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Fekadu Yadassa,1 Gurmesa Tura Debelew,2 Zewdie Birhanu3 1Department of Population and Family Health, Jimma University, Jimma, Ethiopia; 2Department of Population and Family, Jimma University, Jimma, Ethiopia; 3Department of Health Behavior and Society, Jimma University, Jimma, EthiopiaCorrespondence: Fekadu Yadassa, Jimma University, Faculty of Public Health, Department of Population and Family Health, Jimma, Ethiopia, Tel +251 912050454, Email fekadutesso@gmail.com; fekadu.yadassa@ju.edu.etBackground: Individuals with accurate knowledge that goes beyond knowing a few contraceptive methods, such as knowledge of fertility, benefits, and contraceptive side effects, are more likely to use and less likely to discontinue using family planning.Purpose: The aim of the study was to determine the effect of family planning education on knowledge, attitude, and practice towards family planning among married couples in Jimma Zone, Ethiopia.Methods: A quasi-experimental study was done on 766 married couples sampled using a random sampling technique and analyzed using SPSS 23.0. The significance of differences in mean knowledge and attitude between control and experimental couples was measured using the non-parametric 2-independent sample analysis (P < 0.05).Results: The comparison of knowledge score means and significance of their differences between control and experimental women was found to be significant at the posttest (P = 0.001; r = 0.045). Similarly, the experimental men’s knowledge score means and their difference was significant at posttest (P = 0.001, r = 0.26). With respect to a comparison of mean score of attitude and the significance of their difference between control and experimental women at posttest was significant with (P < 0.001; r = 0.13). Similarly, the comparison of the male partners in the control and experimental groups was significant at posttest (P = 0.001; r = 0.12). At the posttest, the proportion of experimental couples using each contraceptive method relatively increased, with a shift to relatively effective ones. Two hundred and ninety five (77.6%) of the control and 318 (83.5%) of the experimental men reported supporting their wives in the use of contraceptives, showing more improvement among the experimental men than the control group.Conclusion: Along with routine counseling, a well-structured behavioral model-based family planning education is required for effective and continuous use of contraceptives.Keywords: knowledge, attitude, education, contraceptives, couples, IMB model

Zeritu Dewana Derbo,1 Gurmesa Tura Debelew2 1Department of Midwifery, Arba Minch Health Science College, Arba Minch, Ethiopia; 2Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, EthiopiaCorrespondence: Zeritu Dewana Derbo, Email dewanazeritu@gmail.comPurpose: Anemia, especially iron-deficiency anemia during pregnancy, significantly impacts maternal health, fetal growth, and development. Moringa leaf is an iron-rich food that can overcome anemia, but there is a lack of evidence on the association between fresh moringa leaf consumption and maternal hemoglobin level during pregnancy. The aim of this study is to test the effect of fresh moringa leaf consumption during pregnancy on maternal hemoglobin levels in southern Ethiopia.Methods: A community-based comparative cross-sectional study was conducted from May to June 2022 among 230 fresh moringa leaf consumers and 230 non-consumers pregnant women. Data were collected using an interviewer-administered structured questionnaire and hemoglobin level was determined by HemoCue Hb 301. Multivariate multilevel linear regression models were fitted using Statistical Software for Data Science (STATA) version 14.Results: The overall mean hemoglobin level among pregnant women was 11.76 g/dl ± 1.47 [12.06 g/dl ± 1.22 among fresh moringa leaf consumers and 11.45 g/dl ± 1.64 among non-consumers] with a significant coefficient of association (β) of 0.90 g/dl [β = 0.90 g/dl, 95% CI: 0.54, 1.27]. A number of under-five children, bleeding during the current pregnancy, male-headed household, and current antenatal care visit were the individual-level factors. Distance from the nearest health facility and urban dweller was identified as the community-level factor associated with maternal hemoglobin level during pregnancy.Conclusion: This study showed that the consumption of fresh moringa leaf during pregnancy increases the level of hemoglobin. So policymakers and maternal and child health program managers need to target moringa tree scale-up and encourage fresh moringa leaf consumption during pregnancy, but its use needs additional rigorous clinical trials. In addition to this, mark the above factors in their efforts to increase maternal hemoglobin levels during pregnancy.Keywords: fresh moringa leaf consumption, hemoglobin level, pregnant women, Southern Ethiopia

Dawit Alemu, Tujuba Diribsa, Gurmesa Tura Debelew Department of Population and Family Health, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Tujuba Diribsa, Department of Population and Family Health, Jimma University, Jimma, Ethiopia, Tel +251 925270679, Email tujubadiribsa@gmail.com; tujuba.benti@ju.edu.etBackground: Currently, COVID-19 disease is a major public health issue that affects a large number of people worldwide. The COVID-19 vaccine is one of the best preventative measures. Adolescents between the ages of 12 and 17 are eligible to get the COVID-19 vaccine. The COVID-19 pandemic cannot be stopped if people are reluctant to use this vaccine. However, the extent of COVID-19 vaccine hesitancy and related variables among adolescents are not well understood.Objectives: To assess the magnitude of COVID-19 vaccine hesitancy and its associated factors among adolescents in Seka Chekorsa town, Jimma, Ethiopia.Methods: Institutional-based cross-sectional study employing both qualitative and quantitative methods were used. The study participants were selected using a simple random sampling technique. Data were collected using interviewer-administered questions. Data collected was checked for completeness and entered into EPI data version 3.1. Finally, data were exported to SPSS version 25 for further analysis. The bivariate analysis was used to identify variables eligible for multivariate logistic regressions. In a multivariable analysis to identify factors that have statistically significant association, a p value less than 0.05 and a 95% confidence interval were used. The qualitative data were triangulated with quantitative data.Results: In this study, 379 adolescents were participated, yielding a response rate of 95.2%. The magnitude of COVID-19 vaccine hesitancy among adolescents was 29% (95% CI: 24.3– 33.5%). Being female (AOR = 1.89, 95%, 1.81– 3.56), primary education (AOR = 2.99, 95% CI: 1.26– 3.56), source information from social media (AOR = 2.42, 95% CI: 1.06– 5.57), poor knowledge about COVID-19 disease (AOR = 3.18, 95% CI: 1.66– 6.12), unfavorable attitude (AOR = 5.2, 95% CI: 2.76– 9.79) and poor knowledge towards COVID-19 vaccine (AOR = 5.66, 95% CI, 2.91– 11.0) were associated with COVID-19 vaccine hesitancy among adolescents.Conclusion: This study shows that COVID-19 vaccine hesitancy among adolescents is very high. Being female, poor knowledge towards COVID-19 disease and the vaccine, an unfavorable attitude and social media were factors significantly associated with COVID-19 vaccine hesitancy.Keywords: COVID-19 disease, adolescent, COVID-19 vaccine hesitancy

Selamawit Getachew,1 Gurmesa Tura Debelew,2 Misra Abdullahi2 1Department of Public Health, Wachemo University, Hosanna, Ethiopia; 2Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, EthiopiaCorrespondence: Selamawit Getachew, Department of Public Health, Wachemo University, Hosanna, Ethiopia, Email selamgetachew900@gmail.comBackground: Globally, women with disabilities have two times higher chance of suffering from violence compared to their non-disabled peers due to double discrimination. However, there is little evidence that quantifies the situation in this segment of the population by considering disability-related factors which make this group more vulnerable to gender-based violence in Ethiopia.Objective: To assess the prevalence of gender-based violence and its associated factors among women with disabilities in Jimma town, southwest Ethiopia, 2020.Methods: A community based cross-sectional study was conducted among a total of 308 women with disabilities. Bivariate and multivariable logistic regression analyses were carried out to identify factors associated with gender-based violence. The significance of the association was decided by using the 95% confidence interval of AOR at a p-value of < 0.05 in the multivariable analysis.Results: The lifetime prevalence of gender-based violence among women with disabilities was found to be 73.1, while 46.1% had experienced it during the last 12 months. Gender-based violence in the past 12 months was significantly associated with non-schooling (AOR=5.10; 95% CI, 1.51, 17.14), being in age group of 20– 34 (AOR=3.5; 95% CI, 1.74, 7.30), having visual impairment (AOR=3.1; 95% CI, 1.27, 7.54), having hearing impairment (AOR=3.0; 95% CI, 1.36, 6.89), alcohol use behavior (AOR=4.1; 95% CI, 1.74, 9.55), and perceived stigma and discrimination (AOR=4.2; 95% CI, 2.44, 7.39).Conclusion: Prevalence of gender-based violence among women with disabilities was found to be high in the study area. Educational status, age, type of disability, alcohol use behavior, and perceived stigma and discrimination were independent predictors of gender-based violence. Measures have to be taken to curb the problem by taking integrated interventions like enrolling girls in school and targeted health education towards identified factors by considering the heterogeneity of disabilities.Keywords: gender-based violence, violence against women, disability, southwest Ethiopia

