All the eligible mothers were participated in the study thereby making 100 % response rate. More than three quarters of the respondent mothers were urban residents [324(76.8%)] and nearly similar number of respondents [322(76.3%)] were in the age group of 20-34 years old. Nearly all the mothers [406(96.2%)] were married. More than half of the mothers were primiparous [223(52.8%)]. Regarding educational status, about one fifth of the mothers [76(18%)] and 32 (7.6%) of the husbands were unable to read and write. Moreover, about half of the mothers were civil servants [216(51.2%)]. More than two third of the respondent mothers [283 (67.1%)] had an average monthly income above poverty line (Table 1).
Obstetrics related factors
Four hundred five (96.0%) mothers had antenatal care during pregnancy of the index neonate. However, only about two third of them [277(65.6%)] attended four and above ANC visits. It was about one third of the mothers [125(30.9%)] who were accompanied with their spouses during antenatal care. Regarding counseling of traditional neonatal uvulectomy, 103 (63.0%) mothers were given antenatal counseling. Besides, 44 (42.7%) of the mothers were given the counseling together with their husbands. Nearly one third [130(30.8%)] of the mothers gave birth at home. Moreover, about 80% of the respondent mothers had at least one post natal care visit and only 46 (13.7%) of whom attended the second postnatal care visit. During postnatal care visit, 317 (94.6%) respondent mothers were accompanied by their spouses. More than one third of the mothers [127 (37.9%)] were counseled of traditional neonatal uvulectomy during their post natal care. However, only 48 (37.8%) of them were given the counseling together with their spouses. The counseling was about disadvantages of traditional neonatal uvulectomy 85 (66.9%), presence of modern medicine for perceived neonatal illness attributed to elongated uvula 46 (36.2%), immediate modern health care seeking behavior during maternal perception of elongated uvula 54 (42.5%) and the benefits of uvula 22 (17.3%) (Table 2).
About three fifth [251(59.5%)] of the neonates were females. One fifth of the neonates [87 (20.6%)] were born before 37 weeks of gestational age. Most of the neonates [254 (60.2%)] were admitted to the hospital in the first 7 days of their postnatal age. One third of the neonates [140 (33.2%)] had low birth weight. At admission, neonates had several medical diagnoses of which hypothermia accounted for the highest percentage [295(69.9%)] followed by early onset [213(50.5%)] and late onset neonatal sepsis [114(27.0%)] (Table 3).
Maternal knowledge of neonatal uvula and traditional uvulectomy
More than three-fourth of the respondent mothers [330 (78.2%)] didn’t mention at least one benefit of neonatal uvula. Furthermore, more than half [230 (54.5%)] of the respondent mothers didn’t mention at least one disadvantage of traditional neonatal uvulectomy. This quantitative finding can be supplemented by the qualitative evidence obtained from 5 key informants who said ‘All neonatal care providers in NICU told me that disease condition of my kid was attributed to postuvulectomy infection. However, I strongly disagree with association of my neonatal illness to the procedure of traditional uvulectomy because the neonates’ illness occurred one week after uvulectomy. If the illness had been attributed to uvulectomy, the kid could have been ill soon after the procedure.’ The authors reached that this indicates their lack of awareness towards the so called incubation period which is between the procedure of traditional uvulectomy and sepsis onset.
There were 94 (22.3%) respondent mothers with prior exposure of traditional uvulectomy for their neonates (Table 4).
