Decomposition and Spatio-temporal analysis of health care access challenges among reproductive age women in Ethiopia, 2005-2016

Abstract

Background: The high maternal mortality, home delivery, unwanted pregnancies, incidence of unsafe abortion, and unmeet family planning needs are maternal health gaps attributed to health care access barriers and responsible for the observed health care disparities. Over the last decades remarkable achievements have made in relation to maternal health problems and the reduction of health care access barriers. Thus, this study aimed to assess the decomposition and spatial-temporal analysis of health care access challenges among reproductive-age women in Ethiopia.

Methods: Secondary data analysis was conducted based on the three consecutive Ethiopian Demographic and Health Surveys (2005-2016 EDHSs). A total weighted sample of 46,235 reproductive-age women was included in this study. A logit based multivariate decomposition analysis was employed for identifying factors contributing to the overall decrease in health care access challenges over time. For the spatial analysis, ArcGIS version 10.6 and SaTScan™ version 9.6 were used to explore hotspot areas of health care access challenges in Ethiopia over time. Variables with p-value < 5% in the multivariable Logit based multivariate decomposition analysis were considered as significantly contributed predictors for the decrease in health care access challenges over time.

Result: The mean age of the women was 27.8(±9.4) years in 2005, 27.7(±9.2) years in 2011, and 27.9 (±9.1) years in 2016. Health care access challenges have been significantly decreased from 96% in 2005 to 70% in 2016 with the Annual Rate of Reduction (ARR) of 2.7%. In the decomposition analysis, about 85.2% of the overall decrease in health care access challenge was due to the difference in coefficient and 14.8% were due to differences in the composition of the women (endowment) across the surveys. Socio-demographic characteristics (age, residence, level of education, female household head, better wealth and media exposure) and service utilization history before the survey (facility delivery and had ANC follow up) contribute to the observed decrease over time. The spatial analysis revealed that health care access challenges were significantly varied across the country over time. The SaTScan analysis identified significant hotspot areas of health care access challenges in the southern, eastern, and western parts of Ethiopia consistently over the surveys.

Conclusion: Perceived health care access challenges have shown a remarkable decrease over time but there was variation in barriers to health care access across Ethiopia. Media exposure improved mothers' health care access in Ethiopia. Public health programs targeting rural, uneducated, unemployed, and women whose husband had no education would be helpful to alleviate health care access problems in Ethiopia. Besides, improving mother's media exposure plays a significant role to improve mothers' health care access. Health care access challenges have significantly varied across the country. This suggests that further public health interventions are important for further reduction of health care access barriers through the uplifting socio-demographic and economic status of the population.

Keywords: Ethiopia; Health care access challenge; Multivariate decomposition analysis; Spatio-temporal analysis.

Fig. 1

The conceptual framework adapting from literatures for analyzing factors contributing to health care access challenges

Fig. 2

The trends of women health care access challenges across regions in Ethiopia

Fig. 3

Forest plot of risk difference between women from urban and rural area in health care access challenge across regions in Ethiopia from 2005 to 2016

Fig. 4

Risk difference between women in rural and urban area across regions in Ethiopia over time

Fig. 5

The global spatial autocorrelation of health care access challenges in Ethiopia 2005, 2011 and 2016

Fig. 6

The spatial distribution of health care access challenges among reproductive-age women in Ethiopia, 2005 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 7

The spatial distribution of health care access problem challenges among reproductive-age women in Ethiopia, 2011 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 8

The spatial distribution of health care access challenges among reproductive-age women in Ethiopia, 2016 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 9

The SaTScan analysis of hotspot areas of women health care access challenges among reproductive-age women in Ethiopia, 2005 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 10

The SaTScan analysis of hotspot areas of women health care access challenges among reproductive-age women in Ethiopia, 2011 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 11

The SaTScan analysis of hotspot areas of women health care access challenges among reproductive-age women in Ethiopia, 2016 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 12

The Kriging interpolation of health care access challenges among reproductive-age women in Ethiopia, 2005 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 13

The Kriging interpolation of health care access challenges among reproductive-age women in Ethiopia, 2011 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)

Fig. 14

The Kriging interpolation of health care access challenges among reproductive-age women in Ethiopia, 2016 (Source: CSA 2013, using Arc-GIS version 10.6 and SaTScan version 9.6 statistical software)