Amanu Aragaw Emiru,1 Getu Degu Alene,2 Gurmesa Tura Debelew3 1Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Bahir Dar University, Bahir, Ethiopia; 3Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Amanu Aragaw EmiruDepartment of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box: 79, Bahir Dar, EthiopiaTel +251 918780295Email amanuaragaw@yahoo.comBackground: Early antenatal visit is critical for the health and well-being of mothers and babies. However, various individual, family level, and contextual factors influence the timely initiation of antenatal care.Objective: The aim of this study was to examine individual, household, and community-level factors associated with the timing of first ANC visit among mothers who gave birth in the last twelve months before the survey.Methods: A community-based cross-sectional study was conducted in June 2018. A multistage cluster sampling technique was applied, and a sample of 898 women was considered. Data were collected using a questionnaire and checklist. The analysis was made using SPSS. A multilevel logistic regression with random effects at the kebele level was developed to assess the predictors of late initiation of antenatal care. Odds ratio with 95% confidence intervals was used to measure association while the intra-class correlation coefficient and the median odds ratio were used to measure variations.Results: Overall, 78.4% (95% CI: 75.6, 80.9) of women started their first ANC in 4 months of gestation or later and significant heterogeneity was observed between clusters. At level 1, women with intended pregnancy (aOR=0.31; 95% CI: 0.12, 0.79), and being knowledgeable about the timing (aOR=0.43; 95% CI: 0.25, 0.75) and pregnancy-related complications (aOR=0.16; 95% CI: 0.10, 0.26) were less likely to delay their first ANC visit. Conversely, the odds of late ANC visit was higher among women with no formal education (aOR=4.08, 95% CI: 2.20, 7.55). Distance to the health facility (aOR=1.04; 95% CI, 1.01– 1.08) was the only level-2 significant predictor.Conclusion: The study revealed that late ANC initiation was rampant. Several factors operating at different levels were associated with late ANC visits; yet, the role of individual-level factors was relatively stronger. Hence, awareness creation is essential to the underprivileged community using the available communication networks.Keywords: antenatal care, timing, delay, late, multilevel

Background: Women in the early postpartum period face substantial unmet needs in contraception to encourage birth intervals and reduce unintended pregnancies. The widespread ownership of mobile devices offers an opportunity to employ mobile health strategies for enhancing communication between healthcare providers and clients. However, little is known about the effectiveness of mobile health interventions to improve early adoption of contraceptive methods after childbirth in Ehiopia., Objective: This study aimed to evaluate the effectiveness of a mobile health intervention in enhancing the uptake of modern contraceptive methods in the early postpartum period in Dessie and Kombolcha cities, northeast Ethiopia., Methods: The research was conducted in Dessie and Kombolcha cities zones located in the Amhara region of Northeast Ethiopia from 15th January to 15th June, 2023. Pregnant women with a confirmed gestation of 30 weeks were enrolled and followed up to the 45-day postpartum period. The study employed a cluster randomized control trial involving 764 participants (381 controls and 383 in the intervention group). The intervention group received a new mobile health intervention in addition to the existing healthcare practices, while the control group solely adhered to the current healthcare practices. Data were collected using the Open Data Kit (ODK) and exported to STATA 17 for analysis. The marginal model Generalized Estimating Equations (GEE) through the application of an exchangeable working correlation was applied. The effect of the intervention on the outcome was measured using the odds ratio with a 95% confidence interval at a p-value less than 0.05 significant level., Results: The study found that 78.7% of participants in the control group and 77.3% in the intervention group had sexual practice after childbirth. The proportion of early postpartum contraceptive uptake in the intervention group (51.6%) was significantly higher than in the control group (38%). The odds of adopting modern contraceptive methods during the early postpartum period were 1.6 times higher among mothers who received the mHealth intervention compared to those in the control group (AOR: 1.6, 95% CI: 1.249-2.123). The study identified significant predictors for the uptake of contraceptive methods during the early postpartum period, including having a live newborn (AOR: 3.7, 95% CI: 1.034-13.353), parity (AOR: 1.7, 95% CI: 1.069-2.695), and previous experience with contraceptive initiation (AOR: 0.5, 95% CI: 0.358-0.912)., Conclusion: This study findings demonstrated that the potential effectiveness of mobile health interventions in promoting timely contraceptive adoption during early postpartum period. The mobile health intervention, combined with factors such as timing of previous contraceptive initiation, newborn status, and maternal parity, significantly enhances the likelihood of early contraceptive adoption. These nuanced insights provide a strong foundation for developing targeted health interventions and policies aimed at improving early postpartum contraception., Registration: The trial was registered on December 23, 2022, in the Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ID: ClinicalTrials.gov ID: NCT05666037., Competing Interests: The authors declare that there is no any conflict of interest., (Copyright: © 2024 Cherie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Maternal morbidity and mortality have long been among the world's most challenging health issues. Uterine rupture is one of the peripartum complications that kills almost one in every thirteen mothers. However, there is limited evidence on uterine rupture trends, proportions, and determinants. Thus, this study assessed the trend, prevalence, and associated factors of uterine rupture at Nekemte Specialized Hospital, Oromia Regional State, Western Ethiopia. An institution-based cross-sectional study was conducted among 2661 clients selected using a systematic random selection technique among the data collected for the project between January 2014 and December 2022 at Nekemte Specialized Hospital. Data were collected through an interview-administered questionnaire and card review from March 2023 to August 2023. The collected data were checked, coded, and entered into Epi info version 7.2 and then exported to SPSS Version 27 for analysis. Logistic regression models were fitted to identify the factors of uterine rupture. Adjusted odds ratio with 95% Confidence Interval was estimated to measure the strength of the association, and statistical significance was declared at a p-value less than 0.05. The trend of uterine rupture declined from 1.54% in 2014 to 0.93% in 2022. The overall prevalence was 3.53% (95%CI: 2.7%, 4.3%). Low household income (Adjusted OR = 3.75, 95%CI: 1.97, 7.13), grandmultiparity (Adjusted OR = 7.78, 95%CI: 4.70, 12.88), having a history of obstetrics complications such as prolonged labor (Adjusted OR = 3.78, 95%CI:2.11, 6.75), a history of cesarean section (Adjusted OR = 2.49, 95%CI:1.42, 4.35), and history of uterine repair (Adjusted OR = 18.01, 95%CI: 6.81, 47.64) were significantly associated with uterine rupture. This finding showed that the trend is declining, and the proportion of uterine rupture is still higher. A more vigilant approach to increase access to lower-income mothers, prevent prolonged and obstructed labor, and maintain antenatal care with complete packages and a referral system are issues to be addressed to minimize the chance of uterine rupture among women., (© 2024. The Author(s).)

Background: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. According to the Ethiopia Demographic and Health Survey report, early postpartum modern contraceptive method uptake is still unacceptably low in Ethiopia., Objectives: This study aimed to determine the magnitude of intention to adopt early postpartum modern contraceptive methods and its associated factors among pregnant women in Dessie and Kombolcha town zones, northeast Ethiopia., Methods: A community-based cross-sectional study was deployed from 15 January-15 February 2023, in the Dessie and Kombolcha zones, northeast Ethiopia, among pregnant women. The study involved 780 pregnant women using the cluster sampling technique. A census was conducted in 20 randomly selected clusters to identify eligible pregnant women. Actual data were collected home-to-home in the community through face-to-face interviews. Data were collected by Open Data Kit (ODK) and exported to STATA 17 for analysis. A multivariable logistic regression analysis was performed, and the goodness of the model was checked by Hosmer-Lemeshow's test statistic and rock curve. An adjusted odds ratio with a 95% confidence interval and p -value < 0.05 was considered statistically significant., Result: The study revealed that 49.6% of pregnant women lack autonomy and 50% lack knowledge about early postpartum contraception, with participants' wealth index status ranging from rich (36.6%) to poor (33.2%). The study found that 75.8% of pregnant women intended to adopt early postpartum modern contraceptive methods early after childbirth. After controlling the potential confounders, mother's age (AOR = 6.2 [2.6-14.6], birth interval (AOR = 2.5 [1.6-3.7]), have paid work (AOR = 1.9 [1.3-2.8]), health facility from home (AOR = 2.6 [1.5-4.4]), last delivery Place (AOR = 2.4 [1.1-5.7]), knowledge on (AOR = 1.5 [1.1-2.1]), and antenatal care follow-up (AOR = 1.9 [1.2-3.3]) were significant associated factors of intention to uptake early postpartum modern contraceptive methods among pregnant women., Conclusions: The study found that 75% of the participants had the intention to adopt contraceptive methods during the early postpartum period. Identified factors influencing this intention were age, birth interval, women's employment status, area of residence, distance to health facilities, last delivery place, knowledge of early postpartum modern contraception, gravidity, and antenatal care follow-up. These findings highlight the need for targeted interventions to address these factors, framing the intended users and enabling access to early adoption of postpartum contraceptive methods.

Background: Uterine rupture is a rare but severe obstetric complication that poses significant risks to maternal and fetal health. Understanding the lived experiences of individuals who have undergone uterine rupture is crucial for improving care and support for those affected by this condition. This qualitative phenomenological study aimed to explore the experiences of individuals who have experienced uterine rupture., Method: The study employed a qualitative phenomenological approach, conducting 12 in-depth interviews and four key informant interviews with individuals who had experienced uterine rupture. Data analysis was conducted thematically using Atlas ti software to identify patterns and themes within the participants' narratives., Results: The analysis of the interviews highlighted six key themes: experience during diagnosis and initial symptoms, perceived predisposing factors of uterine rupture, challenges faced by individuals with uterine rupture, impacts on their lives, and coping and resilience strategies. The findings revealed that women often failed to recognise the initial symptoms of uterine rupture due to a lack of preparation, a preference for home deliveries, husband refusal, and a general lack of awareness. This delay in seeking care resulted in severe consequences, including the loss of their babies, infertility, fistula, psychological trauma, and disruptions to daily life and relationships. To cope, many women resorted to accepting their situation, isolating themselves, and using traditional healing techniques., Conclusions: This study's findings provide valuable insights into the complex and multifaceted nature of uterine rupture, shedding light on the experiences of those affected by this condition. To address the challenges, it is essential to enhance awareness and education through community education programs and comprehensive antenatal classes. Additionally, improving access to healthcare by strengthening health infrastructure and deploying mobile health clinics can ensure better prenatal care. Furthermore, encouraging hospital deliveries through incentives and the support of community health workers can reduce risks. Providing psychological counselling and establishing support groups can help affected women cope with the consequences. Moreover, engaging men in maternal health through educational programs and involving them in antenatal care can foster better support. Finally, promoting safe traditional practices by integrating traditional healers and respecting cultural sensitivities can increase acceptance and adherence., (© 2024. The Author(s).)

