Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study

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Abstract

Objective

Little is known about the extent to which Health Extension Programme (HEP) has played its role to increase service uptake among young girls. This study aims to estimate the status of young girls’ sexual and reproductive health (SRH) services utilisation in rural Ethiopia and to examine the role of health extension workers (HEWs) in this regard.

Design

A cross-sectional study.

Setting

A community-based study among all nine regions of Ethiopia.

Participants

Nine hundred and two young girls aged 15–24 years were included in this study.

Method

We used data from the national HEP assessment, collected from March to May 2019. Multilevel binary logistic regression was used to investigate the association between exposure to HEP and SRH services utilisation of young girls and we reported an adjusted OR with a corresponding 95% CI as measure of the degree of associations.

Result

Only 19.18% (95% CI 16.74% to 21.89%) of young girls used SRH services with significant regional variability (intraclass correlation coefficien=17.16%; 95% CI 6.30% to 39.99%). Exposure to HEP (adjusted OR, aOR 3.13, 95% CI 2.03 to 4.85), knowing about the availability of HEP services (aOR 3.06, 95% CI 1.75 to 5.33) and having good trust in HEWs (aOR 1.82, 95% CI 1.07 to 3.10) and other sociodemographic factors were significantly associated with increased SRH services utilisation.

Outcome

SRH service utilisation.

Conclusion

Although the overall SRH service utilization of young girls in rural Ethiopia was very low, HEWs have a great contribution to improving service utilization of young girls through strong health education provided during home visits, school visits and at health posts. More investment along this line has the potential to improve service uptake among young girls. Encouraging HEWs to build trust among this segment of the population and creating awareness of SRH-related services is crucial to improv service uptake.

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Most cited references 18

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Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.

Donna M Denno, Andrea J Hoopes, Venkatraman Chandra-Mouli (2015)

Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of specific program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS.

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Association between women's empowerment and infant and child feeding practices in sub-Saharan Africa: an analysis of Demographic and Health Surveys.

Muzi Na, Sameera Talegawkar, Saifuddin Ahmed … (2015)

To explore the relationship between women's empowerment and WHO recommended infant and young child feeding (IYCF) practices in sub-Saharan Africa.

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Health workers' attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia

Mesfin Tilahun, Bezatu Mengistie, Gudina Egata … (2012)

Background Adolescents in developing countries face a range of sexual and reproductive health problems. Lack of health care service for reproductive health or difficulty in accessing them are among them. In this study we aimed to examine health care workers' attitudes toward sexual and reproductive health services to unmarried adolescents in Ethiopia. Methods We conducted a descriptive cross-sectional survey among 423 health care service providers working in eastern Ethiopia in 2010. A pre-tested structured questionnaire was used to collect data. Descriptive statistics, chi-square tests and logistic regression were performed to drive proportions and associations. Results The majority of health workers had positive attitudes. However, nearly one third (30%) of health care workers had negative attitudes toward providing RH services to unmarried adolescents. Close to half (46.5%) of the respondents had unfavorable responses toward providing family planning to unmarried adolescents. About 13% of health workers agreed to setting up penal rules and regulations against adolescents that practice pre-marital sexual intercourse. The multivariate analysis indicated that being married (OR 2.15; 95% CI 1.44 - 3.06), lower education level (OR 1.45; 95% CI 1.04 - 1.99), being a health extension worker (OR 2.49; 95% CI 1.43 - 4.35), lack of training on reproductive health services (OR 5.27; 95% CI 1.51 - 5.89) to be significantly associated with negative attitudes toward provision of sexual and reproductive services to adolescents. Conclusions The majority of the health workers had generally positive attitudes toward sexual and reproductive health to adolescents. However, a minority has displayed negatives attitudes. Such negative attitudes will be barriers to service utilization by adolescents and hampers the efforts to reduce sexually transmitted infections and unwanted pregnancies among unmarried adolescents. We therefore call for a targeted effort toward alleviating negative attitudes toward adolescent-friendly reproductive health service and re-enforcing the positive ones.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2022

Publication date (Electronic): 21 September 2022

Volume: 12

Issue: 9

Electronic Location Identifier: e056639

Affiliations

[1 ]departmentSchool of Public Health , Hawassa University College of Medicine and Health Sciences , Hawassa, Ethiopia

[2 ]departmentDepartment of Statistics , College of Natural and computitional Sciences Addis Ababa University , Addis Ababa, Ethiopia

[3 ]departmentAklilu Lemma Institute of Pathology , Addis Ababa University , Addis Ababa, Ethiopia

[4 ]MERQ Consultancy PLC , Addis Ababa, Ethiopia

[5 ]Federal Ministry of Health , Addis Ababa, Ethiopia

[6 ]departmentInstitute of Health Science , Jimma University , Jimma, Ethiopia

Author notes

[Correspondence to ] Meskerem Jisso; meskyj@ 123456gmail.com

Author information

Meskerem Jisso http://orcid.org/0000-0003-0102-658X

Merga Belina Feyasa http://orcid.org/0000-0001-5862-5941

Tegene Legese Dadi http://orcid.org/0000-0003-1361-9649

Article

Publisher ID: bmjopen-2021-056639

DOI: 10.1136/bmjopen-2021-056639

PMC ID: 9494555

PubMed ID: 36130743

SO-VID: 7ca17864-4c01-4b7c-ba4c-93b2e6dae3f0

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 28 August 2021

Date accepted : 31 August 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: INV010174

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ScienceOpen disciplines: Medicine

Keywords: reproductive medicine,public health,sexual medicine,epidemiology,education & training (see medical education & training),statistics & research methods

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ScienceOpen disciplines: Medicine

Keywords: reproductive medicine, public health, sexual medicine, epidemiology, education & training (see medical education & training), statistics & research methods

Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study

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PLOS Global Public Health

Most cited references 18

Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.

Association between women's empowerment and infant and child feeding practices in sub-Saharan Africa: an analysis of Demographic and Health Surveys.

Health workers' attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia

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