Utilization of Health Service and Associated Factors Among Women in Child-bearing Age in Selected Internaly Displaced Persons Camps, Hargeisa – Somaliland

doi:10.21203/rs.3.rs-3101604/v1

Download PDF

Research Article

Utilization of Health Service and Associated Factors Among Women in Child-bearing Age in Selected Internaly Displaced Persons Camps, Hargeisa – Somaliland

https://doi.org/10.21203/rs.3.rs-3101604/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Introduction: The utilization of health care services is an important public health problem in developing countries for the accomplishment of global health coverage. Access to and use services in health care are significant to the development of health outcomes in many African countries. In most sub-Saharan countries, the utilization of health care services is very low. Reproductive health problems are the leading cause of morbidity and mortality among women of childbearing age in developing countries. Although global strategies have been planned to improve access to high-quality health services, there are still obstacles to attain. Women of child-bearing age usually need more health services than other age groups, and they are more likely to experience complications during pregnancy and childbirth, which might result in increased morbidity and mortality.

Objective: To assess the utilization of health services and associated factors among women of childbearing age in internal displaced person (IDP) camps in Hargeisa, Somaliland.

Methods: A community-based cross-sectional study design was employed among women of childbearing age in the selected IDP camps in Hargeisa. Out of eight IDPs in Hargeisa, three were selected by the lottery method. A total of 402 women of childbearing age were selected using a simple random sampling method. Data were collected using an interviewer-administered structured questionnaire. The data were cleaned, coded and entered into SPSS version 23 for further analysis. Bivariate and multivariable logistic regression was used to analyse the data.

Results: The overall health service utilization among women of childbearing age in Hargeisa IDPs was found to be 61.5%.The age groups of 23 – 27 years old and 33 – 37 years old were 5 times and 3 times more likely to utilize health services, respectively [AOR 5.2 (Cl: 2.1 – 13.0)] and [AOR 2.7 (Cl: 1.2 – 5.9)]. Married women had higher odds of utilizing health services than single women. (AOR: 0.23 (0.07 – 0.73).

Conclusion: The overall health service utilization among women in childbearing in IDPs in Hargeisa was found to be unsatisfactory. Respondents’ age group, marital status,and educational level were found to be significantly associated with health service utilization among mothers in childbearing in IDPs in Hargeisa Somaliland.

Health Policy

Health services utilization

child bearing age

internally displaced people

Access to high-quality health care is one of the most vital indicators of community progress. Health services are a precondition for advancing human development, and the lack of health care services makes it difficult to improve human development (1).

The utilization of health care services is an important public health problem in developing countries for the accomplishment of global health coverage. Access to and use services in health care are significant to the development of health outcomes in many African countries. In most sub-Saharan countries, the utilization of health care services is very low. Reproductive health problems are the leading cause of morbidity and mortality among women of childbearing age in developing countries. Although global strategies have been planned to improve access to high-quality health services, there are still obstacles to attain (2, 3).

Women of child-bearing age usually need more health services than other age groups, and they are more likely to experience complications during pregnancy and childbirth, which might result in increased morbidity and mortality (2). Internally displaced women are more vulnerable to health-related complications due to a lack of access to health care services. Internal displacement is common in Africa in general and in Somalia in particular due to civil conflicts and droughts.

According to the Global Shelter Cluster, Somaliland hosts approximately 85,000 internally displaced people, most of whom are displaced by civil conflicts in neighbouring regions and natural hazards such as repeated droughts. According to the report, the displaced people who escaped their home territories due to civil conflict and severe drought conditions are supposed to be approximately 45,000 in Woqooyi Galbeed, 26,000 in Togdheer, 5000 in Sool, 8,000 in Awdal and 1,000 in the Sanaag region, most of whom lack basic health care services(4). This study aims to assess the utilization of health services and associated factors among women of child-bearing age in selected internally displaced peoples (IDPs) camps in Hargeisa, Somaliland.

4.1. Study area and period.

The study was conducted from August 15 to August 30, 2022, in selected IDPs in Hargeisa, Somaliland. Hargeisa is the capital city of Somaliland; the city is located at the centre of Somaliland and near the border with Ethiopia. It is located with the Marodi-jeh valley passing through the city, although it is currently dry. It is the largest city in Somaliland, and estimates using a GIS survey in 2007 placed the population somewhere between 350,000 and 850,000 people. However, based on rural‒urban migration and city growth in general, officials believe that the current population is actually more than 1.5 million people. It currently consists of 5 main districts, 3 small districts and 4 villages (7). There are eight internally displaced camps in Hargeisa.

4.2. Study Design.

A community-based cross-sectional study design was conducted.

