Maternal deaths in Ethiopia are mainly due to complications of pregnancy and delivery. The socio-cultural contexts under which these pregnancies and deliveries occur that pave the way for these complications and mortality. In Ethiopia, the maternal mortality ratio had been 353/100,000 live births in 2015. Therefore, the purposes of this study were to examine, and describe the socio-cultural determinants and missed opportunities of maternal health care in Eastern Ethiopia. The study was conducted in selected districts of Grawa, Chelenko and Haramaya Woreda, East Hararghe, Oromia National Regional State, Ethiopia. A community-based survey involving pregnant women in their third trimester and women who gave birth in the last five years, husbands, mothers-in-law, sisters-in-law, health workers, religious and community leaders were conducted between September up to December 2017. A systematic sampling technique was used to get a total of 422 study participants for quantitative and 24 FGD participants to qualitative study were adopted using triangulation of data collection. Pre-tested and structured questionnaire was used to collect relevant data. The main instrument used for quantitative data collection was the structured questionnaire, specifically in-depth interview methods. Bivariate and Multivariate data analysis were performed using SPSS version 25.0 and focus group discussion (FGD) was used to collect qualitative information and the information was analysed using thematic analysis method based on Atlas.ti version 8.2 statistical software packages. The study revealed that among 359 (85%) pregnant women who planned for ANC visit, 16 (4.5%) received ANC four or more times during their last pregnancies, the respondents (81.3%) claimed that they were taken care of by skilled delivery attendant during delivery, 18.5% of them said that they delivered at home and 71.1% of them received medical care after delivery (missed opportunity). Women in the age group 15-24 years [AOR: 1.18, 95%CI: 1.18 (0.37, 3.74)], primary school [AOR: 4.09, 95%CI: 4.09(0.96, 15.50)], women intended their last pregnancy [AOR: 3.1, 95% CI: 0.32(0.11, 0.94)], and women living in urban residences [AOR: 1.2, 95%CI: 0.86(0.25, 2.95)] were significant predictors of unplanned home delivery. For optimal and effective interventions of maternal health services utilization, provisions should be made for better women‘s education, family planning, community-based health insurance, health facilities access, job opportunity and women empowerment; provisions should also be made for creating income generating activities to women. Strengthening village women‘s army wing, refreshing and enabling health extension workers and traditional birth attendants. What is more, optimal measures should be taken to discourage traditional practices such as female genital mutilation, polygamy, violence against women and teenage marriage. Finally, free maternal and child health services should be advocated for so that the gap in maternal healthcare services is bridged. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

PURPOSE: The main aim of this study was to systematically assess the factors that influence maternal health care services utilization by women in Awash Fentale woreda (district), Ethiopia. DESIGN: A quantitative, descriptive, and cross-sectional design was selected as the methodology for this study. METHOD: Data were collected using a structured questionnaire administered to 422 women aged 15 to 49 years through a stratified sampling technique. Data was entered, analyzed and interpreted using SPSS computer program. Binary logistic regression model was used to identify the factors that influence maternal health care services utilization. RESULTS: The findings of this research indicated that not attending school, not watching television, and not owning a Bajaj (three-tire motorbike) significantly influenced low utilization of antenatal care (ANC) visits, while exposure to media, including reading newspapers, was positively associated with the adequacy of ANC visits. Similarly, factors such as not attending school and not watching television at all influenced delivery care (DC) services utilization negatively, while husbands’ low income and not watching television at all were negatively associated with postnatal care (PNC) service utilization. This research study found that 80 (19%) of the respondents preferred to give birth at home and the remaining 342 (81%) preferred a health facility for their delivery services. In addition, 43% of the respondents were not satisfied with the care and attention given by the health care provider and approximately 52% of the respondents were not satisfied with the cleanliness of the health facilities. It was also illustrated in this study that family members’ influence was one of the major barriers identified for DC services utilization. Conclusion: Policy making, planning, and implementation should focus on factors that influence maternal health care services utilization and barriers to DC services. In order to increase the utilization of maternal health care services by women with low levels of educational status, husbands ’low income or wealth quintile, and low media exposure, strategies were developed by the researcher. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

