While there has been a trend for greater number of women to deliver at health facilities across Tanzania, mothers and their family members continue to face mistreatment with respectful maternity care during childbirth being violated. The objective of this study was to describe the experience of mothers and fathers in relation to (mis) treatment during childbirth in Tanzania. Using a qualitative descriptive design, 12 semi-structured interviews and four focus group discussions were held with mothers and fathers who were attending a postnatal clinic in the Lake Zone region of Tanzania. Mothers’ age ranged from 20 to 45 years whereas fathers’ age ranged from 25 to 60 years. Data were analyzed using a priori coding based on Bohren’s et al. typology of the mistreatment of women during childbirth. Mothers reported facing mistreatment and disrespectful maternity care through verbal abuse (harsh or rude language and judgmental or accusatory comments), failure to meet professional standards of care (refused pain relief, unconsented surgical operations, neglect, abandonment or long delays, and skilled attendant absent at time of delivery), poor rapport between women and providers (poor communication, lack of supportive care, denied husbands presence at birth, denied mobility, denied safe traditional practices, no respect for their preferred birth positions), and health system conditions and constraints (poor physical condition of facilities, supply constraints, bribery and extortion, unclear fee structures). Despite some poor care, some mothers also reported positive birthing experiences and respectful maternity care by having a skilled attendant assistance at delivery, having good communication from nurses, receiving supportive care from nurses and privacy during delivery. Despite the increasing number of deliveries occurring in the hospital, there continue to be challenges in providing respectful maternity care. Humanizing birth care in Tanzania continues to have a long way to go, however, there is evidence that changes are occurring as mothers notice and report positive changes in delivery care practices.

/pdf/humanizing-birth-in-tanzania-a-qualitative-study-on-the-mis-2gx4isb5l5.pdf

Humanizing birth in Tanzania: a qualitative study on the (mis) treatment of women during childbirth from the perspective of mothers and fathers

Introduction Prenatal anxiety and depression are major health problems all over the world. The negative sequela of prenatal comorbid anxiety and depression (CAD) has been suggested to be higher than that of anxiety or depression alone. CAD increases the odds of preterm birth, low birth weight, prolonged labor, operative deliveries, postpartum psychiatric disorders and long term cognitive impairment for the newborn. Despite its significant ill consequences, there is a dearth of studies in low-and middle-income countries. So far, to the best of our knowledge, no study assessed the prevalence of CAD in Ethiopia. Hence, the purpose of this study was to assess CAD and associated factors among pregnant women in Arba Minch Zuria district, Gamo zone, southern Ethiopia. Methods A community-based cross-sectional study was conducted among 676 pregnant women from January 01 to November 30, 2019. Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales were used to assess depression and anxiety respectively. The data were collected electronically using an open data kit (ODK) collect android application and analyzed using Stata version 15.0. Bivariate and multivariable analyses were carried out to identify factors associated with CAD using binary logistic regression. Statistical significance was set at p-value < 0.05. Results A total of 667 women were involved. The prevalence of CAD was 10.04% [95% confidence interval (CI): 7.76, 12.33]. Being married [adjusted odds ratio (AOR): 0.16, 95% CI: 0.05, 0.56], categorized in the highest wealth quintile [AOR: 2.83, 95% CI: 1.17, 6.84], having medical illness [AOR: 3.56, 95% CI: 1.68, 7.54], encountering pregnancy danger signs [AOR: 2.66, 95% CI: 1.06, 6.67], experiencing life-threatening events [AOR: 2.11, 95% CI: 1.15, 3.92] and household food insecurity [AOR: 3.51, 95% CI: 1.85, 6.64] were significantly associated with CAD. Conclusions In general, one in every ten women faced CAD in the study area. Nutritional interventions, early identification and treatment of pregnancy-related illness and medical ailments, prenatal mental health problems screening and interventions are imperative to minimize the risk of CAD in pregnant women.

/pdf/comorbid-anxiety-and-depression-prevalence-and-associated-u1cojqtyj3.pdf

Comorbid anxiety and depression: Prevalence and associated factors among pregnant women in Arba Minch zuria district, Gamo zone, southern Ethiopia.