4.3. Population.

4.3.1. Source of Population.

The source population included all females of reproductive age among the IDPs in Hargeisa.

4.3.2. Study Population

The study population was females in the age group of 18 to 49 years old in selected IDPs in Hargeisa.

4.4. Eligibility Criteria.

4.4.1. Inclusion Criteria.

All females in the age group of 18 to 49 years old in selected IDPs in Hargeisa present at the time of data collection who are seeking health services.

4.4.2. Exclusion Criteria.

Women of reproductive age (18 to 49 years old) who were unable to communicate because of physical and mental disability or severe illness were excluded from the study.

4.5. Sample Size Determination.

The total sample size of 402 was calculated using a single population formula and assuming a proportion of health service utilization of 50%, 95% confidence level, and 5% margin of error and finally adding a 5% nonresponse rate, simple random sampling was used. The first three IPDs were selected out of 8. Then, the childbearing age females in the selected household were interviewed for the questionnaire.

P= prevalence of health care utilization (50%)

Z= level of confidence at 95% certainty (1.96)

d= 5% margin of errors

4.6. Sampling Technique.

There are eight IDPs in Hargeisa. Three of them were selected by the lottery method, namely, Digale, Malawle and Jimcale. The first house was randomly selected, and then every second house (1, 3, and 5) was selected. If the target population was not found in the selected house, the next house was taken until the sample size was obtained. Each IDP has an equal proportion of households to be included.

4.7. Study Variables

4.7.1 Dependent Variables

Level of Health Service Utilization.

4.7.2. Independent (determinant) Variables

Sociodemographic characteristics (sex, mother’s educational status, family size, age, employment status). Wealth index

4.8. Data Collection procedure

A structured questionnaire prepared in the English language was used and translated into the Somali language and then translated back to English to check for consistency.

Data were checked manually for completeness during data collection and before data entry. Then, the data were entered into and analysed with SPSS for Windows (version 23).

Data Analysing

Descriptive analyses, such as proportions, percentages and measurements of central tendency, were used. Binary logistic regression and multiple logistic regression analyses were used to identify associated variables, and those variables with P values < 0.05 at the 95% CI were considered significant determinants of health service utilization of women of childbearing age.

5.1. Sociodemographic characteristics of the study respondents

A total of 402 respondents were interviewed, with a respondent rate of 95%. The mean age of the study participants was 32.40 ± SD 7.59. Approximately 308 (80.2%) respondents were married, and 111 (28.9%) were able to read and write the local language, which is Somali. More than two-thirds of the study participants (263, 68.5%) were exposed to the media, particularly TV (Table 1).

The majority of respondents (51.8%) had a family size of 6–10 individuals, 42.2% had 1–5 individuals, and only 6% had family members greater than 11. Of the respondents, 80.2% were married, 15.4% were divorced, and only 4.4% were single. At the educational level, 20.3% were illiterate, 23.9% were able to read and write only, and 18.2% and 32.6% were at the primary and secondary levels, respectively.

Table 1

Sociodemographic characteristics of study participants (n = 384) Health Service Utilization among IDP Residencies Hargeisa, Somaliland.
Variables(n = 384)	Frequency	Percentage %
Age group
18–22	37	9.6
23–27	69	18.0
28–32	96	25.0
33–37	80	20.8
≥ 38	102	26.6
Family members
1–5	162	42.2
6–10	199	51.8
> 11	23	6.0
Current Marital status
Married	308	80.2
Divorced	59	15.4
Single	17	4.4
Educational status of respondent
Illiterate	78	20.3
Able read and written	111	28.9
Primary school	70	18.2
Secondary education and above	125	32.6
Exposure to mass media
Radio	20	5.2
TV	263	68.5
Social Media	101	26.3

5.3. Health service utilization

The overall health service utilization among Hargeisa IDPs was 61.5%. Two hundred thirty-six respondents visited health facilities in the last 12 months. In total, 87 (36.9%) visited health facilities twice throughout the last year. The majority of study subjects (364, 94.8%) visited governmental health facilities, and 168 (43.8) and 103 (26.8) visited immunization and OPD sections at health facilities, respectively. Almost the majority (376, 97.9%) accessed health facilities near 1–2 km on foot.

