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Background: Respectful maternity care is one of the facilitators of women’s access to maternity healthcare services. However, it has been evidenced that maternal healthcare services are compromised during the pandemic of coronavirus disease 19 (COVID-19). Moreover, there was a dearth of evidence on healthcare provider’s adherence to respectful maternity care guidelines through direct observation. Hence, this study intended to assess healthcare provider’s adherence to respectful maternity care guidelines during COVID-19 in northwest Ethiopia. Methods: A multicenter observational cross-sectional study was conducted at hospitals in northwest Ethiopia from November 15th/2020 to March 10th/2021. A simple random sampling technique was employed to select 406 healthcare providers. Data were collected through face-to-face interviews and direct observation using a structured questionnaire and standardized checklist respectively. The data were entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted. Both bivariable and multivariable logistic regression analyses were undertaken. The level of significance was claimed based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a p-value of ≤0.05. Results: The proportion of healthcare providers adhering to respectful maternity care guidelines during COVID-19 was 63.8% (95% CI: 59.1, 68.4). Job satisfaction (AOR = 1.82; 95% CI: 1.04, 3.18), professional work experience of 3–5 years (AOR = 2.84; 95% CI: 1.74, 4.6) and ≥6 years (AOR = 2.21; 95% CI: 1.11, 4.38), and having education parallel to work (AOR = 0.33; 95% CI: 0.21, 0.51) have an independent statistical significant association with adherence to respectful maternity care guidelines. Conclusion: In this study, six out of ten healthcare providers had good adherence to respectful maternity care guidelines. Ensuring health worker’s job satisfaction and providing education opportunities by the government would improve healthcare provider’s adherence to respectful maternity care standards.
A multicenter institution-based observational cross-sectional study was conducted from November 15th, 2020 to March 10th, 2021. It was conducted at hospitals of northwest Ethiopia, Amhara regional state. Specifically, the study was conducted in the Gondar province which comprises four zones namely South Gondar, Central Gondar, West Gondar, and North Gondar zone. In the province, there are a total of 22 hospitals which include 2 referral hospitals, 1 general hospital, and 19 primary hospitals. These hospitals are serving more than 10 million population in the zones of Gondar province and surrounding zones such as North Wollo and Waghimra zone. All healthcare providers working at the maternity wards in the selected hospitals were the study population. These include medical doctors, midwives, and integrated emergency surgeon officers (IESO). Healthcare providers who were available at the workplace during the data collection period were included. Non-permanent employees (i.e., health care providers who have a professional experience of fewer than six months were excluded). A single population proportion formula was utilized to calculate the sample size (N) by taking the following assumptions into consideration: proportion of provider’s adherence to RMC guidelines – 50% (p = 0.5), level of significance – 5% (α = 0.05), Z α/2–1.96, margin of error – 5% (d = 0.05); and non – response rate −10%. Accordingly, N=(Zα/2)2∗p(1−p)d2 = N=(1.96)2*0.5(1−0.5)(0.05)2 = 384. After adding a 10% for non-response rate, we obtained a total sample size of 422. Data were collected from 15 hospitals (i.e., 2 tertiary hospitals, 1 general hospital, and 12 primary hospitals). During the study period, 544 healthcare providers were present in the selected hospitals. The selected hospitals were the University of Gondar comprehensive specialized hospital (n = 93), Debre Tabor specialized hospital (n = 70), Debark General hospital (n = 33), Ambagiorgis primary hospital (n = 16), Dembia primary hospital (n = 20), Metema primary hospital (n = 30), Tach Giant primary hospital (n = 24), Nefas Mewucha primary hospital (n = 20), Gohala primary hospital) (n = 16), Ebinat primary hospital (n = 10), Andabet primary hospital (n = 14), Delgi primary hospital (n = 10), Ayikel primary hospital (n = 16), Mekaneyesus primary hospital (n = 17), and Addis Zemen primary hospital (n = 17). The seven primary hospitals were excluded due to their very low delivery size. The lists of healthcare providers were obtained from each hospital and the sampling frame was designed by numbering the list of healthcare providers. Then, the total sample size was distributed to each selected hospital proportionally. Finally, the participants were selected randomly. The outcome variable for this study was the healthcare provider’s adherence to RMC guidelines. Whereas, the explanatory variables are socio-demographic factors such as age, sex, educational level, marital status, having smartphones and/or computer and exposure to media, and workplace and professional-related variables including the year of experience, professional category, relation to the nearby boss, intention to stay in the profession, job satisfaction, facility type, working time, training on basic emergency obstetric and newborn care (BEmONC), presence of regular follow-up by the manager, workload in the delivery room, presence of birth assistant, working part-time in private institutions, education while working, training on compassionate respectful care (CRC), and location of the health facility. Respectful maternity care: A total of 30 items were prepared to assess RMC which are classified into seven categories including physical abuse, non-consented care, non-confidential care, non-dignity care, discriminatory care, neglected care, and detention in health facilities. Each item has a “Yes “or “No” response giving a score of 0–30 (i.e., a score of 1 was given for “No” and 0 for “Yes” response). Similarly, healthcare provider’s adherence to RMC standards was dichotomized as good adherence (which was coded as “1”) and poor adherence (which was coded as ‘‘0’’). Accordingly, a score of above the mean was considered as good adherence to RMC guidelines based on the summative score designed to assess healthcare provider’s adherence to RMC guidelines.28 Job satisfaction: A total of 9 questions were prepared to assess the satisfaction level of healthcare providers. Thus, healthcare providers who were able to answer above the mean score were considered as satisfied whereas healthcare providers who scored below the mean were considered as not satisfied.31 The data collection tool was developed by reviewing the literature.30 , 32 , 33 The data were collected through face-to-face interviews and direct observation using a structured questionnaire and checklists respectively. The questionnaire was assessed by a group of researchers to evaluate and enhance the items in the question. The questionnaire contains socio-demographic characteristics, professional and work-related factors, and questions assessing the healthcare provider’s adherence to RMC standards. To decrease the Hawthorne effect, the data was collected over four months to allow health workers to settle to the normal work pattern. In addition, the healthcare providers were observed initially using the checklist and interviewed later on using the standardized questionnaire. Fifteen diploma and 5 BSc midwives were selected for data collection and supervision respectively. Before the actual data collection, a pretest was done on 20 healthcare providers outside of the study area. The data collectors and supervisors were trained about the interview technique and overall data collection process for 3 days. During data collection, the questionnaire was checked for completeness by the supervisors. Data were checked, coded, and entered into EPI INFO version 7.1.2, and analyzed using SPSS version 25. Descriptive statistics were used to present participants’ characteristics, workplace and profession-related characteristics, and healthcare provider’s compliance with RMC guidelines. The binary logistic regression model was fitted. Both bivariable and multivariable logistic regression analyses were carried out. Variables having a p-value of less than 0.2 at the bivariable logistic regression analysis were entered into the multivariable logistic regression analysis for controlling confounders. In the final model, the level of significance was declared based on AOR with its 95% CI at a p-value of ≤0.05.
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