Individual and community-level determinants of skilled birth attendant delivery in Ethiopia; multilevel analysis.

INTRODUCTION: Skilled birth attendant (SBA) delivery is defined as assisting birth by a trained healthcare provider, which is vital for the health of mothers and newborns. Improving maternal health is one of the world health organization's (WHO) key priorities and skilled birth attendant delivery is one of the four pillars of the initiative for safe motherhood to reduce maternal mortality. Therefore, this study aimed to assess the individual and community-level factors associated with SBA delivery in Ethiopia. METHOD: A secondary data analysis was conducted using the 2019 Mini Ethiopian demographic and health survey. A total of 5,527 (weighted) live births were included in the analysis. A multi-level logistic regression model was fitted using Stata 14.0 to identify individual and community-level factors associated with SBA delivery. Finally, AOR with 95% CI and random effects were reported. RESULT: In this study after fitting a multilevel model, women with poor (AOR = 0.44 95%CI 0.32-0.61) and middle wealth index (AOR = 0.64;95% CI 0.46-0.87), multipara (AOR = 0.39;95% CI 0.28-0.55) and grand multipara (AOR = 0.46;95% CI 0.29-0.72), women from rural areas (AOR = 0.34;95% CI 0.16-0.72) and high community poverty level (AOR = 0.40;95% CI 0.21-0.76) had decreased odds of having SBA delivery. Whereas those who initiated Antenatal care (ANC) visits in the first trimester (AOR = 2.65; 95% CI 1.52-4.65) and second trimester (AOR = 1.87:95%CI 1.09-3.20) had increased odds of having SBA delivery in Ethiopia. CONCLUSION: In this study socioeconomic factors like wealth index, parity, the timing of ANC visits, place of residency, and community poverty level were significantly associated with SBA delivery. Therefore, it is better to increase timely ANC initiation particularly for women with low levels of income to improve skilled birth attendant delivery.

Knowledge and attitude of women towards maternity waiting homes and associated factors among women who gave birth in the last twelve months in Dega Damot district, northwest Ethiopia.

Background: Maternal waiting homes have been identified as one strategy to reduce maternal and perinatal mortality by bringing women living in hard-to-reach areas closer to a health facility that provides emergency obstetric care. Even if utilization of maternal waiting homes is repeatedly assessed, there is a scarcity of evidence in Ethiopia regarding women's knowledge and attitude towards maternal waiting homes. Objective: This study aimed to assess women's knowledge and attitude towards maternity waiting homes and associated factors among women who gave birth in the last twelve months in northwest Ethiopia. Methods: A community-based cross-sectional study was conducted from January 1st to February 30th, 2021. A total of 872 participants were selected by using a stratified cluster sampling technique. Data were collected by face-to-face interviews using a structured, pretested, and interviewer-administered questionnaire. Data were entered into EPI data version 4.6 and analysis was done through SPSS version 25. The multivariable logistic regression model was fitted and the level of significance was declared at a p-value of ≤0.05. Result: Women's adequate knowledge and positive attitude towards maternal waiting homes were 67.3% (95% CI: 64-70) and 73% (95% CI: 70-76), respectively. Had antenatal care visit, the shortest distance to reach the nearby health facility, had history of maternal waiting homes utilization, always involved in health care decision, and sometimes involved in health care decisions were significantly associated with women's knowledge regarding maternal waiting homes. Moreover, secondary and above educational level of women, short distance to reach the nearby health facility and had antenatal care visit were significantly associated with women's attitude towards maternity waiting homes. Conclusion: About two-third of women had adequate knowledge and nearly three-fourth of women had a positive attitude towards maternity waiting homes. It is better to improve the accessibility and utilization of maternal health services Furthermore, it is better to promote women's decision making power and create motivation to have better academic achievement of women.

Knowledge of danger signs in pregnancy and their associated factors among pregnant women in Hosanna Town, Hadiya Zone, southern Ethiopia.

