Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia.

BACKGROUND: Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. METHODS: A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. RESULTS: Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). CONCLUSIONS: Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women's use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. TRIAL REGISTRATION: The trial was retrospectively registered on the Clinical Trials website ( https://clinicaltrials.gov ) on 3rd October 2017. The trial identifier is NCT03299491 .

Correction: A 10+10+30 radio campaign is associated with increased infant vaccination and decreased morbidity in Jimma Zone, Ethiopia: A prospective, quasi-experimental trial.

[This corrects the article DOI: 10.1371/journal.pgph.0001002.].

The Relation Between Organizational Justice and Counter-Productive Work Behavior Among Health Care Professionals in Jimma Zone Public Health Institutions.

Background: Counterproductive behavior costs organizations and their members which will ultimately affect work-related outcomes and organizational success. Organizational justice has the potential to affect the level of counter productive behavior. However, there is a paucity of studies to show the link between counterproductive behavior and organizational justice dimensions in the Ethiopian health care system context. Therefore, the purpose of this research was to look into the link between organizational justice, and counterproductive work behavior among health care professionals. Methods: The 395 study participants were chosen using a facility-based cross-sectional study methodology. A proportionate stratified systematic random sampling technique was deployed to select study participants from health facilities. Data was gathered using a structured self-report questionnaire by CWB Scale that was developed by Spector and Fox (2005) with Cronbach's alpha of an average of (0.84-0.87). Data was obtained, cleaned, and entered by Epidata3.1. Finally, for descriptive and inferential statistical analysis, the data was exported to SPSS version 23.0. Results: According to the findings, 159 (40.3%) of the study participants engaged in counterproductive job activities. Organizational justice was assumed to be fair by about half of the respondents, 202 (52.2%). Distributive Justice (=-0.141, p.05) was found to be a significant and negative predictor of counterproductive work behavior in the regression analysis. Age (ß=-0.014, p< 0.05), the average number of hours worked every week (ß=-0.009, p< 0.05), and experience (ß=0.016, p< 0.05) were found to be significant predictors of the counterproductive work behaviors. Conclusion and Recommendation: This study indicated that distributive justice show significant contribution in reduction of counterproductive work behaviour.As a result, improving organizational justice can aid to reduce counterproductive work behavior which in turn increases the facility's productivity.

Maternal social support and health facility delivery in Southwest Ethiopia.

BACKGROUND: Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia. METHODS: A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level. RESULT: Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth. CONCLUSIONS: Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.

A 10+10+30 radio campaign is associated with increased infant vaccination and decreased morbidity in Jimma Zone, Ethiopia: A prospective, quasi-experimental trial.

Mass media interventions have the potential to reach large audiences and influence health behaviours and outcomes. To date, no study has evaluated the effect of a radio-only campaign on infant vaccination coverage, timeliness, and related morbidity in a low-income country. We implemented the "10+10+30" radio campaign involving broadcasting a weekly 10-minute radio drama series on vaccination, followed by a 10-minute discussion by community health workers, and then a 30-minute listener phone-in segment in Jimma Zone, Ethiopia for three months. To assess the impact of 10+10+30, which was aired on a community radio station, we recruited mothers of infants up to 5 weeks old in intervention district clusters that were inside the radio station's reception range (n = 328 dyads) and control district clusters that were outside of the range (n = 332 dyads). Intention-to-treat and per-protocol analyses, adjusted for pre-intervention differences between the districts, were conducted to examine the co-primary outcome of Penta-3 vaccination coverage and timeliness as well as those of other vaccines and outcomes related to infant morbidity. Both intention-to-treat and per-protocol analyses revealed higher vaccine coverage (p<0.001) and more timely vaccine administration (p<0.001) in the intervention district relative to the control district, with infants in the intervention district being 39% more likely to receive a Penta 3 vaccination (adjusted RR: 1.39, p<0.001). In addition, adjusted regression analyses of maternal retrospective reports over a two-week period revealed 80% less infant diarrhoea (RR: 0.20, p<0.001), 40% less fever (RR: 0.60, p<0.001) and 58% less cough (RR: 0.42, p<0.001) in the intervention district relative to the control district. This study provides compelling initial evidence that a radio drama integrated with discussion and phone-in components may improve infant vaccination coverage and timeliness, and may reduce infant morbidity. Randomized controlled trials are needed to confirm and extend these findings with other samples.

