Outcome variable
The outcome variable was a self-reported D&A score measured using types of D&A developed by Bowser and Hills in 2010 and was used in other related studies. (6) The D&A scale was validated in Kenya in study done by Abuya and colleagues in 2015 (1) and we got permission from the author to use the tool. The tool we used had a maximum score of 9 items of D&A with 9 follow-up questions about explanations of reported types of D&A. Each reported item was based on binary responses and was scored 1 for ‘’yes’’ for disrespect and 0 for ‘’no’’ for non-disrespect. We did the score summation of the self-reported 9 D&A items. The total disrespect score was the sum of responses to the 9 RMC questions. In this study the participants can experience more than one item of disrespect. The ‘’0” indicates mother experienced non disrespect at all. Note that we used the word disrespect and D&A interchangeably. After performing the summation of those who responded yes on the 9 Disrespect items (each reported yes item was scored 1). We specified a binary outcome, and ‘’not disrespect’’ and ‘’disrespect’’ as categorical variables. We analysed the data from the follow-up questions using frequency and percentages.
Explanatory variables and covariates
Explanatory variables were mother’s socio-demographic and obstetric history data. There were 6 variables, namely gravida, age of the mother, marital status, education, occupation, condition of the baby at delivery. We categorized these variables where necessary and summarized by frequencies and percentages. Gravida is categorized into 4 categories, the age of the mother into three categories, occupation into three main categories. Marital status was classified in three categories as single, married and cohabitation. Education level was defined into 2 categories as no formal education and primary education, then those who reached the secondary and tertiary education. The condition of the baby at delivery was dichotomous, defined as baby is well/healthy and the baby is admitted in neonatology
Statistical methods
Data was entered, and then the data were cleaned, then we used STATA software version 16 for analysis. Descriptive and inferential statistics were used.
We evaluated the association between explanatory variables and the reported D&A score in chi-square analysis. We used logistic regression to find predictors of disrespect. Primarily, bivariate logistic regression models were fitted to identify factors that were possibly associated with disrespect, using a P-value of 0.20 to investigate all possible confounders. Backward elimination with a P-value of 0.05 was used to select the final model. The strength of association was expressed as odds ratios with 95% confidence limits. Potential multicollinearity was investigated, but no multicollinearity was found.
Table 1 Description of socio-demographic and obstetric characteristics (n = 246)
The majority were primigravida (34.15%) and were aged between 18 to 24 years (36.99%). The majority has attended only the primary education (55.28%). The majority were living with their partners but not legally married (50.41%). The majority were living on selling small things (37.40%) while (35.77%) were staying at home, 86.99% had healthy babies and were staying with their newborns.
Variables
|
Frequency
|
Percentage
|
Gravida
|
|
|
Gravida 1
|
84
|
34.15
|
Gravida 2
|
59
|
23.98
|
Gravida 3
|
50
|
20.33
|
Gravida 4 and more
|
53
|
21.54
|
Age of the mother
|
|
|
18–24
|
91
|
36.99
|
25–30
|
77
|
31.30
|
31 and above
|
78
|
31.71
|
Education level
|
|
|
No formal education and primary
|
136
|
55.28
|
Attended secondary
|
110
|
44.72
|
Marital status
|
|
|
Single mother
|
45
|
18.29
|
Legally married
|
77
|
31.30
|
Cohabitation
|
124
|
50.41
|
Occupation of the mother
|
|
|
Homemaker
|
88
|
35.77
|
Farming
|
66
|
26.83
|
Small sales
|
92
|
37.40
|
Condition of the baby
|
|
|
Healthy baby
|
214
|
86.99
|
Baby admitted in neonatology
|
32
|
13.01
|
Figure 1. Prevalence of disrespect and abuse
In total, 246 mothers were interviewed, the majority 151(67.48 %) reported to experience D&A during their recent childbirth. This means those participants have reported experiencing at least one type or more types of disrespect.
Figure 2. Frequency of D&A experienced by the participants
After summation analysis of all nine types of disrespect, the score indicated that among the participants who reported to experience D&A, therefore 28.86% experienced once D&A and 32.52% reported to receive from two to eight types of disrespect . The minimum, the participants experience D&A is once and the maximum is eight times. No participant who experienced 7 times and 9 times.
Figure 3. Types of disrespect and abuse
The most prevalent received undignified care (30.89%), were abandoned (30.49%), did not receive information on care received (26.42%).
Table 2 Explanations on Types of disrespect experienced by mothers
Table 2 depicts the types of care that showed disrespect to the participants. These responses were received during the follow-up questions asked only to mothers who responded yes on in order to capture the explanation of the type of care they most appreciated. There were six follow-up questions in total A total of 151 participants responded yes to all/at least one on D&A items. During the follow-up questions, the participants were inquired to explain about the kind of disrespect and abuse they experienced. For instance, we posed the question: “At any point during your stay for this delivery were you physically abused by any of the health care workers? Those who responded ‘’yes’’ they were asked to explain what exactly happened, 2 participants reported that they repaired their episiotomy without anesthesia, 2 participants reported that they were beaten and one participant said she was pinched another one was kicked out. The most (15.85%) reported that they were not provided care after birth, (10.16%) reported being less cared in general (Table 2).