Intimate partner violence (IPV) during pregnancy is significantly associated with negative outcomes for both mother and child. Current evidence indicates an association between low levels of social support and IPV, however there is less evidence from low-and-middle income countries (LMIC) than high-income countries. Globally, the COVID-19 pandemic has radically altered how women can access social support. Hence since 2020, studies investigating IPV and pregnancy have occurred within the changing social context of the pandemic.This scoping review summarizes the evidence from LMICs about the effects of IPV during pregnancy on maternal and child health. The review includes the impact of the COVID-19 pandemic on social support as mentioned in studies conducted since 2020.Library databases were used to identify papers from 2016 to 2021. These studies reported the maternal and child health outcomes of IPV during pregnancy, and described how social support during pregnancy, and the COVID-19 pandemic, were associated with rates of IPV during pregnancy. Observational study designs, qualitative and mixed methods studies were included.Twenty - six studies from 13 LMICs were included. Half (n = 13) were cross sectional studies which only collected data at one time-point. IPV during pregnancy was significantly associated with higher odds of postpartum depression, low birth weight, preterm birth and less breastfeeding in the year after birth. Lower levels of social support increased the odds of experiencing IPV during pregnancy, whilst higher levels of social support reduced antenatal anxiety and depression in women experiencing IPV during pregnancy. Of the four studies that investigated IPV during pregnancy throughout the COVID-19 pandemic, only one compared prevalence before and after the pandemic and unexpectedly reported a lower prevalence.Further research on the impact of IPV during pregnancy on maternal and child outcomes in LMICs is required, especially evidence from longitudinal studies investigating a wider range of outcomes. To date, there is limited evidence on the impact of the COVID-19 pandemic on IPV during pregnancy in LMICs, and this should be prioritized as the pandemic continues to affect women's access to social support globally. 

/pdf/intimate-partner-violence-during-pregnancy-and-maternal-and-178hlh3j.pdf

Intimate partner violence during pregnancy and maternal and child health outcomes: a scoping review of the literature from low-and-middle income countries from 2016 - 2021

Background Timely initiating antenatal care (ANC) is crucial in the countries that have high maternal morbidity and mortality However, in developing countries including Ethiopia, pregnant mother’s time to initiate antenatal care was not well-studied Therefore, this study aimed to assess time to first ANC and its predictors among pregnant women in Ethiopia Methods A community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data A two-stage stratified cluster sampling was employed The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit Cox-gamma shared frailty model was applied to determine predictors Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size Model adequacy was assessed by using the Cox-Snell residual plot Statistical significance was considered at p value <005 For data management and analysis Stata 14 was used Results The median time to first ANC was 5 months with IQR (3,-) The independent predictors of time to first ANC visit were primary education [AHR: 124 (95%CI, 113–135)], secondary education [AHR: 128(95% CI, 111–147)], higher education [AHR: 143 (119–172)] as compared to women with no formal education Having media exposure [AHR: 113 (95% CI, 103–124)], early initiation of ANC increases by 25% [AHR: 125 (95% CI, 112–140)] in poorer, 32% [AHR: 132 (95% CI, 117–149)] in middle, 37% [AHR: 137 (95% CI, 120–156)] in richer and 41% [AHR: 141 (95%CI, 1119–167)] in richest households as compared to poorest household wealth index Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit Conclusions The current study revealed that women’s time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO) The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases

/pdf/time-to-initiation-of-antenatal-care-and-its-predictors-2akv31o0en.pdf

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model.

BACKGROUND Women's autonomy in health care decision-making is very crucial for the well-being of women themselves, their children, and the entire family members. Although studying the issue is significant to take proper interventions, the issue is not studied at a nationwide level in Ethiopia. Accordingly, this population-based nationwide study was aimed at assessing the trends of women's autonomy in health care decision-making and its associated factors in Ethiopia. METHOD The sample was limited to married women of 2005 (n = 8617), 2011 (n = 10,168), and 2016 (n = 9824) Ethiopian Demographic and Health Survey (EDHS) data. Women's autonomy in health care decision-making was measured based on their response to the question 'person who usually decides on respondent's health care. To examine associated factors, socio-demographic variables were computed using multinomial logistic regression. RESULT The finding revealed that the trend of women's autonomy in health care decision-making had declined from 18.7% in 2005 to 17.2% in 2011 albeit it had risen to 19.1% in 2016. The autonomy of women who resides in urban areas was 98.7% higher than rural residents, and those who live in the Tigray region, Somali region, and Addis Ababa are 76.6%, 79.7%, and 95.7% higher than who live in Dire Dawa respectively. Unemployed women, women aged from 15 to 24 years, and uneducated women were 45.1%, 32.4%, and 32.2% less likely autonomous in health care decision making respectively. CONCLUSION The autonomy of women in health care decision-making had declined from 2005 to 2011. Therefore, the role of stakeholders in taking possible interventions like empowering women shall be strengthened. This is to protect women from certain health problems as well as for the well-being of women themselves, their children, and the entire family members.

