Study design and period
Health facility-based cross-sectional study was conducted from September 1 to October 30/ 2020G.C in South Gondar zone hospitals, Northwest Ethiopia.
The study was conducted in the South Gondar zone hospitals located in the Amhara Region, Northwest, Ethiopia. Debre Tabor is the capital city of the zone which is found 103kilometers away from Bahir Dar (the capital city of Amhara Regional State) and about 667 Kilometers away from Addis Ababa (the capital city of Ethiopia). According to a report from the south Gondar zone administrative office, the population of this zone is 2,609,823. Females number 1304,911 in this zone, With the majority who are economically dependent on agriculture. There is one Referral Hospital and seven additional governmental hospitals (Mekane-Eyesus, Andabet, Nifas-Mewucha, Addis-Zemen, Tach Gait, Wogeda, and Event). The zone has 96 public health centers, 140 private clinics, and 403 health posts.
All mothers who gave birth in South Gondar zone governmental hospitals in 2020.
All mothers who gave birth in South Gondar zone selected hospitals during a data collection period.
All mothers who gave birth among selected hospitals and resided in the study area.
Mothers who were admitted before the onset of labor for follow up in the waiting room.
Mothers who were not living in the study area for less than six months.
Dependent variable: Delay in making decision to seeking care on institutional delivery
Independent variables: socio-demographic characteristics; age, residence, marital status, ethnicity, religion, education of the mother, education of husband, occupation of the mother, occupation of husband, family income. Obstetrics related factors; gravidity, parity, ANC follow up, type of pregnancy, mode of delivery in the past, the current mode of delivery. Health facility factors: available health facility, the distance of health facility, means of transportation, previous pregnancy birthplace, know any danger signs of labor, and decision-maker for EOC[13, 14].
Institutional delivery utilization: when a mother gave birth at a health.
Delays of the decision to seeking care: refers to the time taken greater than one hour to decision seek care after the onset of labor.
Sample size determination
The sample size was determining using a single population proportion formula by using the following assumptions: the proportion of delay in making decision to seeking care was 26.2%, 5% margin of error and 10% non-response rate and design effect of 2 with the final required minimum sample size estimated to be 653.
Sampling Procedure and Technique
The total sample size was proportionally allocated for five randomly chosen hospitals as a cluster from eight hospitals in the south Gondar zone. For each hospital, the first participant selected randomly; then, the subsequent participants were selected by a systematic sampling technique every two interval for each hospital.
Data collection techniques
The data were collected through face –to- face interview with postpartum mothers in private room before discharge. Five diploma Midwives for data collection and two Midwifery professionals for supervision were recruited. The questionnaires were prepared in English, and then translated to Amharic (local language) for simplicity and back to English to maintain consistency of the tool.
Data quality assurance
The questionnaire was pretested to check participant response, language clarity, and appropriateness of the questionnaires. A pretest was conducted on 5% out of the study area called koladiba hospital. At the end of the pretest, ambiguous and culturally sensitive questions were amended, clarified adjusted before data collection began. One-day training was given for data collectors and supervisors to clarify the purpose of the study and techniques of data collection. The collected data were checked daily for its completeness and consistence. The collected data were kept locked in a file cabinet accessible only for the researchers.
Data Processing, Analysis, and Interpretation
The data were coded and entered into Epi-data version 3.1. Then it was exported to Statistical Package of Social Science (SPSS) version 20.00 for data checking, cleaning, and analysis. Descriptive statistics were performed on numerical value, frequencies, mean, proportion to describe the study population about dependent and independent variables. The results of the study were presented in the text, and tables. Binary logistic regression was used to identify statistically significant independent variables, and independent variables having a p-value of less than 0.2 were entered to multivariable logistic regression for further analysis and to adjust for confounding variables. The Adjusted Odds Ratio (AOR) was used to identify determinant variables for delays to institutional delivery service with 95% confidence interval at P-value < 0.05.