Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020

Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020 Teketay Debalkie Belay, Mulunesh Alemayehu, Nakachew Mekonen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-136347/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : preconception care is provision of biomedical, behavioral, and social health interventions to reproductive age women and their partners before pregnancy to improve maternal and child health. Its package was developed in 2012. Preconception care not well studied in Ethiopia particularly in the study area. Objective: The aimed to assess the level of knowledge and attitude towards preconception care and associated factors among healthcare providers in North Wollo Zone, 2020. Methods : institution based cross sectional study on 536 health care providers was conducted. Multi stage sampling technique was used. Simple random sampling technique was employed to select the health institutions and study participants. Data were collected; structured, pre tested and self-administered questionnaire. Binary logistic regression used to compute descriptive statistics. P-value < 0.05%, OR with 95% CI used for presence and strength of significant association. Result : This study revealed that 49.1% and 44.2% of health care providers had good knowledge and favorable attitude towards preconception care, respectively. Variables; higher monthly salary [AOR 1.9: 95% CI: 1.1-3.2)], midwifery as profession [AOR: 2.1(95% CI: 1.1-3.7)], library in the institution [AOR: 2.6 (95% CI: 1.2-5.8)], ever heard about preconception care [AOR: 5.6 (95% CI: 3.0 - 10.4)] on knowledge and degree & above educational status [(AOR: 2.1 (95% CI: 1.4-3.1)], good knowledge [AOR: 2.3 (95% CI: 1.3-3.3)] and ever read guideline [AOR: 2.0 (95% CI: 1.2-3.3)] on favorable attitude of preconception care were significantly associated factors respectively Conclusion and recommendation: nearly half of the participants had poor knowledge and unfavorable attitude on preconception care due to mentioned factors and can be averted by making the institutions to have library, health care providers should to read about preconception care. Sexual & Reproductive Medicine attitude knowledge preconception care Plain Summary Preconception care is provision of biomedical, behavioral, and social health interventions to reproductive age women and their partners before pregnancy to improve maternal and child health. It includes screening and intervention on major reproductive health problems. It is not well studied in Ethiopia particularly in the study area. The aim of the study was to assess the level of knowledge and attitude towards preconception care and associated factors among healthcare providers in North Wollo, Ethiopia. Institution based cross sectional study on 536 health care providers was conducted. Multi stage sampling technique was used. Simple random sampling technique was employed to select the health institutions and study participants were proportionally allocated for each selected facilities. Data were collected by trained data collectors using a structured, pre tested and self-administered questionnaire. Binary logistic regression was used to compute descriptive statistics such as number, frequency and percentage distribution of study variables. Variables less than 0.25 were eligible for multivariable logistic regression. P-value < 0.05%, Odds ratio with 95% CI used for presence and strength of association. This study revealed that 49.1% and 44.2% of health care provider’s good knowledge and favorable attitude towards preconception care, respectively. This study revealed that 49.1% and 44.2% of health care providers had good knowledge and favorable attitude towards preconception care, respectively. Variables; higher monthly salary [AOR 1.9: 95% CI: 1.1–3.2)], midwifery as profession [AOR: 2.1(95% CI: 1.1–3.7)], library in the institution [AOR: 2.6 (95% CI: 1.2–5.8)], ever heard about preconception care [AOR: 5.6 (95% CI: 3.0–10.4)] on knowledge and degree & above educational status [(AOR: 2.1 (95% CI: 1.4–3.1)], good knowledge [AOR: 2.3 (95% CI: 1.3–3.3)] and ever read guideline [AOR: 2.0 (95% CI: 1.2–3.3)] on favorable attitude of preconception care were significantly associated factors respectively. In conclusion nearly half of the participants had poor knowledge and unfavorable attitude on preconception care due to mentioned factors and can be improved by making the institutions to have library, internet and reading habit of care providers. Background World health organization defines preconception care as the provision of biomedical, behavioral and social health interventions to couples before pregnancy. The aim is improving maternal and child health, and reducing factors contribute to poor maternal and child health outcomes in both the short and long term. Preconception care (PCC) reduce maternal and childhood mortality and morbidity in both high and low income countries ( 1 , 2 ). Areas addressed by the preconception care packages are screening and intervention on chronic illness, nutritional conditions, genetic and environmental conditions, infertility, violence, unintended pregnancy, sexually transmitted infections (STI) including human immunodeficiency virus (HIV), mental health, substance use, vaccine preventable disease and female genital mutilation ( 3 – 5 ). Children have the right to survive and grow in a good health status; couples have also the right to be physically, psychologically and socially healthy. For this to happen, strong public health programmes in the life-course perspective. But the reality is that such programmes do not exist or are very weak in most low and middle income countries ( 6 ). There was a global consensus which held to develop preconception care in February 2012. Different stakeholders held a meeting on PCC services. ( 1 , 7 ). Data shows there is better knowledge and implementation in developed countries, where as there is low knowledge, attitude of health care providers in some Asian and all African countries on PCC ( 8 ). It is provided in some African countries like Egypt, Nigeria, Sudan, Kenya and South Africa. The implementation of the service in Sudan is 9% ( 9 ), the level of knowledge of health care providers on PCC among Egyptian primary health care givers is 22% ( 10 ) and about 68.1–92% for different types of services in South African primary care givers ( 11 ). In Ethiopia PCC service is not included in the health care provider’s pre-service training curriculum except obstetrics/ gynecology specialty ( 12 ). Despite the availability of a number of evidence based preconception care clinical guidelines and WHO recommendations, most of the developing countries including Ethiopia have not well implemented PCC policy and not started implementing preconception care. ( 13 ). Factors affecting the level of knowledge and attitude of HCPs on PCC service includes provider’s level of education, work experience and type of profession, the type of institution, presence of preconception care resources like guideline, protocol, checklist and PCC plan, presence of library in the institution, internet access, working department and trainings accessibility ( 14 – 17 ). In Ethiopia the knowledge and attitude of HCPs on PCC service is low in general as compared with other economically developed countries ( 13 , 15 , 16 ). The knowledge and attitude among health care providers on PCC vital to develop national PCC guideline and Education information communication and behavioral change communication for health care providers and the community( 13 , 16 ). Preconception care is an important component of maternal health care to improve MCH outcomes and addressing SDG plan in 2030. The aim of this study was to assess the level of knowledge and attitude of preconception care and associated factors among health care providers in North Wollo Zone. Methods Study Area, Period and population The study was conducted from 03/07/2020–30/07/ 2020 in North wollo zone health institutions, Northern Ethiopia. The capital city of this zone is Woldiya. It is located 310 km in the North-East of Bahir Dar and 521 km in the North-East of Addis Ababa. The study area had 12 Woredas (2 urban and 10 rural Woredas) consisting of 278 health posts, 35 primary clinics, 5 medium clinics, 76 health centers, 3 primary hospitals and 2 general hospitals with the total health care providers of all professional type in the Zone was 3195. ( 18 ). All health care providers in the selected health institutions during study period were included in the study and those having long term training, permission leaves, and having illnesses were excluded in the study. Study Design Institutional based cross sectional study design was conducted. Sample Size Determination The sample size for the first two specific objectives was calculated by a single population proportion formula using Epi Info software version 7.2.2.6. By using the assumption of Confidence level = 95%, 5%Margin of error = d, 1.5 design effect (DEFF), and P = proportion for level of knowledge and attitude of HCPs to PCC from recent study (the level of knowledge and attitude were estimated to be 31% ( 13 ) and 59% ( 12 ) with 10% non-response rate gives 491 and 551 respectively. The sample size for factors affecting knowledge and attitude of HCPs on PCC calculated using a double population proportion formula using some selected significant variables and Power = 80%, as follows: Table 1 Sample Size Calculation using Factors of Knowledge and Attitude of Preconception Care among Health Care Providers, 2020 Objective Variables Total HCPs P1 P2 Sample size 10% NR Sample size DEFF Total sample Reference 3 Level of education 3195 74.3 56.3 238 24 262 1.5 393 (13) Presence of library 67.1 47.4 216 22 238 357 Type of institution 62.7 46.7 328 32 360 540 4 Work experience 11.2 23.4 332 33 365 548 (16) Level of education 10.3 24.7 240 24 264 396 The final calculated sample size was 551 HCPs including non response rate. Sampling Technique Multi stage sampling technique was applied. First the facilities were stratified in to general hospitals, primary hospitals, health centers, medium clinics, primary clinics, and health posts. Then 20% of the facilities were selected in each stratum using simple random sampling (SRS) method. Finally the participants were allocated proportionally in each selected facilities and each sample was selected using SRS technique. ??? Operational Definitions Good knowledge about PCC: if the respondents correctly respond 60% or more of the knowledge questions ( 13 ). Favorable attitude towards PCC: If the sum of scores of the level of agreement questions for respondents 60% or more of the possible maximum score ( 13 ). Data Collection Procedure Structured, pre-tested and self-administered questionnaire was used through trained data collectors as a data collection tool. The questionnaire was adapted from a previously validated and known to be