title: Poor linkages in maternal health care services-evidence on antenatal care and institutional delivery from a community-based longitudinal study in Tigray region, Ethiopia.
abstract: BACKGROUND
  Progress towards attaining the maternal mortality and maternal health targets set by Millennium Development Goal 5 has been slow in most African countries. Assessing antenatal care and institutional delivery service utilization and their determinants is an important step towards improving maternal health care services.
  
  
  METHODS
  Data were drawn from the longitudinal database of Kilite-Awlaelo Health and Demographic Surveillance System. A total of 2361 mothers who were pregnant and who gave birth between September 2009 and August 2013 were included in the analysis. Potential variables to explain antenatal care and institutional delivery service utilization were extracted, and descriptive statistics and logistic regression were used to determine the magnitude of maternal health care service utilization and associated factors, respectively.
  
  
  RESULTS
  More than three-quarters, 76% [95% CI: 74.8%-78.2%] (n = 1806), of mothers had undergone at least one antenatal care visit during their previous pregnancy. However, only 27% [95% CI: 25.3%-28.9%] (n = 639) of mothers gave birth at a health institution. Older mothers, urban residents, mothers with higher education attainment, and farmer mothers were more likely to use antenatal care. Institutional delivery services were more likely to be used among older mothers, urban residents, women with secondary education, mothers who visited antenatal care, and mothers with lower parity.
  
  
  CONCLUSIONS
  Despite a relatively high proportion of mothers attending antenatal care services at least once, we found low levels of institutional delivery service utilization. Health service providers in Kilite-Awlaelo should be particularly vigilant regarding the additional maternal health needs of rural and less educated women with high parity.
authors.affiliation: Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia. adamayohannes@gmail.com.
authors.forename: Yohannes Adama
authors.initials: YA
authors.lastname: Melaku
authors.affiliation: Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia. berheph@gmail.com.
authors.forename: Berhe
authors.initials: B
authors.lastname: Weldearegawi
authors.affiliation: Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia. fisaha.1999@yahoo.com.
authors.forename: Fisaha Haile
authors.initials: FH
authors.lastname: Tesfay
authors.affiliation: Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia. semawfer@yahoo.com.
authors.forename: Semaw Ferede
authors.initials: SF
authors.lastname: Abera
authors.affiliation: Department of Medicine, Mekelle University, College of Health Sciences, Mekelle, Ethiopia. lokab77@yahoo.com.
authors.forename: Loko
authors.initials: L
authors.lastname: Abraham
authors.affiliation: Department of Nursing, Mekelle University, College of Health Sciences, Mekelle, Ethiopia. alex_aregay@yahoo.com.
authors.forename: Alemseged
authors.initials: A
authors.lastname: Aregay
authors.affiliation: Department of Public Health, Mekelle University, College of Health Sciences, P.O. Box 1871, Mekelle, Ethiopia. yemaneph@gmail.com.
authors.forename: Yemane
authors.initials: Y
authors.lastname: Ashebir
authors.affiliation: Center for Disease Control and Prevention, CDC-Ethiopia, Addis Ababa, Ethiopia. ipk7@cdc.gov.
authors.forename: Friehiwot
authors.initials: F
authors.lastname: Eshetu
authors.affiliation: Center for Disease Control and Prevention, CDC-Ethiopia, Addis Ababa, Ethiopia. hmx8@cdc.gov.
authors.forename: Ashenafi
authors.initials: A
authors.lastname: Haile
authors.affiliation: Ethiopian Public Health Association (EPHA), Addis Ababa, Ethiopia. yihunielakewt@gmail.com.
authors.forename: Yihunie
authors.initials: Y
authors.lastname: Lakew
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, 901 85, Sweden. john.kinsman@epiph.umu.se.
authors.forename: John
authors.initials: J
authors.lastname: Kinsman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000383:Agriculture; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D003906:Developing Countries; D004522:Educational Status; D005002:Ethiopia; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult