Sex Disparities: Couple’s Knowledge and Attitude Towards Obstetric Danger Signs and Maternal Health Care: in Rural Jimma Zone of Ethiopia

Figures & data

Figure 1 Schematic presentation of participants’ selection in Jimma rural Zonal district.

Table 1 Background Characteristics of the Study Participants in Rural Jimma, Ethiopia

Variables	Category	Female		Male
		Frequency	%	Frequency	%
Age	15–25	1276	40.6	262	8.3
	26–35	1514	48.3	1388	43.7
	36–49 (45)	350	11.1	1125	35.4
	≥46			399	12.6
	Total	3140	100	3174	100
Ethnicity	Oromo	3046	94.2	3033	93.8
	Amhara	57	1.8	56	1.7
	yem	51	1.6	58	1.8
	Dawro	23	0.7	24	0.7
	Kefa	28	0.9	28	0.9
	Other	30	0.9	36	1.1
	Total	3235	100	3235	100
Education	No education	1800	55.6	1413	43.7
	Primary	1279	39.5	1546	47.8
	Secondary	134	4.1	230	7.1
	Higher	22	0.7	46	1.4
	Total	3235	100	3235	100
Occupation	House wife	2536	78.4
	Farmer	483	14.9	2749	85.0
	Merchant	193	6.0	453	14.0
	Government	23	0.7	33	1.0
	Total	3235	100	3235	100
Annual Income	≥10,000	2266	70.0	2266	70.0
	10,001–20,000	590	18.2	590	18.2
	20,001–30,000	119	3.7	119	3.7
	≥31.000	260	8.0	260	8.0
	Total	3235	100	3235	100
Literacy level	Able to read whole	714	22.0	1117	34.5
	Able to read part	387	12/0	611	18.9
	Cannot read all	2134	66.0	1507	46.6
	Total	3235	100	3235	100
Time to health facility	<=30 minutes	2467	79.6	2496	80.5
	≥30 minutes	633	20.4	605	19.5
	Total	3100	100	3101	100
Health facility evaluation	Good	589	19.0	770	24.8
	Not good	2511	81.0	2331	75.2
	Total	3100	100	3101	100
Own mobile	Yes	184	5.7	1724	53.3
	No	3051	94.3	1511	46.7
	Total	3235	100	3235	100
Listening radio	Not at all	1447	44.7	907	28.0
	Once/week	878	27.1	918	28.4
	More than one/week	910	28.1	1410	43.6
	Total	3235	100	3235	100

Notes: NB: 36–49(45); 49 in the age category indicate the maximum age of female and 45 is the age category of men in the cell.

Table 2 Sex-Disparity Obstetrics Danger Signs Knowledge in Maternal Health Care

Danger Signs	Female		Male
	Yes (3235)	(%)	Yes (3235)	%
Obstetric danger sign knowledge during pregnancy
Sever weakness	1318	40.7	1438	44.5
Vomiting	1205	46.3	957	29.6
Headache	1206	37.3	1036	32.0
Abdominal problem/Distention	852	26.3	958	29.6
Blurred vision	888	27.4	713	22.0
Bleeding	742	22.9	617	19.1
Swelling	322	10.0	339	10.5
Fetal movement problem	241	7.4	225	7.0
Fit (convulsion)	199	6.2	213	6.6
Difficulty of breathing	134	4.1	163	5.0
Faint	141	4.4	187	5.8
Water break (PROM)	111	3.4	95	2.9
Fever	354	10.9	274	8.5
Obstetric danger sign knowledge during childbirth
Labour >12 h	2319	72.1	1980	61.2
Vaginal bleeding	1555	48.1	1387	42.9
Placenta not delivered 30 min after birth	1051	32.5	1025	31.7
Severe headache	498	18.8	398	14.6
Loss of consciousness	248	7.7	240	7.4
Blurred vision	258	8.0	228	7.0
Fit (Convulsion)	217	6.7	295	9.1
High fever	196	6.1	183	5.7
Obstetric danger sign knowledge during postnatal
Vaginal bleeding	1356	41.9	1088	33.6
Offensive vaginal discharge	188	5.8	300	9.3
Sever weakness	769	23.8	809	25.0
Fever	208	6.4	195	6.0
Severe headache	498	15.4	367	11.3
Body swelling	213	6.6	162	5.0
Fit/convulsion	220	6.8	87	2.7
Difficulty of breathing	153	4.7	134	4.1

Figure 2 Percentage of sex-disparity obstetric danger signs knowledge in the continuum of maternal health care (sample for female=3235 and sample for male=3235).

