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Dagnaw GW, Bizuneh MM, Kassie MB. Person-centered maternity care and associated factors among women who give birth at public hospitals in South Gondar zone, North West Ethiopia, 2023. PLoS One 2024; 19:e0303389. [PMID: 39172931 PMCID: PMC11340964 DOI: 10.1371/journal.pone.0303389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/23/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Person-centered maternity care (PCMC) is the process of maternity care that is responsive to and respectful of each woman's choices, values, and needs. It reflects the quality of maternal health services. The provision of PCMC is influenced by the maternal sociodemographic and obstetric-related variables However, there is little information about person-centered maternity care in Ethiopia; particularly, communication & autonomy, and supportive care are not well investigated. Therefore, the purpose of this study was to assess the proportion of person-centered maternity care and associated factors among women who give birth at the public hospital, in North West, Ethiopia, 2023. METHODS A facility-based cross-sectional study was conducted among 763 mothers who give birth at public hospitals in the South Gondar zone. The study participants were selected using a systematic random sampling technique. Data were collected through exit interviews using a structured pretested Amharic version questionnaire. EPI- Data version 4.6 was used for data entry and SPSS Version 25 for analysis. Bivariable & multivariable linear regression analysis was computed. Predictor variables were identified by using unstandardized β and a 95% confidence interval. A variable that has a p-value < 0.05 was considered statistically significant. RESULTS The mean person-centered maternity care was 42.33 out of 90. Mothers living in rural areas (β = -1.43, 95% CI: -2.76,-0.11), 3-4 providers present during labor and delivery (β = -1.58, 95% CI:-3.67,-0.27), had no history of facility delivery (β = -2.28,95% CI:-4.43,-0.13), two days length of stay at hospitals (β = 1.69,95% CI:0.40,2.48), and highest wealth (β = 1.05,95% CI:0.42,1.41) were factors significantly associated with person-centered maternity care (PCMC). CONCLUSION The mean score of PCMC was low in the study area compared to studies done in low- and middle-income countries. Highest wealth, 3-4 health providers present during labor and delivery, had no history of facility delivery, and had two-day lengths of stay at hospitals were predictors for PCMC. Therefore, strengthening facility delivery and promoting hospital stays for more than a day as a part of first postnatal care is paramount for increasing PCMC.
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Affiliation(s)
- Gizachew Worku Dagnaw
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mekonen Melkie Bizuneh
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Meseret Birhan Kassie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Malka ES, Solomon T, Kassa DH, Erega BB, Tufa DG. Time to death and predictors of mortality among early neonates admitted to neonatal intensive care unit of Addis Ababa public Hospitals, Ethiopia: Institutional-based prospective cohort study. PLoS One 2024; 19:e0302665. [PMID: 38843182 PMCID: PMC11156352 DOI: 10.1371/journal.pone.0302665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/10/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION The largest risk of child mortality occurs within the first week after birth. Early neonatal mortality remains a global public health concern, especially in sub-Saharan African countries. More than 75% of neonatal death occurs within the first seven days of birth, but there are limited prospective follow- up studies to determine time to death, incidence and predictors of death in Ethiopia particularly in the study area. The study aimed to determine incidence and predictors of early neonatal mortality among neonates admitted to the neonatal intensive care unit of Addis Ababa public hospitals, Ethiopia 2021. METHODS Institutional prospective cohort study was conducted in four public hospitals found in Addis Ababa City, Ethiopia from June 7th, 2021 to July 13th, 2021. All early neonates consecutively admitted to the corresponding neonatal intensive care unit of selected hospitals were included in the study and followed until 7 days-old. Data were coded, cleaned, edited, and entered into Epi data version 3.1 and then exported to STATA software version 14.0 for analysis. The Kaplan Meier survival curve with log- rank test was used to compare survival time between groups. Moreover, both bi-variable and multivariable Cox proportional hazard regression model was used to identify the predictors of early neonatal mortality. All variables having P-value ≤0.2 in the bi-variable analysis model were further fitted to the multivariable model. The assumption of the model was checked graphically and using a global test. The goodness of fit of the model was performed using the Cox-Snell residual test and it was adequate. RESULTS A total of 391 early neonates with their mothers were involved in this study. The incidence rate among admitted early neonates was 33.25 per 1000 neonate day's observation [95% confidence interval (CI): 26.22, 42.17]. Being preterm birth [adjusted hazard ratio (AHR): 6.0 (95% CI 2.02, 17.50)], having low fifth minute Apgar score [AHR: 3.93 (95% CI; 1.5, 6.77)], low temperatures [AHR: 2.67 (95%CI; 1.41, 5.02)] and, resuscitating of early neonate [AHR: 2.80 (95% CI; 1.51,5.10)] were associated with increased hazard of early neonatal death. However, early neonatal crying at birth [AHR: 0.48 (95%CI; 0.26, 0.87)] was associated with reduced hazard of death. CONCLUSIONS Early neonatal mortality is high in Addis Ababa public Hospitals. Preterm birth, low five-minute Apgar score, hypothermia and crying at birth were found to be independent predictors of early neonatal death. Good care and attention to neonate with low Apgar scores, premature, and hypothermic neonates.