Proportion of traditional neonatal uvulectomy
There were 67 (15.9%) neonatal admissions attributed to the complications of traditional uvulectomy (figure 1). Post uvulectomy sepsis [59 (88.1%)] comprised the highest proportion of these complications. The mean neonatal age at uvulectomy was 5.42 days (SD=±2.51). Majority [42 (62.7%)] of the uvulectomies were done before the 7th day of postnatal life (Table 5). Neonates’ failure to breast feed 16 (23.9%) was the most reported indicator of elongated uvula (figure 2). Regarding reasons of traditional uvulectomy, 53 (79.1%) mothers claimed that elongated uvula can’t be treated by modern medicine (Figure 3). Qualitatively, 5 key informants also said: ‘When there is elongated uvula, contacting the traditional surgeon is the absolute medicine because, unless so, the elongated uvula becomes ruptured thereby causing inevitable neonatal death. For example, fearing this inevitable death, all my elder children had uvulectomy done during their neonatal lives after which they grew very well. There has been no modern treatment of elongated uvula since earlier times in our society’
Factors associated with traditional neonatal uvulectomy
From bivariable analysis, sex of the neonate, parity, place of delivery, antenatal couple counseling of traditional neonatal uvulectomy, postnatal couple counseling of traditional neonatal uvulectomy, mentioning at least one disadvantage of traditional neonatal uvulectomy, having history of traditional neonatal uvulectomy and history of bad obstetrics were significant factors. However, after adjusting for possible confounding effect in multivariable analysis, sex of the neonate [AOR= 4.87; 95% CI: 1.10, 21.59], antenatal couple counseling of traditional neonatal uvulectomy [AOR=0.053; 95% CI: 0.01, 0.35], home delivery [AOR= 6.02 ; 95% CI: 1.15, 31.61], postnatal couple counseling of traditional neonatal uvulectomy [AOR= 0.101; 95% CI: 0.02, 0.65], having history of traditional neonatal uvulectomy [AOR= 7.15; 95% CI: 1.18, 43.21] and mentioning at least one disadvantage of traditional neonatal uvulectomy [AOR= 0.068; 95% CI: 0.01, 0.44] were independent predictors of the malpractice.
The odds of traditional uvulectomy among male neonates were 4.87 times higher as compared to female neonates [AOR= 4.87; 95% CI: 1.10, 21.59]. Neonates born to parents who were couple counseled of traditional neonatal uvulectomy during antenatal period were 94.7% less likely to be victim as compared to those neonates born to parents who weren’t couple counseled [AOR= 0.053; 95% CI: 0.01, 0.35].
Home delivered neonates were 6.02 times more likely to have traditional uvulectomy when compared to those born at health institution [AOR= 6.02; 95% CI: 1.15, 31.61]. It was supported by the qualitative data of 4 key informants who said: ‘After I delivered at home, all the men and women who helped me during the birth were dealing with the essence of contacting traditional uvulectomy practitioners if my kid becomes irritable despite good breastfeeding. This is because nowadays elongated uvula is chiefly characterized by irritability rather than decreased breastfeeding. Then, I experienced traditional uvulectomy when I was in trouble of the kid’s spontaneous crying despite its successful breastfeeding’
Moreover, neonates born to mothers with prior history of traditional neonatal uvulectomy were 7.15 times more likely to experience the malpractice as compared to those without the history [AOR= 7.15; 95% CI: 1.18, 43.21]. The likelihood of traditional uvulectomy among neonates whose mothers and fathers recieved counseling of traditional uvulectomy during postnatal visit was 89.9% lower than those whose parents weren’t couple counseled [AOR= 0.101; 95% CI: 0.02, 0.65]. This finding was supported by a key informant who said: ‘Just in front of our kid at post natal room, my husband and me were advised of the life threatening septic and hemorrhagic complications of traditional neonatal uvulectomy which we had never known before. It was heart touching to hear the advice in front of our kid. Since then, we promised never to experience traditional uvulectomy for our kid’.
Neonates whose mothers mentioned at least one disadvantage of traditional neonatal uvulectomy were 93.2% less likely to be victim when compared to those whose mothers mentioned none [AOR= 0.068; 95% CI: 0.01, 0.44] (Table 6). This is supported by the qualitative data obtained from 3 key informants who said: ‘I observed when my neighbor’s neonate was done uvulectomy. Some days after the procedure, the neonate developed severe illness manifested by intermittent vomiting of bloody content and strangely difficult type of breathing. Just at that time, the parents and me were too much worried of the neonate’s condition and hence we contacted the traditional practitioner who did the procedure, but he himself was very disturbed when he saw the neonate was vomiting blood. Ultimately, expecting no more solution from the practitioner, we left him and brought the neonate to this hospital. The neonate got cured after it was oxygenated, given medications and blood transfused. The neonatal care providers told us that the neonate suffered from blood loss from hemorrhage during the procedure and also infection. Then, we became convinced and decided never to face traditional neonatal uvulectomy in our village again. The traditional practitioners receive 200 ETB (Ethiopian Birr) per neonate thereby considering the malpractice as their source of income. They should be asked by law because they are endangering neonatal health by encouraging parents for uvulectomy rather than advising for modern medicine here at hospital.