Table 3 Sex Disparity Multivariate Analysis of Attitude on Maternal Health Care

Sex	Variables Category	Maternal Health Care Attitude		AOR	(95% CI)
		Positive	Negative
Male occupation	Farmer	1393	1356
	Trader	199	254
	Govn’t	20	13
Female occupation	House wife	1203	1333	1	1
	Farmer	276	207	1.32	(1.05–1.65)*
	Trader	69	124	0.77	(0.56–1.08)
	Govn’t	6	17	0.80	(0.30–2.15)
Male HH annual income	<=10,000	1122	1144	1	1
	10,001–20,000	285	305	0.97	(0.80–1.17)
	20,001–30,000	47	72	0.69	(0.46–1.04)
	≥30,001	158	102	1.69	(1.28–2.23)**
Female annual income	<=10,000	1100	1166
	10,001–20,000	261	329
	20,001–30,000	56	63
	≥30,001	137	123
Literacy level of male	Not read all	1011	496
	Read partly	389	222
	Read all	855	262
Literacy level of female	Not read all	1460	674	1	1
	Read partly	274	113	0.51	(0.40–0.64)**
	Read all	584	130	0.93	(0.72–1.21)
Time to health facility by male	<=30min	1197	1299	1	1
	≥31min	333	272	1.28	(1.06–1.55)*
Time taken to health facility by female	<=30min	1124	1343	1	1
	≥31min	343	290	1.23	(1.01–1.48)*
Male listen radio	Not at all	667	240	1	1
	Once per week	612	305	1.30	(1.06–1.58)*
	More than once per week	1039	371	1.14	(0.95–1.37)
Female listen radio	Not at all	1045	402	1	1
	Once per week	592	286	1.34	(1.11–1.62)**
	More than once per week	681	229	1.15	(0.95–1.39)
Male health facility evaluative	Not good	1058	1273	1	1
	Good	472	298	1.93	(1.63–2.29)**
Female health facility evaluative	Not good	1102	1409	1	1
	Good	365	224	1.99	(1.63–2.42)**
Male danger sign knowledge during pregnancy	Poor	743	722
	Good	869	901
Female danger sign knowledge during pregnancy	Poor	661	595	1	1
	Good	893	1086	0.75	(0.63–0.89)*
Male danger sign knowledge during labor	Poor	1104	1153	1	1
	Good	508	470	1.25	(1.06–1.48)*
Female danger sign knowledge during labor	Poor	1034	1143	1	1
	Good	520	538	1.26	(1.06–1.49)*
Male danger sign knowledge during postnatal	Poor	1223	1110	1	1
	Good	389	513	0.70	(0.59–0.83)**
Female danger sign knowledge during postnatal	Poor	1171	1073	1	1
	Good	383	608	0.63	(0.53–0.75)**
ANC last pregnancy	No	322	150	1	1
	Yes	1232	1531	0.66	(0.52–0.83)**
Place of delivery	Home	702	1008	1	1
	Health facility	852	673	1.81	(1.54–2.13)**
Postnatal first 2 hours	No	1056	906	1	1
	Yes	498	775	0.63	(0.53–0.75)**

Note: *P<0.05, **P<0.02.

