capital of the
region). Its elevation range from 1200 meter above sea level at the Northern and 1320
above sea level at the southern end. The town has an average temperature 30 and rain fall
of 575mm, and also by two lakes Abaya Lake at the East and Chamo Lake of the South
east. Arba Minch town is one of two towns in the zone with the total population of
74,989. Of these, 37448 (50%) are females and has 16 Keble’s.
3.2 Target Population
The target population for this study was all married and pregnant or child birth women
and whose age is between 15-49 and who live in Nech sar sub-town.
3.3 Method of Data Collection
Basically there are two source of data collection method, namely primary source of data
and secondary source of data. However, for this study the researcher was used primary
method of data collection and obtained the data using a well designed questionnaire from
women in reproductive age who live in Arba Minch Nech sar sub-town during the study
period.
3.4 Sampling Design
Sampling design is the producers by which the sample of units is selected from
population. For this study the researcher would be used simple random sampling and
select Sample units (women) by using random number method.
11
3.4.1 Sampling Technique
Sampling methods or techniques are the scientific technique of selecting representative
of the target population to provide the required estimation. The sampling method used in
this study was simple random sampling procedure. Simple random sampling (SRS) is the
most basic probability sampling techniques in which every individuals unit (member) of
the population has an equal probability of being included in the sample (Cochran, 1977).
3.3.2 Sample Size Determination
Sample size determination is one the first consideration in planning sample survey. The
sample size determination is important because taking too large sample implies increases
the precision, but waste of resources while too small sample reduces precision of
estimation of population parameter or the usefulness of the results. So, it is better to
determine optimum sample size, there are a number of issues, some of the issues are:
 Objective of the research.
 Its consistence with the resources like cost, labor, time and materials
necessary.
 Margin of error or tolerable error.
According to Cochran (1977), the sample size determination formula the researcher
applies for this study was:
n= …………………………………………………… (3.1)
Where, n0=
n0= the initial sample size
P= population proportion of women who use maternal health care services
12
(There was not the previous study about assessment of modern maternal health care
usage in Nech sar sub-town. Therefore, the researcher was decided to use pilot survey
for determining the sample size. By conducting pilot survey the proportion of women
who use maternal health care services was 0.5).
d= 6.5% =0.065, margin of error
z= 95% of the confidence level (zα/2=1.96)
n = the optimum or normal sample size
N= 4550, total number of target population
n0= = =227.314 228
= , it is not significant. Therefore, we need to find n.
n= = =217.12 218.
The calculated sample size at 5% level of significance was 218 women’s and considering
non-response rate of 10% (22), the total sample size included in this study was 240
women.
3.4 The Study Variables
In this study two types of variables are incorporated. These are dependant variable and
independent variables that are supposed to predictors of the dependant variable.
 Dependant variables or response variables:
 Antenatal care: if the woman is checked by a trained health professional, that is,
doctor, nurse, or midwife, at least once during pregnancy is coded “2” and “1”
otherwise.
13
 Delivery care: if the woman is attended by trained health professional during
their delivery coded”2” and “1” otherwise.
 Postnatal care: if the woman is received a medical checkup from a health
professional within 42 days after delivery, coded “2” and “1” otherwise
 Independent variables
Age
Religion
Marital status
Educational level of women’s
Educational level of husband’s
Occupation of women’s
Occupation of husbands
Income
Awareness
Media exposure
Birth order
Access to health services
Quality of antenatal care
Professional ethics
Skill of delivery
Places of delivery
14
3.5 Method of Statistical Data Analysis
After the data collected, the next step would be editing, analyzing and summarizing the data
in appropriate manner and also the available data would be transformed in to reliable and
useful information with the help of statistical analysis procedure by using SPSS software.
Descriptive Statistics
Descriptive statistics refers to the techniques and methods for organizing and summarizing
information obtained from the sample. Descriptive statistics is a kind of statistics which
describe the data using frequency and percentage.
Inferential Statistics
Inferential statistics is statistics that deals with making inference or conclusion about
population based on data obtained from a limited number of observations that come from the
population. Inferential statistics consists of estimation and hypothesis testing
Chi-square test of Independency
The chi-square test for independency is used where you have two categorical variables. The
objective of chi-square test of independency is to test whether there is association between
two categorical variables. The null- hypothesis to be tested is that there is no association
between two variables
H0: There is no association between dependent and independent variable.
H1: not H0.
The appropriate test statistics is given by Chi-square distribution is with (C-1) (R-1) degree of
freedom
15
Where, C=total number of columns
R=total number of row
(Oij  Eij ) 2
  
2
~  2 (( R  1)(C  1))
Eij
…………………… (3.2)
Where X2cal is the value of random variable whose sampling distribution approximately very
close to the chi-square distribution with (R-1) (C-2) degree of freedom
.Oij- observed frequency of ith row and jth column.
Eij- expected frequency of ith row and jth column.
Assumption of Chi-square
 Each cell and every individual object is independent of each other
 Each number qualify for one and only one cell in the table
 It is required sufficiently large
3. 6 Logistic Regression Model
Logistic regression is used when the regressed, the dependent variable or the response
variable is qualitative in nature or categorical. Qualitative response variable are either binary
(dichotomous variable) or multiple category. The researcher was used binary logistic
regression in this study.
3. 7 Binary Logistic Regression
Binary logistic regression is typically used when the dependent variable is dichotomous and
the independent variables are either continuous or categorical variables. One key assumption
16
in regular binary logistic regression is that observations are independent of each other.
Violations of the assumption of independence of observations may result in incorrect
statistical inferences due to biased standard errors. The binary logistic regression model is
defined as:
................................ (3.2) Where
= the constant of the equation
= the coefficient of the ith predictor
An alternative form of the logistic regression equation is;
…………….…...… (3.3)
Assumption of Logistic Regression
Logistic regression is popular in part because it over come many of the restrictive assumption
of ordinals least square (OLS) regression. Its assumptions are as follows:
 Logistic regression does not assume linear relationship between dependent variables
and independent variables.
 The dependent variables need not normally distributed (but does assume its
distribution is within the range of exponentials family of distribution such as normal,
poisons, binomial and gamma)
 The dependent variables need not be homoscedastic for each level of independent
variables, which is there is no homogeneity of variance of assumption
 Normally distributed errors terms are not assumed.
 Logistic regression does not negative that independent variables be continuous.
 Logistic regression does not require that independent variables be unbounded.
17
 The dependent (outcome) variables are dichotomous and the independent variables
are either categorical or continuous variables.
3 .7.1 Odds Ratio
Logistic regressions work with odds so it is necessary to define both odds and odds ratio. The
odds are simply the ratio of the probabilities for the two possible outcomes. If p is the
probability that the event will occur, then 1 –p is the probability that the event will not occur:
, …………………………………………………………. (3.4)
In 2 × 2 tables, within row 1 the odds of success are Odds1 = , and within row 2 the odds
of success equal Odds2 = .
The ratio of the odds from the two rows,
Pi= = ………………………….. (3.5)
is called odds ratio. Whereas the relative risk is a ratio of two probabilities, the odds ratio pi is
a ratio of two odds
Interpretation of odds ratio are this is the factor by which the odds changes when the jth
independent variable increase by one unit.
Note: if βj is positive then the odds increase and if βj is negative, the odds decrease.
3.7.2 Parameter Estimation for Logistic Regression
To estimate the parameters of logistic regression model, the two estimation methods mostly
used are maximum likelihood and non-iterative weighted least squares method. When the
18
assumption of normality of the predictors does not hold, the non- iterative weighted least
squares method is less efficient. In contrast, the maximum likelihood estimation method is
appropriate for estimating the logistic model parameters due to this less restrictive nature of
the underlying assumptions. Thus in this study the maximum likelihood estimation technique
will be applied to estimate parameters of the model.
e Xi
'
Consider the logistic regression model P( xi )  . Since observed values of Y say,

