Study setting and Period
The study was conducted in southern, Ethiopia from March 1, 2019 to March 30; 2019.
Study Design and Population
Community Based Cross Sectional Study was conducted among all reproductive age group of married women in southern, Ethiopia.
Sample Size Determination and Sampling Technique
To determine the sample size for studying factors associated with women autonomy of decision making regarding their maternal health service utilization, the formula for single population proportion was used and the following assumption was made. Significance level of 95% confidence interval and 5% margin of error were taken the study on factors associated with women autonomy of decision making regarding their maternal health service utilization in, Southern Nations, Nationalities and Peoples Republic, Ethiopia. 58.4% of women have autonomy on decision making similar as study conduct in Wolaita and Dawro zones, Southern Ethiopia (Mihiretu A. and Mengistu M, 2017)Let as women autonomy of decision making regarding their maternal health service utilization is the . Prevalence =58.4%; and use 10% non-response rate.
Sample size is calculated by using the single population proportion formula as follows.
Where, n=desired sample size, p=expected prevalence of women autonomy of decision making 58.4%; z=confidence interval – 95% , d=desired precision- 5 %, n= required sample size, N=final sample size and Design effect 1.5
, = 373.3 then to get final sample size (N), use non-response rate (10%), N = 10% * n + n, N =10% of 373 + 373, = 37.3 + 373 = 410*1.5 = 615 N = 615.
Data Collection Procedures
A structured interviewer administered questionnaire which was Adapted from the EDHS, 2016 and different literatures (Tulsi R., 2015), (Deependra K, 2012),(Osamor P and Grady C, 2016).Were used to collect data. The questionnaire was including all the questions that assess women autonomy of decision making on maternal health service utilization. Data was collected by interviewing eligible subjects using a pre-tested structural questionnaire. The tool was prepared in English version and it was translated to Amharic, Amharic again translated back to English language to check consistency.
Data Processing and Analysis
All data were checked for completeness and internal consistency by cross checking and coded and entered onto EPI-DATA version 3.1 and then exported to SPSS 20.0 for analysis. Principal component analysis was conducted to produce wealth quintiles and reveal socioeconomic status of the households. Multi co-linearity test was carried out to see the correlation between independent variables using standard error. Model fitness was checked by using Hosmer –Leme show. Descriptive statistics was used to describe the study population in relation to relevant variables. Both bivariable and multivariable logistic regression models were used to identify factors associated with the outcome variable. In order to enter factors in final multivariable model, only variables with p-value < 0.25 during bivariable analyses were entered into the multiple logistic regression models. Odds Ratio along with 95% Confidence Intervals was estimated to measure the strength of the association between dependent and independent variables. Levels of statistical significance were considered at p - value less than 0.05.
Ethical clearance was obtained from the Institutional health research ethics review committee (IHRERC) Haramaya University College of Health And Medical Sciences. All procedure was conducted after completing permission from the postgraduate office of Haramaya University. After permission letter obtained from school of graduate office, letter was submitted to each Zone. An informed, voluntary, written and signed consent was obtained. Participants were informed clearly about the purpose and benefits of the study and written informed consent was obtained from the participants. Those who are signed written consent were only participating in the study and the confidentiality of respondents was maintained throughout the research process by giving code for participant. Personal privacy and cultural norms were respected. The respondents were having the right not to participate in study or withdraw from the study at any time/stage of interview.
Women decision making Autonomy in their maternal health service utilization: is dictated as “Yes” on the options women are participate in health service utilization if she have the right to use health care, freedom of movement and if she has right to use house hold purchases. If a woman is decide alone and with their husband jointly they are autonomous if only husband and someone give decision she is not autonomous in decision making (EDHS, 2016).
Maternal health service refers a service given by skilled health professional before pregnancy, during pregnancy and postpartum period (WHO, 2018).
Antenatal Care: - a care provided by skilled health-care professionals to women in order to ensure the best health conditions for both mother and baby during pregnancy (WHO, 2018)
Post natal care: a care service given to the delivered mother by skilled birth attendance after birth (WHO, 2018).
Delivery care service: a care given by skilled health care professionals to women during child birth (WHO, 2018).
Knowledgeable: - those women who scored at least 84% and above in knowledge questions.
Moderately knowledgeable: - those women who score 50-84% of knowledge questions.
Less knowledgeable: - those women who scoreless than 50% of knowledge questions (Dabere N et al., 2014).