Professional Documents
Culture Documents
Final Thesis
Final Thesis
Final Thesis
ADVISORS:-
1. MRS. MULUNESH ABUAHAY (MPH/RH, ASSISTANT PROFESSOR)
2. MR. MELAKU HUNIE (MPH/RH)
JUNE, 2021
GONDAR, ETHIOPIA
UNIVERSITY OF GONDAR
Cell phone:_
Email:_
________________ ____________________
Advisors
Examiner
1. _______________________ ____________________________
2. ______________________ __________________________
i
ACKNOWLEDGMENTS
Secondly, I would like to give thanks University of Gondar College of medicine and
health sciences school of midwifery, department of clinical midwifery for giving chance
to do this thesis which undertaken in my area of interest in this specific place and for
support of money.
I would like express my deepest gratitude to the study participantds, data collectors,
supervisors for their involvement to do this thesis.
Special thanks go to my friends, colleagues and to thos who all contributed to do this
work for their critique and support through the development of the thesis.
ii
ABBREVIATIONS/ACRONYMS
iii
TABLE OF CONTENT
CONTENTS PAGE
ACKNOWLEDGMENTS....................................................................................................i
ABBREVIATIONS/ACRONYMS.......................................................................................ii
TABLE OF CONTENT.....................................................................................................iii
LIST OF TABLES............................................................................................................ iv
LIST OF FIGURES..........................................................................................................vi
ABSTRACT..................................................................................................................... vi
1. INTRODUCTION..........................................................................................................1
2. OBJECTIVE............................................................................................................... 12
3. METHODS................................................................................................................. 13
3.3. Populations..........................................................................................................13
iv
3.8. Operational definition...........................................................................................16
4. RESULT..................................................................................................................... 20
5. DISCUSSION.............................................................................................................30
7. REFERENCES...........................................................................................................36
8. ANNEXES..................................................................................................................41
v
LIST OF TABLES
Table 1 Sociodemographic characteristics of respondents at Debre Markos town, North
West Ethiopia from February to March 2021..................................................................20
Table 2 Maternal obstetric characteristics of study participant at Debre Markos town,
North West Ethiopia from February to March 2021........................................................22
Table 3 Maternal health service related variables of study participant at Debre Markos
town, North West Ethiopia from February to March 2021..............................................23
Table 4:- facility, health care providers and companion related causes for non-utilization
of labor companion at Debre Markos town, North West Ethiopia from February to March
2021............................................................................................................................... 25
Table 5 Bi-variable and multivariable binary logistic regression analysis of factors
associated with labor companion utilization, in Debre-Markos town public health
institutions, northwest Ethiopia,2021 (n=548)................................................................28
vi
LIST OF FIGURES
Figure 1: conceptual frame work about labor companionship utilization and associated
Factors which developed from review of literatures (36, 45, 50-55)...............................10
Figure 3 Women future preferred companion at Debre Markos town, North West
Ethiopia 2021................................................................................................................. 24
Figure 4:- prevalence of labor companion utilization among postnatal women at Debre-
Markos town public health institutions north west, Ethiopia 2021..................................26
vii
ABSTRACT
Background: - pregnancy is a matter of life and death besides having baby. Labor
companionship is a human interactive process which provides social support during
childbirth. Even though allowing of labor companion is a part of respectful maternity
care that used to achieve sustainable development goal, evidences on labor companion
utilization and its predictors were limited .in Ethiopia especially Amhara region.
Objective: - The aim of this study was to assess utilization of labor companion and
associated factors in Debre Markos town public health institutions.
Methods: - An institution based cross sectional study design was conducted among
559 postpartum women at Debrem-Markos town, northwest Ethiopia from February 1 to
March 30 2021 with interviewer administered questionnaire. Participants were selected
by systematic random sampling technique. Data were entered and analyzed with Epi-
data version 4.60 and SPSS version 25.0 respectively. Bi-variable logistic regression
was done and variables with p-value ≤ 0.20 were analyzed with multivariable logistic
regression. After model fitness and multi-collinearity checked Variables with p-value ≤
0.05 were considered significantly associated with labor companion utilization.
Results: - A total of 548 participants were involved in the study with 98.03% response
rate. From all respondents 14.6% (95%CI: 11.7, 17.5) of them were utilize labor
companion. Women who had complicated pregnancy Adjusted Odds Ratio ((AOR) =
5.532; 95%CI: 3.086, 9.917), future desire (AOR=3.627; 95%CI: 1.513, 8.698), being
Priemipara (AOR=3.497; 95%CI: 1.926, 6.349), labor followed by female skill birth
attendant (AOR= 0.370;95%CI: 0.166, 0.823), and women’s’ perceived busyness of
skilled birth attendant (AOR=0.128;95%CI: 0.072, 0.228) were significantly associated
with utilization of labor companion.
Conclusion: - Utilization of Llabor companionship was found to be low in the study
area. . Giving emphasis on the desire, primipara, complicated pregnancy, sex of skill
birth attendant and women perceived busy skill birth attendant were suggested for the
improvement of labor companionship.
To improve this great attention needs to be given for all women who have desire
regardless of their parity, complicated pregnancy and skill birth attendant busyness by
both female and male skill birth attendants.
viii
Key words: - Ethiopia, Labor companion, Postnatal, Utilization
ix
1. INTRODUCTION
Evidences suggested that labor and childbirth with companionship have both long term
and short term obstetrical and postpartum benefits like reduction of anxiety(5, 6),
postpartum depression(6), emergency cesarean section rate(3, 6, 7), episiotomy, fetal
distress, instrumental delivery, need of antipain (3, 6),pain perception(5),length of labor
(3, 6-8), need of oxytocin for augmentation(6) and meconium-stained amniotic fluid(9)
and increase; spontaneous vaginal birth, positive feelings about childbirth
experience(6),exclusive breastfeeding practices(3, 6),rate of breast feeding initiation(6),
maternal satisfaction(9, 10) ,five-minute APGAR score(3, 8, 11), mother baby
bonding(6),skin to skin contact, labor easy and enjoyable, sufficient milk for baby(12).
Additionally, evidences also revealed that utilization of birth companion reduced the risk
of disrespected and abused care by 10 times (13), mean of childbirth fear by 0.866 (14),
reduce mistreatment like stigma, non-consented vaginal examination, poor
communication and longer wait time(15) compared to non-utilized one. Furthermore
laboring women self-efficacy increased by 0.903 due to the presence of one preferred
birth companion support in addition to routine childbirth care given by SBAs (14).
1
Generally as conclusion absence of a labor companion is one predominant factors for
negative birth experience(16).
Practice of labor companionship also necessary for family members and health care
providers. Continuous support of woman with her husband increase the satisfaction of
the husband and bonding of baby with the father(17).
In-spite of scholars clearly state about the benefits and women’s willingness , desire or
a profound need of companionship during labor (18), many health-care facilities in
developing countries still do not promote practice of companionship during labor and
delivery (19-21). Because of this many women in LMICS choose home and TBA than
health facility and SBA respectively to give childbirth (22, 23) and more than half of
women in Ethiopia still deliver at home(24).
As a result maternal and neonatal mortality is still a tragedic event in the globe
especially in developing countries. Maternal mortality ratio significantly different
between developed and developing worlds (11/100000 and 462 per 100000 live birth)
(25).This discrepancy is due to lack of quality of care and low utilization of
institutionalized, client centered and continuous preferred companion supported care
especially in less developing countries including Ethiopia(26-28).