Table 2 Explanations on Types of disrespect experienced by mothers (n = 80)
Physical abuse
|
Frequency
|
Percentage
|
1.Beaten
|
2
|
0.81
|
2.Repaired episiotomy without anesthesia
|
4
|
1.63
|
3.Pinched
|
1
|
0.41
|
4.Kicked
|
1
|
0.41
|
Lack of privacy
|
|
|
1.Multiple vaginal examination by multiple people
|
1
|
0.41
|
2.Left uncovered
|
5
|
2.03
|
3. No screen blocking views
|
7
|
2.85
|
Non confidential care
|
|
|
1.Gave birth in waiting room
|
2
|
0.81
|
2. Information was discussed with non-health staff
|
6
|
2.44
|
Non consented care
|
|
|
1.Vaginal examination
|
8
|
3.25
|
2.Caesarian section
|
3
|
1.22
|
3.Placement of intra-uterine device (IUD)
|
2
|
0.81
|
4.Abdominal palpation
|
3
|
1.22
|
Discrimination
|
|
|
1.Omitted care
|
18
|
7.32
|
2.Told bad words
|
3
|
1.22
|
3.Judged
|
2
|
0.81
|
Abandonment
|
|
|
1.Not provided care after birth
|
39
|
15.85
|
2.Not provided during pushing the baby
|
12
|
4.88
|
3.Not provided care during labour
|
15
|
6.10
|
4. Not provided care in post-partum pain
|
11
|
4.47
|
Table 2. Follow-up questions
Table 3 Chi-Square analysis of categorical variables (n = 246)
All variables (explanatory and outcome) were categorical data. The outcome of categorical variables was (no disrespect and disrespect). After chi-square analysis, we found no association between explanatory variables and outcome as shown in the table below.
Variables
|
No Disrespect (%) n=95
|
Disrespect (%)
n=151
|
P-value
|
Gravida
|
|
|
0.131
|
Gravida 1
|
37(44.05)
|
47(55.950
|
|
Gravida 2
|
21(35.59)
|
38(64.41)
|
|
Gravida 3
|
13(26)
|
37(74)
|
|
Gravida 4 and more
|
24(45.28)
|
29(54.72)
|
|
Age of the mother
|
|
|
0.837
|
18–24
|
35(38.46)
|
56(61.54)
|
|
25–30
|
28(36.36)
|
49(63.64)
|
|
31 and above
|
32(41.03)
|
46(58.97)
|
|
Education level
|
|
|
0.146
|
No formal education and primary
|
47(34.56)
|
89(65.44)
|
|
Attended secondary
|
48(43.64)
|
62(56.36)
|
|
Marital status
|
|
|
0,719
|
Single mother
|
15(33.33)
|
30(66.67)
|
|
Legally married
|
31(40.26)
|
46(59.74)
|
|
Cohabitation
|
49(39.52)
|
75(60.48)
|
|
Occupation of the mother
|
|
|
0.923
|
Homemaker
|
33(37.50)
|
55(62.50)
|
|
Farming
|
25(37.88)
|
41(62.12)
|
|
Small sales
|
37(40.22)
|
55(59.78)
|
|
Condition of the baby
|
|
|
0.597
|
Healthy baby
|
84(39.25)
|
130(60.75)
|
|
Baby admitted in neonatology
|
11(34.38)
|
21(13.91)
|
|
Table 3. Chi-Square analysis
Table 4. Logistic regression
This table displays the results from the bivariate model and multivariate logistic regressions that examined the association between the explanatory variables and the outcome (disrespect). The logistic analysis in full model showed gravida three was associated was statistically significant with P-value 0.022 of and crude odds ration 3.2 with confidence interval of [1.18-9.08]. This means there is association between gravida 3 to the outcome (disrespect) compared to gravida 1.
|
N = 246
|
Disrespect (%)
|
Crude OR
[CI 95%]
|
P-value
|
Adjusted OR
[CI 95%]
|
P-value
|
Variable
|
Category
|
No Disrespect (%)
|
Disrespect (%)
|
|
|
|
|
Gravida
|
Gravida 1
Gravida 2
Gravida 3
Gravida 4 and more
|
37(44.05)
21(35.59) 13(26)
24(45.28)
|
47(55.950
38(64.41)
37(74)
29(54.72)
|
1
1.82[ .83- 3.99]
3.2[1.18-9.08]
1.31[.47- 3.59]
|
0.133
0.022
0.597
|
1
1.45[.73-2.90]
2.09[ .96- 4.53]
.86[ .42- 1.75]
|
0.282
0.061
0.683
|
Age of the mother
|
18–24
25–30
31 and above
|
35(38.46)
28(36.36)
32(41.03)
|
56(61.54)
49(63.64)
46(58.97)
|
1
.79[.35- 1.79]
.57[ .20- 1.57]
|
0.585
0.281
|
|
|
Education level
|
No formal & primary
Secondary
|
47(34.56)
48(43.64)
|
89(65.44)
62(56.36)
|
1
.61[.33- 1.12]
|
0.118
|
1
.67 [.39- 1.14]
|
0.147
|
Marital status
|
Single
Married
Cohabitated
|
62(56.36)
31(40.26)
49(39.52)
|
30(66.67)
46(59.74)
75(60.48)
|
1
.90[.36- 2.23]
.67[.31- 1.46]
|
0.836
0.324
|
.
|
|
Occupation of the mother
|
Homemaker
Farming
Small sales
|
33(37.50)
25(37.88)
37(40.22)
|
55(62.50)
41(62.12)
55(59.78)
|
1
1.15[.54-2.41]
1.21[ .62-2.35]
|
0.707
0.571
|
|
|
Condition of the baby
|
Healthy baby
Baby not well
|
84(39.25)
11(34.38)
|
130(60.75)
21(13.91)
|
1
1.32[ .57-3.04]
|
0.503
|
|
|
Table 4. Logistic regression model