1  e Xi
'
Yi’s (i=1, 2… n) are independently distributed as Bernoulli, the maximum likelihood function
of Y is given by:
yi (1 yi )
 e Xi  
'
n n
1 
L(  / y )   P ( y i | X )   
i
'
X '
  X ' 
........................ (3.6)
i 1 1  e i  1  e i 
i 1 
The objective of ML estimation is to get an estimator ˆ  (ˆ0 , ˆ1 , ˆ2 ,..., ˆk ) of  which
maximizes the likelihood function expressed in equation (3.6). Since the likelihood equation
is non- linear in the parameters, the Newton-Raphson iterative maximum likelihood
estimation method that expresses ˆ at the (u  1) th cycle of the iteration is given as:
ˆu 1  ˆu  ( X 'Wˆ u ) 1 XRu ………………………….. (3.7)
^
where u=0,1,2,3, …and W is a diagonal matrix with its diagonal elements piˆ(1  piˆ) i.e.

  Finally,  is the maximum likelihood estimator of  with
^ 
W  diag  pi (1  pi )  cov( y ) .
 

residual R  pi  p (Collet, 1991: Greene, 1991). Newton’s method usually converges to the
maximum of the log – likelihood in just a few iteration unless the data are especially badly
conditioned (Greene, 1991).
19
3.7.3 Assessment of Model Adequacy
After the model is fitted the next important step is checking the model adequacy. There are
several steps involved in assessing the appropriateness, adequacy and usefulness of the
model. First, the overall goodness of fit of the model is tested. Second, the importance of
each of the explanatory variables is assessed by carrying out statistical tests of the
significance of the coefficients.
Goodness of Fit of the model
The goodness of fit or calibration of a model measures how well the model describes the
response variable. Assessing goodness of fit involves investigating how close values
predicted by the model are to the observed values.
The Hosmer–Lemeshow test
The Hosmer–Lemeshow test is a commonly used test for assessing the goodness of fit of a
model and allows for any number of explanatory variables, which may be continuous or
categorical. The test is similar to a goodness of fit test and has the advantage of partitioning
the observations into groups of approximately equal size, and therefore there are less likely to
be groups with very low observed and expected frequencies. The observations are grouped
into g (mostly, g=10) based on the predicted probabilities. For either grouping strategy, the
Hosmer-Lemeshow goodness-of-fit statistic, Ĉ, is obtained by calculating the Pearson chi-
square statistic from the g × 2 table of observed and estimated expected frequencies.
A formula defining the calculation of Ĉ is as follows:
Ĉ= ………………………………………………… (3.8)
where, g denotes the number of groups, n'k (=n/10) is the number of observations in the kth
group, ck denotes the number of covariate patterns in the kth decile, Ok is the number of
20
responses among the ck covariate patterns, and is the average estimated probability. The
distribution of the statistic is well approximated by the chi-square distribution with g - 2
degrees of freedom, (g-2) (Hosmer and Lemeshow, 2000).
If p-value for the Hosmer-Lemeshow goodness of fit test is greater than 0.05, we will not
reject the null hypothesis that there is no difference between observed and model predicted
values, implying that the model estimates are adequate to fit the data at an acceptable level.
The Likelihood Ratio Test
The likelihood ratio test, also called the log-likelihood test, is based on -2LL (deviance). The
likelihood ratio test is a test of the significance of the difference between the likelihood ratio
(-2LL) for the fitted model and the likelihood ratio for a reduced model. This difference is
called "model chi-square". There are two main forms of the likelihood ratio test, one for the
overall test and the other test of individual model parameters.
Test of the overall goodness of fit is used to assess the overall goodness fit of the model.
The likelihood ratio test looks at the model chi-square (chi square difference) by subtracting
deviance (-2LL) for the final (full) model from deviance for the intercept-only model. The
degrees of freedom in this test equal the number of terms in the model minus 1 (for the
constant). This is the same as the difference in the number of terms between the two models,
since the null model has only one term. Model chi-square measures the improvement in fit
that the explanatory variables make compared to the null model. The likelihood ratio test is
thus a test of the overall model. The overall test statistic for likelihood ratio test is given as:
Likelihood ratio test= =-2 =-2ln …………… (3.9)
Where, Lnull is the likelihood of the null model and Lk is the likelihood of the model
comprising k predictors.
21
Under the global null hypothesis, H0: β1 = β2 = ... = βp = 0 the likelihood ratio test statistic,
G2, follows a chi-square distribution with p degrees of freedom.
Test of individual model parameters: The likelihood ratio test assesses the overall logistic
model but does not tell us if particular predictor variables are more important than others. A
non-significant likelihood ratio test indicates no difference between the full and the reduced
models, hence justifying dropping the given variable so as to have a more parsimonious
model that works just as well. Note that the likelihood ratio test of individual parameters is a
better criterion than the alternative Wald test when considering which variables to drop from
the logistic regression model.
Test for individual predictors
To determine the significance of the predictor variables we can use either the Wald statistic
or the likelihood ratio test.
The Wald test
The Wald statistic is an alternative test which is commonly used to test the significance of
individual logistic regression coefficients for each predictor variable (that is, to test the null
hypothesis in logistic regression that a particular logit (effect) coefficient is zero).The Wald
test statistic is:
W= …………………………………………………………………………(3.11)
The Wald statistic, W, under the null hypothesis is approximately chi-square distributed.
Each Wald statistic is compared with an X2 distribution with 1 degree of freedom. Wald
statistics are easy to calculate but their reliability is questionable, particularly for small
samples. For data that produce large estimates of the coefficient, the standard error is often
inflated, resulting in a lower value of the Wald statistic, and therefore the explanatory
22
variable may be incorrectly assumed to be unimportant in the model. Likelihood ratio tests
are generally considered to be superior.
R2 Statistic
The Cox and Snell measure is based on log-likelihood and considers sample size. The
maximum value that the Cox & Snell R2 attains is less than 1. The Nagelkerke R2 is an
adjusted version of the Cox & Snell R2 and covers the full range from 0 to 1. The Cox &
Snell R2 is given by:
2/n
 L(  (0) ) 
RCS  1  
2
 ...............................................................(3.12).

