UNIVERSITY OF GONDAR

COLEGE OF MEDICINE AND HEALTH SCIENCES

SHOOL OF MIDWIFERY
DEPARTMENT OF CLINICAL MIDWIFERY

LABOR COMPANION UTILIZATION AND ASSOCIATED FACTORS

AMONG POSTNATAL MOTHERS AT DEBRE MARKOS TOWN PUBLIC
HEALTH INSTITUTIONS, NORTHWEST ETHIOPIA, 2021

PRINCIPAL INVESTIGATOR: - HUSSIEN MOHAMMED ASSFAW (BSc)

ADVISORS:-
1. MrsRS. MULUNESH ABUAHAY (MPH/RH, ASSISTANT PROFESSOR)
2. MrR. MELAKU HUNIE (MPH/RH)

A THESIS SUBMITTED TO SCHOOL OF MIDWIFERY, COLLEGE OF

MEDICINE AND HEALTH SCIENCES, UNIVERSITY OF GONDAR FOR
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF MASTER IN CLINICAL MIDWIFERY

JUNE, 2021

GONDAR, ETHIOPIA
 UNIVERSITY OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF MIDWIFERY

DEPARTMENT OF CLINICAL MIDWIFERY

LABOR COMPANION UTILIZATION AND ASSOCIATED FACTORS

AMONG POSTNATAL MOTHERS AT DEBRE MARKOS TOWN PUBLIC
HEALTH INSTITUTIONS, NORTHWEST ETHIOPIA, 2021

Principal investigator: - Hussien Mohammed Assfaw (BSc)

Address Cell phone: - +251 9 23 74 48 69

Email: - baluka2007.12.14@gmail.com

Advisors: - 1. Mulunesh Abuahay (MPH/RH, Assis.Prof.) Signature_______

2. Melaku Hunie (MPH/RH) Signature__________

Examiners: - 1. Name _________________________Signature_________

2. Name__________________________Signature________

Approved by the Examining Board

1. Name ____________________________Signature______________
2. Name ____________________________Signature______________

i
ACKNOWLEDGMENTS

First, I would like to acknowledge Mrs. Mulunesh Abuahay (MPH/RH, Assistant

professor) and Mr. Melaku Hunie (MPH/RH) for their cooperation and support to do this
thesis.

Secondly, I would like to give thanks University of Gondar College of medicine and
health sciences school of midwifery, department of clinical midwifery for giving chance
to do this thesis which undertaken in my area of interest in this specific place and for
support of money.

I would like express my deepest gratitude to the study participants, data collectors,
supervisors for their involvement to do this thesis.

Another profound gratitude goes to Debre-Markos town health department, Debre-

Markos referral hospital clinical director, each health institutions ward head for their
permission to do this study and all staffs of each health institution who work at labor and
postnatal ward for being supportive and cooperative during recruitment of respondents
for this study.

Lastly special thanks go to my friends, colleagues and to those who all contributed to do
this work for their critique and support through the development of the thesis.

ii
ABBREVIATIONS

ANC Antenatal Care

AOR Adjusted Odds Ratio
CI Confidence Interval
COR Crude Odd Ratio
EDHS Ethiopian Demographic Health Survey
EMwA Ethiopian Midwifery Association
LMICs Low and Middle Income Countries
RMC Respectful Maternity Care
SBA Skill Birth Attendant
SDG Sustainable Development Goal
UAE United Arab Emirates
UoG University of Gondar
WHO World Health Organization

iii
TABLE OF CONTENT
CONTENTS PAGE
ACKNOWLEDGMENTS...................................................................................................ii
ABBREVIATIONS............................................................................................................iii
TABLE OF CONTENT.....................................................................................................iv
LIST OF TABLES............................................................................................................. v
LIST OF FIGURES..........................................................................................................vi
LIST OF ANNEXES........................................................................................................vii
ABSTRACT....................................................................................................................viii
1. INTRODUCTION..........................................................................................................1
1.1. Statement of the problem......................................................................................1
1.2 Literature reviews................................................................................................. 3
1.3. Justification of the study......................................................................................11
2. OBJECTIVE............................................................................................................... 12
2.1 General objective..................................................................................................12
2.2 Specific objectives................................................................................................12
3. METHODS................................................................................................................. 13
3.1. Study design and period......................................................................................13
3.2. Study setting........................................................................................................13
3.3. Populations..........................................................................................................13
3.4. Eligibility criteria...................................................................................................13
3.5. Sample size determinations.................................................................................14
3.6. Sampling procedure............................................................................................ 14
3.7. Variables of the study..........................................................................................16
3.8. Operational definition...........................................................................................16
3.9. Data collection tools and procedure....................................................................17
3.10. Data quality controls..........................................................................................18
3.11. Data processing and analysis............................................................................18
4. Ethical consideration.................................................................................................19
5. RESULT..................................................................................................................... 20
6. DISCUSSION.............................................................................................................32
7. CONCLUSIONS AND RECOMMENDATION............................................................38
8. REFERENCES...........................................................................................................39
9. ANNEXES..................................................................................................................43

iv
LIST OF TABLES
Table 1 Sociodemographic characteristics of respondents at Debre Markos town, North
West Ethiopia from February to March 2021..................................................................20
Table 2Maternal obstetric characteristics of study participant at Debre Markos town,
North West Ethiopia from February to March 2021........................................................22
Table 3 Maternal health service related variables of study participant at Debre Markos
town, North West Ethiopia from February to March 2021..............................................23
Table 4:- facility, health care providers and companion related causes for non-utilization
of labor companion at Debre Markos town, North West Ethiopia from February to March
2021............................................................................................................................... 25
Table 5 Bi-variable and multivariable binary logistic regression analysis of factors
associated with labor companion utilization, in Debre-Markos town public health
institutions, northwest Ethiopia,2021 (n=548)................................................................28

v
LIST OF FIGURES
Figure 1: conceptual frame work about labor companionship utilization and associated
Factors which developed from review of literatures (33, 36, 41, 43, 45-49)...................10
Figure 2 Schematic presentation of the sampling procedure on utilization of
companionship during labor and associated factors among postnatal mothers who gave
birth at health institution of Debre-Markos town, North West Ethiopia, 2021.................15
Figure 3 Women future preferred companion at Debre Markos town, North West
Ethiopia 2021................................................................................................................. 25
Figure 4:- prevalence of labor companion utilization among postnatal women at Debre-
Markos town public health institutions north west, Ethiopia 2021..................................27

vi
LIST OF ANNEXES
Annex 1Information Sheet..............................................................................................41
Annex 2Consent Form................................................................................................... 41
Annex 3 English version questionnaires.......................................................................42
Annex 4 ስለ ጥናቱ ማስታወቂያ ቅፅ.........................................................................................52
Annex 5 የፍቃደኝነትአማርኛ መጠየቂያቅፅ.................................................................................53
Annex 6 የአማርኛ መጠይቅ.................................................................................................. 54
Annex 7 Declaration.......................................................................................................59

vii
ABSTRACT
Background: - Sstill maternal and neonatal mortality is a global tragedy, so improving
quality care with the approach of person centered care like allowing labor companion is
a hearty intervention. But recently intrapartum care focus on technological approach
rather than both historically and culturally accepted and clearly stated advantageous
continuous companion supported care. Different scholars conclude that providers,
institutional and maternal factors are the predictors of labor companion utilization but in
our setting evidences on labor companion utilization and its predictors were limited.
Objective: - This study aimed to assess utilization of labor companion and its predictors
in Debre Markos town public health institutions. from February 1 to March 30/2021.
Methods: - An institution based cross sectional study design was conducted among
559 postpartum women at Debre-Markos town, northwest Ethiopia from February 1 to
March 30 2021.Systematic random sampling was used. The data were collected by
face to face interview using pretested structured questionnairewith interviewer
administered questionnaire. Participants were selected by systematic random sampling
technique. Data were entered towith Epi-data version 4.60 and exported toanalyzed
with SPSS version 25.0. After bivariable analysis variables with P<0.2 were transferred to
Multivariable logistic regression analysis. Adjusted odds ratio with 95% confidence interval for the
strength and direction of association and P value<0.05 for statistical significance were used.Bi-
variable logistic regression was done and variables with p-value ≤ 0.20 were analyzed
with multivariable logistic regression. After model fitness and multi-collinearity checked
Variables with p-value ≤ 0.05 and 95% confidence interval Adjusted Odds Ratio (AOR)
which exclude one were considered significantly associated with labor companion
utilization.
Results: - A total of 548 participants were involved in the study with 98.03% response
rate. Utilization of labor companion.From all respondents was found to be14.6%
(95%CI: 11.7, 17.5). of them were utilize labor companion. Women who had
complicated pregnancy(adjusted odd ratio(AOR)=) = 5.532; 95%CI: 3.086, 9.917), future
desire (AOR=3.627; 95%CI: 1.513, 8.698), being Primipara (AOR=3.497; 95%CI: 1.926,
6.349), labor followed by female skill birth attendant (AOR= 0.370;95%CI: 0.166, 0.823),

viii
and women perceived busyness of skilled birth attendant (AOR=0.128;95%CI: 0.072,
0.228) were significantly associated with utilization of labor companion.
Conclusionand recommendations: - Utilization of labor companion was found to be
low in the study area. To improve this great attention needs to be given by all
stakeholders for all women who have desire for labor companionship regardless of their
parity, complicated pregnancy, ,and skill birth attendant busyness and sex of health
care provider who follows with both female and male skill birth attendants.
Key words: - Ethiopia, Labor companion, Postnatal, Utilization

ix
1. INTRODUCTION

1.1. Statement of the problem

For most women being pregnant is not just a matter of having a baby, it is a matter of
life and death (1). Enabling women’s pregnancy and childbirth as a part of sexual and
reproductive health rights is a part of International human rights law and fundamental
commitments of each Country including our country Ethiopia (2). As a result every
pregnant woman and newborns have the right to gate quality person centered care (3).

Labor companionship is a human interactive process which provides tangible

continuous social support or assistance (emotional, cognitive and physical support)
during childbirth process to help women cope with stress of labor with an empathic
person. Companion is any person chosen by a woman for providing continuous support
like advice, information and comfort during labor and child birth (4).

Evidences suggested that labor companion utilization have no harm (5) rather than both
long and short for the mother, newborn, father/husband, family members and health
care providers. Those benefits include increase spontaneous vaginal birth (5, 6), self-
efficacy by 0.903 (7), exclusive breastfeeding practices (6), maternal satisfaction (5, 6,
8),five-minute APGAR score (5, 6), maternal strength for labor (9), husband satisfaction
and bonding of baby with the father(10) due to the presence of preferred birth
companion support in addition to routine childbirth care given by SBAs.

In addition to these advantageous labor companion utilization also reduce maternal

anxiety (11), mean of childbirth fear by 0.866 (7), emergency cesarean section rate (5,
6), episiotomy, fetal distress, instrumental delivery, need of antipain (6), pain perception
(11),length of labor (5, 6), risk of disrespected and abused care by 10 times (12), risk of
mistreatment like stigma, non-consented vaginal examination, poor communication and
longer wait time (13). This implies that absence of labor companion is one predominant
factor for negative childbirth experience (14).

In-spite of those evidence based benefits, its historical and cultural acceptability (5) and
consideration as human right (15), this component of maternal care was largely missed

1
in the 20th century when childbirth takes place in health facilities (5) especially in
developing countries (16-18). This is because of intrapartum care focus on risk oriented
and technology dominated approach rather than considering continuous companion
supported as a norm without exception especially in low and middle income countries
(LMICs) (5) .

Because of this many women in LMICs choose home and traditional birth attendant
(TBA) than health facility and skilled birth attendant (SBA) respectively to give childbirth
(19, 20) and more than half of women in Ethiopia still deliver at home (21). As a result
maternal and neonatal mortality is still a tragedic event in the globe especially in
developing countries. Maternal mortality ratio significantly different between developed
and developing worlds (11 and 462 per 100000 live birth (22).This discrepancy is due to
lack of quality, institutionalized, client centered and continuous preferred companion
supported care especially in developing countries including Ethiopia (23-25).

To overcome these problems different countries like South Africa implement doula
care(26)and different scholars, world health organization (WHO), International
Federation of Gynecology and Obstetrics (FIGO), Ethiopian midwife association(EMwA)
and Ethiopian Federal Ministry of Health strongly recommend to practice labor
companionship as a norm rather than the exception in all health facilities to improve
quality of maternal health service provision (4, 6, 27-30).

In-spite of scholars recommendation, women’s willingness, desire or a profound need,

historically and culturally acceptability of the service, there is no sufficient data about
the magnitude of labor companion utilization and its predictors in our country Ethiopia
especially in Amhara region as much as I search with different searching engine.
Therefore this study is aimed to assess the magnitude of labor companion utilization
and associated factors among postnatal mothers in public health institution of Debre-
Markos town.

