HARAMAYA UNIVERSITY
ANTENATAL CARE SERVICE UTILIZATION AND ASSOCIATED FACTORS
AMONG WOMEN WHO HAVE GRADUATED FROM MODEL FAMILY
TRAINING IN, IN PASTORAL KEBELES OF SHINILE WOREDA, SITY ZONE,
ETHIOPIAN SOMALI REGION, ETHIOPIA.
MPH Thesis
By: ESMAEL MOHAMMED
College: Health Sciences
Department: Public Health
Program: General Public Health
Major Advisor: Dr Gudina Egata (PhD)
Co-advisor: Negga Baraki (MPH, Assistant professor)
August, 2015
Haramaya, Ethiopia
i
HARAMAYA UNIVERSITY
ANTENATAL CARE SERVICE UTILIZATION AND ASSOCIATED FACTORS
AMONG WOMEN WHO HAVE GRADUATED FROM MODEL FAMILY
TRAINING, IN PASTORAL KEBELES OF SHINILE WOREDA, SITY ZONE,
ETHIOPIAN SOMALI REGION, ETHIOPIA.
A Thesis Submitted To the College Of Health Sciences,
School Of Graduate Studies,Haramaya University
In Partial Fulfilment of the Requirements for the Degree of Master of Public
Health
By:Esmael Mohammed
Major Advisor: Gudina Egata (PhD)
Co-advisor: Negga Baraki (MPH, Assistant professor)
August, 2015
Haramaya, Ethiopia
ii
SCHOOL OF GRADUATE STUDIES
HARAMAYA UNIVERSITY
As Thesis Research advisor, I hereby certify that I have read and evaluated this thesis prepared,
under my guidance, by Esmael Mohammed Adem entitled antenatal care service utilization and
associated factors among women from model households who have graduated from model family
training, in pastoral kebele’s of Shinile woreda, Sity zone, Ethio-Somali region, Ethiopia.
. I recommend that it be submitted as fulfilling the Thesis requirement.
Gudina Egata_______________
________________
Major Advisor
Signature
Negga Baraki_________________
_______________
Co-advisor
Signature
Date
Date
As member of the Board of Examiners of the MPH Thesis Open Defense Examination, We
certify that we have read, evaluated the Thesis prepared by Esmael Mohammed Adem and
examined the candidate. We recommended that the Thesis be accepted as fulfilling the Thesis
requirement for the Degree of Master of Public health.
______________________
_________________
Chairperson
_____________________
Signature
_________________
Internal Examiner
_____________________
Signature
_________________
External Examiner
Signature
_______________
Date
_______________
Date
_______________
Date
Final approval and acceptance of the thesis contingent upon the submission of final copy of the
thesis to Council of Graduate Studies (CGS) through the Department or School of Graduate
Committee (DGC or SGC) of the candidate.
iii
STATEMENT OF THE AUTHOR
I hereby certify and declare that I am the sole author of this thesis and my genuine work and all
sources and materials used for this thesis have been fittingly acknowledged. This thesis has been
submitted in partial fulfillment of the requirements for an advanced MPH degree at Haramaya
University and is deposited at the University Library to be made available to borrowers under
rules of the Library. I declare that this is a true copy of my thesis and is not submitted to any other
institution or University anywhere for the award of any academic degree, diploma or certificate.
A brief quotation from this thesis is allowable without special permission provided that accurate
and complete acknowledgement of the source is made. Requests for permission for extended
quotations from, or reproduction of, this thesis in whole or in part may be granted by the Head of
the School or Department or the Dean of the School of Graduate Studies when in his or her
judgment the proposed use of the material is in the interest of scholarship. In all other instances,
however, permission must be obtained from the author of the thesis.
Name: Esmael Mohammed Adem
Signature: _____________________
Date: April, 2015
School/Department: MPH
iv
BIOGRAPHICAL SKETCH
The author, Esmael Mohammed, was born in Dessie in 1988 and attended his education in
Sinbileta elementary and junior school and completed his senior secondary education at
Mohammed HanfareSchool in Afar Region. After completion of his high school education
successfully, he joined then Jimma University School of health science in2007 and graduated
with Bachelor of Science degree in Environmental health in 2009.Soon after graduation, he start
working at Shinille district health office as Environmental health officer and HMIS focal person,
Then He joined October 2012 in Haramaya University School of Graduate studies. And he is
currently married and live in Dire Dawa.
v
ACKNOWLEDGEMENTS
I would like to thank the following individuals, first my great thanks goes to my major
advisors Dr. Gudina Egata and Co-advisor Mr Negga Baraki for their fruit full advice,
comments, guidance and help. Secondly I would like to thank my wife Ayan Melaku and my
brothers Jemal Mohammed and Anwar Mohammed for their support in idea generation,
encouragement and financial support to accomplish this work. Thirdly I would like to thank
my friends Ibrahim Dawed and Arebu Issa for their support in SPSS analysis and lastly my
thanks also goes to all my family, study participants and all other individuals who had a role
for the accomplishment of this work.
vi
ABBREVIATION AND ACRONYMS
AIDS
Acquired Immune Deficiency Syndrome
ANC
Antenatal Care
EDHS
Ethiopian Demographic Health Survey
FMOH
Federal Ministry Of Health
FP
Family Planning
HC
Health Center
HEP
Health Extension Program
HP
Health Post
MCH
Maternal And Child Health
MDG
Millennium Development Goal
MHH
Model Household
MM
Maternal Mortality
MMR
Maternal Mortality Ratio
PHC
Primary Health Care
PHCU
Primary Health Care Unit
PNC
Post Natal Care
SRS
Systematic Random Sampling
TB
Tuberculosis
vii
TABLE OF CONTENTS
Statement of the author............................................................................................................ v
Biographical sketch ................................................................................................................. v
Acknowledgement ................................................................................................................. vii
List of acronyms and abbreviations...................................................................................... viii
List of tables ........................................................................................................................... xi
List of figures ........................................................................................................................ xii
Abstract……………………………………………………………………………………xiii
INTRODUCTION…………………………………………...................................................1
1.1 Back ground………………………………………………………………..……...1
1.2 Statement of the problem ………………..............................………………..……2
1.3 Significance of the study ………………….................................……………..….3
1.4 Objectives…………………….…………………………………………………...4
1.4.1 General objective …………………………….....................................................4
1.4.2 Specific objectives …………………………………...........................................4
2. LITERATURE REVIEW…………………………........................................…….……..5
2.1Maternal health service utilization……………………………………….……....5
2.2 Factors affecting maternal health service utilization……………………...…..…5
2.2.1 Socio demographic factors ………………………………………….…...........5
2.2.2Health extension program…. …………………..……..………………..……..7
2.2.3 Health related factors …………………………………………………..……..8
2.2.3.1Health information sourc------------------------------------------------------------9
3. METHODS AND MATERIALS………………………………..………………..…….11
3.1 Study area and Period...………………….…......................................................11
3.2 Study Design.……………………………………………………….…..……...11
3.3 Source population………………………………..……………….……..……....11
3.4 Study population……………………………………..…………………..……...11
3.5 sample population……………………………………………………………….11
3.6 Inclusion and Exclusion Criteria’s………………………………..…….……….11
3.6.1. Inclusion criteria…………………………………………………………….11
viii
3.6.2 Exclusion criteria ………….……..….…………………………..……......12
3.7 Sample size determination…………………..............................................................12
3.8 Sampling procedure…................................................................................................14
3.9 Study variables ...........................................................................................................14
3.9.1 Dependent Variable .................................................................................................14
3.9.2 Independent Variables .............................................................................................14
3.10 Operational Definitions………………….…………………………………………15
3.11 Data collection tools and method…………………………………………………..15
3.12 Data Quality Control ........................................…....................................................15
3.13 Data processing and Analysis...................................................................................16
3.14 Ethical Consideration…………………………........................................................16
3.15 Dissemination of results………….……………………….......................................17
4. Result………………………….……………………… …...........................................19
5. Discussion………………….…………………….........................................................24
5.1 Limitation of the study……………………………………………………………….26
6. Conclusion and Recommendation ................................................................................27
6.1 Conclusion……………………………………………………………………………27
6.2 Recommendation…………………………………………………………………......27
7. Reference………………………………………………………………………………28
8. APPENDICES……………..……………………..........................................................31
8.1PARTICIPANT INFORMATION SHEET AND INFORMED CONSENT FORM........31
8.2 QUESTIONER................................................................ .............. .............. ..............35
8.3 Curriculum Vitae…………………………………………………………………..…41
9. APPROVAL SHEET………………..…………………………...……………………43
ix
LIST OF TABLES
Tables_____________________________________________________________Page
Table 1: Socio demographic characteristics of the study participantshinille town,
2014/15…………………………………………………………………………..………20
Table 2: study participants’ information source, shinile woreda, Somali, Ethiopia
2015…………………………………………………………………………………..….21
Table 3: Factors associated with antenatal care service utilization by model households
graduated
from
model
family
training
in
shinille
town,
2014/15…………………………………………………………………………………..22
x
LIST OF FIGURES
Figure_____________________________________________________________Page
Figure 1: Conceptual frame work ofANC service utilization of the study participants, in
Shinille town, in 2014/15 …………………………………………………… ………10
Figure 2: Schematic presentation of sampling procedure of ANC service utilization ofof
the study participants, in Shinille town, in 2014/15 .….……………………………...14
Figure 3: Antenatal care service utilization of the study participants, in Shinille town, in
2014/15………………………………………………………………………………..19
xi
ABSTRACT
The premise of health extension program is a belief that access and quality of primary
health care for communities can be improved through the transfer of health knowledge and
skills to households. Accordingly, its main strategy is building the capacity of families to
be “model households”. As per the definition 2013 ministry guide line, model households
are those households who had attended sixty training hours and able to implement all 16
packages of health extension program. Researches were conducted on ANC service
utilization. However, there is limited evidence about utilization of antenatal care service
utilization and associated factors among women graduated from model family training in
Ethiopia since the inception of the training program.