Table 4 Multivariate Logistic Regression of Obstetric Danger Signs Knowledge in Maternal Health Care

	Variable Category	Danger Sign Knowledge During Pregnancy		AOR,(95% CI) P-value	Danger Sign Knowledge During Delivery		AOR,(95% CI), P-value	Danger Sign Knowledge During Postnatal		AOR, (95% CI) P-value
		Poor	Good		Poor	Good		Poor	Good
Male age	15–25	133	129		196	66		189	73
	26–35	604	784		959	429		973	415
	36–45	515	609		792	333		841	284
	≥46	189	210		273	126		274	125
Female age	15–25	529	747	1	881	395	1	898	378
	26–35	558	956	1.27(1.07–1.51)** 0.005	995	519	1.30(1.09–1.57)*.004	1037	477
	36–49	123	222	1.31(1.00–1.71)*.045	237	113	1.09(0,83–1.45))	240	110
Male education	No education	691	722	1	1039	374	1	1082	331	1
	Primary	680	866	1.11(0.95–1.31)	1051	495	1.35(1.02–1.79)*.035	1091	455	1.30(1.10–1.55)***.002
	Secondary	84	146	1.47(1.07–2.00)*.015	143	87	2.00(1.33–3.01)*.001	138	92	2.06(1.52–2.79)***.000
	Higher	10	36	2.93(1.39–6.17)**.004	24	22	2.74(1.38–5.40)**004	22	24	3.18(1.74–5.81)***.000
Female education	No education	719	1080		1261	539	1	1279	521
	Primary	484	795		826	453	1.31(1.09–1.57)**.003	862	417
	Secondary	47	87		79	55	1.66(1.11–2.48)*.013	92	42
	Higher	6	15		11	11	1.90(0.56–6.40)	11	11
Male occupation	Farmer	1268	1481		1939	810		1983	766
	Trader	185	268		296	157		323	130
	Government	12	21		22	11		27	6
Female occupation	House wife	1031	1505	1	1773	763	1	1807	729	1
	Farmer	153	330	1.75 (1.38–2.21)***.000	278	205	2.10(1.68–2.63)***.000	314	169	1.40(1.12–1.75)**.003
	Trader	68	125	1.30(0.93–1.81)	115	78	1.62(1.18–2.23)**.003	113	80	1.71(1.25–2.35)***.001
	Gover’t	4	19	3.16(1.01–9.86)*.048	11	12	2.29(0.71–7.37)	10	13	3.29(1.32–8.17)**.010
Male HH Annual income	<=10,000	1043	1223	1	1591	675	1	1645	621
	10,001–20,000	242	348	1.12(0.92–1.36)	399	191	1.03(0.84–1.27)	411	179
	20,001–30,000	33	86	1.77(1.16–2.70)*.008	71	48	1.39(0.93–2.08)	79	40
	≥30,001	147	113	0.56(0.43–0.74)*.000	196	64	0.67(0.49–0.92)*.015	198	62
Female annual income	<=10,000	941	1325	1	1551	715	1	1586	680	1
	10,001–20,000	160	430	1.73(1.40–2.14)***.000	368	222	1.22(1.00–1.49)**.047	379	211	1.31(1.07–1.50)**.007
	20,001–30,000	26	93	2.23(1.40–3.54)**.001	61	58	1.79(1.20–2.65)**.004	71	48	1.42(0.95–2.22)
	≥30,001	129	131	0.68(0.51–0.90)*.007	197	63	0.58(0.42–0.81)*.001	208	52	0.53(0.38–0.75)***.001
Male own mobile	No	743	768	1	1095	416		1134	377
	Yes	722	1002	1.17(1.00–1.38)*.048	1162	562		1199	525
Female own mobile	No	1175	1876	1	2050	1001	1	2112	939	1
	Yes	81	103	0.57(0.40–0.80)**.001	127	57	0.64(0.44–0.92)*.019	132	52	0.66(0.46–0.95*.029)
Literacy level of male	Not read all	723	784		1093	414		1151	356
	Read partly	256	355		398	213		443	168
	Read all	486	631		766	351		739	378
Literacy level of female	Not read all	861	1273	1	1488	646		1516	618	1
	Read partly	146	241	1.35(1.01–1.79)*.038	238	149		273	114	1.32(1.08–1.61)*.006
	Read all	249	465	1.16(0.85–1.57)	451	263		455	259	1.01(0.79–1.31)
Time to health facility/ Male	<=30min	1129	1367		1740	756		1771	725
	≥31min	277	328		425	180		457	148
Time to reach to health facility/ Female	<=30min	929	1538		1646	821		1658	809	1
	≥31min	250	383		437	196		478	155	0.68(0.55–0.83)***.000
Listen radio/Male	Not at all	393	514	1	658	249	1	672	235	1
	Once per week	326	591	1.36(1.12–1.65)**.002	579	338	1.58(1.27–1.96)***.000	601	316	1.50(1.20–1.86)***.000
	More than once per week	536	874	1.23(1.02–1.48)*.029	939	471	1.45(1.18–1.78)**.003	970	440	1.17(0.95–1.43)
Listen radio/Female	Not at all	642	805	1	1059	388	1	1041	406	1
	Once per week	288	590	1.61(1.33–1.94)***.000	546	332	1.62(1.34–1.97)***.000	558	320	1.40(1.15–1.69)**.001
	More than once per week	326	584	1.24(1.02–1.50)*.027	572	338	1.41(1.16–1.72)***.000	645	265	0.88(0.72–1.08)
Health facility evaluative/Male	Not good	1090	1241	1	1646	685		1670	661
	Good	316	454	1.24(1.05–1.47)*.010	519	251		558	212
Health facility evaluative/Female	Not good	1013	1498	1	1746	765	1	1738	773
	Good	166	423	1.67(1.36–2.05)**.001	337	252	1.75(1.44–2.12)***.000	398	191