Table 2

**Health Services Utilization among IDP Residencies Hargeisa, Somaliland. (n = 384)**
Variables	Frequency	Percent
Have you visit health facility for any purpose for the last year
Yes	236	61.5
No	148	38.5
How many times did you visit the facilities
One time	104	27.1
Twice	122	31.8
Three times	10	2.6
Which health facility did you visit
Gov't Hospital/Health centres	221	57.6
Private Hospital	7	1.8
Traditional Healers	8	2.1
Which health service did you seek
Maternal health	33	8.6
Immunization child	103	26.8
OPD	77	20.1
ANC	23	6
Travel time to the nearest Health Centre or Hospital on foot
Near	28	7.3
Medium	166	43.2
Far	42	10.9
Distance to the nearby Health center/Hospital (in kilometers)
1–2 KM	376	97.9
2–5	8	2.1

5.4. Bivariate and multivariate logistic regression of factors affecting health service utilization among women’s residencies at IDP camps (n = 384).

Bivariate and multivariate logistic regression was performed. Multiple logistic regression analysis revealed that the respondent’s age group was significantly associated with health service utilization, and the age groups of 23–27 years old and 33–37 years old were 5 times and 3 times more likely to utilize health services, respectively [AOR 5.2 (Cl: 2.1–13.0)] and [AOR 2.7 (Cl: 1.2–5.9)]. Married women had higher odds of utilizing health services than single women. (AOR: 0.23 (0.07–0.73).

Table 3

Bivariate and multivariate analysis of factors affecting health service utilization among women’s residencies at IDP camps Hargeisa – Somaliland.
Variables	Health Service Utilization		COR (95%Cl)	AOR (95%Cl)	P Value
Variables	Yes (%)	No (%)	COR (95%Cl)	AOR (95%Cl)	P Value
Age group of respondents.
18–22	23(9.7)	14(9.5)	0.91(0.42–1.9)	2.2(0.7–6.3)	0.15
23–27	37(15.7)	32(21.6)	1.29(0.69–2.3)	5.2(2.1–13.0)	0.000***
28–32	70(29.7)	26(17.6)	0.55(0.3–1.0)	1.2(0.5–3.0)	0.57
33–37	45(19.1)	35(23.6)	1.26(0.64–2.1)	2.7(1.2–5.9)	0.017**
≥ 38	61(25.8)	41(27.7)	1	1	1
Marital status of respondents.
Married	199(84.3)	109(73.6)	0.29(0.11–0.8)	0.23(0.07–0.73)	0.012
Divorced	31(13.2)	28(18.9)	0.49(0.16–1.5)	0.35(0.11–1.2)	0.088
Single	6(2.5)	11(7.4)	1	1	1
Educational status of women’s
Illiterate	46(19.5)	32(21.7)	0.83(0.4–1.5)	0.79(0.4–1.6)	0.502
Able reading and written	75(31.8)	36(24.3)	0.57(0.3–0.9)	0.50(0.3–0.9)	0.034*
Primary education	47(19.9)	23(15.5)	0.58(0.3–1.1)	0.48(0.2–0.9)	0.042**
Secondary and above	68(28.8)	57(38.5)	1	1	1
Wealth index of respondents
Poor	75(31.8)	51(34.5)	1.2(0.6–1.8)	1.2(0.7–2.0)	0.600
Middle	83(35.2)	45(30.4)	0.81(0.4–1.3)	0.9(0.5–1.6)	0.677
Rich	78(33.1)	52(35.1)	1	1	1

The overall health service utilization among mothers in childbearing in IDPs in Hargeisa was 61.5% for the last year. The majority of study subjects (364, 94.8%) visited governmental health facilities, and 168 (43.8) and 103 (26.8) visited immunization and OPD sections at health facilities, respectively. Almost the majority (376, 97.9%) accessed health facilities near 1–2 km on foot.

The result of this study is slightly higher than that of a similar study performed in the Dawunt district, North Wollo zone, Ethiopia, which found that the overall health service utilization among fee waiver beneficiaries was 60.98% (8). This finding was also found to be lower than that of a study performed in southern Ethiopia, which found that health service utilization was 77.2% (5). The findings of this study are higher than those of a similar study performed in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia, which was found to be 44.3% (24).

Factors that affect health service utilization were marital status, age, education, and perceived health status. Being married was more likely to indicate the utilization of health services. This finding is higher than that of a study performed in Jimma [2].

Overall health service utilization among mothers in childbearing in hargeisa IDPs was found to be unsatisfactory for the last one year. Respondent age group and marital status were found to be significantly associated with health service utilization among mothers in childbearing in IDPs in Hargeisa Somaliland. Younger age groups are more likely to utilize health services compared to older age groups.