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Affiliation(s)
- Erean Shigign Malka
- School of Public Health, College of Medicine and Health Sciences, Salale University, Salale, Ethiopia
| | - Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Besfat Berihun Erega
- School of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Derara Girma Tufa
- School of Public Health, College of Medicine and Health Sciences, Salale University, Salale, Ethiopia
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Belay DM, Erku D, Bayih WA, Kassie YT, Minuye Birhane B, Assefa Y. Improving the quality of neonatal health care in Ethiopia: a systematic review. Front Med (Lausanne) 2024; 11:1293473. [PMID: 38841585 PMCID: PMC11150606 DOI: 10.3389/fmed.2024.1293473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. Methods We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Results We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. Conclusions This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.
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Affiliation(s)
- Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Erku
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Wubet Alebachew Bayih
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Demissie DB, Molla G, Tiruneh Tiyare F, Badacho AS, Tadele A. Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis. SAGE Open Med 2024; 12:20503121241248275. [PMID: 38737837 PMCID: PMC11085007 DOI: 10.1177/20503121241248275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Background Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. Objective This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. Method We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. Results The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). Conclusions The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.
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Affiliation(s)
- Dereje Bayissa Demissie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Firew Tiruneh Tiyare
- Faculty of Public Health, Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Ashenif Tadele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Birhane BM, Assefa Y, Belay DM, Nibret G, Munye Aytenew T, Liyeh TM, Gelaw KA, Tiruneh YM. Interventions to improve the quality of maternal care in Ethiopia: a scoping review. Front Glob Womens Health 2024; 5:1289835. [PMID: 38694232 PMCID: PMC11061455 DOI: 10.3389/fgwh.2024.1289835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Quality improvement interventions have been part of the national agenda aimed at reducing maternal and neonatal morbidities and mortality. Despite different interventions, neonatal mortality and morbidity rates remain steady. This review aimed to map and synthesize the evidence of maternal and newborn quality improvement interventions in Ethiopia. Methods A scoping review was reported based on the reporting items for systematic reviews and meta-analysis extensions for the scoping review checklist. Data extraction, collation, and organization were based on the Joanna Briggs Institute manual of the evidence synthesis framework for a scoping review. The maternal and neonatal care standards from the World Health Organization and the Donabedian quality of health framework were used to summarize the findings. Results Nineteen articles were included in this scoping review. The review found that the studies were conducted across various regions of Ethiopia, with the majority published after 2013. The reviewed studies mainly focused on three maternal care quality interventions: mobile and electronic health (eHealth), quality improvement standards, and human resource mobilization. Moreover, the reviewed studies explored various approaches to quality improvement, such as providing training to healthcare workers, health extension workers, traditional birth attendants, the community health development army, and mothers and supplying resources needed for maternal and newborn care. Conclusion In conclusion, quality improvement strategies encompass community involvement, health education, mHealth, data-driven approaches, and health system strengthening. Future research should focus on the impact of physical environment, culture, sustainability, cost-effectiveness, and long-term effects of interventions. Healthcare providers' knowledge, skills, attitudes, satisfaction, and adherence to guidelines should also be considered.