2
1.2 Literature reviews

Allowing companionship in labor is one of hearty intervention to achieve quality care

provision which increase maternal satisfaction (6, 31, 32). Every health institutions must
have a written policy that encourages practice of at least one birth companion
throughout labor and delivery to fulfill criteria of mother-baby friendly birthing
centers(29).

Utilization/practice of companionship during labor

Institutional based national survey with hospitalized interview among 23,940 postnatal
women in Brazil asserted that 42.1% of women utilize continuous companionship during
labor(33). Another evaluative retrospective survey among 406 records of immediate
post-partum mothers assisted for normal childbirth at three maternity unit of Southern
Brazil revealed that about 16.7% of women receive childbirth care with the presence of
birth companion(34).

Community based crossectional study at Bangladesh among 1367 mothers who had
history of delivery within one year showed that 68% of women utilize companion of
choice during labor and child birth which was significantly higher at home birth(35).

Large scale cross-sectional observational study among 63077 at 6 hospitals in Nepal

revealed that 19% of study participants were utilize labor companion during their
hospital admission for labor and delivery process(36).

Interview administered prospective cohort study among 402 postpartum women in

Riyadh revealed that only 14.2% mothers ever had a supportive companion during any
of their previous childbirths(37).

Cohort study among 400 surveyed postnatal women who deliver single newborn
vaginally at hospital in United Arab Emirates (UAE) asserted that 59.3% of mothers
utilize companionship from non-professional attendants like mother, sister, friend, close
family relative and husband(38).

3
Quantitative exploratory descriptive study in South Africa among 62 postnatal women
who were selected with convenience sampling asserted that only 15 (24.2%) of women
had companions during labor(26). Another base line evaluation study finding from
interview of 2090 women in 10 hospitals of South Africa revealed that majority (84.5%)
of women had not had child birth companion(39).

Multicounty community based cross-sectional study among 2672 postnatal women up to

8 weeks in Ghana, Guinea, Nigeria and Myanmar revealed that 5.1% participants were
accompanied their companion of choice during labor. Specifically each country
coverage of companion utilization during labor was 11.4% Ghana, 10.9% Guinea, 0.32
Myanmar and 6.3% Nigeria (13).

Descriptive facility based cross sectional study in Nigeria among 512 postpartum
mothers within 48 hours of term uncomplicated delivery asserted that only 13.1% study
participants utilize labor companion (40). Another facility based crossectional study in
Nigeria among 297 pregnant women to assess their desire and preference 204 were
para one and above. Among those who have history of labor 32.66% had history of
labor companion utilization in their previous deliveries (41).

A cross sectional facility and community based study in Tanzania during 2016 among
935 postnatal women who have alive neonate and 732 reproductive age women
asserted that only 44.7% (42) and 60.1%(43) of mothers respectively utilize
companionship during labor.

Mixed community based study in Kenya among 877 surveyed and 8 group discussions
with 58 reproductive age women who delivered in the 9 weeks preceding the study
revealed that 67% were allowed continuous support during labor (44).

According to an institutional based study in Addis Ababa Ethiopia among 378 health
professionals 275 were female SBAs among female SBAs 37% had history of childbirth
and 59.8% of them utilize labor companion during their own facility based childbirth
history (9). Another institutional based observational study in Tigray to asses quality of
intrapartum care among 216 laboring mothers and their newborns and cross-sectional
study with exit interview to assess labor companion utilization among 407 postnatal

4
women at Arbaminch revealed that 39.8% (45) and 13.8% (46) of women were utilize
labor companion respectively.

1.2.2 Factors associated with companionship during labor and childbirth

Utilization of birth companionship affected by women’s perception and preference,

characteristics and attributes of companion (support person), type of supportive care,
health care institutions policy and guidelines(47).

1.2.2.1 Maternal related factors

Socio-demographic related factors of the mother

According to an observational study conducted at Nepal maternal age was significantly

associated with labor companion utilization. A woman’s aged 19-24 years old had 65%
and 25-29 years old had 50% higher odds of having companionship during labor
compared with women aged 35 and older(36).

According to national survey in Brazil and large scale observational study in Nepal
educational status of a woman significantly associated with utilization of continuous
companion support during hospital stay for child birth and labor respectively. In brazil
national survey the odds non utilizing companion support during hospital stay for child
birth among women whose educational status below 11 years were 1.8 times than
those women whose educational status above 11 years (33). In contrast to this a study
in Nepal conclude that women who had formal education had 8% lower odds of having
companionship during labor compared with uneducated women(36). Status of literacy
also significantly associated with labor companion utilization according to community
based survey in Kenya. A woman who write very well 2.89 times more likely utilize labor
companion than a woman who not write totally(44).

According to mixed community based study in Kenya among 877 and 58 among women
who delivered in the 9 weeks preceding the study with interview and group discussion
respectively conclude that economic status of a woman significantly associated with
labor companionship. Being more economically good nearly 2times more likely utilize
labor companion than very less household wealth(44).

5
Mixed community based survey in Kenya about birth companion utilization with
interview and group discussion among 877 and 58 reproductive age women who
delivered in the 9 weeks preceding the study respectively conclude that women’s work
status significantly associated with experience of labor companionship. Employed
women utilize labor companionship 1.97 times higher than un employed woman(44).

An institutional and community based crossectional study conducted at Nepal and

Kenya respectively conclude that ethnicity of mother was statistically associated with
labor companion utilization. In Nepal study being Chhetri/Brahmin and Janajati ethnic
group increase labor companion utilization by 4.6 and 3.8 times respectively compared
with disadvantaged ethnic groups(36). Whereas in Kenya being Kuria ethnic group
reduce utilization of labor complain by 43% compared to Luo tribe(44).

Obstetric related factors

Study in Brazil concludes that type of delivery was significantly associated with
utilization of companionship. Women who give birth with vaginally 1.6 and 2.5 times risk
of complete and partial absence of companionship in hospital admission compared to
women who give birth with cesarean section(33).

Cross-sectional study at Nepal revealed history of prior cesarean section significantly

associated with labor companion utilization. Odds of labor companion utilization nearly
two times for women who had previous cesarean birth compared to counterparts (36).

According to mixed community based survey in Kenya, Brazil national survey and
cross-sectional study at Arbaminch Ethiopia number of delivery significantly associated
with being allowed and utilization of companionship during labor(44), total hospital
stay(33) and utilization of labor companion(46). Being multipara increase a risk of total
and partial absence of companionship by 60% and 20% respectively compared to
nulliparous during hospital stay(33). Being Para 3 had 63% lower odds of allowed
continuous support during labor compared to Para one(44). A recent cross sectional
study in Arbaminch Ethiopia conclude that being primipara was more than two times
increase the utilization of labor companion compared with multipara(46).

6
Community based survey in Kenya among 877 interviewed and 58 group discussed
postnatal women who delivered in the preceding 9 weeks before the study conclude
that history of facility based delivery significantly associated with utilization of labor
companion. Having prior history of institutional delivery increase experience of
continuous support by a factor of 2.19 compared to their counterparts (44).

A 2019 Interviewer administered questionnaires based cross sectional study finding in

Arbaminch Ethiopia among 407 postnatal mothers asserted that women’s who have
pregnancy, labor and delivery complication increase utilization of labor companion by
nearly 3.5 times than the other counterparts(46).

Maternal health service related variables

A study in Nepal asserted that number of antenatal care (ANC) and birth preparedness
like planned for transportation for labor and delivery had association to utilization of
labor companion. Women who had four or more ANC checkups had 9% higher odds of
companionship during labor than those who had less than four checkups. Women who
had planned for transportation for delivery had twofold higher odds of having
companionship during labor than those who did not plan for transportation(36).

Other maternal related factors

Qualitative and quantitative study finding in Kenya showed that Women who desired a
labor companion had about 40% higher odds of being allowed continuous labor support
than those who did not desire one(44).

Institutional based cross sectional study in Arbaminch town, Ethiopia during 2019
conclude that women who have desire to have labor companion more than five times
utilize labor companionship compared to women who have no desire(46).

Qualitative and quantitative study finding in Kenya showed that woman who
accompanied by sister/sister in-law had 1.85 higher odds of being allowed labor
companionship than woman who was not accompanied by sister/sister in-law(44).

Health care providers related factors

7
An explorative descriptive and contextual qualitative study in south Africa during 2013
among 33 midwifes with focus group interview showed that communication status of the
midwives is the challenges for implementation of continuous labor support (48).

A study done in Tanzania and Kenya asserted that companion utilization statistically
associated with health care provider’s sex. Facility based cross sectional study in
Tanzania conclude that more than half (53%) of women’s companionship utilization
affected by client related variables like health care provider’s sex(42). Women who
attend her childbirth process with male and female SBAs at the same time increase
utilization of birth companion by a factor of 4.68 compared to woman who attended by
male SBAs only(44).

Facility related factors

Health institutions policy, input (human resource and bedside chair) and architectural
outlay of maternity unit and space of ward was significantly associated with utilization of
Companionship during maternity service provision (33, 48-50). A study done in Brazil
national survey concludes that facility policy and bedside chair for companion strongly
associated with childbirth companion. Facility that having not policy which allow
companionship was 4.1and 2.3 times more likely not and partial utilization of
companionship respectively compared to facility which have policy that allow
companionship. Presence of chair by the side of every bed and some bed enhance
companionship implementation by a factor of 3.4 and 2.0 respectively compared to
facilities which were not have chair for companion(33).

Facility type is significantly associated with utilization of labor companionship according

to mixed based study in Kenya. Woman who give birth at public health center 1.98
times more likely utilize continuous labor support by their own chosen companion than
who deliver at government hospital(44).

According to client perspective study finding in Kenya 2016 women’s experience for
labor with companionship was significantly associated with facility over crowdedness.
When health facility over crowded most or all time, allowing of labor companion reduced
by 35% compared to not crowded or crowded only a few times(44).

8
Conceptual framework is a diagram which shows the association between labor
companion utilization and its predictors. This conceptual framework developed by
reviewing different literatures (figure 1).

Maternal socio- Health care Women obstetric related factors

demographic providers related Parity
characteristics factors Mode of delivery
Educational status Sex of SBAs History of institutional delivery
Age Busyness of SBAs Availability of companion from
Ethnicity social networks
Occupation Complicated pregnancy
Estimated monthly income

Labor companion utilization

Maternal health service Health facility related factors Other maternal related
related factors Type of facility factors
No of ANC Facility input like bedside chair Knowledge on
Planned transport for Crowdedness of facility companionship
delivery service Architectural outlay of Future preferred
maternity units (space and companion
privacy) Future desire for
companionship

Figure 1: conceptual frame work about labor companionship utilization and

associated Factors which developed from review of literatures (33, 36, 42, 44, 46-
50).

9
1.3. Justification of the study
Knew a time focusing on quality of service is a concern globe especially developing
countries government agenda including Ethiopia to achieve sustainable development
goal by 2030. To achieve this goal and improve quality care client center care like
utilization of companion of choice is a hearty intervention.

Knowing and identifying service of labor companion utilization gap and its predictors will
play a great role for stakeholders who work to improve positive childbirth process by
developing and incorporating companion of choice utilization strategy especially in a
diverse cultural heritage, low institutional delivery coverage and high burdened maternal
and neonatal mortality countries like Ethiopia. Therefore, this study finding will provides
a clue that can be used to improve practice and policies on birth companionship in our
country health institutions by advocating to practice companionship as a norm rather
than complementary clinical service provision because in order to reach the goal of
sustainable development and Ethiopian ministry of health plan.

Even though companionship plays a great role for reduction of maternal and neonatal
mortality and morbidity, evidences related to utilization of labor companion is limited and
the practice also uncommon during my exposure to practice as clinician in midwifery
profession in our public hospitals. Therefore this study is our interest to explore all
aspects of labor companionship in our setup and forward recommendations and
promotions for future practice especially in the study area.

Furthermore this research will objectively identify silent challenges of companionship

utilization and will give some clue of solution to tackle it according to other countries
experience. Additionally this study finding also gives important information for future
researchers who are interested in this specific area.

10
2. OBJECTIVE

2.1 General objective

To assess labor companion utilization and associated factors among postpartum
mothers at Debre-Markos town public health institutions, northwest Ethiopia, 2021

2.2 Specific objectives

To assess labor companion utilization among postpartum mothers at Debre-Markos
town public health institutions, northwest Ethiopia, 2021

To identify factors affecting labor companion utilization among postpartum mothers at

mothers at Debre-Markos town public health institutions, northwest Ethiopia, 2021

11
3. METHODS

3.1. Study design and period

An institution based cross sectional study design was conducted from February-1/2021
to March 30, 2021.