The objective of this study was to assess the magnitude of antenatal care service
utilization and associated factors among women who have graduated from model family
training in 2013/14, in Shinile woreda, from March/28/2015 to April/02/2015.
A community based cross-sectional design was used among randomly selected 422
women graduated from family training in households of all nine pastoralist kebeles of
Shinille woreda. Data were collected using structured pretested questionnaire. Odds ratio
along with 95% CI was estimated to identify factors associated with women’s antenatal
care service utilization. The level of statistical significant was set at P-value less or equal
to 0.05.
The prevalence of antenatal care service utilization was 35.7% 95% CI (30.9, 40.6). In
multivariate analysis women in age group of <= 25[AOR= 2.32, 95% CI (1.35, 3.96)],
with elementary educational status[AOR= 2.10, 95% CI (1.21, 3.62)], <= 2km distance
from nearby health facility [AOR= 2.05, 95% CI (1.23, 3.44)], women’s remember some
of the packages[AOR= 4.89, 95% CI (2.94, 8.13)] and monthly base home visit by health
extension workers[AOR= 2.68, 95% CI (1.41, 5.07) were independently associated with
Antenatal care service utilization. Efforts has to be made to improve quality of the existing
health extension program and education and physical accessibility of health facility also
critical area that need intervention.
Key words: Antenatal Care Service, Health Extension Program, Model Family Training
and Model Household
xii
I.
Introduction
1.1 Background
Access to health services in Ethiopia was very limited before the government introduce
the innovative way of extending affordable primary health care services to its population
through the HEP, for the program appreciable achievement investing in human resource,
health infrastructure, pharmaceutical supplies and operational costs have played great role
(FMOH, 2010; Admassie et al, 2009).
Starting from 2003 Ethiopian government has been implementing the health extension
program (HEP) in order to achieve the millennium Development goals. The premise of
health extension program is belief that access and quality of primary health care for
communities can be improved through the transfer of health knowledge and skills to
households. Accordingly, its main strategy is building the capacity of families to be
“model households”(FMOH, 2010).
As per the old health extension implementation guide line model family was defined as ‘a
family that implemented a minimum of 75% of the 16 packages after taking at least75% of
the 96 hours model family training. In 2013 the ministry had revised the health extension
implementation guide line, in which the total model family training hours changed to sixty
and the definition of model family to ‘a family that implemented all health extension
packages concerning its family with the support and close supervision of health extension
worker’ (FMOH, 2013).
The model family training have 16 packages of preventive and curative health services,
under 4 broad categories. The first category is disease prevention and control under this
HIV/AIDS & TB; Malaria prevention and control and first aid emergency measure are
included. The second category is family health under this maternal and child health,
family paining, immunization, nutrition and adolescent productive health are included, the
third category is hygiene and environmental sanitation under this excreta disposal, solid &
liquid waste disposal, water supply & staff measures, food hygiene and safe measures,
healthy home environment, control of insects and rodents, and personal hygiene and the
fourth category is one package by itself the so called health education and
communication(FMOH, 2007 and FMOH, 2010).
1
The expected changes to be a model household include visible changes in behavior, for
example, owning and using a latrine, proper hand washing, completing immunization
schedules by eligible mothers and children, and accessing antenatal care by pregnant
mothers (FMOH2003 and Nejmudin2012).
The program is Designed to improve PHC service in Ethiopia through graduating model
households by using model family training, the training comprises a total of 96 hours of
training on basic hygiene and environmental sanitation for 30 hours, family health care
for 42 hours and disease prevention & control for 24 hours(FMOH, 2010).
The plan of the HEP is to qualify all households as model households within three years of
the program based on diffusion of innovation theory (FMOH2003).
Even if the plan of the HEP is to qualify all households as model households within three
years of the program; yet eight years after the program implementation the achievement is
low due to under achievement of many components of the program. Failure to achieve
these targets will adversely affect progress towards achieving the Millennium
Development Goals and the Growth and Transformation Plan of the country (FMOH,
2012).
In 2010, six years after the beginning of the HEP in Ethiopia; approximately 4 million out
of 16 million households (26%) had completed the model household training. However,
only 4.3% of households were certified as model households which is very low compared
to the total coverage. This is due to low achievement in some components of the target.
For example, 38% of households did not have any type of latrine. Only 24% of 12-23
month old children were fully immunized (ECSA, 2011 and FMOH, 2010).
1.2 Statement of the problem
Maternal death is death of a woman whilst pregnant or within 42 days of termination of
pregnancy irrespective of what, but not from accidental or incidental causes (WHO, 2005).
In Ethiopia according to the 2011ECSA report, maternal mortality rate was 676 deaths per
100,000 live births. Maternal deaths represent 30% of all deaths to women age 15–49,
compared with 21% in the 2005ECSA and 25% in the 2000 ECSA (ECSA, 2011).
2
In Ethiopia one of the strategy to reduce maternal death is improving maternal antenatal
care service utilization, however the 2005 Ethiopian demographic and health survey
shows that antenatal care service utilization of women were 28% for at least one visit at
health facility level. Nearly nine out of ten in Addis Ababa and one out two women
receive one visit during their pregnancy, but this finding had great difference with Somali
region which is less than one per ten women in the region (ECSA, 2005).
After great effort has been made for five years to improve maternal and child health via
different strategies, the Ethiopian central statistics agency reveal that ANC service
utilization had a difference of 6% from 2005 finding (i.e. ANC utilization 34%) (ECSA,
2011).
Health extension program introduce in Ethiopia in 2003 with aim of producing a number
of model households, but the report from FMOH after six years of implementation shows
that only 4million household out of 16 million had complete the training. However, only
4.3% of households were certified as model households which is very low compared to the
total coverage. This is due to low achievement in some components of the target. For
example, 38% of households did not have any type of latrine. Only 24% of 12-23 month
old children were fully immunized (ECSA, 2011 and FMOH, 2010).
Since the implementation of the HEP, few studies have published findings on model
household’s service utilization comparatively and effectiveness of HEWs. These studies
have shown their effectiveness in improving utilization of maternal and child health in
high land areas. However, none of these studies investigate the improvement on utilization
of antenatal care services at graduated model household level in pastoralist community
specifically in Somali region. Hence, this study is aimed to fill this gap by looking on
what level did the graduated family use the service and what factors did affect it.
1.3 Significance of the study
Even if studies are conducted on HEP and maternal health service utilization in the
community level being researching will provide a very refined information. And also
studies conducted in Somali region are not yet enough, so that this work will contribute to
the planned health extension program and maternal and child health program. Provision
of baseline information about magnitude of antenatal care service utilization and
3
associated factor at model household level can assist program planners to adjust their
intervention strategies. The information which will generate from this study also will
motivate Somali regional health bureau and Shinile woreda health office and other
stakeholders, so that the proper decision can be made and right action can be taken.
4
1.4 Objective
1.4.1 General Objective:
 To assess the magnitude of antenatal care service utilization and associated factors
among women who have graduated from model family training in2013/14, in
pastoral kebeles of Shinile woreda, Mar/28/2015 to Apr/02/2015.
1.4.2 Specific objective:
1. To determine the prevalence of antenatal care service utilization among women
who have graduated from model family training in2013/14in all pastoral kebeles of
Shinile woreda.
2. To identify factors associated with antenatal care service utilization among
womenwho have graduated from model family training in2013/14in all pastoral
kebeles of Shinile woreda. .
5
2. Literature review
2.1 Antenatal care service utilization
A research conducted in Nepal, 2006 shows that ANC service utilization of woman in any
of their pregnancy was 72.2% (Shrestha R, 2006). In contrast to this a study conducted in
rural Balochistan, Pakistan shows that from all study participants 86% of them were never
had any ANC visit in their current and previous pregnancy, only 14% of them were able to
had at least one visit (Abdul G., et.al, 2011).
According to a study conducted in Kenya showed 90% of them visited ANC at least once;
among the attendees. A community based cross-sectional study conducted in Ghana
demonstrated that 86% of pregnant women use ANC service at least once and 60% of
women attend the minimum of 4 visits. Other community based studies conducted in
Sudan, Tanzania, Nigeria, and India revealed 90%, 99.8%, 57% and 73.9% of women had
attended ANC at least once during last pregnancy respectively (Anna M., et.al, 2006;
Overbosch G., et.al 2004; Abdel A., et.al, 2010).
A research conducted in north Gondar, Ethiopia shows that from all study participants
35% of them were able to receive ANC service for four time and above. Another study
conducted in Tigray region, Ethiopia shows that from the general study participants 54%
of them were able to had at least one visit during their last pregnancy (Mesfin N., et. Al,
2004; Yalem T., et.al, 2013).
In addition to the above studies, a study conducted in North, Ethiopia in Degua-Tembien,
Saesi- Tsadamba and Alaje district in 2012, shows that 48% of the participant able to
receive ANC service for four and above times (Araya M. et al., 2012).
2.2 Factor associated with antenatal care service utilization
2.2.1Socio-demographic factors
Different literatures finding shows that socio demographic factors are highly associated
with antenatal care service utilization. A study done in Vietnam showed women in the
richest quintile were 1.67more likely to initiate timely ANC and more likely to have three
or more ANC visits over the course of their pregnancy compared with women in the
poorest quintile [AOR=1.67, 95% CI (4.7, 26.8)] ( Mai D., 2008).