To overcome these problems different countries like South Africa implement doula
care(29) and different scholars, WHO, FIGO, Ethiopian midwife association and the like
strongly recommend to practice labor companionship as a norm rather than the
exception(3, 4, 30-32).The Federal Ministry of Health of Ethiopia has also
endorsed/accepted these principles and adopted it; and streamlined/included in the
package in keeping with the launching of the Respectful Maternity Care(RMC).
Even though principle of birth companion utilization endorsed, adopted and included in
Ethiopian ministry of health of RMC package, there is no sufficient data about the extent
of implementation of labor companionship in our country health institutions as much as
I search with different searching engine. Therefore this study is aimed to assess the
prevalence of labor companion utilization and associated factors among postnatal
mothers in public health institution of Debre-Markos town.
2
1.2 Literature reviews
Enabling women’s pregnancy and childbirth as a part of sexual and reproductive health
rights is a part of International human rights law and fundamental commitments of each
Country including our country Ethiopia(33) . As a result every pregnant woman and
newborns have the right to gate quality person centered care(34). Allowing
companionship in labor is one of hearty intervention to achieve quality care provision
which increase maternal satisfaction(35). Every health institutions must have a written
policy that encourage practice of at least one birth companion throughout labor and
delivery to fulfill criteria of mother-baby friendly birthing centers(31).
Community based crossectional study among 1367 mothers who had history of delivery
within one year in 2018 at Bangladesh showed that 68% of women utilize companion of
choice during labor and child birth which was significantly higher at home birth(38).
3
Cohort study among 420 surveyed postnatal women who deliver single newborn
vaginally at hospital in United Arab Emirates asserted that 59.3% of mothers utilize
companionship from non-professional attendants like mother, sister, friend, close family
relative and husband (41).
Descriptive facility based cross sectional study in Nigeria among 512 postpartum
mothers within 48 hours of term uncomplicated delivery asserted that even more than
half of participants desired to have companionship in labour only 13.1% study
participants utilize labour companion(43).
A cross sectional facility and community based study in Tanzania during 2016 among
935 postnatal women who have alive neonate and 732 reproductive age women
asserted that only 44.7% and 60.1% of mothers respectively utilize companionship
during labor (44, 45).
Qualitative and quantitative study in Kenya about birth companion utilization among 877
surveyed and 8 group discussions with 58 reproductive age women who delivered in the
9 weeks preceding the study revealed that 88% of women were accompanied by
someone from their social network to the health facility during their childbirth, with 29%
4
accompanied by a male partner. Sixty-seven percent were allowed continuous support
during labor, but only 29% were allowed continuous support during delivery. Eighteen
percent did not desire companionship during labor and 63% did not desire it during
delivery(46).
Facility based cross sectional survey from December 2014 to February 2015 in Tigray,
Northern Ethiopia to assess quality of intrapartum care among 216 labouring mothers
andA their newborns showed that for only 39.8% of women allowed their preferred
birthing partners(48).
5
National survey in Brazil stated that educational status of the women significantly
associated with birth companion utilization. Women’s educational status below 11 years
increase a risk of non-utilization of companion by a factor 1.8 compared with
educational status above 11 years(36).
Mixed community based surve in Kenya about birth companion utilization with interview
and group discussion among 877 and 58 reproductive age women who delivered in the
9 weeks preceding the study respectively conclude that economic status of a woman
significantly associated with labor companionship. Being more economically good
nearly 2times more likely utilize labor companion than very less household wealth(46).
Mixed community based survey in Kenya about birth companion utilization with
interview and group discussion among 877 and 58 reproductive age women who
delivered in the 9 weeks preceding the study respectively conclude that women’s work
status significantly associated with experience of labor companionship. Employed
women utilize labor companionship 1.97 times higher than un employed woman(46).
Mixed community based survey in Kenya about birth companion utilization by interview
with 877and group discussion with58 women who delivered in the 9 weeks preceding
the study conclude that status of literacy significantly associated with labor
companionship utilization. A woman who write very well 2.89 times more likely utilize
labor companion than a woman who not write totally(46).
Mixed community based survey in Kenya about birth companion utilization by interview
with 877 and 58 women who delivered in the 9 weeks before the study conclude that
group of ethnicity significantly associated with labor companionship utilization. Being
Kuria reduce utilization of labor complain by 43% compared to Luo tribe(46).
Study in Brazil concludes that type of delivery was significantly associated with
utilization of companionship. Women who give birth with vaginally 1.6 and 2.5 times risk
of complete and partial absence of companionship in hospital admission compared to
women who give birth with cesarean section(36).
6
According to mixed community based survey in Kenya 2016and Brazil national survey
2011/12 number of delivery significantly associated with being allowed and utilization of
companionship during labor and total hospital stay(36, 46). Being multipara increase a
risk of total and partial absence of companionship by 60% and 20% respectively
compared to nulliparous during hospital stay (51).Being Para 3 had 63% lower odds of
allowed continuous support during labor compared to Para one(36).
A recent cross sectional study in Arbaminch Ethiopia conclude that being primipara was
more than two times increase the utilization of labor companion compared with
multipara(49).
Mixed community based survey in Kenya about birth companion utilization by interview
with 877 and 58 women who delivered in the 9 weeks before the study conclude that
history of delivery in health facility significantly associated with utilization of labor
companionship. Having prior history of institutional delivery increase experience of
continuous support by a factor of 2.19 compared to woman who had no history of facility
based delivery(46).
Qualitative and quantitative study finding in Kenya showed that Women who desired a
labor companion had about 40% higher odds of being allowed continuous labor support
than those who did not desire one(46).
Institutional based cross sectional study in Arbaminch town, Ethiopia during 2019
conclude that women who have desire to have labor companion more than five times
utilize labor companionship compared to women who have no desire(49).
7
Qualitative and quantitative study finding in Kenya showed that woman who
accompanied by sister/sister in-law had 1.85 higher odds of being allowed labor
companionship than woman who was not accompanied by sister/sister in-law(46).
An explorative descriptive and contextual qualitative study in south Africa during 2013
among 33 midwifes with focus group interview showed that communication status of the
midwives is the challenges for implementation of continuous labor support(52).
Facility based cross sectional study in Tanzania conclude that more than half (53%) of
women’s companionship utilization affected by client related variables like health care
provider’s sex(45).
Study finding in Kenya during 2016 with both qualitative and quantitative approach
among 877 and 58 women who deliver 9 month before survey with interview and group
discussion revealed that women who attend her childbirth process with male and female
SBAs at the same time increase utilization of birth companion by a factor of 4.68
compared to woman who attended by male SBAs only(46).
Health institutions policy, input (human resource and bedside chair) and architectural
outlay of maternity unit and space of ward was significantly associated with utilization of
Companionship during maternity service provision (51-54).
Facility which is not having policy that allow companionship supported service provision
was 4.1and 2.3 times more likely not and partial utilization of companionship
respectively compared to facility which have policy that allow companionship(51).
Chance of companionship absence strongly associated with facilities which have chair
beside each bed for companion. Presence of chair by the side of every bed and some
8
bed enhance companionship implementation by a factor of 3.4 and 2.0 respectively
compared to facilities which were not have chair for companion(51).
