Determinants of Husbands’ Involvement in Promoting Skilled-Delivery Attendants in Deder Town, Oromiya, Ethiopia

doi:10.21203/rs.3.rs-1447833/v1

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Determinants of Husbands’ Involvement in Promoting Skilled-Delivery Attendants in Deder Town, Oromiya, Ethiopia

https://doi.org/10.21203/rs.3.rs-1447833/v1

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Background

Husbands’ involvement strategies are employed as a means to support their wives to access care, address the influence of gender inequality on maternal and newborn health and promote husbands positive involvement as fathers. Yet, evidence on the husbands’ involvement in promoting skilled-delivery attendants in Ethiopia is scarce which limits the facility to improve institutional delivery services. Therefore, the aim of this study was to assess the determinants of husbands’ involvement in promoting skilled-delivery attendants among fathers of children of less than one year in Deder town, Oromiya, Ethiopia.

Methods

A community-based cross-sectional study was conducted using a structured questionnaire among 399 fathers selected by simple random sampling technique. Data were collected through face to face interview from March 24 to April 20, 2021. Data entry was done by Epi-data version-4.2 and analyzed with SPSS version-21. Descriptive analyses used frequency, mean and median and presented by tables and figures. Level of significance was set at p-value ≤ 0.05 for multivariable logistic regression and adjusted odds ratio with 95% confidence interval was used to measure the degree of statistical significance of dependent and independent variables.

Result

The prevalence of husbands’ involvement in promoting skilled-delivery attendants was 84.2%. Age group of 25 to 29 years (AOR = 2.63, CI: 1.124–6.142), prior knowledge of skilled-delivery attendants (AOR = 2.75, CI: 1.456–5.205) and good attitude on skilled-delivery attendants (AOR = 2.46, CI: 1.227–4.948) were statistically significant determinants of husbands’ involvement in promoting skilled-delivery attendants.

Conclusion and recommendation:

This study revealed that the husbands’ involvement in skilled-delivery attendants was high. Age, level of knowledge and attitude were the significant determinants of husbands’ involvement in promoting skilled-delivery attendants. Therefore, improving husbands’ level of knowledge and attitude towards skilled-delivery attendants are needed.

Delivery

Husbands’ involvement

Skilled attendants

Childbirth is an eventful natural process. All mothers can develop complication at any time between conception and childbirth period. Accordingly, majority of maternal deaths occur due to preventable direct obstetric causes such as hemorrhage, infection, obstructed labor, unsafe abortion and hypertension during pregnancy (1). These causes can be detected and managed early during antenatal and intrapartum period by existing and well known medical interventions (2).

Hence, access to skilled health services during childbirth is one of the strongest determinants of maternal and newborn health outcomes (3). Unfortunately, the percentage of women in Ethiopia using skilled birth attendance (SBA) has been very low (4).

A Prompt decision in seeking reproductive health service like having a skilled birth attendant at every delivery has been found to be markedly influenced by husbands (5, 6). Husbands typically serve as gatekeepers of their wives’ reproductive health including decisions about where they will be delivering as different evidence show (5, 7).

In African countries, husbands generally are considered to be the decision makers regarding the location at which their spouse should give birth (7, 8). Therefore, husbands’ involvement in maternal health care services as a building block for ensuring women’s and children`s wellbeing.

Currently, husband’s involvement in maternal health is being advocated as an essential element for making pregnancy safer. Husbands involvement in maternal health care has been described as the participation, commitment and joint responsibility and behavioral change that is needed for husbands to play in their wives’ health care with the purpose of ensuring wellbeingness of the mother and her newborn child (9).

Maternal mortality is a key indicator of international development and its reduction has long been and continues to be a global challenge, particularly in low-income countries including Ethiopia. Globally, in 2015, an estimated 303,000 women died as a result of pregnancy and childbirth-related complication (10, 11).

