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Prevalence and associated Factors of Adverse Birth Outcomes among Women

Attended Maternity Ward at Negest Elene Mohammed Memorial General
Hospital in Hosanna Town, SNNPR, Ethiopia

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DOI: 10.4172/2167-0420.1000324

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Journal of Women's Health Care

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DOI: 10.4172/2167-0420.1000324
ISSN: 2167-0420

Research Article Open Access

Prevalence and associated Factors of Adverse Birth Outcomes among

Women Attended Maternity Ward at Negest Elene Mohammed Memorial
General Hospital in Hosanna Town, SNNPR, Ethiopia
Abdo RA1, Endalemaw TB2 and Tesso FY3*
1
Samara University, Health Science College, Samara Town, Afar Region, Ethiopia
2
Post Graduate Coordinating Office, College of Health Sciences, Jimma University, Ethiopia
3
Department of Nursing and Midwifery, College of Health Sciences, Jimma University, Ethiopia

Abstract
Background: Throughout the world, approximately 210 million women become pregnant and over 135 million of
them deliverr live born infants, while 75 million pregnancies end in stillbirth, preterm or spontaneous or induced abortion.
Though there are studies on the various forms of adverse birth outcomes particularly in developing countries and few parts
of Ethiopia there is limited data on the adverse birth outcomes at Negest Elene Mohammed memorial general hospital in
Hosanna town Sothern Ethiopia.
Objective: The aim of the study was to assess the prevalence and associated factors of adverse birth outcomes
among deliveries at Negest Elene Mohammed memorial general hospital in Hosanna Town, south west of Ethiopia.
Methods: Facility based Cross sectional quantitative study was carried out from March 1 to May 2, 2015 at Negest
Elene Mohammed memorial general hospital. A convenient sampling technique was used to select 327 study participants.
Data was collected using a pre-tested structured interviewer administered questionnaire and measurements of weight of
the new born were taken and client’s chart was reviewed to retrieve medical information. The data was entered into SPSS
version 20.0 statistical software for windows for analysis, then, logistic regression analysis was carried out to identify
independent predictors of adverse birth outcomes at CI of 95% and significance level of P-value<0.05.
Result: The study finding showed that 80 (24.5%) of women had adverse birth outcomes. The common adverse birth
outcomes were still birth, preterm, and low birth weight with the proportion of 28 (8.6%), 28(8.6%), and 32 (9.8%), respectively).
Being government employee [AOR=4.5,95%CI(1.25,15.9)], lack of antenatal care [AOR=3.2,95%CI(1.27,8.06)], rural residence
[AOR=3.5,95%CI(1.57,7.93)], hemoglobin<11 mg/dl [AOR=2.5,95%CI(1.1,5.45)], malarial infection [AOR=8.6,95%CI(2.6,22.62)],
age<20 years [AOR=4.9,95%CI(11.29,18.6)], pregnancy complications [AOR=6.3%CI(2.8,13.9)], were associated with adverse
birth outcomes.
Conclusion: Occupation, residence, age, malarial infection, lack of antenatal care, hemoglobin level, and pregnancy
complications were associated with adverse birth outcomes. Increasing antenatal care uptake, prevention and treatment of
malarial infection, and anemia and improvements in quality of maternal health services require strict attention.