ˆ
 L(  ) 
2
RCS
The Nagelkerke measure is as follows: RN2  ,
1  ( L(  ( 0) )) 2 / n
Where, L(  (0) ) is the log likelihood function for model without explanatory variables and
L( ˆ ) is the log likelihood function for model with estimated parameters.
23
CHAPTER FOUR
STATISTICAL DATA ANALYSIS AND DISCUSSION
4.1 Summary of Descriptive Statistics
The study was conducted on 240 mother of Nech sar sub-town. The response variables
considered in this study are binary assuming two outcomes (0 = not using, 1 = using
healthcare), which are indicators of maternal healthcare utilization status of mothers in Nech
sar sub-town. Table 4.1 show that from the total number of sample 240; 61.7% of the
respondent was not attended ANC and 38.3% of the respondent was attend ANC. 62.1% of
mothers was not attend delivery care and 37.9% of mothers was attended delivery care.
75.4% of the respondents not used PNC and 24.6% of the respondents used PNC.
From the total number of sample 240 mothers; the average monthly household income of
32.1%, 25%, 19.2%, and 23.8% of the respondent were less than 500 birr, 501-1000 birr,
1001-2000 birr and 2001 and above respectively. The awareness of respondent about
maternal health care services; 53.3% of the respondent who said that “no” and 46.7% of the
respondent who said that” yes”. There was less awareness about maternal health care services
than awareness about maternal health care services in the study area. 52.5% of the respondent
who said that there was no full access of health services in Nech sar sub-town. 47.5% of the
respondent who said that there was full access of health services in Nech sar sub-town. There
was less number of the respondent who said “yes” with relative to a person who said “no”.
Regarding to the quality of ANC; 24.2%, 33.3% and 38.3% of the respondent who said that
very good, medium and low respectively. Regarding to the professional ethics of health
workers; 29.6%, 26.7% and 43.7% of the respondent who said that very good, medium and
bad respectively.
24
Table 4.1 Summary of Descriptive Statistics
ANC Delivery care PNC
Explanatory Categories Frequency Frequency Frequency

variable (Percent ) (percent) (Percent)
age of mothers 18-24 103(42.9) 103(42.9) 103(42.9)

25-34 78(32.5) 78(32.5) 78(32.5)
35-49 59(24.6) 59(24.6) 59(24.6)
religion of mothers orthodox 95(39.6) 96(40.0) 95(39.6)

protestant 85(35.4) 84(35.0) 85(35.4)
Muslim 48(20.0) 48(20.0) 48(20.0)
others 12(5.0) 12(5.0) 12(5.0)
marital status married 213(88.8) 213(88.8) 213(88.8)
divorced 27(11.3 ) 27(11.3) 27(11.3)
educational level of uneducated 93(38.8) 93(38.8) 60(25.0)
mothers primary 71(29.6) 71(29.6) 87(36.3)
secondary and above 76(31.7) 76(31.7) 93(38.8)
educational level of uneducated 10(4.2 ) 10(4.2) 36(15.0)
husbands primary 48(20.0) 48(20.0) 48(20.0)
secondary and above 154(64.2) 154(64.2) 138(57.5)
I haven't husband 28(11.7) 28(11.7) 18(7.5)
occupation of housewife 99(41.3 ) 99(41.3) 99(41.3)
mothers own business 74(30.8 ) 74(30.8) 74(30.8)
private employee 28(11.7 ) 28(11.7) 28(11.7)
public employee 38(15.8 ) 38(15.8) 38(15.8)
others 1(.4) 1(.4) 1(.4)
Occupation of own business 61(25.4) 61(25.4) 57(23.8)
husbands private employee 73(30.4) 73(30.4) 73(30.4)
public employee 75(31.3) 75(31.3) 75(31.3)
others 31(12.9) 31(12.9) 35(14.6)
average household less than 500 77(32.1) 77(32.1) 54(22.5)
income 501-1000 60(25.0) 60(25.0) 65(27.1)
1001-2000 46(19.2) 46(19.2) 54(22.5)
2001 and above 57(23.8) 57(23.8) 67(27.9)
awareness no 128(53.3) 112(46.7) 128(53.3)
yes 112(46.7) 128(53.3) 112(46.7)
Source of mass media 30(12.5) 30(12.5) 30(12.5)
information from the society 20(8.3) 20( 8.3) 20( 8.3)
health institution 51(21.3 ) 51(21.3) 51(21.3)
others 10(4.2) 10( 4.2) 10( 4.2)
not applicable 128(53.3) 35(14.6) 35(14.6)
mothers birth order once 42(17.5) 42(17.5) 42(17.5)
twice 49(20.4) 49(20.4) 49(20.4)
Three times 75(31.3) 75(31.3) 75(31.3)
25
Four times and above 74(30.8) 74(30.8) 74(30.8)
Intended of no 126(52.5) 126(52.5) 126(52.5)
pregnant yes 114(47.5) 114(47.5 ) 114(47.5)
access of health no 126(52.5) 126(52.5) 121(50.4)

service yes 114(47.5) 114(47.5) 119(49.6)
cause for don't lack of awareness 96(40.0) 96(40.0) 95(39.6)
attend waiting time 70(29.2) 70(29.2) 69(28.8)
payment status 27(11.3) 27(11.3) 30(12.5)
due to distance 47(19.6) 47(19.6) 46(19.2)
attend birth order first 50(20.3) 62(25.8) 62(25.8)
second 22(9.2) 22(9.2) 22(9.2)
third 20(8.3) 34(14.2) 34(14.2)
not applicable 148(50.8) 122(50.8) 122(50.8)
Quality of ANC very good 58(24.2) 82(34.2) 59(24.6)
medium 80(33.3) 43(17.9) 67(27.9)
low 92(38.3) 69(28.8) 61(25.4)
Professional ethics very good 71(29.6) 71(29.6) 87(36.3)
of health workers medium 64(26.7) 64(26.7) 74(30.8)
bad 105(43.7) 103(42.9) 78(32.5)
cause for don't payment status 6(2.5 ) 6(2.5) 6(2.5)
attended professional ethics of 80(33.3) 80(33.3) 80(33.3)
workers
ability of midwife 59(24.6) 59(24.6) 59(24.6)
lack of equipment 94(39.2) 94(39.2) 94(39.2)
others 1(.4) 1(.4) 1(.4)
where you birth Home 147(61.3) 138(57.5) 154(64.2)
your last child public health institution 87(36.3) 97(40.4) 81(33.8)
private health institution 6(2.5) 5(2.1) 5(2.1)
the ability of Low 143(59.6) 142(59.2) 154(64.2)
delivery Medium 79(32.9) 21(8.8) 70(29.2)
High 18(7.5) 73(30.4) 12(5.0)
4.2 Bi-variate Analysis of ANC, delivery care and PNC
The bi-variate statistical analysis addresses the marginal effect of a predictor variable on the
response without taking into account other predictors. And it shows the association between
the outcome variable and other predictor variables, obtained by cross tabulation of the
response variables, maternal healthcare (i.e. ANC, delivery care and PNC) usage to the other
predictor variables independently. Bi-variate chi-square analysis is done for all variables and
some of them are statistically significant at 5% (since, p<0.05) significance level for all the
three maternal health care’s.
26
The chi-square test shows utilization of maternal healthcare have a relationship with different
predictor variables, according to the result presented in Table 4.2. The three maternal health
care’s (i.e. ANC, utilization have association with occupation of husbands, income,
awareness about maternal health care, access of health service, quality of antenatal care
services, the professional ethics of health workers, and place of birth; delivery care,
utilization have association with religion, educational level of mothers, educational level of
husbands, occupation of mothers, occupation of husbands, quality of antenatal care services,
place of birth and ability of delivery; and postnatal care, utilization have association with
occupation of mothers, awareness about maternal health care, ANC attended birth order,
professional ethics, place of birth and ability of delivery.
Table 4.2: The results of bi-variate analysis of ANC, Delivery Care and PNC usage.
Delivery
ANC PNC
Explanatory Variables Care
Sig. Sig. Sig.
Religion of mothers 0.049
Educational level of mothers 0.025
Educational level of husbands 0.001
Occupation of mothers 0.000 0.039
Occupation of husbands 0.024 0.000
Average household income 0.012
Awareness about maternal health care 0.000 0.000 0.001
Source of information 0.001 0.000
Access of health service 0.04
Cause for don't attend ANC or have any dairy 0.001 0.000
Attended birth order 0.000 0.000 0.000
Quality of ANC 0.000 0.001
The professional ethics 0.000 0.008
Cause for don't attended or have any dairy 0.000
Where you birth your last child 0.000 0.000
Ability of delivery 0.000 0.000
4.3 Assessment of Model Adequacy
After the model is fitted the next important step is checking the model adequacy which means
assessing the appropriateness, adequacy and usefulness of the model.
27
Test the overall goodness of fit of the model
The goodness of fit of a model measures how well the model describes the response variable.
Assessing goodness of fit involves investigating how close values predicted by the model are
to the observed values.
4.3.1 Test of Model Adequacy for ANC
Table 4.3 Omnibus Tests of Model Coefficients for ANC
Chi-square df Sig.
Step 1 Step 146.912 18 .000
Block 146.912 18 .000
Model 146.912 18 .000
Consider the model which includes all predictors. Omnibus Tests of Model Coefficients gives
us a Chi-Square of 146.912 which is significant at 5% significant level. This is a test of the
null hypothesis that adding the predictors to the model has not significantly increased our
ability to predict utilization of ANC. Since our omnibus test is significant we can conclude
that adding the predictors to the model has significantly increased our ability to predict
utilization of ANC.
Table 4.4 Classification Table for ANC
Predicted
Observed ANC Percentage
Correct
no yes
Step 1 ANC no 135 13 91.2
yes 18 74 80.4
Overall Percentage 87.1
Another way of assessing the goodness of the fitted model is to see how well the model
classifies the observed data. So we often want to look at the proportion of cases we have
managed to classify correctly. The higher the overall percentage of correct prediction is the
better the model. The overall accuracy of the model to predict subject’s ANC is shown in
28
Table 4.4 Out of the 240 sampled mothers 87.1% were correctly predicted. The sensitivity is
given by 80.4% and the specificity is given by 91.3%, which indicates 80.4% of ANC used
and 91.2% of ANC not used mothers were correctly predicted in their respective categories.
Table 4.5 Model Summary for ANC
Step -2 Log Cox & Snell R Nagelkerke