Ethical Approval Addis Ababa Medical University College Hargeisa Campus Research Ethics Committee has analyzed and reviewed the community based research Paper titled “Utilization Of Health Service and associated factors among women in child bearing Age In selected internally displaced persons camp Hargeisa Somaliland ”; authored by Abdikadir Mohamed Nuh and co-authored by Dr.Isahak Mohamoud Askar. After thorough examination of the procedural, methodological and ethical aspects the research, the committee has anonymously decided and declared that it is ethically sound and safe to do the study on human subjects. All methods and procedures in the study fulfilled the procedural, methodological and ethical standards and guidelines of the University and the Helsinki declaration. And hereby, we declare that the data can be collected and the study can be conducted. RESEARCH & QUALITY ASSURANCE Abdeta Muktar Ahmed Competing of interests The authors declare that there is no competing interests at all Consent Participants were verbally explained about the purpose of study. Participant have the right to withdraw from interview at any time based on their interest. So, each respondent gave informed verbal consent after being told the purpose and procedures of the study. All responses was kept confidential

Hasan Howlader M, Ashfikur Rahman M, Imtiaz Hasan Rahul M. Assessment of factors influencing health care service utilization in rural area of Bangladesh. Int J Community Med Public Heal. 2019;6(9):3710.
Girma F, Jira C, Girma B. Health services utilization and associated factors in jimma zone, South west ethiopia. Ethiop J Health Sci [Internet]. 2011;21(Suppl 1):85–94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22435012%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3275873
Bitew Workie S, Mekonen N, Michael MW, Molla G, Abrha S, Zema Z, et al. Modern Health Service Utilization and Associated Factors among Adults in Southern Ethiopia. J Environ Public Health. 2021;2021:5–11.
Global shelter cluster. Coordinating humanitarian shelter. Overview Somaliland IDPS. Available at: URL: https://sheltercluster.org/hub/somaliland
Azevedo MJ. Historical Perspectives on the State of Health and Health Systems in Africa, Volume II. Vol. II, Historical Perspectives on the State of Health and Health Systems in Africa, Volume II. 2017. 1–73 p.
Bazie GW, Adimassie MT. Modern health services utilization and associated factors in North East Ethiopia. PLoS One. 2017;12(9):1–10.
Van Duong D, Binns CW, Lee AH, Hipgrave DB. Measuring client-perceived quality of maternity services in rural Vietnam. Int J Qual Heal Care. 2004;16(6):447–52.
Elo IT. Utilization of maternal health-care services in Peru: the role of women’s education. Health Transit Rev. 1992;2(1):49–69.
Gabrysch S, Campbell OMR. Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9:34.
Navaneetham K, Dharmalingam A. Utilization of maternal health care services in SERVICES IN SOUTH INDIA K . Navaneetham Centre for Development Studies Thiruvananthapuram , India A . Dharmalingam Department of Sociology & Social Policy University of Waikato , Hamilton , New Zealand Octob. 2000;(July 2014).
Bolam A, Manandhar DS, Shrestha P, Ellis M, Malla K, Costello AM. Factors affecting home delivery in the Kathmandu Valley, Nepal. Health Policy Plan. 1998;13(2):152–8.
Bicego G, Curtis S, Raggers H, Kapiga S NS. Sumve Survey on Adult and Childhood Mortality in Tanzania. 1995;1–105.
No Tit.צכןle. Available from: https://www.ptonline.com/articles/how-to-get-better-mfi-results
Wenjuan W, Soumya A, Shanxiao W, Alfredo F. Levels and Trends in the Use of Maternal Health Services in Developing Countries:
Dhs Comparative Reports 26. Int Heal Dev Div [Internet]. 2011;7(5):682–90. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Department+of+Making+Pregnancy+Safer#0%5Cnhttp://whqlibdoc.who.int/hq/2009/WHO_MPS_09.10_eng.pdf%5
Cnhttp://rwanda.unfpa.org/drive/MaternalMortalityReductioninRwanda%28VLR%29.pdf%5Cnhttp://siter
Mrisho M, Schellenberg JA, Mushi AK, Obrist B, Mshinda H, Tanner M, et al. Factors affecting home delivery in rural Tanzania. Trop Med Int Heal. 2007;12(7):862–72.

Download PDF

Version 1

posted

You are reading this latest preprint version

Utilization of Health Service and Associated Factors Among Women in Child-bearing Age in Selected Internaly Displaced Persons Camps, Hargeisa – Somaliland

Status:

Version 1

Abstract

Figures

Background

METHODS AND MATERIAL

4.1. Study area and period.

4.2. Study Design.

4.3. Population.

4.3.1. Source of Population.

4.3.2. Study Population

4.4. Eligibility Criteria.

4.5. Sample Size Determination.

4.6. Sampling Technique.

4.7. Study Variables

4.8. Data Collection procedure

RESULTS

5.1. Sociodemographic characteristics of the study respondents

5.3. Health service utilization

DISCUSSION

Conclusion

Declarations

References

Status:

Version 1