title: The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study.
abstract: BACKGROUND
  Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services.
  
  
  METHODS
  A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women's utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous national survey from 2005. In addition, we investigated the association between several variables and utilization of maternal health services using logistic regression analysis.
  
  
  RESULTS
  HEWs have contributed substantially to the improvement in women's utilization of family planning, antenatal care and HIV testing. However, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant. Women who were literate (OR, 1.85), listened to the radio (OR, 1.45), had income generating activities (OR, 1.43) and had been working towards graduation or graduated as model family (OR, 2.13) were more likely to demonstrate good utilization of maternal health services. A model family is by definition a family which has fulfilled all the packages of the HEP.
  
  
  CONCLUSIONS
  The HEWs seem to have substantial contribution in several aspects of utilization of maternal health services but their insignificant contribution in improving health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards. For example, strengthening HEWs' support for pregnant women for birth planning and preparedness and referral from HEWs to midwives at health centers should be strengthened. In addition, women's participation in income generating activities, access to radio and education could be targets for future interventions.
authors.affiliation: Department of Public Health, Mekelle University, Ethiopia. arayaabrha@yahoo.com.
authors.forename: Araya
authors.initials: A
authors.lastname: Medhanyie
authors.forename: Mark
authors.initials: M
authors.lastname: Spigt
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Kifle
authors.forename: Nikki
authors.initials: N
authors.lastname: Schaay
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Roman
authors.initials: R
authors.lastname: Blanco
authors.forename: Dinant
authors.initials: D
authors.lastname: GeertJan
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
mesh_terms: D000293:Adolescent; D000328:Adult; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D024382:Professional Role