Keywords: Adverse; Birth outcomes; Preterm birth; Birth weight; the age of 5 die worldwide each day from preterm birth complications,
Still birth making it the leading cause of death among young children. Direct
complications from preterm birth caused 965,000 deaths among
Abbreviations: SNNPR: South Nation and Nationality People children up to 28 days old, and another 125,000 deaths among children
Region; SPSS: Statistical Package for Social Science; CI: Confidence aged one month to five years [4]. Preterm born infants that survive
Interval; AOR: Adjusted Odds Ratio; HIV: Human Immunodeficiency often face lifelong health problems such as breathing and respiratory
Virus; NEMMGH: Negest Elene Mohammed Memorial General difficulties, cerebral palsy, vision and hearing loss, feeding and digestive
Hospital problems, and intellectual disabilities [5]. Stillbirth is also a major
contributor to perinatal mortality rate. At least 2.6 million stillbirths
Introduction occur every year, 98% in low-income and middle-income countries [6].
Birth outcomes are measures of health at birth. Birth outcomes As to the factors associated with adverse birth outcomes, late or no
have improved dramatically worldwide in the past 40 years. Yet there
is still a large gap between the outcomes in developing and developed
countries [1]. Adverse birth outcomes such as stillbirth, low birth
weight and preterm birth constituted the highest rates of all the adverse *Corresponding author: Tesso FY, Assistant Professor, Department of
pregnancy outcomes and are common in developing countries [2]. Nursing and Midwifery, College of Health Sciences, Jimma University, Ethiopia,
Tel: +251 47 111 14; E-mail: [email protected]
Low birth weight infants may suffer the risk of developing many Received July 18, 2016; Accepted July 29, 2016; Published August 05, 2016
complications which includes respiratory distress, sleep apnea, heart
problems, jaundice, anemia, chronic lung disorders, and infections are Citation: Abdo RA, Endalemaw TB, Tesso FY (2016) Prevalence and associated
Factors of Adverse Birth Outcomes among Women Attended Maternity Ward at
some of the problems associated with low birth weight babies [3]. Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR,
Ethiopia. J Women’s Health Care 5: 324. doi: 10.4172/2167-0420.1000324
Complications of preterm birth also outrank all other causes as
the world’s number one killer of young children. Complications from Copyright: © 2016 Abdo RA, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
preterm birth caused nearly 1.1 million of the 6.3 million deaths of use, distribution, and reproduction in any medium, provided the original author and
children under age 5 in 2013. Of those more than 3,000 children under source are credited.

J Women’s Health Care, an open access journal Volume 5 • Issue 4 • 1000324

ISSN: 2167-0420
Citation: Abdo RA, Endalemaw TB, Tesso FY (2016) Prevalence and associated Factors of Adverse Birth Outcomes among Women Attended
Maternity Ward at Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR, Ethiopia. J Women’s Health Care 5:
324. doi: 10.4172/2167-0420.1000324