According to client perspective study finding in Kenya 2016 women’s experience for
labor with companionship was significantly associated with facility over crowdedness.
When health facility over crowded most or all time, allowing of labor companion reduced
by 35% compared to not crowded or crowded only a few times (55).
9
Maternal health service
related variables:
Number of ANC
Providers and Facility related factors: antenatal education about
Type of facility companionship
Sex of SBAs
Input like bedside chair
Crowdedness of facility
architectural outlay of the maternity units
(space and privacy)
10
1.3. Justification of the study
Knew a time focusing on quality of service is a concern globe especially developing
countries government agenda including Ethiopia to achieve sustainable development
goal by 2030. To achieve this goal and improve quality care client center care like
utilization of companion of choice is a hearthy intervention.
Knowing and identifying service of labor companion utilization gap and its predictors will
play agreat role for stackholders who work to improve posetive childbirth process by
developing and incorporating companion of choice utilization stratagy especially in a
diverse cultural heritage, low institutional delivery coverag and high burdened maternal
and neonatal mortality countries like ethiopia. Therefore, this study finding will provides
a clue that can be used to improve practice and policies on birth companionship in our
country health institutions by advocating to practice companionship as a norm rather
than complementary clinical service provision because in order to reach the goal of
sustainable development and Ethiopian ministry of health plan.
Even though companionship plays a great role for reduction of maternal and neonatal
mortality and morbidity, evidences related to utilization of labor companion is limited and
the practice also uncommon during my exposure to practice as clinician in midwifery
profession in our public hospitals. Therefore this study is our interest to explore all
aspects of labor companionship in our setup and forward recommendations and
promotions for future practice especially in the study area.
11
2. OBJECTIVE
12
3. METHODS
3.3. Populations
3.3.1. Source population
All postpartum mothers who give labor at public health facilities of Debre-Markos town
All postpartum mothers who give labor at public health facilities of Debre-Markos town
during data collection period
All postpartum mothers who gave labor in Debre-markos town public health institutions
during data collection period
13
Women, who were seriously ill or unable to interviewed due to physical or mental
problems during data collection period.
All mothers who gave birth with elective cesarean section during data collection period.
All postnatal mothers who was admitted to facility after second stage
The sample size of the study was 559 which was determined with the consideration of
proportion of companionship utilization 13.8% from previous study in Arbaminch,
Ethiopia(49), 95% confidence level, 3% margin of error, 10% non-response rate. Then:
n = (zα/2)2×p (1− p ¿/d 2 where: n = sample size, p (0.138) = proportion of women utilize
labor companion during labor, d (3%) = margin of error within 95% CI. Then n= 508 by
adding 10% non-response rate, n =559
14
Total expected delivery at Debre Markos public health facilities in a month
MHC WHC
DMRH:
HHC N=30 N=28
N = 1040
N=60
15
3.7. Variables of the study
3.7.1.Dependent variable
16
Labor companion:- any person chosen by a women to accompany her during labor for
providing continious emotional, tangible, informational and advocacy support in all labor
processes(57).
Continuous labor support: allowing of labor companion to stay with the mother in all
or most of the time during labor at health institutions(46).
Supportive care:- a care during the intrapartum period can involve many factors, like:
emotional care, comfort measures, information and advocacy (2).
Doula: A woman who has been trained in labor support but not a part of health care
facility professional staff (4).
Complicated pregnancy: displays either the presence of risk factors for obstetric
complications (history of chronic illness or bad obstetrics history) or complications
manifested during pregnancy (like gestational diabetes mellitieus, pregnancy induced
hypertension, intrauterine growth restriction) which affect pregnancy outcome and level
of interventions (58).
17
3.10. Data quality controls
To assure the quality of data properly designed data collection tools was developed and
pretest was conducted with 5% (28) participants of this sample size at lumama primary
hospital before one week of actual data collection to check the validity and reliability of
questionnaire to the objective of the study. One day intensive training on data collection
tool, ethical conduct including COVID-19 prevention and quality of data collection was
given for data collectors and supervisors. The questionnaire was translated to Amharic
to make it understandable by the study participants and then was retranslated to
English by another person to check whether the transition is consistent. The data
collectors was strictly followed by the supervisors and reported to principal investigator
in daily basis. The supervisors and principal investigator supervised the correct
implementation of the procedure as per planned and check completeness and logical
consistence during data collection.
the social sciences (SPSS) version 23 after coding and recoding. Data cleaning were
performed to check for accuracy, consistencies, and values. Then any form of error
were identified and corrected. Descriptive statistics like text, frequency distribution,
percentage, tables, and were used to describe and summarize the study population in
relation to relevant variables. Both bivariable and multivariable logistic regression
models were used to identify factors associated with the outcome variable. All variables
with p-value less than 0.20 with bi-variable analysis were entered in to multivariable
analysis that used to not to miss associated factors. Then multiple logistic regression
analysis was performed to investigate independent predictors by controlling for possible
confounders. Finally, variables whose p value <0.05 in logistic regression were
considered as the cutoff point for statistically significance association. Hosmer-
Lemeshow test was used to check goodness of fit of the models. Multicollinearity was
18
diagnosed using variance inflation factor (VIF) and all covariates having a value VIF up
to 10 was tolerated.
19
4. RESULT
20
Secondary education 102 18.6%
College and above 144 26.3%
6 Occupation(n=548) House wife 164 29.9%
Government employee 106 19.3%
Private worker 48 8.8%
Merchant 64 11.7%
Farmer 144 26.3%
Othersa 22 4%
7 Marital status(n=548) Married 497 90.7%
Single(unmarried)/ 51 9.3%
Divorced /Separated
8 Average monthly Less than 3000 239 43.6
income(n=548) >= 3000 309 56.4
9 Husband No formal education 117 22.2%
education(n=527) Primary school 122 23.1%
Secondary school 116 22%
College and above 172 32.6%
10 Husband Farmer 165 31.3%
occupation(n=527) Government employee 132 25%
Merchant 111 21.1%
Private worker 87 16.5%
Daily laborer 21 4%
Othersb 11 2.1%
Foot note: - a; other includes: student, NGO, jobless and daily laborer
21
4.2. Maternal obstetric characteristics respondents
From the total study participants, 333 (60.8%) and 306 (55.8%) mothers were
multigravida and multipara respectively. Among multigravida women 88 (26.4%) and
64(19.2%) had at least one history of abortion and bad obstetric history (BOH)
respectively. Nearly one fifth of (18.8%) of interviewed women had at least one
pregnancy complication. From all interviewed mothers majority (98.7%) had no history
of chronic illness and 61.9% not faced any labor-delivery complication. About 27.6% of
study participants had complicated pregnancy. Three-fourth of (74.6%) study
participants were delivered with spontaneous vaginal delivery [Table 2].
22
complication(n=548)
No 445 81.2%
8 History of chronic Yes 7 1.3%
illness(n=548) No 541 98.7%
9 Labor-delivery complication Yes 209 38.1%
(n=548) No 339 61.9%
10 Current mode of delivery SVD 398 72.6%
(n=548) Cesarean delivery 111 20.3%
Instrumental/episiotomy 39 7.1%
assisted
23
selection at ANC(n=387)
5 Current labor delivery Hospital 491 89.6%
place(n=548) Health center 57 10.4%
6 Previous delivery place(n=306) Health facility 244 79.7%
Home 58 19%
Elsec 4 1.3%
7 Is fear of loneliness at labor Yes 7 12.1%
room risk for home delivery? No 51 87.9%
(n=58)
8 Previous delivery facility Public hospital 149 61.1%
type(n=244) Public health 91 37.3%
center
Health post 4 1.6%
9 History of labor companionship Yes 100 41%
(n=244) No 144 59%
Foot-note:- c: past delivery place other than health facility and home which is at road.