3.2. Study setting

This study was conducted at Debre-Markos town public health institutions, East Gojam
Ethiopia. Debre-Markos town is an administrative town of east Gojam zone, which is
located 276 kilometer from Bahr Dar (capital city of Amhara region) and 300 kilometer
from Addis-Ababa (capital city of Ethiopia). It has latitude and longitude of 10 o20/N 37o
43/ E and an elevation of 2,446 meters. According to population projection of Ethiopia
for all regions at woreda level from 2014-2017, the total population of the town is
estimated to be 92470. Among these 46,738 are females(51). Currently it has seven
kebeles (the smallest administrative unit in Ethiopia). This town has 1 referral hospital
and 3 public health centers. All public health facilities of the town are providing maternity
care service including intrapartum care.

3.3. Populations
3.3.1. Source population

All postpartum mothers who give labor at public health facilities of Debre-Markos town

3.3.2. Study population

All postpartum mothers who gave labor at public health facilities of Debre-Markos town
during data collection period

3.4. Eligibility criteria

3.4.1. Inclusion criteria

All postpartum mothers who gave labor in Debre-Markos town public health institutions
during data collection period

3.4.2. Exclusion criteria

12
Women, who were seriously ill or unable to interviewed due to physical or mental
problems during data collection period.

All mothers who gave birth with elective cesarean section during data collection period.

All postnatal mothers who was admitted to facility after second stage

3.5. Sample size determinations

The sample size of the study was 559 which was determined with the consideration of
proportion of companionship utilization 13.8% from previous study in Arbaminch,
Ethiopia(46), 95% confidence level, 3% margin of error, 10% non-response rate. Then:
n = (zα/2)2p (1-p)/d2 where: n = sample size, p (0.138) = proportion of women utilize
labor companion during labor, d (3%) = margin of error within 95% CI. Then n= 508 by
adding 10% non-response rate, n =559

3.6. Sampling procedure

This study was conducted at all public health institutions of Debre Markos town with
proportional sample size allocation based on their number delivery reports of each
health facilities two month prior to the study period. Calculated k-factors for each
selected facilities was 2 according to their past delivery registration book as sampling
frame (i.e. k=N/n; N = total study population in each health institutions, n = allocated
sample size of each health facilities). After checked eligibility criterion using record
review the study unit was selected by systematic random sampling technique with
consideration of delivery time as reference frame. Starting point of interview was
obtained with lottery method and interview was carried out in every other client interval
for each facility until fulfillment of allocated sample size. A selected client who was not
volunteer to participate in the study was considered as non-response. The overall
sampling technique performed in the town is shown in the form of diagram (figure 2).

13
 Total expected delivery at Debre Markos public health facilities in a month

Public health facilities in the town with

average monthly client flow(4)

Hospital (1) Health centers (3)

MHC WHC
DMRH:
HHC
N=30 N=28
N = 1040
N=60

Proportional allocation for each health institutions

n=501 n=29 n=15 n=14

Systematic random sampling

Total sample size = 559

Figure 2 Schematic presentation of the sampling procedure on utilization of

companionship during labor and associated factors among postnatal mothers
who gave birth at health institution of Debre-Markos town, North West Ethiopia,
2021

14
3.7. Variables of the study
3.7.1.Dependent variable

Labor companion utilization

3.7.2. Independent variables

Client related factors

 Socio-demographic characters: Age, Religion, marital status, Monthly income,

residence, ethnicity of the mother and educational & employment status of the
mothers and her husband.
 Obstetric factors: Gravidity, Parity, bad obstetric history, pregnancy
complication, labor and delivery complication, mode of delivery
 Maternal health service related variable; ANC utilization, place previous of
delivery labor, previous history of companion use, advice/information provided by
health care provider about birth companion utilization selection, counseling about
birth preparedness and complication readiness (BP and CR) during ANC.
 Other client related factors:- desire to have labor companion, clients culture
about companion utilization, knowledge about the right of companion utilization,
women preference companion

Provider related factors: - Care providers’ sex, workload/busyness of SBAs

Facility related factor: crowdedness of the facility, cleanliness of facility, bedside chair
for companion and curtain/single room availability.

3.8. Operational definition

Companion:- Individual who accompanied the client to the facility for support from
community, family member, or her social networks(4, 32).

15
Social network:- includes spouse/partner, a female friend or relative, a community
member (such as, female community leader, health worker or traditional birth attendant)
or a doula(4, 32).

Labor companion:- any person chosen by a women to accompany her during labor for
providing continuous emotional, tangible, informational and advocacy support in all
labor processes(4, 32).

Labor companionship/utilization of labor companion:- a women having a

continuous emotional, tangible, informational and social support with a preferred
companion from their social networks during labor in the labor ward(4, 32).

Continuous labor support: allowing of labor companion to stay with the mother in all
or most of the time during labor at health institutions(44).

Supportive care:- a care during the intrapartum period can involve many factors, like:
emotional care, comfort measures, information and advocacy(4, 32).

Doula: A woman who has been trained in labor support but not a part of health care
facility professional staff(4, 32).

Complicated pregnancy: displays either the presence of risk factors for obstetric
complications (history of chronic illness or bad obstetrics history) or complications
manifested during pregnancy (like gestational diabetes mellitieus, pregnancy induced
hypertension, intrauterine growth restriction) which affect pregnancy outcome and level
of interventions (52).

3.9. Data collection tools and procedure

Data were collected with a pre tested semi structured interviewer administered
questionnaire with trained data collectors. Data collectors and supervisors were four
(three male and one female) unemployed BSc midwifes and two male MSc clinical
midwifery students respectively. Problems faced during data collection were solved at
that specific time point of data collection. On top of that there were continuous follow up

16
and supervision by supervisor and the principal investigator throughout the data
collection period. The questionnaire was taken from the review of all available relevant
literatures and adapted to suit the study context. Questionnaires were grouped and
arranged according to particular objective that they should address.

3.10. Data quality controls

To assure the quality of data properly designed data collection tools was developed and
pretest was conducted with 5% (28 participants) of this sample size at lumama primary
hospital before one week of actual data collection to check the validity and reliability of
questionnaire to the objective of the study. One day intensive training on data collection
tool, ethical conduct including COVID-19 prevention and quality of data collection was
given for data collectors and supervisors. The questionnaire was translated to Amharic
to make it understandable by the study participants and then was re-translated to
English by another person to check whether the transition is consistent. The data
collectors was strictly followed by the supervisors and reported to principal investigator
in daily basis. The supervisors and principal investigator supervised the correct
implementation of the procedure as per planned and check completeness and logical
consistence during data collection.

3.11. Data processing and analysis

All completed questionnaire was checked for completeness and internal consistency by
principal investigator and the coordinators each day and code was given to the
completed questionnaire. Data were cleaned before and after entry. Across checking
data were coded and entered with epi-data 4.6 and analysis with statistical package for
the social sciences (SPSS) version 23 after coding and recoding. Data cleaning were
performed to check for accuracy, consistencies, and values. Then any form of error
were identified and corrected. Descriptive statistics of the study population in relation to
relevant variables were described and summarized by text, table and graph. After chi-
square assumption checked both bivariable and multivariable logistic regression models
were used to identify factors associated with the outcome variable. All variables with p-
value less than 0.25 with bi-variable analysis were entered in to multivariable logistic
regression model. After goodness of model fitness checked with Hosmer-Lemeshow

17
test and multicollinearity checked using variance inflation factor (VIF) by considering all
covariates having a value VIF up to 10 no multicollinearity multivariable logistic
regression analysis was performed to investigate independent predictors by controlling
for possible confounders. Finally, variables whose AOR not include one and its p value
<0.05 in logistic regression were considered as the cutoff point for statistically
significance association.

4. Ethical consideration
The study proposal was submitted to UoG School of midwifery ethical review
committee. The school of midwifery ethical review committee approved the proposal
with protocol number SM1DW/18/2013 Ethiopian calendar on day 16/02/2013
Ethiopian calendar under the delegation of UoG institutional review board. UoG School
of midwifery ethical review committee wrote Official letter to Debre-Markos town health
department and each selected health institutions. An institutional permission was
obtained from Debre-Markos town health department, Debre-Markos referral hospital
clinical director. Protective equipment like face mask was given for data collectors.
Participants were informed clearly about the purpose and benefit of the study and
written and signed informed consent was obtained from them with data collectors who
wear face mask and keep his/her distant. Those who signed written consent was only
participate in the study and leave who were not volunteers to participate and consider
as non response. The confidentiality of responses was maintained throughout the
research process by giving code and interviewing participants based on their convenient
time and place. Personal privacy and cultural norms was respected. All consent form
was translated into and administered in Amharic.

18
5. RESULT
5.1. Socio-demographic characteristics of study participants

From the initially planned sample size of 559 individuals, data was collected from 548
participants with a response rate of 98.03%. The median age of respondents were 27
years (with IQR: 24-30years) and more than half (52.7%) of women were within the age
category of 25-34 years. Most (96.9%) respondents were Orthodox Christian by religion
and two-third (66.8%) of the study participants live in rural. Three of ten (29.9%)
respondents were housewife by occupation. About 153(27.9%) study participants were
not attaining formal education. More than half of (56.4%) respondents average monthly
income was greater than or equal to 3000 ETB. Majority (99.1%) of study participants
were from Amhara ethnic group. About 96.2%of the participants were married and
nearly one-third (32.6%) and 31.3%) of their husband education and occupation was
college and above and farmers respectively (Table1).

Table 1 Sociodemographic characteristics of respondents at Debre Markos town,

North West Ethiopia from February to March 2021

S.No Variables Categories Frequency Percentage

1 Age(n=548) 15 to 24 156 28.5%

25 t0 34 289 52.7%

35 to 49 103 18.8%

2 Residence(n=548) Rural 366 66.8%

Urban 182 33.2%

3 Religion (n=548) Orthodox 531 96.9%

Muslim 16 2.9%

Protestant 1 0.2%

4 Ethnicity (n=548) Amhara 543 99.1%

Oromo and Agew 5 0.9%

5 Educational status(n=548) No formal education 153 27.9%

Primary education 149 27.2%

19
 Secondary education 102 18.6%

College and above 144 26.3%

6 Occupation(n=548) House wife 164 29.9%

Government 106 19.3%

employee

Private worker 48 8.8%

Merchant 64 11.7%

Farmer 144 26.3%

Othersa 22 4%

7 Marital status(n=548) Married 497 90.7%

Single(unmarried)/ 51 9.3%
Divorced /Separated

8 Average monthly Less than 3000 239 43.6

income(n=548)
>= 3000 309 56.4

9 Husband No formal education 117 22.2%

education(n=527)
Primary school 122 23.1%

Secondary school 116 22%

College and above 172 32.6%

10 Husband Farmer 165 31.3%

occupation(n=527)
Government 132 25%
employee

Merchant 111 21.1%

Private worker 87 16.5%

Daily laborer 21 4%

Othersb 11 2.1%

Foot note: - a; other includes: student, NGO, jobless and daily laborer
b; other include: jobless, NGO, intermid

20
5.2. Maternal obstetric characteristics respondents

From the total study participants, 333 (60.8%) and 306 (55.8%) mothers were
multigravida and multipara respectively. Among multigravida women 88 (26.4%) and
64(19.2%) had at least one history of abortion and bad obstetric history (BOH)
respectively. Nearly one fifth of (18.8%) of interviewed women had at least one
pregnancy complication. From all interviewed mothers majority (98.7%) had no history
of chronic illness and 61.9% not faced any labor-delivery complication. About 27.6% of
study participants had complicated pregnancy. Three-fourth of (74.6%) study
participants were delivered with spontaneous vaginal delivery (Table 2).

Table 2Maternal obstetric characteristics of study participant at Debre Markos town,

North West Ethiopia from February to March 2021

S.No Variables Categories Frequency Percent

(%)

1 Gravidity(n=548) Premigravida 215 39.2%

Multigravida 333 60.8%

2 parity(n=548) Premipara 242 44.2%

Multipara 306 55.8%

3 pregnancy status(n=548) Planned 507 92.5%

Un-planned 41 7.5%

Wanted 534 97.4%

Un-wanted 14 2.6%

Supported 528 96.4%

Un-supported 20 3.6%

4 Complicated pregnancy Yes 151 27.6%

(n=548)
No 397 72.4%

5 BOH(n=333) Yes 64 19.2%

No 269 80.8%

6 History of abortion(n=333) Yes 88 26.4%

21
 No 245 73.6%

7 Pregnancy Yes 103 18.8%

complication(n=548)
No 445 81.2%

8 History of chronic Yes 7 1.3%

illness(n=548)
No 541 98.7%

9 Labor-delivery complication Yes 209 38.1%

(n=548)
No 339 61.9%

10 Current mode of delivery SVD 398 72.6%

(n=548)
Cesarean delivery 111 20.3%

Instrumental/episiotomy 39 7.1%
assisted

5.3. Maternal health service related variables

The majority (96%) of mothers had at least one ANC visit, 73.4% of them was informed
about at least a single component of birth preparedness and complication readiness
during index pregnancy. Nearly one-fifth of (18.4%) study participants were informed
about birth companion selection during their ANC follow up time. Among 526
participants, who had ANC follow up 73.4% of them had four and above visit. Among all
548 study participants one from ten (10.4%) were gave labor and delivery at health
center (Table 3).

