ArticleBMC health services research2020
Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Is context considered in health inequity research and why? An examination of current trends in Ethiopia.Philosophy, ethics, and humanities in medicine : PEHM · 2026Pooled it
- Utilisation and associated socio-demographic factors related to the maternal continuum of care in sub-Saharan Africa: A systematic review and meta-analysis.Journal of global health · 2024Pooled it
- How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review.Journal of global health · 2022Pooled it
- Spatial variability in factors influencing maternal health service use in Jimma Zone, Ethiopia: a geographically-weighted regression analysis.BMC health services research · 2021Trial
- Spatial distribution and determinants of full package maternal health service utilization in Ethiopia using 2019 Mini Ethiopian Demographic Health Survey.Scientific reports · 2025Article
- Assessment of mothers' satisfaction towards child vaccination service in South Omo zone, South Ethiopia region: a survey on clients' perspective.BMC women's health · 2024Article
- Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019.BMC health services research · 2022Article
- Geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia: a spatial and geographically weighted regression analysis.BMC pregnancy and childbirth · 2022Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundAnalysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women's education levels were also assessed.
methodsUsing survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran's I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations.
resultsSignificant global spatial autocorrelation was present in ANC use (Moran's I = 0.15, p value = 0.025), delivery care (Moran's I = 0.17, p value = 0.01) and PNC use (Moran's I = 0.31, p value < 0.01), but not MWH use (Moran's I = -0.005, p value = 0.94) suggesting clustering of villages with similarly high (hot spots) and/or low (cold spots) service use. Hot spots were detected in health centre catchments in Gomma district while Kersa district had cold spots. High poverty or low education catchments generally had low levels of service use, but there were exceptions. At village level, hot and cold spots were detected for ANC, delivery care and PNC use. Household-level analyses revealed a primary cluster of elevated MWH-use not detected previously. Further investigation of spatial heterogeneity is warranted.
conclusionsSub-national variation in maternal healthcare services exists in Jimma Zone. There was relatively higher poverty and lower education in areas where service use cold spots were identified. Re-directing resources to vulnerable sub-groups and locations lagging behind will be necessary to ensure equitable progress in maternal health.
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