Background: Danger signs in pregnancy can warn of maternal health problems. In developing African countries, including Ethiopia, the rate of maternal mortality is high. There is little knowledge of danger signs during pregnancy and their associated factors at the community level in the study area. Methods: A community-based, cross-sectional study was conducted to assess knowledge about danger signs among pregnant women in Hosanna Zuria Kebeles between 30 June and 30 July 2021. A simple random sampling method was used to select eligible pregnant women. The sample size was proportionally allocated based on the number of pregnant women in each kebele. Data were collected in face-to-face interviews using a pretested questionnaire. The descriptive results were presented as proportions, whereas the analytic results were presented as adjusted odds ratios (AOR). Results: The prevalence of good knowledge of danger signs in pregnancy was 259/410 (63.2%, 95% confidence interval (CI) 58.3-67.8). The most common known danger signs during pregnancy were severe vaginal bleeding (n = 227, 55.4%), followed by blurred vision (n = 224, 54.6%). In the multivariable analysis, the age of the respondent (AOR = 3.29, 95% CI 1.15-9.38), the tertiary education of the mother (AOR = 5.40, 95% CI 2.56-11.34), and the number of live births (AOR = 3.95, 95% CI 2.08-7.48) were statistically significant factors. Conclusion: There was an adequate prevalence of knowledge of danger signs in pregnancy among pregnant mothers compared with different studies in Ethiopia and different countries. Advanced maternal age, the respondent's level of education, and the number of live births were found to be independent determining factors for the level of knowledge on danger signs in pregnancy among pregnant mothers. Health facilities and healthcare providers should focus on antenatal care and the age and parity of the mother when giving information about danger signs in pregnancy. The Ministry of Health should provide reproductive health services in rural areas and encourage education for women. Further studies need to be conducted and include danger signs in the three trimesters using a qualitative study design.

Self-harm among post-natal mothers in Northwest Ethiopia: Implication for policy and practice.

Introduction: Self-harm is a global public health concern affecting thousands of women. However, it is an under-reported and neglected aspect of maternal health, particularly in developing countries. In Ethiopia, there is a paucity of evidence regarding self-harm, and it is rarely given attention. Therefore, this study aimed to assess the proportion of self-harm and associated factors among postnatal mothers in Gondar city, Northwest Ethiopia. Method: A community-based cross-sectional study was conducted from 1 July, 2021, to 30 August, 2021, in Gondar city. A cluster sampling technique was conducted to select 858 women who gave birth in the last 12 months. The data were collected using a structured questionnaire through face-to-face interviews. The data were entered into EpiData version 4.6 and exported to SPSS 25 for analysis. The multivariable logistic regression analysis was fitted to identify factors associated with the outcome variable. The level of significant association was determined at a p-value of ≤ 0.05. Result: The proportion of postnatal self-harm was found to be 8.5% (95% CI: 6.7,10.5). Having lower family income (AOR: 2.41, 95% CI: 1.05,5.56), having unplanned pregnancy (AOR: 2.70, 95% CI: 1.53,4.79), experiencing adverse birth outcomes (AOR: 3.11, 95% CI: 1.10,8.83), birth not attended by health provider (AOR: 4.15, 95% CI: 1.76,9.79), experiencing intimate partner violence (AOR: 1.93, 95% CI: 1.12,3.32), and poor decision-making power (AOR: 1.70, 95% CI: 1.02, 2.84) were the variables significantly associated with self-harm. Conclusion: This study revealed that the proportion of self-harm among postnatal mothers was prevalent. Factors like monthly income of a family, planned pregnancy, birth outcome, birth assistant, intimate partner violence, and decision-making power show an association with maternal self-harm. Antenatal and postnatal self-harm screening as part of the continuum of maternal healthcare is important. Self-harm is also a danger for women who have experienced intimate partner violence or have low socioeconomic economic status, all of which require exceptional mental health assessment.

Impact of Dysmenorrhea on Academic Performance Among Haramaya University Undergraduate Regular Students, Eastern Ethiopia.

Background: Dysmenorrhea is the most common gynecological problem among students. The disease affects students' academic performance, although studies carried out in Ethiopia primarily focused on the prevalence aspects rather than the impacts of dysmenorrhea on academic performance and its associated factors. Therefore, this study focused on the prevalence of the impact of dysmenorrhea on academic performance and its associated factors among undergraduate female students of Haramaya University in eastern Ethiopia. Methods: A cross-sectional study design was conducted from February to March 2020. A multistage random sampling technique was applied and a total of 356 students were included in the study. To select students, simple random sampling was used and the sample size was proportionally allocated with respect to the total number of each selected department. A semi-structured and a pre-tested self-administered questionnaire were used. The descriptive result was presented as a proportion whereas the analytic part was presented with an adjusted odds ratio. Result: The prevalence of the impact of dysmenorrhea on academic performance was 266 [(74.7%):95%CI (70.0, 79.5%)]. Premenstrual syndrome [AOR = 4.86:95%CI (2.13, 11.06)], early menarche [AOR = 4.89:95%CI (2.03, 11.77)], moderate/severe dysmenorrhea pain intensity [AOR = 8.53:95%CI (4.45, 16.39)], and students monthly pocket money <150ETB [AOR = 3.91:95%CI (1.48, 10.29)] were significantly associated with the occurrence of the impact of dysmenorrhea on academic performance. The most common impacts were difficulty in studying followed by loss of concentration in the class. Conclusion and Recommendation: There was a high prevalence of impact of dysmenorrhea on academic performance among undergraduate female students of the Haramaya University. Awareness should be created among Haramaya university authorities and teachers about the academic performance impact of premenstrual syndrome and dysmenorrhea pain intensity to provide psychological and academic guidance, and managing mechanisms for the affected students. Haramaya University should also establish medical care for the affected students.

