Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia

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FIGURE.
Map of Study Area Analyzing National Health Information System Strengthening Intervention, Ethiopia, 2020

TABLE 1.

Background Characteristics of Respondents, Baseline Survey of Ethiopia Maternal Health Care Service Utilization Study, 2020

	N	No. (%)
Residence (regional clusters)	3,016
Emerging regions		580 (19.2)
Agrarian regions		2,030 (67.3)
Urban		406 (13.5)
Mother’s age, years (mean: 28.3 years)	2,988
15–19		168 (5.6)
20–24		677 (22.7)
25–29		913 (30.6)
30–34		614 (20.6)
35–39		504 (16.9)
40–44		96 (3.2)
45–54		16 (0.5)
Child’s age, months	3,016
12–17		1,622 (53.8)
18–23		1,394 (46.2)
Currently married	3,016	2832 (93.9)
Religion	3,016
Orthodox Christian		1,288 (42.7)
Muslim		1,261 (41.8)
Protestant		424 (14.1)
Other		43 (1.4)
Mothers’ educational status	3,016
No education		991 (32.9)
Elementary (1–8)		1,388 (46.0)
Secondary		469 (15.6)
Above secondary		168 (5.6)
Partner educational status	2,832
No education		712 (25.1)
Elementary (1–8)		1,208 (42.7)
Secondary		599 (21.2)
Above secondary		313 (11.1)
Mother’s occupational status	3,016
Employed (Government or private institution)		154 (5.1)
Farmer		864 (28.6)
Merchant		185 (6.1)
Unemployed		1,577 (52.3)
Other		236 (7.8)
Partner occupation status	2,832
Employed (Government or private institution)		497 (17.6)
Farmer		1,480 (52.3)
Merchant		153 (5.4)
Unemployed		54 (1.9)
Others		648 (22.9)

TABLE 2.

Utilization of ANC Service Among Women Having Child Aged 12–23 Months, Ethiopia Baseline Survey, 2020

	N	No. (%)	95% CI
At least 1 ANC visit with skilled provider	2,967	2,755 (92.9)	91.8, 93.7
No. ANC visits in last pregnancy	2,967
0		212 (7.1)	6.3, 8.1
1–3		1,152 (38.8)	37.1, 40.6
4+		1,603 (54.0)	52.2, 55.8
Gestational age at first ANC visit	2,802
1–4 months		1,709 (61.0)	59.2, 62.8
5–9 months		1,037 (37.0)	35.2, 38.8
I don’t know		56 (2.0)
IFA supplements	2,967	2,434 (82.0)	80.6, 83.4
Length of IFA use	2,967
0–29 days		322 (10.9)	9.8, 12.0
30–59 days		667 (22.5)	21.0, 24.0
60–89 days		603 (20.3)	18.9, 21.8
90+ days		1,375 (46.3)	44.6, 48.1
HIV test (PMTCT)	2,802	2,376 (84.8)	83.4, 86.1
TT vaccination	2,802	2,413 (86.1)	84.8, 87.3

Abbreviations: ANC, antenatal care; CI, confidence interval; TT, tetanus toxoid; IFA, iron folic acid; PMTCT, prevention of mother-to-child transmission of HIV.

TABLE 3.

Utilization of Delivery, PNC, and Maternal Health Care Service Among Women Having Child 12–23 Months, Ethiopia Baseline Survey, 2020

		No. (%)	95% CI
Preterm births		43 (1.4)	1.0, 1.9
Delivery (n=2967)
Delivered at health facility		2,249 (75.8)	74.2, 77.3
Delivered at home or in community		718 (24.2)	22.7, 25.8
Skilled birth attendance		2,248 (75.8)	74.2, 77.3
Cesarean delivery		271 (9.1)	8.1, 10.2
Payment for delivery service		447 (15.1)	13.8, 16.4
Type of provider for delivery service
Doctor		424 (14.3)
Health officer		160 (5.4)
Nurse/midwife		1,809 (61.0)
TBA		198 (6.7)
Health extension		23 (0.8)
Relative		593 (20.0)
Others		34 (1.2)
Unknown		268 (9.0)
PNC service from a skilled health provider		2,094 (70.6)	68.9, 72.2
Facing maternal complication		333 (11.2)	10.1, 12.4
Overall maternal service coverage composite indicator
Mean		71.0	69.9, 72.1
Below mean		1,139 (38.4)	36.6, 40.2
Above mean		1,828 (61.6)	59.8, 63.3
	Total	2,967

Abbreviations: CI, confidence interval; PNC, postnatal care; TBA, traditional birth attendant.

TABLE 4.