Almost all 99% (302, 000) of global maternal deaths occurred in developing countries, with the maternal mortality ratio (MMR) of 239 per 100,000 live births which is more than 14 times higher compared to the developed regions (12 maternal deaths per 100,000 live births). Sub-Saharan Africa (SSA) countries alone accounted for 66% of maternal deaths with the maternal mortality ratio of 546 per 100,000 live births (201,000), followed by Southern Asia 180 per 100,000 live births (66 000)(10).

In Ethiopia, maternal mortality ratio is estimated at 353/100,000 live births according to World Health Statistics 2018 (11), indicating a significant improvement from that reported in 2011 EDHS 676/100,000 live births. However, this figure is far from the millennium development goal (MDG) target of 267 maternal deaths per 100,000 live births by 2015 (10).

Lack of skilled-birth attendance has been considered as one of the reasons that resulted in the poor progress of maternal mortality reduction programs. However, in some cases where the different services exist, husbands are reported to ban their wives from seeking any maternal health care like giving birth with assistance of skilled professionals (12).

Worldwide, the proportion of deliveries attended by skilled health personnel increased from 59% in 1990 to 71% in 2014 (13). Different reports showed that about 90% of births in Ethiopia occur at home without skilled attendance among which 34% receive some level of antenatal care from a skilled provider (4, 14, 15).

The previous studies found that the social, cultural, and religious factors play a great role in skilled birth attendant service uptake. In addition to that, age of mothers, harmful traditional practices, low social status of women, limited female involvement in decision making, family members’ influence and decisions, and women’s limited influence over their families are key determinants in utilization of skilled-birth attendances (16, 17). And also, the studies found that poor attitude of health workers, and poor quality of care are related to low service uptake (18).

World Health Organization have done different intervention for husbands to increase their involvement in order to tackling the above mentioned problems by increasing the involvement in maternal and child health including skilled-birth attendance (9).

Even if different intervention have done regarding to husbands’ involvement to increase their involvement, the evidence of study results in northern Nigeria and Farta district, Northwest Ethiopia revealed that more than 25% and 8.3% of mothers respectively deliver at home due to the influence of their husbands resisting to go to health facility at time of childbirth (12, 19). From their study findings, they recommend that further research has to be undertaken to determine clearly the determinants of husband’s involvement in promoting skilled-birth attendant.

The current prevailing literatures on the issue did not fully address the determinants of husband’s involvement on maternal and child health as whole. Therefore, this study is very curial and timely to identify the determinants of husbands’ involvement in promoting skilled-delivery attendance in the study area.

Study area and period

This study was conducted in Deder town, Eastern Hararghe zone, Oromiya, Ethiopia from March 24 to April 20, 2021. Deder is located on latitude 9.25° or 9° 15' north, at 131.8 km from Harar, the capital of eastern Hararghe zone, and 440.4 km of Addis Ababa, the capital city of Ethiopia. The total population of the town is estimated to be 34,812 out of whom 16,000 were husbands.

Study design

Community-based cross-sectional study design was employed.

Source and Study population

All fathers of less than one year age children in the town were source population whereas randomly selected fathers of less than one year age children were study population.

Sample size determination, techniques and procedures

The sample size required for this study was calculated based on a single population proportions formula as follows.

where

n = the desired sample required, Zα/2 = the standard normal variable at 95% confidence level = 1.96, P = is the prevalence of male partners’ involvement in institutional delivery of spouse 38.2% (taken from a study done at Lemo woreda, Southern Ethiopia 2015) (27) and d = is the margin of error assumed to be tolerated (5%) By considering 10% non-response rate, the final sample size was become 399. Simple random sampling technique the study participants.

Data collection instrument and techniques

Data were collected through face to face interview using Afan Oromo version structured questionnaire that originally prepared in English from different literatures (14, 18, 19). The data collection was conducted by four trained Health Extension Workers and supervised by two BSc Midwives.

Operational Definitions

Husband involvement

a husband is a male partner in a legal marriage. He is who legally married to a woman and thereby specific rights and duties given by law (19). Husband involvement in promoting skilled-birth attendants is measured by five questions. Participants who answered ‘Yes’ to three or more questions were considered as involved or vice versa.

Knowledge of husband’s involvement in decision of place of delivery - five knowledge related questions were included in the assessment tools to differentiate participants with good and poor knowledge.

