ObjectiveTo identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia.DesignCross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses.SettingTwenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia.Participants3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016.Outcome measureThe primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman’s education, woman’s occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births.ResultsOverall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use.ConclusionsUtilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.

Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.

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Background: Self-reported client satisfaction is vital in order to address service provider and facility-based factors that can be upgraded to maximise antenatal care (ANC) satisfaction and utilisation in service-providing institutions. Objective: This study aimed to assess ANC service satisfaction and associated factors among pregnant women attending Hawassa city public health centres (HC), Sidama regional state, Southern Ethiopia. Methods: This health facility–based cross-sectional study was conducted on 422 pregnant women from 14 March to 13 April 2017. Exit interview data were collected from pregnant women attending care service at five randomly selected public HC. Results: Overall, 79.2% were satisfied with the ANC service. As per specific components, 74.2% of respondents were satisfied with the information provided, and 74.2% were satisfied with the institution’s health care. Respondents who had received iron tablets were 3.2 times more likely to be satisfied than their counterparts (adjusted odds ratio (AOR)=3.2, 95% confidence interval (CI) 1.7–5.9). Pregnant women who were counselled on human immunodeficiency virus infection and its testing were 4.3 times more likely to be satisfied than those who had not received such counselling (AOR=4.3, 95% CI 2.2–8.4). Also, those women who waited ⩽30 minutes (AOR=2.6, 95% CI 1.2–5.5) and who received information on foetal movement (AOR=3.5, 95% CI 1.8–6.5) were significantly associated with ANC service satisfaction. Conclusion: More than 20% of pregnant women were not satisfied with ANC services. This reflects a need for attention in each aspect of health-care service provision in order to assure client satisfaction.

Background Counterproductive behavior costs organizations and their members which will ultimately affect work-related outcomes and organizational success. Organizational justice has the potential to affect the level of counter productive behavior. However, there is a paucity of studies to show the link between counterproductive behavior and organizational justice dimensions in the Ethiopian health care system context. Therefore, the purpose of this research was to look into the link between organizational justice, and counterproductive work behavior among health care professionals. Methods The 395 study participants were chosen using a facility-based cross-sectional study methodology. A proportionate stratified systematic random sampling technique was deployed to select study participants from health facilities. Data was gathered using a structured self-report questionnaire by CWB Scale that was developed by Spector and Fox (2005) with Cronbach’s alpha of an average of (0.84–0.87). Data was obtained, cleaned, and entered by Epidata3.1. Finally, for descriptive and inferential statistical analysis, the data was exported to SPSS version 23.0. Results According to the findings, 159 (40.3%) of the study participants engaged in counterproductive job activities. Organizational justice was assumed to be fair by about half of the respondents, 202 (52.2%). Distributive Justice (=−0.141, p.05) was found to be a significant and negative predictor of counterproductive work behavior in the regression analysis. Age (β=−0.014, p< 0.05), the average number of hours worked every week (β=−0.009, p< 0.05), and experience (β=0.016, p< 0.05) were found to be significant predictors of the counterproductive work behaviors. Conclusion and Recommendation This study indicated that distributive justice show significant contribution in reduction of counterproductive work behaviour.As a result, improving organizational justice can aid to reduce counterproductive work behavior which in turn increases the facility’s productivity.