Page 2 of 5

antenatal care care, pregnancy and labor complications, malaria attacks that the rate of low birth weight and preterm birth were 10.5% and
during pregnancy, anemia, short interpregnancy intervals, maternal 10.9% respectively and were associated with antepartum hemorrhage,
education, age, poor nutrition and low socioeconomic status etc were hypertensive pregnancy disorders, rural residence and primiparity
found to play a significant role [1]. [17]. Additionally, study conducted in Bangladesh to assess the
association between birth weight, socio demographic variables and
A cross-sectional study conducted in Brazil, showed that women
maternal anthropometry, indicated that maternal age less than 20 years
living in rural areas were found to be at increased risk of giving birth
and older than 35 years, the lower income group, illiterate and MUAC
to a neonate with very low birth weight compared to urban dwellers
less than 23 cm were significantly associated with low birth weight [18].
[7]. Similarly, women with inter-pregnancy intervals<6 months had an
increased risk of having low birth weight and preterm birth. However, A cross-sectional study done in north Wolo Zone (Ethiopia)
equivocally, prolonged inter-pregnancy intervals also found to be to determine the prevalence of poor birth outcomes and associated
associated with low birth weight and still births [8]. factors among women gave birth in health facilities, showed that 27.5%
of the laboring mothers had a poor birth outcome of which 9.8% were
Similarly, a cross-sectional study conducted in India to compare
still birth, 7.5% preterm, and 12.8 were low birth weight, and associated
obstetrical complications in two parity groups, primiparity and
with mother’s occupation, educational status, non-antenatal care
multiparty and further determine the association of parity status with
attendance, rural residence and being HIV positive [19].
neonatal outcomes, the findings showed that the Low Birth Weight
babies was significant association with primiparity [9]. Though there are studies on the various forms of adverse birth
outcomes particularly in developing countries and few parts of
A study conducted in china revealed that LBW was found to be
Ethiopia, there is limited data on the adverse birth outcomes at Negest
associated with maternal age of less than 20 years, low level of maternal
Elene Mohammed memorial general hospital in Hosanna town.
education(illiterate), previous histories of adverse pregnancies,
and with pregnancy comorbidities and complications, such as Therefore, this study aimed to assess the prevalence and associated
hypertensive disorders during pregnancy, anemia, oligohydramnios, factors of birth outcomes among reproductive age groups of women
premature rupture of membranes, and gestational diabetes [10]. gave birth at Negest Elene Mohammed memorial general hospital in
Additionally, a study conducted in Iran to determine prevalence and Hosanna town, Sothern Ethiopia.
risk factors associated with preterm birth, revealed that the prevalence
rate of preterm birth was 5.1% and history of previous preterm Method and Materials
birth, pregnancy complications (hypertension, oligohydramnios, A facility based cross sectional quantitative study was carried
preeclampsia, premature rupture of membrane, antepartum out from April1 to May, 2015 on systematically sampled 327 study
hemorrhage, hyperemesis gravidarum), anemia were factors associated participants at maternity wards of Negest Elene memorial general
with preterm birth [11]. hospital of Hadiya zone. Hadiya zone is found 230 Km away from
A cross sectional study conducted in Pakistan to evaluate the Addis Ababa, the capital city of Ethiopia in south west of Ethiopia
antenatal maternal hemoglobin and find its impact on perinatal and 194 Km away from Hawassa town of SNNPR. Negest Elene
outcome, the findings revealed that the mothers with anemia have memorial general hospital is the only tertiary (zonal) hospital found
higher risk of having low birth weight, preterm births and still birth in the Hosanna town, capital city of Hadiya Zone. It serves over one
[12]. Another study in same area carried out to determine the obstetric million people residing in urban and rural parts of south west Ethiopia.
causes for stillbirth in low socio-economic settings, showed that On average, there were about 12 deliveries per day, which amounts to
obstructed labor, hypertensive disorders, abruption placenta, placenta (4320) deliveries in previous 12 months in this hospital.
previa, and preterm labor were associated with still birth [13]. A systematically sampled 327 pregnant mothers who came to the
Study conducted in Tanzania to determine the risk factors for poor hospital for delivery from April to May, 2015 were included in the
birth outcomes revealed that the prevalence adverse birth outcomes study. Data was collected using a pretested structured interviewer
was 18% among which 2.7% were still birth, 12% preterm and 8% administered questionnaire, taking weight of the baby at birth, and
low birth weight, and adverse birth outcomes were independently performing maternal chart reviews. The data collection instrument was
associated with maternal malaria and anemia [14]. Another cross structured into four logical sections (socio demographic characteristics
sectional study conducted in Ghana (Kumasi), to investigate factors (9 items), and obstetrics related factors (23 items), maternal medical
influencing antenatal care utilization and its association with adverse conditions (3 items) and mothers’ behavioral factors (12 items) and
pregnancy outcomes (low birth weight, stillbirth and preterm delivery) birth outcomes assessment (4 items). The instrument was pretested on
showed that the prevalence of adverse birth outcome was 19%, and 33 clients at Butajira hospital before the actual data collection date and
women who had more than 5 births were found to be more likely to based on the findings of the test, slight modifications were done on few
experience adverse birth outcomes [15]. of the instruments.
A cross-sectional study carried out in Nigeria to find out the Before data collection, letter of ethical clearance was obtained
epidemiological factors associated with low birth weight low birth from Institutional Review Board of Jimma University, College of
weight among institutional deliveries, showed that 40.0% of mothers health sciences to Hadiya Zonal Health office administration and then
delivered low birth weight babies, and were significantly associated to Negest Elene memorial general hospital authorities. Furthermore,
with preterm birth, maternal age less than 20 years, lack of antenatal verbal consent was obtained from the study participants, confidentiality
care follow up, anemia, severe physical work, tobacco smoking, and and privacy was assured, the right not to participate or withdraw from
birth interval of less than 2 years [16]. the study any time the clients feel uncomfortable and that this does not
have any link with the service and care provided to them.
A cross sectional study conducted in Gambia to determine the
association between low birth weights preterm birth and maternal Data was collected by six trained midwives (who can speak both
demographic characteristics and obstetric complications, showed Amharic and local language) working in the hospital during the

J Women’s Health Care, an open access journal Volume 5 • Issue 4 • 1000324

ISSN: 2167-0420
Citation: Abdo RA, Endalemaw TB, Tesso FY (2016) Prevalence and associated Factors of Adverse Birth Outcomes among Women Attended
Maternity Ward at Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR, Ethiopia. J Women’s Health Care 5:
324. doi: 10.4172/2167-0420.1000324