Satisfaction and its associated factors of infants' vaccination service among infant coupled mothers/caregivers at Hawassa city public health centers.

Studies conducted on caregivers' satisfaction on child vaccination services were very scarce including the study area. Therefore, this study was aimed to assess satisfaction and associated factors in vaccination service among infant coupled mothers/caregivers attending at public health centers. A cross-sectional study was conducted on 404 infant coupled mothers/caregivers from 15 March to 15 April 2018 in the selected health centers of Hawassa city, Southern Ethiopia. A systematic random sampling technique was applied to collect relevant data through exit interview with an interviewer-administered structured questionnaire. The overall proportion of the mothers/caregivers who satisfied with their children immunization service was 76.7%. In addition, 89.7%, 77.1%, 77.2%, 65.8%, and 68.3% were satisfied with conveniences of waiting area, cleanliness of immunization rooms, distance from nearby health center, service providers approach and waiting time to get service, respectively. In addition, caregivers living closer to health centers were 5.9 times more likely to be satisfied than their counterparts, the adjusted odds ratio and 95% confidence interval [AOR and 95%CI : 5.9(1.6-22.4)]. Caregivers who waited for ≤30 minutes to get service were 7.3 times more likely to be satisfied than those waited for >30 minutes [AOR and 95% CI: 7.3(3.9-13.6)]. The study indicated the overall satisfaction of caregivers concerning vaccination service to be suboptimal. Maternal/caregivers satisfaction plays a great role to follow vaccination schedule properly and completeness of immunization service for their infants.

Sharps injuries prevention among healthcare providers in surgical, medical and pediatric wards of a public hospital in Jimma Zone: a best practice implementation project.

BACKGROUND: Sharps injuries are a serious public health problem that healthcare providers face and constitute a major risk for the transmission of blood-borne infections. Prevention of sharps injuries in hospitals requires that healthcare providers comply with universal precautions. OBJECTIVES: The aim of this study was to assess and improve the compliance of healthcare providers with protocols based on best available evidence for prevention of sharps injuries in medical, surgical and pediatric wards of the hospital. METHODS: A three-phase clinical audit was carried out using the online JBI Practical Application of Clinical Evidence System and Getting Research into Practice Program. Six audit criteria based on available evidence were used. Phase 1 of the project was the baseline audit, phase 2 the implementation of the best practice, and phase 3 the follow-up audit. Data were collected through observation, interview and resource inventory. RESULTS: The postintervention compliance report showed maximum improvement in compliance in criterion 1 (sharps containers are not filled above the mark that indicates the bin is full) and criterion 2 (sharps containers are positioned out of the reach of children at a height that enables safe disposal by staff). Between the baseline and postintervention audits, the compliance rate for these criteria improved by more than half (criterion 1) and by nine-fold (criterion 2) (from 38 to 100% and 0 to 93%, respectively). During baseline, two nurses reported experiencing sharps injuries, noting that they think it is not important to report the injury if the patient is negative for HIV, and when they do not know where to report it, regardless. At the postintervention audit no injuries were reported. CONCLUSION: The best practice recommendations using a clinical audit process was an effective intervention for improving knowledge and compliance of healthcare workers with protocols for the prevention of sharps injuries in low-resource settings.

Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis.

OBJECTIVE: To identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia. DESIGN: Cross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses. SETTING: Twenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia. PARTICIPANTS: 3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016. OUTCOME MEASURE: The primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman's education, woman's occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births. RESULTS: Overall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use. CONCLUSIONS: Utilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.