Study area and period
The study was conducted in Jimma University Medical Centre (JUMC) from October to December 2016. JUMC is located in Jimma town, 352 Km Southwest of Addis Ababa. JUMC is one of teaching medical centers in the country giving services to people living in Jimma zone and serving as a referral in Southwest Ethiopia. It is also serving as a clinical postgraduate specialty teaching hospital for Obstetrics and Gynecology, Internal Medicine, Pediatrics & Child Health since 2005 and for Ophthalmology, Anesthesiology, and Surgery since 2007. Department of Obstetrics and Gynecology had 8 consultant Obstetricians & Gynecologists and 33 residents (year I – IV), some midwives and nurses providing services. There were also final year under-graduate medicine students (Medical Interns), midwifery and nursing students providing services under supervision.
Study design
A quantitative cross-sectional study using interviewer-administered questionnaire was conducted to measure the prevalence of disrespect and abuse during facility-based childbirth and associated factors.
Study population
All women who gave birth vaginally at JUMC during the study period and have been given consent were recruited for the study. Mothers who gave birth with cesarean section were excluded for two reasons; to rule out the effect of anesthesia, and to minimize the time lapse between childbirth and time of interview.
Sample size determination and sampling technique
A single population proportion formula was used to estimate the sample size with assumptions of 78.6% prevalence of any D&A [21], 5% margin of error, 95% confidence level and 10% non-response rate.
$$ \mathrm{n}=\frac{\left(\mathrm{Z}\upalpha /2\right)\ast \left(\mathrm{P}\ast \mathrm{Q}\right)}{\mathrm{d}2}=\frac{{\left(1.96\ \right)}^2\ast \left(0.786\ast 0.214\right)}{(0.05)2}=258 $$
Adding 10% for non-response, the final sample size became 284. Study participants were selected by convenient consecutive sampling technique until the required sample size was achieved.
Variables
Dependent variables: prevalence of disrespect and abuse (D&A).
Independent variables: socio-demographic/economic characteristics [age, religion, ethnicity, marital status, educational status, address (Jimma town, Out of Jimma town), monthly income] and obstetric and service-related factors [parity, ANC use, history of institutional delivery, health provider (sex, number), length of stay, complication during delivery].
Data collection and measurement
Data were collected using structured questionnaire prepared after reviewing related literature. The questionnaire was translated into local languages (Amharic and Afan Oromo) and back-translated to English to ensure consistency of translation. A total of 39 questions (16 background and 23 D&A questions) comprised the questionnaire and most questions were closed-ended (yes/no or multiple choice) (Table S1). The average time required to complete the questionnaire was 30 min.
Data were collected by face-to-face interview (the data collectors asked the women the questions and they logged their responses) immediately prior to discharge from the health facility after childbirth. Data collection was delayed until the time of discharge from the hospital to reduce social desirability and recall biases. The soonest data collection was 6 h after childbirth. The interview was conducted in a quiet, private area of the unit with one woman and one interviewer. Four female nurses not involved in the women’s care were recruited for data collection and trained for one day on how to use the data collection tool before embarking on data collection. Disrespect and abuse was measured by 23 verification criteria under major seven categories. The tool was adapted from the Maternal and Child Health Integrated Program (MCHIP) who developed it as part of its respectful maternity care toolkit [25].
Data processing and analysis
Data were entered into EpiInfo and analyzed using SPSS version 20 software. Descriptive statistics were computed. Adequacies of cells were checked in chi-square test for each independent variable. Bivariate binary logistic regression was performed for variables which had adequate cell count. A p-value < 0.05 and clinical importance of variables were used to select candidate variables for multivariable logistic regression to avoid over-fitting of the model. Multicollinearity among independent variables was checked in a linear regression model. After multivariable logistic regression, a p-value < 0.05 was used to declare statistical significance. Adjusted Odds Ratio (AOR) and 95% CI were used to report the strength of association between outcome (any D&A) and independent variables.
Data quality control
Questionnaire translated to local language was back-translated to ensure consistency of translation. Data collectors were trained and data collection tool was pre-tested on 5% of a sample before actual data collection. The supervisor checked filled questionnaires for accuracy and completeness on a daily basis. The supervisor replaced grossly incomplete filled questionnaires if the participants had left the hospital or returned to data collectors to fill the incomplete sections if the participants not yet left the hospital.
Dissemination plan
The finding of this study was submitted to Research and Graduate Studies Coordinating Office, Jimma University.
Operational definition
● Skilled providers or skilled health personnel or skilled birth attendants are health professionals who are educated and trained to national or international standards [2]. They are qualified to:
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(i)
Give evidence-based, human-rights-based, quality, socio-culturally acceptable and self-respectful care to women and newborns;
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(ii)
Help with physiological processes during labor and delivery to ensure a clean and positive childbirth experience;
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(iii)
Diagnose and treat or refer women and/or newborns with complications.
● For a specific category of abuse and disrespect with more than one verification criterion, a woman was labeled “abused and disrespected” in that category if she was abused and disrespected in at least one of the verification criteria during childbirth.
● If a mother was identified as disrespected and abused in at least one of the seven categories, she was considered “disrespected and abused”.