A number of studies using the GDHS demonstrated important demographic- and policy-level factors associated with institutional delivery [ 7- 9].
Effective interventions to promote maternal health service utilization should target the underlying individual, household, community and policy-level factors.
For example, achievement of the health policy goal of engagement of HIV patients in a continuum of care model in the UK has been measured using a socio-ecological perspective to understand the interplay of individual, community, and health system and policy-level factors that influence the way that engagement in HIV care operates [ 25].
While appropriate medical care of the patient should be the prevailing factor for all health care decision makers, whether at the care delivery or the policy level, economic factors cannot be ignored.
This finding justifies that a lot of work needs to be done in order to decrease this high neonatal mortality rate by considering child health policy and household level factors, which significantly influence neonatal mortality in Butajira.
A qualitative study in Latin American hospitals has identified barriers to change at level of individual providers, hospitals policies and macro level factors; and suggests that interventions must attempt to bring about sustainable change at all levels [ 31].
Prevention strategies directed at reducing neonatal death should address policy and household and level factors, which significantly influence neonatal mortality in Butajira.
The research team will work in collaboration with Boston Public Schools to identify policies, classroom-level factors, and school experiences that are associated with children's school success during pre-k and early elementary school grades.
Context includes school level factors such as policies, economy, organisational climate, access to canteen, student composition which may influence programme implementation [ 9].
