Balis Bikila, Bekele Habtamu, Balcha Tegenu, Habte Sisay, Debella Adera, Husen Ahmed Mohammed, Mussa Ibsa, Ahmed Fila, Bekele Deribe, Amin Abdi, Alemu Addisu, Getachew Amalshet, Amare Getachew, Yadeta Elias, Negash Abraham, Lami Magarsa, Eyeberu Addis, Kure Mohammed Abdurke, Getachew Tamirat, Eshetu Bajrond
Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
Health Serv Insights. 2024 Apr 6;17:11786329241245218. doi: 10.1177/11786329241245218. eCollection 2024.
Unsafe abortion is a serious reproductive health problem in developing countries including Ethiopia. The attitude of healthcare providers toward abortion is one of contributing factors to unsafe abortion. This study aimed to determine the pooled effect of healthcare workers' attitudes toward safe abortion care and its determinants factors in Ethiopia.
Search engines such as Scopus, CINAHL, EMBASE, PubMed, Web of Science, and CAB Abstracts were used to find published studies where as Google and Google Scholar were used to find unpublished research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The analysis was performed using STATA 14 and the random-effects model was used to calculate the odds ratios of medical professionals' attitudes regarding safe abortion services. Study heterogeneity was assessed by using and -values. To evaluate the stability of pooled values to outliers and publication bias, respectively, sensitivity analysis and funnel plot were also performed.
A total of 15 published and unpublished articles with a sample size of 4060 were incorporated in this Review. The overall pooled prevalence of this study was 56% (95% CI: 45-67). Sex of participants (AOR: 2.37; 95% CI: 1.57, 3.58), having training (AOR: 2.86; 95% CI: 1.58, 5.17), Professional type (AOR: 1.55; 95% CI: 1.04, 4.46), and knowledge of abortion law (AOR:2.26; 95% CI: 1.14, 4.46) were the determinants factors that significantly associated with health care workers' attitude toward safe abortion care. Sensitivity analysis shows that the pooled odds ratios were consistently stable throughout all meta-analyses, and the funnel plot shows no evidence of publication bias.
Half of health care providers sampled among the pooled studies have favorable attitudes toward abortion services in Ethiopia; which could hamper women's access to safe abortion care. Sex, training, type of profession, and knowing abortion law were determinants of health care workers' attitudes toward safe abortion services. Stakeholders should emphasize improving the attitude of healthcare workers toward safe abortion care which has a vital role in reducing maternal mortality. Moreover, working on modifiable factors like training, assigning personnel whose professions align with the service, and updating care providers about abortion law is also the essential key point to improve their intentions to deliver the services.
不安全堕胎是包括埃塞俄比亚在内的发展中国家面临的一个严重生殖健康问题。医疗服务提供者对堕胎的态度是导致不安全堕胎的因素之一。本研究旨在确定埃塞俄比亚医护人员对安全堕胎护理的态度及其决定因素的综合影响。
使用Scopus、CINAHL、EMBASE、PubMed、Web of Science和CAB Abstracts等搜索引擎查找已发表的研究，同时使用谷歌和谷歌学术查找未发表的研究。采用系统评价和Meta分析的首选报告项目（PRISMA）指南。使用STATA 14进行分析，并使用随机效应模型计算医疗专业人员对安全堕胎服务态度的比值比。通过I²值和P值评估研究异质性。为了分别评估合并值对异常值的稳定性和发表偏倚，还进行了敏感性分析和漏斗图分析。
本综述共纳入15篇已发表和未发表的文章，样本量为4060。本研究的总体合并患病率为56%（95%CI：45 - 67）。参与者性别（比值比：2.37；95%CI：1.57，3.58）、接受过培训（比值比：2.86；95%CI：1.58，5.17）、专业类型（比值比：1.55；95%CI：1.04，4.46）以及对堕胎法律的了解（比值比：2.26；95%CI：1.14，4.46）是与医护人员对安全堕胎护理态度显著相关的决定因素。敏感性分析表明，在所有Meta分析中合并比值比始终稳定，漏斗图显示没有发表偏倚的证据。
在汇总研究中抽样的医护人员中有一半对埃塞俄比亚的堕胎服务持积极态度；这可能会阻碍妇女获得安全堕胎护理。性别、培训、专业类型以及对堕胎法律的了解是医护人员对安全堕胎服务态度的决定因素。利益相关者应强调改善医护人员对安全堕胎护理的态度，这对降低孕产妇死亡率至关重要。此外，致力于如培训等可改变的因素、分配专业与服务匹配的人员以及向护理人员更新堕胎法律知识也是改善他们提供服务意愿的关键要点。
