Care Providers' Perspectives on Disrespect and Abuse of Women During Facility-Based Childbirth in Ethiopia: A Qualitative Study.

BACKGROUND: It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman's rights and a deterrent to the use of life-saving maternity care. Understanding care providers' perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities. OBJECTIVE: To explore care providers' perspectives of disrespect and abuse during facility-based childbirth. METHODS: This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants. RESULTS: Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies. CONCLUSION: Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources.

"I Would Have Stayed Home if I Could Manage It Alone": A Case Study of Ethiopian Mother Abandoned by Care Providers During Facility-Based Childbirth.

BACKGROUND: Every woman is entitled to respectful care during pregnancy and childbirth as a basic human right. However, not all women are being treated equally well. CASE PRESENTATION: This case study highlights some of the common disrespectful practices that women face. This is a testimony of a 28-year-old mother of two, narrated in her own words. The data were collected during an in-depth interview in November 2019. The interview was conducted in her house and her name has been changed to protect her identity. The interview was audio-taped using a digital voice recorder, later transcribed, and translated verbatim from the local language - Amharic, to English. CONCLUSION: This woman's story highlights the unfortunate reality for some women. Five themes emerged from her narrative: denial of care: the provider left her unattended at a critical moment and denied her the care that she came for; non-consented care: she did not consent to the episiotomy; non-dignified care: she was carried by her arms and legs to the delivery couch, and left naked and bleeding on the couch after birth; taking a sick baby home without medical assistance: she was forced to leave the hospital even though her child had breathing difficulties and was not able to suck or breastfeed; and loss of trust in care providers: for her second birth this woman went to a facility where a relative works, as she no longer trusted these providers.

Diarrhea Prevention Practice and Associated Factors among Caregivers of Under-Five Children in Enemay District, Northwest Ethiopia.

Background: Diarrhea is the leading cause of mortality among infants and children younger than 5 years of age in both underdeveloped and developing countries. Factors determining the occurrence of diarrhea in children are complex, and the relative contribution of each factor varies as a function of interaction between socioeconomic, environmental, and behavioral variables. Objectives: To assess diarrhea prevention practice and associated factors of diarrheal disease among caregivers who have under-five children in Enemay district, Ethiopia, 2018. Methods: Community-based cross-sectional study was done from June 1-30, 2018, among 398 caregivers who have under-five children, in the Enemay district that were selected by using the simple random sampling technique. A structured and pretested data collection tool was used to collect the data. Data were entered using EPI DATA version 4.2, and analysis was done using SPSS version 20 statistical package to be cleaned and analyzed. Descriptive analysis was done to describe study participants, and logistic regression (bivariable and multivariable) analysis was done to identify factors that have association with the dependent variable. The P value was less than 0.05. Results: A total of 398 with a response rate of 97% under-five caregivers were participated in this study. Nearly, half (48.7%) of the participants were in the age group 25-34. The study revealed that good practice of diarrhea prevention was 52.8%. This study was also identified that occupation (AOR: 3.922, 95% CI: 1.593, 9.657), family size (AOR: 0.088, 95% CI: 0.009, 0.916), and understanding on diarrhea (AOR: 0.237, 95% CI: 0.091, 0.613) were associated factors of diarrhea prevention practice of under-five children caregivers. Conclusion: This finding showed that diarrhea prevention practice among under-five children caregivers was low and prevention practice was significantly associated with caregivers' awareness on frequency of diarrhea in a day, occupation, and family size in a house.

Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study.

BACKGROUND: In Ethiopia, majority (62%) of pregnant women receive at least one antenatal follow-up, yet only 26% give birth in health facility. Understanding factors underlying this high uptake of antenatal care and low institutional delivery service is critical. Women had antenatal care follow-up means; by default they have access to health facilities. Thus, why do some give birth at home even after receiving antenatal care? Methods. Fourteen key informant interviews and six focused group discussions were held among purposively selected women who gave birth in the last 12 months without skilled attendance after receiving antenatal care. The study explored women's perspectives on maternity care, care providers, and factors that influence place of delivery. Interpretative phenomenological analysis was used to examine various behaviors and beliefs of respondents. RESULTS: Study participants described range of experiences and beliefs that made them give birth at home after receiving antenatal care at health facilities. Four themes emerged from women's description: poor counseling during antenatal care service, traditions, early pregnancy symptoms, and lack of planning in advance for childbirth. CONCLUSION: Poor counseling during antenatal care is deterring women from seeking skilled attendance at birth. Thus, healthcare providers need to stress necessity of facility based delivery care during antenatal follow-up counseling.

Factors Affecting the Presence of Adequately Iodized Salt at Home in Wolaita, Southern Ethiopia: Community Based Study.

