Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale-up in Tigray Region, Ethiopia.

AIM: To evaluate coverage of effective Kangaroo mother care (KMC) by developing a model that would result in high coverage (≥80%) of KMC for newborn weighing less than 2000 g at birth in Tigray region, Ethiopia. METHODS: The study used formative research and continuous programme learning in iterative cycles of model development and modification conducted in close collaboration with the Tigray Regional Health Bureau. Quantitative methods were used to evaluate the various models. All study facilities were enrolled simultaneously, and hospitals and health centres were considered to become KMC-providers. RESULTS: The final scalable model implemented in two rural districts and one special urban zone of Tigray region attained the desired objective, with coverage of effective KMC of 82.3% at discharge. CONCLUSION: Achieving high coverage of KMC is possible through the design of context-specific implementation strategies. The key factors for success were the commitment and strong leadership from the regional health bureau, strong linkages within the health system and between different departments within health facilities, improved health worker knowledge, skills and attitudes, hospitals and health centres that supported KMC performance, and systematic generation and use of data for continuous quality improvement.

Sexual and reproductive health services use among adolescents in pastoralist settings, northeastern Ethiopia.

BACKGROUND: Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia. METHOD: A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10-19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables. RESULTS: The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29-2.70)], being in school [AOR = 2.38(CI: 1.05-5.41), better family income [AOR = 10.92 (CI; 7.10-16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35-16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02-3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake. CONCLUSION: Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. "Gender-culture-context-appropriate" interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.

Individual and community-level risk factors of women's acceptance of intimate partner violence in Ethiopia: multilevel analysis of 2011 Ethiopian Demographic Health Survey.

BACKGROUND: The prevalence of Intimate partner violence (IPV) is higher in societies with higher acceptance of norms that support IPV. In Ethiopia, the proportion of women's acceptance of IPV was 69%, posing a central challenge in preventing IPV. The main objective of this study was to assess the individual and community-level factors associated with women's acceptance of IPV. METHODS: Two-level mixed-effects logistic regression was applied to the 2011 Ethiopia Demographic and Health Survey data. A total of 16,366 women nested in the 596 clusters were included in the analysis. RESULTS: The acceptability of the IPV was estimated to be 69%. Among the individual-level factors: women's education with secondary and above (AOR = 0.38; 95% CI 0.29-0.52), partner's education secondary and above (AOR = 0.71; 95% CI 0.54-0.82), women aged 35-49 years (AOR = 0.67; 95% CI 0.54-0.82), fully empowered in household level decision making (AOR = 0.67; 95% CI0.54-0.81), literate (AOR = 0.76; 95% CI 0.62-0.92), and perceived existence of law that prevents IPV (AOR = 0.56; 95% CI 0.50-0.63) were significantly associated with women's acceptance of IPV. Similarly, rural residence (AOR = 1.93; 95% CI 1.53-2.43) and living in the State region (AOR = 2.37; 95% CI 1.81-3.10) were significantly associated with the women's acceptance of IPV among the community-level factors. CONCLUSION: Both individual and community-level factors were significant risk factors for the acceptability of intimate partner violence. Women's education, women's age, women's empowerment, partner education level, perceived existence of the law, and literacy were among individual factors. State region and residence were among community-level risk factors significantly associated women's acceptance of IPV.

Use of community-based interventions to promote family planning use among pastoralist women in Ethiopia: cluster randomized controlled trial.

BACKGROUND: Afar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia. METHODS: The study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women's education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI). RESULTS: The proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women's education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women's education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women's education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm. CONCLUSION: The present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03450564, March, 2018.

Prevalence, outcomes and associated factors of labor induction among women delivered at public hospitals of MEKELLE town-(a hospital based cross sectional study).

BACKGROUND: Induction of labor refers to iatrogenic stimulation of uterine contractions before the onset of spontaneous labor as a therapeutic option when benefits of expeditious delivery outweigh the risks of continuing the pregnancy. This research was to study the prevalence, outcomes and associated factors of labor induction among women delivered at Ayder comprehensive specialized hospital and Mekelle general hospital in Mekelle town, Tigray, North Ethiopia. METHODS: A hospital based cross sectional study was conducted on 346 laboring mothers who delivered after induction of labor, from January 1st, to July 31st, 2017. Using structured questionnaire and quota sampling techniques, all eligible participants were immediately enrolled upon admission until the desired sample size was achieved. SPSS windows version 23.0 was used for analysis and both descriptive and inferential statistics were conducted; statistical significance to declare relationship between the dependent and independent variables was set at p < 0.05. RESULTS: Total of 3834 women delivered at the study area out of which 346 were induced making (9%) prevalence of induction. Out of this, 244 (70.5%) delivered vaginally, 19 (5.5%) were instrumental deliveries and 83 (24%) by Cesarean section, induction was successful in 263 (76%) while the failure rate was 25 (7.2%). All who failed induction (25) were delivered by cesarean section making a 3.3% contribution of failed induction into the overall rate of the institutions cesarean deliveries during the study period. Prolonged rupture of membranes was the commonest indication and Bishop's score after cervical ripening significantly predicted the success of induction [AOR = 8.150, 95% CI = (1.265, 52.526)]. CONCLUSION: Our prevalence of labor induction is very low compared to the rate of other institutions in developed countries, rate of successful inductions (76%) is slightly higher than the rate of similar institutions in Ethiopia but comparable to the regional rates while failed induction is very low in comparison to both local and regional institutions. Bishop's score significantly predicted the success of induction.

