Study setting, design, and period
An institutional-based cross-sectional study was conducted at public hospitals of Bale Zone, from March 1-30, 2021. Bale zone is located in Southeast Ethiopia. Robe, the Zone city, is located 435 km far from the capital town of Ethiopia; Addis Ababa. Based on the report of Bale Zonal health department, the Zone has a total population of 1,269,951 from which women of childbearing age is around 281,040. The estimated number of pregnant women in the zone is around 44067. Currently, the zone has five hospitals namely, Goba Referral Hospital, Delo Mena General Hospital, Madda Walabu General Hospital, Goro Hospital, and Robe General Hospital which is under robe town administration. Among five public hospitals, only Goba Referral Hospital, Delo Mena General Hospital, and Madda Walabu General Hospital were providing labor and delivery services during the data collection period. Robe General Hospital served as the center for COVID19 and Goro General Hospital was non-functional (Bale zone health department report, 2021).
All mothers who gave birth in public hospitals of Bale Zone and in the immediate post-delivery period were the source population, whereas randomly selected mothers who were in the immediate post-delivery period were the study population. In this study, mothers with severe complications of birth were excluded.
Sample size determination
The sample size was calculated using the single population proportion formula, assuming 71 % proportion of women-friendly care provision from an institutional-based cross-sectional study conducted in public Hospitals of Jimma Zone, Ethiopia(11), 95% confidence interval (CI), and 5% margin of error. n= (1.96)2 0.71(0.29)/ (0.05)2=316. After adding a 15% non-response rate, the final sample size was found to be 363.
According to the report from the zonal health department, the total number of delivery for the last three months was 1990, 289, and 137 in Goba Referral Hospital, Delo Mena General Hospital, and Madda Walabu General Hospital respectively. The monthly average number of delivery for these three hospitals was 663, 96, and 46 respectively. Further allocation of the sample was done for these hospitals proportionally based on the average number of clients who have received childbirth services in the last three months. So, the final sample size was 299, 43, and 21 for respective hospitals. Individual participants in each of the hospitals were selected by systematic sampling technique every K of 2 using a list of a mother who gave birth and recorded on postnatal registration book for the last three months as the sampling frame.
Data collection tool and Data collection procedure
A structured questionnaire which was adapted from different works of literature and consists of 36 questions and 21 verification criteria [3,11,15] is used in this study to assess the level of women-friendly care provision. It was made up of four sections, the first section was used to assess socio-demographic characteristics of the mother with 13 items, the second section was used to assess obstetric characteristics of participants with 13 items, the third section was used to assess facilities services use and providers related characteristics with 10 items, the fourth section was used to measure the level of women-friendly care provision experienced by mothers during facility childbirth with 21 criteria. Four data collectors and four supervisors were assigned to facilitate the data collection. Data were collected during the immediate post-delivery period through interviews administered questions prepared by local language.
Study variables, outcome variable, and operational definitions
Socio-demographic, provider, facility-related, and obstetrics variables were study variables whereas the level of women-friendly care provision was outcome variable.
A series of 21 questions related to the level of women-friendly care provision were asked. Study participants who scored at least score of 50% towards women-friendly care provision questions were categorized as getting a "good level of women-friendly provision" and else were categorized as getting poor women-friendly care provision.
Severe birth complications were complications like postpartum convulsion due to eclampsia and severe birth canal injury secondary to instrumental deliveries.
Data Quality Assurance
An adopted questionnaire prepared in English was translated to Afan Oromo and then translated back to English by another language expert to check and maintain its consistency. Pretest was done to improve clarity, understandability, and simplicity of the messages of the tools before actual data collection. Data collectors and supervisors were trained for two days on the objective, method, sampling technique, ethical issues, data collection instrument, and data collection procedure before data collection. All of the questionnaires were checked for completeness and accuracy during and after the period of data collection.
Data Processing and Analysis
The data were entered into Epi Data 22.214.171.124 and was coded. After that, it was exported to SPSS version 26.0 and cleaned before analysis. Descriptive statistics were calculated for the variables. Statistical significance and strength of the association between independent variables and outcome variables were analyzed by using the logistic regression model. A variable with a P value of less than 0.25 was transferred to a multivariable logistics regression model to adjust the confounder’s effects. Crude and adjusted odds ratios with their 95% confidences intervals were calculated. A p-value less than 0.05 was considered as significantly associated. Finally, the result of the study was presented using tables, chart, and texts based on the data obtained.