Background: Approximately 80% of people in Ethiopia live in rural areas, where poor access to maternity services, accounts for the majority of maternal and perinatal deaths. Maternity waiting homes are residential facilities for women who come from remote areas to stay and wait before giving birth at health facilities, particularly in hospitals and health centers. It is a new initiative and one of the strategies that increase skilled care utilization at birth. However, there is no evidence on the status of maternity waiting home utilization in the study area. Therefore, this study aimed to generate evidence on the status of maternity waiting home utilization and its associated factors., Methods: A community-based cross-sectional household survey was conducted from June 5-30, 2022. The sample size was calculated using the single population proportion formula, which resulted in 354 participants. The study population included mothers who gave birth within 12 months before the survey were selected by using a systematic sampling method. The data were coded, edited, cleaned, and entered into Epi Data version 3.1. The data were subsequently exported to SPSS version 25 for analysis. Descriptive, bivariable, and multivariable binary logistic regression analyses were performed. The results are presented in the text, figures, and tables. Finally, variables with a p value < 0.05 in the multivariable analysis were reported as significantly associated with the independent variables and outcome variable., Results: The magnitude of maternity waiting home utilization was 36.4% (95% CI = 31.4, 41.8). Being knowledgeable about the presence of maternity waiting home (AOR = 3.9; 95% CI: 1.0-15.2), being able to afford transportation (AOR = 2.4; 95% CI: 1.01-5.9), being home delivery (AOR = 0.007; 95% CI: 0.002-0.031) and being acess to transportation services (AOR = 3.0; 95% CI: 1.2-7.5) were significantly associated with maternity waiting home utilization., Conclusion: The magnitude of maternity waiting home utilization in the study area was found to be low. Access to and affordability of transportation services, being knowledgeable and being home delivery were associated factors for the use of maternity waiting homes. Therefore, increasing maternal knowledge, economically empowering women and respecting care while waiting at maternity homes are important for improving the utilization of maternity waiting homes., (© 2024. The Author(s).)

Birth weight is an indicator of neonatal survival and development; however, poor nutrient intake during pregnancy is a primary contributor to low birth weight. Moringa is a multipurpose tree high in macro- and micronutrients. There is insufficient evidence on the relationship between fresh moringa leaf consumption during pregnancy and birth weight. The purpose of this study was to determine the association between maternal fresh moringa leaf consumption on birth weight in southern Ethiopia. A community-based, prospective cohort study design was used with 230 pregnant women who consumed fresh moringa leaves and 230 who did not consume moringa leaves. The mothers were enrolled in their second trimester and monitored until delivery. The structural equation model was used to analyze β coefficients with p -values <.05. The mean birth weight of newborns born to mothers who took fresh moringa leaves during pregnancy was 3334.42 g, which was considerably higher than the non-consumer 3196.73 g ( p  = .008). Consuming it during pregnancy significantly increased birth weight by 115.77 g compared to non-consumers ( β  = 115.77; SE = 43.03: p  = .007). The study found that eating fresh moringa leaves during pregnancy increased the birth weight of the newborn. As a result, policymakers and managers of mother and child health programs should strive to promote the use of fresh moringa leaves throughout pregnancy. However, more clinical trials are required to discover the ideal/optimal amount per day and duration of fresh moringa leaves for best outcomes., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Author(s). Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in effective early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. In Ethiopia, early postpartum modern contraceptive method uptake is still unacceptably low. The barriers/challenges have not yet been sufficiently explored. A deep and detailed understanding of the contextualized barriers and challenges in the adoption of early postpartum contraceptive methods is crucial in developing future locally-appropriate interventions., Objectives: This study aimed to explore barriers/challenges to the uptake of early postpartum modern contraceptive methods after childbirth in Dessie and Kombolcha zones, in northeast Ethiopia., Methods: Aconventional content analysis qualitative study was deployed in Dessie and Kombolcha town zones, northeast Ethiopia using a theoretical purposive sampling technique. A total of 57 study subjects were participated. The sample size was determined using the rule of information saturation through 7 key informant interviews, 6 in-depth interviews, and 5 focused-group discussions with 8-10 participants each. Data were collected using an unstructured interview guide and recorded using a digital audio recorder and field notes. The trustworthiness of the study was assured using different techniques. The collected data were transcribed and translated from native language to English. Atlas-ti version7 software was used to facilitate conventional content qualitative data analysis approach. Open coding, categories, subthemes, and overreaching themes were developed, and a conceptual model of barriers was organized through network analysis., Result: Barriers to uptake of early postpartum modern contraception quoted by study participants and themed were related knowledge, attitude, family-community, health facility, contraceptive method, cultural, religious, fertility desire, gender issues, and misconceptions. The sub-themes of knowledge-related barriers that emerged were lack of awareness of the time to take birth control methods, not knowing the time pregnancy is likely after childbirth, and not being committed to taking contraceptives early enough after childbirth. Moreover, beliefs that modern contraceptives cause breast milk to dry up and perceived low fecundability after childbirth were indicated as attitude barriers. Health facility barriers were lack of reminders and follow-up mechanisms, sporadic service delivery and opening time, long waiting time, and card withdrawal process and providers' approach. Social stigma, child sex preference, and religious restrictions against contraceptive use were community barriers., Conclusion: Generally individual, facility-based, method-related, misconceptions, societal, and cultural barriers were identified as hindrances to the uptake of early postpartum modern contraceptive methods. There is a need for health-seeking behavioral interventions, innovative contraceptive methods, and facility-level interventions to overcome each identified barrier., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Cherie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: A woman's health and nutritional status has significant impact on her pregnancy situation. However, many pregnant women are undernourished. Moringa stenopetala is a plant consumed worldwide in various forms, and its consumption showed a reduction in the incidence of malnutrition. Although Moringa stenopetala is rich in essential macro- and micronutrients, there is little evidence on the proportion and determinants of fresh Moringa stenopetala leaf intake among pregnant women. The objective of this study was to fill this gap in the littérature and provide a baseline evidence for further research or intervention by investigation the proportion and determinants of fresh Moringa stenopetala leaf intake among pregnant women in the Gamo zone, south Ethiopian region., Methods: A community-based cross-sectional study was conducted among 623 randomly selected pregnant women using a pre-tested and structured questionnaire via a face-to-face interview. The consumption pattern was assessed based on a self-reported dietary history over the last 30 days before data collection. Multivariable logistic regression model was fitted using STATA version 14. An adjusted odds ratio with a 95% confidence interval was reported to show an association between the dependent and independent variables with level of statistical significance at a p -value of <0.05., Results: The proportion of fresh Moringa stenopetala leaves intake among pregnant women was 49.60% (95% CI: 45.67, 53.52%). The déterminants of fresh moringa leaf intake were being below 24 years old (AOR: 2.92; 95% CI: 1.51, 5.63), rural résidence (AOR: 1.97; 95% CI: 1.10, 3.50), antenatal care attendance (AOR: 2.08; 95% CI: 1.03, 4.21), history of contraceptive use (AOR: 1.88; 95% CI: 1.03, 3.55), and having a good knowledge about the importance of moringa Stenopetala (AOR: 9.76; 95% CI: 5.30, 17.95)., Conclusion: The study showed that almost half of the pregnant women consumed fresh Moringa stenopetala leaves. Women's age, place of residence, prenatal care, history of contraceptive use, and knowledge of the benefits of Moringa Stenopetala were positively associated with the consumption of fresh Moringa Stenopetala leaves. Therefore, health authorities and stakeholders involved in maternal and child health need to target older women, and urban residents and promote the benefits of consumption by strengthening uptake of maternal health services and raising awareness about Moringa Stenopetela. Future studies involving large scale and longitudinal designs evidence are required to further validate the findings so that this nutritious diet can be promoted widely among pregnant women in the study area and Ethiopia at large., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Derbo and Debelew.)

Background: Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia., Objective: To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia., Methods: We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model., Results: In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts., Conclusion: In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gebrekidan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To identify the determinants of the unmet need for modern contraceptives in Ethiopia., Design: Community-based cross-sectional study., Setting: Ethiopia., Participants: A group of 6636 women of reproductive age (15-49 years) who were sexually active were included in the study., Outcome: Unmet need for modern contraceptives METHOD: The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15-49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering., Results: The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40-44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45-49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40-44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45-49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran's I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001)., Conclusions: High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The quality of life (QoL) of women during the postpartum period is affected by their living circumstances, reproductive history, exposure to and use of antenatal care, etc. The quality of life (QoL) issues associated to postpartum health among Ethiopian women have not been adequately examined in studies. Therefore, this study identified associated factors in relation to the health-related quality of life (QOL) among postpartum women in Jimma Town, Ethiopia., Methods: A structured face-to-face interview and a self-administered questionnaire were utilized in a community-based cross-sectional study to obtain data from 397 postpartum women from May 15 to June 14, 2022, using a multistage sampling strategy. The data analysis utilized several descriptive statistics. Multiple logistic models were run on factors that were significant at the 25 % level in univariate analysis. Adjusted odds ratios and 95 % confidence intervals were computed to identify associated factors., Results: The majority (51.2 %) of postpartum women had a low health-related quality of life, with a mean score of 50.58. Women poor health-related quality of life (QoL) was associated with age (AOR = 10.09; CI: 3.45-29.51), non-formal education of partners (AOR = 3.67; CI: 1.25-10.72), multiparousness (AOR = 2.21; CI: 1.14-4.29), unplanned pregnancy (AOR = 7.36; CI: 1.98-27.37), giving birth to a dead baby (AOR = 3.15; CI: 1.54-6.42), and not admitted to the hospital while pregnant (AOR = 5.50; CI: 3.86-26.30)., Conclusion: The finding revealed that the majority of postpartum women reported poorer health-related QoL. Thus, stakeholders should give attention to significant factors to set up measures to prevent and improve women's postpartum health-related QoL, and should be aware of women about the risk associated with poor health-related QoL., Competing Interests: The authors declared that they have no competing interests or personal interactions that could have been believed to affect the work presented in this study., (© 2024 The Authors.)

