Traditional Ethiopian Coffee Ceremony in a Rural Ethiopian Hospital to Increase Hospital-Based Delivery Rates: A Randomized Controlled Trial
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Published
Feb 1, 2021
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Abstract
Abstract
Word count: 250
Background
Ethiopia has an estimated maternal mortality ratio of 353 per 100,000 live births. In an effort to improve acceptability of hospital-based deliveries, health facilities have adopted traditional practices in the labor ward. We hypothesized that offering postpartum coffee ceremonies to antenatal care patients would increase the hospital-based delivery rate.
Trial design
Non-blinded randomized controlled trial
Methods
From April to June 2015, pregnant patients presenting for their first antenatal care visit were block-randomized per day to receive a postpartum coffee ceremony, compared to not receiving coffee postpartum. The primary outcome was presentation for delivery at Gambo Hospital.
Results
254 Patients were randomized to the ceremony group and 185 to the no-ceremony group. There was no significant difference in hospital-based delivery rates between the randomized groups (32.1% versus 31.7%; relative risk 1.01; 95% CI, 0.76 to 1.35). Results were likely compromised by patients’ misunderstanding of the randomization process. 12.7% of patients self-reported that the postpartum coffee ceremony served as motivation to deliver in the hospital. Hospital delivery was positively associated with shorter travel time, higher education grade, and previous delivery at a health-facility. It was negatively associated with previous home delivery and a higher number of antenatal care visits.
Conclusions
The likely flawed randomization process undercuts our ability to draw conclusions about the effect of this sociocultural intervention on the observed hospital-based delivery increase. This study exemplifies the difficulty of applying conventional research concepts to sociocultural interventions, especially in a setting of low educational levels, language barriers, and limited research capacity.
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Keywords
References
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18. Yousuf J, Ayalew M, Seid F. Maternal health beliefs, attitudes and practices among Ethiopian Afar. Exchange. 2011;1:12-3.
19. Bedford J, Gandhi M, Admassu M, Girma A. ‘A normal delivery takes place at home’: a qualitative study of the location of childbirth in rural Ethiopia. Maternal and child health journal. 2013;17(2):230-9.
20. Kaba M, Bulto T, Tafesse Z, Lingerh W, Ali I. Sociocultural determinants of home delivery in Ethiopia: a qualitative study. Int J Womens Health. 2016;8:93-102. Epub 2016/04/27. doi: 10.2147/ijwh.S98722. PubMed PMID: 27114718; PubMed Central PMCID: PMCPMC4833377.
21. Yedes J, Clamons R, Osman A. Buna: Oromo women gathering for coffee. Journal of Contemporary Ethnography. 2004;33(6):675-703.
22. Wayessa BS. Buna Qalaa: A Quest for Traditional Uses of Coffee among Oromo People with Special Emphasis on Wallaga, Ethiopia. African Diaspora Archaeology Newsletter. 2011;14(3):3.
23. Kumsa A, Tura G, Nigusse A, Kebede G. Satisfaction with emergency obstetric and new born care services among clients using public health facilities in Jimma Zone, Oromia Regional State, Ethiopia; a cross sectional study. BMC Pregnancy Childbirth. 2016;16:85. Epub 2016/04/27. doi: 10.1186/s12884-016-0877-0. PubMed PMID: 27113573; PubMed Central PMCID: PMCPMC4843201.
24. de Fouw M, Kaba M, Hailu M, Bereket FZ, Beltman JJ. Local community networks in the fight against cervical cancer: the role of coffee ceremonies in the uptake of screening in Ethiopia. Tropical doctor. 2019;49(4):298-300.
25. Esma’el J, Dolamo B, Bekele T, Kaso M. Community conversation experiences regarding HIV/AIDS awareness and beyond awareness in rural community of Ethiopia: A qualitative study. Family Medicine and Medical Science Research. 2015;4:168.
26. Jackson R, Tesfay FH, Gebrehiwot TG, Godefay H. Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia. Tropical Medicine & International Health. 2017;22(2):148-60.
27. Mirkuzie AH. Exploring inequities in skilled care at birth among migrant population in a metropolitan city Addis Ababa, Ethiopia; a qualitative study. International journal for equity in health. 2014;13(1):110.
28. Mehretie Adinew Y, Abera Assefa N, Mehretie Adinew Y. Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study. Biomed Res Int. 2018;2018:3249786. Epub 2018/08/17. doi: 10.1155/2018/3249786. PubMed PMID: 30112377; PubMed Central PMCID: PMCPMC6077686.
29. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11(1):32.