6
A research conducted in 31 developing countries in Africa shows that difference in
service among poorest and richest women’s, in this study the likelihood of poorest
women’s in antenatal care service utilization 84% lower than richest women’s(Saifuddin
A. et al, 2010). Another study conducted in Pakistan also shows that women’s from good
income family had an odds of 4.32 than women’s from low income family (Yalem T., et
al. 2013). A study conduct in India shows that also odds of ≥4 ANC visits were 56% lower
among the poorest women compared with women from the richest wealth quintile
(Prashant K., et al. 2013).
A community based study conducted in Indonesia by 2008, shows that pregnant women
who were able to access primary school were 3.2 times more likely to have inadequate
utilization of antenatal care compared to those with secondary school (Erlindawati M., et
al., 2008).Another study conducted in Japan, shows women ever enrolled in school were
6.8 times more likely to utilize antenatal care service than women never enrolled in school
[AOR= 6.8, 95% CI (2.7, 16.8)] (Yang Y., et.al, 2008).
A community based survey study conducted in 31 developing countries in Africa shows
that educational status of women’s had significant association with ANC service
utilization, this study finding was 2.89 more likely to made at least four ANC visit by
women’s who have completed primary education than women’s with no or less than
primary education (Saifuddin A. et al, 2010). The study conducted in Metekel, Ethiopia
shows that women with high school and above educational status were 6.52 times more
likely to utilize the service than women doesn’t educated [AOR= 6.52, 95% CI (1.55,
27.39)] (Gurmesa T., 2007).In a study conducted in Nigeria in 2009 the likely hood of
women availing themselves of ≥ 4 ANC visit was 38% lower among illiterate women
compared to women wife higher secondary level of education and above (Stella B and
Adesegun F., 2009).A study conducted in Tigray, Ethiopia also revealed that women’s
from 5-12 grade were 3.18 times more likely to seek the ANC service than women’s from
non-education and < 5grade.(Yalem T., et al. 2013).
Other research finding shows that husband educational status and working condition had
association with ANC service utilization. A study conducted in Shindh, Pakistan shows
that wives of husband having formal education were 2.95 times more likely to utilize the
7
ANC service than wives of illiterate husband (Fatmi Z. and Avan B., 1997). A study
conducted in Nigeria shows that the likely hood of taking >= 4 ANC visit among women’s
whose husband not educated were 18% lower than women’s whose husbands were
educated (Yalem T., et al. 2013).
Another study conducted in North, Ethiopia in Degua-Tembien, Saesi- Tsadamba and
Alaje district in 2012, shows that woman who were educated, were 59.5% more likely
than those were not educated (Araya M. et al., 2012)
Some studies findings show that age of women’s had an association with ANC service
utilization. A study conduct in Pakistan shows that maternal age was found to be a factor
in the utilization of ANC services. For instance, mothers who are in the age group of 2529 years were less likely to utilize ANC service than those 35 years and older (OR=0.32;
95%CI 0.16, 0.62)(Zeine A., et al., 2009). Similar study result was observed in an
Indonesian demographic health survey in 2007, women at age < or 27 age were 0.97 times
less likely to utilize the service than women at age of > 27 age (Christiana R., et. al. 2007).
Another study conducted in Afghanistan at 3rd international conference on RH and social
science research, reported that women’s at age of middle and older groups are 43% and
52% respectively less likely to utilize the ANC service than younger age group (the 3rd
International Conference on Reproductive Health and Social Sciences Research, August 7,
2009).A study in Tigray, Ethiopia also show that the proportion of women’s for ANC
service at an age between 16-40 year was 23.5% whereas > or = 41 age of women’s were
7% (Yalem T., et al. 2013).
2.2.2Program related factors
Different study findings Indicates that frequent visit of households by health extension &
community health workers has been important contributor to the utilization of maternal
health service in west Gojjam, Ethiopia and Nigeria (FMOH., 2010: Ugal D., 2010). A
study conduct in west Gojjam, Ethiopiain 2012, shows that mothers who had frequent
household visits by the HEWs were 1.289 more likely to visit the Health post for maternal
health care than mothers who did not have frequent household visit. In the same study
mothers from model households were 2.150 times likely to visit HP for service compared
to mothers from non-model households (FMOH. 2010: Mezgebu Y., et al. 2012).
8
A research conducted in North, Ethiopia in Degua-Tembien, Saesi- Tsadamba and Alaje
district in 2012, shows that, those households get frequent visit by HEWs were 64% more
likely to utilize ANC service than those receive less or no visit by HEWs(Araya M. et al.,
2012).
A study conducted in west Gojjam, Ethiopia in 2012 shows that women who remember
the health extension program package were 1.573 times more likely than women who
can’t remember the packages (Mezgebu Y., et al. 2012).
2.2.3Health and maternal related factors
A research conducted in western urban district of Turkey shows that woman who had gave
birth for the first time were 5.1 times more likely to have ANC adequate(=> 4) visit than
those gave birth third and more times (Meltem C., 2000). A study in Nigeria revealed that
only 19% of women with a parity of more than 4 children utilized the services, while
71.5% of those with a parity of 1-4 did so (Ugal D., 2010). A study conducted in Hadiya
Zone, Ethiopia, shows that women with a parity of less than 4 were 0.4 times less likely to
have ANC service than women with a parity of >= 5 [AOR= 0.4, 95% CI
(0.17,0.98)](Zeine A. et al., 2010). A community based study conducted in Indonesia
shows that women who hadn’t face complication were 1.44 times more to utilize ANC
service than women who had face complication [AOR= 1.44, 95% CI (1.16,1.78)]
(Christiana R. et al., 2010). Other study conducted in Hadiya shows that women with
gravidity of 2-4 were 0.52 times less likely to utilize antenatal care service than women
with five or more gravidity [AOR= 0.52, 95% CI (0.32,0.86)](Zeine A. et al., 2010). A
cross sectional study conducted in Indonesia shows that women with unwanted pregnancy
were 4.9 times more likely than women with planned pregnancy [AOR= 4.90, 95% CI
(1.61,14.94)] (Erlindawati., 2008).
In the abstract, study report of, the 3rd International Conference on Reproductive Health
and Social Sciences conducted in Afghanistan in 2009, reported that, woman who are
living more than one hour distance, 22% of them are less likely to use ANC service than
women who are living less than one hour distance (3rd International Conference on
Reproductive Health and Social Sciences Research, August 7, 2009).An Indonesian
demographic health survey in 2007 shows that women mention far distance as a big
9
problem to utilize the service were 1.21 times greater than women mention as small
problem[AOR= 1.21, 95% CI (1.03, 1.42)] (Christiana R., et. al. 2007).
In a study conducted in North Ethiopia, in Degua-Tembien, Saesi- Tsadamba and Alaje
district in 2012, also shows that proximity to the health facility had an association, in this
study women at approximate distance were 2.26 times more likely to visit the health
facility during prenatal than women’s far from the health facility (Araya M. et al., 2012).
2.2.3.1 Health Information source
A study conducted in Indonesia shows that, pregnant women who acquired less
information about ANC from health care providers were nearly 7.5 times more likely to
utilize the antenatal care inadequately compared to those who obtained enough
information (Erlindawati M., et al., 2008).
A study conducted in Uganda, the findings of the study prove that, there is a high average
percentage of women who have access to media everyday (42%) who used the entire
content of antenatal care as compared to with no access at all (14%) (Bbaale E., 2011).
In an abstract, study report of, the third international conference on reproductive health
and social science in Afghanistan in 2009, shows that source of information had
significant association with ANC service utilization, in this study the finding approve that
women’s who get information from TV were 1.49 times more likely to use the service
than those didn’t use TV as source of information. This study also shows that using Radio
as source of information had no statistical significant on ANC service utilization (3rd
International Conference on Reproductive Health and Social Sciences Research, August 7,
2009). But in contrast to this the study conducted in Northern Ethiopia, Degua-Tembien,
Saesi- Tsadamba and Alaje districtin 2012, shows that radio use as source of information
had an association, in this study those women’s listen to radio were 1.45 times more likely
to use the ANC service than those didn’t use radio as source of information (Araya M. et
al., 2012).
In general the literature’s reviewed in this study shows that, socio-demographic factor,
health factors, health extension program factors and source of information about the
service, had direct or indirect association with antenatal care service utilization of
women’s.
10
Socio Demographic
Factors
-
Education
Income level
Occupation
Maternal related factors
- Number of birth
- Birth complication
Antenatal care
service utilization
by model household
graduated mothers
Program related factors
-Number of visit by health
extension to women during the
training.
- Women Package remembering
ability
Health Related Factor
-
Health information source
other than health workers
Accessibility to health
facility
Figure 1: Diagrammatic representation of conceptual frame work for the study,
constructed from the literature review of this study.
11
3. METHODS AND MATERIALS
3.1 Study Area and Study Period
Shinile is one of the seven woredas found in the Siti zone in Ethio-Somali region. It is
bounded from North by Dire Dawa/Dembel, south by Hadigala, East by Erer, and West by
Dembel. There are 12 kebeles 9 rural & 3 urban kebeles in the woreda. Under Shinile
woreda administration there are different governmental development sectors among those
Shinile woreda health office is on off them and under it there are one functional health
center and three under construction and 18 functional health posts, all health facilities
heath facilities provides antenatal care service except two health posts. Majority of the
communities are pastoral and there are few agro-pastoral and merchants. According to the
population and housing census of 2005 and 2007 projection of the woreda has a total
population 57, 841, under one year’s 1,698, pregnant women/expected delivery 1,828,
women in reproductive age who are not pregnant 11,418 .(ECSA, 2005).And the study
was conducted from Mar/28/2015 to Apr/02/2015.
3.2 Study Design
 A community based cross-sectional study design was used.