Background: Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings., Objective: The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia., Methods: A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention., Result: After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups., Conclusions: School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

Introduction: Adverse pregnancy outcomes are a personal and social crisis caused by easily preventable pregnancy-related problems. Despite that, studies on the effectiveness of adherence to the continuity of antenatal care (ANC) services are scarce. Therefore, this study aims to determine the effectiveness of the continuity of ANC services and the determinants of adverse pregnancy outcomes., Methods: A prospective follow-up study design was conducted from March 2020 to January 2021 in Northwest Ethiopia among randomly selected study subjects. Data were collected by trained data collectors using pre-tested structured questionnaires and analyzed using STATA Software version 14. A multilevel regression model was used to identify determinant factors, whereas the propensity score matching (PSM) model was used to look at the effectiveness of adherence to ANC services on adverse pregnancy outcomes., Results: Among 2,198 study participants, 26.8% had adverse pregnancy outcomes, with 95% CI: 24.9-28.7 [abortion (6.1%; 95% CI: 5.1-7.1), low birth weight (11.5%; 95% CI: 10.2-12.9), and preterm birth (10.9; 95% CI: 9.6-12.3)]. Determinant factors were iron-folic acid supplementation (AOR = 0.52; 95% CI: 0.41, 0.68), delayed initiation of ANC visits at 4-6 months (AOR = 0.5; 95% CI: 0.32, 0.8), initiation of ANC visits after 6 months (AOR = 0.2; 95% CI: 0.06, 0.66), received four ANC visits (AOR = 0.36; 95% CI: 0.24, 0.49), an average time of rupture of the amniotic membrane of between 1 and 12 h (AOR = 0.66; 95% CI: 0.45, 0.97), and pregnancy-related problems (AOR = 1.89; 95% CI: 1.24, 2.9). As a treatment effect, completion of a continuum of visit-based ANC (ATET; β  = -0.1, 95% CI: -0.15, -0.05), and continuum of care via space dimension (ATET; β  = -0.11, 95% CI: -0.15, -0.07) were statistically significant on the reduction of adverse pregnancy outcomes., Conclusion: In the study area, the rate of adverse pregnancy outcomes was high. Even though adherence to the continuity of ANC services via time and space dimensions is effective in the prevention of adverse pregnancy outcomes, programmatically important factors were also detected. Therefore, key strategies for promoting the uptake of antenatal services and strengthening iron-folic acid supplementation are strongly recommended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Zelka, Yalew and Debelew.)

Background: Sustainable Development Goals -3 (SDG - 3) were to ensure healthy live and promote well-being by reducing global maternal and neonatal deaths. These were to be implemented through the concept of continuum of care in maternal health program framework to improve health outcomes. There is a paucity of published evidences; as such, this review is designed to assess the effectiveness of the concept of continuum of care in maternal and neonatal health services on the reduction of maternal and neonatal mortality., Methods: A search was conducted using the key words; maternal and neonatal, health services, continuum of care, maternal and neonatal mortality. Search focused on PubMed, Cochrane, MEDLINE and Google Scholar. Extractions of articles were done based on predetermine criteria. Data were compiled, and screened, entered and analysis was done using STATA 13 and Rev. Man. software. Effects of the intervention package were determined and the result was interpreted in random effect RR with 95%CI. The publication bias was determined by using funnel plot, Egger and Bagger test, heterogeneity, and sensitivity test., Results: A total of 4685 articles were retrieved of these 20 articles reviewed. Articles on 631,975 live births (LBs) were analyzed. Results showed the distribution as follows; 23,126 newborns died within 28 days resulting [NMR = 35/1000LBs among the intervention group whereas NMR = 39/1000LBs among the control group]. The pooled effect of the intervention was significantly reduced neonatal mortality (RR = 0.84; 95%CI: 0.77-0.91). Similarly, 1268 women died during the pregnancy period up to 42 days after childbirth that resulted [MMR = 330/100,000LBs among the intervention group whereas MMR = 460/100,000LBs among the control group]. The pooled effect of the intervention was not a statistically significant association with maternal mortality (RR = 0.64; 95%CI: 0.41-1.00)., Conclusion: Adoption of continuum of care concepts in maternal health services reduced maternal and neonatal mortality. We recommend strengthening and effective implementation of a continuum of care in maternal health services to improve maternal and neonatal health care outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (© 2023 The Authors.)

Objective: To assess barriers to contraceptive use among secondary school adolescents in Gedeo zone, South Ethiopia, in 2021., Design: A grounded theory approach to the qualitative study was conducted between December 2020 and April 2021 in Gedeo zone, South Ethiopia., Setting: The study was conducted in two urban and four rural schools, in Gedeo zone; Gedeo zone is one of the 14 zones in the Southern Nations, Nationalities, and Peoples' Region of Ethiopia., Participants: The study involved 24 in-depth interviews with secondary school adolescents and 28 key informants. The interviews were conducted with students, school counsellors, Kebele youth association coordinators, zonal child, adolescent, and youth officers, health workers, and non-governmental organisation workers., Results: The findings were organised into four major themes that influence contraceptive use; these include; (1) Individual-related barriers such as knowledge, fear and psychosocial development. (2) Community-related barriers encompass fear of rumours, family pressure, social and cultural norms, economic vulnerability, and religious beliefs. (3) Health service-related barriers include the lack of adolescent-responsive health services, health workers' behaviour, and fear of health workers. Furthermore, (4) The school and service integration barrier was identified., Conclusions: Adolescents' contraceptive use was affected by various barriers ranging from individual to multisectorial levels. Adolescents note various barriers to using contraception and that, without contraception, sexual activity can lead to an increased risk for unintended pregnancy and its associated health risks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Even though the immediate postpartum period is a golden time and a great opportunity to provide long-acting reversible contraceptives to prevent unintended pregnancy, its utilisation is very low in Ethiopia. Quality of care in postpartum long-acting reversible contraceptive provision is thought to be an issue for this low utilisation. Thus, continuous quality improvement intervention is necessary to increase the use of postpartum long-acting reversible contraceptives at Jimma University Medical Center., Method: A quality improvement intervention to offer long-acting reversible contraceptive methods to immediate postpartum women at Jimma University Medical Center was initiated in June 2019. To study the baseline prevalence of long-acting reversible contraceptive use at Jimma Medical Centre over 8 weeks, we reviewed postpartum family planning registration logbooks and patients' charts. Based on the baseline data, the quality gaps were identified, prioritised and change ideas were generated and tested over another 8 weeks towards achieving the immediate postpartum long-acting reversible contraceptive prevalence target set., Result: This new intervention resulted in an average increase in immediate postpartum long-acting reversible contraceptive methods use from 6.9% to 25.4% by the end of the project intervention. The major barriers to low long-acting reversible contraceptive use were lack of attention from hospital administrative staff and quality improvement teams on the provision of long-acting reversible contraceptives, lack of training of healthcare providers on postpartum contraception and unavailability of contraception commodities at each postpartum service delivery points., Conclusion and Recommendations: The immediate postpartum long-acting reversible contraceptive use at Jimma Medical Centre was increased by training of healthcare providers, availing contraception commodities through administrative staff involvement, weekly audit and feedback on contraception use. Thus, training of the newly hired healthcare providers on postpartum contraception, involvement of hospital administrative staff, regular audits and feedback on contraception use is necessary to increase postpartum long-acting reversible contraception uptake., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Sexual harassment is undoubtedly widespread, and many countries have enacted laws to punish and prevent it as insulting behavior. However, its impacts on the job, psyche, and physical health, especially reproductive health, are still severe and noticeable. Thus, this study aimed to examine the impacts of sexual harassment on the job, psychology, physical health, and reproductive health of women in the hospitality industry., Methods: Institution-based cross-sectional survey was conducted between October 1 and November 30, 2021. Data were collected among 689 women who experienced sexual harassment in the hospitality industry. In selecting the participants, two-stage cluster sampling techniques were used. The data collection was carried out in two complementary ways. The model of structural equations examines the relationship between the experience of sexual harassment and coping with consequences. The associations were confirmed via AMOS 23., Results: Sexual harassment positively predicted job outcomes and negatively predicted physical health. In contrast, coping with sexual harassment positively predicts health at work and in the body and is negatively associated with health in reproduction. Physical health fully mediated the link between sexual harassment (β = 0.017, t = 0.85, p = 0.022) and reproductive health outcomes and partially mediated (β = -0.021, t = -1.235, p = 0.017) between sexual harassment coping and physical health. The interaction between sexual harassment experiences and work experiences also strengthens the negative relationship between sexual harassment experiences and physical health., Conclusions: The impact of sexual harassment on women's reproductive health was investigated in this study. It expands awareness of the effects of sexual harassment exposure, how to survive it, and how to establish effective preventative strategies, particularly in the hospitality industry. Effective prevention depends on preventing psychological and physical health, ultimately improving reproductive health. Thus, safe workplace initiatives and reproductive health care services are needed. Hospitality organizations should also devise a strategy for providing a supportive environment that can significantly improve women's health., (© 2023. The Author(s).)