Utilization and factors associated with antenatal, delivery and postnatal Care Services in Tigray Region, Ethiopia: a community-based cross-sectional study.

BACKGROUND: This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. METHODS: A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May-June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. RESULTS: Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic media, and having 2-5 children were factors associated with an ANC 4+ visit. Whereas, partner involvement in ANC visit (AOR = 2.4, 95% of CI: 1.37, 4.35) and content of ANC discussed (AOR = 4.0, 95% of CI: 1.08, 14.93), having birth preparedness (AOR = 2.6, 95% of CI: 1.44, 4.97), residing within a distance of less than a 30-min walk to the nearest health facility (AOR = 2.0, 95% of CI: 1.16, 3.64), and having ANC 4+ visits (AOR = 2.4, 95% of CI: 1.39, 4.31) were the factors that were found to be associated with institutional delivery. As regards to PNC visits within 42 days of birth, age of 40-45 years, having 2-5 children, and ANC 4+ visits were found to be significant factors associated with it. CONCLUSION: The proportion of women who attended antenatal care and gave birth in a health facility was high. However, the proportion of women who attended antenatal and postnatal care was low. Residing in urban areas, having an electronic media, living near a health facility, having partner involvement in decision making, receiving appropriate ANC counseling, having birth preparedness, age of the woman, and number of children could potentially influence maternal health services utilization.

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design.

BACKGROUND: In low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia. METHODS: We conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing the mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression. RESULTS: One hundred and two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.49; CI 3.55-15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67-5.99), notified their birth (AOR, 6.16; CI 3.50-10.84) and those members of community health insurance (AOR, 1.87; CI 1.13-3.10) were factors associated with postnatal home visit by a health extension worker. CONCLUSION: The coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. The existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates.

BACKGROUND: Birth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia. METHOD: We used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge. RESULTS: The finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09-3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate. CONCLUSION: Only half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment's. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas.

BACKGROUND: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. METHODS: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. DISCUSSION: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017.

Validation of family planning tool in the pastoralist community.

BACKGROUND: Pastoralist community, Afar, women felt that they are embedded in strong cultural and religious perspectives which promotes a high number of children, and discourages family planning (FP) use. They are multifaced factors which hinder women not to use FP and it is time to develop a context-based tool to understand the situation at the ground. However, we have a dearth of evidence on a reliable and valid tool. Therefore, this study aims in developing a reliable and valid tool that considers the women's knowledge, male involvement, attitude, and belief about whether most people approve or disapprove of the behavior to use or not use of FP. METHODS: A total of 891 married women participated in the study. Reviewing the literature, piloting, pretesting, and collecting the actual data were the steps we used to develop a reliable and valid tool. We used the integrated behavioral model (IBM) as a conceptual framework for developing the tool. The developing tool consists of 1) knowledge 2) perceived male involvement and 3) constructs of integrated behavioral model (IBM); expressional and instrumental attitude, subjective norm, self-efficacy, perceived control and intention to use of FP. The IBM items composed of direct and indirect measurement. In the analysis of the data, exploratory and confirmatory factor analysis was done. Independent t. test with cohen's d was used to calculate the effect size. The correlation coefficient was carried between the direct and indirect measurements of the items of the integrated behavioral model (IBM). RESULTS: A total of 891 pastoralist married women were included in the analysis of the reliability and validity of the tool. The mean age of the participants was 26.74(±6.45). The KMO value for all items was greater than 0.83 with a Bartlett test of sphericity of (p < 0.00). Thirteen items were used to measure the knowledge of the respondent towards FP use. The tool had 64.92 variances explained and Cronbach alpha of 0.85. Acceptable values of the fitness indices were obtained in the confirmatory factor analysis (CFA) The items of knowledge towards FP had normed chi-square of 4.5, RMSEA with 90% CI of 0.064(0.056,.0.071), SRMR of 0.039, CFI of 0.969 and TLI of 0961. All the developed items had a Cohen's d ranges from 0.5 to 2. Moreover, the correlation test of the IBM ranges from 0.6 to 0.7 which shows a higher correlation between the measurement direct and indirect items. CONCLUSION: The pastoralist community version of the FP questionnaire is a valid and reliable tool and can be used to measure future family planning use. The indirect measurement of the IBM constructs was a good item to measure FP. However, as a limitation of the study respondents may face difficulty in realizing the difference one item to another especially when items on the scale look so similar to her.