1 likelihood Square R Square
137.524(a) .532 .722
.
Cox and Snell’s R2 has the disadvantage that for discrete models (such as logistic regression)
it may not achieve the maximum value of one, even when the model predicts all the outcomes
perfectly. Nagelkerke’s R2 is an improvement over Cox and Snell’s R2 that can attain a value
of one when the model predicts the data perfectly. The model (with ANC as the single
explanatory variable) explains about 72.2% of the variation in the data.
Table 4.6 Hosmer and Lemeshow Test for ANC
Step Chi-square df Sig.

1 5.106 8 .746
Hosmer-Lemeshow test is used to assess the overall goodness of fit of the fitted model. The
Hosmer-Lemeshow test is performed by dividing the predicted probabilities into deciles (10
groups based on percentile ranks) and then computing a Pearson chi-square that compares the
predicted to the observed frequencies (in a 10×2 table). The P-value is 0.746 for the Hosmer-
Lemeshow goodness of fit test is greater than 0.05, we will not reject the null hypothesis that
there is no difference between observed and model predicted values, implying that the model
estimates are adequate to fit the data at an acceptable level.
4.3.2 Test of Model Adequacy for Delivery Care
Table 4.7 Classification Table for Delivery Care
29
Predicted
Observed Delivery Percentage
care Correct
no yes
Step 1 Delivery No 132 17 88.6
care Yes 15 76 83.5
Overall Percentage 86.7
managed to classify correctly. The higher the overall percentage of correct prediction is the
better the model. The overall accuracy of the model to predict subject’s delivery care is
shown in Table 4.7 Out of the 240 sampled mothers 86.7% were correctly predicted. The
sensitivity is given by 83.5% and the specificity is given by 88.6%, which indicates 83.5% of
delivery care used and 88.6% of delivery care not used mothers were correctly predicted in
their respective categories.
Table 4. 8 Model Summary for Delivery Care
Step -2 Log Cox & Snell R Nagelkerke R

likelihood Square Square
1 94.000(a) .608 .827
Nagelkerke’s R2 is an improvement over Cox and Snell’s R2 that can attain a value of one
when the model predicts the data perfectly. The model (with delivery care as the single
explanatory variable) explains about 82.7% of the variation in the data.
Table 4.9 Omnibus Tests of Model Coefficients for Delivery Care
df Sig.
Chi-square
Step 1 Step 168.662 22 .000
Block 168.662 22 .000
Model 168.662 22 .000
30
us a Chi-Square of 168.662 which is significant at 5% significant level. This is a test of the
null hypothesis that adding the predictors to the model has not significantly increased our
ability to predict utilization of delivery care. Since our omnibus test is significant we can
conclude that adding the predictors to the model has significantly increased our ability to
predict utilization of delivery care.
Table 4.10 Hosmer and Lemeshow Test for Delivery Care
Step Chi-square df Sig.

1 6.087 8 .638
4.3.3 Test of Model Adequacy for PNC

Table 4.11 Classification for PNC
Predicted
Observed PNC Percentage
no yes Correct
Step 1 PNC no 171 10 94.5

yes 36 33 55.9
Overall Percentage 85.
31
managed to classify correctly. The higher the overall percentage of correct predictions is the
better the model. The overall accuracy of the model to predict subject’s PNC is shown in
Table 4.11 Out of the 240 sampled mothers 85% were correctly predicted. The sensitivity is
given by 55.9% and the specificity is given by 94.5%, which indicates 55.9% of PNC used
and 94.5% of mothers not used PNC were correctly predicted in their respective categories.
Table 4.12 Model Summary for PNC
Step -2 Log Cox & Snell R Nagelkerke

1 likelihood Square R Square
165.298(a) .347 .517
Nagelkerke’s R2 is an improvement over Cox and Snell’s R2 that can attain a value of one
when the model predicts the data perfectly. The model (with PNC as the single explanatory
variable) explains about 51.7% of the variation in the data
Table 4.13 Omnibus Tests of Model Coefficients for PNC
Chi-square df Sig.
Step 1 Step 102.403 50 .000
Block 102.403 50 .000
Model 102.403 50 .000
us a Chi-Square of 102.403 which is significant at 5% level. This is a test of the null
hypothesis that adding the predictors to the model has not significantly increased our ability
to predict utilization of PNC. Since our omnibus test is significant we can conclude that
adding the predictors to the model has significantly increased our ability to predict utilization
of PNC.
Table 4.14 Hosmer and Lemeshow Test for PNC
Step1 Chi-square df Sig.