HIS Resource Availability and Performance of Health Facilities Based on Selected HIS Indicators, Ethiopia, 2020

	Score, %	95% CI
HIS resource
HIS infrastructure at facility level (average score)	82	81, 83
eHIS tools availability score	39	38, 40
Number of staff with training on HIS topics at facility level 1 year prior to survey (average score)	7.8	7.4, 8.1
Percentage of facilities with at least 1 trained staff in any HIS topics	72	70, 74
Data management
Data quality control practices (average score)	72	71, 74
Level of data analysis practice (average score)	68	67, 69
Data visualization practice	86	84, 87
Presence of feedback mechanism	92	90, 93
Data quality^a
Source document completeness: all three months complete	73	71, 75
Data accuracy: acceptable range (90%–110%)	74	72, 76
Data accuracy: overreporting (<90%)	20	19, 22
Data accuracy: underreporting (>110%)	6	5, 7
Data use
Use of routine data for RHIS quality improvement (average score)	45	43, 46
Use of routine data for performance review and evidence-based decision making (average score)	50	48, 51
Use of data for annual plan and target setting	84	83, 85
Use of data to produce narrative analytical reports	31	29, 32

Abbreviations: CI, confidence interval; eHIS, electronic health information system; HIS, health information system; RHIS, routine health information system.
↵^a Data quality measures (source document completeness and accuracy calculation) based on 3 months of skilled birth attendance data (April, May, June 2020).

TABLE 5.

Factors Associated With ANC4+ Visits, Ethiopia Baseline Survey, 2020

	AOR	P	95% CI
Regional clusters (residence)
Pastoralist	1		1
Agrarian	1.53	0.147	.86, 2.71
Urban	3.42	0.004	1.48, 7.87^a
Educational status of mother
No education	1		1
Elementary (1–8)	1.29	0.010	1.06, 1.58^a
Secondary and above	2.02	0.000	1.55, 2.65^a
Wealth index
Lowest	1		1
Low	1.15	0.302	.88, 1.49
Middle	1.13	0.383	.86, 1.48
High	1.24	0.186	0.90, 1.72
Highest	1.65	0.018	1.09, 2.51^a
HIS infrastructure availability score	1.07	0.271	.95, 1.21
eHIS tools availability score	1.33	0.009	1.07, 1.65^a
SBA reporting accuracy score	4.36	0.022	1.24, 15.36^a
_constant	0.05	0.000	0.01, 0.21

Abbreviations: ANC4+, 4 or more antenatal care visits; AOR, adjusted odds ratio; CI, confidence interval; eHIS, electronic health information system; HIS, health information system; SBA, skilled birth attendance.
↵^a Significantly associated.

TABLE 6.

Factors Associated With SBA Among Mothers, Ethiopia Baseline Survey, 2020

	Odds Ratio	P>z	95% CI
Belongs to HIS intervention woreda	1.53	0.42	0.54, 4.34
Regional clusters (residence)
Pastoralist	1		1
Agrarian	1.17	0.774	0.40, 3.44
Urban	4.46	0.083	0.82, 24.19
Educational status of mother
No education	1		1
Elementary (1–8)	1.90	0.000	1.48, 2.43^a
Secondary and above	3.43	0.000	2.26, 5.23^a
Wealth index
Lowest	1		1
Low	1.41	0.031	1.03, 1.93^a
Middle	1.80	0.000	1.29, 2.51^a
High	2.45	0.000	1.56, 3.83^a
Highest	5.64	0.000	2.52, 12.60^a
SBA source document completeness
Not complete	1		1
1 or 2 months complete	0.49	0.326	0.12, 2.01
All months complete	1.69	0.288	0.64, 4.44
Distance from HH to HF (km)	0.93	0.001	0.89, 0.97^a
HIS infrastructure availability score	1.14	0.23	0.92, 1.43
_constant	0.77	0.765	0.14, 4.13

Abbreviations: CI, confidence interval; HF, health facility; HH, household; HIS, health information system; km, kilometer; SBA, skilled birth attendance.
↵^a Significantly associated.

TABLE 7.

Factors Associated With Maternal Care Service Composite Indicator, Ethiopia Baseline Survey, 2020

	Odds Ratio	P>z	95% CI
Educational status of mother
No education	1		1
Elementary (1–8)	1.52	0.000	1.24, 1.86^a
Secondary and above	2.74	0.000	2.04, 3.68^a
Wealth index
Lowest	1		1
Low	1.34	0.036	1.02, 1.80^a
Middle	1.5	0.009	1.10, 2.0^a
High	1.7	0.003	1.2, 2.4^a
Highest	1.95	0.003	1.26, 3.02^a
SBA source document completeness
Not complete	1		1
1 or 2 months complete	0.68	0.42	0.27, 1.73
All months complete	1.60	0.14	0.86, 2.96
Distance from HH to HF (per additional km)	0.96	0.05	0.93, 0.99^a
eHIS tools availability score	1.43	0.003	1.13, 1.82^a
_constant	0.44	0.033	0.20, 0.94

Abbreviations: CI, confidence interval; eHIS, electronic health information system; HF, health facility; HH, household; km, kilometer; SBA, skilled birth attendance.
↵^a Significantly associated.