title: Do Health and Demographic Surveillance Systems benefit local populations? Maternal care utilisation in Butajira HDSS, Ethiopia.
abstract: BACKGROUND
  The benefits of Health and Demographic Surveillance sites for local populations have been the topic of discussion as countries such as Ethiopia take efforts to achieve their Millennium Development Goal targets, on which they lag behind. Ethiopia's maternal mortality ratio is very high, and in the 2011 Ethiopia Demographic and Health Survey (2011 EDHS) it was estimated to be 676/100,000 live births. Recent Global Burden of Disease (GBD) and estimates based on the United Nations model reported better, but still unacceptably high, figures of 497/100,000 and 420/100,000 live births for 2013. In the 2011 EDHS, antenatal care (ANC) utilization was estimated at 34%, and delivery in health facilities was only 10%.
  
  
  OBJECTIVE
  To compare maternal health service utilization among populations in a Health and Demographic Surveillance System (HDSS) to non-HDSS populations in Butajira district, south central Ethiopia.
  
  
  METHODS
  A community-based comparative cross-sectional study was conducted in January and February 2012 among women who had delivered in the 2 years before the survey.
  
  
  RESULTS
  A total of 2,296 women were included in the study. One thousand eight hundred and sixty two (81.1%) had attended ANC at least once, and 37% of the women had attended ANC at least four times. A quarter of the women delivered their last child in a health facility. Of the women living outside the HDSS areas, 715 (75.3%) attended ANC at least once compared to 85.1% of women living in the HDSS areas [adjusted odds ratio (AOR) 0.59; 95% CI 0.46, 0.74]. Of the women living outside the HDSS areas, only 170 (17.9%) delivered in health facilities and were assisted by skilled attendants during delivery, whereas 30.0% of those living in HDSS areas delivered in health facilities (AOR 0.66; 95% CI 0.48, 0.91).
  
  
  CONCLUSIONS
  This paper provides possible evidence that living in an HDSS site has a positive influence on maternal health. In addition, there may be a positive influence on those living nearby or in the same district where an HDSS is located even when not included in the surveillance system.
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; mesganaw.f@gmail.com.
authors.forename: Mesganaw Fantahun
authors.initials: MF
authors.lastname: Afework
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Seifu Hagos
authors.initials: SH
authors.lastname: Gebregiorgis
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Meselech Assegid
authors.initials: MA
authors.lastname: Roro
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Alemayehu Mekonnen
authors.initials: AM
authors.lastname: Lemma
authors.affiliation: Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D040361:Healthy People Programs; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Ethiopia; antenatal care; demographic; facility delivery; skilled attendance; surveillance