3.380 8 .908
32
4.4 Binary Logistic Regression Analysis
The dichotomous use of modern maternal healthcare utilization, namely whether a woman
utilized maternal health care or not, a dichotomous logistic regression was employed to
determine which factors best explain and predict the outcome of the use of a maternal
healthcare utilization during pregnancy, delivery and after delivery.
4.4.1 Binary logistic regression result for ANC
Table 4.15 Variables in the Equation for ANC
95.0% C.I for

Variables
B S.E. Wald df Sig. Exp(B) EXP(B)
Lower Upper
Husband occupation 1.177 3 .758
Husband occupation(1) -.412 .836 .243 1 .622 .662 .129 3.409
Income 13.211 3 .004
Income(1) -.709 .714 .984 1 .321 .492 .121 1.996
Income(2) 1.139 .785 2.105 1 .147 3.123 .671 14.54
Income(3) 1.883 .813 5.367 1 .021 6.571 1.336 32.31
awareness(1) 1.893 .580 10.658 1 .001 6.638 2.131 20.68
Who give 12.464 3 .006
Who give(1) .914 .894 1.044 1 .307 2.493 .432 14.39
Who give(2) -1.600 .983 2.650 1 .104 .202 .029 1.386
Who give(3) -.235 .943 .062 1 .803 .791 .125 5.021
Access of health 1.589 .542 8.598 1 .003 4.900 1.694 14.17
services(1)
Why not 7.794 3 .050
Why not(1) -1.286 .676 3.621 1 .057 .276 .073 1.039
Why not(2) .232 .663 .123 1 .726 1.261 .344 4.622
Why not(3) -.253 .783 .104 1 .747 .777 .167 3.605
33
Attended birth order 16.707 3 .001
Attended birth order(1) 1.988 .767 6.727 1 .009 7.304 1.625 32.81
Attended birth order(3) 1.641 .843 3.788 1 .052 5.159 .989 26.92
Quality of services 13.023 3 .005
Quality of services(1) 1.168 .796 2.149 1 .143 3.215 .675 15.31
Quality of services(2) 1.229 .684 3.230 1 .072 3.419 .895 13.06
Quality of services(3) -1.307 .760 2.957 1 .085 .271 .061 1.200
This analysis shows the effect of each variable on the status of use of ANC services. The
results show that the age, religion, marital status of mothers, mother education, husband
education, and husband occupation are not significant indicators of use of ANC services.
The estimated odds ratio for mothers whose household income is greater than 2000 birr as
compared to those mothers whose household income is less than 500 is 6.571, 95% CI:
(1.336, 32.31). This implies that the utilization of ANC by mothers whose household income
is greater than 2000 is about 6.571 more likely to use ANC, than mothers whose household
income is less than500 (reference group) controlling for all the other variables in the model.
The estimated odds ratio of ANC utilization for mothers had awareness about maternal
health care services as compared to those mothers who had no awareness is 6.638, 95% CI:
(2.131, 20.682). Utilization of ANC by mothers who had awareness about maternal health
care services is more likely to use 6.638 relative to mothers who had not awareness about
maternal health care services controlling for all the other variables in the model.
The odds of using ANC service was about 4.9 more likely when mothers who said that there
is access for health care services as compared to mothers who said no is 4.900, 95% CI:
(1.6940, 14.174) controlling for all the other variables in the model
At their second and third birth order mothers are about 7.304 and 44.299 times more likely to
use ANC as compared to the mothers at their first birth order is 7.304, 95% CI: (1.625,
34
32.818) and 44.299 95% CI: (6.872, 285.575) respectively, controlling for all the other
variables in the model.
4.4.2 Binary Logistic Regression Result for Delivery Care
Table 4.16 Variables in the Equation for Delivery care
95.0% C.I for

B S.E. Wald df Sig. Exp(B) EXP(B)
Variables
Lower Upper
Religion 8.478 3 .037
Religion(1) 2.936 1.24 5.555 1 .018 18.848 1.640 216.6
Religion(2) 1.961 1.24 2.478 1 .115 7.107 .619 81.66
Religion(3) 3.196 1.33 5.726 1 .017 24.428 1.783 334.6
Husband education 7.645 3 .054
Husband education(1) 1.328 1.54 .739 1 .390 3.774 .183 78.03
Husband education(2) 1.874 1.49 1.577 1 .209 6.514 .350 121.4
Husband education(3) 3.093 1.35 5.179 1 .023 22.053 1.536 316.5
Husband occupation 10.95 3 .012
Husband occupation(1) -2.718 1.46 3.452 1 .063 .066 .004 1.161
Husband occupation(2) -4.321 1.50 8.270 1 .004 .013 .001 .253
Husband occupation(3) -2.922 1.40 4.307 1 .038 .054 .003 .850
Mother education 3.280 2 .194
Mother education(1) .481 .571 .709 1 .400 1.617 .528 4.954
Mother education(2) -.548 .581 .887 1 .346 .578 .185 1.807
Awareness(1) .908 .509 3.189 1 .074 2.480 .915 6.721
Who give 6.699 4 .153
Who give(1) 1.477 .772 3.659 1 .056 4.382 .964 19.91
Who give(2) 1.316 .854 2.373 1 .123 3.728 .699 19.87
Who give(3) 1.210 .839 2.081 1 .149 3.354 .648 17.35
Who give(4) 2.404 .946 6.460 1 .011 11.071 1.734 70.69
Why not 6.561 3 .087
Why not(1) 1.545 .666 5.388 1 .020 4.688 1.272 17.28
Why not(2) 1.384 .681 4.127 1 .042 3.989 1.050 15.15
Why not(3) .328 .942 .121 1 .727 1.388 .219 8.789
Attended birth order 35.56 3 .000
Quality of services 13.01 2 .001
Quality of services(1) -2.222 .618 12.91 1 .000 .108 .032 .364
Quality of services(2) -1.964 .748 6.904 1 .009 .140 .032 .607
Constant -5.857 1.611 13.21 1 .000 .003
35
This analysis shows the effect of each variable on the status of use of delivery care services.
The results overall sample show that mother’s religion, husband occupation, quality of ANC
and attended birth order are predictors that affect utilization of delivery care services in Nech
sar sub-town. Other variables like age, marital status, mother occupation education, husband
education, income and awareness etc are not significant.
The estimated odds ratio of using delivery care for mothers who follow protestant and others
as compared to mothers who follow orthodox are 18.848, 95% CI: (1.640, 216.640) and
24.428, 95% CI: (1.783, 334.698) respectively. This shows that the utilization of delivery
care by mothers who follow protestant and others is about 18.848 and 24.428 are more likely,
respectively, than mothers who follow orthodox (reference group) controlling for all the other
variables in the model.
The odds of using delivery care service was about 98.7% and 94.6% less likely when mothers
whose husband occupation had private employee and others as compared to mothers whose
husband occupation had own business is 0.013, 95% CI: (0.001, 0.253) and 0.054, 95% CI:
(0.003, 0.850) respectively, controlling for all the other variables in the model.
The odds of using delivery care service was about 40.965, 11.566 and 31.553 more likely
when mothers who attended at second, third and fourth or above birth orders as compared to
mothers with the first birth order is 40.965, 95% CI: (11.241, 149.284); 11.566, 95% CI:
(2.313, 57.832) and 31.553, 595% CI: (7.785, 127.893) respectively, controlling for all the
other variables in the model.
The odds of using delivery care service were about 90% and 86% less likely when mothers
who said medium and low as compared to mothers who said very good about the quality of
delivery care services is 0.108, 95% CI: (0.032, 0.364) and 0.140, 95% CI: (0.032, 0.607)
respectively, controlling for all the other variables in the model.
36
4.4.3 Binary Logistic Regression Result for PNC
Table 4.17 Variables in the Equation for PNC
95.0% C.I for