The aim of this study was to identify factors affecting facility-based delivery with the purpose of developing a framework for the promotion of facility-based delivery among women living in rural Ethiopia. Explanatory mixed methods design, comprising of four phases-the descriptive (quantitative), explorative (qualitative), meta-inference and development phases was employed. The quantitative phase was conducted first using a structured questionnaire to identify the variables influencing facility-based delivery care seeking behaviour. A sample of 389 responses were used for data analysis using Structural Equation Modeling. The quantitative phase conducted next to explain the determinants that contributed to influencing facility-based delivery care seeking behaviour. Sixteen participants who were involved the first phase were involved in the follow-up second phase. As illustrated by the results of the study, the majority of women in the study areas continued to deliver at home, putting themselves at risk of dying from pregnancy related causes. As highlighted by the key findings from the quantitative and qualitative data of this study, the most influential factors in predicting and explaining delivery care seeking behaviour are response efficacy, attitude, subjective norm, and perceived behavioural control which are shaped by mothers’ confidence in the outcome, quality of care, interpersonal relations with family members, willingness to conform, access to services, and their decision making power. The way these findings emphasized the factors attitude, subjective norm and perceived behavioural control were consistent with the Theory of Planned Behaviour, while the significance of response efficacy was in line with Protection Motivation Theory. The study developed a framework to help promote facility-based delivery among mothers living in rural Ethiopia. / Health Studies / D. Litt. et Phil. (Health Studies)

This study aimed to assess the magnitude, trends and determinants of intrapartum stillbirths in the public health facilities in Addis Ababa. A case-control study design was used along with quantitative data collection methods. Obstetric care data on key variables were collected from medical records of 728 cases and 1551 controls in the public health facilities during July 1, 2010 and June 30, 2015. Data were analysed using SPSS version 24 to determine associations and risk factors against intrapartum stillbirth. HMIS data from different sources were further analysed for the same period to determine trends of stillbirth in the public health facilities of Addis Ababa. Findings from this study showed a staggering high prevalence of stillbirth at an average rate of 28 per 1000 births during the period 2010-2015. This figure was comparable with the population level prevalence of prenatal death in Addis Ababa which was 30 per 1000 birth (Central Statistical Agency 2011:115). No statistically significant associations were revealed against the effects of maternal medical conditions including diabetes, hypertension, cardiac and renal diseases and key socio-demographic variables including age, parity and marital status, and intrapartum stillbirth. On the contrary, HIV and syphilis infections, foetal presentations, multiple pregnancy and the frequency of ANC visits during the index pregnancy had statistically significant associations with intrapartum stillbirth. Furthermore, low FHR, non-vertex foetal presentations and ruptured cervical membrane on admission to labour were among risk factors for intrapartum stillbirth. Similarly, women in the stillbirth group received substandard care regarding the timely assessment of foetal decent, cervical dilatation, labour induction, and episiotomy care compared to women in the livebirth group. Obstetrical complications including obstructed labour, eclampsia and preeclampsia were more common among women in the intrapartum stillbirth group indicating that the above variables were key determinant of intrapartum stillbirth. These findings suggest that poor quality of obstetric care during labour and childbirth were the underlying risk factors for intrapartum stillbirth. In conclusion, strategies to overhaul the obstetric care practices in the public health facilities through skills building, accurate use of labour monitoring tools, close supervisions, accurate classification of stillbirth, proper documentation, and ongoing research efforts. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English with abstracts and keywords in English and Setswana / Aim: The purpose of the research was to determine the magnitude and factors associated with gestational diabetes mellitus (GDM), and to explore the experiences of gynaecologists/obstetricians and midwives in the monitoring and prevention of GDM- related adverse maternal outcomes in order to propose best practice guidelines which may be implemented to overcome the problem. Methods: A concurrent mixed methods design was used. Participants for the quantitative study were selected using systematic random sampling, with purposive sampling being used for the qualitative part of the study. A total of 2000 medical records were reviewed using a checklist, in addition to which 7 gynaecologists/obstetricians and 12 midwives were interviewed using an in-depth interview guide. Descriptive and inferential statistics were used for the quantitative part, while Colaizzi’s manual qualitative data analysis method wasused for the qualitative part of the study. Findings: The magnitude of GDM was found to be 2.2%. Age and family history of diabetes mellitus were found to be factors associated with GDM (at p < 0.001). Other factors such as obesity, previous GDM, previous history of fetal macrosomia and multiple gestations were identified by respondents as factors related with GDM. In addition, the study explored the experiences of health professionals (HPs) in the monitoring and prevention of adverse maternal outcomes related to GDM, with the results showing some differences in screening and diagnostic techniques. It was also shown that lifestyle modification (physical exercise, diet management) and medication were utilised for managing women with GDM. In this regard, all the HPs agreed that creating awareness is the best intervention for preventing GDM as well as its adverse maternal outcomes. Conclusions: The magnitude of GDM is increasing, and much needs to be done to draw attention to the burden that GDM places on the health of pregnant women and the public. Since GDM is not considered a public health problem, little is being done to monitor the condition and its adverse maternal outcomes. It is hoped that the best practice guidelines developed from this research study may assist in reducing the adverse maternal outcomes of GDM in Ethiopia / Maikaelelo: Lebaka la patlisiso e ne e le go tlhotlhomisa go nna teng le mabaka a a golaganeng le bolwetsi jwa sukiri jwa baimana (GDM), le go tlhotlhomisa maitemogelo a dingaka tsa malwetsi a basadi (gynaeologists/ obstetricians) le babelegisi mo go tlhokomeleng le go thibeleng ditlamorago tse di maswe mo baimaneng tse di amanang le GDM gore go tshitshinngwe dintlhakaelo tse di gaisang tse di ka diragadiwang go fenya bothata. Mekgwa: Go dirisitswe thadiso ya mekgwa e e tlhakantsweng. Banni-le-seabe ba thutopatlisiso e e lebelelang dipalopalo ba ne ba tlhophiwa go diriswa go tlhopha sampole ka go se latele thulaganyo, mme go tlhopha sampole ka maikaelelo go ne ga diriswa mo karolong ya thutopatlisiso e e lebelelang mabaka. Go sekasekilwe palogotlhe ya direkoto tsa kalafi tse 2 000 go diriswa lenanetshekatsheko, mme mo godimo ga moo, go ne ga nna le dipotsolotso le dingaka tsa malwetsi a basadi di le supa le babelegisi ba le 12 go diriswa kaedi ya dipotsolotso tse di tseneletseng. Dipalopalo tse di tlhalosang le tse go sweditsweng ka tsona di ne tsa diriswa mo karolong ya dipalopalo ya thutopatlisiso, fa go dirisitswe mokgwa wa ga Colaizi wa tokololo ya data ya mabaka mo karolong e e lebelelang mabaka. Diphitlhelelo: Go nna teng ga GDM go ne ga fitlhelwa e le 2.2%. Dingwaga le hisetori ya bolwetsi jwa sukiri ya baimana mo lelapeng di fitlhetswe e le dintlha tse di golaganeng le GDM (ka p < 0.001). Dintlha dingwe, jaaka go nona phetelela, GDM mo nakong e e fetileng, go nna teng ga macrosomia ya masea mo nakong e e fetileng le boimana jwa masea a feta bongwe di ne tsa supiwa ke batsibogi jaaka dintlha tse di golaganeng le GDM. Go tlaleletsa foo, thuto e ne ya sekaseka maitemogelo a baporofešenale ba boitekanelo (HPs) mo tlhokomelong le thibelo ya ditlamorago tse di sa siamang mo baimaneng tse di golaganeng le GDM, mme dipholo di bontshitse dipharologano dingwe mo dithekeniking tsa go sekirina le go phekola. Go bonagetse gape gore phetolo ya mokgwa wa botshelo (katiso ya mmele, tsamaiso ya mokgwa wa go ja) le kalafi di ne tsa diriswa go laola bolwetsi jwa basadi ba ba nang le GDM. Mo lebakeng le, baporofešenale botlhe ba boitekanelo ba ne ba dumelana gore go dira temoso ke tsereganyo e e gaisang ya go thibela GDM ga mmogo le ditlamorago tsa yona tse di sa siamang mo baimaneng. Ditshwetso: Go nna teng ga GDM go a oketsega, mme go tshwanetse go dirwa go le gontsi go lemosa ka mokgweleo o bolwetse jono bo o bayang mo boitekanelong jwa baimana le setšhaba. Ka ntlha ya gore GDM ga e kaiwe jaaka bothata jwa boitekanelo jwa setšhaba, ga go dirwe go le kalo go tlhokomela bolwetsi le ditlamorago tsa jona tse di sa siamang mo baimaneng. Go solofelwa gore dintlhakaelo tsa tiriso e e gaisang tse di dirilweng mo thutopatlisisong eno di ka thusa go fokotsa ditlamorago tse di sa siamang tsa GDM mo baimaneng kwa Ethiopia. / Health Studies / D. Litt. et Phil. (Public Health)