3.3 Source Population
All women who are pregnant or gave birth graduated from model household family
training live in Shinile woreda.
3.4 Study Population
All women who are currently pregnant or gave birth in last year and graduated from
MHH family training in 2013/14 in the selected pastoral kebeles of Shinile woreda.
3.5. Sample population
 All randomly selected women who are currently pregnant or gave birth in last year and
graduated from Model Household family training in 2013/14. in pastoral kebeles of
Shinile woreda
12
3.6 Inclusion and exclusion Criteria
3.6.1 Inclusion criteria

The selected graduated household has to be graduated in shinile woreda by shinile
woreda health office HEWs.
3.6.2 Exclusion criteria
 Those women who were severely sick and cannot able to communicate were
excluded.
3.7 Sample Size Determination
For the first objective, the study sample size was determined by using single population
proportion formula with the assumptions of 95% level of confidence interval (CI), 5%
margin of error, 48%proportion of ANC service utilization which was taken from previous
study conducted in North Ethiopia (Araya M. et al., 2012) with10% non-response.
n= (Zα/2)2P (1-P)
d2
Where:
n = required sample size
Zα/2 = critical value for normal distribution at 95% confidence level which equals to 1.96
(z value at α =0.05)
P = proportion of ANC service utilization (48%)
d = absolute precision (margin of error 5%)
n = (1.96)2(0.48) (0.52)
(0.05)2
= 384, so that the total sample will be
n = [384 + 10 %( Non response rate)] = 422
13
For the second objective, sample size was determined by using double population
proportionformula taking proportion of education level and visiting households by health
extension workers from previous study conducted in the North Ethiopia (Araya M. et al.,
2012).
2
n1= [zα/2√[(1+1/r)p(1-p)] + zβ √[(p1(1-p1))+(p2(1-p2)/r)]]
(P1-p2)2
Where:
Z1-α = Z score for the desired confidence level (Z1-α = 1.96 at 95% confidence level)
Z1-β = Z score for the desired power (Z1-β = 0.80 at 80% power)
r=n1/n2=1for the population allocation ratio
P (pooled population proportion) = P1+rP2
1+r
By using Epi Info version 6 unmatched case control study sample size for double population
proportion becomes as follow (Araya M. et al., 2012)
Factors
Maternal
health
service
Sample size
utilization
Yes
No
Women with elementaryeducation
59.5
40.5
246
visiting households by
64.1
35.9
112
5%
95%
health extension workers
Since the first sample size greater than the second, so that the first had been taken as the
study sample size.
14
3.8 Sampling Procedure
The study was based on a systematic random sampling method using an administrative
division of woreda of the kebele. Then the proportion selection of households from the
kebele was performed by using proportionate allocation formula of:
nj= n Nj
N
Where nj = is sample size for the jth kebele.
n= sample size needed for the survey which is previously calculated (422)
Nj= Total Model households of the jth kebele.
N= N1+N2+N3+ N4 + N5+ N6+N7+N8+N9is the total model households in the
9pastoralist kebeles.
The total model house in 9 kebele from kebele one up to nine is K1= 110, K2= 125, K3=
84, K4= 98, K5= 65, K6= 132, K7= 87, K8= 112, K9= 71, totally they are 884.
Based the above information the sample proportion can be calculated as follow:
nj= n Nj = nj1= 422(110) = 52
N
884
There for, nj2= 60, nj3= 40, nj4= 47, nj5= 31, nj6= 63, nj7= 42, nj8= 53 and nj9= 34 and
the interval (kth) in selected kebeles were every two household and also to select study
participants list of households by health extension workers for model family training was
used as sample frame. Lastly Five days of survey was conducted by health extension
workers to identify the target women (women who are currently pregnant and gave birth
in last year) in model households.
15
Shinile woreda
With 9 pastoral kebele
Survey
Survey
N1=110
N2=125
N3=84
N1=110
N2=125
N3=84
n2=60
n3=40
N4=98
N5=65
P
P
S
n1=52
N4=98
N5=65
n4=47
n5=31
N6=132
N6=132
n6=63
N7=87
N7=87
n7=42
N8=112
N9= 71
N8=112
N9=71
n8=53
n9=34
SRS
n= 422
Fig.2: schematic presentation of sampling procedure of ANC service utilization of women
from MHH graduated from model family training, in shinille town, in 2014/15.
3.9 Study Variables
3.9.1 Dependent variable
Antenatal care service utilization
3.9.2 Independent variables
Different literatures shows different factor which affect the utilization antenatal care
service utilization by woman, by taking those
in to account this study include the
following factors as independent variables socio-demographic factors, program, health
related and information source about the ANC service.
16
3.10 Operational definitions
 ANC utilization: When a pregnant women graduated from model family training visit
health facility at least four times during her current pregnancy or last year pregnancy, by a
health professional including health extension worker, for reasons related to pregnancy,
after the time of graduation.
 Kebele: The lower administration level of Ethiopia which have its own cabinet or
structure.
 Model Households: Those households in Shinille woreda who had received the
graduation certificate when one member of the Household attend the Model family
training.
 Model family training: A training that have been given for model households for 60
hours.
 Pastoral Kebele: When the kebele residences life style depends on domestic animals
and their products and they move temporarily from place to place in fever of their
domestic animals.
 Woreda: It a district which had its own administrative boundary line with defined
population and kebeles under its administration.
 High Income Family: When a family have, > 15 Camels or >30 Cows or > 60 goats or
Sheep.
 Middle Income Family: When a family have, 3-15 Camels or 5-30 Cows or 20-60
Goats or Sheep.
 Poor Income Family: When a family have, < 3 Camels or < 5 Cows or < 20s Goats or
Sheep.
3.11 Data collection tools and method
An interviewer administered structured questionnaire adopted from questionnaires that
had been used in the previous studies (Araya M., et al, 2012)with some modification was
used. It was prepared in English language which was translated into Somalic language so
that that translation bias minimized further pre-test performed in order to assure flow of
question well designed and appropriate modification done and interviewer understanding
17
of the tool. The questions aimed to gather information from selected woman graduated
from MHH family training regarding relevant socio-demographic characteristics of the
respondents, their institutional service utilization. Four trained female diploma profession
were collect the data via interview. The principal investigator and one BSc supervisors
were supervising the data collection process. They were making frequent checks on the
data collection process to ensure the completeness and consistency of the gathered
information.
3.12 Data quality controls
Data quality was assured by using different mechanism. First of all, the data collection
instrument (questionnaire) was adopted from other published studies. Secondly, the
questionnaire was translated in to local language which is Somali, and careful translation
of the questionnaire was checked by the language expertise to compare consistency.
Adequate training and orientation was provided to supervisors and data collectors and pretest was performed and based on the pre-test the necessary improvement was made.
Thirdly, the supervisors together with the principal investigator were checking
completeness of the questionnaires daily. Incomplete questionnaires was identified, the
data collectors was asked to refill them again if the respondents were voluntary, otherwise
the questionnaires was discarded and data was feed to the computer by different two data
entry clerk.
3.13 Data Processing and Analysis
Data were sorted, coded and entered in to computer by using Epi Data version 3 after
checked by the principal investigator and the supervisors for completeness and accuracy
manually. Then data were exported to SPSS database program 16.0 version for data
coding and cleaning during data analysis. Univariate analysis such as proportion,
percentage, ratios, frequency distributions and appropriate graphic presentations besides
measures of central tendency and dispersion was used for describing data. Bivariate
analysis of demographic and other factors associated with antenatal care service utilization
was done and to ascertain the association; variables found to be significant (p<0.3) in the
bivariate analyses were used to construct a multivariate models. Independent variables
were tested for multicollinearity using correlation of Hosmer lemshow and omnibus tests
18
were used to test for model fit. Odds ratio along with 95% Confidence Interval (CI) was
estimated to identify factors associated with antenatal care service utilization using
multivariate logistic regression analysis. For all statistical procedures applied p-value of
less than 0.05 was considered to be statistically significant.
3.14 Ethical Considerations
Ethical approval was obtained from Haramaya University, College of Health and Medical
Sciences. A permission letter obtained from school of graduate studies was submitted to
Shinille worda health office and kebele administration office. In order to get the
participant willingness, they were informing clearly in detailed about the importance of
the study, the way they become candidate, the importance their participation, they have
the right to ask any question at any time during the data collection period, confidentiality
and their right to leave the study if they feel any discomfort without any responsibility and
they let to decide on whether to participate or not in the study which ensures the right of
self-determination and autonomy. The respondents who agreed to participate were given a
written consent and they were assure by their signature. The data obtained was treat
privately with no name tag on it and only authorized person
3.15 Dissemination of Results
The finding of this study upon the finalization of the analysis and interpretation will be
defended and comprehensive report will be submitted to Haramaya University School of
Graduate Studies. Then it will be distributed to all NGO who working together with the
region via Somali regional health bureau and hard copy of the research will give to Somali
regional health bureau and Shinille woreda health office.
19
4. Result
4.1 Socio demographic characteristics of the study participant
In the study a total of 392 women were participated with a response rate of 93.3%. The
age of the respondents ranged from 18 – 44 years with a mean age of 31.8 years. Most of
the study participants were 269(68.6%) not educated, only 53(13.5%) their husband
education were elementary and above, 374 (95.4%) were married, 279 (71.2%) work as
house wife, 288(73.5%) were from poor income, 287(73.2%) with parity of >3, only
143(36.5) were live at a distance which may take <= 2hours, 372(94.9%) Somali and
100% of them were Muslim (Table 1).
