Health service access, utilization and prevailing health problems in the urban vulnerable sections of Ethiopia
Background: Currently, one-third of urban residents in Africa and Asia reside in slum settings with a compromised state of health, and this proportion is increasing at an alarming rate. In Ethiopia, it is estimated that 70-80% of the urban population lives in settings that are believed to be slums and most of the urban population has no access to improved sanitation. Though there is still a limitation on proper urban health profile data, there is evidence of vulnerability to a wide range of health-related problems in the country, including HIV. Hence, this study aimed to generate evidence on access to and utilization of health services, particularly by mothers and children, and the prevailing health problems of vulnerable sections of the urban population.
Methods: A total of 115 urban vulnerable sections were identified in 46 towns in five regions (Amhara; Oromia; Tigray; Southern Nations, Nationalities, and Peoples’ (SNNP); and Harari) and two city administrations (Addis Ababa and Dire Dawa) where John Snow Inc. (JSI) urban centers are located. A cross-sectional household survey design was conducted among identified urban vulnerable sections of the population on 10–20 May 2017. A total of 1,220 households were included, based on a two-stage stratified sampling method. The analysis used mainly descriptive statistics and SPSS version 21 software was used for the analysis.
Results: The mean age of the respondents was 43.2 (SD=14.8) years, and females accounted for 75% of all participants. The average time (SD) from the households to the health facility is 18 (±11) minutes. One month prior to the study, 32.6% of the household members reported having had some form of illness and 44% of them visited a health center and 36% a hospital. More than two thirds (68.6%) of women gave birth at a health facility and most (70.1%) births were assisted by a skilled provider. Nearly two thirds (63.4%) of women received a postnatal check-up. In 7.6% of the households, diarrhea occurred among children under 5 in the past two weeks, and 88% sought advice or further treatment. Non-communicable diseases (NCDs) account for the largest share of causes of morbidity among adults (29%) and death was observed in 8.4% of the households in the last three-year period prior to the survey. The most perceived causes of death in households were kidney disease, hypertension, heart disease, and other NCDs (65%).
Conclusions: Health facilities are located near households. However, a significant proportion of mothers are still giving birth at home and more than a third of the births are attended by non-skilled attendants. Postnatal care utilization remained a challenge. NCDs were found to be the most prevailing problem among adults in the households and most of the deaths were also related to NCDs. Social changing interventions are recommended so that women have trust to deliver at facilities and postnatal visits are increased. Targeted preventive interventions are also essential to avert the growing burden of NCDs and others in the urban vulnerable sections. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):12-23]
Keywords: Health service, access, health problem, vulnerable sections, Ethiopia