Factors Associated with Health Extension Service Utilization in Dera District, Oromia, Ethiopia: A Multi Level Analysis
American Journal of Theoretical and Applied Statistics
Volume 8, Issue 3, May 2019, Pages: 85-93
Received: Apr. 4, 2019;
Accepted: May 20, 2019;
Published: Jul. 30, 2019
Views 395 Downloads 81
Abate Tadesse Zeleke, Department of Statistics, Madda Walabu University, Bale Robe, Ethiopia
Dejen Tesfaw Molla, Department of Statistics, Addis Ababa University, Addis Ababa, Ethiopia
Nega Assefa Kassa, Department of Public Health, Haramaya University, Haramaya, Ethiopia
Follow on us
Introduction: Health Extension Program is implemented in Ethiopia since 2004 as a flagship of preventive, promotive, and basic curative services for poor and rural community, especially for children and mother. The purpose of this study is to examine the determinants and variations in health extension service utilization in Dera district, Oromia, Ethiopia. Methodology: Three-stage cluster sampling was used to select a random sample of 534 households from 10 kebeles of the district. The study used both descriptive and inferential statistics to identify the determinants of Health extension service utilization and variations. Result: The descriptive result revealed that out of 534 respondents, 223 (41.8%) of them utilized and 311 (58.2) of them not utilized health extension service given at the health post and outreach level. The random intercept binary logistic regression analysis identified that mother's age, mother educational level, mothers' employment status, knowledge on Health Extension Program, being model in Health Extension Program implementation, frequency of home visited by Health Extension Workers, number of students in a family and perception about conduct of Health Extension Workers were significant determinants of Health Extension Program utilization. Conclusion: Comparison between multilevel models has done and random intercept binary logistic model was found to have a better fit for utilization of health extension program and the district health office has to work to reduce the variance and factors that affect Health Extension Program utilization for each kebeles of the district.
Dera, Health Extension Program, Multilevel Logistic and Utilization
To cite this article
Abate Tadesse Zeleke,
Dejen Tesfaw Molla,
Nega Assefa Kassa,
Factors Associated with Health Extension Service Utilization in Dera District, Oromia, Ethiopia: A Multi Level Analysis, American Journal of Theoretical and Applied Statistics.
Vol. 8, No. 3,
2019, pp. 85-93.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Federal Ministry of Health (FMOH) 2007. “Health Extension Program in Ethiopia – Profile.” Addis Ababa.
World Bank. 2013. UNICO Studies Series 10, The Health Extension program in Ethiopia. Washington DC.
Assefa A, Alebachew H, Fassil N; Haniko M and Ihalainen A, B K. 2010. HIV/AIDS and the health related millennium development goals. The Experience in Ethiopia 2010, 369(2112): 2112–2311.
Ghebreyesus A 2010. Achieving the Health MDGs: country ownership in four steps. 376(9747): 11228. (http://www.lancet.com/journals/lancet/article/PIIS0140 6736(10)61465- 1/full text)
Federal Ministry of Health (FMOH) and Abt Associates. 2010. Fourth National Health Account Report. Addis Ababa.
Dera district administrative: Health profile 2016.
Central Statistical Agency (CSA) and ICF International. 2012. “Ethiopia Demographic and Health Survey 2011.” Addis Ababa and Calverton, Maryland, USA: Central Statistical Agency and ICF International.
CSA (Ethiopia), 2013. Population Projection of Ethiopia for All Regions at Wereda Level from 2014 – 2017: Addis Ababa, Ethiopia.
Snijders, T. and Bosker, R. 1999. Multilevel Analysis: an Introduction to Basic and Advanced Multilevel Modeling. London. Thousand Oaks, New Delhi. Sage Publications.
Peter C Austin. 2010. Estimating Multilevel Logistic Regression Models When the Number of Clusters is Low: A Comparison of Different Statistical Software Procedures. Int J Biostat; 6(1): doi: 10.2202/1557-4679.1195.
Kelbessa Zewudu, Baraki Negga and Egata Gudina. 2014. Level of health extension service utilization and associated factors among community in Abuna Gindeberet District, West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Services Research 14: 324. doi: 10. 1186/1472-6963-14-324.
Anthony G. Turner. 2003. Sampling strategies. Review the Draft Handbook on Designing of Household Sample Surveys. ESA/STAT/AC.93/2.
Gelman, A. and Hill, J. 2006. Data Analysis Using Regression and Multilevel or Hierarchical Models. Columbia University, Journal of the American Statistical Association.
Goldstein, H. and Rasbash, J. 1996. Improved approximations for multilevel models with binary responses. J. Roy. Statist. Soc. A, 159: 505–513.
Araya Medhanyie, Mark Spigt, Yohannes Kifle, Nikki Schaay, David Sanders, Roman Blanco, Dinant GeertJan and Yemane Berhane. 2012. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Services Research 12: 352 doi: 10.1186/1472-6963-12-352.
Yilkal Tafere, Mirkuzie Woldie, Henok Assefa, Amanu Aragaw 2014. Utilization of Environmental Health Services of Urban Health Extension Program and Associated Factors in Debretabor Town, North West Ethiopia: Cross Sectional Study. Science Journal of Public Health. Vol. 2, No. 5, 2014, pp. 494-501. doi: 10.11648/jsjph.20140205.28.
Yitayal Mezgebu, Berhane Yemane, Worku Alemayehu and Kebede Yigzaw. 2014. The community-based Health Extension Program significantly improved contraceptive utilization in West Gojjam Zone, Ethiopia. Journal of Multidisciplinary Healthcare 2014: 7.
Abajobir Alemu Amanuel and Seme Assefa. 2014. Reproductive health knowledge and services utilization among rural adolescents in east Gojjam zone, Ethiopia: a community-based cross-sectional study. BMC Health Services Research 2014, 14: 138. doi: 10.1186/1472-6963-14-138.
Yitayal Mezgebu, Berhane Yemane, Worku Alemayehu and Kebede Yigzaw. 20014. Health extension program factors, frequency of household visits and being model households, improved utilization of basic health services in Ethiopia. BMC Health Services Research 2014, 14: 156. doi: 10. 1186/1472-6963-14-156.