reliable source which accessed online as “Andarg-Ethio PCC-KAP-Questionnaire for HCP”. Its content validity index was 92.4%, reliability was checked with Cronbach’s α test and demonstrated a score of 0.945 ( 15 ). The questionnaire had six sections with six questions related to socio-demographic characteristics, ten questions related to individual and professional factors, seven questions related to institutional factors, three question related to client related factor twenty four questions related to knowledge about PCC, seventeen items related to attitude of HCPs with likert scale of one to five scales: scale 1 shows strongly disagree on idea to 5 shows strongly agree. Then the sum of the level of agreement score was categorized in to favorable and unfavorable based on cut point of 60% from the possible maximum score. Data Quality Control Structured and pretested questionnaire was used for data collection. Training was provided for one day to both the data collectors and supervisors about technique of interviewing, communication skill, the ethical aspect in keeping the information confidentiality was also another focus of the training, the time of data collection, timely collection and reorganization of the collected data and submission on due time. The questionnaire was pretested on 5% of the sample size in other unselected institutions, out of the study area, appropriate modifications were taken accordingly. Data collectors were supervised regularly by the supervisors and by the principal investigator too at the time of data collection each day to communicate and solve any challenges that could happen during the data collection process. The collected data was checked for completeness, accuracy and clarity on daily bases. Data Processing and Analysis For data completeness all the questionnaires were checked visually each day at the end of data collection, coded and entered into EPI data version 3.1 then it was exported to STATA version 14 software packages for analysis. Binary logistic regression was used to identify the associations between the dependent and independent variables. Those variables with p-value of < 0.25 on bivariate binary logistic regression analysis were transferred to multivariable logistic regression. The original Bloom’s cutoff point was used to determine the level of knowledge and attitude of the respondents; (less than 60% knowledge/attitude score was labeled as low level of knowledge/ negative attitude, 60–80% intermediate level of knowledge/ attitude and more than 80% as high level of knowledge/positive attitude) ( 19 ). For analysis, those who had intermediate and high knowledge and attitude were recoded as good knowledge and favorable attitude. The degree of association between dependent and independent variables was assessed using odds ratio with 95% confidence interval and variables with p value < 0.05 was taken as statistically significant. Tables and graphs were used to describe the results. The goodness of fit of the models was tested by Hosmer and Lemeshow test. Result Socio-Demographic Characteristics of the Respondents In this study 536 respondents were participated with 97.3% of response rate. The mean age of the study participants was 29.6 years (SD ± 5.8). Two hundred eight six (53.4%) were male respondents. Three hundred fifty one 351(65.5%) of the respondents were married and 296 (55.3%) were degree and above holders respectively (Table 2 ). Table 2 Socio demographic Characteristics of Knowledge and Attitude of PCC among Health Care Providers, Ethiopia, 2020 (n = 536). Variables Frequency percentage Sex Male 286 53.4 Female 250 56.6 Age (in complete years) 20–24 76 14.2 25–29 241 44.9 30–34 yrs 133 24.8 35 & above 86 16.0 Religion Orthodox 408 76.1 Muslim 119 22.2 Protestant 9 1.7 Marital status Single 172 32.1 Married 351 65.5 Divorced/ Widowed/ Separated 13 2.4 Educational status Diploma 240 44.8 Degree & above 296 55.2 Work experience 5 yrs 259 48.3 Monthly income 4791 ETB 255 47.5 Professional or Individual Related Characteristics of Respondents Majority, 201(37%) of the respondents are nurses in profession and only 25 (5%) of the respondents ever look anyone who provide the PCC service to the clients. More than three fourth, 442 (84.5%) of the respondents had smart phone of which 434 (98.2%) uses their smart phone as a source of medical information (Table 3 ). Table 3 Professional and individual characteristics of knowledge and attitude of PCC care among HCPs in North wollo zone, Ethiopia, 2020 (n = 536). Variables Frequency percentage Profession MD 33 6.2 HO 85 15.9 Nurse 201 37.5 Midwifery 91 17.0 HEW 54 10.1 Others* 72 3.4 Ever look anyone who provide the service Yes 25 4.7 No 511 95.3 Smart phone ownership Yes 442 82.5 No 94 7.5 Internet access Yes 432 97.7 No 10 2.3 Use smart phone for medical information Yes 434 98.2 No 8 1.8 Read PCC guideline Yes 102 19.0 No 434 81.0 * Professionals like lab, pharmacy, psychiatric nurses, radiology, optometrists, environmental health, and anesthesia Institution Related Characteristics About half, 374 (50.4%) of the respondents had been working in health center, 195 (36%) in hospital, 54 (10%) health post, 11 (2%) medium clinic and 6 (1%) primary clinic. Only 60 (11%) of the institution had internet access and 70 (13%) had library but all institutions had no PCC guideline, policy procedures, procedural document and plan. Client Related Characteristics From the total participants 453 (84.5%) HCPs visited less than 45 clients per day in their service room. Only 9 (1.7%) of the respondents had contacted with clients who wanted PCC service. Majority (56%) of the clients had contacted for preconception laboratory examinations like blood group and rhesus disease as well as HIV testing. Level of Knowledge on Preconception Care There were 20 knowledge questions with true or false answers. The minimum knowledge score of the respondents was 4 points and the maximum score was 19 points from the possible maximum 20 points of the knowledge score. The mean score of HCP's knowledge on PCC service was 12.33 points (SD ± 2.78). Two hundred seventy three (50.9%) of the HCPs had low knowledge, 243(45.3%) had medium knowledge and 20(3.7%) had high knowledge on PCC service. After merging medium and high knowledge as good level of knowledge 273 (50.9%) of the HCPs had poor knowledge and 263 (49.1%) (95% CI: 44.8%-53.3%) had good knowledge about PCC. Level of Attitude on Preconception Care There were 17 questions which used to assess the level of agreement of the respondents towards PCC service using likert scale. The minimum score of the respondent was 21 and the maximum was 84. The mean score of HCP's attitude towards PCC service was 52.03 (SD ± 7.66). Two hundred ninety nine (55.8%) of the HCPs had negative attitude to this service, 227 (42.4%) had intermediate attitude and only 10 (1.9%) had positive attitude to PCC service. After merging intermediate and high attitude to favorable attitude of HCPs to PCC service, more than half, 299 (55.8%) of the HCP had unfavorable attitude and 237 (44.2%) (95% CI: 39.9–48.4%) had favorable attitude towards PCC service. Factors Affecting the Knowledge of Heath Care Providers on Preconception Care Respondent’s sex, religion, monthly salary, type of profession, work experience, ever read PCC guideline, presence of library in working institution, presence of internet in working institution, heard about PCC, client number and ever look anyone who practice PCC service were found to be significantly associated at p- value of < 0.25 in binary logistic regression and entered to multiple logistic regression for further analysis and variables. Monthly salary, type of profession, presence of library in the working institution, and ever heard about PCC was found to be statistically significant at p-value of 4791 ETB were 1.9 times more likely to have good knowledge than HCPs whose monthly salary was < 4015 [AOR: 1.9 (95% CI 1.1–3.2)]. According to the profession of respondents midwives were 2.1 times knowledgeable than nurses [AOR: 2.1 (95% CI: 1.1–3.7)]. Health care providers who work in an institution which had library were 2.6 times knowledgeable than those whose institution had no library [AOR: 2.6: (95% CI 1.2–5.8)]. Those HCPs who ever heard about this service were 5.6 time knowledgeable than HCPs who ever heard about the service [AOR: 5.6 (95% CI 3.0-10.4)] (Table 4 ). Table 4 Factors Associated with Knowledge of PCC among Health Care Providers in North Wollo Zone, Ethiopia, 2020. Variables Knowledge COR (95% CI) AOR (95% CI) Good Poor sex Male 146 140 1.2(0.9–2.3) 1.2(0.8–1.7) Female 117 133 1 1 Religion Orthodox 208 200 1.4 (0.4–0.9) 1.3(0.3–4.9) Muslim 51 68 1 0.9 (0.2–3.7) Educational status Diploma 82 158 1 1 Degree &above 181 115 0.3 (0.3–1.3) 3.0(2.1–4.3) Monthly salary 4791 ETB 48 14 8.3(1.2–2.8) 1.9(1.1– 3.2) * Profession MD 23 5 5.3 (2.1–13.5) 1.3(0.4–3.8) HO 54 31 2.1(1.2–3.5) 1.1(0.6–2.1) Nurse 92 109 1 1 Midwives 65 26 2.9 (1.7-5.0) 2.1(1.1–3.7)* HEWs 7 47 0.2(0.1–0.4) 0.3(0.1–0.8)* Work experience = 5 years 133 126 0.8 (0.4–1.1) 1.2(0.8–1.7) Heard about PCC Yes 92 10 12.5(6.4–19.3) 5.6 (3.0-10.4)** No 184 250 1 1 Use of smart phone for medical information Yes 241 201 3.93 (0.3–0.9) 1.5(0.8–2.8) No 22 72 1 1 Type of institution Hospital 127 68 12.5(0.6-1.0) 2.3(0.6–3.4) HC 119 151 1 1 Private clinic 10 7 0.2(0.1–0.8) 1.8(0.7–4.9) Health post 7 47 0.4(0.3–0.9) 0.2(0.8–2.4) Presence of library in the institution Yes 60 10 7.8 (3.9–15.6) 2.6 (1.2–5.8)* No 203 263 1 1 Client number 45 44 39 1 1 NB: COR = Crude odds ratio, AOR = Adjusted odds ratio*p-value < 0.05, **p-value < 0.01 Factors Affecting the Attitude of Health Care Providers towards Preconception Care Age of respondents, religion, work experience, educational status, monthly salary, ever looking anyone who provide PCC service, read PCC guidelines of any country, presence of internet as well as library in the working institution and knowledge were found to be significantly associated at p- value of < 0.25 in binary logistic regression. After multivariable logistic regression educational status, knowledge and ever read about PCC were found to be statistically significant at p-value of < 0.05. Health care providers who had degree and above had 2.1 times favorable attitude than those diploma holding [AOR: 2.1 (95% CI: 1.4–3.1)] as well as good knowledge on PCC were 2.3 more likely to have favorable attitude than those who had poor knowledge [AOR: 2.3 (95% CI: 1.3–3.3)] and those who ever read guideline on PCC service were 2.0 times more likely to have favorable attitude than whom never read about PCC service [AOR: 2.0 (95% CI: 1.2–3.3)]. (Table 5 ). Table 5 Factors Associated with Attitude towards PCC among Health Care Providers in North Wollo Zone, Ethiopia, 2020. Variables Attitude COR (95% CI) AOR (95% CI) favorable unfavorable Sex Male 132 154 1 1 Female 105 145 1.2(0.5–2.2) 0.9(0.6–1.3) Age in complete years 20–24 24 52 1 11 25–29 107 134 1.7(1.0–3.0) 1.7(0.9–2.9) 