title: Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study.
abstract: BACKGROUND
  Ethiopia has high maternal mortality ratio and poor access to maternal health services. Attendance of at least four antenatal care (ANC) visits and delivery by a skilled birth attendant (SBA) are important in preventing maternal deaths. Understanding the reasons behind the poor use of these services is important in designing strategies to address the problem. This study aimed to determine the coverage of at least four ANC visits and delivery by a SBA and to identify determinants of utilisation of these services in three districts in South West Shoa Zone, Ethiopia.
  
  
  METHODS
  A cross-sectional survey of 500 women aged 15-49 years with a delivery in two years prior to the survey was conducted in Wolisso, Wonchi and Goro districts in February 2013. Data were collected using an interviewer administered questionnaire. Logistic regression models were used to explore determinants of ANC attendance and SBA at delivery.
  
  
  RESULTS
  Coverage of at least four ANC visits and SBA at delivery were 45.5 and 28.6 %, respectively. Most institutional deliveries (69 %) occurred at the single hospital that serves the study districts. Attendance of at least four ANC visits was positively associated with wealth status, knowledge of the recommended number of ANC visits, and attitude towards maternal health care, but was negatively associated with woman's age. SBA at delivery was negatively associated with parity and time to the health facility, but was positively associated with urban residence, wealth, knowledge of the recommended number of ANC visits, perceived good quality of maternal health services, experience of a pregnancy/delivery related problem, involvement of the partner/family in decision making on delivery place, and birth preparedness.
  
  
  CONCLUSIONS
  Raising awareness about the minimum recommended number of ANC visits, tackling geographical inaccessibility, improving the quality of care, encouraging pregnant women to have a birth and complication readiness plan and community mobilisation targeting women, husbands, and families for their involvement in maternal health care have the potential to increase use of maternal health services in this setting. Furthermore, supporting health centres to increase uptake of institutional delivery services may rapidly increase coverage of delivery by SBA and reduce inequity.
authors.affiliation: Projects Department, Doctors with Africa CUAMM, Via San Francesco 126, Padua, Italy. calistuswilunda@yahoo.co.uk.|Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Kyoto, Japan. calistuswilunda@yahoo.co.uk.
authors.forename: Calistus
authors.initials: C
authors.lastname: Wilunda
authors.affiliation: Department of Innovation, Research and Planning, Azienda ULSS 9, Treviso, Italy. gquaglio@ulss.tv.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Quaglio
authors.affiliation: Projects Department, Doctors with Africa CUAMM, Via San Francesco 126, Padua, Italy. g.putoto@cuamm.org.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Putoto
authors.affiliation: Department of Nursing Science, Naragakuen University, 3-15-1, Nakatomigaoka, Nara-ishi, Nara, Japan. tlisa5353@yahoo.ca.
authors.forename: Risa
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Doctors with Africa CUAMM, P.O Box 12777, Addis Ababa, Ethiopia. fcalia@iol.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Calia
authors.affiliation: St. Luke Hospital, P.O. Box 250, Wolisso, Ethiopia. desalegnabebe51@gmail.com.
authors.forename: Desalegn
authors.initials: D
authors.lastname: Abebe
authors.affiliation: Projects Department, Doctors with Africa CUAMM, Via San Francesco 126, Padua, Italy. f.manenti@cuamm.org.|St. Luke Hospital, P.O. Box 250, Wolisso, Ethiopia. f.manenti@cuamm.org.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manenti
authors.affiliation: Projects Department, Doctors with Africa CUAMM, Via San Francesco 126, Padua, Italy. d.dallariva@cuamm.org.
authors.forename: Donata
authors.initials: D
authors.lastname: Dalla Riva
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, 1211, Geneva 27, Switzerland. betrana@who.int.
authors.forename: Ana Pilar
authors.initials: AP
authors.lastname: Betrán
authors.affiliation: Projects Department, Doctors with Africa CUAMM, Via San Francesco 126, Padua, Italy. a.atzori@cuamm.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Atzori
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D008875:Middle Aged; D008880:Midwifery; D016017:Odds Ratio; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors