Cultural malpractice during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa city administration, Eastern Ethiopia, in 2021.

Background: Cultural practices are any experiences or beliefs that are socially shared views and behaviors practiced in a certain society at a certain time. Cultural malpractices are defined as socially shared views and traditionally accepted behaviors experienced in a certain society that harm maternal health. Worldwide, the period of pregnancy, labor, and delivery is embedded with different beliefs, customs, and rituals in different societies that contribute a lot to maternal death. They are responsible for the annual deaths of 303,000 mothers and 2.7 million newborns globally. In developing countries, it accounts for approximately 5%-15% of maternal deaths. In Ethiopia, approximately 18% of infant deaths occur due to cultural malpractice, and 52% of pregnant mothers give birth at home following cultural customs in Dire Dawa city. The objective of this study was to assess cultural malpractices during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa City in 2021. Methods: Community-based mixed study was conducted. A total of 624 study participants were selected through a systematic random sampling technique, and a purposive sampling method was used for qualitative data. The study was conducted in the randomly selected Kebeles of Dire Dawa City, Eastern Ethiopia, from November 1 to December 30, 2021. Data were entered into Epi Data version 4.1 and exported to SPSS version 24 for analysis. Bivariate and multivariate analyses were done, and the degree of association was measured by using the odds ratio with 95% CI and significance was declared at a p-value of <0.05. The qualitative data were analyzed thematically using ATLAS-ti version 7. Results: The overall prevalence of cultural malpractice during pregnancy, childbirth, and the postnatal period was 74.6% [95% CI: 70.59%, 77.49%]. Women over the age of 35 were two times more likely [AOR 2.61, 95% CI, 1.45-4.72] to commit cultural malpractice than women aged 15-24 and 25-34. Those with no antenatal care (ANC) follow-up were three times more likely to commit cultural malpractice [AOR 3.57, 95% CI, 1.72-7.40], those who were absent from health education were nearly two times more likely to commit cultural malpractice [AOR 1.83, 95%CI, 1.25-2.67], and women whose culture allows harmful traditional practices were nearly two times more likely to commit cultural malpractices than their counterparts [AOR 1.69, 95%CI, 1.29-2.54]. Conclusion: In this study, nearly three-fourths of participants were involved in cultural malpractices. Therefore, strengthening community education and behavioral change messages on the importance of ANC and avoiding unhealthy care during pregnancy, childbirth, postnatal and neonatal periods, especially with pregnancy at old age (age > 35), may help to reduce cultural malpractices.

Pregnancy and sexual related problems among women living on the street in dire Dawa City, Eastern Ethiopia, 2021: qualitative study.

BACKGROUND: The problem of women and youths living on the street is a global phenomenon. It has created countless problems while they lived on the street; such as unwanted pregnancies, sexual exploitation and prostitution. It is a frequent observation to see women begging on the streets of major cities in Ethiopia having one or two babies by their sides. This study will give an in-depth understanding of the distressing and highly challenging problem among women on the street regarding pregnancy and related problems. OBJECTIVE: To explore pregnancy and sexual-related problems among women living on the street in Dire Dawa city, Eastern Ethiopia 2021. METHODS: A community-based phenomenological qualitative study was conducted at Dire Dawa city. Data was collected from homeless women and Key informants through focus group discussion and in-depth interviews using a semi-structured tool aided by a voice recorder. Data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with inductive approach goes through 6 steps; Familiarization, Coding, Generating themes, Reviewing themes, Defining and naming themes and Writing up. RESULT: Women living on the street are more likely to experience physical abuse, sexual harassment, Sexual transmitted infection, unprotected sex and unwanted pregnancy. As a result, the fate of this pregnancy is abortion leads to high risk of getting health complications as most abortions are made in illegal and unsafe ways. CONCLUSION: Teen pregnancy, STI, rape and unsafe abortion are the major concerns as it accompanied by their homelessness situation and abusive lifestyles. The regional health bureau needs to understand the extent of problem and plan to organize an awareness creation program on STI, risk of pregnancy and SRH services.

Women experiencing homelessness in Dire Dawa city: Coping mechanisms and suggestions to stakeholder, 2021.

BACKGROUND: In Ethiopia, the number of homeless girls and women is increasing, and the government has yet to devise a strategy to address the issue of teenage homelessness. They are influenced by numerous dimensions of health, including physical health, mental health, and social isolation. At all stages of homelessness, the stakeholders and homeless people must work together to address the issue. As a result, this study will be helpful to generate relevant data that may guide policymakers in designing solutions for this underserved group of people. OBJECTIVES: To explore coping mechanisms and suggestions to stakeholders among women experiencing homelessness in Dire Dawa city, eastern Ethiopia, 2021. DESIGN: A community-based phenomenological qualitative study was conducted at Dire Dawa city. METHODS: Data were collected from women experiencing homelessness and key informants through focus group discussion and in-depth interviews using a semi-structured tool. A total of 31 women experiencing homelessness (13 in-depth interviews and 3 focus group discussion with 6 participants in each) and 2 key informants participated in this study. Data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti 7. The thematic analysis follows six steps: familiarization, coding, generating themes, reviewing themes, naming themes, and writing up. RESULTS: Two major themes were driven: coping mechanisms and suggestions to stakeholders. There are three subthemes under the coping mechanism (begging, survival sex, and child prostitution) while there are a total of seven subthemes under suggestions to stakeholders (integration and collaboration, special attention to children, family education, shelter and job, schooling, sexual education, and addiction rehabilitation). CONCLUSION: Child prostitution and survival sex are a very common coping mechanism which is practiced by women experiencing homelessness. Changing society's mindset and paying special attention to children is critical. Furthermore, the government and various stakeholders should work together to develop a rehabilitation program for street children who have been exposed to substance use.

