title: Skilled Antenatal Care Service Utilization and Its Association with the Characteristics of Women's Health Development Team in Yeky District, South-West Ethiopia: A Multilevel Analysis.
abstract: BACKGROUND
  In response to high maternal and perinatal morbidities and mortalities in Ethiopia, "Women's Health Development Army" was established to enhance utilization of skilled maternity services including antenatal care (ANC). However, its effect on skilled ANC service utilization is not well measured. Our study was aimed to assess skilled antenatal care service utilization and its association with the characteristics of women's health development team (WHDT).
  
  
  METHODS
  A community based cross sectional study was conducted from January to February 2015. A multi-stage cluster sampling technique was applied, and a total of 748 women (15-49 years) who gave birth in one year preceding the study were included in the study. Data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Bivariate and multilevel mixed effects analysis techniques were applied to check for association of selected independent variables with utilization of skilled ANC.
  
  
  RESULTS
  About 71% women received skilled ANC service at least once. A significant heterogeneity was observed between WHDTs for skilled ANC utilization. Level-1 predictors of skilled ANC utilization were: preference of skilled personnel (AOR=11.0; 95%, CI, 3.02-40.04), awareness about places where to get skilled providers (AOR=51.6; 95% CI, 13.92-,190.97) and listening to radio (AOR=5.7; 95% CI, 1.46-21.94). Distance of WHDT within 2 km radius from the nearest health facility (HF) was the only level-2 significant predictor of skilled ANC service utilization (AOR=8.28; 95%CI, 1.08-62.20).
  
  
  CONCLUSIONS
  Skilled ANC service utilization is the joint effect of individual and WHDT characters. Awareness and perception creation towards skilled maternity service utilization need to be enhanced. Facilities and transport services should be more accessible towards WHDTs.
authors: Department of Public Health, College of Medical and Health Sciences, Wollega University.
authors: Melese
authors: M
authors: Girmaye
authors: Chief Executive Director with Vice-President Rank, College of Health Sciences, Addis Ababa University.
authors: Yifru
authors: Y
authors: Berhan
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005002:Ethiopia; D005260:Female; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D055361:Multilevel Analysis; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Ethiopia; community based; cross sectional study; multilevel analysis; skilled antenatal care service; women's health development team