Table 3 Maternal health service related variables of study participant at Debre

Markos town, North West Ethiopia from February to March 2021

S.N Variables Categories Frequency Percent

o (%)

1 At least one ANC(n=548) Yes 526 96%

No 22 4%

2 Number of ANC(n=526) Less than 4 140 26.6%

22
 >= four 386 73.4

3 Counseled on BP and CR Yes 387 73.6%

during ANC(n=526)
No 139 26.4%

4 Informed about birth companion Yes 110 28.4%

selection at ANC(n=387)
No 277 71.6%

5 Current labor delivery Hospital 491 89.6%

place(n=548)
Health center 57 10.4%

6 Previous delivery place(n=306) Health facility 244 79.7%

Home 58 19%

Road 4 1.3%

7 Is fear of loneliness at labor Yes 7 12.1%

room risk for home delivery?
(n=58) No 51 87.9%

8 Previous delivery facility Public hospital 149 61.1%

type(n=244)
Public health 91 37.3%
center

Health post 4 1.6%

9 History of labor companionship Yes 100 41%

(n=244)
No 144 59%

5.4. Mother’s knowledge, desire and preference on labor companion utilization

From all 548 study participants, more than two third of (69.9%) them knowledge status about
labor companion was below the mean (2.31) and the rest (30.1%) above the mean. About 450
(82.1%) study participants had a desire to utilize labor companion for their future laboring
process. Among women who had desire 37.23% were preferred their husband followed by
mothers/mother in-law (30.66%) (Figure 3)

23
 37.23%

30.66%

17.88%

9.12%

5.11%

husband/partner mother/mother in-law sister/sister in-law no desire/no one others

Figure 3 Women future preferred companion at Debre Markos town, North West
Ethiopia 2021

5.5. Providers, facility and companion related variables

From total 468 respondents who were not utilizing labor companion during their labor
process religion and culture were not their reasons. Whereas facility related, health care
professional related and companion related variables were mentioned by the
respondents as a cause for non-utilization of labor companion. Among these variables
93.8% were by non-allowing of SBAs (Table 4).

Table 4:- facility, health care providers and companion related causes for non-
utilization of labor companion at Debre Markos town, North West Ethiopia from
February to March 2021

S.N Variable Category Frequency Percent (%)

o

1 Facility not Allow(n=468) Yes 410 87.6%

No 58 12.4%
2 No bed side chair for companion Yes 123 26.3%
(n=468)
No 345 73.7%

24
3 Busy laboring room/Crowdedness of Yes 224 47.9%
ward (n=468)
No 244 52.1%
4 No single room or curtain for Yes 225 48.1%
labor(n=468)
No 243 51.9%
5 SBA not allow(n=468) Yes 439 93.8%
No 29 6.2%
6 No preferred companion at a Yes 41 8.8%
time(n=468)
No 427 91.2%
7 I did not want/no desire(n=468) Yes 129 27.6%
No 339 72.4%

5.6 Labor companion utilization and its predictors

5.6.1 Labor companion utilization

Even all most all 547(99.8%) of respondents were accompanied from home to health
facility with at least one supporting person from her social-networks, only The
magnitude of Labor companion utilization was found to be 80(14.6%(; 95%CI: 11.7,
17.5) of them were utilized labor companion. From those who utilized labor companion
four of ten were by their husband (39.4%) followed by mother/mother in-law (35.5%).
Among participants who accompanied from home to health facility (547), more than two
third were accompanied by husband (78.4%) followed by mother/mother in-law (37.5%),
sister/sister in-law (35.6%), father/father in-law (17.2%), brother (16.1%) and
friends/neighbors (16.1%). Among respondents (547) who had companion from their
social networks 55.21% of them totally not allow companion of choice whereas
10(1.8%), 12.8%, and 30.16% of them were allowed to had support all of the time, most
of the time and few times respectively during their labor process after admission to the
labor ward. Among respondents who were allowed to had labor companion at labor
ward 98.8% of them were accompanied with their preferred companion (figure 4).

25
 14.6%

utilized

not utilized

85.4%

Figure 4:- prevalence of labor companion utilization among postnatal women at

Debre-Markos town public health institutions north west, Ethiopia 2021

5.6.2 Factors associated with labor companion utilization

Bi-variable and multivariable binary logistic regression analysies were done to identify
factors associated with labor companion utilization. On bi-variable binary logistic
regression mothers’ age, parity, complicated pregnancy, current mode of delivery type,
busyness of staff, sex of SBAs mostly followed, women’s future desire, knowledge of
women, marital status and number of pregnancy had an association with utilization of
labor companion. However, after controlling confounding on multivariable logistic
regression analysis complicated pregnancy, SBAs busyness, sex of SBAs mostly
followed, parity and future desire were significantly associated with labor companion
utilization.

Those women who had complicated pregnancy were 5.53 times more likely utilize labor
companion compared to their counterparts (AOR = 5.532, 95%CI: 3.086, 9.9173).
Women who had future desire for labor companion utilization 3.63 (AOR=3.627, 95%CI:
1.513, 8.698) times more likely utilize labor companion compared to those women who
had no future desire. Being Primipara were 3.5 times more likely utilize labor companion
compared to multipara women (AOR=3.497, 95%CI: 1.926, 6.349).

26
According to women’s perspective view being busyness of staffs were decreased the
odds of labor companion utilization with 87.2% compared to counterparts (AOR=0.128,
95%CI: 0.072, 0.228). The odds of utilizing labor companion among women who were
followed their most laboring time with only female SBAs were reduced by 63% (AOR=
0.370, 95%CI: 0.166, 0.823) compared to those women followed by only male SBAs for
their most laboring time after admission to the health facility (Table 5).

Table 5 Bi-variable and multivariable binary logistic regression analysis of factors

associated with labor companion utilization, in Debre-Markos town public health
institutions, northwest Ethiopia,2021 (n=548).

Labor companion COR(95%CI) AOR (95%CI)

Variable utilization

Yes No

Age of women
(n=548)

18 to 24 26 130 2.743 (1.143, 6.582)* 1.480 (0.464, 4.717)

25 to 34 47 242 2.664 (1.163, 6.099)* 1.782 (0.654, 4.862)

≥35 7 96 1 1

Marital status
(n=548)

Married 76 421 2.121 (0.743, 6.059) 1.858 (0.585, 5.905 )

Separated/single/ 4 47 1 1
divorced

Future desire
(n=548)

Yes 73 349 3.556 (1.593-7.937)** 3.627 (1.513, 8.698)**

No 7 119 1 1

Gravidity (n=548)

Premigravida 46 169 2.394(1.479, 3.875)*** 0.967 (0.289, 3.237)

Multigravida 34 299 1

27
Parity(n=548)

Premipara 51 191 2.550(1.560-4.170)*** 3.497(1.926, 6.349)***

Multipara 29 277 1 1

Complicated
Pregnancy
(n=548)

Yes 45 106 4.391(2.685, 7.181)*** 5.532(3.086, 9.917)***

No 35 362 1 1

Knowledge of
respondents
(n=548)

Below mean 46 337 1 1

Mean and above 34 131 1.901 (1.168, 3.095)** 1.538 (0.862, 2.744)

SBA Busyness
(n=548)

Yes 34 390 0.148(0.089,0.245)*** 0.128 (0.072 ,0.228)***

No 46 78 1 1

Mode of delivery
(n=548)

SVD 56 342 1 1

C/S 12 99 0.740 (0.382, 1.436) 0.844 (0.389, 1.830)

Instrumental/ 12 27 2.714 (1.300,5.668)** 1.805 (0.759, 4.296)

episiotomy assisted
vaginal delivery

Sex of SBAs
mostly
followed(n=548)

Both 21 88 1.247 (0.708, 2.195) 0.898 (0.458, 1.758)

Female 10 124 0.421 (0.207, 0.860)* 0.370 (0.166, 0.823)**

Male 49 256 1 1

28
AOR= Adjusted odd ratio, COR = Crude odd ratio, CI = Confidence interval,
1; reference category, ***P ≤0.001, **P≤0.01, *P≤0.05

6. DISCUSSION
This study aimed to assess utilization of labor companion and associated factors among
women who gave birth at public health institutions of Debre-Markos town, Ethiopia. The
overall prevalence of labor companion utilization in this study is 14.6% ((11.7, 17.5).
This study is lower than a study done at Tigray Ethiopia (39.8%)(45), Addis Ababa
Ethiopia (59.8%)(9), Kenya (67%)(44), north-western Tanzania (44.7%)(43), Tanzania
(44.7%)(42), Nigeria (32.66%)(41), South Africa (24.2%)(26), Nepal (19%)(36), UAE
(59.3%)(38), rural Bangladeshi (68%)(35) and Brazil (42.1%)(33) .The general possible
explanation might be our study was done in the era of COVID-19 which mainly
transmitted with contact and the glob at all proclamations distance keeping policy and
wearing of personal protective equipmentsequipment’s .This might limit the involvement
of acampanions.

Prevalence of labor companion utilization in our study is lower than a study done in
Addis Ababa Ethiopia (59.8%) (9) and Tigray Ethiopia (39.8%)(45). The possible
explanation for discrepancy from Addis Ababa might be difference in study population.
In our study participants were postpartum women regardless of occupation, whereas
their study participants were female health care professionals who had delivery history.
Being staff or health care professional by itself enhance labor companion utilization
because of their knowledge status and relationship to SBAs. One main reason for non
utilization of labor companion in current study and previous study is SBAs’ denial to
allowing this se.rvice utilization(46).

Prevalence of labor companion utilization in our study is lower than a study done in
Tigray Ethiopia (39.8%)(45). Possible justification for discrepancy from Tigray might be
the difference with technique of data collection and outcome measurement. We collect
with interview whereas they collect data with observation due to observation effect
providers allow companion which leads over estimation. In our study outcome variable
is determined with 3 variables (availability of companion, duration of companion stay

29
with mother and preference) but they simple observe companion duration of staying
rather than knowing women’s relationship and preference about that companion. As a
result it might be overestimate the coverage of labor companion utilization.

Our prevalence study finding is lower than a study conducted in Kenya (67%)(44). The
possible justification might be the study populations and health policy different. Our
study participants we recruited from only public health institutions, while they include
participants from private facilities. Private facilities mainly endure for profit as a result
allowing of companion of choice might become increased to attract the clients to their
facilities. In addition to this Kenya start doula based approach companion service
provision, whereas Ethiopia is not launch it. This implies Kenya ministry of health give
more emphasis for this service than Ethiopia ministry of health.

Coverage of labor companion utilization in our study is lower than a study result in
Tanzania. The possible explanation might be the difference in the study population,
sociocultural difference. In our study maximum numbers of participants were
interviewed from hospital whereas they interview more than 50% of respondents from
health-center(42). Giving labor at public health center increase chance of labor
companion utilization compared to government hospital(44).

In our study magnitude of labor companionship is lower than a study conducted in

Nigeria (41). The possible explanation might be the difference with source population
and sociodemographic characteristics of study population. In our study the source
population is postnatal women whereas their source population was antenatal one.
Interviewing antenatal mother about their history of labor companionship might be at
high risk for recall bias which might end up with overestimation. In addition, our
respondents include women who have no formal education while their participants had
at and above primary educational level. So, being more educated enhance high likely
hood of labor companion utilization (33, 44), therefore this might be another possible
justification.