Clinical Practice Competence and its Associated Factors Among Midwifery and Nursing Students at Dire Dawa Health Sciences Colleges, East Ethiopia, 2020.

BACKGROUND: Competence is defined as the ability to perform a task with desirable outcomes. Globally, an estimated 530,000 women and 2 million newborns die each year, because of no access to competent health professionals. But half of those deaths can be prevented with competent health professionals. However, the existing literature shows that most new graduates have a lack of competence in the clinical environment, none of them have assessed whether student or preceptor factors have an association with clinical competence or not. So, this study is crucial to fill data scarcity. OBJECTIVE: To determine the clinical practice competence and associated factors among midwifery and nursing students at Dire Dawa. METHODS: Institutional cross-sectional study was conducted on nursing and midwifery students from February 10/2020 to February 30/2020. Self-administered questionnaires were given to 318 students through a simple random lottery. Multivariate logistic regression analysis was done for variables with a p-value <0.2 in binary logistic regression. The odds ratio was used to measure the degree of association. RESULTS: Only 19.2% are clinically competent. Students who were oriented about assessment methods were 4 times more likely competent [AOR = 4.096 p-value 0.035]. Students who have staff encouragement and have preceptors were 5 times [AOR = 4.900 p-value 0.12] and 11 times [AOR = 11.052 p-value 0.00] more likely competent, respectively. Confident students were 4 times more likely competent [AOR = 4.460, p-value 0.005]. CONCLUSION: The prevalence of clinical competence is very minimal. This is due to assessment methods orientation, staff encouragement, clinical preceptor support and students' confidence. This finding contributes to the federal ministry of health should work closely with teaching institutions, health facilities, and other stakeholders to overcome those gaps.

Community Perception Regarding Maternity Service Provision in Public Health Institutions in 2018 and 2019: A Qualitative Study.

BACKGROUND: In the perspective of health care, community perception is defined as a combination of experiences, expectations and perceived needs. The community and client's perception of health services seem to have been largely ignored by health-care providers in developing countries. There is a knowledge gap about communities' perception and perspective of maternal health. If the community's perception is known, the quality of maternity care may be improved, maternal morbidity and mortality could be decreased, and the overall health of the mother can be improved. The aim of this study was to explore community's perception of maternity service provision in public health institutions. METHODS: A qualitative study with the underpinning philosophy of phenomenology was conducted in five subcities of Mekelle city, Ethiopia. Focus group discussions (FGDs) and in-depth interviews (IDSs) with participants who are residing in Mekelle city and who experienced maternity service as a client or as attendants were conducted to collect the necessary information. Using a semi-structured tool that has been translated into the local language, collected data were analyzed thematically using computer-assisted qualitative data analysis software ATLAS version 7. Qualitative data were transcribed through replaying the tape recorded interview from IDIs and FGDs. The text was carefully read and similar ideas were organized together. The participant's inductive meanings were extracted verbatim and described in narratives. The researcher and research assistants independently transcribed participant's comments verbatim to confirm the reliability of the findings. RESULTS: Participants reported that maternal health services in public health institutions were negative. Participants described experiencing poor staff attitude, lack of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment made them develop a negative perception towards public health institutions. Despite these complaints, participants acknowledged public health facilities for affordable, accessible, qualified personnel and usually stocked with quality medications and equipment. CONCLUSION: This study revealed that the community has a negative perception of the maternal health services in the public health institutions. The main reasons for their negative perception were poor staff attitude, unavailability of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment.

Midwifery as a Future Career: Determinants of Motivation Among Prep Students in Harar, Eastern Ethiopia.

BACKGROUND: Midwifery is a profession that deals with care and advice during pregnancy, labor, childbirth and postpartum period including support for the newborn. Like other professions, the sustainability of midwives depends on recruiting new professionals who are inspired to train as their future career. In this regard, the inspiration of preparatory students to embracing the profession and secure the future midwife workforce is critical. In Ethiopia, there is no literature on the assessment of students' intention toward the midwifery profession. Hence, this study is crucial to fill data scarcity. OBJECTIVE: To assess the intention and related factors to choose midwifery as a future profession among preparatory students at Harar. METHODOLOGY: An institutional cross-sectional study was conducted on preparatory students from March 20 to April 12/2019. Self-administered questionnaires were randomly given to 423 students. Multivariate logistic regression analysis was done for variables with p-value <0.2 in binary logistic regression. The odds ratio was used to measure the degree of association. RESULTS: Only 18.1% intended to choose midwifery as a future profession. The odds of considering to choose midwifery is 5 times higher in those who have a health professional mother [AOR= 5.518 p-value 0.009]. Students who have good perceptions are 7 times more likely to choose the profession [AOR= 7.072 p-value 0.00]. Students who perceived low regard toward the profession [AOR= 0.231 p-value 0.001] and blood contact as a barrier to be a midwife [AOR= 0.174 p-value 0.001] are less likely to choose it. CONCLUSION: Preparatory students in Harar have minimal intention to choose midwifery. This is due to a lack of information about the profession, poor perception, low regard to the profession, and fear of blood contact. This finding contributes to the midwifery association and ministry of health to enhance positive perception toward the profession.