30–34 61 72 1.8(1.0-3.3) 1.8(0.3–3.3) >=35 45 41 2.8(1.3–4.5) 2.3(0.9–4.4) Educational status Diploma 74 166 1 1 Degree and above 163 133 2.8(1.9–2.9) 2.1(1.4–3.1)** Religion Orthodox 190 218 0.6(0.4–0.9) 4.2(0.8–22.1) Muslim 45 74 3.0(0.5–16.8) Protestant 2 7 1 1 Ever look anyone who practice PCC Yes 18 7 6.3(0.1–1.1) 3.4(1.4–8.4) No 119 292 1 1 Clients contact to PCC Yes 3 6 0.63(0.6–11.3) 1.5(0.4–6.4) No 234 293 1 1 Read about PCC Yes 69 33 1 1 No 168 266 3.3 (2.1–5.2) 2.0(1.2–3.3)** Presence of Internet in the institution Yes 39 21 2.6(0.2–1.1) 2.6(0.4–4.6) No 198 278 1 1 Presence of library in the institution Yes 42 28 2.1(0.9–5.2) 2.1(0.2–3.5) No 195 271 1 1 Knowledge of PCC Poor 83 190 1 1 Good 154 109 3.2(2.3–4.6) 2.3(1.5–3.3)** Discussion The finding of the study revealed that 49.1% (95% CI: 44.8–53.3%) of healthcare providers had good level of knowledge on preconception care which is consistent with the finding reported in Awi zone which showed 52% ( 20 ). However, higher than the study done in Hawassa City ( 31%) ( 13 ) and lower than in Addis Ababa (69.2%) ( 16 ) and South Africa (55%) ( 11 ). This difference may be due to time difference between the studies, participant’s academic difference, absence of PCC guideline and plan (for poor knowledge) in studied institutions and implementation of PCC service in other counties like South Africa (for good knowledge). Health care providers who earn better monthly salary had good level of knowledge. Which is in line with a study conducted in Hawassa, ( 13 ) and Awi ( 20 ) in Ethiopia. Knowledge difference among higher and lesser salaries may not afford to have smart phones to access medical information and unable to pay for internet. Types of profession have significant difference on knowledge of preconception care among care providers. Midwives have good knowledge than HEW on PCC service. It is supported by the study done in Addis Ababa (which indicated internists and gynecologists had different level of knowledge), Iran which revealed all physician and midwives (100%) aware on PCC and other HCPs lower awareness about PCC ( 21 ), study done in Netherlands which revealed 95% of midwives had good PCC knowledge where as other providers had lower knowledge score ( 22 ). This may due to closeness of PCC service elements to their profession and working department, presence of some of the PCC services like family planning and inter-pregnancy spacing, prevention of mother to child transmission of HIV, nutrition, iron and folic acid supplementation in some professions curriculum. In the present study HCPs who had been working in health institutions those having library were knowledgeable than those who have no library. This result is in line with the study conducted in Hawassa, Ethiopia ( 13 ), this is because of the reason that different books, training manuals and guidelines will kept in library; motivate HCPs to read medical information and may encourages reading habit and access new information thereby improve their knowledge. In this study the attitude towards PCC was favorable in 44.2% (95% CI: 39.9–48.4%) of HCPS. Almost similar with study done in Addis Ababa 48.5% ( 16 ), however, it is lower than studies conducted in Hawassa Ethiopia 59% ( 23 ) and Belgium 85% ( 24 ) and USA 87.3% ( 25 ). This may be due to accessibility of IEC/BCC materials, internet, and soft copy manual as well as guidelines. Health care providers whose educational status of degree and above holders was more likely to have favorable attitude towards PCC service than the counterparts. This result is supported by study conducted in Belgium ( 26 ) and other study in this country also revealed lower educational status of the community pharmacies as a barrier for positive attitude of PCC services ( 24 ). Educational level affects the health care provider’s attitude on preconception care. Study participants in this study who ever read PCC guideline had favorable attitude. This is true that PCC service guideline, implementation rules and importance of PCC service elements have been clearly stated in WHO and accessed online as well as the service had been implemented in developed and few developing countries ( 8 ). So that reading such guidelines may change care providers attitude and motivate them to implement in their facility. Knowledgeable HCPs had favorable attitude in relation to PCC. It is consistent with other study of systematic review which done in Western world ( 17 ). Knowledgeable health care providers may be motivated and view different PCC service elements to make understand the importance and consequences of their service provision. Hence care providers accept the service as to be provided. Limitation Of The Study Though this study incorporates all HCPs, works in public, private, urban and rural health facilities, it didn’t include: level of practice of PCC service in health institutions and any professionals those have no direct involvement in PCC service like radiologists, optometrists, laboratory technology professionals and dental health care service providers. Conclusion The larger number of HCPs in this study had poor knowledge and unfavorable attitude towards PCC services. Higher monthly salary, midwifery profession, ever read about PCC service guidelines and presence of library in the institutions may increases the knowledge of HCPs on PCC service. The attitude towards PCC service was favorable among HCPs with degree and above educational status, good level of knowledge about PCC service and among those who ever read guidelines. Recommendation Federal ministry of health set national PCC guideline, protocol and to have in-service training for health professional about PCC, zonal health department heads and health institutions managers to avail guideline, library and internet in their institution, to avail internet in their institutions to improve the health care providers level of knowledge and attitude about PCC, future researchers to study PCC level of practice and qualitative study on PCC. Acronyms And Abbreviations AIDS: Acquired Immunodeficiency Syndrome, APO: Adverse Pregnancy Outcome, FMOH: Federal Ministry of Health, GP: General Practitioner, HCP: Health Care Provider, HEW: Health Extension Worker, KAP: Knowledge, Attitude and Practice, MCH: Maternal and Child Health, MCFHN: Maternal, Child and Family Health Nurses, OPD: Outpatient Department, PCC: Preconception Care, RH: Reproductive Health, US: United States, WHO: World Health Organization, ZHD: Zonal Health Department Declarations Ethical approval and consent for participation The proposal was first presented and submitted to Debre Markos University public health department, then to Ethical Review Committee of the College for Ethical Approval and Clearance. Ethical clearance letter was taken from Debre Markos University ethical review committee office and submitted to North Wollo zone health department. Support letter to each selected health institutions. Informed consent from the respondents was found after explaining the purpose of the study to them. To protect confidentiality no name of respondents in the questionnaire was recorded, respondents have the right not to participate in the study. Consent for publication Not applicable Availability of data The dataset is avail from correspondence and the first Author. We are ready to communicate if any suggestions. Funding Not applicable Conflict of interest The Authors declared that there are no conflicts of interest about this work. Authors’ contribution Teketay Debalkie originated the proposal, participated in the data collection; analyze data, drafted and final thesis writing. Mulunesh Alemayehu, Nakachew Mekonen approved the proposal with minor revision, analysis the data and revise the paper. Tesfaye Birhane thesis edition and prepare manuscript. Acknowledgment We would like to heartfelt thanks go to Debre Markos University for technical, Alemu Gebeye giving useful information, Meket woreda health office for its valuable support. We would like to say thanks data collectors, supervisors for their unlimited devotion and study participants for their time. References World Health Organization. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: World Health Organization Headquarters, Geneva, 6–7 February 2012: Meeting report. 2013: 2-16. Alio A. PRECONCEPTION AND INTERCONCEPTION CARE: THE ROLE OF THE HOME VISITOR. 2017: 2-4. World Health Organization. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization. 2013. Mason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA. Preconception care: advancing from ‘important to do and can be done’to ‘is being done and is making a difference’. Reproductive health. 2014;11(S3):S8. McDiarmid MA, Gardiner PM, Jack BW. The clinical content of preconception care: environmental exposures. American journal of obstetrics and gynecology. 2008;199(6):S357-S61. Posner SF, Johnson K, Parker C, Atrash H, Biermann J. The national summit on preconception care: a summary of concepts and recommendations. Maternal and Child Health Journal. 2006;10(1):199-207. Boulet SL, Parker C, Atrash H. Preconception care in international settings. Maternal and child health journal. 2006;10(1):29-35. Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception Care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reproductive Health. 2014;11(3):S1. Ahmed K, Elbashir IMH, Mohamed S, Saeed A, Alawad AAM. Knowledge, attitude and practice of preconception care among Sudanese women in reproductive age about rheumatic heart disease at Alshaab and Ahmad Gassim hospitals 2014–2015 in Sudan. Basic Res J Med Clin Sci. 2015;4(7):5. Fadia M, Azza Refaat T, Emam E. Awareness of primary health care providers in Elminia Governorate about preconception care, Egipt. El-Minia Medical Bulletin. 2012;23(1):14. Ukoha WC, Dube M. Primary health care nursing students’ knowledge of and attitude towards the provision of preconception care in KwaZulu-Natal. African journal of primary health care & family medicine. 2019;11(1). Biratu AK. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care (PCC) in the health system of Ethiopia 2017. Kassa A, Human SP, Gemeda H. Knowledge of preconception care among healthcare providers working in public health institutions in Hawassa, Ethiopia. PloS one. 2018;13(10):e0204415. Bayrami R, Ebrahimipour H, Ebrahimi M, Forootani M, Najafzadeh B. Health care provider s’ knowledge, attitude and practice regarding pre-conception care. Journal of Research and Health. 2013;3(4):519-26. Kassa A, Human S, Gemeda H. Level of Healthcare Providers’ Preconception Care (PCC) Practice and Factors Associated with Non-Implementation of PCC in Hawassa, Ethiopia. Ethiopian journal of health sciences. 2019;29(1). Waji ST, Seman WA. KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) OF RESIDENT PHYSICIANS AT TIKUR ANBESA HOSPITAL ON PRECONCEPTIONAL CARE. Ethiopian Medical Journal. 