Page 3 of 5

day and night working hour shifts and one midwife supervisor was Variable (N=327) Number Percent
assigned from Hosanna health science college who took similar data <20 18 5.5
collection training. The collected data was checked for completeness Age group 20-34 279 85.3
and consistency by data collection supervisor on daily basis. 35+ 30 9.2
The collected data was first checked for its completeness, coded Residence
Urban 192 58.7
and entered into SPSS version 20.0 statistical software programs for Rural 135 41.3
analysis. After cleaning data for inconsistencies and missing value Married 322 98.5
Marital status
in SPSS, descriptive statistical analysis was done to determine the Single 5 1.5
proportion of adverse birth outcomes and mothers’ socio-demographic Orthodox 101 12.5
characteristics. Muslim 34 10.4
Religion
Protestant 181 74.1
Logistic regression analysis was carried out to identify independent
Catholic 11 3
predictors of adverse birth outcomes. Bivariate analysis was carried
Hadiya 280 85.4
out to determine presence of significant association between each
independent factor and adverse birth outcome. Variables with p value Kambata 20 6.1
Ethnicity
less than 0.25 selected for multiple logistic regression. Multiple logistic Silte 13 4
regression was done for variables that have p-value<0.25 during the Others* 14 4.6
bivariate logistic analysis to control for potential confounders and Illiterate 74 22.6
to see pure effect of individual variables in the model. The degree of Educational status
Primary 165 50.5
association between independent and dependent variables was assessed secondary and
88 26.9
using odds ratio with 95% confidence interval. P- Value ≤0.05 was higher
considered statistically significant. Odds ratio was used to determine House wife 195 59.6
the strength of association between independent variables and adverse Occupation Private job 87 26.6
birth outcomes. Employed 45 13.8
*others include Gurage, Tigre and Amhara
Result
Table 1: The Socio-demographic Characteristics of women attended maternity
The socio-demographic characteristics of women attended ward at Negest Elene Mohammed Memorial General Hospital, SNNPR State,
Ethiopia.
maternity ward at Negest Elene Mohammed Memorial
Hospital, SNNPR, Ethiopia Variables Number Percent

A total of 327 women were involved in the study of which Primi-gravida 133 40.7
Gravidity (n=327)
259(79.2%) were in the age group of 20-34, followed by 50(15.3%) Multi-gravida 194 59.3
between 35-49 years with mean age of 32 years and SD of 5.54. Majority <=23 48 24.7
of the mothers 322(98.5%) were married, and 192(58.7%) were urban Inter-pregnancy interval (n=164) 24-59 130 67
residents. Regarding educational status, majority, 165(50.5%) had >=60 16 8.3
elementary school education, while 88(26.9%) secondary school and Wanted 265 81
Pregnancy status (n=327)
above. One hundred and eighty one (55.5%) mothers were followers Unwanted 62 19
of Protestants and 71(21.7%) were Orthodox Christians. Ethnically, Yes 274 83.8
ANC follow up (n=327)
majority 229(70%) were Hadiya, 39(11.9%) Silte and 28(8.6%) No 53 16.2
Kambata. Most of the respondents 195(56.9%) were housewives First trimester' 119 43.4
(Table 1). Second
First ANC visit (n=274) 115 42
trimester
The obstetric characteristics of women attended maternity Third trimester 40 14.6
ward at Negest Elene Mohammed Memorial Hospital, SNNPR <4 112 40.9
State, Ethiopia Number of ANC visits (n=274)
4 and above 162 59.1
Among the study participants, 194(59.3%) were multi-gravidas, Yes 226 82.5
Iron/Folic acid supplementation
100(61%) had 24-59 months inter pregnancy interval, and 274(83.8%) No 48 17.5
of the pregnancy was wanted. 274(83.8%) had antenatal care follow up Duration of Iron/Folic acid <3 months 152 67.3
and 226(69.1%) ha iron and folic acid supplement (Table 2). supplement (n=226) >= 3 months 74 32.7
Live birth 178 91.8
Pregnancy and labour related problems among women Still birth 6 3.1
Pervious perinatal outcomes
attended maternity ward at Negest Elene Mohammed (n=194) Abortion 3 1.5
Memorial Hospital, SNNPR, Ethiopia Others* 7 3.6
Sixty three (19.3%) mothers encountered complications during SVD 178 91.8
recent pregnancy, comprising of PIH 20(31.7%) followed by Mode of delivery in preceding caesarean
10 5.2
APH 17(27%). Among all deliveries 68(20.8%) had experienced Pregnancy(n=194) section
complications, among which 28(41.1%) were prolonged labor followed Others** 6 3
by malposition/ mal presentation 23(26.7%) and obstructed labor *Neonatal death **Destructive delivery and instrumental delivery
11(16.2%). Two hundred fifty (76.5%) of current deliveries were IPI classified based on WHO recommendation
spontaneous vaginal deliveries followed by caesarean section (CS) Table 2: Obstetric related characteristics of mothers attended maternity ward at
46(14.1%) (Tables 3 and 4). Negest Eleni Mohammed Memorial Hospital, SNNPR, Ethiopia.

