title: The Health Extension Program and Its Association with Change in Utilization of Selected Maternal Health Services in Tigray Region, Ethiopia: A Segmented Linear Regression Analysis.
abstract: BACKGROUND
  In 2003, the Ethiopian Ministry of Health established the Health Extension Program (HEP), with the goal of improving access to health care and health promotion activities in rural areas of the country. This paper aims to assess the association of the HEP with improved utilization of maternal health services in Northern Ethiopia using institution-based retrospective data.
  
  
  METHODS
  Average quarterly total attendances for antenatal care (ANC), delivery care (DC) and post-natal care (PNC) at health posts and health care centres were studied from 2002 to 2012. Regression analysis was applied to two models to assess whether trends were statistically significant. One model was used to estimate the level and trend changes associated with the immediate period of intervention, while changes related to the post-intervention period were estimated by the other.
  
  
  RESULTS
  The total number of consultations for ANC, DC and PNC increased constantly, particularly after the late-intervention period. Increases were higher for ANC and PNC at health post level and for DC at health centres. A positive statistically significant upward trend was found for DC and PNC in all facilities (p<0.01). The positive trend was also present in ANC at health centres (p = 0.04), but not at health posts.
  
  
  CONCLUSIONS
  Our findings revealed an increase in the use of antenatal, delivery and post-natal care after the introduction of the HEP. We are aware that other factors, that we could not control for, might be explaining that increase. The figures for DC and PNC are however low and more needs to be done in order to increase the access to the health care system as well as the demand for these services by the population. Strengthening of the health information system in the region needs also to be prioritized.
authors.affiliation: Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Tesfay Gebregzabher
authors.initials: TG
authors.lastname: Gebrehiwot
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Edin
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D005002:Ethiopia; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards / Q000639:trends; D012189:Retrospective Studies