Good knowledge:- Those participants who scored more than or equal to the median value of knowledge related questions
Poor knowledge: - Those participants who scored less than the median value of knowledge related questions.

Attitude -The respondents were asked to reflect their opinion about skilled-delivery attendants.

Good attitude: participants who scored more than or equal to the median value of attitudinal related questions.
Poor attitude: participants who scored less than the median value of attitudinal related questions.

Data processing and analyses

After data collection, data were coded and entered into Epi–data version-4.2. The analysis was made with SPSS version-21. First descriptive analyses like frequency, mean and median were done and presented by tables and figures. Then Hosmer-Lemeshow and Collinarity Test were done to check model fitness and the relationship among independent variables respectively.

Finally, binary and multivariable logistic regressions were run to assess the association between the dependent and independent variables. Again, p-value ≤ 0.2 and ≤ 0.05 in binary and multivariable logistic regression respectively were considered as significant at 95% confidence level.

Socio-demographic Characteristics

All 399 study participants completed the questioners making a response rate of 100%. One hundred twenty six (31.6%) were in the age group of 30–34 years. The mean age of the participant was 31.89 ± 5.15 SD years. The study participants were predominantly Oromo [375 (94.0%)] and Muslim [361 (90.5%)] by their ethnicity and religion respectively. One hundred twenty five (31.3%) of the participants were merchants and 178 (44.6%) have completed college and above (Table 1).

Table 1

Socio-demographic characteristics of husbands’ involvement in promoting skilled-birth attendants, Deder town, Oromiya, Ethiopia, 2021, (n = 399)
Variables	Frequency	Percentage (%)
Age
20–24 yrs.	28	7.0
25–29 yrs.	124	31.1
30–34 yrs.	126	31.6
>/=35 yrs.	121	30.3
Religion
Muslim	361	90.5
Orthodox	22	5.5
Protestant	16	4.0
Ethnicity
Oromo	375	94.0
Amhara	9	2.3
Harari	3	0.7
Gurage	12	3.0
Occupation
Merchants	125	31.3
Private employee	60	15.0
Farmer	49	12.3
Government employee	116	29.1
Labor work and others	49	12.3
Educational status
Read and write only	46	11.5
Primary education (1–8)	57	14.3
Secondary education(9–12	118	29.6
College and above	178	44.6

Health care services and cultural related barriers of husbands’ involvement in promoting skilled-birth attendants

The result of this study showed that more than half of participants [228(57.1%)] reach to the health facility on walk within 30 minutes and below. Regarding cultural related barriers of husbands’ involvement in promoting skilled-delivery attendants, about 223 (55.9%) said that child-birth is a woman’s affair which does not require husband participation and 40(10%) believed that discussions with wife about place of childbirth was not their culture. (Table 2).

Table.2 Health care services and cultural related barriers of husbands’ involvement in promoting skilled-birth attendants, Deder town, Oromiya, Ethiopia, 2021, (n = 399)

Variables Categories		Frequency	Percentage
Time taken on walking to reach to the nearest health facilities	</=30 minutes	228	57.1
	> 30 minutes	171	42.9
Cost of the health service	Absolutely free	307	76.9
Cost of the health service	Partially free	92	23.1
Health facilities open day and night	Yes	238	59.6
Health facilities open day and night	No	161	40.4
Child-birth is a woman’s affairs does not require men participation	Yes	223	55.9
	No	176	44.1
Child-birth is natural phenomenon that should not be given much attention	Yes	393	98.5
	No	6	1.5
Discussion with wife about place of delivery not our culture	Yes	40	10.0
	No	359	90.0
Spouses living together	Yes	364	91.2
Spouses living together	No	35	8.8

Knowledge of husbands’ toward skilled-delivery attendance of their wives

All of the participants reported that they had known their spouses had received ANC follow up but only 202(50.6%) know correctly the recommended minimum number of times that a pregnant needs to attend ANC. The result of this study showed that the majority, 295(73.9%), of the participants were found to have good knowledge regarding to skilled-delivery attendance.

