Assessing the competence of midwives to provide care during labor, childbirth and the immediate postpartum period - A cross sectional study in Tigray region, Ethiopia.

BACKGROUND: The availability of a skilled birth attendant is widely recognized as a critical factor in reducing maternal and newborn mortality. Competence of maternal healthcare providers directly affects quality of care and health outcomes. This study assessed competence of midwives and associated factors in provision of care during labor, and the immediate postpartum period at public health facilities in Tigray, Ethiopia. METHODS: A cross-sectional study design was employed to collect data through direct observation of the performance of 144 midwives selected from 57 health facilities. Data were collected from January to February 2015 by 12 experienced midwives who were trained on basic emergency obstetric care and had previous experience with data collection. Using a standardized competence checklist, adapted from International confederation of midwives, data collectors interviewed and directly observed the performance of midwives from admission of laboring mothers to six hours after delivery. Multivariable linear regression was used to identify predicators associated with overall clinical competence of midwives. RESULT: The mean competence score of midwives was found to be 51%. In multivariable linear regression, male midwifery professionals (p = 0.022), availability of up to date job aids in work place (p = 0.04) and being recognized for improved performance (p = 0.005) were significantly associated with competence of midwives in the provision of care during labor, childbirth and immediate postpartum period. CONCLUSION: Competence of midwives was found to be low to provide safe and quality maternity care in the region. Male gender, availability of complete job aids and receiving recognition/awards for better performance were predicted competence. This requires attention and investment from Tigray regional health bureau and health development partners working on maternal and child health. Competence based in-service training, on-the-job mentoring, availing up to dated standard job aids, recognition of high performing midwives are recommended to improve the quality of maternity care in public health facilities of the region. Moreover, affirmative actions including on-the-job training and supervision are needed to improve the competence of female midwives.

Prevalence of workplace abuse and sexual harassment among female faculty and staff.

OBJECTIVES: To determine the one year prevalence of workplace abuse and sexual harassment and to determine the extent of their associations with symptoms of depression. METHODS: A total of 387 female faculty and staff from colleges in Awassa, Ethiopia completed a self-administered questionnaire which collected information about relationships, mood and feelings, thoughts and satisfaction concerning the workplace, and experiences with sexual harassment. Symptoms of depression were evaluated using the Patient Health Questionnaire (PHQ-9). Logistic regression procedures were employed to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The 12 mo prevalence of either workplace abuse or sexual harassment was 86.3%; with 39.5% reporting workplace abuse only, 4.1% of them reporting sexual harassment only, and 42.6% reporting experiences of both sexual harassment and workplace abuse. Overall, the mean depression score for this cohort was 3.7 (standard deviation 4.2, range 0-19), and 9.3% of the cohort were identified as having moderate or moderately severe depression. The proportion of participants with depression were statistically significantly elevated in relation to reported experience of workplace abuse and sexual harassment (p=0.001). Compared with women reporting no experience with workplace abuse or sexual harassment, those who reported experiencing both workplace abuse and sexual harassment had an 8.00 fold increased risk of depression (OR=8.00, 95% CI:1.05-60.85). Inferences from this analysis are limited by our relatively small sample size as reflected by the wide 95% CI. CONCLUSIONS: Workplace abuse and sexual harassment are highly prevalent, and are positively correlated with symptoms of depression among college female faculty and staff in Awassa, Ethiopia. Future policies should include a combination of education, health, and public policy initiatives that clearly outline the problem and consequences of workplace abuse and sexual harassment in educational settings.

Prevalence and risk factors of gender-based violence committed by male college students in Awassa, Ethiopia.

We sought to determine the prevalence and risk factors for the perpetration of gender-based violence among 1,378 male undergraduate students in Awassa, Ethiopia. A self-administered questionnaire was used to collect information. Nearly a quarter (24.4%; 95% confidence interval [CI] 22.1-26.7) of students admitted perpetrating acts of gender-based violence during the current academic year. Approximately 15.8% (95% CI 13.7-17.9) of students reported physically abusing, and 16.9% (95% CI 14.8-19.0) reported committing acts of sexual violence against an intimate partner or nonpartner. Alcohol consumption, khat use (Catha edulis, a natural stimulant), combined use of alcohol and khat, and witnessing parental violence were risk factors for committing gender-based violent acts. These findings suggest an obvious need for effective prevention programs targeted toward changing social norms on the use of violence.

Depressive symptoms among female college students experiencing gender-based violence in Awassa, Ethiopia.

Little epidemiologic research has focused on the mental health effects of gender-based violence among sub-Saharan African women. The objective of this study was to assess risk of depression and depressive symptoms among 1,102 female undergraduate students who were victims of gender-based violence. Students who reported experience of any gender-based violence were nearly twice as likely to be classified as having moderate depression during the academic year (OR = 1.98, 95% CI = 1.39-2.82) as compared with nonabused students. Compared with nonabused students, those who had experienced both physical and sexual abuse were 4 times more likely to report either moderately severe (OR = 4.32, 95% CI = 2.00-9.31) or severe depressive symptoms (OR = 4.19, 95% CI = 1.01-17.43). Our findings, consistent with previous studies, support the thesis that women's mental health status is adversely affected by exposure to gender-based violence.

Prevalence and risk factors of gender-based violence among female college students in Awassa, Ethiopia.

We determined the prevalence and risk factors of gender-based violence among 1,330 female college students in Awassa, Ethiopia. Participants completed a self-administered questionnaire that collected information on experience with gender-based violence during three time periods (lifetime, since enrolling in college, and current academic year). The lifetime prevalence of gender-based violence was 59.9%; 46.1% of participants reported experiencing gender-based violence since enrolling in college, and the prevalence was 40.3% during the current academic year. Protestant religious affiliation, childhood rural residence, alcohol consumption, combined alcohol and khat (a natural stimulant) consumption, and witnessing domestic violence as a child were risk factors of lifetime experience with gender-based violence. Counseling for women who have experienced violence and awareness-raising programs aimed at preventing gender-based violence are needed in colleges.

Anger expression, negative life events and violent behaviour among male college students in Ethiopia.

AIMS: To assess the prevalence of violent behaviour and to identify risk factors associated with violent behaviour among male college students in Ethiopia. METHODS: A cross-sectional study among 1294 male college students in Awassa, Ethiopia was conducted in June 2006. A self-administered questionnaire was used to collect information concerning violent acts, anger expression, and sociodemographic and lifestyle characteristics. Multivariable logistic regression procedures were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: More than half of the students (54.3%) reported committing at least one act of physical violence during the current academic year. Academic year of studies, use of khat, a natural stimulant with amphetamine-like effects, anger proneness and stressful life events were statistically significant covariates associated with committing acts of violence. Seniors, as compared with freshmen, were less likely to admit violent behaviour (OR=0.46; 95% CI 0.30-0.71). Those who reported using khat were more likely to report committing violent acts (OR=1.46, 95% CI 1.02-2.08) than were non-users. Students with moderate levels of anger expression (scores of 11- 14) were 3.40 times more likely to report committing acts of violence (OR=3.40; 95% CI 2.42-4.79) than were those with low levels of anger expression (scores v11). For students with high levels of anger expression (> or = 15 scores), the corresponding OR was 7.62 (95% CI 5.15-11.29). Participants who had experienced > or = 4 negative life events during the current academic year were more likely (OR=2.41; 95% CI 1.58-3.69) to report violent behaviour than were those with fewer stressful life events. CONCLUSIONS: Screening for violent behaviour and violence prevention programmes, particularly those in educational settings, should include strategies that address students' stressful life events, anger management, and substance use.