BACKGROUND: Universal use of iodized salt is a simple and inexpensive method to prevent and eliminate iodine deficiency disorders like mental retardation. However, little is known about the level of adequately iodized salt consumption in the study area. Therefore, the study was aimed at assessing the proportion of households having adequately iodized salt and associated factors in Wolaita Sodo town and its peripheries, Southern Ethiopia. METHODS: A cross-sectional study was conducted from May 10 to 20, 2016, in 441 households in Sodo town and its peripheries. Samples were selected using the systematic sampling technique. An iodometric titration method (AOAC, 2000) was used to analyze the iodine content of the salt samples. Data entry and analysis were done using Epi Info version 3.5.1 and SPSS version 16, respectively. RESULT: The female to male ratio of the respondents was 219. The mean age of the respondents was 30.2 (±7.3 SD). The proportion of households having adequately iodized salt was 37.7%, with 95% CI of 33.2% to 42.2%. Not exposing salt to sunlight with [OR: 3.75; 95% CI: 2.14, 6.57], higher monthly income [OR: 3.71; 95% CI: 1.97-7.01], and formal education of respondents with [OR: 1.75; 95% CI: 1.14, 2.70] were found associated with the presence of adequately iodized salt at home. CONCLUSION: This study revealed low levels of households having adequately iodized salt in Wolaita Sodo town and its peripheries. The evidence here shows that there is a need to increase the supply of adequately iodized salt to meet the goal for monitoring progress towards sustainable elimination of IDD.

Risk Factors of Underweight in Children Aged 6-59 Months in Ethiopia.

BACKGROUND: Undernutrition in early childhood has irreversible and long-lasting implications. Hence, this study was aimed at assessing risk factors of child undernutrition. METHODS: A community-based cross-sectional study was conducted on 642 households with mothers to children pairs aged 6-59 months selected by a multistage systematic random sampling method. Child anthropometric measurements on weight were recorded using standardized and calibrated weighing scales. Weight-for-age was compared to the 2007 WHO growth reference by WHO Anthro software. Data were entered using Epi-Info and analyzed using SPSS. Bivariate and multivariate logistic regression analyses were used to evaluate the association between underweight children and their predictors; both crude and adjusted odds ratios with 95% confidence interval were reported. RESULTS: One-fourth (25%) of the children were underweight. Child age (AOR: 2.36), gender (AOR: 1.82), illness (AOR: 0.09), maternal decision making power (AOR: 0.07), maternal education (AOR: 0.19), employment/occupation (AOR: 5.29), and household income (AOR: 4.16) were found to be independent and significant predictors of underweight children. CONCLUSION: Significant proportion of the children were underweight. Maternal decision-making power persists as a strong predictor of children's weight. Therefore, intervention programs focusing on improving mothers' decision-making power on child nutrition would contribute to the efforts towards alleviating the problem.

Appropriate Weaning Practice and Associated Factors among Infants and Young Children in Northwest Ethiopia.

BACKGROUND: The right nutrition from the start of a pregnancy to the child's second birthday has a profound impact on the future health, wellbeing, and success of a child. This can be achieved through proper maternal nutrition during pregnancy, exclusive breastfeeding, and appropriate weaning practice. OBJECTIVE: This study was aimed at assessing appropriate weaning practice and associated factors among infants and young children aged 6-23 months in Feres Bet Town, Northwest Ethiopia. METHODS: A community based cross-sectional study was conducted among 351 children aged 6-23 months. Simple random sampling technique was used to select study participants. Interviewer administered questionnaires were used. Bivariate and multivariable logistic regression analyses were employed to identify factors associated with appropriate weaning practice. RESULTS: Nearly quarter (23.9%) of mothers have practiced appropriate weaning. Proportion of children who started consumption of weaning food timely and met the recommended dietary diversity was 61.5% and 43.9%, respectively. Child age [AOR (Adjusted Odds Ratio): 7.04], husband's occupation [AOR: 6.85], and maternal weaning advice [AOR: 4.38] were positively associated with appropriate weaning practice, while family size [AOR: 0.28] showed negative association. CONCLUSION: Appropriate weaning practice was found to be low. Health education at community level and one-on-one advice for mothers in health institutions are highly recommended to improve appropriate weaning.

Experience of Facility Based Childbirth in Rural Ethiopia: An Exploratory Study of Women's Perspective.

BACKGROUND: In Ethiopia, majority (62%) of pregnant women attend antenatal care at least once, yet only 26% deliver with skilled birth attendants in the available health units. Thus, this study explored beliefs and behaviors related to labour and skilled attendance among the women, their perspectives on health care providers, and traditional birth attendants. METHODS: Sixteen key informant interviews and eight focus group discussions were conducted among purposively selected women who had previous experience of facility based childbirth but gave birth to their most recent child without skilled attendance in the last 12 months. Thematic content analysis was used to elicit and assess the various perspectives of each group of participants interviewed. FINDINGS: The study participants described a range of experiences they had during childbirth at health facilities that forced them to choose home delivery in their most recent delivery. Three themes and six subthemes emerging from women's description were abusive and disrespectful treatment, unskilled care, poor client provider interaction, noncontinuous care, lack of privacy, and traditional practices. CONCLUSION: The abuse and disrespect from providers are deterring women from seeking skilled attendance at birth. Thus the health care providers need to improve client provider relationships.