Effect of community engagement interventions on child health care utilization: a quasi-experimental study in Afar and Benishangul Gumuz Regions, Ethiopia

Abstract

BACKGROUND: Child health in Ethiopia is influenced by socioeconomic disparities, limited healthcare access, weak community engagement, and low service utilization, with greater challenges in resource-limited regions such as Afar and Benishangul Gumuz. To address these issues, Emory University Ethiopia, in partnership with UNICEF, Ministry of Health, and regional health bureaus, implemented community engagement interventions from February 2021 to April 2024 to improve health-seeking behavior and service use. However, their effects on care-seeking for sick children and infant immunization remain unassessed. This study addressed this gap. METHODS: A pre-post quasi-experimental study was conducted in 14 Woredas (7 per region). Over three years, interventions included training quality improvement teams to identify mothers and children needing care and link them to facilities, alongside community festivals, dialogues, women's conferences, and social and behavior change activities. Baseline and endline surveys were conducted in January 2021 and April 2024, respectively, with baseline immunization data drawn from the 2019 Demographic and Health Survey. Mixed-effects multilevel logistic regression assessed intervention effects by controlling for potential confounders (p < 0.05). RESULTS: At the endline, 21.9% of children under 18 months of age (26.6% in Afar and 17.6% in Benishangul Gumuz) presented symptoms of common illnesses, a decrease from 43.3% at baseline (48.8% in Afar and 37.8% in Benishangul Gumuz). Among them, 90.4% (89.0% in Afar and 92.3% in Benishangul Gumuz) sought treatment at health facilities, an increase from 83.4% at baseline (75.1% in Afar and 94.1% in Benishangul Gumuz). The percentage of full immunization coverage increased from 40.0% at baseline to 66.4% at the endline. Mothers who participated in community interventions were nearly four times more likely to have their children fully immunized (AOR = 3.96; 95% CI: 1.70, 9.20). Other predictors included residence, parity, maternal education, knowledge, attitudes and healthcare utilization. CONCLUSIONS: Community engagement interventions significantly improved treatment-seeking behavior and the full immunization rate in the study area. Future efforts should focus on context-specific strategies that engage existing community platforms and address factors such as parity, education, and geographic location to enhance child health care.