Background: Despite priority being given to maternal and child health programs in Ethiopia, the reduction of neonatal mortality rate is stagnant, which is more than double the national target. Immediate newborn care and continuity of maternal health services are comprehensive, wide-ranging, and core strategies to overcome neonatal mortality and morbidity. However, the evidence of immediate newborn care practices and the effectiveness of continuity of maternal health services on immediate newborn care practices are scarce. Hence, this study aimed to fill this gap., Methods: A prospective follow-up study was conducted from March 2020 to January 2021, among 2198 pregnant women screened from the study areas. The data were collected using pretested semi-structured questionnaires and a registration logbook. Data were coded, entered, cleaned, and analyzed using STATA software 14. Descriptive statistics, multilevel regression, and propensity score matching (PSM) models were computed. Finally, ICC (ρ), AOR, and coefficient (β) along with 95%CI were calculated and statistical significance was considered at a p-value < 0.05., Results: The magnitude of immediate newborn care practice was 50.9% (95%CI: 50.5%, 51.3%). Partner attended primary cycle school (AOR = 2.32), women attended ANC visit ≥4 (AOR = 2.69), initiated 1st ANC visit between 4-6 months of GA (AOR = 0.47), IFA supplementation (AOR = 2.99), women who make a decision (AOR = 2.25), women whose husband make a decision (AOR = 1.66) and immunizing the newborn (AOR = 2.46) were determinant factors of immediate newborn care practices. As treatment effect, completion of COC in MHS via time dimension (β = 0.31; 95%CI: 0.27, 0.35); whole key service MHS (β = 0.43; 95%CI: 0.39, 0.48) and COC via space dimension (β = 0.17; 95%CI: 0.12, 0.21) were significantly increased the likelihood of immediate newborn care practices., Conclusion: The magnitude of optimal immediate newborn care practices was low. Different enabling factors were discovered in the study. Therefore, strengthening those enabling factors such as partner education, immunization program, IFA supplementation, early initiation and receiving ANC services, the decision-making power of women and partners, as well as scaling up a continuum of care in maternal health services are strongly recommended., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Objective: The use of maternal health services is an important indicator of maternal health and socioeconomic development. Evidence on individual-level and community-level determinants of use of maternal health services in Benishangul Gumuz Region was not well known so far. Hence, this study fills this gap., Design: A prospective follow-up study SETTING: This study was conducted from March 2020 to January 2021 in Northwest Ethiopia., Participants: A total of 2198 pregnant women participated in the study., Main Outcome Measures: A multistage random sampling technique was used to select study subjects. Data were collected via face-to-face interviews using pretested semistructured questionnaires. Collected data were coded, cleaned and analysed using Stata software. Multilevel regression models were applied to determine individual-level and community-level factors of use of maternal health services., Results: This study found that the proportions of women who visited recommended antenatal care (ANC), received skilled delivery care and postnatal care (PNC) were 66.1%, 58.3% and 58.6%, respectively. Being rural (adjusted OR (AOR)=3.82, 95% CI 1.35 to 10.78), having information on maternal health services (AOR=2.13, 95% CI 1.21 to 3.75), with a history of pregnancy-related problems (AOR=1.83, 95% CI 1.15 to 2.92) and women with decision-making power (AOR=1.74, 95% CI 1.14 to 2.68) were more likely to attend fourth ANC visits. Similarly, women who attended tertiary school (AOR=4.12, 95% CI 1.49 to 11.33) and who initiated the first ANC visit within 4-6 months of pregnancy (AOR=0.66, 95% CI 0.45 to 0.96) were determinants of skilled delivery care. Finally, women whose partners attended tertiary education (AOR=3.67, 95% CI 1.40 to 9.58), women with decision-making power (AOR=1.8, 95% CI 1.09 to 2.97), women who attended the fourth ANC visit (AOR=10.8, 95% CI 6.79 to 17.2), women received iron-folic acid during pregnancy (AOR=1.96, 95% CI 1.11 to 3.49) and women who received skilled delivery care (AOR=1.63, 95% CI 1.1 to 2.42) were more likely to get PNC services., Conclusion: The proportion of women who attended ANC, received skilled delivery services and PNCs was low. Different individual-level and community-level factors that influenced the use of these services were discovered. Therefore, community-based interventions should target those identified factors to improve maternal health services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The provision of a continuum of care to women throughout pregnancy, labor, and after delivery has become a fundamental strategy for improving maternal and neonatal health. A better understanding of where the gaps are in seeking care along the pathway and what factors contribute to the gaps is required for successful program implementation. Hence, this study was targeted to determine the status and determinant factors of the completion rate of a continuum of care in maternal health services., Methods: A prospective follow-up study was conducted among 2,198 sampled pregnant women and followed for 11 months in Benishangul-Gumuz region. A multistage clustered sampling technique was employed to select the study participants. Data were collected via face-to-face interviews using a pretested, semi-structured questionnaire, and logbook registry. Collected data were edited, cleaned, and analyzed using STATA software . The multilevel regression model was used to examine the effects of individual- and community-level factors and expressed as AOR with 95% CI., Results: The completion rate of a continuum of care via visit-based, content-based, and space dimensions was 33.1, 20, and 37.2%, respectively. The enabling factors were having information on maternal health services (AOR = 2.25; 95% CI: 1.11-4.55), iron and folic acid supplementation (AOR = 2.58; 95% CI: 1.37-4.86), tetanus toxoid vaccination during pregnancy (AOR = 2.21; 95% CI: 1.39-3.52), having pregnant-related problems (AOR = 2.1; 95% CI: 1.15-3.71), dry and stimulate newborn (AOR = 2.61; 95% CI: 1.42-4.77), appropriate cord care (AOR = 2.01; 95% CI: 1.07-3.79), and immunizing newborn (AOR = 6.9; 95% CI: 3.79-12.59), whereas risk factors were ever having a stillbirth (AOR = 0.52; 95% CI: 0.32-0.85) and delay of 1st ANC initiation at 4-6 months of pregnancy (AOR = 0.45; 95% CI: 0.3-0.68)., Conclusion: The completion rates via visit-based, content-based, and space dimensions were low. Different determinant factors which have a programmatically important implication were identified. Thus, interventions should focus on increasing women's awareness and improving the availability and accessibility of the whole packages of maternal health services to facilitate the completion rate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zelka, Yalew and Debelew.)

Background: Globally, around 4 million babies die within the first month of birth annually with more than 3 million stillbirths. Of them, 99% of newborn deaths and 98% of stillbirths occur in developing countries. Despite giving priority to maternal health services, adverse birth outcomes are still major public health problems in the study area. Hence, a continuum of care (CoC) is a core key strategy to overcome those challenges. The study conducted on the effectiveness of continuum of care in maternal health services was scarce in developing countries and not done in the study area. We aimed to assess the effectiveness of continuum of care and determinants of adverse birth outcomes., Methods: Community and health facility-linked prospective follow-up study designs were employed from March 2020 to January 2021 in Northwestern Ethiopia. A multistage clustered sampling technique was used to recruit 2198 pregnant women. Data were collected by using a semi-structured and pretested questionnaire. Collected data were coded, entered, cleaned, and analyzed by STATA 14. Multilevel logistic regression model was used to identify community and individual-level factors. Finally, propensity score matching was applied to determine the effectiveness of continuum of care., Results: The magnitude of adverse birth outcomes was 12.4% (95% CI 12.2-12.7): stillbirth (2.8%; 95% CI 2.7-3.0), neonatal mortality (3.1%; 95% CI 2.9-3.2), and neonatal morbidity (6.8%; 95% CI 6.6-7.0). Risk factors were poor household wealth (AOR = 3.3; 95% CI 1.07-10.23), pregnant-related maternal complications during pregnancy (AOR = 3.29; 95% CI 1.68-6.46), childbirth (AOR = 6.08; 95% CI 2.36-15.48), after childbirth (AOR = 5.24; 95% CI 2.23-12.33), an offensive odor of amniotic fluid (AOR = 3.04; 95% CI 1.37-6.75) and history of stillbirth (AOR = 4.2; 95% CI 1.78-9.93). Whereas, receiving iron-folic acid (AOR = 0.44; 95% CI 0.14-0.98), initiating breastfeeding within 1 h (AOR = 0.22; 95% CI 0.10-0.50) and immunizing newborn (AOR = 0.33; 95% CI 0.12-0.93) were protective factors. As treatment effect, completion of continuum of care via time dimension (β = - 0.03; 95% CI - 0.05, - 0.01) and space dimension (β = - 0.03; 95% CI - 0.04, - 0.01) were significantly reduce perinatal death., Conclusions: Adverse birth outcomes were high as compared with national targets. Completion of continuum of care is an effective intervention for reducing perinatal death. Efforts should be made to strengthen the continuum of care in maternal health services, iron supplementation, immunizing and early initiation of breastfeeding., (© 2022. The Author(s).)

Background: In Ethiopia, the proportion of mothers who attend the fourth antenatal care visit is lower than the proportion who attend the first visit. Although the reasons for these dropouts were investigated, few studies introduced interventions to promote the fourth antenatal care visit. Hence, the aim of this study was to assess the effectiveness of checklist-based box system intervention on improving fourth antenatal care visit., Method: This study employed a double-blind, parallel-group, two-arm cluster randomized controlled trial to compare the effectiveness of checklist-based box system intervention with the usual standard of care as a control arm. Study clusters are assigned to intervention and control arm in 1:1 allocation ratio using simple randomization technique. Pregnant mothers below 16 weeks of gestation were enrolled. Open data kit was used to collect data from the baseline and end-line surveys, and STATA version 15.0 was used to analyse the data. A difference-in-difference estimator was used to compare fourth antenatal care visit between the intervention and control groups across time. Mixed effect multi-level logistic regression was used to examine the relationship between the dependent and independent variables., Result: Data were collected from 2224 mothers who belong to 15 intervention and 15 control clusters. The difference in difference estimation resulted in a significant difference (26.1, 95%CI: 18-34%, p < 0.0001) between the intervention and control groups. Similarly, as compared to controls, the fourth antenatal care visit was found significantly higher in the intervention clusters (432 (85.2%) Vs. 297 (53.7%), p < 0.0001)/(AOR:5.69, 95% CI:4.14-7.82). Mothers who were knowledgeable about the services given during antenatal care visits (AOR: 2.31, 95% CI:1.65-3.24) and mothers who had a high level of social support (AOR:1.47, 95% CI: 1.06-2.04) were more likely to attend the fourth antenatal care visit., Conclusion: Implementation of checklist-based box system intervention resulted in a statistically significant effect in attendance of fourth antenatal care visit. Community-level variables were found to be more important in explaining variability in the fourth antenatal care visit. It is recommended that the intervention be implemented on a larger scale., Trial Registration: ClinicalTrials.gov , Retrospectively registered on 26/03/2019, with trial registration number-NCT03891030., (© 2022. The Author(s).)