(Table 3)

Table 3

Knowledge of husbands toward skilled-delivery attendants, Deder town, Oromiya, Ethiopia, 2021. (n = 399)
Variables Categories		Frequency	Percentage
Mentioned correctly the recommended minimum number of times that a pregnant needs to attend ANC	Yes	202	50.6
	No	197	49.4
Institutional delivery has access to skilled attendance	Yes	371	93.0
Institutional delivery has access to skilled attendance	No	28	7.0
Institutional delivery prevent delay in getting medical care in a case of emergency	Yes	299	74.9
	No	100	25.1
Institutional delivery has important to get immediate treatment for mother and new born	Yes	303	75.9
	No	96	24.1

Husbands’ Attitude on skilled-delivery attendance

The study result showed that 209(52.4%) of husbands had good attitude towards skilled-delivery attendance whereas 190 (47.6%) had poor attitude.

Husbands’ involvement in promoting skilled-delivery attendance

The overall husbands’ involvement in promoting skilled delivery attendance was 366(84.2%) (Fig. 1).

More than three fourth (79.4%) participants have ever went to health facility with their wives for her antenatal care services in her last pregnancy. About 396(99.2%) of participants were involved in birth preparedness of recent child among whom 362(90.7%) saved money, 349(87.5%) prepared essential items for delivery and 197(49.4%) planned ahead for the place of delivery. Regarding the motives to discuss with health professionals 77(19.3%), 139(34.8%) and 145(36.3%) have previous experience, listing mass media and personal interest respectively as the sources of their motives to be involved in promoting skilled-delivery attendants (Table 4).

Table 4

Distribution of husbands’ involvement in promoting skilled-delivery attendants, Deder town, Oromiya, Ethiopia, 2021, (n = 399)
Variables Categories		Frequency	Percentage
Accompanied their spouse for antenatal care follow-up	Yes	317	79.4
Accompanied their spouse for antenatal care follow-up	No	82	20.6
Birth preparedness support by husbands for recent child	Yes	396	99.2
Birth preparedness support by husbands for recent child	No	3	0.8
Discussed with health professionals	Yes	165	41.4
Discussed with health professionals	No	234	58.6
Discussed with their friends	Yes	176	44.1
Discussed with their friends	No	223	55.9
Discussed with their relatives	Yes	328	82.2
Discussed with their relatives	No	71	17.8

Factors associated with husbands’ involvement in promoting skilled-delivery attendants

Results of the bi-variable logistic regression showed that the husbands’ age, educational status, occupational status, knowledge, attitude and educational status were statistically significant determinants of husbands’ involvement in promoting skilled-delivery attendants. But after adjusting the confounding variables, husbands’ age, knowledge and attitude were found to be statistically significant determinants of husbands’ involvement in promoting skill-delivery attendants at alpha value of 5%. Husbands who were in the age group of 25 to 29 years old were 2.75 times higher odds of promoting skilled-delivery attendance when compared to those who were at the age group of 35 years and above (AOR = 2.75, CI: 1.169–6.448). Husbands who had good knowledge were 2.83 times higher in promoting skilled-delivery attendance than those who had poor knowledge (AOR = 2.83, CI: 1.491–5.384).

The odds of promoting skilled-delivery attendant were two times higher among husbands who had good attitude when compared to their counterparts (AOR = 2.40, CI: 1.194, 4.842) (Table 5).

Table 5: Bivariate and multivariable logistic regression analysis of determinants of husbands’ involvement in skilled-delivery attendants, Deder town, Oromiya, Ethiopia, 2021,

(n = 399)

