Determinants of Ambulance Service Utilization among Pregnant Women in Mekelle City, Ethiopia: a Case-Control Study

Abstract

Background: Evidence suggests that the use of ambulance can help to improve health facility deliveries. However, few studies have explored the motivators for and barriers to ambulance use.
An effective ambulance services system forms the link between home and health facility providing basic or comprehensive emergency obstetric care. Hence, the creation of a strong ambulance services network across the country based on evidences from local study is necessary for the improvement of ambulance service utilization among pregnant women.
Objective: To identify the determinants of ambulance service utilization among pregnant women in Mekelle town.
Methods: A facility based unmatched case control study was conducted among 358 mothers from Mekelle City. One referral hospital, two general hospitals and three health centers have participated in the study. Data were collected by trained data collectors via face to face interview using a pre-tested and structured questionnaire. Bivariate and multivariable logistic regression analyses and SPSS version 20 were used to analyze the data. Statistical significance was set at p<0.05 and the strength of statistical association was assessed by odds ratio (OR) with 95% confidence intervals.
Results: A total of 356 (118 cases and 238 controls) women with a response rate of 99.4% participated in the study. The mean age and standard deviation of the cases and controls was 16.4 ±5.8 and 18.8±5.7 years, respectively. Maternal education (AOR=2.49, 95% CI: 1.1, 5.7), maternal age (AOR= 2.14, 95% CI: 1.01, 4.55), travel distance to the health facilities (AOR = 3.3, 95% CI: 2.24, 4.74), prior knowledge of the Red Cross telephone number (AOR = 7.51, 95% CI: 3.64, 15.50), monthly income (AOR = 2.8, 95%CI: 2.18, 3.68), decision making process (AOR = 2.12, 95%CI: 1.82, 5.37) and prior knowledge of the availability of free ambulance services (AOR = 0.12, 95%CI: 0.28, 0.49) were found to have a significant effect on ambulance use by pregnant mothers in Mekelle city.
Conclusion and recommendation: The use of the ambulance service by pregnant mothers was far from optimal in Mekelle city. The use of ambulance services can be improved if mothers are informed well about the availability of the ambulance service, whom to contact when they need the service, creating opportunities for income generation and improving women involvement in decision making.