Background: Sexual harassment among female employees in the hospitality industry is a complex phenomenon, and it has ramifications for employment, psychological, physical, and reproductive health. Nevertheless, our interpretation is constrained by a lack of agreement on its definition and measurement. As a result, hospitality workplaces require accurate tools that provide a detailed understanding of sexual harassment and inputs for action to limit adverse outcomes. Thus, this study aimed to develop a reliable and valid measure of female hospitality employees' perceptions, experiences, and coping features concerning sexual harassment., Methods: Item development, scale development, and scale evaluation were all parts of the design process. Following a round of feedback from the expert group, qualitative results, and a comprehensive literature review on related themes, item pools were created for the first version of the questionnaire. Pre-testing, survey administration, item reduction, and transformation of extracted latent factors of individual items into a unified and measurable construct were also performed. Field testing included five cognitive interviews with women who had experienced sexual harassment, a pre-test study of 30 women, and a survey of 345 women who worked in hospitality workplaces. Finally, tests for dimensionality, reliability, and validity were conducted., Results: In Bahir Dar, Ethiopia, 345 women working in the hospitality workplaces, with a mean age of 24.31 ± 4.30 years, took part in this study. The robust maximum likelihood estimation approach was used to do confirmatory factor analysis. The model's stability was determined by calculating the goodness of fit and the factorial invariance. Subsequently, the validity was confirmed. The findings supported the validity and reliability of the questionnaires designed for the target group. Therefore, the questionnaires can be used as research instruments., Conclusions: The sexual harassment perceptions, experiences and coping scales provide a locally verified method for assessing sexual harassment in Ethiopia by government authorities and local and international non-governmental organisations, which aid in providing necessary services and the evaluation of efforts aimed at improving workplace safety, workplace health, and psychosocial well-being., (© 2022. The Author(s).)

Background: Recognizing that adolescents face barriers in accessing services, may feel embarrassed, face stigma on sexual matters, or have concerns about judgmental providers, youth-friendly service (YFS) has been introduced to deliver health services that meet the sexual and reproductive health (SRH) needs of young people. Evidences on the role of YFS in addressing the socio-cultural norms influence unmarried adolescent SRH behaviour are limited. Therefore, this study explore whether the socio-cultural norms influencing adolescent SRH behaviour vary between youth friendly service program and non Program areas in West Gojjam Zone, North West Ethiopia., Methods: Qualitative case study design was employed to explore the socio-cultural context of adolescent sexuality. Purposive sampling was used to identify study participants. Data were collected from 112 participants both from YFS program and non-program areas using semi-structured in-depth interviews, key informants, and focus group discussions guides. A total of 18 key informant interviews, twelve FGDs and four in-depth interviews were conducted. Participants were comprised from unmarried adolescents, parents, religious leaders, community elders, health professionals, teachers, and unmarried adolescents who experienced SRH problem. Thematic analysis was used to summarized the data., Results: The socio-cultural norms related to adolescent sexuality in both YFS program and non-program areas indicated that the community is intolerant to premarital sex, SRH service utilization (eg., contraceptive use) by unmarried adolescent; and discourage SRH communication with unmarried adolescents. According to the participants, premarital sex and SRH service use were not accepted by the community. Moreover, participants believed that, having communication on SRH issues with unmarried adolescents are equivalent to encouraging them to initiate sex, therefore, should not be practiced., Conclusion: The socio-cultural norms influencing adolescent sexual behaviour were more or less the same between settings. In both areas, the socio-cultural context discourages YFS intervention like SRH communication and service use. Also, the YFS program does not modify the socio-cultural norm affecting adolescent sexuality. Therefore, the YFS interventions strategies should give due emphasis to the socially accepted sexual norms like sexual abstinence., (© 2022. The Author(s).)

Background: Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery., Method: The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery., Result: Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery., Conclusion: The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account., Trial Registration: ClinicalTrials.gov , NCT03891030 , Retrospectively registered on 26 March, 2019., (© 2021. The Author(s).)

Background: The period after childbirth poses a substantial risk both to the mother and the newborn. Yet, this period received less attention as compared to the cares provided during pregnancy and childbirth. Hence, this study aimed to assess the effectiveness of checklist-based box system intervention on improving three postnatal care visit utilization., Methods: A double blind, parallel group, two-arm cluster randomized controlled trial design was used to assess effectiveness of checklist-based box system intervention on improving third postnatal care visit. Pregnant mothers below 16 weeks of gestation were recruited from 15 intervention and 15 control clusters, which were randomized using simple randomization. Data from baseline and end line surveys were collected using open data kit and analyzed using STATA version 15.0. The status of three postnatal care visit between intervention and control groups over time was assessed using difference in difference estimator. The predictors of the outcome variable were then analysed using mixed effects multilevel logistic regression model., Result: Of 1200 mothers considered from each of the baseline and end line studies, this study included data from 1162 and 1062 mothers at baseline and end line surveys, respectively. As it is shown from the difference-in-difference estimation (14.8%, 95%CI 5.4-24.2%, p = 0.002) and the final model (AOR 4.45, 95%CI 2.31-8.54), checklist-based box system intervention was effective on improving third postnatal care visit. In addition, institutional delivery (AOR 1.62, 95%CI 1.15-2.28) and knowledge on danger signs during postnatal period (AOR 5.20, 95%CI 3.71-7.29) were found to be significant predictors of the outcome variable. In the contrary, mothers who got influenced by older generations of individuals were (AOR 0.32, 95%CI 0.18-0.59) less likely to attend three postnatal care visit., Conclusions: The implementation of checklist-based box system intervention was found to be effective in improving utilization of the recommended three postnatal care visits. The contribution of the trial on improving third postnatal care visit can be enhanced by minimizing practical level challenges, as well as expanding health messages to reach unreached mothers and significant others who can influence the mother's decision., Trial Registration: ClinicalTrials.gov, NCT03891030, Retrospectively registered on 26 March, 2019, https://clinicaltrials.gov/ct2/show/NCT03891030 ., (© 2021. The Author(s).)

Background : Health extension workers (HEWs) have substantial inputs to reduce maternal and newborn morbidity and mortality in Ethiopia. However, their perceptions and experiences were not well understood. Therefore, this study aimed to explore their perceptions and experiences on facilitators and barriers to maternal and newborn health services in Ethiopia. Methods : A descriptive qualitative study was conducted from 8-28 April 2021 in Oromia, Amhara and Southern Nation, Nationality, and People's Regional State of Ethiopia. Focused group discussions were made with purposively selected 60 HEWs. The data were transcribed verbatim and translated into English. An inductive thematic analysis was carried out using Atlas ti.7.1. The findings were presented in major themes, categories, and sub-categories with supporting quote(s). Results : The findings were categorized into two major themes (i.e., facilitators and barriers) and seven sub-themes. Community-related facilitators encompass awareness and behavior at the individual, family, and community. Significant others such as traditional birth attendants, religious leaders, women developmental armies, and kebele chairman substantially contributed to service utilization. Availability/access to infrastructures such as telephone, transportation services, and solar energy systems facilitated the service utilization. Furthermore, health facility-related facilitators include the availability of HEWs; free services; supervision and monitoring; maternity waiting rooms; and access to ambulance services. Maternal and newborn health services were affected by community-related barriers (i.e., distance, topography, religious and socio-cultural beliefs/practices, unpleasant rumors, etc.), health facility-related barriers (i.e., health worker's behaviors; lack of logistics; lack of adequate ambulance service, and placement and quality of health post), and infrastructure (i.e., lack or poor quality of road and lack of water). Conclusions : The HEWs perceived and experienced a wide range of facilitators and barriers that affected maternal and newborn health services. The study findings warrant that there was a disparity in behavioral factors (awareness, beliefs, and behaviors) among community members, including pregnant women. This underscores the need to design health education programs and conduct social and behavioral change communication interventions to address individuals, families, and the broader community to enhance maternal and newborn health service utilization. On the other hand, the health sector should put into practice the available strategies, and health workers provide services with empathy, compassion, and respect.

Background: Coping depicts how people detect, appraise, deal with, and learn from stressful encounters. Applying preferred coping strategies in various situations makes the issue a persistent agenda in hospitality workplaces, where women are unduly victims of sexual harassment. Thus, this study aimed to develop a context specific and data-driven coping strategy framework and barriers to coping strategy mechanisms for sexual harassment victimisation against women working in hospitality workplaces., Methods: A qualitative, grounded theory approach was used. Data were collected from female employees, managers, cashiers, and customers. Semi-structured focus-group discussions and in-depth interview guides were employed. A constant comparative approach was used to describe the meanings and summarise the data. Data were coded, categorised, and networks were visualised using the ATLAS ti version 8.4.24 software package., Results: In this study, six focus group discussions, ten in-depth interviews, and thirteen key informant interviews were conducted. The provided context specific coping strategic framework consists of four strictly interconnected dimensions with corresponding barriers practised by female hospitality employees. These were normalisation, engagement, help-seeking, and detachment. The normalisation dimension encompasses silence, acceptance, denial, refusal, grief, and tolerance. Confrontation, negotiation, retaliation/threatening, and discrimination of the perpetrators were included in the engagement dimension. Elements such as discussing with friends, complaining with supervisors, consulting professionals, and accusing perpetrators were in the help-seeking dimension. Lastly, job-hopping, job withdrawal, work withdrawal, and distancing were in the detachment dimension. Some barriers deterred all dimensions, some factors facilitated normalisation, and some adverse outcomes ended the engagement dimension., Conclusion: Our study demonstrated that the coping capacities of sexual harassment among female hospitality employees have been apparent, providing space for stakeholders to intervene. Our new coping strategy framework can serve as a valuable guide for designing context-specific interventions. These interventions could help women and stakeholders prevent sexual harassment, decrease barriers, and alleviate these effects., (© 2021. The Author(s).)