Beyond health system contact: measuring and validating quality of childbirth care indicators in primary level facilities of northern Ethiopia.

BACKGROUND: Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia. METHODS: A validation study was conducted by comparing women's self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n = 478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis. FINDINGS: 455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93-basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC > 0.60 and 0.75 < IF< 1.25). Few of the valid indicators were: whether women and their companion were greeted respectfully, whether an HIV test was offered, and whether severe bleeding (hemorrhage) was experienced by the woman. An additional 21(28.4%) indicators accurately measure at the facility or individual level, but the indicators under or over estimate at population level. Thirteen other indicators could accurately measure at population level. Eight (8.6%) indicators didn't meet either of the validity criteria. CONCLUSION: Women were able to accurately report on several indicators of quality for basic child birth care. For those few indicators that required a technical understanding tended to have higher don't know response from the women. Therefore, valid indicators should be included as a potential measurement of quality for the childbirth care process to ensure that essential interventions are delivered.

Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia.

BACKGROUND: Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. METHODS: Data on maternal and child health utilization emanated from a baseline survey conducted for a large project 'Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12-23 months; and vitamin A supplementation for 6-23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). RESULTS: The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12-23 months and vitamin A supplementation were equitably distributed. CONCLUSION: Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

Husbands' involvement in family planning use and its associated factors in pastoralist communities of Afar, Ethiopia.

BACKGROUND: Husbands play an influential role in women's access to health care, such as family planning services. However, there is little evidence of the level of husbands' involvement in family planning services among pastoralist communities, who possess a distinct lifestyle. This study was aimed to assess husbands' involvement in family planning use and factors associated in pastoralist communities of Afar, Ethiopia. METHODS: Community-based cross-sectional survey was conducted among randomly selected 418 married women in Afambo district, Afar pastoralist community in 2017. Data were collected using semi-structured questionnaire. Data were entered to EPI-Info version 7 statistical software programs and exported to SPSS. Descriptive and multivariable logistic regression analyses were applied to identify factors associated with husband involvement. Odds ratio at 95% confidence interval were reported and significant association of factors was declared at the p-value of less than 0.05. RESULT: Four hundred eighteen married women were included in the study, making a response rate of 98%. The magnitude of husbands' involvement in family planning was found to be 42.2%. Women who ever used family planning (AOR: 7.21; 95%CI: 3.58-14.67), those who participated in community networks, those who reported health center as their source of information for family planning (AOR: 5.56; 95%CI: 1.92-16. o7) were higher likely to report husband involvement compare to their counterparts. Participants' increased knowledge was also significantly associated with higher odds of husband involvement in family knowledge (AOR = 1.31; 95% CI: 1.16-1.58). . CONCLUSION: Husbands' involvement in the district is low. Women's engagement in community networks aimed at increasing the knowledge of the women may involve in family planning. In addition, due focus among health care providers in lower health care units to provide information for both women and men might have a promising power to improve husbands involvement.

Magnitude and determinants for place of postnatal care utilization among mothers who delivered at home in Ethiopia: a multinomial analysis from the 2016 Ethiopian demographic health survey.