B S.E. Wald df Sig. Exp(B)
EXP(B)
Variables
Lower Upper
Ability of delivery 8.305 2 .016
Ability of delivery(1) 1.663 .627 7.042 1 .008 5.275 1.544 18.016
Ability of delivery(2) .650 .392 2.753 1 .097 1.916 .889 4.130
Where you birth 32.165 2 .000
Where you birth(1) .501 .608 .678 1 .410 1.650 .501 5.438
Where you birth(2) 2.377 .594 15.993 1 .000 10.769 3.360 34.517
Professional ethics 6.969 2 .031
Professional ethics(1) -1.117 .445 6.294 1 .012 .327 .137 .783
Professional ethics(2) -.679 .401 2.868 1 .090 .507 .231 1.113
Constant -2.200 .606 13.196 1 .000 .111
The odds of using postnatal care service was about 5.275 more likely when mothers who said
medium as compared to mothers who said low about the ability of delivery is 5.275, 95% CI:
(1.544, 18.016), controlling for all the other variables in the model.
The odds of using postnatal care service was about 10.769 more likely mothers birth private
health institution as compared to mothers birth at home is 10.769, 95% CI: (3.360, 34.517),
controlling for all the other variables in the model.
The odds of using postnatal care service was about 67.3% less likely when mothers who said
medium as compared to mothers who said very good about the professional ethics of health
workers is 0.327, 95% CI: (0.137, .783) controlling for all the other variables in the model.
4.5 Discussion
(Masaki M. and Binna G., 2012) using logistic regression model analysis that education of
women is the most important factor in determining increased utilization of maternal health
services. Similar study conducted using EDHS data of 2005, by the Ethiopian Society of
Population Studies (2008), indicated female education retains a net effect on maternal health
37
service use, independent of other women’s background characteristics, households’
socioeconomic status and access to health care services. In contrast, in this study, the
utilization of maternal health care services was not affected by mother’s educational status.
Several studies have found a strong association between birth order and use of health care
services (Wong et al., 1987; Elo, 1992; Kamal, 2009). Because of perceived risk associated
with first pregnancy, a woman is more likely to seek MHC services for first birth than higher-
order births. In contrast, in this study the second, third and fourth or above birth orders of
mothers are more likely to use delivery care as compared to first birth order.
In Addis Ababa using logistic regression model religion is found to be significantly related
with use of delivery care and PNC services but not with use of ANC services (Mehari, 2012).
Similarly, in this study, religion is significantly related with utilization of delivery care and
not related with ANC. In contrast to this study, religion is not significantly related with
utilization of PNC. A study in Ethiopia by Yared and Asnaketch (2002) using logistic
regression model found that mothers who follow orthodox religion use ANC, delivery care,
and PNC more than mothers who follow any other religion. In contrast, in this study, the
utilization of delivery care by mothers who follow protestant and other religion is more likely
than mothers who follow orthodox. Another studies (Kamal, 2009) using regression model
indicate that religion is negatively associated with the use of some maternal healthcare
services but shows no significant difference for others.
Kamal (2009) using regression model showed that husbands’ education is another factor
which affects utilization of maternal health care services. Husbands’ education is found to
have a significant positive association with maternity care service utilization. In contrast, in
this study, husbands’ education is not significant association with utilization of maternal
health care services.
38
In Ethiopia, finding form analysis of EDHS, 2000, identified that, there is a little difference
among married and unmarried women on utilization of ANC in all nations but married
women uses ANC services two-times more than unmarried women in urban areas. In
contrast, in this study marital status is not significant indicator of utilization of ANC services.
A study by Addai (2000) found that older mothers are more likely to use maternal health care
services than younger mothers. The result of this study is also consistent with Chakraborty et
al. (2003). In contrast, in a cross-sectional survey of 7005 pregnant women from 28 districts
in 14 states of India, reported that there is statistical significance in reduction of ANC
utilization as age increases (Chandiok N, 2006). But, in this study, age is not statistically
significant effect in the utilization of ANC services.
According to EDHS, 2005, women with highest wealth quintiles use ANC five times greater
than women with lowest wealth quintiles. A study in over 50 countries showed that on
average more than 80% of births were attended for the richest women compared with only
34% of the poorest women (Gill et al, 2007). Similarly, in this study, income of household is
significantly related with utilization of ANC services.
39
CHAPTER FIVE
Conclusion and Recommendation
5.1 Conclusion
The utilization of maternal health care is one of the important factors to reduce the incidence
of maternal mortality. The main objectives of this study were to determine factors affecting
utilization of modern maternal healthcare services in Nech sar sub-town. From the empirical
result, the major factors for ANC services were income, awareness, access of health services,
and attended birth order. Whereas for delivery care services the major factors that found to be
significantly affect were attended birth order, religion, husband occupation and quality of
antenatal care; and postnatal care: place of birth, professional ethics and ability of delivery.
The level of awareness of women’s about the utilization of maternal health care in the study
area was low. The utilization of maternal health care services in Nech sar sub-town was
different in different components of maternity. The utilization of ANC services was more
used by Nech sar sub-town woman’s than delivery care and postnatal care services; and
postnatal care services was less utilize by Nech sar sub-town women’s than delivery care
services.
5.2 Recommendation
Based on the above identification of factors those are significantly associated with a
mother’s utilization of maternal health care services the following recommendations are