20
Table 1: Socio demographic characteristics of women graduated from model family
training (n = 392) in shinille woreda, 2015
Variable
Level
ANC utilization
=< 24
Yes (%)
50(44.2)
No (%)
63(55.8)
24 – 34
32(44.4)
40(55.6)
>= 35
170(82.1)
37(17.9)
Somali
240(64.5)
132(35.5)
Oromo
12(60.0)
8(40.0)
Marital
Married
243(65.0)
131(35.0)
Status
Divorced
1(25.0)
3(75.0)
Widowed
8(57.1)
6(42.9)
Not Educated
194(72.1)
75(27.9)
Elementary and above
58(47.2)
65(52.8)
House Wife
188(67.4)
91(32.6)
Rearing domestic animals
58(59.2)
40(40.8)
Government employee
2(66.7)
1(33.3)
Daily laborer
4(40.0)
6(60.0)
Others
0(0.0)
2(100)
Husband
Not Educated
220(68.5)
101(31.5)
Education
Elementary and above
23(43.3)
30(56.6)
Husband
Rearing domestic animals
228(65.5)
120(34.5)
Occupation
Government Employee
10(83.3)
2(16.7)
Daily laborer
3(60.0)
2(40.0)
Others
2(22.2)
7(77.8)
Middle and Above
51(49.0)
53(51.0)
Poor
201(69.8)
87(30.2)
> 2 hours
181(72.7)
68(27.3)
<= 2hours
71(49.7)
72(50.3)
1
6(23.1)
20(76.9)
2-3
48(61.5)
30(38.5)
>3
197(68.6)
90(31.4)
Age
Ethnicity
Education
Occupation
Income
Distance
Parity
21
4.2 ANC service utilization
From the total study participants140 (35.7%) 95% CI (30.9, 40.6) of them were able to
receive the service according to the WHO definition of the service (i.e. greater than four
visit) as per the report of the study participants, but the rest 252 (64.3%) 95% CI (59.4,
69.1) were able to receive less than four visit including zero visit. (Figure 3)
ANC
300
252
250
227
200
150
140
ANC
100
50
0
> =4 Visit
< 4 Visit (0-3 visit)
Ever visit (1 and above)
Figure 3: ANC service utilization of women from MHH graduated from model family
training in shinille woreda, pastoral kebele, 2015.
4.3 Frequency of proximal factors
To get enough information and check their utilization of the service questions was asked
regarding to a proximal factors which was found to have an association with outcome
variable in different literature, which includes Distance from the nearest health facility,
reproductive health problem history, information source, remembering of the packages
and frequency of Home visiting by HEWs.
From the study participants women who live at a distance which may take >2 hour to
reach the nearest health facility were found to be more than half of the study participants
249(63.5%). In the case of level of parity of the participants, women which have > 3 parity
take the first rank 287(73.2%) followed by 2-3 parity and single parity, 78(19.9) and
22
26(6.6%) respectively. In case of reproductive health history only 47(12%) of the study
participants had face the problem. Information source of the study participants were also
assessed and their major source were HEWs 271(69.1%) followed by radio and TV,
84(21.4) and 37(9.4) accordingly. When we see the result of the participants remembering
situation to the 16 packages less than twenty percent of the participant 67(17.1) were able
to remember greater than half of the package. In case of home visit by HEWs, from the
total participants about 282(71.9%) were ever visited by HEWs, but from those ever
visited houses only 72 of them were able to receive a monthly based visit(table 2 ).
Table 2: study participant information source, health extension related information status
in Shinile woreda, Somali, Ethiopia 2015
Variable
Information
Source
Frequency
of
House visit by
HEW
Reproductive
problem
Remembering
health extension
packages
Parity
Distance
Level
HEW
Radio
TV
Per four month
Per three month
Per month
Yes
No
>8
<8
None
1
2-3
>3
>2 hours
=<2hours
Frequency
271
84
37
259
61
72
47
345
67
95
230
26
78
288
249
143
Percent
69.1
21.4
9.5
66
15.6
18.4
12
88
17.1
24.2
58.7
6.6
20
73.4
63.5
36.5
4.4 Factors associated with ANC service utilization
The bivariate logistic regression shows that women with age of = < 25 year [COR= 3.03,
95% CI (2.09, 5.20)], with elementary educational status [COR= 2.83, 95% CI (1.78,
4.49)], with high school and above husband educational status [COR= 2.84, 95% CI (1.57,
5.13)], with middle and rich family income category [COR= 2.40, 95% CI (1.51, 3.80)],
able to remember >= 8 health extension package [COR= 5.24, 95% CI (3.35, 8.20)], with
HEWs visit per month [COR= 2.54, 95% CI (1.49, 4.34)], with distance =< 2hr [COR=
23
2.69, 95% CI (1.75, 4.15)], and with complication [COR= 2.27, 95% CI (1.22, 4.20)] was
significantly associated with women ANC service utilization(table 3).
Following bivariate logistic regression multivariate regression was performed and women
with age =<25 year [AOR= 2.32, 95% CI (1.35, 3.96)], elementary education [AOR=
2.10, 95% CI (1.21, 3.62)], live at a distance that take a time of =< 2hr [AOR= 2.05, 95%
CI (1.23, 3.44)], had get visit by HEWs per month [AOR= 2.68, 95% CI (1.41, 5.07)] and
able to remember >= 8 health extension package [AOR= 4.89, 95% CI (2.94, 8.13)] was
had significant association with women ANC service utilization.
Table 3: Bivariate and Multivariate logistic regression analysis of antenatal care service utilization
by model households graduated from model family training (n = 392) in Shinille town, 2014/15
Variables
Age
Level
>=25 year
< 25 year
Women
Not educated
Education
Elementary
High school and above
Husband
Not educated
education
Elementary and above
Income
Poor
Middle and above
Distance
>2hr
=<2hr
Remembering None
HEP package Able to mention >= 8 packages
Frequency of Per four month
home visit by Per two month
HEW
Per month
RH problem
Yes
No
ANC service
utilization
Yes
No
77(27.6)
202(72.4)
63(55.8)
50(44.2)
75(27.9)
194(72.1)
57(52.3)
52(47.7)
8(57.1)
6(42.9)
101(31.5) 220(68.5)
30(56.6)
23(43.4)
87(30.2)
201(69.8)
53(51)
51(49)
68(27.3)
181(72.7)
72(50.3)
71(49.7)
47(20.4)
183(79.6)
39(58.2)
28(41.8)
76(29.3)
183(70.7)
27(44.3)
34(55.7)
37(51.4)
35(48.6)
25(53.2)
22(46.8)
115(33.3) 230(66.7)
*=P<0.05
24
Crude OR
95% CI
Adjusted OR
95% CI
1.00
3.03(2.09, 5.20)
1.00
2.83 (1.78, 4.49)
3.44(1.58, 10.27)
1.00
2.84(1.57, 5.13)
1.00
2.40(1.51, 3.80)
1.00
2.69(1.75, 4.15)
1.00
5.24(3.35, 8.20)
1.00
1.91(1.08, 3.38)
2.54(1.49, 4.34)
2.27(1.22, 4.20)
1.00
1.00
2.32(1.35, 3.96)*
1.00
2.10(1.21, 3.62)*
1.56(0.40, 5.97)
1.00
0.99(0.47, 2.08)
1.00
1.37(0.79, 2.38)
1.00
2.05(1.23, 3.44)*
1.00
4.89(2.94, 8.13)*
1.00
1.90(0.90, 3.78)
2.68(1.41, 5.07)*
1.01(0.48, 2.10)
1.00
5. Discussion
The study result shows that ANC service utilization of women from model households and
trained on model family training was 35.7% 95% CI (30.9, 40.6) as reported by the study
participants and in multivariate analysis age =<25, elementary education, live at a distance
that take a time of =< 2hr, had get visit by HEWs per month and those able to remember
the health extension package were independently associated with women antenatal care
service utilization. This study result was low when compare a community based crosssectional study conducted in Ghana 60% (Anna M., et.al, 2006) and in North, Ethiopia in
Degua-Tembien, Saesi- Tsadamba and Alaje district 48%(Araya M. et al., 2012). This
may be community life style and a time difference in the implementation of the program,
almost same result were observed in a study conducted in north Gondar, Ethiopia 35%
(Mesfin N., et. Al, 2004), but the study conducted by ECSA in 2011 and in rural
Balochistan, Pakistan was very low 19% and 14% accordingly(CSA, 2011 and Abdul G.,
et.al, 2011).In this study the level of women ANC service utilization with at least one visit
was 58% and this result was low when we compare with a study conducted in rural
Balochistan, Pakistan 86% (Abdul G., et.al, 2011), in Ghana 86% (Overbosch G., et.al
2004), in Kenya 90% (Anna M., et.al, 2006) and in North, Ethiopia in Degua-Tembien,
Saesi- Tsadamba and Alaje district 85%( Araya M. et al., 2012), this may be due to their
advancement in development and urbanity. But a result of a study conducted in Tigray
region, Ethiopia was lower than this study 54% (Yalem T., et.al, 2013).The difference in
utilization may be due to difference of the study population and Heterogeneity of the study
participants and also the different associated factors that were found to have association
with the outcome variable in this study as well as other studies.