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Affiliation(s)
- Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gedefaye Nibret
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Tewachew Muche Liyeh
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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Ehret DEY, Demtse Gebremedhin A, Hadgu Berhe A, Hailu Y, Metaferia G, Kessler K, Kessler R, Dunn M, Golan A, Stavel M, Belava J, Horbar JD, Edwards EM, Worku B, Dunn M, Abayneh M. High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress. Acta Paediatr 2023; 112:2329-2337. [PMID: 37675588 DOI: 10.1111/apa.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/13/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
AIM To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress. METHODS We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4. RESULTS Of the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score-based treatment. CONCLUSION Incorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near-perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score-based treatment recommendations. These results highlight an opportunity for task-shifting assessments and empowering nurses.
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Affiliation(s)
- Danielle E Y Ehret
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
| | | | - Amanuel Hadgu Berhe
- Department of Pediatrics and Child Health, Mekelle University, Mekelle, Ethiopia
| | - Yohanes Hailu
- Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
| | - Gesit Metaferia
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kaitlin Kessler
- University of Vermont Medical Center, Burlington, Vermont, United States
| | - Ryan Kessler
- University of Vermont Medical Center, Burlington, Vermont, United States
| | - Marie Dunn
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Miroslav Stavel
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Jeffrey D Horbar
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
| | - Erika M Edwards
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Vermont Oxford Network, Burlington, Vermont, United States
- University of Vermont College of Engineering and Mathematical Sciences, Burlington, Vermont, United States
| | - Bogale Worku
- Ethiopian Pediatrics Society, Addis Ababa, Ethiopia
| | - Michael Dunn
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mahlet Abayneh
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Bitew DA, Diress M, Gela YY, Belay DG, Kibret AA, Chilot D, Sinamaw D, Seid MA, Seid AM, Simegn W, Eshetu HB, Andualem AA. Determinants of early discharge after birth among mothers delivered vaginally at health facilities: further analysis of the Ethiopian demographic health survey. BMC Public Health 2023; 23:2128. [PMID: 37904085 PMCID: PMC10617109 DOI: 10.1186/s12889-023-16922-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/06/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION The majority of maternal and newborn deaths take place during the first few hours and days after birth and thus postnatal contacts should begin as early as possible, especially within the first 24 h, then again within two to three days after delivery. Globally, early postnatal discharge has increased over the past 50 years and currently too. Even if Ethiopia has very low PNC coverage, there is no evidence on who is discharged early. Hence, the aim of this study was to determine the magnitude and the predictors for early postnatal discharge in Ethiopia. METHODS This study was based on the secondary data analysis using the Ethiopian Demographic and Health survey (EDHS) 2016 data set. The weighted sample of 2,225 delivered mothers were included for the final analysis. The model was best fitted as assessed by Hosmer-Lemeshow test (p value = 0.1988). The variables with P-value ≤ 0.2 in the bi- variable binary logistic regression analysis were included in to the multi-variable binary logistic regression analysis. The Adjusted Odds Ratio (AOR) with 95% confidence interval (95% CI) was computed to assess the strength of association between the outcome and independent variables. The variables with a P-value of less than 0.05 in the multi-variable binary logistic regression analysis were declared as statistically significant predictors of the outcome variable. RESULT The overall magnitude of early discharge was 70.41% (CI: 68.48, 72.30). Residence (rural; AOR: 0.61, 95% CI: 0.46, 0.80), educational status (No education; AOR: 1.87, 95% CI: 1.19, 2.94), religion (Muslim; AOR: 0.69, 95% CI: 0.55, 0.87, Others; AOR: 0.24, 95% CI: 0.10, 0.57), wealth index (Poor; AOR: 0.77; 95% CI: 0.59, 0.99), marital status (Not married; AOR: 0.29; 95% CI: 0.13, 0.67), ANC visits (No ANC visits; AOR: 0.63; 95% CI: 0.46,0.86), parity (3rd parity; AOR: 1.48; 95% CI: 1.03, 2.11), and size of the child (larger size; AOR: 0.63;95% CI: 0.50,0.79, (smaller size; AOR: 0.72; 95% CI: 0.56,0.92) were independent determinants of early discharge. CONCLUSION A substantial proportions of mothers in Ethiopia had been discharged early (before 24 h). Residence, education, wealth index, religion, marital status, ANC follow up, parity and size of the child were predictors of early discharge. Adequate hospital stay should be promoted. Since the early discharge in Ethiopia is very high, home based postnatal visit should be strengthened focusing the identified predictors.
