A community based nested case control study was conducted from October 2009-August 2011 at the University of Gondar health and demographic surveillance systems site which is located at Dabat district, Northwest Ethiopia. Dabat district is located about 75 kms away from Gondar town. It has an area of 1,199.15 km2 and had an estimated total population of 145,458 (89% live in rural area). Altitude ranges from 1000–2600 m above sea level. Agriculture is the backbone of their economy. The district has a total of 29 functioning health institutions (27 health posts and 2 health centers).
The demographic survey site has three ecological regions including high, mid and lowland. Baseline data collection for the research center was started in November 1996 and subsequent vital events (birth, death, migration) registration has been continued since August 2004. According to the second baseline survey conducted in August 2007, the total numbers of households were about 9,334 and the total population of the center was 46,165. Antenatal care coverage and prevalence of contraceptive were found to be 51% and 19.2% respectively. Only 7.2% of deliveries took place in health institutions and 7.85% of the births were attended by skilled professionals .
All mothers with second and third trimester pregnancy were registered and on follow up from October 2009 to August 2011 for infant mortality prospective study. The population for this study consisted of sampled cases and controls of women who gave birth during the follow up period. Cases were women who gave birth by the help of skilled attendants while controls were those who gave birth by the help of traditional birth attendants, relatives or health extension workers. All cases and a random sample of controls were taken from the deliveries, which took place in the study period.
Data were collected via interview using pretested and structured questionnaire. The questionnaire was prepared in English, translated to Amharic and then translated back to English to check for consistency. Six female data collectors working at the research site were recruited. Training was given to the data collectors for one day about the objective, relevance of the study, confidentiality of information, participant’s right, pre-test, informed consent and techniques of interview.
The sample size was calculated using Epi info version 18.104.22.168 by considering the following assumptions: the proportion of urban women among the controls 23.9% , 95%CI, 80% power and case to control ratio of 1:4 to detect an odds ratio of 2.0. The total sample size was 510(102 cases and 408 controls). There were 1752 pregnant women recruited for the prospective infant mortality study. Among these, 213 (12.2%) delivered with the assistance of a skilled attendant. Since there were more participants for the study from the follow up database, we took all the cases (213) and a random sample of controls (852 out of the 1539) for final analysis.
Before the actual data collection, pretest was conducted in adjacent kebeles to ensure the validity of the survey tool. The supervisors and the principal investigator made frequent checks on the data collection process to ensure the completeness and consistency of the gathered information.
Data were entered and cleaned using EPI info version 6 statistical software and exported to SPSS version 16 statistical packages for analysis. Frequencies, proportion and summary statistics were used to describe the study population in relation to relevant variables.
Factors affecting utilization of skilled attendants are the same in Dabat and elsewhere in Ethiopia. These are parity, having ANC, women`s and their husbands educational status, occupational status, having TV and Radio, urban residence, history of family planning use, younger age, economic status, knowledge about danger signs of pregnancy, availability and attitude towards health professionals, husband`s approval and involvement.
Bivariate and multivariate analyses were carried out to see the effect of each independent variable on the dependent variable. Odds ratio with 95%CI was computed to assess the strength of the association and statistical significance. P-value less than 0.05 was used to declare statistical significance in the multivariate analysis.
Ethical clearance was obtained from the Institution Review Board of the University of Gondar. The purpose and importance of the study were explained to the participants. Data were collected after full informed verbal consent is obtained and confidentiality of the information has been maintained throughout by excluding names as identification in the questionnaire and keeping their privacy during the interview by interviewing them alone.