2019;57(3). Goossens J, De Roose M, Van Hecke A, Goemaes R, Verhaeghe S, Beeckman D. Barriers and facilitators to the provision of preconception care by healthcare providers: A systematic review. International journal of nursing studies. 2018;87:113-30. North Wollo zone health department 2012 Ethiopian fisical year zonal based annual health plan. Woldiya: North Wollo zone; 2012 july 2019. Yimer M, Abera B, Mulu W, Bezabih B. Knowledge, attitude and practices of high risk populations on louse-borne relapsing fever in Bahir Dar city, north-west Ethiopia. 2014. Bekele MM, Gebeyehu NA, Kefale MM, Bante SA. Knowledge of Preconception Care and Associated Factors among Healthcare Providers Working in Public Health Institutions in Awi Zone, North West Ethiopia, 2019: Institutional-Based Cross-Sectional Study. Journal of Pregnancy. 2020;2020. Bayrami R, Ebrahimipour H, Ebrahimi M, Froutani MR, Najafzadeh B. HEALTH CARE PROVIDER S’KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING PRE-CONCEPTION CARE. 2013, vol.3, 4; 519-526. van Heesch PN, de Weerd S, Kotey S, Steegers EA. Dutch community midwives’ views on preconception care. Midwifery. 2006;22(2):120-4. Biratu AK. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care (PCC) in the health system of Ethiopia [PHD]. Pretoria, South Africa: University of South Africa (UNISA). 2017. Ceulemans M, Liekens S, Van Calsteren K, Allegaert K, Foulon V. Community pharmacists’ attitudes, barriers, knowledge and counseling practice with regard to preconception, pregnancy and lactation. Research in Social and Administrative Pharmacy. 2019: 1; 3-6. Morgan MA, Hawks D, Zinberg S, Schulkin J. What obstetrician-gynecologists think of preconception care. Maternal and child health journal. 2006;10(1):59-65. Ojukwu O, Patel D, Stephenson J, Howden B, Shawe J. General practitioners’ knowledge, attitudes and views of providing preconception care: a qualitative investigation. Upsala journal of medical sciences. 2016;121(4):256-63. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-136347","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":7112008,"identity":"0adf6bb2-f5cf-4ed9-a834-33448828470a","order_by":0,"name":"Teketay Debalkie Belay","email":"","orcid":"","institution":"North Wollo Zone Health Department, Meket District, Filakit Health center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Teketay","middleName":"Debalkie","lastName":"Belay","suffix":""},{"id":7112009,"identity":"e7eef750-94c0-451a-b31f-b463f4d24ca6","order_by":1,"name":"Mulunesh Alemayehu","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mulunesh","middleName":"","lastName":"Alemayehu","suffix":""},{"id":7112010,"identity":"19d6578b-9d19-4b36-9600-ba4e2f0d3aa0","order_by":2,"name":"Nakachew Mekonen","email":"","orcid":"","institution":"Debre Markos University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nakachew","middleName":"","lastName":"Mekonen","suffix":""},{"id":7112011,"identity":"aa750d7c-5a1f-4499-9e2d-fa6892915ba9","order_by":3,"name":"Tesfaye Birhane Tegegne","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYHACNoYEBhsefhAzoYAI9TwQLWkykg0gLQbEamFgOGxjcADEJUaLPXv7swcP9zDzGJ9fnfjhgQGDPL/YAQK28JwxN0h4xsZjduPtZgmgwwxnzk4goEUih00i4QAPUMvZDSAtCQa3CWmRf/4MqEWCx3jG2c0/iNMiwWAG1GLAY8Dfu41IW87kAP1yIIFH4gbvNosEAwnCfmFvP/7s4Y8D/+35+89uvvmjwkaeX5qAFgSQAKuUIFY5CPAfIEX1KBgFo2AUjCQAANlVQNBOxzcaAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6025-9706","institution":"team leader and lecturer","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Tesfaye","middleName":"Birhane","lastName":"Tegegne","suffix":""}],"badges":[],"createdAt":"2020-12-26 11:43:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-136347/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-136347/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13640827,"identity":"eabbfe54-8ba8-48ae-92d6-7aa96893c331","added_by":"auto","created_at":"2021-09-17 09:01:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":553787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-136347/v1/2eb97cf3-0fcf-4f58-b49a-cf924646d6e7.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eKnowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020\u003c/p\u003e","fulltext":[{"header":"Plain Summary","content":"\u003cp\u003ePreconception care is provision of biomedical, behavioral, and social health interventions to reproductive age women and their partners before pregnancy to improve maternal and child health. It includes screening and intervention on major reproductive health problems. It is not well studied in Ethiopia particularly in the study area. The aim of the study was to assess the level of knowledge and attitude towards preconception care and associated factors among healthcare providers in North Wollo, Ethiopia. Institution based cross sectional study on 536 health care providers was conducted. Multi stage sampling technique was used. Simple random sampling technique was employed to select the health institutions and study participants were proportionally allocated for each selected facilities. Data were collected by trained data collectors using a structured, pre tested and self-administered questionnaire. Binary logistic regression was used to compute descriptive statistics such as number, frequency and percentage distribution of study variables. Variables less than 0.25 were eligible for multivariable logistic regression. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05%, Odds ratio with 95% CI used for presence and strength of association. This study revealed that 49.1% and 44.2% of health care provider\u0026rsquo;s good knowledge and favorable attitude towards preconception care, respectively. This study revealed that 49.1% and 44.2% of health care providers had good knowledge and favorable attitude towards preconception care, respectively. Variables; higher monthly salary [AOR 1.9: 95% CI: 1.1\u0026ndash;3.2)], midwifery as profession [AOR: 2.1(95% CI: 1.1\u0026ndash;3.7)], library in the institution [AOR: 2.6 (95% CI: 1.2\u0026ndash;5.8)], ever heard about preconception care [AOR: 5.6 (95% CI: 3.0\u0026ndash;10.4)] on knowledge and degree \u0026amp; above educational status [(AOR: 2.1 (95% CI: 1.4\u0026ndash;3.1)], good knowledge [AOR: 2.3 (95% CI: 1.3\u0026ndash;3.3)] and ever read guideline [AOR: 2.0 (95% CI: 1.2\u0026ndash;3.3)] on favorable attitude of preconception care were significantly associated factors respectively. In conclusion nearly half of the participants had poor knowledge and unfavorable attitude on preconception care due to mentioned factors and can be improved by making the institutions to have library, internet and reading habit of care providers.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eWorld health organization defines preconception care as the provision of biomedical, behavioral and social health interventions to couples before pregnancy. The aim is improving maternal and child health, and reducing factors contribute to poor maternal and child health outcomes in both the short and long term. Preconception care (PCC) reduce maternal and childhood mortality and morbidity in both high and low income countries (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAreas addressed by the preconception care packages are screening and intervention on chronic illness, nutritional conditions, genetic and environmental conditions, infertility, violence, unintended pregnancy, sexually transmitted infections (STI) including human immunodeficiency virus (HIV), mental health, substance use, vaccine preventable disease and female genital mutilation (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eChildren have the right to survive and grow in a good health status; couples have also the right to be physically, psychologically and socially healthy. For this to happen, strong public health programmes in the life-course perspective. But the reality is that such programmes do not exist or are very weak in most low and middle income countries (\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere was a global consensus which held to develop preconception care in February 2012. Different stakeholders held a meeting on PCC services. (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). Data shows there is better knowledge and implementation in developed countries, where as there is low knowledge, attitude of health care providers in some Asian and all African countries on PCC (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). It is provided in some African countries like Egypt, Nigeria, Sudan, Kenya and South Africa. The implementation of the service in Sudan is 9% (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e), the level of knowledge of health care providers on PCC among Egyptian primary health care givers is 22% (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e) and about 68.1\u0026ndash;92% for different types of services in South African primary care givers (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia PCC service is not included in the health care provider\u0026rsquo;s pre-service training curriculum except obstetrics/ gynecology specialty (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). Despite the availability of a number of evidence based preconception care clinical guidelines and WHO recommendations, most of the developing countries including Ethiopia have not well implemented PCC policy and not started implementing preconception care. (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFactors affecting the level of knowledge and attitude of HCPs on PCC service includes provider\u0026rsquo;s level of education, work experience and type of profession, the type of institution, presence of preconception care resources like guideline, protocol, checklist and PCC plan, presence of library in the institution, internet access, working department and trainings accessibility (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). In Ethiopia the knowledge and attitude of HCPs on PCC service is low in general as compared with other economically developed countries (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). The knowledge and attitude among health care providers on PCC vital to develop national PCC guideline and Education information communication and behavioral change communication for health care providers and the community(\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003ePreconception care is an important component of maternal health care to improve MCH outcomes and addressing SDG plan in 2030. The aim of this study was to assess the level of knowledge and attitude of preconception care and associated factors among health care providers in North Wollo Zone.