INTRODUCTION: Above half of mothers in Ethiopia give birth at home. Home based care within the first week after birth as a complementary strategy to facility-based postnatal care service is critical to increase the survival of both mothers and newborns. However, evidence on utilization of postnatal care and location of service among mothers who delivered at home in Ethiopia is insufficiently documented. Therefore, this study assessed the magnitude and determinants for place of postnatal care service utilization among mothers who delivered at home in Ethiopia. METHODS: We used the 2016 Ethiopian Demographic and Health Survey, and extracted data from 4491 mothers who delivered at home during 5 years preceding the survey. A multinomial logistic regression model was applied to examine the determinants of both facility and home -based postnatal care service utilization. Likelihood ratio test was used to see the model fitness and p-value of < 0.05 was used to determine statistical significance at 95% confidence interval. RESULTS: From the total 4491 mothers who delivered at home, only 130(2.9%) and 236(5.3%) of them utilized postnatal service at home and at a health facility respectively. Being from an urban region (AOR = 0.378, 95%CI: 0.193-0.740), ever using the calendar method to delay pregnancy (AOR = 0.528, 95%CI: 0.337-0.826), receiving four and above antenatal care visits (AOR = 0.245, 95%CI: 0.145-0.413) and having a bank account (AOR = 0.479, 95%CI: 0.243-0.943) were the factors associated with utilizing home- based postnatal care. Similarly being a follower of the orthodox religion (AOR = 1.698, 95%CI: 1.137-2.536), being in the rich wealth index (AOR = 0.608, 95%CI: 0.424-0.873), ever using the calendar method to delay pregnancy (AOR = 0.694, 95%CI: 0.499-0.966), wantedness of the pregnancy (AOR = 0.264, 95%CI: 0.352-0.953), receiving four and above antenatal care visits (AOR = 0.264, 95%CI: 0.184-0.380) and listening to radio at least once a week (AOR = 0.652, 95%CI: 0.432-0.984) were the determinants of facility-based postnatal care utilization. CONCLUSION: The coverage of postnatal care service utilization among mothers who delivered at home was very low. Living in urban region, following the Orthodox religion, having higher wealth index, having a bank account, ever using calendar method to delay pregnancy, wantedness of the pregnancy, receiving four and above antenatal care visit and listening to radio at least weakly were associated with postnatal care service utilization. Therefore, targeted measures to improve socio-economic status, strengthen the continuum of care, and increase health literacy communication are critically important to increase postnatal care service utilization among women who deliver at home in Ethiopia.

Women suffer more from disrespectful and abusive care than from the labour pain itself: a qualitative study from Women's perspective.

BACKGROUND: Utilization of institutional delivery services could be hampered by women's experience of disrespectful and abusive care during childbirth. However, such experiences are not well documented and taken into consideration id planning maternal health services in many developing countries. The aim of this study was to describe women's experience of disrespect and abuse during giving birth at health facilities in northern Ethiopia. METHODS: A qualitative phenomenological study was conducted in Tigray, Ethiopia. Focus group discussions (FGDs) with primipara and multipara women were conducted to collect the necessary information. All study participants had their last delivery at a health facility in the year preceding the study. A semi-structured discussion guide was used to elicit discussion. Discussions were audio recorded and transcribed verbatim in the local language and then translated to English. Data were analyzed using thematic analysis approach assisted by the Open Code qualitative data management software. RESULTS: The study participants described disrespect and abuse as serious obstacles to utilization of maternal health services. Women reported experiencing feelings of being infantilized, losing self-control, being overlooked, being informed bad news without proper preparation, repeated examination without being properly communicated/informed, disallow companions, and left unattended during labor. Facility related issues include women's perception of incompetence of professionals attending delivery, unhygienic facilities, and unavailability of basic supplies. CONCLUSION: Women consider health facilities not fully prepared to provide respectful maternal care. Sustainable increase in institutional delivery requires ensuring quality, compassionate and caring services in all health facilities.

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey.

BACKGROUND: Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. METHODS: A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. RESULTS: The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91-21.86) and (3.35, 95% CI: 1.10-10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06-9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55-27.75) than women who lacked knowledge about the services. CONCLUSIONS: Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services.

Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: a case-control study.

BACKGROUND: Every year, an estimated 19-20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. METHODS: Unmatched case-control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions ("repeat abortion") were taken as cases and those who had a total of one abortion were taken as controls ("single abortion"). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. RESULTS: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1-3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. CONCLUSION: This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

Foot length, chest and head circumference measurements in detection of Low birth weight neonates in Mekelle, Ethiopia: a hospital based cross sectional study.

BACKGROUND: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal deaths. The early identification of Low birth weight (LBW) neonates is essential for any comprehensive initiative to improve their chance of survival. However, a large proportion of births in developing countries take place at home and birth weight statistics are not available. Therefore, there is a need to develop simple, inexpensive and practical methods to identify low birth weight (LBW) neonates soon after birth. METHODS: This is a hospital based cross sectional study. Four hundred twenty two (422) live born neonates were included and anthropometric measurements were carried out within 24 h of birth by three trained nurses. Birth weight was measured by digital scale. Head and chest circumference were measured by using non extendable measuring tape and foot length with hard transparent plastic ruler. Data was entered into SPSS version 20 for analysis. Characteristics of study participants were analyzed using descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for continuous data. Correlation with birth weight using Pearson's correlation coefficient and linear regression were used to identify the association between dependent and independent variables. Receiver operating characteristic (ROC) curve was used to evaluate accuracy of the anthropometric measurements to predict LBW. RESULTS: The prevalence of low birth weight was found to be 27%. All anthropometric measurements had a positive correlation with birth weight, chest circumference attaining the highest correlation with birth weight (r = 0.85) and foot length had the weakest correlation (r = 0.74). Head circumference had the highest predictive value for birth weight (AUC = 0.93) followed by Chest circumference (AUC = 0.91). A cut off point of chest circumference 30.15 cm had 84.2% sensitivity, 85.4% specificity and diagnostic accuracy (P < 0.001). A cut off point of head circumference 33.25 had the highest positive predictive value (77%). CONCLUSION: Chest circumference and head circumference were found to be better surrogate measurements to identify low birth weight neonates.