30. StataCorp. Stata Statistical Software. 15 ed. College Station, TX: Stata Corp LLC; 2017.
31. Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015;351:h4672. Epub 2015/09/06. doi: 10.1136/bmj.h4672. PubMed PMID: 26341898.
32. Amano A, Gebeyehu A, Birhanu Z. Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2012;12:105. Epub 2012/10/10. doi: 10.1186/1471-2393-12-105. PubMed PMID: 23043258; PubMed Central PMCID: PMCPMC3506545.
33. Wilunda C, Quaglio G, Putoto G, Takahashi R, Calia F, Abebe D, et al. Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study. Reprod Health. 2015;12:74. Epub 2015/10/04. doi: 10.1186/s12978-015-0067-y. PubMed PMID: 26432298; PubMed Central PMCID: PMCPMC4592558.
2. CSA/ICF. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia and Rockville, Maryland, USA: Central Statistical Agency (Ethiopia) and ICF International, 2017.
3. Godefay H, Byass P, Kinsman J, Mulugeta A. Understanding maternal mortality from top-down and bottom-up perspectives: Case of Tigray Region, Ethiopia. J Glob Health. 2015;5(1):010404. Epub 2015/02/13. doi: 10.7189/jogh.05.010404. PubMed PMID: 25674351; PubMed Central PMCID: PMCPMC4306295.
4. Tessema GA, Laurence CO, Melaku YA, Misganaw A, Woldie SA, Hiruye A, et al. Trends and causes of maternal mortality in Ethiopia during 1990-2013: findings from the Global Burden of Diseases study 2013. BMC Public Health. 2017;17(1):160. Epub 2017/02/06. doi: 10.1186/s12889-017-4071-8. PubMed PMID: 28152987; PubMed Central PMCID: PMCPMC5290608.
5. Yaya Y, Lindtjorn B. High maternal mortality in rural south-west Ethiopia: estimate by using the sisterhood method. BMC Pregnancy Childbirth. 2012;12:136. Epub 2012/11/28. doi: 10.1186/1471-2393-12-136. PubMed PMID: 23176124; PubMed Central PMCID: PMCPMC3534518.
6. Koblinsky MA, Campbell O, Heichelheim J. Organizing delivery care: what works for safe motherhood? Bulletin of the World Health Organization. 1999;77(5):399.
7. EPHI/ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Rockville, Maryland, USA: Ethiopian Public Health Institute (EPHI) and ICF, 2019.
8. Roro MA, Hassen EM, Lemma AM, Gebreyesus SH, Afework MF. Why do women not deliver in health facilities: a qualitative study of the community perspectives in south central Ethiopia? BMC Res Notes. 2014;7:556. Epub 2014/08/22. doi: 10.1186/1756-0500-7-556. PubMed PMID: 25143017; PubMed Central PMCID: PMCPMC4155096.
9. Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy Childbirth. 2013;13:5. Epub 2013/01/18. doi: 10.1186/1471-2393-13-5. PubMed PMID: 23324550; PubMed Central PMCID: PMCPMC3562506.
10. Tsegay Y, Gebrehiwot T, Goicolea I, Edin K, Lemma H, Sebastian MS. Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study. Int J Equity Health. 2013;12:30. Epub 2013/05/16. doi: 10.1186/1475-9276-12-30. PubMed PMID: 23672203; PubMed Central PMCID: PMCPMC3658893.
11. Warren C. Care seeking for maternal health: challenges remain for poor women. Ethiopian Journal of health development. 2010;24(1).
12. Worku AG, Yalew AW, Afework MF. Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC Int Health Hum Rights. 2013;13:20. Epub 2013/04/17. doi: 10.1186/1472-698X-13-20. PubMed PMID: 23587369; PubMed Central PMCID: PMCPMC3639034.
13. Worku AG, Yalew AW, Afework MF. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia. PLoS One. 2013;8(3):e60171. Epub 2013/04/05. doi: 10.1371/journal.pone.0060171. PubMed PMID: 23555915; PubMed Central PMCID: PMCPMC3610646.
14. Yebyo H, Alemayehu M, Kahsay A. Why do women deliver at home? Multilevel modeling of Ethiopian National Demographic and Health Survey data. PLoS One. 2015;10(4):e0124718. Epub 2015/04/16. doi: 10.1371/journal.pone.0124718. PubMed PMID: 25874886; PubMed Central PMCID: PMCPMC4398378.
15. King R, Jackson R, Dietsch E, Hailemariam A. Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia. Midwifery. 2015;31(5):540-6. Epub 2015/03/10. doi: 10.1016/j.midw.2015.02.004. PubMed PMID: 25745841.