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Area, Period and population\u003c/h2\u003e\n\u003cp\u003eThe study was conducted from 03/07/2020\u0026ndash;30/07/ 2020 in North wollo zone health institutions, Northern Ethiopia. The capital city of this zone is Woldiya. It is located 310\u0026nbsp;km in the North-East of Bahir Dar and 521\u0026nbsp;km in the North-East of Addis Ababa. The study area had 12 Woredas (2 urban and 10 rural Woredas) consisting of 278 health posts, 35 primary clinics, 5 medium clinics, 76 health centers, 3 primary hospitals and 2 general hospitals with the total health care providers of all professional type in the Zone was 3195. (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). All health care providers in the selected health institutions during study period were included in the study and those having long term training, permission leaves, and having illnesses were excluded in the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eInstitutional based cross sectional study design was conducted.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eSample Size Determination\u003c/h2\u003e\n\u003cp\u003eThe sample size for the first two specific objectives was calculated by a single population proportion formula using Epi Info software version 7.2.2.6. By using the assumption of Confidence level\u0026thinsp;=\u0026thinsp;95%, 5%Margin of error\u0026thinsp;=\u0026thinsp;d, 1.5 design effect (DEFF), and P\u0026thinsp;=\u0026thinsp;proportion for level of knowledge and attitude of HCPs to PCC from recent study (the level of knowledge and attitude were estimated to be 31% (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e) and 59% (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e) with 10% non-response rate gives 491 and 551 respectively.\u003c/p\u003e\n\u003cp\u003eThe sample size for factors affecting knowledge and attitude of HCPs on PCC calculated using a double population proportion formula using some selected significant variables and Power\u0026thinsp;=\u0026thinsp;80%, as follows:\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSample Size Calculation using Factors of Knowledge and Attitude of Preconception Care among Health Care Providers, 2020\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eObjective\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal HCPs\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP1\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP2\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSample size\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e10% NR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSample size\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDEFF\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal sample\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLevel of education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e3195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e74.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e238\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e262\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e393\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e(13)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePresence of library\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e67.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e238\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e357\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType of institution\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e328\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e360\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e540\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWork experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e332\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e548\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e(16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLevel of education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e264\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e396\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eThe final calculated sample size was 551 HCPs including non response rate.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eSampling Technique\u003c/h2\u003e\n\u003cp\u003eMulti stage sampling technique was applied. First the facilities were stratified in to general hospitals, primary hospitals, health centers, medium clinics, primary clinics, and health posts. Then 20% of the facilities were selected in each stratum using simple random sampling (SRS) method. Finally the participants were allocated proportionally in each selected facilities and each sample was selected using SRS technique. ???\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n\u003ch2\u003eOperational Definitions\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eGood knowledge about PCC:\u0026nbsp;\u003c/strong\u003eif the respondents correctly respond 60% or more of the knowledge questions (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFavorable attitude towards PCC:\u0026nbsp;\u003c/strong\u003eIf the sum of scores of the level of agreement questions for respondents 60% or more of the possible maximum score (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collection Procedure\u003c/h2\u003e\n\u003cp\u003eStructured, pre-tested and self-administered questionnaire was used through trained data collectors as a data collection tool. The questionnaire was adapted from a previously validated and known to be reliable source which accessed online as \u0026ldquo;Andarg-Ethio PCC-KAP-Questionnaire for HCP\u0026rdquo;. Its content validity index was 92.4%, reliability was checked with Cronbach\u0026rsquo;s \u003cstrong\u003e\u0026alpha;\u003c/strong\u003e test and demonstrated a score of 0.945 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe questionnaire had six sections with six questions related to socio-demographic characteristics, ten questions related to individual and professional factors, seven questions related to institutional factors, three question related to client related factor twenty four questions related to knowledge about PCC, seventeen items related to attitude of HCPs with likert scale of one to five scales: scale 1 shows strongly disagree on idea to 5 shows strongly agree. Then the sum of the level of agreement score was categorized in to favorable and unfavorable based on cut point of 60% from the possible maximum score.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eData Quality Control\u003c/h2\u003e\n\u003cp\u003eStructured and pretested questionnaire was used for data collection. Training was provided for one day to both the data collectors and supervisors about technique of interviewing, communication skill, the ethical aspect in keeping the information confidentiality was also another focus of the training, the time of data collection, timely collection and reorganization of the collected data and submission on due time. The questionnaire was pretested on 5% of the sample size in other unselected institutions, out of the study area, appropriate modifications were taken accordingly. Data collectors were supervised regularly by the supervisors and by the principal investigator too at the time of data collection each day to communicate and solve any challenges that could happen during the data collection process. The collected data was checked for completeness, accuracy and clarity on daily bases.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eData Processing and Analysis\u003c/h2\u003e\n\u003cp\u003eFor data completeness all the questionnaires were checked visually each day at the end of data collection, coded and entered into EPI data version 3.1 then it was exported to STATA version 14 software packages for analysis. Binary logistic regression was used to identify the associations between the dependent and independent variables. Those variables with p-value of \u0026lt;\u0026thinsp;0.25 on bivariate binary logistic regression analysis were transferred to multivariable logistic regression. The original Bloom\u0026rsquo;s cutoff point was used to determine the level of knowledge and attitude of the respondents; (less than 60% knowledge/attitude score was labeled as low level of knowledge/ negative attitude, 60\u0026ndash;80% intermediate level of knowledge/ attitude and more than 80% as high level of knowledge/positive attitude) (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). For analysis, those who had intermediate and high knowledge and attitude were recoded as good knowledge and favorable attitude.\u003c/p\u003e\n\u003cp\u003eThe degree of association between dependent and independent variables was assessed using odds ratio with 95% confidence interval and variables with p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as statistically significant. Tables and graphs were used to describe the results. The goodness of fit of the models was tested by Hosmer and Lemeshow test.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eSocio-Demographic Characteristics of the Respondents\u003c/h2\u003e\n\u003cp\u003eIn this study 536 respondents were participated with 97.3% of response rate. The mean age of the study participants was 29.6\u0026nbsp;years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8). Two hundred eight six (53.4%) were male respondents. Three hundred fifty one 351(65.5%) of the respondents were married and 296 (55.3%) were degree and above holders respectively (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSocio demographic Characteristics of Knowledge and Attitude of PCC among Health Care Providers, Ethiopia, 2020 (n\u0026thinsp;=\u0026thinsp;536).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003epercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e286\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e53.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAge (in complete years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;34 yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 \u0026amp; above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e408\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e76.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtestant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e172\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e351\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced/ Widowed/ Separated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEducational status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree \u0026amp; above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e296\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eWork experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5 yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e277\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;5 yrs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e259\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMonthly income\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;4015 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e181\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4015\u0026ndash;4791 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;4791 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e255\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eProfessional or Individual Related Characteristics of Respondents\u003c/h2\u003e\n\u003cp\u003eMajority, 201(37%) of the respondents are nurses in profession and only 25 (5%) of the respondents ever look anyone who provide the PCC service to the clients. More than three fourth, 442 (84.5%) of the respondents had smart phone of which 434 (98.2%) uses their smart phone as a source of medical information (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eProfessional and individual characteristics of knowledge and attitude of PCC care among HCPs in North wollo zone, Ethiopia, 2020 (n\u0026thinsp;=\u0026thinsp;536).