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Affiliation(s)
- Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, P. O. Box 269, Debre Markos, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, P. O. Box: 272, Debre Tabor, Ethiopia
| | | | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Education and Behavioral Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Weldearegay HG, Kahsay AB, Godefay H, Petrucka P, Medhanyie AA. The effect of catchment based mentorship on quality of maternal and newborn care in primary health care facilities in Tigray Region, Northern Ethiopia: A controlled quasi-experimental study. PLoS One 2022; 17:e0277207. [PMID: 36395101 PMCID: PMC9671353 DOI: 10.1371/journal.pone.0277207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Ethiopia, quality of maternal and newborn care is poor. This situation has persisted, despite the wide implementation of several capacity building-oriented interventions including clinical mentoring for skilled birth attendants that were anticipated to translate in to high-quality maternal and newborn care on each encounter. The effectiveness of mentoring programs is not yet well documented in the research literature. Therefore, we evaluated the effect of a catchment based clinical mentorship in improving the quality of maternal and newborn care in primary level facilities of Tigray, Northern Ethiopia. METHODS We conducted a controlled quasi-experimental pre-post study among 19 primary health care facilities, with 10 facilities assigned to the group where the catchment based clinical mentorship program was implemented (intervention group), and 9 facilities to the control group. We assigned the group based on administrative criteria, number of deliveries in each facility, accessibility, and ease of implementation of the intervention. A sample of 1320 women(662 at baseline; 658 at post intervention) and 233 skilled birth attendants(121 at baseline and 112 at end line) were included. We collected data from mothers, skilled birth attendants and facilities. The first round of data collection (baseline) took place two weeks prior the inauguration of the intervention, 05 October to 04 November 2019. The end line data collection occurred from 22 May to 03 July 2020. The primary Outcome was "receipt quality of maternal/newborn care". We analyzed the data using difference in differences (DiD) and logistic regression with Generalized Estimating Equation. The level of significance of predictors was declared at p-value less than 0.05in the multivariable analysis. INTERVENTION We deployed a team of local clinical mentors working at primary hospitals to provide clinical mentorship, and direct feedback in routine and emergency obstetrical and newborn care to the mentees (all skilled birth attendants performing maternal and newborn health services) functioning in their catchment rural health centers for duration of six months. While visiting a facility, mentors remain at the facility each lasting at least five to seven days per month, over the course of intervention period. RESULTS A significantly higher proportion of women at intervention facilities received quality of care services, compared with women at comparison facilities. (DiD = 18.4%, p<0.001). Moreover, following the implementation of the intervention we detected a difference in the occurrences of maternal complication outcome during delivery and immediately after birth. This was decreased by 4.5%, with significant differences between intervention and comparison sites (DiD = 4.5%, p = 0.013). We also found a favorable difference in occurrences of neonatal obstetric complications, with a decrease of 4.8% in the intervention site and almost no change in the comparison site (DiD = 4.8%, p = 0.002). Among the determinants of quality of care, we found that providers' job satisfaction (AoR = 2.95, 95%CI: 1.26 to 6.91), and making case presentation at regular basis(AoR = 1.89, 95%CI: 1.05 to 3.39) were significantly associated to improve the quality of care. However, delivery load(AoR = 0.95, 95%CI: 0.93 to 0.98) was negatively associated with quality of care. CONCLUSIONS We conclude that the catchment based clinical mentorship intervention is effective to improve quality of care and reduce childbirth complications in northern Ethiopia. This finding further elaborated that incorporating maternal and newborn health catchment based clinical mentorship activities into the existing health system strengthening strategies can catalyze improvement processes to quality practice and health systems. This is seen as a necessary step to achieve the effective quality universal health care required to meet the health-related Sustainable Development Goals. Besides, more attention needs to be given to develop interventions and strategies that directly enhance providers' job satisfaction and reduce delivery work load.