Our study finding showed that prevalence of labor companion utilization is lower than a
study conducted at South Africa. The possibility for the difference might be due to

30
difference with sampling method, eligibility criterion, sociodemographic characteristics of
participants and health policy. In our study include all postpartum women regardless of
birth outcome and mode of delivery with systematic random methods. Whereas their
study sampling technique was convenience which enhance systematic error and end up
with failed generalization and they exclude women who have loss and women who
deliver other than SVD. Labor companion utilization by itself reduce pregnancy loss and
need of assisted delivery(6). There for prevalence of utilization might be high among
women who deliver with SVD and who have good birth outcome compared to their
counterparts. Our participants maximum age group is 25 to 34 years and educational
status of participants include women with no formal education up to higher education
whereas in south Africa maximum age of their participants were ≤25 years and include
only women who read and write (26). Being young age and read and write by itself
might be enhance utilization of labor companion. This idea was supported by a study in
Nepal and Kenya. Women’s age decrease utilization of labor companion increase(36).
A woman who write very well 2.89 times more likely utilize labor companion than a
woman who not write totally(44). Compared to our country South Africa give more
emphasis for this service and launch doula approach practice of childbirth
companionship in their health institutions(26).

The possible justification for the inconsistency between studies at Nepal and our study
might be sociodemographic characteristics’ of study population, inclusion criterion of
population, study setting and method of data collection. In our study data were collected
with exit interview among women who deliver after 28 weeks of gestation from both
hospital and health centers and majority (99.1%) participants were from similar ethnic
group. While in Nepal they collect data with observation among women who deliver
after 22 weeks of gestation at hospital only and from different ethnic groups (36). This
implies in their study there might be more complication, Hawthorne effect and ethnicity
different effect. Because of these effects utilization of labor companion might be higher
than our finding. These explanations supported by literature that is the more remote
from term the more complication as a result being complicated labor (preterm labor)
enhance labor companion utilization(46). Commonest cause for not utilizing labor
companion is denial of the service by SBAs according to this study and previous study

31
at Arbaminch Ethiopia(46). There for SBAs denial might be reduced due to
observational effect which ends up with enhancement of labor companion utilization in
their study.

The possible explanation for lowering of our study compared to a study conducted at
UAE(38) might be sampling technique, sociodemographic characteristics difference,
socio-economic difference and study population difference. In our study women with
multiple or singleton delivery, complicated or uncomplicated pregnancy, good or bad
birth outcome and vaginal or cesarean delivery were selected randomly. However, in
their study they select only women with post vaginal uncomplicated delivery with good
birth outcome by non random sampling technique(38) this implies they collect data from
advantageous group because labor companionship by itself had benefit like good birth
outcome and increase spontaneous vaginal delivery(5, 6) and due to bias of their
sampling technique prevalence might be higher compared to our finding.

In addition to this difference in educational status of study participants might be a

possible explanation of discrepancy between our and UAE study. Because in our study
55.1% of respondent’s educational status is below secondary whereas 82% of their
study participants attend more than secondary education. This possible explanation was
supported with a study done in brazil which revealed that educational level increase
utilization increase (33). In addition to this UAE is not third world country, so it might
have private room, bedside chair and good architectural outlaid labor room which
comfortable for laboring mother and her companion.

The discrepancy of our finding from Bangladeshi study might be due to difference in
study population, study setting and sociocultural. Our study is an institutional based
which involve only who gave labor at public facility with exit interview. In contrast to this
their study was community based house hold study which includes women who gave
birth at home (63.2%), private facility (33.3%) and public facility (3.5%) in the preceding
one year. This implies their majority (96.5%) study participants were women who gave
childbirth at home and private facility might increase coverage of labor companion
utilization. This idea was agree with history of child birth before 20 th century(5) and

32
women who gave childbirth at private facility less likely not utilize companion than
women who gave childbirth at public facilities (33).

The inconsistency of our study from Brazil national survey might be due to difference
with method of study and health system policies of the countries. The first possible
justification might b regarding with methodology difference in our study data were
collected from only public health institutions, while they collected data from all postnatal
women at private, mixed and public health facilities including baby friendly hospitals. In
their study 4.7% and 29.5% of women had no companion at private and public hospitals
respectively during their hospital stay (33). This implies women who gave childbirth at
private facilities more likely utilize childbirth companion than women who gave childbirth
at public hospitals. Therefore including population from private health facility might
enhance the coverage of labor companion.

Another possible explanation for the discrepancy of our study from Brazil might be due
to policy discrepancy different between study settings. Even though Ethiopia ministry of
health and EMwA recommend utilization of childbirth companion, doula based child birth
companion not implemented and companion utilization is not a key maternal health
indicators as we understand from EDHS. Whereas Brazil launch doula based service,
incorporate implementation of labor companion for all women in their national, include
recording it on the chart and incorporate in to Brazil national demographic health survey
as key maternal health indicator. Specifically in their 0.2% of respondents were
accompanied with doula (33). This implies Brazil ministry of health gave more emphasis
than Ethiopia ministry of health for this service. When a service had more emphasis its
implementation and coverage might be enhanced.

But prevalence of labor companion utilization in our study become in line with studies
conducted at in south Brazil (16.7%)(34), Riyadh (14.2%)(37), south Africa (14.5%)(39),
Nigeria (13.1%)(40) and Arbaminch, south Ethiopia (13.8%)(46). The possible
explanation for south Brazil (data collection technique (record review)), Riyadh (recall
bias), South Africa (study period and setting hospital only), Nigeria (study setting
hospital only) and Arbaminch (sociodemographic characteristics like maximum number
of age category and obstetric factors like parity). Record review lead to underestimation,

33
gave child birth reduce chance of utilization due to ward crowdedness and respondents
similarity especially with significant factor number of observation in the categories at the
some country leads in line value.

On the other hand coverage of labor companion utilization in our study (14.6%) higher
than a multicounty study (5.1%) which was done at Ghana, Guinea, Nigeria and
Myanmar. Furthermore this study finding higher than prevalence of each country 11.4%
Ghana, 10.9% Guinea, 0.32 Myanmar and 6.3% Nigeria(13). The possible explanation
might be difference with sociocultural and facility selection. We include all facilities in the
town while they select facilities purposively. Purposive selection by itself might leads
bias which end up with underestimation and failed to generalization.

There are evidences which support our study regarding to significantly associated
factors like complicated pregnancy, future desire, parity, sex of SBAs mostly follow and
women’s perceived busyness of SBAs. Among those factors statistical association of
number of delivery to labor companion utilization is supported by studies done in
Brazil(33), Kenya(44) and Arbaminch Ethiopia (46). In this finding the odds of labor
companion utilization for Premipara were 3.5 times higher than Multipara. This finding is
consistent with a study done at Arbaminch Ethiopia (2.05)(46). This finding also
supported by a study done in Brazil, being Multipara increase a risk of non utilization of
companion with odds of 1.6 times. The possible explanation might be women with no
experience a child birth process needs more social support, emotional support than
women who had history of childbirth. Premigravida women experience fears concerning
helplessness, loss of control her self’s in labor and had negative child birth expectation
compared to Multipara(53). Another possible justification might be multiparous women
were less worry on pregnancy and less prepared for labor and delivery compared to
premiparous. Multiparous had generally expected shorter time of labor and receive less
support from people compared to counter parts(54).

Our study concludes that complicated pregnancy is significantly associated with

companionship service utilization during labor. Women who had complicated pregnancy
utilize labor companion 5.5 times higher than women who had not complicated
pregnancy. This finding is supported by a study done at Arbaminch which asserted that

34
the odds of labor companion utilization is 3.5 times for women who had complication
during labor and delivery compared to counterparts (46). The possible explanation
might be high risk pregnancy or complicated labor needs more support from both health
professionals and social networks in order to assist for decision making and to improve
the outcome. However this study finding higher than a study done at Nepal which
conclude that the odds of labor companionship for women having previous history of
cesarean birth nearly two times higher than counterparts (36). The possible explanation
might be in our study all risk factors are included in addition to previous cesarean scar.

Women desire for companionship significantly associated with labor companion

utilization. The odds of labor companion utilization among women who had future desire
for the service 3.6 times more likely than those women who had no desire. This finding
supported with a study in Arbaminch(46). The possible explanation might be desire of
the service had strong correlation with culture, education and knowledge. Most
Ethiopian women were delivered at home with the presence of families. From definition
to say utilize women should accompanied with their companion of choice. Before decide
desire should be considered.

In this study unpredictably women who followed their labor with female health care
provider reduce prevalence of labor companion utilization by 63% compared to male.
Which is difficult to infer because of disagreement with stereotype of women being care
and more emphatic than man. Our finding supported with another related study on RMC
in Ethiopia. The possible explanation might be females deployed violence against
patient in their work as a means of creating social distance and maintaining fantasies
identity and power in their continues struggle to assert their professional and middle
class identity(55). In addition to this female health care providers had triple burdens
(reproductive, productive and community management) which might be end up with
moral distress and burn out which may lead to abusive behavior(56).Abusive behavior
leads to break down of women centered maternity care including allowing companion of
choice during child birth.

According to woman’s perspective SBAs busyness decrease the likely hood of labor
companion utilization by 87.2% compared to their counterparts. This finding is

35
supported with another related study done in Kenya crowdedness of facility affect
utilization of companion of choice negatively (44). Facility inputs like human power is a
determinant factor for labor companion utilization (49). When SBAs busy they become
burn out and their behavior change which end up with non respect full maternity care. In
addition to this mostly busyness of SBAs related to crowdedness of ward which difficult
to accommodate laboring mothers and their companion in the ward due to privacy
issue, space issue, ward cleanliness and bedside chair availability for companion.

Limitation of the study

This study was done cross-sectional study design which precludes any conclusion of
casual effect association between outcome of interest and independent variables.

In this study we face social desirability bias and recall bias even we interview the client
alone by probing them especially obstetrics history, preference and maternal health
service variables like birth preparedness and complication readiness counseling service
utilization history.

7. CONCLUSIONS AND RECOMMENDATION

Conclusions

36
Even though WHO recommend utilization of labor companion for all women who have a
desire, coverage of labor companion utilization at this study was low. This implies
practice of labor companion which is one main component of RMC failed to practice
during institutional labor and delivery service of study area. Complicated Pregnancy,
future desire for the service and being Premipara are predictors which increase
utilization of labor companion. In contrast to these variables followed their labor by
female SBAs and SBAs busyness negatively affect labor companion utilization.
Therefore focusing on health care providers, health facilities and women’s’ related
factors to improve quality of maternity care is un-doing activities of concerning bodies.

Recommendations

For health facilities: - we recommend to health facilities to permit and encourage

women to have companion of their choice during labor by preparing curtain from locally
available materials to assure privacy. We also recommend to-give in-service
refreshment training especially for females to reduce burn out from multiple tasks.

For policy makers and administrators: - we recommend to policy makers and

administrators to focus and consider accommodating companion in promoting on quality
care like RMC including labor companion utilization by looking at system reform and
rigorous attention to evidence based use of interventions. In addition to reduce
busyness of staffs employ additional health care providers.

For researchers: - we recommend for researchers a qualitative research to dig out

more information and to add new knowledge especially a reason for superior allowing of
labor companion male over female providers.

For health care providers: - we recommend for both male and female SBAs to allow
companion of choice for all regardless of parity and complicated pregnancy and do their
activities based on evidence based intervention by referring WHO and EMOH health
care plan.

8. REFERENCES

37
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41
9. ANNEXES
Annex 1Information Sheet

Hello, how are you? My name is _______________. This is an interview to be done with
you for a study that is being conducted at UoG, College of medicine and health
Sciences School of midwifery, Department of clinical Midwifery.

The purpose of the study is to assess labor companion utilization and associated factors
among women who gave birth in Debre Markos public health institutions, East Gojam,
Ethiopia.

I would like to ask you some questions that are related to your sociodemographic,
obstetric history and labor companion utilization. I believe that the results of this finding
will help policy makers, planners and health professionals for improving quality of
delivery service provision and also contribute to provide adequate quality peripartum
care by involving social support during institutional labor and delivery service provisions.

Your contribution has a great input for the study and I would greatly appreciate your
participation. There is no possible risk associated with participating in this study. Your
name will not be written in the questionnaire and please be assured that all the
information you give will be kept strictly confidential. Your participation is completely
voluntary.

Therefore, you will not be obliged to answer any question that you do not want to and
you may end this interview at any time you want to. There are also no obligations for not
participating in the interview. The interview will take about at most 15 minutes.

If you have questions regarding this study or would like to be informed of the results
after its completion, please do not hesitate to contact Mr. Hussien Mohammed
(0923744869).

Annex 2Consent Form

42
I have read the information sheet concerning this study (or have understood the verbal
explanation) and I understand what will be required of me and what will happen to me if
I take part in it. I also understand that any time I may withdraw from this study without
giving a reason and without me or my families’ routine service utilization and provision
being affected for my refusal.

Participant’s signature ___________________ Date___________________

Interviewer signature certifying that informed consent has been given verbally.

Interview‘s name ______________

Interview’s signature ______________ Date ______________

May I continue the interview?