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003epercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eProfession\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMidwifery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHEW\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEver look anyone who provide the service\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSmart phone ownership\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e442\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e82.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eInternet access\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e432\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e97.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eUse smart phone for medical information\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e434\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRead PCC guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e434\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e81.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e* Professionals like lab, pharmacy, psychiatric nurses, radiology, optometrists, environmental health, and anesthesia\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eInstitution Related Characteristics\u003c/h2\u003e\n\u003cp\u003eAbout half, 374 (50.4%) of the respondents had been working in health center, 195 (36%) in hospital, 54 (10%) health post, 11 (2%) medium clinic and 6 (1%) primary clinic. Only 60 (11%) of the institution had internet access and 70 (13%) had library but all institutions had no PCC guideline, policy procedures, procedural document and plan.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eClient Related Characteristics\u003c/h2\u003e\n\u003cp\u003eFrom the total participants 453 (84.5%) HCPs visited less than 45 clients per day in their service room. Only 9 (1.7%) of the respondents had contacted with clients who wanted PCC service. Majority (56%) of the clients had contacted for preconception laboratory examinations like blood group and rhesus disease as well as HIV testing.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eLevel of Knowledge on Preconception Care\u003c/h2\u003e\n\u003cp\u003eThere were 20 knowledge questions with true or false answers. The minimum knowledge score of the respondents was 4 points and the maximum score was 19 points from the possible maximum 20 points of the knowledge score. The mean score of HCP's knowledge on PCC service was 12.33 points (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78). Two hundred seventy three (50.9%) of the HCPs had low knowledge, 243(45.3%) had medium knowledge and 20(3.7%) had high knowledge on PCC service. After merging medium and high knowledge as good level of knowledge 273 (50.9%) of the HCPs had poor knowledge and 263 (49.1%) (95% CI: 44.8%-53.3%) had good knowledge about PCC.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eLevel of Attitude on Preconception Care\u003c/h2\u003e\n\u003cp\u003eThere were 17 questions which used to assess the level of agreement of the respondents towards PCC service using likert scale. The minimum score of the respondent was 21 and the maximum was 84. The mean score of HCP's attitude towards PCC service was 52.03 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;7.66). Two hundred ninety nine (55.8%) of the HCPs had negative attitude to this service, 227 (42.4%) had intermediate attitude and only 10 (1.9%) had positive attitude to PCC service. After merging intermediate and high attitude to favorable attitude of HCPs to PCC service, more than half, 299 (55.8%) of the HCP had unfavorable attitude and 237 (44.2%) (95% CI: 39.9\u0026ndash;48.4%) had favorable attitude towards PCC service.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eFactors Affecting the Knowledge of Heath Care Providers on Preconception Care\u003c/h2\u003e\n\u003cp\u003eRespondent\u0026rsquo;s sex, religion, monthly salary, type of profession, work experience, ever read PCC guideline, presence of library in working institution, presence of internet in working institution, heard about PCC, client number and ever look anyone who practice PCC service were found to be significantly associated at p- value of \u0026lt;\u0026thinsp;0.25 in binary logistic regression and entered to multiple logistic regression for further analysis and variables. Monthly salary, type of profession, presence of library in the working institution, and ever heard about PCC was found to be statistically significant at p-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003eIn this study monthly salary was found to be significantly associated with outcome variable knowledge. HCPs whose monthly salary\u0026thinsp;\u0026gt;\u0026thinsp;4791 ETB were 1.9 times more likely to have good knowledge than HCPs whose monthly salary was \u0026lt;\u0026thinsp;4015 [AOR: 1.9 (95% CI 1.1\u0026ndash;3.2)]. According to the profession of respondents midwives were 2.1 times knowledgeable than nurses [AOR: 2.1 (95% CI: 1.1\u0026ndash;3.7)]. Health care providers who work in an institution which had library were 2.6 times knowledgeable than those whose institution had no library [AOR: 2.6: (95% CI 1.2\u0026ndash;5.8)]. Those HCPs who ever heard about this service were 5.6 time knowledgeable than HCPs who ever heard about the service [AOR: 5.6 (95% CI 3.0-10.4)] (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFactors Associated with Knowledge of PCC among Health Care Providers in North Wollo Zone, Ethiopia, 2020.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eKnowledge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAOR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGood\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003esex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.9\u0026ndash;2.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.8\u0026ndash;1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.4 (0.4\u0026ndash;0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3(0.3\u0026ndash;4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.9 (0.2\u0026ndash;3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree \u0026amp;above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e181\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3 (0.3\u0026ndash;1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.0(2.1\u0026ndash;4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonthly salary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;4015ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4015\u0026ndash;4791 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.8(1.2\u0026ndash;3.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.5 (0.8\u0026ndash;2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;4791 ETB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.3(1.2\u0026ndash;2.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.9(1.1\u0026ndash; 3.2) *\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.3 (2.1\u0026ndash;13.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.3(0.4\u0026ndash;3.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1(1.2\u0026ndash;3.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.1(0.6\u0026ndash;2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMidwives\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.9 (1.7-5.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.1(1.1\u0026ndash;3.7)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHEWs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2(0.1\u0026ndash;0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.3(0.1\u0026ndash;0.8)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWork experience\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;5\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;= 5\u0026nbsp;years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8 (0.4\u0026ndash;1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.8\u0026ndash;1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHeard about PCC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.5(6.4\u0026ndash;19.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5.6 (3.0-10.4)**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUse of smart phone for medical information\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.93 (0.3\u0026ndash;0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.5(0.8\u0026ndash;2.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of institution\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e127\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.5(0.6-1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.3(0.6\u0026ndash;3.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate clinic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2(0.1\u0026ndash;0.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.8(0.7\u0026ndash;4.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth post\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.4(0.3\u0026ndash;0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2(0.8\u0026ndash;2.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePresence of library in the institution\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.8 (3.9\u0026ndash;15.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 (1.2\u0026ndash;5.8)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e203\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eClient number\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;=45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e219\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.8(0.3\u0026ndash;1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.7\u0026ndash;1.