Adherence to respectful maternity care guidelines during COVID-19 pandemic and associated factors among healthcare providers working at hospitals in northwest Ethiopia: A multicenter, observational study

Clinical Epidemiology and Global Health, Volume 12, Year 2021

Ukuhunyushwa

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.

I-AI Digest

Study Justification:

– Respectful maternity care is important for women’s access to maternity healthcare services.
– Maternal healthcare services have been compromised during the COVID-19 pandemic.
– There is a lack of evidence on healthcare provider’s adherence to respectful maternity care guidelines during the pandemic.
– This study aims to assess healthcare provider’s adherence to respectful maternity care guidelines during COVID-19 in northwest Ethiopia.

Study Highlights:

– The study was conducted at hospitals in northwest Ethiopia from November 15th, 2020 to March 10th, 2021.
– A total of 406 healthcare providers were randomly selected for the study.
– Data were collected through face-to-face interviews and direct observation using a structured questionnaire and standardized checklist.
– The proportion of healthcare providers adhering to respectful maternity care guidelines during COVID-19 was found to be 63.8%.
– Factors such as job satisfaction, professional work experience, and education parallel to work were found to have a significant association with adherence to respectful maternity care guidelines.

Study Recommendations:

– Ensuring healthcare worker’s job satisfaction is important for improving adherence to respectful maternity care standards.
– Providing education opportunities for healthcare providers by the government can also improve adherence to respectful maternity care guidelines.

Key Role Players:

– Healthcare providers (medical doctors, midwives, integrated emergency surgeon officers)
– Hospital administrators
– Government officials
– Training institutions

Cost Items for Planning Recommendations:

– Training programs for healthcare providers on respectful maternity care guidelines
– Resources for improving job satisfaction among healthcare providers
– Educational opportunities for healthcare providers
– Monitoring and evaluation of adherence to respectful maternity care guidelines
Please note that the cost items provided are general suggestions and may vary based on the specific context and needs of the healthcare system in northwest Ethiopia.

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a multicenter observational study conducted in northwest Ethiopia. The study employed a simple random sampling technique to select 406 healthcare providers. Data were collected through face-to-face interviews and direct observation. The study found that 63.8% of healthcare providers adhered to respectful maternity care guidelines during COVID-19. The study also identified factors such as job satisfaction, professional work experience, and education parallel to work that were associated with adherence to guidelines. The study provides specific details about the study population, data collection methods, and statistical analysis. However, the abstract does not mention the limitations of the study or potential biases. To improve the evidence, it would be helpful to include information about the limitations and potential biases of the study, as well as recommendations for future research.

Abstract

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.

Izinto zokwakha

N/A

Emisha

The study conducted in northwest Ethiopia aimed to assess healthcare provider’s adherence to respectful maternity care (RMC) guidelines during the COVID-19 pandemic. The following innovations were used in the study:

1. Multicenter observational study: The study was conducted at multiple hospitals in northwest Ethiopia, allowing for a broader representation of healthcare providers and facilities.

2. Direct observation: Data collection included direct observation of healthcare providers using a standardized checklist. This method provided objective information on adherence to RMC guidelines.

3. Structured questionnaire: Face-to-face interviews were conducted using a structured questionnaire to collect additional data on socio-demographic characteristics, professional and work-related factors, and healthcare provider’s adherence to RMC standards.

4. Binary logistic regression analysis: Both bivariable and multivariable logistic regression analyses were performed to identify factors associated with adherence to RMC guidelines. This statistical analysis helped control confounders and determine the significance of the findings.

5. Assessment of job satisfaction: The study included questions to assess healthcare provider’s job satisfaction, which was found to have a significant association with adherence to RMC guidelines.

6. Education parallel to work: The study found that having education parallel to work was associated with lower adherence to RMC guidelines. This highlights the importance of providing education opportunities to healthcare providers to improve adherence.

Overall, these innovations helped provide valuable insights into healthcare provider’s adherence to RMC guidelines during the COVID-19 pandemic in northwest Ethiopia. The findings suggest that improving job satisfaction and providing education opportunities could enhance healthcare provider’s adherence to respectful maternity care standards.