From all 548 study participants, more than two third of (69.9%) them knowledge status about
labor companion was below the mean (2.31) and the rest (30.1%) above the mean. About 450
(82.1%) study participants had a desire to utilize labor companion for their future laboring
process. Among women who had desire 37.23% were preferred their husband followed by
mothers/mother in-law (30.66%) see figure (1) below
24
37.23%
30.66%
17.88%
9.12%
5.11%
Figure 2 Women future preferred companion at Debre Markos town, North West
Ethiopia 2021
From total 468 respondents who were not utilizing labor companion during their labor
process religion and culture were not their reasons. Whereas facility related, health care
professional related and companion related variables were mentioned by the
respondents as a cause for non-utilization of labor companion. Among these variables
93.8% were by non-allowing of SBAs (Table 4).
Table 4:- facility, health care providers and companion related causes for non-
utilization of labor companion at Debre Markos town, North West Ethiopia from
February to March 2021
25
5 SBA not allow(n=468) Yes 439 93.8%
No 29 6.2%
6 No preferred companion at a Yes 41 8.8%
time(n=468) No 427 91.2%
7 I did not want/no desire(n=468) Yes 129 27.6%
No 339 72.4%
Even all most all 547(99.8%) of respondents were accompanied from home to health
facility with at least one supporting person from her social-networks, only 80(14.6%;
95%CI: 11.7, 17.5) of them were utilized labor companion. From those who utilized
labor companion four of ten were by their husband (39.4%) followed by mother/mother
in-law (35.5%). Among participants who accompanied from home to health facility (547),
more than two third were accompanied by husband (78.4%) followed by mother/mother
in-law (37.5%), sister/sister in-law (35.6%), father/father in-law (17.2%), brother (16.1%)
and friends/neighbors (16.1%). Among respondents (547) who had companion from
their social networks 55.21% of them totally not allow companion of choice whereas
10(1.8%), 12.8%, and 30.16% of them were allowed to had support all of the time, most
of the time and few times respectively during their labor process after admission to the
labor ward. Among respondents who were allowed to had labor companion at labor
ward 98.8% of them were accompanied with their preferred companion.
26
14.6%
utilized
not utilized
85.4%
Bi-variable and multivariable binary logistic regression analyses were done to identify
factors associated with labor companion utilization. On bi-variable binary logistic
regression mothers’ age, parity, complicated pregnancy, current mode of delivery type,
busyness of staff, sex of SBAs mostly followed, women’s future desire, knowledge of
women, marital status and number of pregnancy had an association with utilization of
labor companion. However, after controlling confounding on multivariable logistic
regression analysis complicated pregnancy, SBAs busyness, sex of SBAs mostly
followed, parity and future desire were significantly associated with labor companion
utilization.
Those women who had complicated pregnancy were 5.53 times more likely utilize labor
companion compared to their counterparts (AOR = 5.532, 95%CI: 3.086, 9.9173).
Women who had future desire for labor companion utilization 3.63 (AOR=3.627, 95%CI:
1.513, 8.698) times more likely utilize labor companion compared to those women who
had no future desire.
27
Being Premipara were 3.5 times more likely utilize labor companion compared to
multipara women (AOR=3.497, 95%CI: 1.926, 6.349). According to women’s
perspective view being busyness of staffs were decreased the odds of labor companion
utilization with 87.2% compared to those staffs that were not busy during their labor
follow up time (AOR=0.128, 95%CI: 0.072, 0.228).
The odds of utilizing labor companion among women who were followed their most
laboring time with only female SBAs were reduced by 63% (AOR= 0.370, 95%CI: 0.166,
0.823) compared to those women followed by only male SBAs for their most laboring
time after admission to the health facility. For more information see table below
28
Table 5 Bi-variable and multivariable binary logistic regression analysis of factors
associated with labor companion utilization, in Debre-Markos town public health
institutions, northwest Ethiopia,2021 (n=548).
29
(n=548)
Yes 45 106 4.391(2.685, 7.181)*** 5.532(3.086,
9.917)***
No 35 362 1 1
Knowledge of
respondents
(n=548)
Below mean 46 337 1 1
Mean and above 34 131 1.901 (1.168, 3.095)** 1.538 (0.862, 2.744)
SBA Busyness
(n=548)
Yes 34 390 0.148(0.089,0.245)*** 0.128
(0.072 ,0.228)***
No 46 78 1 1
Mode of delivery
(n=548)
SVD 56 342 1 1
C/S 12 99 0.740 (0.382, 1.436) 0.844 (0.389, 1.830)
Instrumental/ 12 27 2.714 (1.300,5.668)** 1.805 (0.759, 4.296)
episiotomy assisted
vaginal delivery
Sex of SBAs
mostly
followed(n=548)
Both 21 88 1.247 (0.708, 2.195) 0.898 (0.458, 1.758)
Female 10 124 0.421 (0.207, 0.860)* 0.370 (0.166,
0.823)**
Male 49 256 1 1
AOR= Adjusted odd ratio, COR = Crude odd ratio, CI = Confidence interval,
1; reference category, ***P ≤0.001, **P≤0.01, *P≤0.05
30
5. DISCUSSION
This study aimed to assess utilization of labor companion and associated factors among
women who gave birth at public health institutions of Debre-Markos town, Ethiopia. The
overall prevalence of labor companion utilization in this study is 14.6%.
This study is in line with studies conducted at retrospective record review based in
south Brazil (16.7%), prospective cohort in Reyadis (14.2%)(59), base line evaluation
study in south Africa (14.5%), Nigeria (13.1%) and Arbaminch, south, Ethiopia (13.8%)
(49).
The inconsistency of our study from Brazil national survey might be due to the
difference between health system policies of the countries which we understand from
their demographic health survey. Companionship is key maternal health indicators in
Brazil and which incorporate in to Brazil national demographic health survey as key
maternal health indicators and implementation of labor companion for all women were
included in their national law, whereas in our EDHS this service is not included as
maternal health service indicator like ANC, PNC and institutional delivery coverage. In
addition to this the disagreement between the studies might be due to sociocultural
difference and methods mainly study setting and data collection tool. In Brazil study all
postnatal women were included from both private and public health facilities including
baby friendly hospitals and data were collected with both interview and record review
whereas in this study sample was collected with interview only at public health
institutions.
31
The possible explanation for lowering of our study compared to a study conducted at
UAE (59) might be sampling technique, study design, setting, sociocultural difference,
socio-economic difference and study population difference. In our study women with
multiple or singleton delivery, complicated or uncomplicated pregnancy, good or bad
birth outcome and vaginal or ceserean delivery were selected randomly in the first 24
hours of postdelivery. However, in their study they select only women with post vaginal
uncomplicated delivery with good birth outcome upto 2 months of post delivery by non
random sampling technique.