J Women’s Health Care, an open access journal Volume 5 • Issue 4 • 1000324

ISSN: 2167-0420
Citation: Abdo RA, Endalemaw TB, Tesso FY (2016) Prevalence and associated Factors of Adverse Birth Outcomes among Women Attended
Maternity Ward at Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR, Ethiopia. J Women’s Health Care 5:
324. doi: 10.4172/2167-0420.1000324

Page 4 of 5

Variables Number Percent encountered adverse birth outcomes three times more than those
Yes 63 19.3 lived in urban area, [AOR=3.5, 95% CI(1.57, 7.93)]. Mothers who
Current pregnancy complications
No 264 80.7 didn’t attend antenatal care were 3 times more likely to have adverse
PIH 22 34.9 birth outcome when compared to those who attended antenatal care
Type of complication during pregnancy PROM 18 28.6 follow up, [AOR=3.2, 95% CI(1.27, 8.06)]. Similarly, mothers with
(n=63) APH 19 30.2 hemoglobin level less than 11 mg/dl were encountered adverse birth
Others 4 6.3 outcomes 2 times more when compared to those with hemoglobin
Yes 68 20.8 level greater or equal to 11 mg/dl [AOR=2.5, 95% CI(1.11, 5.45)].
Complications of labor(n=327)
No 259 79.2 Mothers whose occupation was governmental employees were found
Prolonged Labor 30 44.1 5 times more likely to have adverse birth outcomes [AOR=4.5, 95%
Malposition 21 30.9 CI(1.25, 15.9)] when compared to house wife. The presence of any form
Type of labor complications(n=68)
Obstructed Labor 13 19.1 of pregnancy complication to current pregnancy were 4 times more
Others 4 5.9 likely to result in adverse birth outcomes [AOR=4.5, 95% CI(1.25,
Spontaneous 308 94.2 15.9)]. Furthermore, clients with malaria infection during pregnancy
Status of labor (n=327) were eight times more likely to have adverse birth outcomes than their
Induced 19 5.8
SVD 250 76.5 counterparts times [AOR=8.6, 95% CI(2.6, 22.62)] as well, maternal
Caesarean section 46 14 age less than 20 years were 5 times more likely to have adverse birth
Mode of delivery (n=327)
Instrumental outcomes when compared to mothers with age between 20 and 34 years
31 9.5
delivery of age (Table 6).
Table 3: Pregnancy and labour related problems among women who attended
maternity ward at Negest Elene Mohammed memorial Hospital, SNNPR, Ethiopia. Discussion
The finding of the study showed that the prevalence of adverse
Variable Number Percent
birth outcome was 80(24.5%) among which 28(8.6%) were still birth,
Yes 21 6.4
Medical Illness 28(9.4%) preterm and 32(10.7%) were low birth weight. These figures
No 306 93.6
were higher than the findings of Tanzania [14], and Ghana [15], in
Hypertension 7 33.3
Types of medical illness HIV 9 42.9
Variables Number Percentage
TB 5 23.8
Still birth 28 8.6
Yes 30 9.2 Status of newborn baby at birth
Malaria infection Live birth 299 91.4
No 297 90.8
2500-4500 g 267 89.3
<11 gm/dl 58 17.7 Birth weight of live babies
Hgb <2500 g 32 10.7
>=11 gm/dl 269 82.3
38-42 weeks 271 90.6
Never 28 8.6 Gestational age
<=37 weeks 28 9.4
Daily 229 70
Caffeine use Yes 6 1.8
Weekly 23 7 Visible birth defect
No 321 98.2
Occasionally 47 14.4
Table 5: Adverse birth outcomes among women who attended maternity ward at
Never 304 93
Negest Elene Mohammed Memorial Hospital, SNNPR, Ethiopia.
Daily 2 0.6
Alcohol
Weekly 6 1.8 Adverse
Occasionally 15 4.6 birth
Variables outcome COR(95% CI) AOR (95% CI)
Table 4: Medical and behavioral factors among women who attended maternity Yes No
ward at Negest Elene Mohammed memorial hospital, SNNPR, Ethiopia.
Urban 27 165 1 1
Residence
The adverse birth outcomes among women attended Rural 53 82 4.3(2.481, 7.550) 3.5(1.57, 7.3)*
maternity ward at Negest Elene Mohammed Memorial <20 7 11 2.48(0.91, 6.6) 4.9 (1.29, 18.6)*
Hospital, SNNPR, Ethiopia Age 20-34 53 226 1 1
>=35 6 24 2.68 (1.32, 5.45) 0.99 (.3.6, 2.77)
The study finding showed that the prevalence of adverse birth House wife 42 153 1 1
outcome among the study participants was 80(24.5%). Out of 327 births Occupation Private Job 28 59 1.73 (.98, 3.04) 2.6 (1.18, 5.75)*
28(8.6%) were still birth, 32(9.8%) were LBW, 28(8.6%) preterm and Employed 10 35 1.04(.47, 2.27) 4.5(1.25, 15.9)*
6(1.8%) were with visible birth defects. Among babies with congenital Illiterate 27 47 1 1
malformations four were still births. The mean plus SD birth weight Education Primary 34 131 0.47(.25, .91) 0.44 (.173, 1.12)
of the neonates was 3171 ± 523 grams with 95% CI(3111, 3230.44). >= Secondary 19 69 0.263(.24, 1.012) 0.51(.16, 1.65)
The mean gestational age was 38.38 ± 2 weeks with 95% CI(38.17, Yes 55 219 1 1
ANC
38.60) (Table 5). No 25 28 3.89(2.03, 7.44) 2.5(1.1, 5.45)*
<11 gm/dl 26 32 2.36 (1.26, 4.4) 2.5(1.1, 5.45)*
Factors associated with adverse birth outcomes among women Hgb
>=11 gm/dl 51 218 1 1
who attended maternity ward at Negest Elene Mohammed
Memorial Hospital, SNNPR, Ethiopia *Significant at p<0.05