/pdf/the-trends-of-women-s-autonomy-in-health-care-decision-3hwo5l4yut.pdf

The trends of women's autonomy in health care decision making and associated factors in Ethiopia: evidence from 2005, 2011 and 2016 DHS data.

Background Non-adherence to insulin therapy is a major global public health issue that has a causal relationship with increased diabetic complications that leads to further increase in the health care cost. However, adherence to insulin therapy and associated factors among diabetic mellitus (DM) patients are still not studied adequately in Ethiopia. Objective To assess the adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow-up at Madda Walabu University—Goba Referral Hospital, South East Ethiopia. Method An institution-based, cross-sectional study was employed among 311 both type 1 and type 2 diabetic patients, Madda Walabu University—Goba Referral Hospital from March 4 to April 30, 2020. Study participants were recruited with simple random sampling method. Adherence to insulin therapy was measured by 8-item Morisky medication adherence scale. Therefore from these 8-items, those who score 6 or more are considered as adherent to insulin therapy. The data were collected through interviewer administered questionnaires by trained graduating class nurse students. The data were entered to Epidata version 3.1, and analyzed with SPSS version 25. Bivariate and multivariable logistic regression analyses were used to identify factors associated with adherence to insulin therapy. Statistical significance were declared at p <0.05. Result A total of 311 patients participate in the study with response rate of 100%. Among these only 38.9% of them were adherent to insulin therapy with a CI of [33.5, 44.3]. Having glucometer (AOR = 3.88; 95% CI [1.46, 10.35]), regular hospital follow-up (AOR = 3.13; 95% CI [1.12, 8.70]), being knowledgeable (AOR = 3.36; 95% CI [1.53, 7.37]), and favorable attitudes (AOR = 4.55; 95%CI [1.68, 12.34]) were the factor associated with adherence to insulin therapy. Conclusion This study concluded that adherence to insulin therapy was low in the study area. Having glucometer, regular hospital follow-up, being knowledgeable, and favorable attitudes were the factor associated with adherence to insulin therapy. Attention should be paid to help diabetic patients on acquiring knowledge regarding the need of consistent adherence to insulin therapy and its complications.

Adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow up in Madda Walabu University Goba Referral Hospital, South East Ethiopia

Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia. Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec–Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated. The prevalence of CMD during pregnancy was 35.8% (95% CI: 34–38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness. CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.

/pdf/prevalence-of-common-mental-disorder-and-associated-factors-2c38gznr1c.pdf

Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study

Workplace violence among nurses has increased dramatically in the last decade. Still, mitigation techniques have not been well explored; many studies used a quantitative research approach, and there is a knowledge gap on the current status of workplace violence. The aim of this study was to assess the prevalence of workplace violence and associated factors among nurses working at university teaching hospitals in the South Region of Ethiopia.An institution-based cross-sectional study was conducted using a mixed approach. A random sample of 400 nurses was interviewed for the quantitative analysis, and nine key informants were interviewed for the qualitative analysis. Descriptive statistics were used to summarize the data. A logistic regression model was used to analyze the data. An adjusted odds ratio with a 95% confidence interval and a corresponding p-value < 0.05 was used to determine the association between variables. The qualitative data were transcribed and translated, then themes were created, followed by thematic analysis using Open Code version 4.02.The prevalence of workplace violence was 61.3% within the last 12 months. Nurses working in emergency departments [AOR = 4.27, 95% CI: 2.21, 8.24], nurses working in inpatient departments [AOR = 2.58, 95% CI: 1.40, 4.72], the number of nurses in the same working unit from one to five [AOR = 2.36, 95% CI: 1.21, 4.63], and six to ten staff nurses [AOR = 2.12, 95% CI: 1.17, 3.85], nurses routinely making direct physical contact [AOR = 2.77, 95% CI: 1.55, 4.95], and nurses' work time between 6 pm and 7 am [AOR = 1.68, 95% CI: 1.00, 2.82] were factors significantly associated with workplace violence.In this study, the prevalence of workplace violence against nurses was high. We identified factors significantly associated with workplace violence among nurses. Interventions should focus on early risk identification, the management of violent incidents, and the establishment of violence protection strategies that consider contextual factors to reduce workplace violence.

Workplace violence and its associated factors among nurses working in university teaching hospitals in Southern Ethiopia: a mixed approach

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Adherence to insulin therapy and associated factors among type 1 and type 2 diabetic patients on follow up in Madda Walabu University Goba Referral Hospital, South East Ethiopia

Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study

Workplace violence and its associated factors among nurses working in university teaching hospitals in Southern Ethiopia: a mixed approach