Study design
A community-based cross-sectional study design was used.
Study area and period
This study was conducted in Awi, East, and West Gojjam zones (Debre Markos University research catchment areas) from February 1 to May 30, 2020.
East Gojjam zone: Debre Markos is its administrative center with a total population of 2,153,937 and 506,520 households who are distributed in 22 woredas and 480 Kebeles. There are 10 hospitals, 102 health centers, and 423 health posts in this Zone. Awi zone: Injibara is its administrative center and has a total population of 982,942 and 215,564 households. West Gojjam zone: West Gojjam zone: Finoteselam is its administrative center with total population of 2,106,596, of whom 1,058,272 men and 1,048,324 women [21].
Source population
All women who had at least one history of delivery in Awi, East and West Gojjam Zones, Amhara Region, North West Ethiopia.
Study population
All women who had at least one history of delivery in randomly selected Kebeles of Awi, East and West Gojjam Zones, Amhara Region, Northwest Ethiopia.
Inclusion and exclusion criteria
Inclusion criteria
All women who had experienced at least one delivery and available during the data collection period were included in the study.
Exclusion criteria
Women who were severely ill that could not communicate verbally and those who were not lived at least for six months in the study area during the data collection period were excluded from the study.
Sample size determination and sampling procedure
Sample size determination
The sample size was determined based on a single population proportion formula assumption. Using the prevalence of cultural malpractices from the study done in Meshenti town [17], west Gojjam, Amhara region, Ethiopia which is 50.9% with 5% confidence limit (margin of error) and 95% confidence interval.
$$\boldsymbol{n}={(\boldsymbol{Z}\frac{\boldsymbol{a}}{2})}^{2}\boldsymbol{*}\frac{\boldsymbol{p}(1-\boldsymbol{p})}{\boldsymbol{w}2}={1.96}^{2}\mathrm{*}\frac{0.509(1-0.509)}{({0.05)}^{2}}=384$$
where: n is the sample size.
Zα/2: with 95% confidence interval equal to 1.96.
p: estimation of cultural malpractice which is 50.9%
w: margin of error which is 1 − confidence level = 1–0.95 = 0.05.
Since it has two stages, we take a design effect of 2 and the sample size was 384*2 = 768. By considering a 10% non-response rate, the estimated number of non-response participants was 768*0.10 = 77.
Therefore, the minimum sample size for this study was 768 + 77 = 845.
Sampling procedure
A multistage cluster sampling technique was used. Twelve (12) Woredas were selected by using the lottery method from the three zones and cluster sampling was again employed after proportionally allocate the total sample size (845) to the selected kebeles of each woreda (Fig. 1).
Study variables
Dependent
Cultural malpractices during labor and delivery.
Independent
Age, Education status, Marital status, Residence, Religion, Ethnicity, Income, Occupation.
History of abortion, ANC follow-up, Heath care-seeking, decision-maker, caregiver for home delivery.
Operational definitions
Labor: a continuous process in which progressive uterine contraction results in the expulsion of the product of conception from the uterus through the birth canal after progressive effacement and dilatation of the cervix after viability of the fetus or after 28 weeks of gestation [22, 23].
Delivery: The release of the fetus and other products of conceptus from the uterus either vaginally or abdominally after viability of the fetus or after 28 weeks of gestation [22, 23].
Cultural practices: Experiences or beliefs that are socially shared views and behaviors practiced in a certain society at a certain time [2].
Cultural malpractice: Any cultural practice that can lead to an injurious, negligent, or improper practice which is accepted by a certain community [24].
Home Delivery: Child birth at home with culturally acceptable ceremonies by unskilled attendants [25]
Food taboo: Prohibitions of some foods for a certain occasions like pregnancy, labor/delivery or any others due to cultural and religious influences [26].
Abdominal massage: Hand-based downward rubbing of the pregnant woman's abdomen to shorten the labor duration and alleviating pain by using lubricants commonly butter [18].
Data quality control
To assure the data quality, the data collection tool was pretested to check its clarity, and training was given for data collectors and supervisors regarding the objectives of the study, data collection method, and the significance of the study. Daily communication was conducted among data collectors, supervisors, and principal investigators for discussion regarding presenting difficulties and to assess the progress of data collection. Collected data was checked for completeness and on spot corrective measures were taken by data collectors and supervisors.
Data processing and analysis
All collected questionnaires were rechecked for completeness and coded. Then these data were entered and cleaned using Epi Info 7.2 software and exported to SPSS version 23 for analysis. Bivariable logistic regression was employed to identify an association, and a multivariable logistic regression model was used to control the effect of confounders.
Variables having P-value less than 0.05 in the Bivariable analysis were fitted into the multivariable logistic regression model. Ninety-five percent confidence interval of odds ratio was computed and a variable having P-value less than 0.05 in the multivariable logistic regression analysis was considered to declare statistical significance.
Before the actual logistic regression analysis was done, the necessary assumption of the logistic regression model was checked by using the Hosmer–Lemeshow test of goodness of fit which has a chi-square distribution.
For further analysis, descriptive statistics like frequencies and cross-tabulation were performed. Graphical presentations such as bar charts and pie charts were used to present the result findings of the study in addition to texts and tables.