The possible justification for the inconsistency between studies at Nepal and our study
might be sociodemographic characteristics’ of study population, inclusion criterion of
population, study setting and measurement tool of outcome variable (labor companion
utilization). In this study 99.1% participants were from similar ethnic group (Amhara) and
women who came for abortion service (gestational age < 28 weeks) were excluded. Our
tool for outcome measurement was not with single yes or no question rather it contains
three variables and respondents were from both hospital and health center. While in
Nepal study finding was affected mainly with women sociodemographic characteristics.
Participants were from different ethnic groups, at hospital level only and they include
women who deliver after 22 weeks of gestation and measure utilization with single yes
or no question (54). The more remote from term the more complication as a result being
complicated labor (preterm labor) enhance labor companion utilization (47).
Our study finding showed that prevalence of labor companion utilization is lower than a
study conducted at South Africa. The possibility for the difference might be sampling
method, eligibility criterion and sociodemographic difference. The maximum age group
of our study participants are 25 to 34 whereas in Nigeria maximum participants age
category was less than or equal to 25(28). Women’s age decrease utilization of labor
companion increase (54). our study participants educational status include women with
no formal education up to higher education but they includes only women who read and
write. The higher educational level the high chance of labor companion utilization (36,
44). In our study include all postpartum women regardless of birth outcome and mode
of delivery with systematic random methods. Whereas their study sampling technique
32
was convenience which enhance systematic error and end up with failed generalization
and they exclude women who have loss and women who deliver other than SVD. Labor
companion utilization by itself reduce pregnancy loss and need of assisted delivery(3,
6). There for prevalence of utilization might be high among women who deliver with
SVD and who have good birth outcome compared to their counterparts.
Coverage of labor companion utilization in our study is lower than a study result in
Tanzania. The possible explanation might be the difference in the study population,
sociocultural difference. In our study maximum numbers of participants were
interviewed from hospital whereas they interview more than 50% of respondents from
health-center (43).
Our prevalence study finding is lower than a study conducted in Kenya (67%) the
possible justification might be the study populations, they include participants from
private facilities(46) whereas in our study only from public facilities which are not
enduring for profit.
Prevalence of labor companion utilization in our study is lower than a studies done in
Addis Ababa Ethiopia (59.8%) (47) and Tigray Ethiopia (39.8%)(48). The possible
explanation for discrepancy from Addis Ababa might be study population. In our study
all non staff postpartum women are included whereas their study participants were
female health care professionals who had delivery history. Being staff or health care
professional by itself enhance labor companion utilization because of their knowledge
status and relationship to SBAs. One main reason for non utilization of labor companion
in current study and previous study is SBAs’ denial to allowing this service
utilization(49). Possible justification for discrepancy from Tigray might measure
measurement tool. Our outcome measured with three composite variables while they
measure with single question and their outcome of interest is not this service.
There are evidences which support our study regarding to significantly associated
factors like complicated pregnancy, future desire, parity, sex of SBAs mostly follow and
women’s perceived busyness of SBAs. Among those factors statistical association of
number of delivery to labor companion utilization is supported by studies done in
33
Brazil(36), Kenya(46) and Arbaminch Ethiopia (49). In this finding the odds of labor
companion utilization for Premipara were 3.5 times higher than Multipara. This finding is
consistent with a study done at Arbaminch Ethiopia (2.05)(49). This finding also
supported by a study done in Brazil, being Multipara increase a risk of non utilization of
companion with odds of 1.6 times. The possible explanation might be women with no
experience a child birth process needs more social support, emotional support than
women who had history of childbirth. Premigravida women experience fears concerning
helplessness, loss of control her self’s in labor and had negative child birth expectation
compared to Multipara(60). Another possible justification might be multiparous women
were less worry on pregnancy and less prepared for labor and delivery compared to
premiparous. Multiparous had generally expected shorter time of labor and receive less
support from people compared to counter parts(61).
34
In this study unpredictably women who followed their labor female health care provider
reduce prevalence of labor companion utilization by 63% compared to male. which is
difficult to infer because of disagreement with stereotype of women being care and
more emphatic than man. Our finding supported with another related study on RMC in
Ethiopia. The possible explanation might be females deployed violence against patient
in their work as a means of creating social distance and maintaining fantasies identity
and power in their continues struggle to assert their professional and middle class
identity(62). In addition to this female health care providers had triple burdens
(reproductive, productive and community management) which might be end up with
moral distress and burn out which may lead to abusive behavior(63). Abusive behavior
leads to break down of women centered maternity care including allowing companion of
choice during child birth.
According to womens’ perispective skill birth attendents busyness decrease the likely
hood of labor companion utilization by 87.2% compared to their counterparts. This
findind is supported with another related study done in keniya crowdiness of facility
affect utilization of companion of choice negatively (46). Facility inputes like human
power is a determinant factor for labor companion utilization (64). When SBAs busy
they become burn out and there behavior change which end up with non respect full
maternity care. In addition to this most of the time busyness of SBAs related to
crowdedness of ward which difficult to accommodate laboring mothers and their
companion in the ward due to privacy issue, space issue, ward cleanliness and bedside
chair availability for companion.
In this study we face social desirability bias and recall bias even we interview the client
alone by probing them especially obstaric history, preference and maternal health
service variables like birth preparedness and complication readiness counseling service
utilization history.
35
6. CONCLUSIONS AND RECOMMENDATION
Conclusions
In this study, coverage of labor companion utilization was low and this implies practice
of labor companion which is one main component of RMC failed to practice during
institutional labor and delivery service of study area. Complicated Pregnancy, future
desire for the service and being Premipara are predictors which increase utilization of
labor companion. In contrast to these variables followed their labor by female SBAs and
SBAs busyness negatively affect labor companion utilization. Therefore focusing on
health care providers, health facilities and women’s’ related factors to improve quality of
maternity care is un doing activities of concerning bodies.
Recommendations
For health care providers: - we recommend for both male and female SBAs to allow
companion of choice for all regardless of parity and complicated pregnancy and do their
activities based on evidence based intervention by referring WHO and EMOH health
care plan.
36
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8. ANNEXES
8.1. Information Sheet and Consent Form: English Version
Hello, how are you? My name is _______________. This is an interview to be done with
you for a study that is being conducted at UoG, College of medicine and health
Sciences School of midwifery, Department of clinical Midwifery.
41
The purpose of the study is to assess labor companion utilization and associated factors
among women who gave birth in Debre Markos public health institutions, East Gojam,
Ethiopia.
I would like to ask you some questions that are related to your sociodemographic,
obstetric history and labor companion utilization. I believe that the results of this finding
will help policy makers, planners and health professionals for improving quality of
delivery service provision and also contribute to provide adequate quality peripartum
care by involving social support during institutional labor and delivery service provisions.
Your contribution has a great input for the study and I would greatly appreciate your
participation. There is no possible risk associated with participating in this study. Your
name will not be written in the questionnaire and please be assured that all the
information you give will be kept strictly confidential. Your participation is completely
voluntary.
Therefore, you will not be obliged to answer any question that you do not want to and
you may end this interview at any time you want to. There are also no obligations for not
participating in the interview. The interview will take about at most 15 minutes.
If you have questions regarding this study or would like to be informed of the results
after its completion, please do not hesitate to contact Mr. Hussien Mohammed
(0923744869).
I have read the information sheet concerning this study (or have understood the verbal
explanation) and I understand what will be required of me and what will happen to me if
I take part in it. I also understand that any time I may withdraw from this study without
giving a reason and without me or my families’ routine service utilization and provision
being affected for my refusal.