1. Yes ____________Continue the interview

2. No ______________Stop the interview and thank the respondent

Result: (to confirm for completeness)

A. Questionnaire completed _____________

B. Questionnaire partially completed _____________

C. Participant refused _____________

D. Others (please Specify) _____________

Checked by Supervisor:

Supervisor’s Name _____________

Supervisor’s Signature _____________ Date _____________

43
Annex 3 English version questionnaires

Part I:- Socio-demographic profile of the women

Name of institution --------------------- Questioner code --------------------- Remark

S.No Question/variables Coding category/response

100 How old are you? _______( age in years)

101 Where do you live? 1. Rural 2. Urban

102 What is your religion 1. Orthodox 2. Muslim

3. Protestant 4. Other specify--

103 What is your ethnicity 1. Amhara 2. Oromo

3. Agew 4. Other specify-----

104 What is your highest level of 1. No formal education 2. Primary school

education?
3. Secondary school 4. College& above

105 What is your occupation? 1. Housewife

2. Government employed
3. Self-employed
4. Merchant 5. Farmer
6. Non-governmental employee
7. Others specify_______

106 What is your current marital 1. Married 2. Un-married If 2/3/4

status? skip to
3. Widowed 4. Divorced 109
5. Separated

107 What is your husband’s 1. No formal education

highest level of education?
2. Primary school
3. Secondary school
4. College& above

44
108 What is your partner’s 1. Farmer
occupation?
2. Government employed
3.Merchant
4. Self-employed
5. Daily laborer
6. Non-governmental employed
7. Others specify__

109 How much your estimated ------Ethiopian birr

average family monthly
income

Part II:-past and current obstetrics related factors of the women

200 How many times have you had pregnant? Any type ------( in numbers)

201 How many times have you delivered a baby after 28 -------(in numbers)
weeks of gestation? alive or dead

202 Have you had history of abortion? 1. Yes 2. No

203 Have you had poor obstetric history before index baby? 1. Yes If no skip
2. No to Q 205

204 If yes in Q no 204 which problem? More than or equal to 3 abortions

More than one answers possible Intra-uterine fetal death
Still birth
Early neonatal death
Others specify--------

205 Was this pregnancy planned? 1. Yes

2. No

206 Was this pregnancy wanted? 1. Yes

2. No

207 Was this pregnancy supported? 1.Yes

2. No

208 Have you ever faced any of maternal morbidity 1. Yes If no skip

45
 during index pregnancy period? 2. No to Q 210

209 If yes which common 1. Early vaginal bleeding (before 28 weeks )

morbidity? More than one 2. late vaginal bleeding (at & after 28 weeks)
answer possible 3. Pregnancy induced hypertension
4. Gestational diabetes mellitus
5. Premature rupture of membrane
6. Post term pregnancy
7. Others specify-------

210 Have you had history of chronic illness? 1. Yes If no skip to 212
(only approved by health care provider)
2. No

211 If yes which one (more than one answer 1. Diabetes mellitus
possible) 2. Hypertension
3. Cardiac illness
4. Asthma
5. Epileptic
6. Others specify________

212 Did you have any complication 1. Yes If no

during labor of your index baby? skip to
2. No 214

213 If yes types of complication of labor? 1. non reassuring fetal heart rate pattern
(only you told from SBAs)
2. Cephalo-pelvic disproportion
3. Uterine rupture
4. Preterm labor
5. prolonged labor
6. cord prolapsed/presentation
7. Others specify…..…

214 Mode of delivery for your index baby? 1 Spontaneous vaginal delivery
2. Cesarean delivery
3.Operative vaginal
delivery(forceps, vacuum&

46
 destructive)
4.Episiotomy assisted delivery

PartIII: - Maternal health service-related factors during index pregnancy, labor

and delivery and post-partum period.

300 Did you attend antenatal clinic for this pregnancy? 1.Yes If no go
to Q 306
2. No

301 If yes at what time have you start first ANC visit? ------ in weeks

302 Where was your ANC started? 1. Health post 2. Health center
3. Hospital 4. Private clinic

303 How many times did you receive antenatal care? _____ in numbers

304 Did you get advice about birth preparedness plan 1. Yes
during your antenatal care follow up? 2. No

305 If yes for Q number 305 what 1.Decision on delivery place

were advices you get? More than
one answer is possible 2. Save money
3. Skill attendant at birth
4. How to access emergency transport
5. Emergency blood donors
6. Family support during birth
7. Collecting items needed for birth

306 Did the provider ever mentioned about your choose your 1. Yes
companion in labor at the time of your antenatal care visit?
2. No

307 If multiparous where did you gave birth health facility If health facility go
your last baby? to Q 309
Home
Other specify----

308 If you delivered at home why? 1.my pregnancy is normal

2. fear of being abused and disrespected
3. To be attended by TBA’S

47
 4. it is usual practice/culture
5. Fear of being lonely in labor
6. No transport
7. Shorter labor duration
8. Other specify-------------

309 From Q 307 if answer is health 1. Health post

facility from which?
2. Health center
3. Public hospital
4.Private Health institution

310 Did you have labor companion during your history of 1. Yes
health facility birth other than your index baby?
2. No

311 When was your most time of laboring From ____to_______(in hours)
after admission to the labor ward?

Part IV:- variable of labor companion utilization

400 Did anyone accompany you from home to this health 1. Yes If no skip
facility? to Q: 500
2. No

401 If yes for Q 401 Who accompanied you? 1) Husband 2) TBA

3) Mother/ Mother in Law
4) Friend/Neighbor
5) Sister/Sister in law
6) Others (specify)______

402 Were you allowed to have someone from 1.No, never If 1 or 2

your social networks/family members to stay skip to
with you during labor? 2. Yes, few times Q: 406
3. Yes, most of the time
4. Yes, all the time

403 Yes, most of the time and above, who was? 1.Husbund
2.Mother /mother in law

48
 3.Sister/sister in law
4.TBA
5.friend or neighbor
6.others,specify-----------

404 If yes for all the time or most of the time, was that support 1. Yes
person your preferred choice?
2. No

405 If your answer for Q yes for 404 all 1. There for me
the time or most of the time Which 2. Talking to me
intervention carried out by your 3. Holding my hands
companion/support person during 4. Mopping my sweat
this labor? More than one possible 5. Keeping my informed of the
answer progress
6. Encouraging fluid intake
7. Meeting elimination needs
8. Encouraging deep breathing
& relaxation
9. Massaging my back and
extremities
10. Communicating me with other
family members
11. Praying for me
12. Calling SBAs when I need
13. Others specify--------

406 If no or yes few times or both for Q 1.Absence of preferred companion

404 did you know the reason of not
allowing continuous support during 2. institution not allow
labor?
3. providers not allow
4. Privacy issue
5. cultural reason
6. religious reason
7. ward was crowded
8. I don’t need
9. absence of chair for companion
10. others specify_______

Part V:- women’s knowledge, desire and preference toward labor companion

49
A)women’s knowledge toward labor companion utilization

500 Have you ever heard about support or companion in labor? 1. Yes
2. No

501 If yes what is labor 1. support person during labor other than
companion is? SBA’s/staff
2. Support person during labor who was staff
3. support person during ANC other than staff
4. support person during ANC from staff
5. support person during ANC other than staff
6. support person during ANC from staff
7. other

502 Did you know everyone has a right to utilize labor 1. Yes 2. No If no skip
companion? to 504

503 If yes where do you 1. Mass media/social media

get this information?
2) From health care provider (ANC follow up)
3) Read about it
4) Heard from people/friends
5) experienced it before
6) Others specify……..

504 What do you say about having support 1. Good practice

person during labor?
2. Not good practice

505 Is utilization of labor companion beneficial 1. Yes If no skip to 507

for positive birth out come? 2. No

506 If yes what are the benefits? 1. Reduce labor pain and need of antipain
2. Enhance spontaneous vaginal birth
3. decrease anxiety and fear
4. reduced loneliness
5. Reduced chance of abuse and

50
 disrespect by SBA’s
6. make women happy
7. reduce need of cesarean delivery
8. reduce length of labor
9. enhance newborn survival
10. make eager for institutional delivery
11. others specify-------------

B) women’s desire toward labor companion utilization

507 Would you like someone of your choice to 1. Yes If no skip to 510
stay with you for future labor?
2. No

508 If yes did you have any expectation from your 1. Yes If no skip to 511
companion? 2. No

509 If yes What is 1. Tangible support (back rub, hold hand, mop sweat)
your expectation?
(you can choose 2. Emotional support (there for me, pray, encourage)
more than one)
3. Informational support (about labor progress other family)
4. Advocacy (from fail dawn, abuse & disrespect)
5. others specify____________

510 Why not you have no desire? 1. Cultural reason

2. wanted loneliness
3. religious reason
4. privacy reason
5. fear of seeing family anxiety
6. others specify_______

C) women’s preference companion during labor

511 Who will be your preferred type of 1)Husband

companion for future labor? (choose only
one) 2) TBA
3) Mother/ Mother in Law

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 4) Friend/Neighbor
5)Sister/Sister in law
6) no one/ no desire
7. Others (specify)______

512 What dictate your choice? 1) feel more comfortable with

(you can choose more
than one reason) 2)his/her experience or knowledge about labor
3) religious concern
4) cultural acceptability
5) others specify-------------

Part VI :- women’s perspective to providers and facility related factors

600 Do you think this facility is comfortable to be accompanied by 1. Yes

your choose of companion during labor? 2. No

601 If no what is the reason? 1.crowdness of room

2. absence of screen
3. absence of bed side chair
4. room is not well cleaned
5. others specify---------

602 Do you think that SBA’s in this facility busy? 1. Yes

2. No

603 Do you think enough staff in this facility? 1.Yes 2. No

604 What sex of your SBAs who give most of your labor care? 1. Male
2. Female
3. Both

Thank you a lot for your participation

Annex 4 ስለ ጥናቱ ማስታወቂያ ቅፅ

ለመረጃ ሰብሳቢ፡- እባክዎ የፊትና ያፍንጫ ጭንብልወን በትክክል ይልበሱናእርቀትዎን በመጠበቅ የጥናቱን ተሳታፊ

የፊትና ያፍንጫ ጭንብልወን በትክክል እንድለብሱ ያድርጉና ሰላምታ ሰጥተው ራስዎን ካስተዋወቁ በኋላ ከዚህ በታችየ

52
ተገለፀውን መረጃ ተገንዝበው ለጥናቱ ለመሳተፍ ፍቃዳቸውን መሰጠት ይችሉ ዘንድ አንብቡላቸው እና ፈቃደኛ ከሆኑ

ቲክ/የራትምልክት ፈቃደኛ ካልሆኑ የኤክስም ልክት ያድርጉ፡፡

ሰላምታ፡እንደምንወዋልሽ/ክወይምእንደምንአደርሽ/ክ እኔ…………በዚህ ጥናት እንደ መረጃ ሰብሳቢ ሁኜ የምሰራ

ስሆን ይህ ጥናት ከጎንደር ዩኒቨርሲቲ ሚድዋይፈሪ ት/ቤት ጋር በመተባበር በአቶ ሁሴን ሙሀመድ አስፋው

በክሊኒካል ሚድዋይፈሪ የማስትሬት ዲግሪ በከፊል ለማጠናቀቅ ለሚደረግ የምርምር ጥናት ቃለመጠይቅ

ሲሆን ለዚህጥናትእርስዎየተመረጡ በመሆንዎ በዚህ ጥናት እንዲሳተፉበትህትና እንጠይቃለን፡፡

የጥናቱአላማ የአገልግሎት ጥራት መጠንን ለመጨመር በምጥክትትል ወቅት ከሆስፒታል ሰራተኛ ዉጭ ማህበራዊ የእገዛ
አገልግሎት ስለማግኘተወ እና ለማግኘተወ ወይም ላለማግኘተወ ምክናየቶችን ለማጥነት ነዉ፡፡እርሶንም በማዋለጃ ክፍል
ውስጥ ወላድ በመሆንዎ የምጥ ክትትል አገልግሎት ሲያገኙ ከሆስፒታል ሰራተኛ ዉጭ የማህበራዊ እገዛ አገልግሎት
ስለማግኘተወ እና ለማግኘተወ ወይም ላለማግኘተወ ምክናየቶችን እና ስለራስወ ማንነት ጥያቄዎችን እንጠይቀወታለሁ፡፡

የዚህጥናትዉጤትለፖሊሲአስፈጻሚዎች፣ዕቅድአዉጭዎች፣የጤናበላሙዋዎችየጥራትመጠንንከፍለማድረግእናጥሩአገልግሎት
ለመስጠትይረዳልብለንእናምናለን፡፡
በዚህጥናትበመሳተፎየምናገኘዉመረጃለጥናታችንዉቴታማነትእንዲሁምየጥናቱዉጤትበሚያበረክተዉአስተዋጽዎላይከፍተኛእ
ገዛይኖረዋል፡፡ስለዚህምበዚህቃለመጠይቅቢሳተፉምስጋናዬየላቀነዉ፡፡