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eNB: COR\u0026thinsp;=\u0026thinsp;Crude odds ratio, AOR\u0026thinsp;=\u0026thinsp;Adjusted odds ratio*p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eFactors Affecting the Attitude of Health Care Providers towards Preconception Care\u003c/h2\u003e\n\u003cp\u003eAge of respondents, religion, work experience, educational status, monthly salary, ever looking anyone who provide PCC service, read PCC guidelines of any country, presence of internet as well as library in the working institution and knowledge were found to be significantly associated at p- value of \u0026lt;\u0026thinsp;0.25 in binary logistic regression. After multivariable logistic regression educational status, knowledge and ever read about PCC were found to be statistically significant at p-value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cp\u003eHealth care providers who had degree and above had 2.1 times favorable attitude than those diploma holding [AOR: 2.1 (95% CI: 1.4\u0026ndash;3.1)] as well as good knowledge on PCC were 2.3 more likely to have favorable attitude than those who had poor knowledge [AOR: 2.3 (95% CI: 1.3\u0026ndash;3.3)] and those who ever read guideline on PCC service were 2.0 times more likely to have favorable attitude than whom never read about PCC service [AOR: 2.0 (95% CI: 1.2\u0026ndash;3.3)]. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFactors Associated with Attitude towards PCC among Health Care Providers in North Wollo Zone, Ethiopia, 2020.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAttitude\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCOR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAOR (95% CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efavorable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eunfavorable\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e145\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.2(0.5\u0026ndash;2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.9(0.6\u0026ndash;1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAge in complete years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.7(1.0\u0026ndash;3.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.7(0.9\u0026ndash;2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.8(1.0-3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.8(0.3\u0026ndash;3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;=35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.8(1.3\u0026ndash;4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.3(0.9\u0026ndash;4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEducational status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiploma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e166\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree and above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.8(1.9\u0026ndash;2.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.1(1.4\u0026ndash;3.1)**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodox\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e190\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e218\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.6(0.4\u0026ndash;0.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.2(0.8\u0026ndash;22.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.0(0.5\u0026ndash;16.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProtestant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEver look anyone who practice PCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.3(0.1\u0026ndash;1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.4(1.4\u0026ndash;8.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e292\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eClients contact to PCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.63(0.6\u0026ndash;11.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.5(0.4\u0026ndash;6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e293\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRead about PCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e266\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.3 (2.1\u0026ndash;5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.0(1.2\u0026ndash;3.3)**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePresence of Internet in the institution\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.6(0.2\u0026ndash;1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.6(0.4\u0026ndash;4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e198\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePresence of library in the institution\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1(0.9\u0026ndash;5.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1(0.2\u0026ndash;3.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e271\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eKnowledge of PCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e190\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGood\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.2(2.3\u0026ndash;4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.3(1.5\u0026ndash;3.3)**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe finding of the study revealed that 49.1% (95% CI: 44.8\u0026ndash;53.3%) of healthcare providers had good level of knowledge on preconception care which is consistent with the finding reported in Awi zone which showed 52% (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). However, higher than the study done in Hawassa City ( 31%) (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e) and lower than in Addis Ababa (69.2%) (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e) and South Africa (55%) (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). This difference may be due to time difference between the studies, participant\u0026rsquo;s academic difference, absence of PCC guideline and plan (for poor knowledge) in studied institutions and implementation of PCC service in other counties like South Africa (for good knowledge).\u003c/p\u003e\n\u003cp\u003eHealth care providers who earn better monthly salary had good level of knowledge. Which is in line with a study conducted in Hawassa, (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e) and Awi (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e) in Ethiopia. Knowledge difference among higher and lesser salaries may not afford to have smart phones to access medical information and unable to pay for internet.\u003c/p\u003e\n\u003cp\u003eTypes of profession have significant difference on knowledge of preconception care among care providers. Midwives have good knowledge than HEW on PCC service. It is supported by the study done in Addis Ababa (which indicated internists and gynecologists had different level of knowledge), Iran which revealed all physician and midwives (100%) aware on PCC and other HCPs lower awareness about PCC (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e), study done in Netherlands which revealed 95% of midwives had good PCC knowledge where as other providers had lower knowledge score (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). This may due to closeness of PCC service elements to their profession and working department, presence of some of the PCC services like family planning and inter-pregnancy spacing, prevention of mother to child transmission of HIV, nutrition, iron and folic acid supplementation in some professions curriculum.\u003c/p\u003e\n\u003cp\u003eIn the present study HCPs who had been working in health institutions those having library were knowledgeable than those who have no library. This result is in line with the study conducted in Hawassa, Ethiopia (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e), this is because of the reason that different books, training manuals and guidelines will kept in library; motivate HCPs to read medical information and may encourages reading habit and access new information thereby improve their knowledge.\u003c/p\u003e\n\u003cp\u003eIn this study the attitude towards PCC was favorable in 44.2% (95% CI: 39.9\u0026ndash;48.4%) of HCPS. Almost similar with study done in Addis Ababa 48.5% (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e), however, it is lower than studies conducted in Hawassa Ethiopia 59% (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e) and Belgium 85% (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e) and USA 87.3% (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). This may be due to accessibility of IEC/BCC materials, internet, and soft copy manual as well as guidelines.\u003c/p\u003e\n\u003cp\u003eHealth care providers whose educational status of degree and above holders was more likely to have favorable attitude towards PCC service than the counterparts. This result is supported by study conducted in Belgium (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e) and other study in this country also revealed lower educational status of the community pharmacies as a barrier for positive attitude of PCC services (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e). Educational level affects the health care provider\u0026rsquo;s attitude on preconception care.\u003c/p\u003e\n\u003cp\u003eStudy participants in this study who ever read PCC guideline had favorable attitude. This is true that PCC service guideline, implementation rules and importance of PCC service elements have been clearly stated in WHO and accessed online as well as the service had been implemented in developed and few developing countries (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). So that reading such guidelines may change care providers attitude and motivate them to implement in their facility.\u003c/p\u003e\n\u003cp\u003eKnowledgeable HCPs had favorable attitude in relation to PCC. It is consistent with other study of systematic review which done in Western world (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). Knowledgeable health care providers may be motivated and view different PCC service elements to make understand the importance and consequences of their service provision. Hence care providers accept the service as to be provided.\u003c/p\u003e"},{"header":"Limitation Of The Study","content":" \u003cp\u003eThough this study incorporates all HCPs, works in public, private, urban and rural health facilities, it didn\u0026rsquo;t include: level of practice of PCC service in health institutions and any professionals those have no direct involvement in PCC service like radiologists, optometrists, laboratory technology professionals and dental health care service providers.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eThe larger number of HCPs in this study had poor knowledge and unfavorable attitude towards PCC services. Higher monthly salary, midwifery profession, ever read about PCC service guidelines and presence of library in the institutions may increases the knowledge of HCPs on PCC service. The attitude towards PCC service was favorable among HCPs with degree and above educational status, good level of knowledge about PCC service and among those who ever read guidelines.\u003c/p\u003e \n\u003ch2\u003eRecommendation \u003c/h2\u003e\n \u003cp\u003eFederal ministry of health set national PCC guideline, protocol and to have in-service training for health professional about PCC, zonal health department heads and health institutions managers to avail guideline, library and internet in their institution, to avail internet in their institutions to improve the health care providers level of knowledge and attitude about PCC, future researchers to study PCC level of practice and qualitative study on PCC.