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Affiliation(s)
| | | | | | - Pammla Petrucka
- University of Saskatchewan, College of Nursing, Saskatoon, Canada
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
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Abate M, Mulissa Z, Magge H, Bitewulign B, Kiflie A, Biadgo A, Alemu H, Seman Y, Woldesenbet D, Estifanos AS, Parry G, Quaife M. Key factors influencing motivation among health extension workers and health care professionals in four regions of Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0272551. [PMID: 36178908 PMCID: PMC9524639 DOI: 10.1371/journal.pone.0272551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although Ethiopia has improved access to health care in recent years, quality of care remains low. Health worker motivation is an important determinant of performance and affects quality of care. Low health care workers motivation can be associated with poor health care quality and client experience, non-attendance, and poor clinical outcome. Objective this study sought to determine the extent and variation of health professionals’ motivation alongside factors associated with motivation. Methods We conducted a facility based cross-sectional study among health extension workers (HEWs) and health care professionals in four regions: Amhara, Oromia, South nations, and nationalities people’s region (SNNPR) and Tigray from April 15 to May 10, 2018. We sampled 401 health system workers: skilled providers including nurses and midwives (n = 110), HEWs (n = 210); and non-patient facing health system staff representing case team leaders, facility and district heads, directors, and officers (n = 81). Participants completed a 30-item Likert scale ranking tool which asked questions across 17 domains. We used exploratory factor analysis to explore latent motivation constructs. Results Of the 397 responses with complete data, 61% (95% CI 56%-66%) self-reported motivation as “very good” or “excellent”. Significant variation in motivation was seen across regions with SNNPR scoring significantly lower on a five-point Likert scale by 0.35 points (P = 0.003). The exploratory factor analysis identified a three-factors: personal and altruistic goals; pride and personal satisfaction; and recognition and support. The personal and altruistic goals factor varied across regions with Oromia and SNNPR being significantly lower by 0.13 (P = 0.018) and 0.12 (P = 0.039) Likert points respectively. The pride and personal satisfaction factor were higher among those aged > = 30 years by 0.14 Likert scale points (P = 0.045) relative to those aged between 19-24years. Conclusions Overall, motivation was high among participants but varied across region, cadre, and age. Workload, leave, and job satisfaction were associated with motivation.
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Affiliation(s)
- Mehiret Abate
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
- * E-mail:
| | - Zewdie Mulissa
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | - Hema Magge
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | | | - Abiyou Kiflie
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | - Abera Biadgo
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Yakob Seman
- Medical Service General Directorate, Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Dorka Woldesenbet
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gareth Parry
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Siseho GM, Mathole T, Jackson D. Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia. Front Pediatr 2022; 10:972815. [PMID: 36699289 PMCID: PMC9869061 DOI: 10.3389/fped.2022.972815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Quality of care around childbirth can reduce above half of the stillbirths and newborn deaths. Northeast Namibia's neonatal mortality is higher than the national level. Yet, no review exists on the quality of care provided around childbirth. This paper reports on baseline assessment for implementing WHO/UNICEF/UNFPA quality measures around childbirth. METHODS A mixed-methods research design was used to assess quality of care around childbirth. To obtain good saturation and adequate women opinions, we purposively sampled the only high-volume hospital in northeast Namibia; observed 53 women at admission, of which 19 progressed to deliver on the same day/hours of data collection; and interviewed 20 staff and 100 women who were discharged after delivery. The sampled hospital accounted for half of all deliveries in that region and had a high (27/1,000) neonatal mortality rate above the national (20/1,000) level. We systematically sampled every 22nd delivery until the 259 mother-baby pair was reached. Data were collected using the Every Mother Every Newborn assessment tool, entered, and analyzed using SPSS V.27. Descriptive statistics was used, and results were summarized into tables and graphs. RESULTS We reviewed 259 mother-baby pair records. Blood pressure, pulse, and temperature measurements were done in 98% of observed women and 90% of interviewed women at discharge. Above 80% of human and essential physical resources were adequately available. Gaps were identified within the WHO/UNICEF/UNFPA quality standard 1, a quality statement on routine postpartum and postnatal newborn care (1.1c), and also within standards 4, 5, and 6 on provider-client interactions (4.1), information sharing (5.3), and companionship (6.1). Only 45% of staff received in-service training/refresher on postnatal care and breastfeeding. Most mothers were not informed about breastfeeding (52%), postpartum care and hygiene (59%), and family planning (72%). On average, 49% of newborn postnatal care interventions (1.1c) were practiced. Few mothers (0-12%) could mention any newborn danger signs. CONCLUSION This is the first study in Namibia to assess WHO/UNICEF/UNFPA quality-of-care measures around childbirth. Measurement of provider-client interactions and information sharing revealed significant deficiencies in this aspect of care that negatively affected the client's experience of care. To achieve reductions in neonatal death, improved training in communication skills to educate clients is likely to have a major positive and relatively low-cost impact.