በጥናቱ በመሳተፍዎ ምክንያት የሚገጥመዎት ምንም ችግር አይኖረዉም ፡፡ ስለሆነም እርሶ የሚሰጡት መረጃ በሙሉ
ሚስጢርነቱ የተጠበቀ እንደሚሆን እርግጠኛ ይሁኑ ፡፡ በጥናቱ ዉስጥም በማንኛውም ሁኔታ ስምዎ በመጠይቁ ላይ
አይገለጽም፡፡ በዚህ ጥናት ለመሳተፍ የእርሶ ፈቃድ በጣም አስፈላጊ ነው፡፡ በተጨማሪም ለመመለስ የማይፈልጓቸውን
ጥያቄዎች ካሉ ጥያቄዎችን ለመመለስ በፍጹም አይገደዱም፤ እንዲሁም በጥናቱ ላለመሳተፍ ከፈለጉ በማንኛዉም ሰዓት
ማቋረጥ ይችላሉ፡፡ ቃለመጠይቁ ጥቂት ደቂቃዎችን ይወስዳል፡፡ ቃለመጠይቁን በተመለከተ ወይም ስለጥናቱ ማንኛዉንም
ጥያቄ ወይም አስተያየት ቢኖሮት በሚከተለዉ አድራሻ ማነጋገር ይችላሉ፡፡ ሁሴን ሙሀመድ አስፋው ስልክቁጥር፡

0923744869 ኢሜል፡baluka2007.12.14@gmail.com

Annex 5የፍቃደኝነትአማርኛ መጠየቂያቅፅ

ከላይበመግቢያውላይየተጠቀሰውንመረጃአንብቢያለሁወይምበቃልየተሰጠኝንማብራሪያተረድቻለሁ፡፡
በዚህመሰረትከእኔየሚጠበቅብኝንድርሻበሚገባአውቄያለሁ፡፡
እናምበዚህጥናትላይበመሳተፌሊከሰቱየሚችሉትንሁኔታዎችተገንዝቢያለሁ፡፡
ከዚህጥናትበማንኛውምሠዓትያለምንምቅድመሁኔታናምክንያትእራሴንከተሳታፊነትየማግለልሙሉመብትእንዳለኝተረ
ድቻለሁ፡፡
ይህንውሳኔዬንተከትሎበእኔምሆነበቤተሰቦቼላይበምንፈልገውየጤናአገልግሎትላይምንምአይነትአሉታዊተጽኖእንደማይ
ደርስብኝተረድቻለሁ፡፡

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 የተሳታፈዉ ፊርማ--------------- ቀን----------------

ጥናቱንበተመለከተየቃልማብራሪያየተሰጠመሆኑንየሚያረጋግጥው

የቃለመጠይቅአድራጊውግለሰብ ስምናፊርማ

የጠያቂውስም----------------------------------------- ፊርማ--------------- ቀን -------------

መጠይቁንእንድቀጥልፈቃደኛነዎት ?

1. ፈቃደኛናቸው---------------------- ቃለመጠይቁይቀጥላል፡፡

2. አይፈቃደኛአይደሉም ------------------ ቃለ መጠይቁንበማቆምአመስግነውይለያዩ፡፡

ዉጤት(መጠይቁንመሙላቱንለማረጋገጥ)

ሀ. ሙሉለሙሉየተሞላ----------------

ለ. በከፊልየተሞላ-----------

Annex 6. የአማርኛ መጠይቅ

ክፍል አንድ፡- የማህበረሰባዊና ስነ-ህዝብ ጥናት መረጃ

የተጠየቀበት ጤና ተቋም ስም _________ የጥያቄው መለያ ቁጥር________

ተ.ቁ ጥያቄዎች አማራጭ መልሶች ዝለል
100 እድሜዎ ስንት ነው? ------------- (በዓመት)
101 የት ነዉ የሚኖሩት? 1. ገጠር 2. ከተማ
102 ሃይማኖትዎ ምንድን ነው? 1) ኦርቶዶክስ 2) ሙሰሊም
3) ፕሮቴስታንት 4) ሌሎች (ይገለጹ) ---
103 ብሔርዎ ምንድን ነው? 1. አማራ 2. ኦሮሞ 3. አገው 4. ሌሎች (ይገለጹ)____
104 የርስዎ የት/ት ሁኔታ? 1. አልተማረኩም 2. የመጀመሪያ ደረጃ
3.የሁለተኛ ደረጃ 4. ኮሌጅ እና ከዚያ በላይ
105 ስራወት ምንድን ነው? 1) የቤት እመቤት 2) የመንግስት ሰራተኛ 3) የግል ስራ

54
 4)መንግስታዊ ያልሆነ ድርጅት ሰራተኛ 5) ነጋደ
6) ገበሬ 7) ሌላ ካለ ይገለፅ-------------
106 ባሁኑ ወቅት የረስዎ የጋብቻ 1. ያገባች (አብረው የሚኖሩ) 2.ያላገባች ያላገባች፣ የፈታች ወይም
ሁኔታ ምንድን ነው? 3. የፈታች 4. የሞተባት የሞተባት ከሆነች ወደ
5. ያገባች (ተለያይተው የሚኖሩ) 109
107 የባለቤትዎ የት/ት ደረጃ? 1) አልተማረም 2) የመጀመሪያ ደረጃ
3) የሁለተኛ ደረጃ 4) ኮሌጅ እና ከዚያ በላይ
108 የባለቤትዎ ስራ ምንድን ነው? 1) ገበሬ 2) የመንግስት ሰራተኛ 3) ነጋደ
4) የግልስራ 5) መንግስታዊ ያልሆነ ድርጅት ሰራተኛ
6) የቀን ሰራተኛ 7)ሌላካለይገለጽ------------
109 የቤተሰበዎ አማካኝ የወርገቢ ስንት ነው? ------------------- በኢትዮጵያ ብር
ክፍል ሁለት፡- ከቀደሞው እና ከአሁኑ ከእርግዝና እና ምጥ ጋር የተያያዙ ጥያቄዎች
200 ስንተኛ እርግዝናዎ ነው? ማንኛዉንምአይነትእርግዝና --------በቁጥር
201 ስንተኛ ወሊድዎ ነው? (ከ 7 ወር በኋላ በሒዎት/ሞቶ የተወለድ) --------በቁጥር
202 እርግዝናዎ ከ 1 በላይ ከሆነ አስወርዶዎት ያውቃል? 1)አዎ 2) አልነበረም
202 እርግዝናዎ ከ 1 በላይ ከሆነ ከዚህ በፊት መጥፎ 1)አዎ 2) አልነበረም ካልነበረ ወደ
የእርግዝና ውጤት ነበረወት? 204 ዝለይ
203 አዎ ካሉ የትኛው? (ከአንድ በላይ መምረጥ 1) 3 እና ከዚያ በላይ ውርጃ
ይችላሉ) 2) ከ 7 ወር በኋላ በማህፀን ውስጥ መጥፋት
3) ሞቶመወለድ
4) ከተወለደ በኋላ በ 1 ወር ውስጥ መሞት
5) ሌላ ካለ ይገለጽ--------

204 ይህ እርግዝናሽ የታቀደ ነበር? 1)አዎ 2) አልነበረም

205 ይህ እርግዝናሽ የተፈለገ ነበር? 1)አዎ 2) አልነበረም
206 ይህእርግዝናሽ የተደገፈ ነበር? 1)አዎ 2) አልነበረም
207 በዚህ እርግዝና የተለየ ችግር ነበር? 1) አዎ 2) አልነበረም ካልነበረ ወደ 2010 ዝለይ
208 አዎ ካሉ ምንድን ነበር? ከአንድ 1) ከ 7 ወርበፊትደምመፍሰስ
በላይ መመለስ ይቻላል 2) ከ 7 ወር በኋላ ደም መፍሰስ
3) ከእርግዝና ጋር የተያያዘ የደም ግፊ
4) ከእርግዝና ጋር የተያያዘ የስኳር በሽታ
5) የእንሽርት ውሀ ከምጥ ቀድሞ መፍሰስ
6) ምጥ ሳይመጣ ቀኑን ማለፍ
7) ሌሎች ይገለፁ-------

209 ስር የሰደደ በሽታ ነበረበዎት? (በህክምና የተረጋገጠ) 1) አዎ 2) አልነበረም ካልነበረ ወደ 211

210 አዎካሉምንድንነው/ነበር? 1)የስኳር በሽታ 2) የደምግፊት
(ከአንድበላይመምረጥይቻላል) 3) የልብህመም 4) የአስም በሽታ

55
 5) የሚጥል በሽታ 6)ሌሎች ይጠቀሱ---

211 በዚህ ምጥ/ወሊድ ወቅት ያጋጠመሽ ችግር ነበር? 1) አዎ 2) አልነበረም ካልነበረ ወደ 213
212 አዎካሉምንድንነበር?በባለሙያ 1)የፅንስ መታፈን 2) የማህፀን መጥበብ
የተነገረዎትን ብቻ 3) የማህፀን መተርተር 4) ቀኑ ሳይደርስ ምጥ መጀመር
(ከአንድበላይመመለስይቻላል) 5)የምጥ ጊዜ መርዘም 6) የእትብት ከልጁ መቅደም 7)
ሌሎች ይገለፁ----

213 ያሁኑየወሊድአይነትበምንነበር? 1)በብልቴ 3)በመሳሪያ ታግዠ በብልቴ

2) በኦፕሬሽን 4)በብልት ኦፕሬሽን/እስቲች
ታግዠ
ክፍል፡- 3 ከእናቶች ጤና አገልግሎት ጋር የተያያዙ ጥያቄዎች
300 በዚህ እርግዝና የቅድመ ወሊድ ክትትል አድርገው ነበር? 1)አዎ 2) አልነበረም ካልነበረ ወደ 307
301 አዎ ካሉ በስንት ሳምንተዎ ጀመሩ? ------------(በሳምንት)
302 የትጀመሩ? 1)ጤና-ጣቢያ
2)ሆስፒታል
3)የግል-ክሊኒክ
4) ጤና ኬላ
303 ስንት ጊዜ የቅድመ ወሊድ ክትትል አደረጉ? --------------በቁጥር
304 በቅድመ ወሊድ ክትትል ጊዜ ስለወሊድ 1)አዎ 2) አላገኘሁም ካልነበረ ወደ 307
ዝግጅት ምክር አገኙ?
305 አዎ ካሉ ምን ምክር አገኙ? (ከአንድ በላይ 1) የመውለጃ ቦታ ስለመወሰን
መመለስ ይቻላል) 2) ገንዘብ ስለማዘጋጀት/መቆጠብ
3) በጤና ባለሙያ ስለመውለድ
4) የድንገተኛ ትራንስፖርት እንደት እንደማገኝ
5) ለድንነገተኛ ደም ለጋሽ ስለማዘጋጀት
6) በወሊድ ጊዜ ስለቤተሰብ ድጋፍ አስፈላጊነት
7) ለወሊድ አስፈላጊ ነገሮችን ስለማዘጋጀት
8) ሌላ ካለ ይጠቀስ--------

306 በቅድመ ወሊድ ክትትል ጊዜ በምጥ ወቅት አብሮሽ የሚሆን ሰው 1 አዎ

መምረጥ እንደምትችይ ገለጻ ተደርጎልሽ ያውቃል? 2) አያውቅም
307 የመጨረሻ ልጅዎን የት ወለዱ? 1)ጤና-ተቋም 2)ቤት  ጤና ተቋም ካሉ ወደ 309
(ወልደው ላወቁ ብቻ) 3)ሌላ ካለ ይገለፅ---------  ሌላ ካሉ ወደ 310
308 በቤት ከወለድሽ ለምን? (ተገቢ 1) እርግዝናዬ የጤና ችግር ስለሌለው
ከሆነ ከ 1 በላይ መልስን መስጠት 2) ባህላዊ አዋላጆችን ስለምመርጥ
ትችያለሽ) 3)በጤና አገልግሎት ሰጪ እንዳልንገላታና ክብሬን እንዳላጣ
4) የተለመደ ስለሆነ/ባህል ስለሆነ
5) በምጥ ወቅት ብቻዬን መሆን ስለምፈራ
6)የትራንስፖርት ችግር ስላለ

