Socio-demographic characteristics
This study surveyed 1,210 eligible participants, 440 of whom were Golden Hands community members. The majority of research participants, 516 (42.64%), are in the wealth index's fifth quintile. The average age of the respondents was 26.64 years, with a standard deviation of + 4.76. The most of respondents, 856 (70.50%), identified as protestant Christians. In terms of residence, half (50.25%) of survey participants lived in rural areas. (Table 1)
Table 1
Socio-demographic characteristics of respondents, their spouses according to groups of the women in two community, Kembata Tembaro zone; Southern Ethiopia, November 2021
Socioeconomic variables | Participant’s category | Total participants |
---|
Underprivileged (Golden-hands) | Non golden-hand | Frequency | % |
---|
Wealth index | | | | |
---|
1st quintile | 150(82.4%) | 32(17.6%) | 182 | 15.04 |
2nd quintile | 104(82.5%) | 22(17.5%) | 126 | 10.04 |
3rd quintile | 94(55.0%) | 77(45.0%) | 171 | 14.13 |
4th quintile | 63(29.3%) | 152(70.7%) | 215 | 17.77 |
5th quintile | 29(5.6%) | 487(94.4%) | 516 | 42.64 |
Residence | | | | |
Urban | 399(65.6%) | 209(34.4) | 602 | 49.75 |
Rural | 41(6.8%) | 561(93.2%) | 608 | 50.25 |
Respondents’ occupation | | | | |
Government employed | 16(3.8%) | 408(96.2%) | 697 | 57.60 |
Housewife | 377(57.1%) | 283(42.9%) | 412 | 34.05 |
NGO | 12(48.0%) | 13(52.0%) | 69 | 5.70 |
Merchant / self employed | 21(30.9%) | 47(69.1%) | 20 | 1.65 |
Students | 13(40.6%) | 20(60.3%) | 33 | |
Spouse’s occupation | | | | |
Government employed | 3(0.8%) | 389(99.2%) | 392 | 32.59 |
Farmer/housewife | 140(51.5%) | 132(48.5%) | 272 | 32.75 |
NGO employee | 9(13.01%) | 60(86.99%) | 69 | 5.74 |
Merchant / self employed | 231(58.6%) | 163(41.4%) | 394 | 22.61 |
Student | 1(25. %) | 3(75%) | 4 | 0.25 |
Others | 64(87.7%) | 9(12.3%) | 73 | 6.07 |
Respondents’ education | | | | |
No formal education | 332(72.2%) | 128(27.8%) | 468 | 38.68 |
Primary education | 90(48.4%) | 96(51.6%) | 187 | 15.45 |
Secondary education | 9(5.5%) | 156(94.5%) | 165 | 13.64 |
College and above | 9(2.3%) | 390(97.7%) | 390 | 32.23 |
Utilization of Antenatal care services.
More than half of the research participants, (56.61%) used an antenatal care service during their previous pregnancy. The most of normal community members (80.34%) use ANC services, but just 12.75% of gold hand community members have utilized ANC in their most recent pregnancy (Table 2).
Table 2
Summary statistics of Antenatal care service utilization of the study participants by socio economic variables in Kembata Tembaro zone, Southern Ethiopia 2022.
