Zegeye et al., Primary Health Care 2014, 4:1 DOI: 10.4172/2167-1079.1000150 Volume 4 • Issue 1 • 1000150 Primary Health Care ISSN: 2167-1079 PHCOA, an open access journal Open Access Research The Role of Geographical Access in the Utilization of Institutional Delivery Service in Rural Jimma Horro District, Southwest Ethiopia Kifom Zegeye 1 , Abebaw Gebeyehu 2 * and Tesfahun Melese 3 1 Communicable disease control Team, Kellem Wollega Zonal Health Department, Oromia Regional State, Ethiopia 2 Department of Reproductive Health, Institute of Public Health, University of Gondar, Ethiopia 3 Department of Health Informatics, Institute of Public Health, University of Gondar, Ethiopia *Corresponding author: Abebaw Gebeyehu, Department of Reproductive Health, Institute of Public Health, University of Gondar, Ethiopia, Tel: +251 581110243; E-mail: abebawgebeyehu@yahoo.com Received November 18, 2013; Accepted Feburary 20, 2014; Published Feburary 24, 2014 Citation: Zegeye K, Gebeyehu A, Melese T (2014) The Role of Geographical Access in the Utilization of Institutional Delivery Service in Rural Jimma Horro District, Southwest Ethiopia. Primary Health Care 4: 150. doi:10.4172/2167- 1079.1000150 Copyright: © 2014 Zegeye K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Geographic access; Institutional delivery Background Access to skilled maternal care at all births is a central strategy for ensuring safe motherhood [1]. It is also well documented that, apart from the skill, an enabling environment, where there is access to the necessary equipments, drugs, and other supplies that improve management of pregnancy-related complications has substantial impact on the reduction of both maternal and neonatal deaths [2,3]. Despite such proven interventions, the issue of maternal mortality remains to be a major public health problem of many developing countries to this day [4,5]. Sub-Saharan Africa alone accounts for 56% of the global maternal deaths, where rural women bear the highest burden [5-7]. Maternal deaths occur mostly during labor, delivery, and the immediate postpartum period [4]. Te Ethiopian Demographic and Health Survey (EDHS) 2011 reported 676 maternal deaths per 100,000 live births, which is almost the same with that of 2005 EDHS fgure (673) [7]. Historical and contemporary evidences ascribed the fundamental grounds for such high mortalities and morbidities at least partly to lack of access and timely use of appropriate delivery care services [8,9]. Majority of these deaths could be averted by improving access to the interventions for addressing complications of pregnancy and childbirth and utilization of these services by all mothers [4]. Tis requires both the availability of such services as well as the will of pregnant women to seek apposite care at delivery. Despite decades of ongoing eforts to strengthen delivery care services, institutional delivery service utilization by women during childbirth has been persistently very low in Ethiopia [10]. Te situation is more serious in rural areas where only 4.1% of the deliveries occur in health facilities compared to 49.8% for urban areas [7]. While the likelihood of a woman giving birth in a health facility depends on multitude of factors, poor geographic access has been identifed as one of the major barriers facing rural women in seeking and using life-saving maternity care services in many developing countries including Ethiopia [2,11]. Geographic access, the distance (or time) needed in order to reach a health facility, is not only a direct physical barrier that precludes women from reaching health institutions but it also afects even the decision to look for care. It could have more infuence in rural areas of Ethiopia, where it is norm to see women in labor being carried on men’s shoulder traveling many kilometers to reach a health facility [12]. Many of the studies, particularly in Ethiopia, assess geographic accessibility in terms of subjective data on distance or travel time to health facilities as study participants or “informants” reported [13,14]. Tis kind of assessment ofen raises the question of internal validity of the data. Hence, this study was conducted to shed light on the extent to which geographic access of rural women to health facilities can infuence the use of institutional delivery care by adjusting for Abstract Introduction: Access to skilled maternal care in a suitable setting at all births is momentous to reduce maternal mortality. The role of geographical access particularly in rural Ethiopia is not suffciently investigated. Hence, the central intention of this study was to estimate the effect of geographic access of rural mothers on institutional delivery care use in Jimma Horro District, Southwest Ethiopia. Methods: A community-based cross-sectional survey was conducted in April 2012 in six randomly selected kebeles. Data on socio-demographic, maternal history and maternity services use were collected from 528 eligible mothers using structured questionnaire. Geo-referenced data on respondents’ houses and health institutions as well as walking tracks from each village center to the nearest health center were recorded using hand-held Global Positioning System (GPS) instrument and mapped using Arc GIS 9.3. Multivariate logistic regression analysis was performed to estimate the effect of distance on facility delivery use by controlling for range of confounders. Results: Only 8% of the mothers gave birth to their last babies in health facilities. One third of the respondents live within 5-kilometer walking distance of the nearest health center. Each kilometer increase in walking distance to the nearest health center resulted in a reduction of institutional delivery service by 22% (AOR=0.78, 95% CI: 0.64 to 0.96). Use of institutional delivery service was also signifcantly higher among mothers who faced obstetric complications, and those who attended four and more ANC visits. Conclusion: Geographic access to health centers plays a major role in institutional delivery care use among rural mothers. Tackling the geographical dimension of access is pivotal in elevating institutional delivery care utilization. Primary Health Care: Open Access J o u r n a l o f P r i m a r y H e a lt h c a r e : O p e n A c c e s s ISSN: 2167-1079