AI Innovations Description

Based on the study conducted in northwest Ethiopia, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Adherence to Respectful Maternity Care (RMC) Guidelines: The study found that healthcare providers who adhered to RMC guidelines had a positive impact on improving access to maternal healthcare services. Therefore, it is recommended to develop innovative strategies to ensure healthcare providers consistently adhere to RMC guidelines. This can be achieved through continuous training and education programs that focus on promoting respectful and compassionate care for pregnant women.

2. Enhancing Job Satisfaction: The study identified job satisfaction as a significant factor associated with healthcare providers’ adherence to RMC guidelines. To improve access to maternal health, it is important to prioritize the well-being and job satisfaction of healthcare providers. Innovative approaches such as providing incentives, creating a supportive work environment, and recognizing the contributions of healthcare providers can help improve job satisfaction and ultimately enhance the quality of maternal healthcare services.

3. Providing Education Opportunities: The study also found that healthcare providers with higher levels of education were more likely to adhere to RMC guidelines. To improve access to maternal health, it is crucial to provide education opportunities for healthcare providers, especially in underserved areas. Innovative solutions such as scholarships, distance learning programs, and partnerships with educational institutions can help healthcare providers acquire the necessary knowledge and skills to provide quality maternal healthcare services.

4. Government Support: The study highlighted the importance of government support in improving healthcare providers’ adherence to RMC guidelines. Governments should prioritize maternal health and allocate resources to support training programs, infrastructure development, and the implementation of guidelines and protocols. Innovative policies and initiatives that promote respectful maternity care and address the specific needs of pregnant women can significantly improve access to maternal health services.

Overall, by implementing these recommendations, innovative solutions can be developed to improve access to maternal health, ensuring that pregnant women receive respectful and high-quality care during the COVID-19 pandemic and beyond.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Telemedicine and Mobile Health: Implementing telemedicine and mobile health technologies can provide remote access to healthcare services, including prenatal care and consultations. This allows pregnant women in remote or underserved areas to receive necessary care without the need for physical travel.

2. Community Health Workers: Training and deploying community health workers can help bridge the gap between healthcare facilities and pregnant women in rural or marginalized communities. These workers can provide education, support, and basic healthcare services, improving access to maternal health services.

3. Transportation and Infrastructure: Improving transportation infrastructure, such as roads and ambulances, can ensure that pregnant women can reach healthcare facilities in a timely manner. This is particularly important in remote areas where access to healthcare facilities is limited.

4. Financial Support: Providing financial support, such as subsidies or insurance coverage, can reduce the financial barriers to accessing maternal health services. This can include covering the costs of prenatal care, delivery, and postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of prenatal visits, percentage of deliveries attended by skilled birth attendants, or distance to the nearest healthcare facility.

2. Collect baseline data: Gather data on the current state of access to maternal health services in the target population. This can include surveys, interviews, or existing data sources.

3. Develop a simulation model: Create a simulation model that incorporates the potential recommendations and their expected impact on the identified indicators. This can be done using statistical software or simulation tools.

4. Input data and parameters: Input the baseline data and parameters into the simulation model. This includes information on the target population, healthcare facilities, and the potential impact of the recommendations.

5. Run simulations: Run multiple simulations using different scenarios, such as implementing one or more of the recommendations at varying levels of coverage or intensity. This allows for the evaluation of different strategies and their potential impact on access to maternal health.

6. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on the identified indicators. This can include comparing the outcomes of different scenarios and identifying the most effective strategies.

7. Refine and iterate: Based on the simulation results, refine the recommendations and parameters as needed. Iterate the simulation process to further optimize the strategies for improving access to maternal health.

By using this methodology, policymakers and healthcare providers can gain insights into the potential impact of different innovations and interventions on improving access to maternal health. This can inform decision-making and resource allocation to effectively address the challenges in maternal healthcare access.

Umbhali

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1016/j.cegh.2021.100830

Research Areas:

COVID, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Violence and Injury, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female

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