Socioeconomic variables | Total number | ANC utilization |
---|
Frequency | Percentage |
---|
Community subgroups | | | |
---|
Golden hand subgroups | 440 | 56 | 12.73 |
Non golden hand subgroups | 770 | 629 | 80.34 |
Wealth index | | | |
1st quintile | 182 | 42 | 23.08 |
2nd quintile | 126 | 22 | 17.46 |
3rd quintile | 171 | 67 | 39.18 |
4th quintile | 215 | 121 | 56.28 |
5th quintile | 516 | 433 | 83.92 |
Residence | | | |
Urban | 602 | 503 | 83.55 |
Rural | 608 | 182 | 29.93 |
Respondents’ occupation | | | |
Housewife | 660 | 247 | 37.42 |
Government employed | 424 | 365 | 86.08 |
Merchant / self employed | 68 | 44 | 64.71 |
NGO | 25 | 11 | 44.00 |
Students | 33 | 18 | 54.54 |
Respondents’ education | | | |
No formal education | 460 | 121 | 26.30 |
Primary education | 186 | 69 | 37.10 |
Secondary education | 165 | 149 | 90.3 |
College and above | 399 | 346 | 86.72 |
Knowledge and Attitude of study participants toward ANC services
According to modified blooms cut off points, the overall magnitude of good, medium, and bad knowledge among research participants was 79.87% (95% CI = 77.48% − 82.05%), 17.44% (95% CI = 15.38% − 19.71%), and 2.70% (95% CI = 1.90% − 3.80%). According to modified blooms cut off points, the overall magnitude of positive, neutral, and negative attitude towards the service was 53.72% with 95% CI = 50.89% − 56.52%, 40.91%with 95%CI = 38.16%- 43.71%, and 5.37% with 95% CI = 4.23% − 6.80%
5.2. Concentration index and concentration curve showing service utilization inequality
Pregnant women in urban areas use ANC more than those in rural ones, educated women use it more than uneducated women, and affluent women use it more than poorer women. The rate of ANC service is 3.64 times greater in women in the top quintile than in those in the lowest. The concentration index was 0.29, indicating that the wealthy are the primary users of ANC services. There was a statistically significant difference in ANC service utilization between golden hands and the rest of the community [Diff = 0.09, p-value = 0.0001]. The rate of having excellent knowledge of the service was 4.02 times greater among economically well-situated women than among the poorest women. This is corroborated by a calculated CI of 0.15, which demonstrated that the wealthier section of the population had better awareness of the service than the poorest segment. There is a statistically significant difference in knowledge level about the service between golden hands and other community members [Diff = 0.15, p-value = 0.001]. Furthermore, among economically better-off women, the rate of having a good opinion toward the service was 2.11 times greater than among the poorest women. This is corroborated by a calculated CI of 0.04 indicating that the wealthier part of the population has a more positive attitude about the service than the lowest segment. There is no statistically significant difference in service attitudes between golden hands and other members of the community [Diff = 0.01, p-value = 0.886] (Table 3).
Table 3
Rate-ratio (rich/poor), Concentration indices, standard error and P-value for maternal and reproductive health services, Kembata- Tembaro; Southern Ethiopia 2021.
Indicators | Rate – Ratio (rich/ poor) | Combined Concentration index (CI). | Standard error | P-value | Difference in CI between golden hands and others | P- value for test of statistically significant difference (Ho: - difference = 0 if P > 0.05) |
---|
ANC service utilization* | 3.64 | 0.29 | 0.014 | 0.001 | 0.09 | 0.0001 |
Good knowledge of ANC service* | 4.02 | 0.15 | 0.015 | 0.001 | 0.15 | 0.001 |
Positive attitude towards ANC service | 2.11 | 0.04 | 0.02 | 0.030 | -0.01 | 0.884 |
*Indicates significant at p < 0.05.
The concentration curve for the investigated indicator (ANC) of reproductive and maternal health services revealed a pro-rich bias (see Figs. below). The concentration curve of ANC revealed that the services were highly utilized by a wealthy segment of the population (Fig. 1)
Generalized Lorenz curve showing inequality in antenatal care service utilization between golden hands and non–golden hand community members.
Lorenz curve for ANC service utilization revealed that the service was lowly utilized by Golden hands community net of characteristics composition. Lorenz curves depicted below clearly indicate that service distribution for the golden hands' community was more unequal than service distribution for non -golden hand community members. (Fig. 2)
Decomposition analysis for Antenatal care service utilization
The coefficient (discrimination) component is clearly bigger than the endowment component (characteristics), showing that evidence for ANC service use discrimination exists in addition to individual characteristics such as educational achievement, employment, location, and so on(23). Discrimination explains 60.23 percent of the lower ANC service consumption by golden hand community members as compared to non-golden community members. Endowment accounts for just 39.47 percent of the reduced ANC service consumption for the golden hand community subgroups as compared to non-golden hand groupings. The tiny endowment components demonstrate that individual characteristics such as education and other endowment disparities explain a minor portion of the service use differentials among community groupings. However, the discriminating component is substantial, resulting in decreased service consumption by golden hand persons with the same domicile, employment, wealth index, and educational levels as non-golden hand individuals. (Table 4)
Table 4
Overall logistic multivariate decomposition analysis of ANC service utilization in Kembata Tembaro zone, Southern Ethiopia, 2021
Decomposition | Antenatal care (ANC) |
---|
Coefficient | Pct |
---|
Endowments (E) Unexplained | .27207 (.17711, .36704)* | 39.47 |
Coefficients (C) Explained | .41725 (.31001, .52449)** | 60.23 |
Gap (E + C) | .68932 (.65088, .72776)* | 100 |