Prevalence and predictors of implanon utilization among women of reproductive age group in Tigray Region, Northern Ethiopia.

BACKGROUND: The Ethiopian Federal Ministry of Health introduced provision of the contraceptive Implanon at community level by trained health extension workers in 2009. However, little is known regarding the utilization and factors associated with Implanon use among rural women since the introduction of the community based intervention. Thus, this study assessed the utilization of Implanon and associated factors among reproductive aged women in rural areas of Saesie-Tsaeda Emba and Ofla districts in Tigray, Northern Ethiopia. METHODS: A cross sectional community based survey was conducted in May and June 2014. A multistage sampling technique was used to randomly select 524 reproductive aged women (15-49 years). Data was collected through interview using a pre-tested and structured questionnaire. Univariate analysis was done to determine the prevalence for Implanon use, to assess general characteristics of respondents, and to produce summaries. Bivariate analysis was conducted to examine the relationship between each independent variable with the dependent variable. Multivariate logistic regression was conducted to identify factors influencing Implanon use by controlling effect of confounding variables. RESULTS: Of all the women, 444 (84.7%) had heard of Implanon. Health extension workers were the primary source of information on Implanon as mentioned by 376 (71.8%) of the respondents. Little more than seven women in every ten, 319 (71.8%), had good knowledge of Implanon and 248 (55.5%) of the women had supportive attitudes towards Implanon use. Among our sample, 10.1% women were using Implanon, 33 (62.3%) reported having received their Implanon at a health post from health extension worker. Women's employment (AOR: 2.73, 95% CI: 1.20-6.21), the number of modern contraceptive methods known (AOR: 2.24, 95% CI: 1.09-4.62), and the number of contraceptive methods ever used (AOR: 11.0, 95% CI: 5.06-23.90) were positively associated with Implanon use. CONCLUSION: Trained health extension workers played a major role in information and service provision of Implanon. However, this study revealed that a significant number of women had incorrect information regarding Implanon. Hence, health extension workers and other health professionals should provide appropriate counseling and education regarding Implanon and other contraceptives.

Factors associated with contraceptive use in Tigray, North Ethiopia.

BACKGROUND: Family planning interventions are cost-effective and have several cross-cutting benefits. Despite these benefits of family planning, progress in ensuring universal access to family planning to women in developing countries has been slow. In light of this; this study investigated the prevalence and factors associated with contraceptive use in Tigray Region, Northern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 1966 women of reproductive age group (15-49) in 13 districts (3 urban and 10 rural) from May-June 2015. Multistage sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the effect of independent variables on utilization of contraceptive use. RESULTS: Out of total 1966 women, 1879 (95.6%) have ever heard about family planning. Depo-Provera (depot medroxyprogesterone acetate, or DMPA) was the most popular contractive method as mentioned by 1757 (93.5%) of the participants. The overall contraceptive prevalence rate among all women was 623 (35.6%) while the contraceptive prevalence rate among married women was 543 (41.0%). Seven-in-ten women had ever used short acting contraceptive. In fact Depo-Provera was the most common type of contraceptive used as mentioned by 402 (64.5%) of the women. The odds of using family planning by married women living in urban areas was two times more than their counterparts (AOR = 2.0, 95% of CI: 1.33, 3.06). Similarly, the odds of using family planning among mothers with primary education was 1.3 times more as compared with no education (AOR = 1.3, 95% of CI: 1.02,1.93). However, as regards to long acting contraceptive methods, the odds of using long acting contraceptive methods use among married women in urban areas was 50% less when compared to rural married women (AOR = 0.5, 95% of CI: 0.3, 0.88). CONCLUSION: Contraceptive prevalence rate in Tigray region increased almost four fold in just 15 years. However, the increase is not yet enough to meet national and global targets. Further interventions are needed to narrow disparities in contraceptive use among different population groups and increase long acting contraceptive users. Moreover, improving quality of family planning in terms of the content of information provided to clients is crucial.