Background: Workplace sexual harassment is a public health problem that depends on gender, context, and perceived ideology. Although studies have documented the prevalence and consequences of workplace sexual harassment worldwide, victims' perceptions and experiences are still poorly understood in low and middle-income countries, particularly Ethiopia. Female workers in the hospitality industry, including hotels, bars, restaurants, fast-food restaurants, and cafeterias, are particularly affected. Hence, this study aimed to explore sexual harassment perceptions and experiences among women working in these workplaces., Methods: An exploratory qualitative study was conducted from 1 January to 30 August 2019. Data were collected from female employees and key informants from several hospitality workplaces in Bahir Dar City. Data were collected through focus group discussions, in-depth interviews, and key-informant interviews. Women who experienced sexual harassment were selected using the snowball method, and key informants were recruited purposefully. Six focus group discussions, ten in-depth interviews, and thirteen key informant interviews were conducted. Data were analysed using the ATLAS ti version 8.4.24., Results: In this study, most participants perceived that sexual harassment is pressuring, threatening, touching, abducting sexual advances, and experiencing verbal, physical, and non-verbal types. Similarly, the perceived risk factors were related to the organisations, the customers, and the victims, with the consequences being work-related, health-related, financial-related, and family-related., Conclusions: Workplace sexual harassment in hospitality workplaces is poorly understood, but many women experience it. A variety of factors also caused it, and it influenced both organisations and people. Public awareness programs, pre-service preparation, in-service training, prevention, and psychosocial support are needed. Similarly, policies and strategies for the organisations should be developed and implemented.

Despite highly effective modern contraceptive methods (both short and long acting) are made widely available and accessible globally, their utilization remains low among young women in low- and middle-income countries, including Ethiopia. Hence, this study is aimed at determining its status and identifying the determinant factors by using nationally representative data. A multilevel analysis of the nationwide Performance Monitoring for Action 2018 of Ethiopia round 6 data, collected from June to July, 2018, was conducted. A total of 982 both married and unmarried young women (15-24) were included in the analysis. Descriptive statistics was used to describe the status of contraceptive method utilization and unmet need across regions. A mixed-effects multilevel logistic regression model was used to identify the determinants of the contraceptive method utilization. Adjusted odds ratios with corresponding 95% confidence intervals were used to show the significance of the associations at p < 0.05. The status of contraceptive method utilization was 54.8% (95% CI: 51.7%, 57.9%), and 18.6% (95% CI: 16.3%, 21.2%) had unmet need. Afar (12.3%), Harari (12.5%), and Ethiopian Somali (20.0%) regions had the lowest contraceptive method utilization. Wealth quintiles and religion were the higher level variables affecting contraceptive method utilization among the young women. Age, marital status, parity, future birth intention, and knowledge of contraceptive methods were the individual level factors identified as determinants of contraceptive method use among the young women. In conclusion, the status of contraceptive method utilization among the young women in Ethiopia is promising as compared to the national target of 55% for 2020; however, still high unmet need exists. The factors also exist both at the contextual and at individual levels. Hence, multilevel interventions need to be in place giving special emphasis to the low performing regions. Besides, region-specific behavioral interventions and family planning services that will be able to reach the young women need to be designed., Competing Interests: The authors declared that they have no competing interests., (Copyright © 2021 Gurmesa Tura Debelew and Mahilet Berhanu Habte.)

Background: Workplace sexual violence is a significant public health problem in low and middle-income countries, including Ethiopia. However, except for individual studies with varying prevalence rates in different occupations, there are no national prevalence studies conducted in workplace settings in Ethiopia. Appropriate estimation of the problem is essential to formulate health service plans most fitted for workplaces. Hence, this review and meta-analysis intended to estimate the national pooled prevalence of workplace sexual violence in Ethiopia., Methods: The databases used were; PubMed, Google Scholar, CINAHL, and African Journals Online. For a critical appraisal of the papers, we used the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument for cross-sectional studies. The meta-analysis was conducted using comprehensive meta-analysis and MetaXL software. Descriptive information of studies was presented in narrative form, and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were employed to test heterogeneity across studies. A random-effect model computed the pooled estimate prevalence with 95% confidence intervals., Results: The pooled prevalence of workplace sexual violence was 22% (95% CI 17%, 28%). The pooled prevalence was 14.1% (95% CI 10.4%, 18.9%) for attempted rape, 8% (95% CI 5.7%, 11.1%) for rape, and 33.2% (95% CI 24.1%, 43.7%) for sexual harassment. The pooled prevalence was the highest among female university staffs 49% (95% CI 45%, 56%), and among commercial sex workers 28% (95% CI 3%, 59%)., Conclusions: This analysis revealed that the prevalence of sexual violence and sexual harassment in Ethiopian workplaces is high. It was also exceptionally high among female faculty staff, commercial sex workers, and workplaces in Tigray National regional state. Thus, concerned stakeholders must design and implement effective interventions to prevent workplace sexual violence in workplaces in Ethiopia and provide necessary support and care to the victims.

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p < 0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR = 0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR = 0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR = 0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR = 3.38; 95% CI: 1.90, 6.00), twin births (AOR = 5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR = 3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR = 4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications., Competing Interests: The author declared that he has no competing interests., (Copyright © 2020 Gurmesa Tura Debelew.)

Objectives: The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality., Design: Cross sectional., Setting: Healthcare facilities providing ANC services in Northwest Ethiopia., Participants: 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities., Outcome Measures: The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI., Results: The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR 1 =aOR 2 ; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR 1 = aOR 2 ; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR 1 = aOR 2 ; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR 1 = aOR 2 ; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction., Conclusions: The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Risky sexual behavior established during adolescence adversely affect young people's health and well-being. Youth-friendly services (YFS) programs are believed to improve the sexual and reproductive health of adolescents. Little is known about the effect of YFS programs on adolescents' sexual behavior in Ethiopia. Therefore, this study assessed the sexual behavior of unmarried adolescents in YFS-program and nonprogram areas and factors contributing to their sexual behavior in West Gojjam Zone, Northwest Ethiopia., Methods: This community-based comparative cross-sectional study was conducted among 1,125 randomly selected unmarried adolescents (545 from program areas and 580 from nonprogram areas) in June 2018. Data were collected in face-to-face interviews using a pretested questionnaire and analyzed using SPSS version 21. Between groups, comparisons were made using χ 2 and t -tests. A hierarchical logistic regression model was employed to identify important variables explaining risky sexual behavior., Results: Of all respondents, 305 (27.1%) had risky sexual behavior, which was comparable between the YFS-program and nonprogram areas (25.0% vs 29.1%, p =0.12). Including YFS program-related variables in the hierarchical regression model did not improve the explanation of risky sexual behavior over the individual attributes. On the other hand, including interpersonal-related variables (eg, with parents) significantly improved the explanation of risky sexual behavior over and above individual attributes and YFS program-related variables. A point increase in parent-adolescent communication score reduced risky sexual behavior by 20% (AOR 0.80, 95% CI 0.75-0.85). Being female, being older, having knowledge on family planning and HIV, out of school, and watching pornography were associated with higher odds of engaging in risky sexual behavior., Conclusion: Risky sexual behavior was comparable between settings. Parent-adolescent communication about sexual and reproductive health issues is more important in predicting adolescents' risky sexual behavior than other variables. Therefore, interventions should give emphasis to parent-adolescent communication to reduce adolescents' risky sexual behavior., Competing Interests: The authors declare that they have no competing interests., (© 2020 Mekonnen Munea et al.)

Background: The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women's service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia., Methods: A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval., Results: The study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care., Conclusions: The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.

Background: Although there has been momentum in implementing sexual and reproductive health services in Ethiopia, young people remain underserved despite their demonstrated needs. Quality care improves utilization of health service and increases the likelihood of obtaining ongoing care. However, little is known about the quality of youth-friendly sexual and reproductive health service in Ethiopia. Therefore, this study sought to investigate the quality of youth-friendly sexual and reproductive health service in West Gojjam Zone, North West Ethiopia., Methods: Health facility-based cross-sectional study was conducted in West Gojjam zone in 2018 to assess the quality of the service using the Donabedian model. The assessment was done through the triangulation of multiple methods: simulated client study; structured interviews with service providers; observations; and key informant interview with providers and expertise. Fifty-four visits were made to 18 randomly selected health facilities by three simulated clients trained to present three different scenarios (i.e., adolescent with sexually transmitted infection, pregnancy test request and a lady with dry cough). Data were entered and analyzed using SPSS version 21. Facility visit score of ≥ 75% in all quality component categorized as "good quality" otherwise classified as performing below the standard. Thematic analysis was done to analyze qualitative data., Results: In this study, none of the health facilities achieved ≥ 75% in the three components of quality measurement. From 18 health facilities, 6(33.3%) provided low quality in all domains. Process component, which measures client-provider interaction and privacy/confidentiality, was the most compromised one. However, a promising result was reported in the input quality that measured the availability of trained providers, drugs, and supplies. The presence of community-based health insurance and age driven comprehensive youth-friendly service delivery approach were identified as challenges to deliver quality services., Conclusions: The quality of the service ranges from low to medium, with adolescent related elements performing poorly. Minor renovations of health facilities, training on client handling, and contextual modifying the age driven youth-friendly service approach may improve the quality of the services.