Variables	Male involvement		COR(95%CI)	AOR(95%CI)
Variables	Involved	Not Involved	COR(95%CI)	AOR(95%CI)
Age categories
20–24 yrs.	25(89.3%)	3(10.7%)	2.75(.774, 9.750)	3.16(.723,13.816)
25–29 yrs.	111(89.5%)	13(10.5%)	2.82(1.388, 5.710)	2.75(1.169,6.448)*
30–34 yrs.	109(86.5%)	17(13.5%)	2.11(1.096, 4.077)	1.82(.838,3.954)
>/=35 yrs.	91(75.2%)	30(24.8%)	1	1
Educational status
Read and write only	29(63.0%)	17(37.0%)	.146(0.065,0.327)	3.53(.245,50.853)
Primary education (1–8)	41(71.9%)	16(28.1%)	.23(0.099, 0.484)	1.70(.140,20.733)
Secondary education(9–12)	102(86.4%)	16(13.6%)	.54(0.255,1.162)	1.734(.193,15.610)
College and above	164(92.1%)	14(7.9%)	1	1
Occupational status
Merchant	118(94.4%)	7(5.6%)	6.09(2.258,16.411	6.29(.473,83.747)
Private employee	53(88.3%)	7(11.7%)	2.73(0.994,7.519)	2.51(.223,28.101)
Farmer	29(59.2%)	20(40.8%)	.52(.223,1.228)	.52(.180,1.505)
Governmental employee	100(86.2%)	16(13.8%)	2.26(0.989,5.150)	1.38(.363,5.217)
Labor work and others	36(73.5%)	13(26.5%)	1	1
Level of knowledge about skilled-delivery attendant
Good knowledge	266(90.2%)	29(9.8%)	4.46(2.542, 7.808)	2.83(1.491,5.384)*
Poor knowledge	70(67.3%)	34(32.7%)	1	1
Attitude towards skilled-delivery attendant
Good attitude	194(92.8%)	15(7.2%)	4.37(2.354, 8.118)	2.40(1.194,4.842)*
Poor attitude	142(74.7%)	48(25.3%)	1	1
* = Show statistically significant association in multivariate logistic regression at p-value ≤ 0.05

The current study revealed that the prevalence of husbands’ involvement in promoting skilled-delivery attendance was 84.2%. Husbands’ age, knowledge and attitude were the variables which show statistical significance with husbands’ involvement in promoting skill-delivery attendance at alpha value of 5%. There are a lot of researches published in male partners’ involvement in promoting skilled-delivery attendance. However, the articles published on determinants of husbands’ involvement in promoting skilled-delivery attendance.

The current study found that the prevalence of husbands’ involvement in promoting skilled-delivery attendants was 84.2% with 95% confidence interval. This finding is higher than the study done in Mareka woreda (41.3%), south east Ethiopia and Lemmo woreda (38.2%), southern Ethiopia respectively (14, 20). The finding is relatively in line with findings of studies done on husbands’ involvement in promoting skilled-delivery attendance in Kenya (68%), Ghana (73.3%) and Myanmar (69.7%) (20, 22, 23). These big levels of variation of male involvement might be occurred due to the variation of the study area, because those two previous studies were done at rural level whereas, the present study was done at relatively urban area.

Regarding the determinants of husbands’ involvement in promoting skilled-delivery attendance, this study revealed that the age of the husbands was statistically significant in promoting skilled delivery attendance. This finding was similar to studies conducted in Mareka Woreda, Ethiopia and Nigeria (8, 16). This might be due to the fact that younger men are more heroic and likely to challenge cultural norms. Additionally, they might have a better chance of an education which is known to positively influence health seeking behaviors in this age group most of the time.

However, the age category which had an association with husbands’ involvement in this study was older when compared to with other study done in Ghana relatively (23). The difference could be due to different educational status, socio cultural characteristics of the study participants and health care strategies of the country’s regarding to husbands’ involvement on maternal & child health.

Knowledge about skilled-delivery attendance was another statistically significant determinant for husbands’ involvement in promoting skilled-delivery attendance. This finding was consistent with study done in Myanmar and Lemmo woreda, Southern Ethiopia (21, 18) in which having good knowledge about skilled delivery could influence husbands’ involvement in promoting skilled-

In fact, the reason for this might be explained by the possibility that those with good knowledge understand well possible birth complications, benefits, advantages and disadvantages; so that they encourage their spouses to gate skill delivery attendance.