16. Abera M, Gebremariam A, Belachew T. Predictors of safe delivery service utilization in arsi zone, South-East ethiopia. Ethiop J Health Sci. 2011;21(Suppl 1):95-106. Epub 2011/08/01. PubMed PMID: 24776809; PubMed Central PMCID: PMCPMC3275878.
17. Godefay H, Byass P, Graham WJ, Kinsman J, Mulugeta A. Risk Factors for Maternal Mortality in Rural Tigray, Northern Ethiopia: A Case-Control Study. PLoS One. 2015;10(12):e0144975. Epub 2015/12/19. doi: 10.1371/journal.pone.0144975. PubMed PMID: 26678047; PubMed Central PMCID: PMCPMC4683071.
18. Yousuf J, Ayalew M, Seid F. Maternal health beliefs, attitudes and practices among Ethiopian Afar. Exchange. 2011;1:12-3.
19. Bedford J, Gandhi M, Admassu M, Girma A. ‘A normal delivery takes place at home’: a qualitative study of the location of childbirth in rural Ethiopia. Maternal and child health journal. 2013;17(2):230-9.
20. Kaba M, Bulto T, Tafesse Z, Lingerh W, Ali I. Sociocultural determinants of home delivery in Ethiopia: a qualitative study. Int J Womens Health. 2016;8:93-102. Epub 2016/04/27. doi: 10.2147/ijwh.S98722. PubMed PMID: 27114718; PubMed Central PMCID: PMCPMC4833377.
21. Yedes J, Clamons R, Osman A. Buna: Oromo women gathering for coffee. Journal of Contemporary Ethnography. 2004;33(6):675-703.
22. Wayessa BS. Buna Qalaa: A Quest for Traditional Uses of Coffee among Oromo People with Special Emphasis on Wallaga, Ethiopia. African Diaspora Archaeology Newsletter. 2011;14(3):3.
23. Kumsa A, Tura G, Nigusse A, Kebede G. Satisfaction with emergency obstetric and new born care services among clients using public health facilities in Jimma Zone, Oromia Regional State, Ethiopia; a cross sectional study. BMC Pregnancy Childbirth. 2016;16:85. Epub 2016/04/27. doi: 10.1186/s12884-016-0877-0. PubMed PMID: 27113573; PubMed Central PMCID: PMCPMC4843201.
24. de Fouw M, Kaba M, Hailu M, Bereket FZ, Beltman JJ. Local community networks in the fight against cervical cancer: the role of coffee ceremonies in the uptake of screening in Ethiopia. Tropical doctor. 2019;49(4):298-300.
25. Esma’el J, Dolamo B, Bekele T, Kaso M. Community conversation experiences regarding HIV/AIDS awareness and beyond awareness in rural community of Ethiopia: A qualitative study. Family Medicine and Medical Science Research. 2015;4:168.
26. Jackson R, Tesfay FH, Gebrehiwot TG, Godefay H. Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia. Tropical Medicine & International Health. 2017;22(2):148-60.
27. Mirkuzie AH. Exploring inequities in skilled care at birth among migrant population in a metropolitan city Addis Ababa, Ethiopia; a qualitative study. International journal for equity in health. 2014;13(1):110.
28. Mehretie Adinew Y, Abera Assefa N, Mehretie Adinew Y. Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study. Biomed Res Int. 2018;2018:3249786. Epub 2018/08/17. doi: 10.1155/2018/3249786. PubMed PMID: 30112377; PubMed Central PMCID: PMCPMC6077686.
29. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11(1):32.
30. StataCorp. Stata Statistical Software. 15 ed. College Station, TX: Stata Corp LLC; 2017.
31. Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015;351:h4672. Epub 2015/09/06. doi: 10.1136/bmj.h4672. PubMed PMID: 26341898.
32. Amano A, Gebeyehu A, Birhanu Z. Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study. BMC Pregnancy Childbirth. 2012;12:105. Epub 2012/10/10. doi: 10.1186/1471-2393-12-105. PubMed PMID: 23043258; PubMed Central PMCID: PMCPMC3506545.
33. Wilunda C, Quaglio G, Putoto G, Takahashi R, Calia F, Abebe D, et al. Determinants of utilisation of antenatal care and skilled birth attendant at delivery in South West Shoa Zone, Ethiopia: a cross sectional study. Reprod Health. 2015;12:74. Epub 2015/10/04. doi: 10.1186/s12978-015-0067-y. PubMed PMID: 26432298; PubMed Central PMCID: PMCPMC4592558.
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