42
Interviewer signature certifying that informed consent has been given verbally.
Checked by Supervisor:
43
103 What is your ethnicity 1. Amhara 2. Oromo
3. Agew 4. Other specify-----
104 What is your highest level of 1. No formal education
education? 2. Primary school
3. Secondaryschool
4. College& above
105 What is your occupation? 1. Housewife
2. Farmer.
3. Non-governmental employee
4. Self-employed
5. Government employed
6. Daily laborer
7. Others specify__
106 What is your current marital 1. Married
status? 2. Un-married/single
3. Widowed
4. Divorced
5. Separated
107 What is yourhusband’s 1. No formal education
highest level of education? 2. Primary school
3. Secondaryschool
4. College& above
108 What is your partner’s 1. Farmer
occupation? 2. Government employed
3. Non-governmental employee
4. Self-employed
5. Daily laborer 7. Others specify__
109 How muchyour average ------Ethiopian birr
family monthlyincome
44
numbers
201 How many times have you delivered a baby after 28 -------in alive or
weeks of gestation? numbers dead
202 Have you had poor obstetric history before index Yes If no go
baby? No to Q 205
203 If yes in Q no 204 which problem? Abortion
More than one answers possible Intra-uterine fetal death
Still birth
Early neonatal death
Others specify--------
204 Was this pregnancy planned? 1. Yes
2. No
205 Was this pregnancy wanted? 1. Yes
2. No
206 Was this pregnancy supported? 1.Yes
2. No
207 Have you ever faced any of maternal morbidity 1. Yes If no skip
during index pregnancy period? 2. No to Q 209
208 If yes which common Antepartum hemorrhage
morbidity?More than one Pregnancy induced hypertension
answer possible Gestational diabetes mellitus
Premature rupture of membrane or
chorioamnionitis
Others specify-------
209 Did you have any complication 1. Yes
during labor of your index baby? 2. No
210 If yes types of complication of labor? 1. non reassuring fetal heart
(only you told from SBAs) rate pattern
2. contracted pelvis
3. Uterine rupture
4. Preterm labor
45
5. prolonged labor
6. cord prolapse/presentation
7. Others specify…..…
211 Mode of delivery for your index baby? 1 Spontaneous vaginal delivery
2. Cesarean delivery
3.Operative vaginal
delivery(forceps, vacuum&
destructive)
4.Episiotomy assisted delivery
PartIII: - Maternal health service-related factors during index pregnancy, labor
and delivery and post-partum period.
300 Did you attend antenatal clinic for this pregnancy? 1.Yes If no go
2. No to Q 306
301 If yes at what time have you start first antenatal care visit? ------ in weeks
302 Where was your ANC started? Health post
Health center
Hospital
Private clinic
Others specify-----
303 How many times did you receive antenatal care? ____ in numbers
304 Did you get advice about birth preparedness plan during Yes
your antenatal care follow up? No
305 If yes for Q number 305 what 1.Decision on delivery place
were advices you get? More than 2. Save money
one answer is possible 3. Skill attendant at birth
4. How to access emergency transport
5. Emergency blood donors
6. Family support during birth
7. Collecting items needed for birth
306 Did the provider ever mentioned about your choose your 1. Yes
companion in labor at the time of your antenatal care visit?
46
2. No
307 Where did you gave birth your last baby? health facility If no home
Home go to Q
Other specify------ 309
308 If you delivered at home why? 1.my pregnancy is normal
2. fear of being abused and disrespected
3. To be attended by TBA’S
4. it is usual practice/culture
5. Fear of being lonely in labor
6. No transport
7. Shorter labor duration
8. Other specify-------------
309 From Q 307 if answer is health 1. Health post
facility from which? 2. Health center
3. Public hospital
4.Private Health institution
310 Did you have labor companion during your history of 1. Yes
health facility birth other than your index baby? 2. No
311 When was your most time of laboring 1. Night 2. Morning
after admission to the labor ward? 3. Day in the working hours
Part IV:- variable of labor companion utilization
400 Did anyone accompany you from home to this health 1. Yes If no skip
facility? 2. No to Q: 404
401 If yes for Q 401 Who accompanied you? 1) Husband
2) TBA
3) Mother/ Mother in Law
4) Friend/Neighbor
5) Sister/Sister in law
6) Others (specify)______
402 Were you allowed to have someone from 1.No, never If a&/b
your social networks/family members to 2. Yes, few times skip to
47
stay with you during labor? 3. Yes, most of the time Q: 406
4. Yes, all the time
403 Yes, most of the time and above , who was 1.Husbund
? 2.Mother /mother in law
3.Sister/siter in law
4.TBA
5.friend or neighbour
6.others,specify-----------
404 Did you want this person to stay with you Yes
during labor? Or was that support person No
your preferred choice?
404 If yes for all the time and most of the time or either of 1. Yes
them, was that support person your preferred choice? 2. No
405 If your answer for Q yes for 404 all There for me
the time and most of the time or Talking to me
either of them Which intervention Holding my hands
carried out by Mopping my sweat
yourcompanion/support person Keeping my informed of the
during this labor? More than one progress
possible answer Encouraging fluid intake
Meetingelimination needs
Encouraging deep breathing &
relaxation
Massaging my back and extremities
Communicating me with family
members
Praying for me
Calling SBAs when I need
13. Others specify--------
406 If no or yes few times or both for Q 1.Absence of preferred companion 40
404 did you know the reason of not 2. institution not allow 5
48
allowingcontinuous support during 3. providers not allow
labor? 4. Privacyissue
5. cultural issue
6. religious issue
7. ward was crowded
8. I don’t need
9. absence of chair for companion
10. others specify_______
Part V:- women’s knowledge, desire&preference toward labor companion
A)women’s knowledge toward labor companion utilization
500 Have you ever heared about support or companion in labor? 1. Yes
2. No
501 If yes what is labor 1. support person during labor other than SBA’s/staff
companion is? 2. Support person during labor who was staff
3. support person during ANC other than staff
4. support person during ANC from staff
5. support person during ANC other than staff
6. support person during ANC from staff
7. other
502 Did you know everyone has a right to utilize labor companion? 1. Yes
2. No
503 If yes where do you 1. Mass media
get this information? 2) From health care provider (ANC follow up)
3) Social media/read about it
4) Heard from people/friends
5) experienced it before
6) Others specify……..
504 What do you say about having support 1. Good practice
person during labor? 2. not good
505 Is utilization of labor companion beneficial 1. Yes 2. No
for positive birth out come?