In multivariate analysis of this study, educational status of women was significantly
associated with antenatal care service utilization, women with at least elementary
education were 2.10 times more likely to utilize the service than women doesn’t educated
[AOR= 2.10, 95% CI (1.218, 3.620)]. In general the following study finding support the
association, however this study finding was lower when compared with a study in
Metekel, women with high school and above educational status were 6.52 times more
likely to utilize the service than women doesn’t educated [AOR= 6.52, 95% CI (1.55,
27.39)] (Gurmesa T., 2007). another study conducted in Tigray, Ethiopia women from
25
elementary and above were 3.18 times more likely to utilize antenatal care service than
women with no education[AOR= 3.18, 95% CI (1.85, 5.47)] (Yalem T. et al, 2006), a
study conducted in 31 African countries, women with primary education were 2.89 times
more likely to use the service than women doesn’t educated [AOR= 2.89, 95% CI (2.56,
3.27)] (Saifuddin A. et al, 2010), and a study conducted in Japan, women ever enrolled in
school were 6.8 times more likely to utilize antenatal care service than women never
enrolled in school [AOR= 6.8, 95% CI (2.7, 16.8)] (Yang Y., et.al, 2008). And this study
result was higher when compared with the study conducted in North-Ethiopia, women
categorized as literate were 1.85 times more likely to utilize the service than women
categorized as illiterate [AOR= 1.85, 95% CI (2.56, 3.27)] (Araya M. et al., 2012).
Evidence shows that education access is get increasing, women access to education also
increasing, so that their knowledge on health service also may increase, so that their
utilization to different health service may directly associate with their educational status.
In this study age was one of the associated factors with antenatal care service utilization.
From multivariate analysis women at age < 25 year were 2.321 times more likely than
women age >= 25 year [AOR= 2.32, 95% CI (1.35, 3.96)]. In contrast to this study result,
a study conducted in Indonesia and Pakistan show age increase had protective association.
A study result of Pakistan shows that women age 25 – 39 year were 0.32 times less likely
to utilize antenatal care service than women age 35 years and older[AOR= 0.32, 95% CI
(0.16, 0.62)](Zeine A., et al., 2009). A study conducted in Indonesia also shows that
women age < or =27year were 0.97 times less likely to utilize antenatal care service than
women at age of > 27 year [AOR= 0.97, 95% CI (0.96, 0.98)] (Christiana R., et. al. 2007).
From socio demographic factors, distance from the nearest health facility was associated
with the outcome variable. In this study women live at a distance <= 2 hours were 2.05
times more likely to utilize the service than women live at a distance > 2 hours [AOR=
2.05 95% CI (1.23, 3.44)]. A similar study conducted in North Ethiopia shows that women
live at a proximate distance were 2.26 times more likely to utilize the service than women
at far distance (Araya M. et al., 2012). An Indonesian demographic health survey in 2007
shows that women mention far distance as a big problem to utilize the service were 1.21
times greater than women mention as small problem[AOR= 1.21, 95% CI (1.03, 1.42)]
(Christiana R., et. al. 2007).All this above studies shows that as distance had an
26
association with ANC service utilization, this may be due to, as the distance between
home and health facility get closed, time wastage for health decrease, so that they can visit
health facility easily as well as they can perform their home activities.
The other associated factor of this study was frequency of home visit by health extension
workers, the likely hood of women who get monthly based home visit by health extension
workers was 2.680 times greater than women who get home visit by health extension
workers once per four month [AOR= 2.68 95% CI (1.41, 5.07)]. A similar study was
conducted in west Gojam, Ethiopia shows that shows that women who get frequent visit
by health extension was 1.289 times more likely than women from no visit or less frequent
visit [AOR= 1.28 95% CI (1.02. 1.82)] (Mezgebu Y., et al. 2012).
The participant ability to mention some of the health extension program packages was also
appear to had an associated with the outcome variable, in this study women who able to
mention > = 8 health extension packages was 4.89 times more likely than those women
who are not able to mention a single package [AOR= 4.89, 95% CI (2.94, 8.13)], this
finding was supported by a similar study conducted in west Gojjam, Ethiopia in 2012
shows that women who remember the health extension program package were 1.573 times
more likely than women who can’t remember the packages [AOR= 1.57 95% CI (1.05,
2.34)] (Mezgebu Y., et al. 2012). When compered this study level of association with
respect to home visit by health extension and ability of the participant to remember the
health extension program packages, in both case this study result has higher association
this may be due to the health extension program quality becoming improving as the year
of implementation get increased.
5.1. Limitation of the study
First this study used a cross sectional method and it shows level of utilization at a point at
one time, so that we can’t be sure the causal relationship. Secondly, recall bias. Lastly,
even if this study was conducted in pastoral community, place where doing research is
highly recommended, due to shortage of reference which directly intimate with this study
I had used literature of non-model household and non-pastoral community as comparison
group.
27
6. CONCLUSION AND RECOMMENDATIONS
6.1. Conclusion
Antenatal care service utilization of women from model household graduated as model
family in Shinille woreda was relatively low. And women age, distance, remembering
ability to health extension packages, HEWs visit and Reproductive problem was
significantly associated with antenatal care service utilization.
6.2 Recommendation
Based on this study finding, I would like recommend the following:

Woreda health office should direct the health extension workers and health extension
worker should consider >=25 years of women while selecting them for model family
training

Woreda health office should strength the existing follow-up and confirm the
understandability of the training and frequent home visit to be made and Health extension
workers also should give more emphasis on frequent home visit or follow-up

Woreda health office should plan to expand potential health service coverage, so that
community can access health service within recommended distance
28
7. Reference
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Sudan. Journal of BMC Pregnancy and Childbirth; 10(67):1471-2393.
Abdul Ghaffar, Sathirakorn Ponganich, Seah chapman, Alessio Panza, Sheh Mureed and Najma
Ghaffar, 2011. Provision and Utilization of Routine Antenatal Care in Rural Balochistan
Province, Pakistan: a Survey of Knowledge, Attitudes, and Practices of Pregnant Women.
Journal of Applied Medical Sciences, 1(1):93-116
Adeyinka A., Asabi O. and Adedotun O., 2012. Knowledge and practice of contraception
among women of reproductive ages in South West, Nigeria, journal of BMC 1(2):70–76.
Admassiea A., D. Abebawa, and A. Woldemichael, 2009. Impact Evaluation of the
EthiopianHealth Services Extension Program. Journal of Development Effectiveness. 1(4):
430–491.
Anna M.,Hanneke M.,Frank O., 2006. Use of antenatal services and delivery care among women
in rural western Kenya: a community based survey.Journal of Reproductive health, 3(2):123311
Araya Medhanyie, Mark Spigt, Yohannes Kifle, Nikki Schany, David Sandres, Roman Blanco,
Dinant Geert and Yemane Berhane, 2012. The role of health extension workers in improving
utilization of maternal health services in rural areas in Ethiopia, Bio Medical Center health
service research, 12:352
Bbaale Edwar, 2011. Factors influencing the utilization of antenatal care content in Uganda.
Austria Medical Journal. 4(9):516-526
Christan R Titaley, Michael J and Christine L., 2007. Factor associated with underutilization of
antenatal care service in Indonesia. BMC public health; 10(485): 2-10
Christiana R., Michael J. and Christine L., 2010. Factors associated with underutilization of
Antenatal care services in Indonesia. Bio Medical center. 10:485
Erlindawati M., Chompikul J. and Isaranurug S., 2008. Factors related to the utilization of
antenatal careServices among pregnant women at health centersIn aceh besar district,
nanggroe acehDarussalam province, Indonesia. Journal of Public Health and Development. 6
(2): 2551
29
Ethiopia central statistics agency: Key Findings Report, 2011
Fatmi Z. and Avan B., 1997. Demographic, Socio-economic and Environmental Determinants
of Utilization of Antenatal Care in a rural setting of Sindh, Pakistan, journal of BMC, 1(2):
110-234
Federal Ministry of Health 2003, Health Extension Package Implementation Guide
Federal Ministry of Health of Ethiopia Health Sector Development Program III 2010. Addis
Ababa: Annual performance report.
Federal Ministry of Health 2013 rural health extension program implementation guide line.
Federal Ministry of Health Planning and Programming Department, 2005. Health Sector Strategic
Plan (HSDP-III) Addis Ababa, Ethiopia.
Federal Ministry of Health: Health Extension and Education Center, 2007. Health Extension
Program in Ethiopia Profile: Addis Ababa Ethiopia.
Federal Ministry of Health: Health Extension program implementations guide line, 2007. Addis
Ababa Ethiopia.
Gurmesa Tura, 2007. Antenatal care service utilization and associated factors in Metekel zone,
Northwest Ethiopia. Ethiop J Health Sci; 19(2) 111-119
Hailom B., 2011. Ethiopia’s Health Extension Program: Improving Health through
CommunityInvolvement MEDICC Review; 13(3).
Mai D., 2008. Antenatal Care Service Availability and Utilization in Rural Viet Nam. AsiaPacific Population Journal; 23(1):29-54.
Meltem Ciceklioglu, Meral Turky and Zeliha Asli, 2000. Factors associated with the utilization
and content of prenatal care in a western urban district of Turkey, international journal for
quality in health care, 17(6):533-539
Mesfin Negusu, Damen Haile, Getnet Mitiku, 2004. Assessment of Safe Delivery Service
Utilization among women of child bearing age in North Gondar Zone, Ethiopian J. health
Development 18(3):146–150.
30
Mezgebu Yitayal, Yemane Berhane, Alemayehu Worku,Yigzaw Kebede, 2012. The
community-based Health Extension Program significantly improved contraceptive utilization
in West Gojjam Zone, journal of multidisciplinary health care, 3(7): 201-208
Narzary P., 2009. Knowledge and use of contraception among currently married adolescent
women in India. Health policy and planning journal; 3(1):43–49.
Nejmudin Bilal, 2012. Health Extension Program: An innovative solution to public health
challenges of Ethiopia case study. Development Policy Review. 24 (5): 513-536.
Okech T., Wawire N. and Mburu T., 2011. Contraceptive use among women of reproductive
age in Kenya’s city slums,Journal of African economics; 2(1): 22–43.
Overbosch G., Vanden B., Damnyag L., 2004. Determinants of antenatal care use in Ghana.