necessary, To increase the utilization of maternal health care services in the study area.
 Governments should expand the awareness about the utilization of modern maternal
health care for mothers who live in Nech sar sub-town and also, expends the access of
health care services in their village to minimize the transportation cost and waiting
time.
40
 Governments should provide training for health workers who deliver in Nech sar sub-
town health institution to increase their ability to delivery mode.
 The health institution should provide training for health workers for increasing their
professional ethics; and health workers try to improve their professional ethics.
 The health institution should improve the quality of maternal health care services by
fulfilling the material which is important for delivery care, being punctual, by
respecting mothers.
 Governments should help mothers who have lowest income.
41
6. References
1. Addai, I.( 2000). Determinants of use of maternal-child health services in rural Ghana.
Journal of Biosocial Science 32(1):1-15.
2. Agresti, A. (2002). Categorical Data Analysis, 2nd edition. New York: Wiley.
3. Chandiok, N. et al.( 2006), Determinants of ANC utilization in rural areas of India, J
Obstetric Gynecol India January/February; 56 [1]: 47-52.
4. Cochrane W.G. (1977) Sampling Techniques third edition, New York Wiley.
5. Elo, T. I. (1992) Utilization of maternal health-care services in Peru: the role of
women education. Health TransitionReview, 2, 49–69.
6. Ethiopian Society of Population Studies (2008) Maternal Healthcare Seeking
Behavior in Ethiopia: Findings from EDHS 2005, Addis Ababa.
7. Fausdar R. et al 2006, Is ANC effective in improving maternal health in rural Uttar
Pradesh? Evidence from district level household survey, international
8. Gill K, Pande R, and Malhotra A. (2007) Women deliver for development. Lancet 13;
1347-57.
9. Kamal, S.M.M. (2009): Factors affecting utilization of skilled maternity care services
among married adolescents in Bangladesh, Asian Population Studies, 5:2, 153-170..
10. Gubhaju B. et al. (2001) Women's status, household structure and utilization of
maternal health services in Nepal. Asia Pacific Population Journal 2001, 16(1):23-43.
11. McCaw-Binns, A., J. La Grenade and D. Ashley (1995), Under-users of antenatal
care: a comparison of non-attenders and late attenders for antenatal care, with early
attenders. Social Science and Medicine 40: 1003-1012
12. Mehari, K. 2012 , determinant factors affecting utilization of maternal health care
services in rural Ethiopia , Addis Ababa Ethiopia , Addis Ababa University
13. Mekonnen, Yared, and Asnaketch Mekonnen. 2002. Utilization of Maternal Health
Care Services in Ethiopia. Calverton, Maryland, USA: ORC Macro.
42
14. Meseret, G. et al. 2009 Lifesaving emergency obstetric services are inadequate in
south-west Ethiopia: a formidable challenge to reducing maternal mortality in
Ethiopia
15. Talia M. An issue of culture: the effect of daily activities on prenatal care utilization
patterns in rural South Africa. soc. sci.& med. 2004, 59:1843-1855
UNICF\FMOH. Safe motherhood action agenda: priorities for the next decade, 1987-
1998
16. Weesie, J. (1998). Windmeijer's goodness-of-fit test for logistic regression.
Stata Technical Bulletin, STB-44, 22-27.
17. WHO (2010). Trends in Maternal Mortality: 1990 to 2008, estimates developed by
WHO, UNICEF, UNFPA and The World Bank
18. WHO, UNCEF, and UNFPA. Maternal mortality in 1996; Estimates developed by
WHO and UNICEF. Geneva 2001.
19. WHO. Report on the safe motherhood technical consultation Oct.1997, Colombia
20. Wong, et al (1987) Accessibility, quality of care and prenatal care use in the
Philippines. Social Science and Medicine, 24, 927–944. .
21. World Health Organization (WHO). 1998. Improved access to maternal health
services. WHO 98.7. Geneva: WHO.
22. World Health Organization 2004a, maternal mortality in 2000: Estimates developed
by WHO,
23. Zenebe, M. 2011, Socio demographic factors affecting antenatal care service
utilization among women in ofa woreda, wolaita zone
43
APPENDIX
ARBA MINCH UNIVERSITY
COLLEGE OF NATURAL SCIENCES
DEPARTMENT OF STATISTICS
Questionnaire:
Dear respondent: The objective of this questionnaire is to collecting data about assessment of
modern maternal health care usage from Nech sar sub-town married and pregnant or child birth
women’s. Therefore, I will request you to respond this entire questionnaire carefully and correctly.
Whatever information you provide will be kept strictly confidential and will not be shown to other
persons or institutions.
Instruction: Your name will not be included in the information. Please circle the number
your choice from the given alternative.
1. Your age –––––.
2. What is your Religion?
1. Orthodox 2. Protestant 3. Muslim 4. Others––––––
3. What is your marital status? 1. Married 2. Divorced
4. What is your Educational level?
1. Uneducated 2. Primary 3. Secondary and above
5. What is Educational level of your husband?
1. Uneducated 2. Primary 3. Secondary and above
44
6. What is your Occupation
1. Housewife 2. Own business 3. Private employee 4. Public employee
7. What is your husband occupation?
1. Own business 2. Private employee 3. Public employee
8. What is your average monthly household income? (in birr)
1. Less than 500 2. 501-1000 3. 1001-2000 4. 2001 and Above
9. Do you have (obtain) information about modern maternal health care services?
1. No 2. Yes
10. If you say “yes” for question number “9” where did you obtained the information about
modern maternal health care services?
1. Mass media 2. From the society 3. Health professionals 4. Not applicable
11. Is there a service in Nech sar sub-town to use or practice modern maternal health care?
1. No 2. Yes
12. Are you checked by a trained health professional, that is, doctor, nurse, or midwife, at
least once during pregnancy?
1. No 2. Yes
13. The cause you don’t attend ANC or if you have any dairy when you attend ANC?
1. Have no enough knowledge or awareness 2. Waiting time is too long
3. Payment status 4. Due to distance
14. If your answer is “yes” for question number “12” in what orders are checked by a trained
health professional during pregnancy?
45
1. First birth 2. Second birth 3. Third 4. Fourth and above 5. Not applicable
15. What is the quality of antenatal care services given in Nech sar sub-town?
1. Very good 2. Medium 3. Lowest