49
506 If yes what are the benefits? 1. Reduce labor pain and need of antipain
2. Enhance spontaneous vaginal birth
3. decrease anxiety and fear
4. reduced loneliness
5. Reduced chance of abuse and
disrespect by SBA’s
6. make women happy
7. others specify-------------
B) women’s desire toward labor companion utilization
039 Would you like someone of your choice to stay with you for future 1. Yes
labor? 2. No
040 If yes What are your expect from labor 1. Tangible support
companion? (you can choose more than one) 2. Emotional support
3. Informational support
4. Advocacy
041 Why not you have no desire? 1. Cultural issue
2. companion issue
3. religious issue
4. personal issue
5. institutional issue
6. others specify_______
042 Allowing you to choose labor companion would make eager 1. Yes
to deliver at health institution? 2. No
C) women’s preference companion during labor
043 Who will be your preferred type of 1)Husband
companion for future labor? (choose only 2) TBA
one) 3) Mother/ Mother in Law
4) Friend/Neighbor
5)Sister/Sister in law
6)Others (specify)______
044 What dictate your choice? 1) feel more comfortable with
50
(you can choose more 2)his/her experience or knowledge about labor
than one reason) 3) religious concern
4) cultural acceptability
5) others specify-------------
Part VI :- women’s perspective to providers and facility related factors
600 Do you think this facility is comfortable to be accompanied by 1.Yes
your choose of companion during labor? 2. No
601 If no what is the reason? 1.crowdness of room
2. absence of screen
3. absence of bed side chair
4. room is not well cleaned
5. others specify---------
602 Do you think that SBA’s in this facility busy? 1. Yes
2. No
603 Was your SBA’s who mostly followed you allowed to have 1.Yes
labor companion? 2. No
604 What sex of your SBAs who give most of your labor care? 1.Male
2. Female
3. Both
Thank you a lot for your participation
ለመረጃ ሰብሳቢ፡- እባክዎ የፊትና ያፍንጫ ጭንብልወን በትክክል ይልበሱናእርቀትዎን በመጠበቅ የጥናቱን ተሳታፊ
የፊትና ያፍንጫ ጭንብልወን በትክክል እንድለብሱ ያድርጉና ሰላምታ ሰጥተው ራስዎን ካስተዋወቁ በኋላ ከዚህ በታችየ
ተገለፀውን መረጃ ተገንዝበው ለጥናቱ ለመሳተፍ ፍቃዳቸውን መሰጠት ይችሉ ዘንድ አንብቡላቸው እና ፈቃደኛ ከሆኑ
እኔ…………በዚህ ጥናት እንደ መረጃ ሰብሳቢ ሁኜ የምሰራ ስሆን ይህ ጥናት ከጎንደር ዩኒቨርሲቲ
ሚድዋይፈሪ ት/ቤት ጋር በመተባበር በአቶ ሁሴን ሙሀመድ አስፋው በክሊኒካል ሚድዋይፈሪ የማስትሬት
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ዲግሪ በከፊል ለማጠናቀቅ ለሚደረግ የምርምር ጥናት ቃለመጠይቅ ሲሆን ለዚህ ጥናት እርስዎ የተመረጡ
በመሆንዎ በዚህ ጥናት እንዲሳተፉ በትህትና እንጠይቃለን፡፡የዚህ ጥናት ዋና አላማ “በምጥ ወቅት ከጤና
ተቋም ሰራተኛ ውጭ ከማህበራዊ አውታርዎ እገዛ የማግኘት ተግባራዊነት እና ተግዳሮቶችን ማጥናት ሲሆን
ከ 10-15 ደቂቃ የሚፈጁ በተለያዩ ክፍሎች የተከፈሉ ጥያቄዎችን እጠይቀወታለሁ፡፡በዚህ ጥናት በመሳተፍዎ
የሚያገኙት ምንም አይነት ጥቅምም ጉዳትም የለም፡፡ነገር ግን የዚህ ጥናት ዉጤት ለፖሊሲ
አስፈጻሚዎች፣ዕቅድ አዉጭዎችና ለጤና ባለሙያዎች ጥሩና ጥራት ያለው የእናቶች አገልግሎት ለመስጠት
ይረዳል ብለን እናምናለን፡፡ስለዚህም በዚህ ቃለመጠይቅ ቢሳተፉ ምስጋናዬ የላቀነዉ፡፡ከዚህ ጥናት የሚገኘው
መረጃ ሁሉ በማህደር የሚቀመጥ ሲሆን ማህደሩም በስም ሳይሆን በተለየ ኮድ ሲቀመጥ ኮዱን ከዋናው
በጣም አስፈላጊ ቢሆንም በጥናቱ ሙሉ በሙሉ ወይም በከፊል ያለመሳተፍ መብትዎ የተጠበቀነው፡፡ስለ ጥናቱ
ስልክቁጥር፡0923744869
ኢሜል፡baluka2007.12.14@gmail.com
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ክፍልአንድ፡- የማህበረሰባዊናስነ-ህዝብጥናትመረጃ
የተጠየቀበትጤናተቋምስም______________ የጥያቄውመለያቁጥር________
ተ.ቁ ጥያቄዎች አማራጭመልሶች ዝለል
100 እድሜዎስንትነው? -------------ዓመት
101 የትነዉየሚኖሩት? 1. ገጠር 2. ከተማ
102 ሃይማኖትዎምንድንነው? 1) ኦርቶዶክስ 2) ሙሰሊም
3) ፕሮቴስታንት 4) ሌሎች (ይገለጹ) ------
103 ብሔርዎምንድንነው? 1. አማራ 2. ኦሮሞ
3. አገው 4. ሌሎች(ይገለጹ)____
104 የርስዎየት/ትሁኔታ? 1. አልተማረኩም 2. የመጀመሪያደረጃ
3.የሁለተኛደረጃ 4. ኮሌጅእናከዚያበላይ
105 ስራወትምንድንነዉ? 1) የቤትእመቤት 2) የመንግስትሰራተኛ
3) የግልስራ 4)ነጋደ
5) ገበሬ 6) መንግስታዊያልሆነድርጅትሰራተኛ
7) ሌላካለይገለጹ-------------
106 ባሁኑወቅትየረስዎየጋብቻሁኔ 1. ያገባች(አብረውየሚኖሩ) 2.ያላገባች ያላገባች፣ የፈታች ወይም
ታ 3. የፈታች 4. የሞተባት የሞተባት ከሆነች ወደ 109
5. ያገባች (ተለያይተውየሚኖሩ)
107 የባለቤትዎየት/ትደረጃ? 1)አልተማረም 2)የመጀመሪያደረጃ
3)የሁለተኛደረጃ 4)ኮሌጅእናከዚያበላይ
108 የባለቤትዎስራምንድንነው? 1)ገበሬ 2)የመንግስትሰራተኛ