\u003c/p\u003e "},{"header":"Acronyms And Abbreviations","content":"\u003cp\u003eAIDS: Acquired Immunodeficiency Syndrome, APO: Adverse Pregnancy Outcome, FMOH: Federal Ministry of Health, GP: General Practitioner, HCP: Health Care Provider, HEW: Health Extension Worker, KAP: Knowledge, Attitude and Practice, MCH: Maternal and Child Health, MCFHN: Maternal, Child and Family Health Nurses, OPD: Outpatient Department, PCC: Preconception Care, RH: Reproductive Health, US: United States, WHO: World Health Organization, ZHD: Zonal Health Department\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent for participation \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proposal was first presented and submitted to Debre Markos University public health department, then to Ethical Review Committee of the College for Ethical Approval and Clearance. Ethical clearance letter was taken from Debre Markos University ethical review committee office and submitted to North Wollo zone health department. Support letter to each selected health institutions. Informed consent from the respondents was found after explaining the purpose of the study to them. To protect confidentiality no name of respondents in the questionnaire was recorded, respondents have the right not to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset is avail from correspondence and the first Author. We are ready to communicate if any suggestions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declared that there are no conflicts of interest about this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTeketay Debalkie originated the proposal, participated in the data collection; analyze data, drafted and final thesis writing. Mulunesh Alemayehu, Nakachew Mekonen approved the proposal with minor revision, analysis the data and revise the paper. Tesfaye Birhane thesis edition and prepare manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to heartfelt thanks go to Debre Markos University for technical, Alemu Gebeye giving useful information, Meket woreda health office for its valuable support. We would like to say thanks data collectors, supervisors for their unlimited devotion and study participants for their time.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: World Health Organization Headquarters, Geneva, 6\u0026ndash;7 February 2012: Meeting report. 2013: 2-16.\u003c/li\u003e\n\u003cli\u003eAlio A. PRECONCEPTION AND INTERCONCEPTION CARE: THE ROLE OF THE HOME VISITOR. 2017: 2-4.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization. 2013.\u003c/li\u003e\n\u003cli\u003eMason E, Chandra-Mouli V, Baltag V, Christiansen C, Lassi ZS, Bhutta ZA. Preconception care: advancing from \u0026lsquo;important to do and can be done\u0026rsquo;to \u0026lsquo;is being done and is making a difference\u0026rsquo;. Reproductive health. 2014;11(S3):S8.\u003c/li\u003e\n\u003cli\u003eMcDiarmid MA, Gardiner PM, Jack BW. The clinical content of preconception care: environmental exposures. American journal of obstetrics and gynecology. 2008;199(6):S357-S61.\u003c/li\u003e\n\u003cli\u003ePosner SF, Johnson K, Parker C, Atrash H, Biermann J. The national summit on preconception care: a summary of concepts and recommendations. Maternal and Child Health Journal. 2006;10(1):199-207.\u003c/li\u003e\n\u003cli\u003eBoulet SL, Parker C, Atrash H. Preconception care in international settings. Maternal and child health journal. 2006;10(1):29-35.\u003c/li\u003e\n\u003cli\u003eDean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception Care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reproductive Health. 2014;11(3):S1.\u003c/li\u003e\n\u003cli\u003eAhmed K, Elbashir IMH, Mohamed S, Saeed A, Alawad AAM. Knowledge, attitude and practice of preconception care among Sudanese women in reproductive age about rheumatic heart disease at Alshaab and Ahmad Gassim hospitals 2014\u0026ndash;2015 in Sudan. Basic Res J Med Clin Sci. 2015;4(7):5.\u003c/li\u003e\n\u003cli\u003eFadia M, Azza Refaat T, Emam E. Awareness of primary health care providers in Elminia Governorate about preconception care, Egipt. El-Minia Medical Bulletin. 2012;23(1):14.\u003c/li\u003e\n\u003cli\u003eUkoha WC, Dube M. Primary health care nursing students\u0026rsquo; knowledge of and attitude towards the provision of preconception care in KwaZulu-Natal. African journal of primary health care \u0026amp; family medicine. 2019;11(1).\u003c/li\u003e\n\u003cli\u003eBiratu AK. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care (PCC) in the health system of Ethiopia 2017.\u003c/li\u003e\n\u003cli\u003eKassa A, Human SP, Gemeda H. Knowledge of preconception care among healthcare providers working in public health institutions in Hawassa, Ethiopia. PloS one. 2018;13(10):e0204415.\u003c/li\u003e\n\u003cli\u003eBayrami R, Ebrahimipour H, Ebrahimi M, Forootani M, Najafzadeh B. Health care provider s\u0026rsquo; knowledge, attitude and practice regarding pre-conception care. Journal of Research and Health. 2013;3(4):519-26.\u003c/li\u003e\n\u003cli\u003eKassa A, Human S, Gemeda H. Level of Healthcare Providers\u0026rsquo; Preconception Care (PCC) Practice and Factors Associated with Non-Implementation of PCC in Hawassa, Ethiopia. Ethiopian journal of health sciences. 2019;29(1).\u003c/li\u003e\n\u003cli\u003eWaji ST, Seman WA. KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) OF RESIDENT PHYSICIANS AT TIKUR ANBESA HOSPITAL ON PRECONCEPTIONAL CARE. Ethiopian Medical Journal. 2019;57(3).\u003c/li\u003e\n\u003cli\u003eGoossens J, De Roose M, Van Hecke A, Goemaes R, Verhaeghe S, Beeckman D. Barriers and facilitators to the provision of preconception care by healthcare providers: A systematic review. International journal of nursing studies. 2018;87:113-30.\u003c/li\u003e\n\u003cli\u003eNorth Wollo zone health department 2012 Ethiopian fisical year zonal based annual health plan. Woldiya: North Wollo zone; 2012 july 2019.\u003c/li\u003e\n\u003cli\u003eYimer M, Abera B, Mulu W, Bezabih B. Knowledge, attitude and practices of high risk populations on louse-borne relapsing fever in Bahir Dar city, north-west Ethiopia. 2014.\u003c/li\u003e\n\u003cli\u003eBekele MM, Gebeyehu NA, Kefale MM, Bante SA. Knowledge of Preconception Care and Associated Factors among Healthcare Providers Working in Public Health Institutions in Awi Zone, North West Ethiopia, 2019: Institutional-Based Cross-Sectional Study. Journal of Pregnancy. 2020;2020.\u003c/li\u003e\n\u003cli\u003eBayrami R, Ebrahimipour H, Ebrahimi M, Froutani MR, Najafzadeh B. HEALTH CARE PROVIDER S\u0026rsquo;KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING PRE-CONCEPTION CARE. 2013, vol.3, 4; 519-526.\u003c/li\u003e\n\u003cli\u003evan Heesch PN, de Weerd S, Kotey S, Steegers EA. Dutch community midwives\u0026rsquo; views on preconception care. Midwifery. 2006;22(2):120-4.\u003c/li\u003e\n\u003cli\u003eBiratu AK. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care (PCC) in the health system of Ethiopia [PHD]. Pretoria, South Africa: University of South Africa (UNISA). 2017.\u003c/li\u003e\n\u003cli\u003eCeulemans M, Liekens S, Van Calsteren K, Allegaert K, Foulon V. Community pharmacists\u0026rsquo; attitudes, barriers, knowledge and counseling practice with regard to preconception, pregnancy and lactation. Research in Social and Administrative Pharmacy. 2019: 1; 3-6.\u003c/li\u003e\n\u003cli\u003eMorgan MA, Hawks D, Zinberg S, Schulkin J. What obstetrician-gynecologists think of preconception care. Maternal and child health journal. 2006;10(1):59-65.\u003c/li\u003e\n\u003cli\u003eOjukwu O, Patel D, Stephenson J, Howden B, Shawe J. General practitioners\u0026rsquo; knowledge, attitudes and views of providing preconception care: a qualitative investigation. Upsala journal of medical sciences. 2016;121(4):256-63.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"attitude, knowledge, preconception care","lastPublishedDoi":"10.21203/rs.3.rs-136347/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-136347/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: preconception care is provision of biomedical, behavioral, and social health interventions to reproductive age women and their partners before pregnancy to improve maternal and child health. Its package was developed in 2012. Preconception care not well studied in Ethiopia particularly in the study area. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe aimed to assess the level of knowledge and attitude towards preconception care and associated factors among healthcare providers in North Wollo Zone, 2020. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: institution based cross sectional study on 536 health care providers was conducted. Multi stage sampling technique was used. Simple random sampling technique was employed to select the health institutions and study participants. Data were collected; structured, pre tested and self-administered questionnaire. Binary logistic regression used to compute descriptive statistics. P-value \u0026lt; 0.05%, OR with 95% CI used for presence and strength of significant association. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: This study revealed that 49.1% and 44.2% of health care providers had good knowledge and favorable attitude towards preconception care, respectively. Variables; higher monthly salary [AOR 1.9: 95% CI: 1.1-3.2)], midwifery as profession [AOR: 2.1(95% CI: 1.1-3.7)], library in the institution [AOR: 2.6 (95% CI: 1.2-5.8)], ever heard about preconception care [AOR: 5.6 (95% CI: 3.0 - 10.4)] on knowledge and degree \u0026amp; above educational status [(AOR: 2.1 (95% CI: 1.4-3.1)], good knowledge [AOR: 2.3 (95% CI: 1.3-3.3)] and ever read guideline [AOR: 2.0 (95% CI: 1.2-3.3)] on favorable attitude of preconception care were significantly associated factors respectively\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion and recommendation:\u003c/strong\u003e nearly half of the participants had poor knowledge and unfavorable attitude on preconception care due to mentioned factors and can be averted by making the institutions to have library, health care providers should to read about preconception care.\u003c/p\u003e","manuscriptTitle":"Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-30 17:26:51","doi":"10.21203/rs.3.rs-136347/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3931eb1a-a060-445e-9b07-c200ea5f6860","owner":[],"postedDate":"December 30th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1666248,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2020-12-30T17:26:53+00:00","versionOfRecord":[],"versionCreatedAt":"2020-12-30 17:26:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-136347","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-136347","identity":"rs-136347","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}