Journal of African economics; 13(2):277-301
Prashant Kumar, Chandan Kumar, Rajesh Kumarand Lucky Singh, 2013. Factors associated
with maternal health care services utilization in nine high focus states in India, health policy
and planning journal, 1(1): 1-18
Saifuddin Ahmed, Andreea A.creange Duff Gillespieand Amy Otusi, 2010. Economic Status,
Education and Empowerment: Implications for Maternal Health Service Utilization in
Developing Countries, journal of PLoS ONE, 5(6):11190
Shrestha R, 2006. Maternal mortality in Nepal: addressing the issue. IJHSR. 2012;2(9):65-74.
Stella Babalola and Adesegun Fatusi, 2009. Determinants of use of maternal health services in
Nigeria – looking beyond individual and household factors, journal of bio medical center
1(3): 383-393.
The 3rd International Conference onReproductive Health and Social Sciences Research report,
August 7, 2009.(Abstract)
Ugal D., 2010. Household environment and maternal health among rural women of Northern
Cross River State, Nigeria,Journal of African economics; 1(2): 213-297
Yalem Tesgaye, Tesfay Gebrehiwot, Isabel Goicoliea, Kerstin Edin and Miguel S., 2013.
Determinants of antenatal and delivery care utilization in Tigray region, International journal
for equity health 12(30):2-10
31
Yang Y., Yoshitoku Y., Harunand Junichi S., 2008. Factors affecting the utilization of antenatal
care servicesamong women in kham district.Nagoya J. Med. Sci. 23-33
Zeine Abosse, Mirkuzie Woldie and Shimeles Ololo, 2009. Factors influencing antenatal care
service utilization in hadiya zone. Ethiopian health science journal. 20(2)
32
8. Appendix
8.1 Participant information sheet and consent form for study participants
My name is ____________. I am working as a data collector for the study being conducted in
this community by Esmael Mohammed who is studying for his Master’s Degree at Haramaya
University, College of Health and Medical Sciences. I kindly request you to lend me your
attention to explain you about the study and being selected as the study participant.
The study title
Determine the magnitude of antenatal care service utilization and identify associated factors
among model households who have graduated from model family training in 2006 EFY, in
Shinile woreda, Mar/28/2015 to Apr/02/2015.
Purpose of the study
The findings of this study can be a paramount importance for the Regional Health Bureau and
Woreda health office to plan intervention program to strength the existing HEP and service
utilization by the community via dif. More over the aim of this study is to write a thesis for
the partial requirement for the fulfillment of a Master’s Degree Program in General Public
Health for the principal investigator.
Procedure and duration
I will be interviewing you using a questionnaire to provide me with pertinent data that is
helpful for the study. There are 19 questions to answer. The completion time of the data
collection is about 15 to 20 minutes, so I kindly request you to spare me this time for the
interview.
Risks and Benefits
The risk of being participating in this study is very negligible when we compare with its
importance, only taking few minutes from your time. You will not get any direct payment for
the participation. However, findings may reveal important information for the local health
planers.
Confidentiality
33
When I ask you, I need to feel free because all the information that you will provide me
will kept confidential and placed in a secured place. During our conversation also no need
of writing your name or any other personal or household identification no can’t identify
you even the Principal investigator. The questionnaire will be coded to exclude any
identification and the study findings will be general for the community.
Rights
Your participation in this study is fully voluntary. You have a right to participate or refuse
in this study and not to answer any question if you feel any discomfort within the data
collection process.
Contact address
If you have any questions or concerns any time about the study, you can contact the
concerned bodies with the following address given below.
Principal investigator Address
Name- Esmael Mohammed Haramaya University
Address –Shinille woreda health office
Tel: 0921861919 Tel 025-114 0014
E-mail ibnumohammed2003@gmail.com or osmi2003@hotmail.com
IHRERC address:
Office Phone: 0256661899, P.O.Box: 235, Harar, Ethiopia.
Declaration of informed Voluntary Consent
I have understood that the purpose the study, procedures, risks and benefits of
participating in the study, issue of confidentiality, rights of participation and contact
address for queries. I was informed that I have the right to withdraw from the study at any
time or not to answer any question that I do not want without any way of affecting me.
Therefore, I declare my voluntary consent to participate in this study with my signature as
indicated below.
Signature of participant _________________
Signature of the data collector_______________
34
Translated Somali Participant Information Sheet
Foomka xog uruurinta ka qaybgalaha
Subax/galab wanaagsan, magacaygu waa…………………………………
Waxaan ahay xog uruuriye, waxaan uruurinayaa xogta daraasada ay sameyneyso Jaamacada
Haramaaya, kulliyada caafimaadka sidaa daraadeed si aad unoqoto qof ka qaybgala
daraasaadkan, fadlan akhriso ama halaguu akhriyo heshiiskan.Waxaan rabaa inaan su‟aalo ku
weydiiyo ku saabsan isticmalka adega xoyoyinka, waxaanan u baahanahay inaad saxeexdo
ama aad calaamadayso warqada. Fadlan waqti qaado aad ku qo’aan sato inaad ka qaybgasho
daraasaadkan, waxaanad fahmina na waydii.
Ujeedada daraasaadkan: - Si loo ogaado heerka uu gaadhsiisanyahay xanuunka ama
cudurka dhiigyaraanta ee gabdhaha dayarta ah ee loo yaqaano xiliga dhalinyarta iyo in uu
xidhiidh laleeyahay cuntada, da,da, dhiiga caadada, iyo siloo sameeyo baadhitaan ku
salaysan cilmi xeel dheer. Waxaana raacsan taas qorista buuga maastarka.
Xilliga ama geedi socodka iyo sida loo fulinayo howsha: - gabadh kasta oo da,deedu tahay
ama ay u dhaxayso jir islamarkaana buuxiyayna shuruudaha looga baahanyaahay, waxaa la
balami dadka xogta ururinaaya, haduuu qofkaasi ku raaco waxaa loo sheegi in laga qaadi
doono dhiiga islamaarkaana laga cabiri doono culayskiisa. Daraasaadku wuxuu qaadan
doonaa ama kula joogi doono mudo 20 daqiiqo.
Faa iidada: -. Daraasaadkani wuxuu kaa caawinayaa si aad u ogaato in ay dhiigyari ku
hayso iyo inkale wakhtiga aad ku jirtid da,da dhalinyarnimada aad ku jirtid. Hadii dhiigaagu
yaryahay waxaa islamarkaaba lagu siin daawada ku haboon iyo wixii talo ah islamarkaana
ayna jirin waxkale oo lagu siin doono. Haase ahaatee, warbixintani waxay faa‟iideneysaa
dawladeena si ay u ogaato heerka ay taagantahay dhiigyarida haysashaystaan wixii kahortag
ah ama xakamayn ah.
dhibaatooyinka: - waa wakhtiga oo lagaa isticmaalo iyo xanuun yar ood ka dareento farta
wakhtiga dhiiga laga qaadayo, xanuunkaas oo laga yaabo inaad la kulantay hada kahor.
Fadlan, hadaad u aragtid dhib nala socodsii adigoo dagan
kalsoonida: - waxaan kuu ballan qaadaynaa in jawaabaha aad bixisid sir ahaan loo ilaalin
doono. Warbixin kastood na siisaana waxaa loo diiwaan galin doonaa koodh ahaan, mana
ahan magacaaga dhabta ah.wax kastoo laqoreyna waa la tirtiri markey dhammaato daraasadu.
Sidaa darted, haka war warin.
Xaqa ka qayb galaha: ka qayb qaadashadaadu waxay ku xidhantahay kaliya
ogolaanshahaaga, marwalbana waxaad awood u leedahay inaad diido ka qayb qaadashada
35
xog uruurinta markasta oo aad u baahato, wax dhibana kala kulmi meysid helitaanka adeega
caafimaadka, wixii su‟aala ood tabaneyso wey kuu bannaantahay inaad iweydiiso.
Hadii ay jirto wax dheeriya ood tabaneysidna kazoo xiriir
Esmael mohammed 0921861919ama
Foomka sixiixa: Xog uruurintan ujeedadeeda, faaiidadeeda, dhibkeeda iyo xaqa aan leehay
waa la ii sheegey waana la ii akhriyey. Waxaana la isiiyey jaanis aan ku weydiin karo
su‟aasha aan rabo taasoo ku saabsan daraasadan. Waxaa kaloon ogaadey ka qayb
qaadashadeydu iyo sixiixeygu kaliya inay ku xidhantahay ogolaanshaheyga. Kana tagi karo
markasta oon u baahdo anoon dhib u keeneyn nolosheyda.
Sixiixa ka qayb galaha______________________________
Magaca & sixiixa xog uruuriyaha______________________
36
8.2Questioner Magnitude of antenatal care service utilization and identify associated
factors among model households who have graduated from model family training in 2006
EFY, in Shinile woreda, Mar/28/2015 to Apr/02/2015 (Araya M., et al, 2012).
001. Questionnaire identification number _________
002. Interviewer name________________________
003. Date of interview______________________
Checked by supervisor; Name___________________________, Signature_____________
SOCIO-DEMOGRAPHIC INFORMATION
No
1
Question
How old are you
2
Ethnicity
3
Religion
4
Marital status
5
Educational Status
6
Occupation
7
Husband
status
8
Husband occupation
9
Income
educational
Response
……….. year
Remark
Somalia…………………………1
Oromo …………..……………..2
Amhara ………….……………..3
Others (specify)……….………..4
Muslim …………………………1
Orthodox………………………2
Other(specify)………………....4
Single…………………………..1
Married………………………...2
Divorced……………………….3
Widowed……………………….4
No education…………………..1
Elementary …………………..2
high school and above……..…..3
Other (specify)…………………5
House Wife…………………….1
Rearing domestic animals…….2
Government Employee………...3
Daily Laborer…………………..4
Other (specify)…………………5
No education…………………..1
Elementary …………………..2
high school and above……..…..3
Other (specify)…………………5
Rearing domestic animals…..….1
Government Employee………...2
Daily Laborer…………………..3
Other (specify)…………………4
----------------------- in birr
37
1 rich
2 mid
3 poor
Program Related factors
10
Among the components
you had learn in the
training please tell me
what you remember?