3)ነጋደ 4)የግልስራ
5)የቀንሰራተኛ 6)መንግስታዊያልሆነድርጅትሰራተኛ
7)ሌላካለይገለጽ------------
109 የቤተሰበዎአማካኝየወርገቢስንትነው? ------------------- ኢትዮጵያንብር
ክፍልሁለት፡- ከቀደሞውእናከአሁኑከእርግዝናእናምጥጋርየተያያዙጥያቄዎች
200 ስንተኛእርግዝናዎነው?ማንኛዉንምአይነትእርግዝና ------------በቁጥር የመጀመሪያካሉወደ 204
201 ስንተኛ ወሊድዎ ነው? (ከ 7 ወርበኋላበሒዎት/ሞቶ የተወለድ) ------------በቁጥር
202 ከዚህበፊትመጥፎየእርግዝውጤትነበረወት? 1)አዎ 2)አልነበረም ካልነበረወደ 204
203 አዎካሉየትኛው?ከአንድበላይመምረጥይችላሉ 1)ውርጃ 2)ከ 7
ወርበኋላበማህፀንውስጥመጥፋት 3)ሞቶመወለድ
4)ከተወለደበኋላበ 1
ወርውስጥመሞት 5)ሌላካለይገለጽ--------
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209 ስርየሰደደበሽታነበረበዎት? (በህክምናየተረጋገጠ) 1) አዎ 2) አልነበረም ካልነበረወደ 211
210 አዎካሉምንድንነው/ነበር? 1)የስኳርበሽታ 2)የደምግፊት
(ከአንድበላይመምረጥይቻላል) 3)የልብህመም 4)የአስም በሽታ
5)የሚጥልበሽታ 6)ሌሎችይጠቀሱ----
306 በቅድመወሊድክትትልጊዜበምጥወቅትአብሮሽየሚሆንሰውመምረጥእ 1 አዎ
ንደምትችይገለጻተደርጎልሽያውቃል? 2) አያውቅም
307 የመጨረሻልጅዎንየትወለዱ? 1)ጤና- ጤናተቋምካሉወደ 309
ተቋም 2)ቤት 3)ሌላካለይገለፅ ሌላካሉወደ 310
---------
308 በቤትውስጥከወለድሽለምን? 1) እርግዝናዬየጤናችግርስለሌለው
(ተገቢከሆነከ 1 2)ባህላዊአዋላጆችንስለምመርጥ
በላይመልስንመስጠትትችያለሽ) 3)በጤናአገልግሎትሰጪእንዳልንገላታናክብሬንእንዳላጣ
4) የተለመደስለሆነ/ባህልስለሆነ
5) በምጥወቅትብቻዬንመሆንስለምፈራ
6)የትራንስፖርትችግርስላለ
7)ያማጥሁትለአጭርጊዜበመሆኑ
8)ሌሎች (ይግለጹ)--------------------
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309 ጤናተቋምከወልዱየት? 1)ሆስፒታል 2)ጤናጣቢያ 3)ከግል-ጤና-ተቋም 4)ጤናኬላ
ክፍልአምስት፡-በምጥወቅትአብሯትስለሚሆንና ስለሚረዳትሰውያላትንእውቀት፣ፍላጎትናምርጫበተመለከተ
ሀ) በምጥወቅትአብሯትስለሚሆንናእናስሚረዳትሰውያላትንእውቀትበተመለከተ
500 በጤናተቋምውስጥበምጥጊዜበቤተሰብአባላትስለሚደረግእገዛሰምተሽታ 1) አዎ አላውቅምከሆ
ውቂያለሽ (እውቀትአለሽ)? 2) አላውቅም ነወደ 502
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501 አዎከሆነምንማለትነው? 1) በምጥጊዜበተቋሙሰራተኞችየሚደረግእገዛ
2) በእርግዝናጊዜበተቋሙሰራተኞችየሚደረግእገዛ
3) በምጥጊዜከተቋሙሰራተኞችውጭየሚደረግእገዛ
4) በእርግዝናጊዜከተቋሙሰራተኞችውጭየሚደረግእገዛ
5) ከወሊድበኋላከተቋሙሰራተኞችውጭየሚደረግእገዛ
6) ከወሊድበኋላበተቋሙሰራተኞችየሚደረግእገዛ
7) ሌላካለ------
502 በምጥላይያለችሴትበጤናተቋምውስጥልጇንእስክትገላገልድረስአብሯትእንዲቆይናእንዲደግ 1)አዎ ካላወቁወ
ፋትየምትፈልገውንሰውየመምረጥመብትእንዳላትታውቂያለሽ? 2)አላውቅም ደ 504
503 አዎከሆነእንዴትልታውቂቻልሽ/ 1)ከሰዎች/
ከየትመረጃውንአገነኙት? ከጓደኛሰምቼ 3)ከዚህበፊትተሞክሮስላለኝ 2)አንብቤ 4)ከማህበራዊ/
ሌሎችሚድያዎችሰምቸ
5)ከጤናአገልግሎትሰጪዎችሰምቸ/በክትትልወቅትተንግሮኝ
6)ሌሎች ( ይግለጹ)------------
504 በምጥወቅትየሚረዳሽአንድቤተሰብአብሮስለመሆኑየምትይውነገርምን 1) በጣምጥሩአሰራርነው
ድንነው? 2) ጥሩአሰራርአይደለም
505 በምጥወቅትበፈለጉትረዳት/ቤተሰብድጋፍማግኘት/ 1) አዎአውቃለሁ አላውቅምካሉ
የሚረዳሽሰውአብሮሽቢኖርያለውንጥቅምታውቂለሽ? 2) አላውቅም ወደ 507
ለ) በምጥወቅትአብሯትስለሚሆንናእናስለሚረዳትሰውያላትንፍላጎትበተመለከተ
507 ለወደፊቱበምጥጊዜየሚረዳሽሰውአብሮሽእንዲሆንፍላጎቱአለሽ? 1)አዎ 2)የለኝም ከሌላትወደ 510
508 አዎከሆነበምጥጊዜአብሮሽየሚሆንሰውእንዲደርግልሽየምትፈልጊዉ/ 1) አዎ የለምካሉወደ 511
የምጠብቂውነገርአለ? 2) የለም
509 አለካሉበምጥወቅትምንእ 1)ስነልቦናዊድጋፍ (ማበረታታት፣መፀለይ)
ንዲያደርግልዎትይጠብቃ 2)ተግባራዊድጋፍ(ጀረባማሸት፣እጅመያዝ/መደገፍ፣አስፈላጊነገሮችንማቅረብ)
ሉ? 3)መረጃዊድጋፍ(ስለምጡ ደረጃ፣ስለሌላው ቤተሰብ ሁኔታ) መረጅ መስጠት
(ከአንድበላይመልስመምረ 4)ጥበቃዊድጋፍ(እንዳልወድቅ፣ባለሙያው እንዳያንገላታኝናክብሬን እንዳይነካኝ)
ጥይቻላል) 5)ሌላካለይጠቀስ----------------
56
511 በምጥጊዜአብሮዎትየሚሆንአንድሰ 1)ባለቤቴን 2)እናቴን/ ሴትአማቴን 3)እህቴን/አይቴን
ውምረጡቢባሉማንንይመርጣሉ 4)የባህልአዋላጅ 5)ጓደኛየን/ጎረቤቴን 6)ማንንምአልመርጥ 7)ሌላካለይጠቀ
(ከአንድበላይመምረጥአይቻልም) ስ-------------------
ክፍልስድስት፡- ከጤናተቋማትእናከባለሙያዎችጋርየተያያዙመረጃዎች
600 በዚህተቋምበምጥወቅትአብሮሽለሚሆንሰውሁኔታወቹምቹይመስሉሻል? 1)አዎ 2)አይደለም አዎካሉወደ
602
601 አይደለምካሉለምን? 1) የምጥክፍሉስለሚጠብ/ስለተጨናነቀ
(ከአንድበላይመምረጥይችላሉ) 2) የግልየምጥክፍል/መጋረጃስለሌለው
3) ለድጋፍሰጭውመቀመጫቦታስለሌለ
4) የምጥክፍሉንፅህናስለማይመች
5) ሌላካለይጠቀስ----------------------------
Declaration
I, the undersigned, senior MSc clinical midwifery declare that this thesis is my original
work in partial fulfillment of the requirements for the degree of master of science in
clinical midwifery.
Signature ___________________
Place of submission: school of midwifery, college of medicine and health science, UoG
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This thesis work has been submitted for examination with my/our approval as university
advisor(s) for thesis defense with my school of midwifery advisor(s).
Advisor(s)
Name Signature
1. _____________________ _____________________
2. _____________________ _____________________
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