Table 6: Factors associated with adverse birth outcomes among women attended
The study finding showed that mothers who lived in rural area maternity ward at Negest Elene Mohammed Memorial Hospital, SNNPR, Ethiopia.

J Women’s Health Care, an open access journal Volume 5 • Issue 4 • 1000324

ISSN: 2167-0420
Citation: Abdo RA, Endalemaw TB, Tesso FY (2016) Prevalence and associated Factors of Adverse Birth Outcomes among Women Attended
Maternity Ward at Negest Elene Mohammed Memorial General Hospital in Hosanna Town, SNNPR, Ethiopia. J Women’s Health Care 5:
324. doi: 10.4172/2167-0420.1000324

Page 5 of 5

which 18%, 19% had experienced adverse birth outcomes respectively. of results as well as drafting and review of the manuscript. Tesso FY- Participated
in conceptualization and design of the study, drafting and critical reviewing the
The variations between the findings may be attributable to variations in
manuscript. All authors read and approved the final manuscript.
quality of maternal health services, facility and logistic parameters in
respective study areas. Acknowledgement
Our acknowledgment goes to Jimma University, College of Health Sciences
Clients with pregnancy complications (pregnancy induced for funding this research project. We extend our gratitude to Negest Elene
hypertension, Antepartum hemorrhage, premature rupture of fetal Mohammed Memorial General Hospital authorities, supervisors, data collectors,
membranes, oligohydramnios and poly hydramnios and hyper emesis and respondents who participated on this study.
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Conflict of Interest
The authors declare that they don’t have any conflict of interest in any aspect
of the article.

Authors’ Contributions
AbdoRA-The principal investigator designed the study, collected, analyzed
and interpreted the data, and also drafted the manuscript. Endalemaw TB-
Participated in conceptualization of the study, design, analyses and interpretation

J Women’s Health Care, an open access journal Volume 5 • Issue 4 • 1000324

ISSN: 2167-0420

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