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This institutional-based cross-sectional study was carried out in Adis Zemen primary hospital from May1-30, 2018. Addis Zemen primary hospital is found in Adis Zemen town which is an administrative town of Libo Kemkem Wereda. Libo Kemkem Wereda is one of the wereda which found in South Gondar Zone of Amhara regional state. It is located90 kilometers far from Bahirdar (the capital city of Amhara Regional State) and it is 656 kilometers far from Addis Ababain the north direction. Addis zemen has a latitude and longitude of 12o07’37o47’E/12.117oN 37.783oE and an elevation of 1975 meters above sea level. The town is divided into three kebelles (the smallest unit of the woreda). According to 2018 Adis Zemen town health statistics report, the estimated total population is 45, 125 of whom 22, 260 (49.3%) are men and 22, 865(50.7%) are women. The total number of women in the reproductive age group (15–49 years) is 14, 843 which accounts for 32.9% of the total town population. The town has one district hospital, one health center and two private clinics. Adis Zemen Hospital established in 2015 with a total of 91 staffs and currently, the hospital has a total of 236 staff[31].
All pregnant women who attended antenatal clinics of the Adis Zemen Hospital were the source of population and all pregnant women who attended antenatal clinics of the Adis Zemen Hospital during the study period were the study population. All pregnant women who attended antenatal clinics of the Adis Zemen Hospital during the study period and who were voluntary to participate were included in the study whereas; all pregnant women who attended antenatal clinics of the Adis Zemen Hospital for the second time during the study period were excluded from the study.
Sample size determination and sampling procedure: The required sample size was calculated using single population proportion formula;n = (Zα/2)2p(1-p)//d2 where; n is the required sample size, Za/2 is the value of standard score at 95% confidence interval, p is the expected proportion of knowledge, and d2 is marginal error. And the following assumptions were used inorder to calculate the required sample size; 17.7% population proportion of malaria knowledge [25], 95% confidence interval, marginal error of 5% and 5% non-response rate. So the final sample size was 236 and those sampled participants were selected by systematic sampling technique. Since the data were collected for a one month period, the sampling interval was calculated by dividing the total number of client flows within one month by sample size. The average client flow for ANC clinic was 539 per month. Finally, the Kth value was found to be 2.3 (539/236) and every 2nd woman was interviewed.
Data collection tools and techniques: For the purpose of data collection, interviewer-administered questionnaire was adopted from differentliteratures. The questionnaire was prepared originally in English which had three parts like socio-demographic, and knowledge and utilization parts. The questionnaire was translated to the local language, Amharic for the purpose of data collection and it was translated back to English again for consistency. Before the actual data collection, pre-test was made on 5% of the total sample size of the respondent’s in Addis Zemen health centre. The data were collected via face to face interview by two diploma holder midwives under the guidance of one BSc midwife supervisor before the women receiving the care in waiting room. Two days of training about data collection procedures and research ethics was given for data collectors and supervisors.The data collection process was closely supervised on a daily basis and prompt feedback was given timely. Regular manual check-up for completeness and consistency was made.
The dependent variable of this study was women’s knowledge (poor/good knowledge) and the independent variables of this study were socio-demographic characteristics like age, religion, ethnicity, residence, occupation, marital status, monthly income, educational status, and means of communication. Knowledge on malaria; was assessed by using 5 malaria knowledge related questions. Questions used to assess the knowledge were; 1) what is the causes of malaria?2) what are the sign and symptoms of malaria? 3) What is the mode of transmission of malaria? 4) what is the complication of malaria on pregnancy? 5) what are the prevention mechanism of malaria?. The first question (what is the causes of malaria?) had only 1 correct answer wheras the rest had multiples answer. Each multiples answer which was correct were considered as one point and coded 1 whereas incorrect answers were coded 0. Finally women’s knowledge on malaria was masured based on 22 points of 5 questions and dichotomized in to two; - Good Knowledge- those who scored more than 60% of correct response for Knowledge related questions [24]. - Poor Knowledge—those who scored less than 60% of correct response for Knowledge related questions [24].
The collected data were coded and entered into epidata software version 3.1 and exported to SPSS V-20 for analysis. The collected data were presented by frequency and percentage using tables, bar and pie charts. Mean and standard deviation was computed for numerical variables. To see the association between dependent and independent variables, binary and multivariate logistic regressions were used at 95% confidence interval. To control confounding factors, variable having a P value of<0.25 in binary logistic regression were transferred into multivariate logistic regression. After controlling confoundings, variables which had a P value of<0.05 were treated as predictor variables of knowledge. The direction and strength of association were determined based on adjusted odds ratio.
The ethical clearance of this study was approved by an instituttional review board of Debre Tabor University. Before data collection, informed verbal consent was obtained from every respondent. Participants were informed about the purpose of study and their full right not to be interviewed at all or at any time. Participants were also informed that there was no direct benefit they gain in participating in this research. Confidentiality of participants was ensured through by keeping the information confidential, not including address and name of the respondents.
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