https://repository.ju.edu.et//handle/123456789/177 2026-04-17T11:23:23Z https://repository.ju.edu.et//handle/123456789/10038 Assessment of Covid-19 Self-Protective Practices and Associated Factors among Secondary School Students in Jimma Town, Jimma, Oromia, Ethiopia Genzebie Tesfaye; Zewdie Birhanu; Kasahun Girma Background: School student are one of the vulnerable groups to coronavirus (COVID-19) due to different factors (such as crowding) which can potentially increase the risk of transmissions of this virus. Thus, school students could play a crucial role in the prevention and the spread of this disease. However, evidence is lacking regarding COVID-19 self-protective practices and associated factors among school students. Objectives: To assess COVID-19 self-protective practices and associated factors among secondary school students in Jimma town. Methods: A school-based cross-sectional study was conducted in Jimma town, Oromia, Ethiopia, from May 25 to June 10, 2021. The total sample size was 634 who were randomly selected from both public and private secondary schools. Self-administered questionaries were used to collect the data. The data were cleaned, and entered into, and analyzed using SPSS 21.0 statistical software package. Composite index (after adjusted the score adjusted to 0-50 score) was computed for each dimension and constructs for the health belief model. Descriptive statistics such as proportion and mean were computed to describe the findings and linear regression was used to identify predictor of self-protective behavior. Results: In this study, the four most mentioned symptoms of COVID-19 by respondents were fever (96.7%), dry cough (89.6%), difficult breathing (86.3%), and sore throat (83.9%). Most of the participants (95.8%) knew that COVID-19 spreads through respiratory droplets, (90.3%) direct contact with contaminated hands (87.2%) kissing or greetings (95%) handshaking, and (93.2%) crowded area. Almost all (96%) know that the use of facemask prevents COVID-19. Similarly, 96.4% of the participants know that avoiding touching eyes, nose, and mouth before washing hands is one way of preventing the method of COVID-19 and 93.1% of the respondents also know that keeping a physical distance is also the other mechanism to prevent the disease. For multidimensional knowledge, the score the highest mean was recorded for knowledge of ways COVID-19 preventive and safety practices (mean=46.0, possible value=0-50), and the lowest mean knowledge score was observed for knowledge of ways of transmissions or spread of the coronavirus (mean=25.6, possible value=0-50). The mean score for overall knowledge was found to be 31.2 (SD=8.6). Likewise, the mean score for perceived vulnerability, severity, benefits, barriers, self-efficacy and school support were 33.4, 31.7, 43.1, 16.2, 33.4, and 25.5, respectively. On the other hand, COVID-19 self-protective measure was not optimal (mean 25.5), indicating a huge gap. Perceived benefits (0.348, p=0.000), self-efficacy (β=0.080, p=0.036), and perceived school support (β=0.360, p=0.000) independently predicted increased self-care practices. Conversely, perceived vulnerability (β=-0.339, p=0.000) and maternal education are associated with negative or decreased self-care practices. Conclusions: Despite knowledge of the disease (COVD-19), transmissions and preventive measures were quite high, the level of adherence to self-protective behaviors was unsatisfactory. Maternal education, perceived susceptibility, self-efficiency, perceived benefits, and school support to COVID-19 self-protective practice were factors significantly affecting the practice of COVID-19 self-protective measure among secondary school students. 2021-12-18T00:00:00Z https://repository.ju.edu.et//handle/123456789/9969 Effect of Couple-Based Breastfeeding Education and Support Intervention on Optimal Breastfeeding Practice in Hadiya Zone, Central Ethiopia: A Cluster-Randomized Controlled Trial. Mulatu Abageda; Tefera Belachew; Belayneh Hamdela Background: Optimal breastfeeding is essential for the survival, growth, and development of children, as well as the health of mothers. Globally, optimal breastfeeding practices are still low: only 42% of newborns start breastfeeding (BF) within the first hour of birth, 41% of infants less than 6 months of age are exclusively breastfed, and only 45% of mother’s breastfeed for at least two years. Every year, it is estimated that optimal breastfeeding practices might avoid 823,000 child deaths. However, breastfeeding practices are not optimal in Ethiopia. Male partners play a vital but frequently neglected role in the promotion of breastfeeding practices, and they are currently not included in health-care providers' breastfeeding education. The effect of couple-based breastfeeding interventions on optimal breastfeeding has not been studied in the Ethiopian context. Therefore, the objective of this study was to evaluate the effect of couple-based breastfeeding education and support on optimal breastfeeding practice in Hadiya Zone, central Ethiopia. Methods: A cluster-randomized controlled trial and phenomenological qualitative study design was conducted to evaluate the effect of couple-based breastfeeding education and support on optimal breastfeeding practice compared to