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Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study

Calistus Wilunda1*, Giovanni Putoto1, Fabio Manenti1, Maria Castiglioni2, Gaetano Azzimonti3, Wagari Edessa4, Andrea Atzori1, Mario Merialdi5, Ana Pilar Betrán5, Joshua Vogel56 and Bart Criel7

Author Affiliations

1 Doctors with Africa CUAMM, via san Francesco 126, Padua 35121, Italy

2 Department of Statistical Sciences, University of Padua, via Cesare Battisti 241, Padua 35121, Italy

3 Wolisso Hospital, P.O. Box 250, Wolisso, Ethiopia

4 Zonal Health Department, South West Showa Zone, P.O. Box 253, Wolisso, Ethiopia

5 Department of Reproductive Health and Research, World Health Organization, Geneva 27 1211, Switzerland

6 University of Western Australia, 35 Stirling Highway Crawley, Perth, Australia

7 Institute of Tropical Medicine, Nationalestraat 155, Antwerp 2000, Belgium

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International Journal for Equity in Health 2013, 12:27  doi:10.1186/1475-9276-12-27

Published: 22 April 2013



Improving equity in access to services for the treatment of complications that arise during pregnancy and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia and compare the wealth status of EmOC users with women in the general population.


Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well across quintiles were selected to create a questionnaire that was administered to women at discharge from the maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison with the reference population.


760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset, indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest) to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest two quintiles. Transportation costs seem to play an important role.


We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool.

Socio-economic status; Emergency obstetrics care; Maternal health; Access