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Affiliation(s)
- Gloria Mutimbwa Siseho
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal Newborn and Child Health, United Nations Children s Fund (UNICEF), Windhoek, Namibia
| | - Thubelihle Mathole
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Debra Jackson
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Biru YB, Lemelem GA, Solomon N. Length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia: a cross-sectional study from a national survey. BMJ Open 2021; 11:e055327. [PMID: 34876438 PMCID: PMC8655577 DOI: 10.1136/bmjopen-2021-055327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to assess the length of stay in health facilities after childbirth and associated maternal and neonatal factors in Ethiopia. DESIGN A cross-sectional study. SETTING Ethiopia. PARTICIPANTS 2260 mothers who participated in the 2016 Ethiopian Demographic and Health Survey were included in the study. OUTCOME Length of stay in health facilities after childbirth was the outcome variable of the study. RESULT In Ethiopia, the mean duration of postpartum stay for mothers in health facilities was 21.96 (19.97-23.94) hours. Nine hundred and sixty-eight (34.80%) women remained in health institutions for ≥24 hours after delivery. Gestational age, birth weight and mode of delivery were significantly associated with length of stay. Gestational age was found to be inversely associated with length of stay. Mothers who had a vaginal delivery were 8.89% (adjusted HR (AHR) 8.89, 95% CI (4.28 to 18.46), p<0.001) more likely to discharge earlier from health facilities after delivery, compared with those who had a caesarian section. Women with larger size neonates during birth were 19% (AHR=0.81, 95% CI (0.67 to 0.96), p=0.019) more likely to stay longer in health facilities than women with average size neonates. Women with a smaller size neonate during birth were 16% (AHR=0.84, 95% CI (0.70 to 0.99), p=0.040) more likely to stay longer at a health facility, compared with those with an average size neonate. CONCLUSION A small percentage of Ethiopian mothers stayed in health facilities for 24 hours or more after delivery. Encouraging mothers to stay in health facilities for the recommended period after childbirth can play a significant role in reducing maternal and neonatal deaths.
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Affiliation(s)
| | | | - Nahom Solomon
- Public Health, Mizan-Tepi University, Mizan, Ethiopia
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Ayele AA, Tefera YG, East L. Ethiopia's commitment towards achieving sustainable development goal on reduction of maternal mortality: There is a long way to go. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211067073. [PMID: 34913391 PMCID: PMC8689608 DOI: 10.1177/17455065211067073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022]
Abstract
Maternal mortality reduction has been recognized as a key healthcare problem that requires prioritizing in addressing. In 2015, the United Nations has set Sustainable Development Goals to reduce global maternal mortality ratio to 70 per 100,000 live births by 2030. Ethiopia as a member country has been working to achieve this Sustainable Development Goals target for the last decades. In this article, we discussed Ethiopia's commitment towards achieving Sustainable Development Goals in maternal mortality. Furthermore, the trends of maternal mortality rate in Ethiopia during Millennium Development Goals and Sustainable Development Goals are also highlighted. Although maternal mortality has been declining in Ethiopia from 2000 to 2016, the rate of death is still unacceptably high. This requires many efforts now and in future to achieve the Sustainable Development Goals target by 2030.
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Affiliation(s)
- Asnakew Achaw Ayele
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, Australia
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Leah East
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, Australia
- Hunter New England Health, Armidale, Australia
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