16. What is the professional ethics who providing Antenatal care services in Nech sar sub-
town?
1. Very Good 2. Medium 3. Bad

17. Do you attended by a trained health professional during delivery? 1. No 2. Yes
18. The cause you don’t attended by trained health professional or if you have any dairy
when you attended by trained health professional?
1. Payment scheme 2. Professional ethics of health workers 3. Ability of midwife

4. Lack of material for deliver
19. Where are you born your last child?
1. Home 2.Public Health institution 3. Private health institution

20. What is the skill of delivery in Nech sar sub-town health professionals?
1. Low 2. Medium 3. High

21. Did you receive a medical checkup from a health professional within 42 days after
delivery?
1. No 2. Yes
Thank you!
46
አርባ ምንጭ ዩንቨርሲቲ
የተፈጥሮ ሳይንስ ኮሌጅ
የስታቲስቲክስ ትምህርት ክፍል
መጠይቅ:
የተከበራችሁ የዚህ መጠይቅ ተሳታፊዎች፡-የመጠይቁ አላማ ስለዘመናዊ የእናቶች የጤና ክትትል

ግምገማን በተመለከተ በነጭ ሳር ክፍለ ከተማ ከአገቡ እና ከነፍሰ ጡሮች ወይም ከወለዱ እናቶች
መረጃን ለመሰብሰብ ነው።ስለዚህ እርሰዎ ይህንን መጠይቅ በትክክል እዲሞልልኝ ስል በአክብሮት
እጠይቃለሁ።እርሰዎ የሚሰጡኝን መረጃ ለሌላ ግለሰብ ወይም ተቋም አሳልፊ የማልሰጥ እና
ለጥናታዊ ጽሁፌ ብቻ የምጠቀምበት በመሆኑ ሚስጥራዊነቱ እንደተጠበቀ ነው።
መመሪያ:- ከመረጃው የእርሰዎ ስም አይካተትም።ከተሰጡት አማሪጮች መካከል እርሰዎ
የመረጡትን ቁጥሩን ያክብቡት::
1. የእርሰዎ ዕድሜ______.
2. የእርሰዎ ሃይማኖት 1. ኦርቶዶክስ 2. ፕሮቲስታንት 3. ሙስሊም 4. ሌላ___
3. የእርሰዎ የጋብቻ ሁኔታ 1. ያገባች 2. የፈታች እና ባል የሞተባት
4. የእርሰዎ የትምህርት ደረጃ 1.ያልተማረች 2. አንደኛ ደረጃ 3. ሁለተኛ ደረጃ እና ከዚያ በላይ
5. የባለቤተዎ የትምህርት ደረጃ 1. ያልተማረ 2. አንደኛ ደረጃ 3. ሁለተኛ ደረጃ እና ከዚያ በላይ
6. እርሰዎ የሥራ ሁኔታ 1. የቤት እመቤት 2. የግል ሥራ 3. የግል ድርጅት ተቀጣሪ 4. የመንግስት
ተቀጣሪ
7. የባለቤተዎ የሥራ ሁኔታ
1. የግል ሥራ 2. የግል ድርጅት ተቀጣሪ 3. የመንግስት ተቀጣሪ 4. ሌላካለ ይግለፁ _____.
8. የቤተሰበዎ አማከይ ወራዊ ገቢ በብር 1. ከ 500 በታች 2.ከ 501-1000 3.ከ 1001-2000 4. 2001 እና
ከዚያ በላ
9. ስለዘመናዊ የእናቶች የጤና አጠባበቅ አገልግሎት ክትትል መረጃ አለዎት ወይም (መረጃ ያገኛሉ)?
1. የለም 2. አዎ
10. ለጥያቄ ቁጥር 9 መልሰዎ አዎ ከሆነ መረጃውን ያገኙት ከየት ነው?
1. ከመገናኛ ብዙሀን 2. ከአካባቢው ማህበረሰብ 3. ከጤና ባለሙያች 4. ሌላ ካለ ይጥቀሱ_______.
11. ዘመናዊ የእናቶች የጤና ክትትል አገልግሎት በነጭሳር ክፍለ ከተማ ይሰጣል?
1. አይሰጥም 2. ይሰጣል
12. በእርግዝናዎ ጊዜ በሰለጠነ የጤና ባለሙያ ተመርምረው (የጤና ክትትል አድርገው) ያወቃሉ?
1. የለም 2. አዎ
13. የጤና ክትትል ያላደረጋችሁበት ምክንያት ወይም የጤና ክትትል እያደረጋችሁ ያጋጠማችሁ ገጠመኝ
ካለ____
1. በቂ የሆነ እውቀት እና ግንዛቤ ስለሌለኝ 2. የሚወስደው ጊዜ 3. የክፍያ ሁኔታ 4. የቦታው እርቀት
47
14. ለጥያቄ ቁጥር “12”. መልሰዎ “አዎ” ከሆነ በስንተኛ እርግዝናዎ ነው የቅድመ ወሊድ ክትትል
ያደረጉት?
1. በመጀመሪያው 2. በሁለተኛው 3. በሶስተኛው 4. በአራተኛው እና ከዚያ በላይ 5.
በሁሉም
15. በነጭ ሳር ክፍለ ከተማ የቅድመ ወሊድ (የነፍሰጡር) የጤና ክትትል የአገልግሎት ጥራት____ነው።
1. በጣም ጥሩ 2. መካከለኛ 3.ዝቅተኛ
16. በነጭ ሳር ክፍለ ከተማ የቅድመ ወሊድ (የነፍሰጡር) የጤና ክትትል አገልግሎት የሚሰጡ የጤና
ባለሙያዎች የሙያ ስነምግባር______ነው። 1. በጣም ጥሩ 2. መካከለኛ 3. መጥፎ
17. በሚውልዱበት ጊዜ በሰለጠነ የጤና ባለ ሙያ ታግዘው ነው የውለዱት? 1. አይደለም 2. አዎ
18. በጤና ባለ ሙያ ያልታገዙበት ምክንያት ወይም በጤና ባለ ሙያ በምትታገዙበት ጊዜ ያጋጠማችሁ
ገጠመኝ ካለ_____?
1. የክፍያ ሁኔታ 2. የባለሙያዎች የሙያ ስነምግባር ችግር 3. አዋላጆች በቂ የሆነ ችሎታ ስለሌላቸው
4. የመሳሪያዎች እጥርት 5. ሌላ ካለ ይግለፁ ______.
19. የት ነበር የመጨረሻ ልጀወትን የወልዱት?
1. ከቤት 2. ከመንግስት ጤና ተቋም 3. ከግል ጤና ተቋም 4. ሌላ ካለ ይግለፁ ________
20. የነጭ ሳር ክፍለ ከተማ የጤና ባለሙያዎች የማዋለድ ችሎታቸው ወይም ብቃታቸው
1. ዝቅተኛ 2. መካከለኛ 3. ከፍተኛ
21. ከወሊድ በኃላ በ42 ቀናት ውስጥ እራሰዎን በጤና ባለሙያ አስመርምረው ያወቃሉ? 1. የለም 2. አዎ
አመሰግናለሁ!
48
View publication stats

Assessment of Modern Maternal Health Care Usage of Urban Women

Uploaded by

Copyright:

Available Formats

You might also like

Assessment of Modern Maternal Health Care Usage of Urban Women

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Assessment of Modern Maternal Health Care Usage of Urban Women

Uploaded by

Copyright:

Available Formats

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

ASSESSMENT OF MODERN MATERNAL HEALTH CARE USAGE OF URBAN

Thesis · June 2014

Addisu Tesfaw Zinabu

The user has requested enhancement of the downloaded file.

(IN CASE OF NECH SAR SUB-TOWN, ARBA MINCH TOWN)

ADVISOR: TARIKU TESFAYE (M.SC)

SUBMITTED TO DEPARTMENT OF STATISTICS, COLLEGE OF NATURAL

SCIENCES, ARBAMINCH UNIVERSITY

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE BSC DEGREE

CHAPTER ONE ........................................................................................................................................... 1

1.1 Background of the Study ..................................................................................................................... 1

1.2 Statement of Problem .......................................................................................................................... 2

1.3 Objectives of the Study ....................................................................................................................... 3

1.4 Significance of the Study .................................................................................................................... 4

1.5 Limitation of the Study ....................................................................................................................... 4

CHAPTER TWO .......................................................................................................................................... 5

2.1 Definition and Concept of Maternal Health Care ............................................................................... 5

2.2 Impact of Maternal Mortality and Morbidity ...................................................................................... 5

2.3 The Dimension of Maternal Health Care Services .............................................................................. 6

2.4 Factors that Influence Maternal Health Care ...................................................................................... 8

3.1 Population and Study Area................................................................................................................ 11

3.2 Target Population .............................................................................................................................. 11

3.3 Method of Data Collection ................................................................................................................ 11

3.4.1 Sampling Technique................................................................................................................... 12

3.3.2 Sample Size Determination ........................................................................................................ 12

3.4 The Study Variables .......................................................................................................................... 13

3.5 Method of Statistical Data Analysis .................................................................................................. 15

3. 6 Logistic Regression Model .............................................................................................................. 16

3 .7.1 Odds Ratio ................................................................................................................................. 18

3.7.2 Parameter Estimation for Logistic Regression ........................................................................... 18

3.7.3 Assessment of Model Adequacy ................................................................................................ 20

CHAPTER FOUR ....................................................................................................................................... 24

STATISTICAL DATA ANALYSIS AND DISCUSSION......................................................................... 24

4.1 Summary of Descriptive Statistics .................................................................................................... 24

4.2 Bi-variate Analysis of ANC, delivery care and PNC ........................................................................ 26

4.3 Assessment of Model Adequacy ....................................................................................................... 27

4.3.1 Test of Model Adequacy for ANC ............................................................................................. 28

4.3.2 Test of Model Adequacy for Delivery Care ............................................................................... 29

4.3.3 Test of Model Adequacy for PNC.............................................................................................. 31

4.4 Binary Logistic Regression Analysis ................................................................................................ 33

4.4.1 Binary logistic regression result for ANC .................................................................................. 33

4.4.2 Binary Logistic Regression Result for Delivery Care ................................................................ 35

4.4.3 Binary Logistic Regression Result for PNC............................................................................... 37

4.5 Discussion ......................................................................................................................................... 37

CHAPTER FIVE ......................................................................................................................................... 40

Conclusion and Recommendation............................................................................................................... 40

Table 4.1 Summary of Descriptive Statistics ................................................................................ 25

Table 4.3 Omnibus Tests of Model Coefficients for ANC ........................................................... 28

Table 4.4 Classification Table for ANC ....................................................................................... 28

Table 4.5 Model Summary for ANC ............................................................................................ 29

Table 4.6 Hosmer and Lemeshow Test for ANC ......................................................................... 29

Table 4.7 Classification Table for Delivery Care ......................................................................... 30

Table 4. 8 Model Summary for Delivery Care ............................................................................. 30

Table 4.11 Classification Table for PNC ...................................................................................... 31

Table 4.12 Model Summary for PNC ........................................................................................... 32

Table 4.13 Omnibus Tests of Model Coefficients for PNC.......................................................... 32