routine care at the community level. The intervention was provided to the mothers and male partners by trained health care workers selected from nearest health center. The mothers and male partners in the Intervention Group (IG) were received both antnatal and postnatal breastfeeding education and support starting from their 3rd trimester of pregnancy till 6 month post-delivery, but those in the Control Group (CG) was received routine care. The breastfeeding education and support intervention is comprised of three components: 1) group education, 2) providing specific take-home print materials, 3) Individual home visit. A total of 408 couples in their third trimenster pregnancy were recruited to either the intervention group (204) or a control group (204) from 16 clusters (Kebeles) and the duration of the intervention was 9 months. Epi-data version 3.1 was used to enter data, SPSS for Windows version 23 and STATA version 14.0 were used to analyze the data. DID and Generalized Estimating Equation (GEE) model was used to deteremine the effect of the intervention on optimal breastfeeding practice. P values < 0.05 were used to declare statistical significance. A thematic analysis was performed by using Atlas Ti7 software for qualitative study. Result: In the qualitative study, four themes and 9 sub-themes emerged from mothers’ and fathers’ experience of male partners’ support for optimal breastfeeding practices. The themes include the following: sociocultural barriers to male support; emotional and practical support; xii education and exposure access for fathers; and economic hardships and work-related barriers. The couple-based breastfeeding support intervention showed meaningful improvements in both parental behaviors and infant health. Mothers who received the intervention alongside their partners were significantly more likely to practice optimal breastfeeding and reported higher confidence in their ability to breastfeed. Compared to those receiving routine care, the intervention group saw a 17.5% increase in optimal breastfeeding practices and a 20.9% boost in mothers’ breastfeeding self-efficacy. Male partners also showed notable progress: their knowledge about breastfeeding improved by 25.3%, their attitudes became 24.9% more supportive, and their practical support increased by 30.9%. These changes were not only statistically significant but also practically important. Further analysis using the GEE model confirmed that mothers in the intervention group were 38% more likely to breastfeed optimally and 48% more likely to feel confident about breastfeeding. Their male partners were 61% more likely to be knowledgeable, 59% more likely to have a favorable attitude, and 78% more likely to actively support breastfeeding. Most strikingly, the intervention had a powerful effect on infant health: infants whose parents received this support experienced a 92.7% reduction in reported illness during the intervention period. These findings make it clear that when both mothers and fathers are engaged in breastfeeding support, the benefits ripple across the family, improving knowledge, changing attitudes, strengthening confidence, and ultimately protecting the health of children. Conclusion and Recommandation: The study indicated that involving fathers in breastfeeding support made a big difference. Parents who took part in the intervention saw clear improvements: mothers were optimal and felt more confident in breastfeeding, and fathers became more knowledgeable, had more positive attitudes, and gave stronger support. The study also found that when fathers were more involved, breastfeeding practices improved, and babies were much healthier, with a significant drop in illness. At the same time, the interviews with mothers and fathers showed that while many dads wanted to help, they faced challenges like cultural expectations, lack of information, work pressures, and financial strain. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT05173454, First registered on 30/12/2021 2025-08-06T00:00:00Z https://repository.ju.edu.et//handle/123456789/9968 Trends, Determinants, and Perinatal Outcomes of Uterine Rupture: The Role of Three Delays at Nekemte Specialized Hospital, West Oromia, Ethiopia Mitiku Getachew Kumara; Gurmesa Tura; Beyene Wondafrash Uterine rupture is a life-threatening obstetric emergency characterized by the complete disruption of the uterine wall, including the endometrium, myometrium, and serosa. This condition poses significant risks to maternal and neonatal health, such as severe hemorrhage, infection, and perinatal death. The prevalence of uterine rupture is markedly higher in low- and middle-income countries due to limited access to quality maternal healthcare. In Ethiopia, facility-based studies indicate a prevalence of 1% to 5% in specialized hospitals, with uterine rupture contributing significantly to maternal mortality (10%-25%) and perinatal mortality rates exceeding 50%. Recognizing this public health concern, the study was conducted to understand the prevalence, determinants, and outcomes of uterine rupture at Nekemte Specialized Hospital, Oromia, Ethiopia, and to provide evidence for localized healthcare interventions. Methods A mixed-methods design was employed for this study. Quantitative data were collected