Socio-demographic characteristics
A total of 363 women were interviewed with a respondent rate of 98.4%. Among interviewed 232(63.9%) pregnant and 131(36.1%) were delivered mothers in the past one year before the study period. The mean age of the respondent was 27.33 (S.D, ±5.8: CI, 26.73-27.94) years Half of the respondents were Orthodox 183 (50.4%) followed by Muslim129 (36. 1%). The majority 313 (86.2%) of the respondent were illiterate and the majority of the women were housewives 271 (74.7%) (Table 1). There were three major themes to summarize qualitative data. Theme one Knowledge, perceptions, experiences about obstetric danger signs, these two healthcare-seeking practices, and theme three factors/barriers/ that affecting appropriate health care seeking action.
Bivariate analysis was conducted and variables with significance level 0.2 and less were moved to multivariate analysis. Based on this criteria Age less than 25 years, deciding on maternal own health care alone, inability to judge the severity of graveness, having ANC follow up, knowing obstetric danger sign, maternal perception of unavailability of drug and equipment were showed significant association with healthcare-seeking behavior and entered to multivariate logistic regression to control confounding variable. According to qualitative data; among interviewed most mother, Keble leader and religious leader were stated only some commonly known obstetric danger signs these are postpartum bleeding, obstructed labor, and weakness of mother.
One mother stated that “… Is obvious that every pregnancy has its discomfort or sickness. This is not happening today our grandparents also facing …so this problem is relieved after delivery”. when she explained about health-seeking practice in the area.
Of respondents 62(17.1%) were knowledgeable. The most commonly mentioned danger signs severe bleeding during delivery 217(11.2%), retained placenta 174(9.0%), and obstructed labor 150(7.8%) (Table 2).
Around 61.7% of participants were primigravida and 60.1% of the participants had Antenatal care contact but 39.4 % of women delivered at home (Table 3)
Factors Associated with Health seeking Behavior
In multivariate analysis, our study showed that the following factors are determinants of the outcome variable. Deciding on maternal health outcome, having an Antenatal care visit, knowledge about obstetric danger signs, failure to estimate or judge the severity of the conditions are some of the identified factors (Table 4)
In the adjusted model, women who have ANC follow were 1.7 times (AOR=1.735, 95%CI, 1.107-2.721) more likely to have appropriate health care action than those who have no ANC follow up.
Another participant in an in-depth interview said “I think Having Antenatal care follow up is the basis for seeking health care and visiting for the general health status of a pregnant mother”
Women who are aware of the obstetric danger signs were 2.4 times (AOR = 2.430, 95% CI: 1.360-4.342)) more likely to health care seeking behavior than those who are unaware of the signs of obstetric hazard. This idea was supported by the qualitative study, as another woman stated that “if she knows danger sign, why is she not willing to go to the health center? In my opinion, there is a lot of information gaps, for example, there are mothers who do not even have a radio in our area "
Among women who can’t able to judge the graveness of conditions were 49% (AOR=0.509, 95% CI: (0.302-0.859) less likely to have appropriate health care action than those who can able to judge the graveness or bad outcome of conditions. “…Some of the women believe that pregnancy is a normal natural process and their parents were not delivered at the hospital and even mother was bleeding they were not bothered by considering as normal. These practices are harmful to mothers and newborns. But Many mothers are careless about the problem…” (A 32-year-old mother from tere Keble).
Women who can decide alone for their health care were 2.5 times (AOR=2.514, 95% CI: (1.130-5.591) more likely to have appropriate health care seeking than those who can’t decide
Belief and cultural factors were identified by an in-depth interview. Guard spirit/wuqabi/ and movement restriction of the postpartum mother out of home were commonly practiced in the study area. “I have a spirit (wuqabi) which is confiscated from my grandmother...Nowadays my wuqabi makes me too sick and aborting repeatedly. I am recently aborted at five-month gestation. During aborting I was excessively bleeding and saved my life at a private hospital. Wuqabi dislikes treatment and physical examination in hospital…. Generally, I am under its control and can’t go to the hospital for ANC follow-up and delivery” (witness of a 36 years old mother).