Note: *P<0.05, **P<0.02, ***P<0.01.

Table 5 Association of Obstetric Danger Sign Knowledge in the Continuum of Maternal Health Care and Maternal Health Care Service Utilization

KNOWLEDGE	Category	Women Used ANC in Last Pregnancy N=3235 (%)	AOR (95% CI) P-value	Women Gave Birth in the Health Facility N=3235 (%)	AOR (95% CI) P-value	Women Received Postnatal care with in 48 hrs N=3235 (%)	AOR (95% CI) P-value
Female danger sign knowledge during pregnancy	Poor	1019(36.9)	1	552(36.2)	1	416(32.7)	1
	Good	1744(63.1)	1.44(1.16–1.78).001***	973(63.8)	1.26(1.08–1.47).003**	857(67.3)	1.43(1.22–1.68).000***
Male danger sign knowledge during pregnancy	Poor	1216(44.0)	1	653(42.8)	1	514(40.4)	1
	Good	1547(56.0)	1.32(1.07–1.62).008*	872(57.2)	1.13(0.97–1.31).095	759(59.6)	1.34(1.15–1.55).000***
Female danger sign knowledge during labor and delivery	Poor	1827(66.1)	1	1039(68.1)	1	782(61.4)	1
	Good	936(33.9)	1.19(0.94–1.50).136	486(31.9)	0.86(0.73–1.00).057	491(38.6)	1.41(1.21–1.65).000***
Male danger sign knowledge during labor and delivery	Poor	1914(69.3)	1	1037(68.0)	1	856(67.2)	1
	Good	849(30.7)	1.00(0.80–1.26).953	488(32.0)	1.08(0.92–1.26).336	417(32.8)	1.10(0.94–1.29).215
Female danger sign knowledge during postnatal care	Poor	1865(67.5)	1	1042(68.3)	1	863(67.8)	1
	Good	898(32.5)	1.67(1.29–2.15).000***	483(31.7)	1.04(0.89–1.22).557	410(32.2)	1.10(0.79–1.10).421
Male danger sign knowledge during postnatal care	Poor	1958(70.9)	1	1055(69.2)	1	896(70.4%)	1
	Good	805(29.1)	1.48(1.16–1.89).002**	470(30.8)	1.26(1.07–1.47).005**	377(29.6)	1.10(0.89–1.23).533

Note: *P<0.05, **P<0.02, ***P<0.01.

Data Sharing Statement

All relevant data are within the paper and in the supporting information file.