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Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach
Authors: Seman K. Ousman, Jeanette H. Magnus, Johanne Sundby, and Mekdes K. Gebremariam
Source: International Journal of Environmental Research and Public Health, 17(5): 1712; DOI: 10.3390/ijerph17051712
Topic(s): Antenatal care
Delivery care
Health care utilization
Institutional births
Maternal health
Country: Africa
Published: MAR 2020
Abstract: Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner’s education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner’s education, woman’s employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles. Keywords: Positive deviance; skilled maternal healthcare; multilevel approach; DHS; Ethiopia