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Maternal and child health care utilisation often vary with geographic location. This paper analyses the geographic distribution and determinants of utilisation of four or more antenatal care visits, health facility delivery, child immunisation and care utilisation for common childhood illnesses across four Ethiopian regions.

Atkure Defar, Dagu project lead at the Ethiopian Public Health Institute and a PhD student supported through the  project and his co-authors, published this paper in the International Journal for Equity in Health.

The authors employed a cross-sectional community-based study with two-stage stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women and 3110 children below the age of 5 years residing in 5714 households were included.

Of the 6321 women included in the study, 714 had a live birth in the 12 months before the survey. One third of the women had made four or more antenatal visits and almost half of the women had delivered their most recent child at a health facility. Nearly half of the children with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunised children was 41%. Institutional delivery was clustered at district level. Full immunisation coverage was also spatially clustered. Four or more antenatal visits were associated with women’s age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunisation was associated with household members owning a mobile phone.

The study showed evidence for geographic clustering in coverage of health facility deliveries and immunisation at the district level, but not in the utilisation of antenatal care and utilisation of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage.



Atkure Defar

Dagu Lead, Ethiopian Public Health Institute

Yemisrach Okwaraji

Research Fellow

Professor Lars Åke Persson

Professor of Public Health Evaluation