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 7)ያማጥሁት ለአጭር ጊዜ በመሆኑ
8)ሌሎች (ይገለፁ)--------------------
309 ጤና ተቋም ከወልዱ የት? 1)ሆስፒታል 2) ጤና ጣቢያ
3) ከግል-ጤና-ተቋም 4) ጤና ኬላ
310 በባለፈው ምጥ በጤና ተቋሙ ውስጥ ከተቋሙ ሰራተኛ ውጭ 1)አዎ
የምትፈልጊው አጋዥ አብሮሽ ነበር? 2)አልነበረም
311 በዚህ ምጥ በዚህ ጤና ተቋም ከተኛሽ በኋላ ያማጥሽበት ጊዜ ከመቸ እስከ ከ------እስከ------በሰዓት
መቸ ነው?
ክፍልአራት፡- በምጥጊዜሊኖርዎትስለሚችልረዳት/ድጋፍሰጪያለውንተግባራዊነትጥያቄዎች
400 ከቤትሽ ወደ ጤና ተቋም አብሮሽ የመጣ ድጋፍ ሰጭ ሰው 1)አዎ 2)አልነበረም ካልነበረ ወደ 500
ነበር?
401 አዎ ካልሽ ማን/ምንሽ ነበር? (ከአንድ 1)ባለቤቴ 2)የባህልአዋላጅ
በላይ መምረጥ ይቻላል) 3)እህቴ/አይቴ 4)እናቴ/አማቴ
5)ጓደኛዬ/ጎረቢቴ 6)ሌሎች ( ይግለጹ)_____
402 የመጣው ቤተሰብ በምጥ ወቅት 1)አልነበረም አልነበረም/አልፎአልፎ
ከእርስዎ ጋር እንድቆይ ተፈቅዶልዎት 2) አዎ አልፎአልፎ ካሉ ወደ 406
ነበር? 3)አዎ አብዘሀኛውን ጊዜ
4)አዎ ሁል ጊዜ
403 አዎ አብዘሀኛውን ጊዜ/ሁል ጊዜ ከሆነ 1)ባለቤቴ 2) የባህል አዋላጅ 3)እህቴ/አይቴ
ማን ነበር ከጎንሽ በመሆን የረዳሽ? 4) እናቴ/አማቴ 5)ጓደኛዬ/ጎረቢቴ 6)ሌሎች ( ይግለጹ)____
404 ይህ እንድረዳሽ የተፈከደለት ሰው/ግለሰብ የምትፈልጊው ምርጫሽ ነበር? 1)አዎ 2)አልነበረም

405 አብሮሽ የቆየው ረዳትሽ 1) ምንም አላደረገልኝ 2) ለእኔብሎመቆየቱንአሳየኝ

ምን አደረገልሽ? 3) እጀንያዘልኝ 4) ላቤን ጠረገልኝ
5)ፈሳሽእንድጠቀምአበረታታኝ 6) ጀረባየንአሸልኝ
7)ለሰገራናሽንትመቀበያአመቻቸልኝ 8) ከሌላውቤተሰቤጋርአነጋገረኝ
9)ጤናባለሙየውንሰፈልገውጠራልኝ 10)ፀለየልኝ
11)በደንብእንድተነፍስእናእንድፈታታአበረታታኝ
12)እምንእንደደረስኩከጤናባለሙያውበመጠየቅነገረኝ
13)ሌላካለይገለፅ------

406 አብዘሀኛውንጊዜእናከዚያበላይየረዳሽእናከጎን 1) ዕኔ ስላልፈለኩ

ሽየቆየሰውከሌለለምን? 2) ጤና ተቋሙ ስለማይፈቅድ
3) የጤና ባለሙያው ባለመፍቀዱ
4) ረዳቴ የሚቀመጥበት ወንበር ሰለሌለ
5) ሀይማኖቴ ስለማይፈቅድ
6) ባህሌ ስለማይፈቅድ
7) የምጥክፍሉስለተጨናነቀ
8) የምጥ ክፍሉ መጋረጃ/የግል ክፍል ስለሌለው

57
 9) የምመርጠው ረዳቴ ስለሌለ
10) ሌሎች ( ይግለጹ)-----------

ክፍልአ ምስት፡-በምጥ ወቅት አብሯት ስለሚሆንና ስለሚረዳት ሰው ያላትን እውቀት፣ፍላጎትና ምርጫ በተመለከተ
ሀ) በምጥ ወቅት አብሯት ስለሚሆንና እና ስሚረዳት ሰው ያላትን እውቀት በተመለከተ
500 በጤና ተቋም ውስጥ በምጥ ጊዜ በቤተሰብ አባላት ስለሚደረግ 1) አዎ ካላወቁ ወደ 502
እገዛ ሰምተሽ ታውቂያለሽ (እውቀትአለሽ)? 2) አላውቅም
501 አዎከሆነምንማለትነው? 1) በምጥ ጊዜ በተቋሙ ሰራተኞች የሚደረግ እገዛ
2) በእርግዝና ጊዜ በተቋሙ ሰራተኞች የሚደረግ እገዛ
3) በምጥ ጊዜ ከተቋሙ ሰራተኞች ውጭ የሚደረግ እገዛ
4) በእርግዝና ጊዜ ከተቋሙ ሰራተኞች ውጭ የሚደረግ እገዛ
5) ከወሊድ በኋላ ከተቋሙ ሰራተኞች ውጭ የሚደረግ እገዛ
6) ከወሊድ በኋላ በተቋሙ ሰራተኞች የሚደረግ እገዛ
7) ሌላካለ------
502 በምጥ ላይ ያለች ሴት በጤና ተቋም ውስጥ ልጇን እስክወልድ ድረስ አብሯት 1)አዎ ካላወቁ
እንዲቆይና እንዲደግፋት የምትፈልገውን ሰው የመምረጥ መብት እንዳላት 2)አላውቅም ወደ 504
ታውቂያለሽ?
503 አዎ ከሆነ እንዴት 1)ከሰዎች/ከጓደኛ ሰምቼ 2) ከዚህ በፊት ተሞክሮ ስላለኝ
ልታውቂ ቻልሽ/ከየት 3) አንብቤ 4) ከማህበራዊ/ ሌሎች ሚድያዎች ሰምቸ
መረጃውን አገነኙት? 5)ከጤና አገልግሎት ሰጪዎች ሰምቸ/በክትትል ወቅት ተነግሮኝ
6)ሌሎች ( ይግለጹ)------------
504 በምጥ ወቅት የሚረዳሽ አንድ ቤተሰብ አብሮ ስለመሆኑ 1) በጣምጥሩአሰራርነው
የምትይው ነገር ምንድን ነው? 2) ጥሩአሰራርአይደለም
505 በምጥ ወቅት በፈለጉት ረዳት/ቤተሰብ ድጋፍ ማግኘት/የሚረዳሽ 1) አዎአውቃለሁ ካላወቁ ወደ
ሰው አብሮሽ ቢኖር ያለውን ጥቅም ታውቂለሽ? 2) አላውቅም 507

506 አዎ ከሆነ ጥቅሙ ምንድን 1)የምጥ ህመምን እና የምጥ ህመም ማስታገሻ ፍላጎትን መቀነስ
ነው? (ከአንድ በላይ መምረጥ 2) የእናትን ደስታ መጨመር
ትችያለሽ) 3)በቀዶ-ጥገና የመውለድ አስፈላጊነት መቀነስ
4) ጭንቀት እና ፍርሀትን መቀነስ
5) የምጥ ጊዜ እንዲቀንስ ያደርጋል
6) በማህፀን/ በብልት የመውለድ እድልን መጨመር
7) የጨቅላውን በህይወት የመቆየት እድል የተሻለ ያደርጋል
8) በጤና ባለሙያ የሚመጣን እንግልት እና ክብር ማሳጣትን መቀነስ
9) በጤና ተቋም የመውለድ ፍላጎት ለመጨመር
10) ብቸኝነት እንዳይሰማ ማድረግ
11)ሌላካለይጠቀስ--------

ለ) በምጥ ወቅት አብሯት ስለሚሆን እና ስለሚረዳት ሰውያላትን ፍላጎት በተመለከተ

507 ለወደፊቱ በምጥ ጊዜ የሚረዳሽ ሰው አብሮሽ እንዲሆንፍላጎቱ 1)አዎ ከሌለ ወደ 510

58
 አለሽ? 2) የለኝም
508 አዎ ከሆነ በምጥ ጊዜ አብሮሽ የሚሆን ሰው እንዲደርግልሽ 1)አዎ ከሌለ ወደ 511
የምትፈልጊዉ/የምጠብቂው ነገር አለ? 2) የለም
509 አለካሉበምጥወቅትምን 1)ስነልቦናዊድጋፍ (ማበረታታት፣መፀለይ)
እንዲያደርግልዎትይጠ 2)ተግባራዊድጋፍ (ጀረባማሸት፣ እጅመያዝ/መደገፍ፣ አስፈላጊ ነገሮችን
ብቃሉ? ማቅረብ)
(ከአንድበላይመልስመ 3) መረጃዊ ድጋፍ (ስለምጡ ደረጃ፣ ስለሌላው ቤተሰብ ሁኔታ) መረጅ
ምረጥይቻላል) መስጠት
4)ጥበቃዊ ድጋፍ (እንዳልወድቅ፣ ባለሙያው እንዳያንገላታኝና ክብሬን
እንዳይነካኝ)
5)ሌላ ካለ ይጠቀስ----------------

510 ፍላጎትየለኝምካሉለምን?1)አብሮኝ ላለ ሰው ተጋላጭ ላለመሆን

(ከአንድበላይመምረጥይች2) ብቻዬን መሆን ስለምፈልግ
ላሉ) 3) ባህሌ ስለማይፈቅድ
4) ሀይማኖቴ ስለሚከለክለኝ
5) የቤተሰቤን ጭንቀት ላለማየት/እንዳይጨነቁ
6) ሌላ ምክኒያት-------------
ሐ)ድጋፍ ሠጭን ሰው ምርጫ በተመለከተ
511 በምጥ ጊዜ አብሮዎት የሚሆን አንድ ሰው 1)ባለቤቴን 2) እናቴን/ ሴትአማቴን
ምረጡ ቢባሉ ማንን ይመርጣሉ (ከአንድ 3)እህቴን/አይቴን 4) የባህል አዋላጅ
በላይ መምረጥ አይቻልም) 5)ጓደኛየን/ጎረቤቴን 6) ማንንም አልመርጥ
7)ሌላ ካለ ይጠቀስ-------------------

512 ለምርጫዎ ምክናየቱ ምንድን ነው? 1)ምቾት ስለሚሰጠኝ 2) በሀይማኖት ምክናየት

(ከአንድ በላይ መምረጥ ይችላሉ) 3)ልምድ እና እውቀት ስላለው 4) በባህል ስለሚፈቀድ
5)ሌላካለይገለፅ---------------

ክፍልስድስት፡- ከጤናተቋማትእናከባለሙያዎችጋርየተያያዙመረጃዎች
600 በዚህ ተቋም በምጥ ወቅት አብሮሽ ለሚሆን ሰው 1)አዎ 2) አይደለም አዎ ካሉ ወደ 602
ሁኔታወቹ ምቹ ይመስሉሻል?

601 አይደለም ካሉ ለምን? (ከአንድ በላይ መምረጥ 1) የምጥ ክፍሉ ስለሚጠብ/ስለተጨናነቀ

ይችላሉ) 2) የግል የምጥ ክፍል/መጋረጃ ስለሌለው
3) ለድጋፍ ሰጭው መቀመጫቦታ ስለሌለ
4) የምጥ ክፍሉ ንፅህና ስለማይመች
5) ሌላ ካለ ይጠቀስ---------------------

602 በዚህተቋምውስጥየሚሰሩባለሙያዎችስራይበዛባቸዋልብለውያስባሉ ? 1)አስባለሁ 2) አላስብም

603 በዚህጤናተቋምበቂጤናባለሙያአለብለሽታስቢያለሽ? 1) አስባለሁ 2) አላስብም

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604 አብዘሀኛውንየምጥጊዜየተከታተለወትጤናባለሙያፆታምንድንነው? 1)ወንድ 2) ሴት 3) ሁለቱም

ለተሳትፎዎ በጣም አመሰግናለሁ፡፡

Annex 7 Declaration

I, the undersigned, senior MSc clinical midwifery declare that this thesis is my original
work in partial fulfillment of the requirements for the degree of master of science in
clinical midwifery.

Name Hussien Mohammed Assfaw

Signature ___________________

Place of submission: school of midwifery, college of medicine and health science, UoG

Date of submission ______________________-

This thesis work has been submitted for examination with my/our approval as university
advisor(s) for thesis defense with my school of midwifery advisor(s).

Advisor(s)

Name Signature

_____________________ _____________________

_____________________ _____________________

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