Background: Maternal mortality is still high in Ethiopia. Antenatal care, the use of skilled delivery and postnatal care are key maternal health care services that can significantly reduce maternal mortality. However, in low- and middle-income countries, including Ethiopia, utilization of these key services is limited, and preventive, promotive and curative services are not provided as per the recommendations. The aim of this study is to examine the effectiveness of checklist-based box system interventions on improving maternal health service utilization., Methods: A community-level, cluster-randomized controlled trial will be conducted to compare the effectiveness of checklist-based box system interventions over the routine standard of care as a control arm. The intervention will use a health-extension program provided by health extension workers and midwives using a special type of health education scheduling box placed at health posts and a service utilization monitoring box placed at health centers. For this, 1200 pregnant mothers at below 16 weeks of gestation will be recruited from 30 clusters. Suspected pregnant mothers will be identified through a community survey and linked to the nearby health center. With effective communication between health centers and health posts, dropout-tracing mechanisms are implemented to help mothers resume service utilization. Data will be collected using an open data kit and analyzed using STATA version 13.0. Data will be analyzed by the intention-to-treat analysis. Risk ratios will be computed at the cluster level and the summary will be compared using t tests. Outcomes between intervention and control groups will be compared with random effects logistic regression models. Achieving four antenatal care visits, health facility delivery, and postnatal care visits at 6 weeks after delivery were treated as primary outcomes for this study., Discussion: We expect that the study will generate evidence on the effectiveness of checklist-based box system interventions on improving utilization of maternal health care service that will produce inputs for related policies in Ethiopia., Trial Registration: ClinicalTrials.gov, NCT03891030. Retrospectively registered on 26 March 2019.

Introduction: The first year after birth is an ideal time to offer contraception services, as many women have many opportunities to be in contact with the health care system. Nevertheless, a large number of postpartum women in developing countries do not use the service owing to the interplay of factors operating at various stages. Therefore, this study aimed to assess predictors of modern contraceptive use in the extended postpartum period., Methods: A community based retrospective cross-sectional study was done among 1281 women who gave birth within 12 months preceding the survey. Kaplan-Meier plots and log rank tests were used to explore the rate of modern contraceptive use. The Weibull regression survival model with multivariate frailty was employed to identify the predictors of time to contraception., Results: Of the respondents, 59.1% (95% CI: 56.8%-62.2%) had started using modern contraceptive methods within 12 months after birth. By the second month after birth, only 11.1 percent of the women surveyed started to use a contraceptive method, which increased steadily to 25.9%, 37.7%, and 59.5% at 6, 9, and 12 months, respectively. The most preferred contraceptive method was injectable (71.5%), followed by implants (21.5%). Women's education (aHR = 1.29; 95%CI: 1.02, 1.66), four or more antenatal care (aHR  =  1.59; 95% CI: 1.22, 2.06), early initiation of antenatal care (aHR = 2.03; 95% CI: 1.28, 3.21), and early postnatal checkup (aHR  =  1.39; 95% CI: 1.12, 1.73) were statistically significant predictors of earlier initiation of modern contraceptive methods., Conclusions: A substantial proportion of women did not use modern contraceptive methods in the first year after birth. Maternal services were found to be the sole predictors in postpartum contraceptive use. Findings suggest the importance of linking postpartum family planning along the continuum of care. The observed heterogeneity at cluster level also urges the need of disaggregating data for decision-making., Competing Interests: The authors have declared that no competing interests exist.

Background: Adverse birth outcome which attributes to most perinatal deaths is an important indicator of child health and survival. Hence, this study aims to identify determinants of adverse birth outcome among mothers who gave birth in public hospitals of Tigrai region, North Ethiopia., Methods: Hospital based case-control study was conducted in Tigrai region, Ethiopia between December 2015 and January 2016 among 405 (135 cases and 270 controls) consecutively selected mothers who gave birth in four randomly selected public Hospitals. Mothers with adverse birth outcome (preterm birth; < 37 gestational weeks at birth, low birth weight; < 2.5 kg at birth, or still birth) were the cases while mothers without adverse birth outcome (live birth, birth weight ≥ 2.5 kg and of ≥37 gestational weeks at birth) were the controls. Data were collected by interview and reviewing medical records using structured questionnaire. The collected data were entered into database using EPI info version 3.5.1 then exported to SPSS version 21 for analysis. Finally, multivariate logistic regression was used to identify determinants of adverse birth outcomes at P value < 0.05., Result: The mean age of cases and controls was 27.3 (SD = 6.6) and 26.14 (SD = 4.9) years, respectively. In a multivariate analysis; less than four antenatal care visits [AOR = 4.35, 95% CI: 1.15-13.50], not receiving dietary counseling [AOR = 11.24, 95% CI: 3.92-36.60], not using family planning methods [AOR = 4.06, 95% CI:1.35-17.34], less than 24 months inter pregnancy interval [AOR = 5.21, 95% CI: 1.89-13.86], and less than 11 g/dl hemoglobin level [AOR = 4.86, 95% CI: 1.83-14.01] were significantly associated with adverse birth outcomes., Conclusion and Recommendation: The number of antenatal care visits, ever use of family planning methods, not receiving dietary counseling during antenatal care follow up visits, short inter-pregnancy interval, and low hemoglobin level were identified as independent determinants of adverse birth outcome. A concerted effort should be taken improve family planning use, and antenatal care follow-up with special emphasis to maternal nutrition to prevent adverse birth outcomes.

Background: Antiretroviral treatment (ART) has been shown to enhance the survival of people living with HIV worldwide. In Ethiopia, the number of ART users has increased from 47,422 in 2005 to 703,516 in 2017; yet, early mortality of patients has presented challenges to the success of the ART program. Because of gender roles, it is assumed that females are at risk of dying earlier after the start of the medications. Hence, this study aimed to assess the sex difference in the survival status among the ART users., Methods: A retrospective cohort study was conducted in March 2017 among sample of 687 ART users registered from 2010 to 2015. Data were extracted from patient records by using a structured checklist. The extracted data were analyzed by STATA version 13. Survival analysis and Cox regression were used to determine survival status and identify associated factors., Results: Among 685 reviewed records of ART users, 20 males and 64 females died in the 5 years period of ART initiation. This makes the overall 5 years survival rate of 84.23%. Females had lower survival probability (80.10%) as compared to males (91.18%) (Adjusted Hazard Ratio (AHR) = 1.79; 95% CI: 1.04, 3.06). Divorced individuals as compared to married (AHR = 2.09; 95% CI: 1.10, 3.97), individuals with less education (AHR = 2.54 95% CI: 1.29, 4.98) or those who attended only primary education (AHR = 2.07; 95% CI: 1.18, 3.65) as compared to those who attended secondary or above had low survival probability. Those who never disclosed their HIV status (AHR = 3.62; 95% CI: 1.25, 10.46) as compared to disclosed, bedridden individuals as compared to normal functional status (AHR = 2.7; 95% CI: 1.24, 5.89) and those who had tuberculosis (TB)-co infection (AHR = 2.60; 1.48, 4.45) had lower rates of survival., Conclusion: Females were at higher risk of dying within 5 years of ART initiation as compared to males. Hence, intervention to further reduce mortality should take sex differences into account. Behavioral interventions and HIV counseling service should also be strengthened to improve rate of disclosure and functional status as well as reduce TB co-infections.

Introduction: Birth preparedness and complication readiness have been considered as comprehensive strategy aimed at promoting the timely utilization of skilled maternal health care. However, its status and affecting factors have not been well studied at different levels in the study area. Thus, this study was aimed to fill this gap by conducting community based study., Methods: A cross-sectional study was conducted among randomly selected 3612 pregnant women from June-September 2012. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Mixed-effects multilevel logistic regression model was used to identify factors affecting birth preparedness and complication readiness., Results: The status of birth preparedness and complication readiness was 23.3% (95% CI: 21.8%, 24.9%). Being in urban residence and having health center within two hours distance were among the higher level factors increasing birth preparedness and complication readiness. Educational status of primary or above, husband's occupation of employed or merchant, third or above wealth quintiles, knowledge of key danger signs during labor, attitude and frequency of antenatal care visits were among the lower level factors found to increase the likelihood of preparation for birth and its complications., Conclusion: The status of birth preparedness and complication readiness was low in the study area. Both community level and individual level factors had important program implications. Socio demographic, economic, knowledge of key danger signs, attitude and antenatal care use were identified as associated factors. Improving antenatal care, giving special emphasis to danger signs and community based health education are recommended.

Background: Ethiopia is among the countries with the highest neonatal mortality with the rate of 37 deaths per 1000 live births. In spite of many efforts by the government and other partners, non-significant decline has been achieved in the last 15 years. Thus, identifying the determinants and causes are very crucial for policy and program improvement. However, studies are scarce in the country in general and in Jimma zone in particular., Objective: To identify the determinants and causes of neonatal mortality in Jimma Zone, Southwest Ethiopia., Methods: A prospective follow-up study was conducted among 3463 neonates from September 2012 to December 2013. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Verbal autopsies were conducted to identify causes of neonatal death. Mixed-effects multilevel logistic regression model was used to identify determinants of neonatal mortality., Results: The status of neonatal mortality rate was 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Though significant variation existed between clusters in relation to neonatal mortality, cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestation age at birth, premature rupture of membrane, complication during labor, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality accounting for 93%., Conclusions: This study revealed high status of neonatal mortality in the study area. Higher-level variables had less importance in determining neonatal mortality. Individual level variables related to care during pregnancy, intra-partum complications and care, neonatal conditions and the immediate neonatal care practices were identified as determinant factors. Improving antenatal care, intra-partum care and immediate neonatal care are recommended.