retrospectively from hospital records spanning 2014 to 2022, analyzing trends, prevalence, and associated factors. Regression modeling was used to identify predictors of maternal and neonatal outcomes. Qualitative data were gathered through phenomenological interviews with twelve uterine rupture survivors and four key informants, exploring emotional, physical, and social impacts. Systematic random sampling was applied for the quantitative component, while purposeful sampling was used for the qualitative interviews. Quantitative data were analyzed using SPSS software, and qualitative data were thematically analyzed. Results The study revealed several significant findings. Over nine years, there was a gradual decline in uterine rupture prevalence, reflecting improvements in maternal healthcare services. Key determinants of uterine rupture included lack of antenatal care, high parity, rural residency, previous cesarean sections, and prolonged labor. Maternal outcomes highlighted high mortality rates caused by hemorrhage, uterine atony, and infections, with survivors often experiencing long- term complications such as anemia and infertility. Neonatal outcomes were equally severe, with xiii perinatal mortality exceeding 50%, primarily due to birth asphyxia and stillbirth. Premature delivery and low birth weight were identified as significant predictors of neonatal mortality. The study also examined the impact of the three-delay model. Cultural beliefs, financial barriers, and a lack of awareness influenced delays in seeking care. Delays in reaching care stemmed from geographical barriers, poor road infrastructure, and transportation challenges. Finally, delays in receiving adequate care were linked to shortages of trained healthcare personnel, inadequate emergency obstetric services, and inefficient referral systems. Women who survived uterine rupture shared their lived experiences, which included profound psychological, social, and economic challenges. Survivors reported experiencing post-traumatic stress disorder, anxiety, and depression. Cultural stigmatization and feelings of guilt exacerbated their psychological distress. Socially, survivors often faced marital discord, community ostracization, and financial hardships caused by medical expenses and loss of productivity. Despite these challenges, coping mechanisms such as family support, healthcare providers' assistance, and community organization engagement were instrumental in recovery. However, access to counseling and rehabilitation services was limited. Conclusions Uterine rupture remains a significant public health challenge in Ethiopia, particularly in resource- constrained settings. To address this, healthcare infrastructure should be improved through investments in emergency obstetric services, including training, deploying skilled birth attendants, and providing essential medical supplies. Strengthening referral systems by enhancing communication and transportation networks is also critical to reducing delays in accessing care. Community education campaigns are needed to raise awareness about the importance of early healthcare-seeking behavior and to address cultural stigmas surrounding maternal health. Additionally, psychosocial support programs, including counseling and rehabilitation services, should be established to address survivors' needs. Finally, region-specific policies must be developed to tackle disparities in maternal healthcare access and outcomes. 2025-08-06T00:00:00Z https://repository.ju.edu.et//handle/123456789/9967 Compliance to Antenatal Psychosocial Assessment Practice and the Effectiveness of Antenatal Group-Based Psychoeducation in Preventing Postpartum Depression, Jimma, Ethiopia: A Cluster-Randomized Controlled Trial Marta Tessema; Zewdie Birhanu; Muluemebet Abera Background: - In Ethiopia, one in five mothers suffers from postpartum depression. It carries adverse physical and psychological consequences for the mother, child, family, and society as a whole. Though the condition is an indication of the need for prompt interventions, there is no assessment and prevention targeted to this problem at maternal health care units in Ethiopia. Evidence indicates that, to prevent postpartum depression (PPD), universal screening and psychosocial support to be undertaken in early pregnancy to be effective. Pertinent to this, the WHO indicates that maternal health care providers hold a crucial role in detecting, preventing, and, if necessary, providing referrals to mental health care services. Objectives: So, the study tried to improve compliance to antenatal psychosocial assessment practice (ANPA) among maternal health care providers (MHCP) and assessed the effectiveness of antenatal group-based psychoeducation intervention in preventing PPD in maternal health care units, Jimma, Ethiopia. Methods: - To enhance compliance with ANPA practices among MHCP, a pre-post study design was implemented. Audit, feedback, and re-audit standard criteria were utilized, alongside a team-based analysis of organizational barriers. Additionally, strategies were identified to address those barriers. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit and feedback tool were used. The study was conducted from December 2018 to April 2019 using four standard ANPA audit criteria from JBI-PACES for both the baseline and follow up audits. All MHCP and 66 pregnant women, selected using the consecutive sampling method, participated. On the basis of the results, the gaps and barriers were analyzed using GRiP strategies. The next objective assessed the effectiveness of antenatal group-based psychoeducation (ANGPE) intervention aimed at preventing PPD while also enhancing postpartum depression literacy and social support. A cluster-randomized controlled trial was conducted using a parallel-group, single-blind, and two-arm intervention design with a 1:1 allocation ratio. This trial took place from March 28 to December 1, 2022, and involved 550 IX (intervention=286 and control=264) pregnant women across 32 non-adjusted health centers. The health centers were randomized into two groups, with 16 health centers assigned to each arm, using a simple randomization technique. The units of randomization were health centers with an average cluster size of 20 pregnant women, 12-20 weeks of gestation, who scored (0-9) on the Patient Health Questionnaire-9. The intervention group received usual care plus five ANGPE classes, while the control group received only usual care. A well-validated patient health questioner-9, functional social support, and PPD literacy scale assessed PPD, social support, and PPD literacy, respectively. Data were collected in face-to-face interviews at 12–20 weeks gestation and 6 weeks postpartum. An Intention-to-treat analysis was used, and baseline characteristics were compared between groups using a χ² and an independent sample t-test for categorical and continuous measures, respectively. Finally, the magnitude of the intervention effect and predictors of the outcome variable were analyzed by using a relative risk and a mixed-effect model based on the objective of the study. Result: The baseline audit result revealed a 0% compliance rate for all evidence-based ANPA audit criteria. Lack of knowledge or training gaps, weak internal referral system or weak linkage between antenatal clinic and medical or behavioral treatment services, lack of locally validated tools for assessing depression in the antenatal clinic, client load, and shortage of private rooms were identified as barriers. However, the post implementation result showed that an average 91.5% practice of evidence based ANPA was applied as per standards by working on the above identified barriers. Regarding the cluster randomized controlled trial: - The overall response rate at the end line was 92.9%. The results showed that the prevalence of (PPD) in the intervention clusters was significantly lower than in the control group, with rates of 20 (7%) compared to 74 (28%), P = 0.001. Additionally, the relative risk (RR: 0.25 [0.07/0.28]) indicates that mothers who received ANGPE were 75% less likely to develop PPD than those in the control group who received only the usual care. Additionally, after controlling the community and individual-level variables, a mixed-effect analysis showed that ANGPE intervention (65%; AOR = 0.35, 95% CI = 0.13–0.99), social support (AOR = 0.04, 95% X CI = 0.01–0.15), partner emotional support (AOR = 0.24, 95% CI = 0.12–0.51), PPD literacy (AOR = 0.25, 95% CI = 0.11–0.62), and self-esteem (AOR = 0.22, 95% CI = 0.11–0.47) were more likely to protect mothers from PPD. On the contrary, domestic work (AOR = 9.75, 95% CI = 3.37–28.16), neonates with complications (AOR = 5.79, 95% CI = 2.04–16.45), and unhealthy coping (AOR = 2.39, 95% CI = 1.06–5.42) exposed mothers to PPD. Furthermore, the study showed that mothers in the intervention arms were 2.04 times more likely than controls to have adequate social support (RR=2.044, 95% CI: 1.684-2.481). Similarly, mixed-effect analysis indicated that mothers in the intervention clusters (3.607; AOR=2.136–6.090) had partner emotional support (AOR=1.61; 1.00–2.59) and get support from their mother (AOR=4.25; 1.78–10.15) had adequate social support. However, mothers with PPD (AOR=.057 (.02-.19)), unhealthy coping (AOR=.27), and loneliness (AOR=.28 (.11-.69)) were less likely to have adequate social support. Furthermore, the study demonstrated a significant difference between groups regarding the overall mean PPD literacy score (intervention, 3.75±.46; control, 3.48±.46; ηp²=.07), ability to recognize PPD (intervention, 4.30±.64; control, 3.94±.75; ηp²=.06), knowledge of risk factors and causes (intervention, 4.03±.69; control, 3.67±.70; ηp²=.05), and access to PPD information (intervention, 3.28±1.25; control, 2.01±1.13; ηp²=.21) at p=.001, with marginal significance regarding self-care activities (intervention 4.37±.54, control 4.26±.50, ηp²=.01, P =.051). Conversely, there were no significant differences in knowledge of professional help (intervention 2.97±1.13, control 2.83±.80, ·p²=.00, P=.303), beliefs regarding professional help (intervention 2.67±.89, control 2.50±.72, ·p²=.01, P=.063), and attitudes towards PPD recognition and help-seeking (intervention 3.91±1.02, control 3.91±1.02, ·p²=.00, P=.586). Moreover, partner emotional support (AOR = .1, 95% CI = .02–.17), unhealthy coping (AOR = -.14, 95% CI = -.22–(-.07)), and multiparty (AOR = -.15, 95% CI = -.22–(-.08)) showed significant associations with overall PPD literacy score. 2025-10-27T00:00:00Z