Husband Involvement in Maternal, Neonatal, and Child Health Care among Women who Have a Child Less Than one Year in Gondar City, Northwest Ethiopia, 2021.

Background: Improving maternal, neonatal and child health is one of the major components of Sustainable Development Goal and countries implement different strategies to achieve this goal. In spite of this, maternal, neonatal and child mortality remains a public health burden in the developing countries, including Ethiopia. World Health Organization recommend active involvement of men during pregnancy, child birth and the postpartum period as an effective strategy to improve maternal as well as newborn health. Therefore, this study aimed to assess husband involvement in maternal, neonatal and child health care among women who have child less than one year in Gondar city, northwest Ethiopia. Methods: A community-based cross-sectional study was conducted among 870 married women who have a child less than one year in Gondar city. A cluster sampling technique was employed to select study participants. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable logistic regression was done and adjusted odds ratio with a 95% confidence interval was used to report the association between covariates and the outcome variable. Results: Husband involvement in Maternal, Neonatal and Child Health (MNCH) care was 66.2% (95%CI: 63, 69.3). Maternal age (18-25years) and (26-35years), having diploma and above education, husband occupation (government employee), (merchant) and (self-employed), planned pregnancy and cesarean delivery were significantly associated with husband involvement in MNCH care. Conclusion: In this study, nearly two thirds (66.2%) of women had husband involvement in MNCH care. Therefore, it is important to improve women's educational attainment and actions should be taken to prevent unplanned pregnancy.

Prevalence of Dysmenorrhea and Associated Factors Among Haramaya University Students, Eastern Ethiopia.

Purpose: Dysmenorrhea is the most common gynecological problem among adolescents and a common cause of school absenteeism. Previously, there was no study conducted on prevalence of dysmenorrhea and associated factors among university students in Ethiopia. Therefore, the aim of this study was to assess prevalence and associated factors of dysmenorrhea among Haramaya university undergraduate regular students in Eastern Ethiopia. Materials and Methods: An institution-based cross-sectional study design was conducted from February to March 2020. A multistage random sampling technique was applied and a total of 569 participants were included into the study. The total sample size was proportionally allocated based on the total number of students in each departments, and simple random sampling technique was employed to select participants. The data were entered to EPI­info version 3.5.4 and then exported to Statistical Package for Social Science version 23.0 software for analysis. The associations between independent variables and outcome variable were explored using bivariate and multivariable logistic regression models. The results of these analysis were reported as odds ratios with 95% confidence intervals. Results: The prevalence of dysmenorrhea in this study was 356 (64.7%) 95% CI [60.7%, 68.7%]. Premenstrual syndrome (AOR = 5.20:95% CI [2.82, 9.61]), early menarche (AOR = 4.67:95% CI [2.33, 9.37]), history of anxiety (AOR = 4.08:95% CI [2.31, 7.19]), taking of ≥4 glass of tea per day (AOR = 5.69:95% CI [1.49, 21.77]), usually eating fat and oil (AOR = 2.03:95% CI [1.15, 3.59]) and usual use of meat food (AOR = 3.61:95% CI [2.03, 6.39]) were positively and independently associated with the occurrence of dysmenorrhea. Conclusion: Dysmenorrhea was a common problem among Haramaya University female students. History of anxiety, early menarche, premenstrual syndrome, tea consumption, usual use of fat and oil containing food and usual use of meat food were significantly associated to dysmenorrhea. We recommend Haramaya University to provide accessible and appropriate medical treatment and counseling service for dysmenorrhea affected students.