Husbands’ attitude was also another statistically significant determinant for husbands’ involvement in promoting skilled-delivery attendance. This finding was similar with other studies done in Mareka woreda, south east Ethiopia, Kenya and Myanmar respectively (14, 21, 22). The possible explanation for this similarity is that getting new and healthy child is the desire of all husbands; so that they encourage their spouses to gate skill delivery attendance.

This study revealed that husbands’ involvement in skilled-delivery attendance was high. Husbands’ age-related experiences, level of knowledge and having positive attitude were the contributing factors for male partners’ involvement in promoting skill delivery attendant.

Therefore, awareness creation about institutional delivery to help the husbands know about skilled-attendance institutional delivery and creating the community culture which act on creating positive attitude towards skilled-attendance institutional delivery is recommended.

Ethics Approval and Consent to Participate

Ethical clearance was obtained from Institutional Research Review Board of Harar Health Sciences College. Then supportive letter was obtained from Deder town Administration Office and given to each kebele administrative office. Concerned body from each kebele were officially communicated before conducting the data collection and verbal informed consent from each study participants were obtained.

To keep the confidentiality of the participants, personal identifiers like name of the participants were not included in the data collection booklet. Again the information obtained was utilized only for research purpose. The participants were informed that they had full right not to participate in the study or to stop participation at any time during the data collection was reassured.

Consent for Publications

The consent for publication as a ‘written informed consent for publication’ was obtained from the study participants. Thus, the authors are ready to share the form with the journal editorial office if requested.

Availability of Data and Materials

All necessary materials of this manuscript will be obtained from the corresponding author upon the request.

Competing Interests:

The authors declared that there is no conflict of interest.

Funding:

There is no funding obtained for this research.

Authors’ Contribution:

Abdusamed Mohammed: Conceptualization, methodology, and original draft preparation
Gizaw Kifle: Data entry and analysis
Abas Mume: Reviewing and editing
Yasin Abdullahi: Supervision
Remzia Abdulwehab: Supervision
Furo Beshir: Validation

Acknowledgments:

We are greatly indebted to Harar Health Sciences College for making it possible to have this opportunity. Our special thanks go to Deder town administration for their cooperation in all this research activity. And also we would like to thank all data collectors and supervisors for their commitment. Finally, our grateful recognition will go to all husbands who have participated in the study sacrificing their valuable time and information.

Authors’ Information:

Mr. Abdusamed Mohammed, MSc, PhD fellow, Department of Midwifery, Harar Health Science College, Harar, Ethiopia,

Email: [email protected],

ORCID ID: http://orcid.or/0000-0002-1055-8871

Mr. Gizaw Kifle, MSc, Department of Midwifery, Harar Health Science College, Harar, Ethiopia,

Email: [email protected]

Mr. Abas Mume, MSc, Department of Nursing, Harar Health Science College, Harar, Ethiopia

Email: [email protected]

Mr. Yasin Abdullahi, MBA, Department of Business and Economics, Harar Health Science College, Harar, Ethiopia

Email: [email protected]

Mrs. Remzia Abdulwehab, MSc, Department of Public Health, Harar Health Science College, Harar, Ethiopia

Email: [email protected]

Mr. Furo Beshir, MSc, Department of Medical Laboratory Sciences, Harar Health Science College, Harar, Ethiopia

Email: [email protected]

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No competing interests reported.

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Determinants of Husbands’ Involvement in Promoting Skilled-Delivery Attendants in Deder Town, Oromiya, Ethiopia

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Abstract

Background

Methods

Result

Conclusion and recommendation:

Figures

Background

Methods And Materials

Source and Study population

Sample size determination, techniques and procedures

Data collection instrument and techniques

Operational Definitions

Data processing and analyses

Results

Socio-demographic Characteristics

Health care services and cultural related barriers of husbands’ involvement in promoting skilled-birth attendants

Knowledge of husbands’ toward skilled-delivery attendance of their wives

Husbands’ Attitude on skilled-delivery attendance

Husbands’ involvement in promoting skilled-delivery attendance

Factors associated with husbands’ involvement in promoting skilled-delivery attendants

(n = 399)

Discussion

Conclusion And Recommendation

Declarations

References

Additional Declarations

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