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Background All women require access to high-quality care during pregnancy, labor, and after childbirth. The occurrence of delay at any stage is one of the major causes of maternal mortality. There is, however, a scarcity of data on women’s access to maternal health services during the COVID-19 pandemic. Therefore, the goal of this study was to assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic. Methods A facility-based cross-sectional study was conducted among 402 pregnant women selected by systematic random sampling. Data were analyzed using IBM SPSS Statistics version 26. Descriptive and summary statistics were used to describe the study population. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratio with respective 95% CI was used to report significant covariates. Results A total of 402 pregnant women participated in this study. The median age of the respondents was 25 years (IQR = 8). On average, a woman stays 1.76 hours (SD = 1.2) to make a decision to seek care. The prevalence of first, second and third delay were 51%, 48%, and 33.3%, respectively. Being unmarried [AOR (95% CI)], [0.145 (0.046–0.452)], being unemployed [AOR (95% CI)], [4.824 (1.685–13.814)], age [AOR (95% CI)], [0.227 (0.089–0.0579)], fear of COVID-19 [AOR (95% CI)], [1.112 (1.036–1.193)], urban residence [AOR (95% CI)], [0.517 (0.295–0.909)], and lack of birth preparedness [AOR (95% CI)], [6.526 (1.954–21.789)] were significantly associated with first delay. Being unmarried [AOR (95% CI)], [5.984 (2.930–12.223)], being unemployed [AOR (95% CI)], [26.978 (3.477–209.308)], and age [AOR (95% CI)], [0.438 (0.226–0.848)] were significantly associated with second delay. Having lengthy admission [AOR (95% CI)], [7.5 (4.053–13.878)] and non-spontaneous vaginal delivery [AOR (95% CI)], [1.471 (1.018–1.999)] were significantly associated with third delay. Conclusion This study identified a significant proportion of mothers experiencing delays, although there were no data to suggest exacerbated delays in utilizing maternal health services due to fear of the COVID-19 pandemic. The proportion of maternal delay varies with different factors. Improving the decision-making capacity of women is, therefore, essential.
A facility-based cross-sectional study was conducted from February to April 2021 among pregnant women in the Ilubabor zone, which is located at about 555 km to the southwest of Ethiopia’s capital, Addis Ababa. The zone’s population is estimated to be 968,303 people, according to the 2007 Census. Of this population, 480,178 were female with roughly 214,285 of them in the reproductive age groups who gave birth to 33,600 babies in the last 12 months of the census. There are 2 hospitals and 40 health centers in the zone. The study population was all pregnant women who visited public health facilities in the Ilubabor zone for complications or delivery services during the study period. All pregnant women who visited the selected health facilities for pregnancy-related complications or delivery services were included in the study. Women who were severely ill and unable to respond to questions were excluded from the study. The minimum sample required for the study was calculated using Epi-info 7.2.2.2 software using the following assumptions [Table 1]. CI: Confidence interval; d: Margin of error; n: Sample size; AOR: Adjusted odds ratio Accordingly, the largest sample size was selected which was 382. After adjusting for a 10% non-response rate, the final sample size became 425¯¯. From public health facilities located in the Ilubabor zone, two hospitals and ten health centers were selected randomly using a lottery method. A systematic random sampling method was used to select the study participants in each health facility. Selected women were then interviewed until the proportionally allocated sample for that health facility was reached. First maternal delay: is the time interval between recognition of the labor and/or complication and deciding to seek a health institution. Time taken ≥1 hour to decide to seek care was considered as delay and less than an hour was considered as no delay [18]. Second maternal delay: is the time interval from starting to reach the health facility after the decision has been made. Time taken ≥1 hour to reach the facility was considered as delay and less than an hour was considered as no delay [18]. Third maternal delay: is the time interval between reaching the facility and receiving health care. Time taken ≥1 hour to receive care was considered as delay and less than an hour was considered as no delay [18]. Fear of COVID 19 infection: 5-point Likert scale was used and participants rated their level of agreement with the statements, ranging from “strongly disagree” to “strongly agree”. The minimum score possible for each question was 1, and the maximum was 5. A total score was calculated by adding up each item score (ranging from 7 to 35). The higher the score shows the greater the fear of COVID-19 [19]. The data were collected using a structured interviewer-administered questionnaire. The questionnaire was adapted from a survey tool developed by JHPIEGO maternal and neonatal health program [20]. Fear of COVID-19 infection was assessed by using the fear of COVID-19 scale (FCV-19S) [21]. The data were collected by midwifery professionals after receiving a two-day training. The study instrument was pilot tested on 5% (22) of the sample size. Two-day training was given for data collectors regarding the objective of the study, data collection tools and procedures, how to approach respondents, and how to keep confidentiality. The collected data were checked for completeness by data collectors before leaving the respondents. Finally, 10% of the questionnaire was double entered to check the consistency. The collected data were checked for completeness and entered into Epi-data version 3.1. The data were then exported to IBM SPSS Statistics version 26 for analysis after cleaning. Descriptive statistics like frequency, percentage, mean, and standard deviation (Median and IQR) were used to describe the finding of the study. Bivariate and multivariable logistic regression analyses were used to identify covariates significantly associated with the outcome variables. P-value less than 0.25 and theoretical knowledge were used to include variables in the multivariable logistic regression model. The fitness of the model was checked by Hosmer and Lemeshow’s test. P-value less than 0.05 and adjusted odds ratio with respective 95% confidence interval were used to identify statistically significant covariates. Ethical clearance letter was received from Mettu University College of Health Science’s Ethical Review Committee. Written informed consent was obtained from study participants after explanation of the objective, benefit, and risk of the study. Only those who volunteered were included in the study. Confidentiality was assured by avoiding personal information of the participants and coding questionnaires.