11
Immunization --------------------------1
Excreta disposal -----------------------2
Family planning -----------------------3
Solid and liquid waste disposal ----4
Food supply and safety measures--5
Personal hygiene ---------------------6
Water supply and safety measures-7
Health house environment ----------8
Malaria ---------------------------------9
Maternal and child health-----------10
HIV/AIDS, Other STD and TB----11
Nutrition------------------------------12
Adolescent reproductive health----13
Insect and rodent control-----------14
Health education--------------------15
First aid------------------------------16
Did theHEWs visit you
Yes ----------------------------------1
during training?
No -----------------------------------2
If Q10, yes, Frequency of
13
What are the sources of information
for ANC service?
15
16
17
18
19
20
good
2
mod
3 poo
One time/4 month-----------------1
One time/2 month ----------------2
home visits by HEWs
One time/ Month -----------------3
Source of Information about the service
12
14
1
Radio ------------------------------1
TV ---------------------------------2
HEWs------------------------------3
Health related factors
Total number of birth you gave?
One -------------------------------1
2-3 --------------------------------2
>3 ---------------------------------3
Have you ever face any reproductive
Yes -------------------------------1
health problem?
No --------------------------------2
Distance to nearest health facility
__________in hour
Maternal health service utilization
Are you pregnant now?
Yes --------------------------------1
No ---------------------------------2
If yes, did you visit any health facility Yes --------------------------------1
for ANC service?
No ---------------------------------2
If yes, How many times you visit the
One --------------------------------1
health facility during your pregnancy? Two --------------------------------2
Three-------------------------------3
Four and above ------------------4
Did you give birth in last one year?
Yes --------------------------------1
No ---------------------------------2
38
21
22
If yes, did you visit any health
facility for ANC service at that
time?
If yes, How many times you visit
the health facility during your last
year pregnancy?
39
Yes -------------------------------1
No --------------------------------2
One --------------------------------1
Two --------------------------------2
Three-------------------------------3
Four and above ------------------4
`
Xog ururin ku saabsan kaalinta ay ka qaataan bixiyayaasha adeega caafimaadka dhinaca
isticmalka adeega cafimaadaka ee hooyooyinka khaasatan kuwa qoysaska lagudaydo ah
(model) kuwaasoo ka qalinjabiyay tababarkii qoysaska lagudaydo loo fidiyay wakhtigii
2006EC, dagmada shiniile, 2015.
01.
02.
03.
04.
No ka xogta _______________
Magaca xog ururiyaha___________________
Taariikhda __________________________
Magaca goobta ______________________
Waxaa xaqiijiyay; magaca____________________, saxeexa__________________
Qaybta koobaad : Xogta shakhsiga
Jawaab
No
Su’aal
1
Da’da
2
Qoomiyada
3
Diinta
4
Xaalada guurka
5
Heerka wax barashada
6
Shaqada
7
Heerka tacliineed
odayga reerka
8
Shaqada odayga reerka
9
Hantida uu haysto
……….. Sano
Somalia…………………………1
Oromo …………..……………..2
Amhara ………….……………..3
waxkale (qeex)……….………..4
muslim…………………………1
Orthodox………………………2
3 waxkale(qeex)………………..3
ee
kali……………………………1
reer leh………………………..2
furay…………………………..3
ka dhintay…………………….4
Wax ma baran…………………1
Dugiga hoose ………………..2
Dugsiga sare…………………..3
Wax kale (qeex)………………4
Hooyo guri……………………..1
holodeqata……………………2
shaqaale dawladeed………........3
nolol maalmeed………………...4
waxkale (qeex)…………………5
Wax ma baran…………………1
Dugiga hoose ………………..2
Dugsiga sare…………………..3
Wax kale (qeex)………………4
holodeqata ……………………1
shaqaale dawladeed……….......2
muruq maal……………………3
waxkale (qeex)………………...4
----------------------- birr ahaan
40
Xasuu
sin
Qaybtii labaad : Programka adeega caafimaad
10
Maxasuusataa/Waaxdee
baad fahantay programka
adeega caafimaadka?
11
Talaalka Immunization ---------------1
Maareynta musqusha-------------------2
Qorshaynta qoyska --------------------3
Maaraynta qashinka hooraha iyo
adkaha--------------------------------4
Maaraynta nadaafada cuntada-----5
Nadaafada shakhsi ahaaneed-------6
Maaraynta biyaha acabka ah---------7
Maaraynta deegaanka ----------------8
Kaniicada (duumada)-----------------9
Caafimaadka hooyada iyo cunuga--10
HIV/AIDS, xanuunada kale ee lagu
kala qaado galmada iyo TB da----11
Nafaqaynta ----------------------------12
Adolescent reproductive health----13
Maaraynta cayayaanka xanuunada
keena iyokuwafidiya-----------------14
Wax barashada guud ee caafimaadka-------------------15
Gargaarka koobaad----------------16
Ma ku soo booqdeen
Haa ----------------------------------1
bixiyayaasha adeega
Maya --------------------------------2
cafimaadka?
12
booqdaan
13
14
15
16
17
18
Ima soo booqdaan-----------------------1
Mar mar bay isoo booqdaan-----------2
In badan (ugu yaraan mar 4 tii
todobaadba)------------3
Information source
Imisa jeer ayay ku soo
Xagee baad ka heshaa macluumaadka Radiyaha -------------------------1
ku saabsan wacyigalinta isticmaalka
TV ga-----------------------------2
ANC?
Shaqaalaha fidinta caafimadka-3
Health Related factors
Imisa jeer baad dhashay?
Mar -------------------------------1
2-3 --------------------------------2
>3 ---------------------------------3
Hada ka hor ma la kulantay dhibaato
Haa -------------------------------1
xaga taranka ah?
Maya ------------------------------2
Baaxada darar ee adeega caafimaadka __________saacadood
Isticmaalka adeega caafimaadka hooyooyinka
Uur maad leedahay?
Haa --------------------------------1
Maya-------------------------------2
Hadii ay haa tahay, ma booqatay
Haa -------------------------------xaruun caafimaad adeega ANC ga
Maya ------------------------------2
41
19
20
21
22
dartiis ugu yaraan mar?
Sanadkii na soo dhaafay ma dhashay?
Hadii ay haa tahay, ma booqatay
xaruun caafimaad adeega ANC ga
dartiis ugu yaraan mar sanadkii na
soo dhaafay?
Hadii haa tahay jawabta, xarunta
mategtay ?
Hadii haa tahay jawabta imisa jeer
tegaty ?
Haa --------------------------------1
Maya-------------------------------2
Haa -------------------------------1
Maya ------------------------------2
Haa -------------------------------1
Maya ------------------------------2
Kew-----------------------------1
Leba ----------------------------2
Sedeh ---------------------------3
Afar -----------------------------4
Wax badan ---------------------5
42
8.3CURRICULUM VITA
1. PERSONAL INFORMATION
Name
Esmael Mohammed
Date of birth
03-03-1980EC
Place of birth
Dessie
Sex
Male
Marital status
Married
Address
Mobile – 0921861919
E-mail: osmi2003@htmail.com
2. EDUCATIONAL BACK GROUND
SN Grade type
Year
Place
1
Elementary and junior
1993-2001
Sinbileta Primary School
2
High School and preparatory
2002-2005
Mohammed Hanfera School
3
Higher Education
2006-2009
Jimma University
3. LANGUAGE
SN
Language Name
Writing
Reading
Speaking
Listing
1
Amharic
Excellent
Excellent
Excellent
Excellent
2
English
Excellent
Excellent
Excellent
Excellent
3
Somaligna
V. good
V. good
V. good
Excellent
4
Arebic
V. good
Excellent
V. good
Excellent
4. SKILLS
Very good computer skills and internet explorer
Very good skill in field work and data collection
43
5. TRAINING AND SEEMINAR
SN
Type of training
Place
1
TOT on HMIS
FMOH/SAVE/SRHB
2
Community based training (CBTP)
Jimma University
3
Team training program (TTP)
Jimma University
4
Essential nutrition action (ENA)
IFHP
5
Community leading total sanitation (CLTs)
SRHB/UNICEF
6
TOT of TB/HIV
ICAP/SRHB
7
On-going LMG TOT
SRHB
6. WORKING EXPERIENCE
I have been working in shinille health office starting from 2002EC up to now as
-
Environmental sanitation and hygiene expert
-
HMIS focal person
7. Qualification
I had graduated from the well-known university of JIMMA with BSc in Environmental Health,
June-2009
.
44
9. APPROVAL SHEET
HARAMAYA UNIVERSITY
SCHOOL OF GRADUATE STUDIES
Determine the magnitude of antenatal care service utilization and identify associated
factors among model households who have graduated from model family training in 2006
EFY, in Shinile woreda,Mar/28/2015 to Apr/02/2015.
Submitted by:
____________________
Name of Student
__________________ ________________
Signature
Date
Approved by:
1. ___________________
Major Advisor
2. ___________________
Co-Advisor
3. ___________________
Name of chairman, DGS
__________________
Signature
__________________
Signature
__________________
Signature
4. ___________________
__________________
Name of Dean, SGS
Signature
45
________________
Date
________________
Date
________________
Date
________________
Date