The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study
The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study
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DOI：
10.1186/1472-6963-12-352
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发表时间：
2012-10-08
影响因子：
2.8
通讯作者：
Berhane, Yemane
中科院分区：
文献类型：
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作者：
Medhanyie, Araya;Spigt, Mark;Berhane, Yemane
背景：社区卫生工作者被广泛用于为一系列广泛的健康问题提供护理。自2003年以来，埃塞俄比亚政府一直在部署经过专门培训的新型社区卫生工作者队伍，即卫生推广工作者（HEWs）。这一举措被称为卫生推广计划。很少有研究调查这些社区卫生工作者在提高孕产妇保健服务利用方面的作用。
方法：对来自埃塞俄比亚北部三个地区的725名随机选择的有五岁以下儿童的妇女进行横断面调查。我们调查了妇女对计划生育、产前护理、分娩协助、产后护理、艾滋病检测以及碘盐使用的情况，并将我们的结果与2005年之前的一次全国性调查结果进行了比较。此外，我们使用逻辑回归分析研究了几个变量与孕产妇保健服务利用之间的关联。
结果：卫生推广工作者对妇女计划生育、产前护理和艾滋病检测的利用情况的改善做出了重大贡献。然而，他们对改善在医疗机构分娩、产后检查以及碘盐使用方面的贡献似乎微不足道。识字的妇女（比值比，1.85）、听广播的妇女（比值比，1.45）、有创收活动的妇女（比值比，1.43）以及朝着模范家庭努力或已毕业成为模范家庭的妇女（比值比，2.13）更有可能表现出对孕产妇保健服务的良好利用。模范家庭根据定义是一个完成了卫生推广计划所有项目的家庭。
结论：卫生推广工作者似乎在孕产妇保健服务利用的几个方面有重大贡献，但他们在改善医疗机构分娩和熟练接生方面贡献不显著仍然是一个重要问题。在这些方面需要更多努力来提高卫生推广工作者的有效性。例如，应加强卫生推广工作者对孕妇分娩计划和准备的支持，以及从卫生推广工作者到卫生中心助产士的转诊。此外，妇女参与创收活动、获取广播和教育可以成为未来干预的目标。
Background: Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services.Methods: A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women's utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous national survey from 2005. In addition, we investigated the association between several variables and utilization of maternal health services using logistic regression analysis.Results: HEWs have contributed substantially to the improvement in women's utilization of family planning, antenatal care and HIV testing. However, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant. Women who were literate (OR, 1.85), listened to the radio (OR, 1.45), had income generating activities (OR, 1.43) and had been working towards graduation or graduated as model family (OR, 2.13) were more likely to demonstrate good utilization of maternal health services. A model family is by definition a family which has fulfilled all the packages of the HEP.Conclusions: The HEWs seem to have substantial contribution in several aspects of utilization of maternal health services but their insignificant contribution in improving health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards. For example, strengthening HEWs' support for pregnant women for birth planning and preparedness and referral from HEWs to midwives at health centers should be strengthened. In addition, women's participation in income generating activities, access to radio and education could be targets for future interventions.