title: Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study.
abstract: BACKGROUND
  Improving equity in access to services for the treatment of complications that arise during pregnancy and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia and compare the wealth status of EmOC users with women in the general population.
  
  
  METHODS
  Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well across quintiles were selected to create a questionnaire that was administered to women at discharge from the maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison with the reference population.
  
  
  RESULTS
  760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset, indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest) to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest two quintiles. Transportation costs seem to play an important role.
  
  
  CONCLUSIONS
  We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool.
authors.affiliation: Doctors with Africa CUAMM, via san Francesco 126, Padua 35121, Italy. calistuswilunda@yahoo.co.uk
authors.forename: Calistus
authors.initials: C
authors.lastname: Wilunda
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
authors.forename: Maria
authors.initials: M
authors.lastname: Castiglioni
authors.forename: Gaetano
authors.initials: G
authors.lastname: Azzimonti
authors.forename: Wagari
authors.initials: W
authors.lastname: Edessa
authors.forename: Andrea
authors.initials: A
authors.lastname: Atzori
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.forename: Ana Pilar
authors.initials: AP
authors.lastname: Betrán
authors.forename: Joshua
authors.initials: J
authors.lastname: Vogel
authors.forename: Bart
authors.initials: B
authors.lastname: Criel
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult