Level of knowledge on preconception care and associated factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia

Level of knowledge on preconception care and associated factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia | 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 Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Level of knowledge on preconception care and associated factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia Gemechu Dereje Feyissa, Gemechis Girma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5455142/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 Background : Preconception care is the provision of biomedical, behavioral, and social health interventions to women and couples before pregnancy occurs. Preconception care is the most recently identified innovative approach among the spectrum of maternal and child health services to address all adverse pregnancy outcomes and to considerably reduce maternal, new-born, infant, and child morbidity and mortality. Therefore, the findings of this study may be used as preliminary information by concerned bodies. Objective : The study aimed to assess the level of knowledge on preconception care and associated factors among healthcare providers working in public health facilities in Adama town, Oromia, Ethiopia, from February 01 to 28, 2022. Methods : An institutional-based cross-sectional study was conducted among 429 health care providers selected using a multistage sampling technique. Data was collected by an interviewer-administered questioner, then entered into Epi-Info version 7.2 and exported to SPSS version 22 for analysis. Descriptive statistics was performed to describe the study population. A simple binary logistic regression analysis was performed, and variables with a p-value < 0.25 were selected for multivariable regression analysis. The association between dependent and independent variables was estimated by an adjusted odds ratio along with a 95% confidence interval (CI). P-value < 0.05 was considered to declare statistical significance. Results : Among the total study participants, 261 (61.3%) (95% CI: 56.8%–66.2%) of healthcare providers had a good level of knowledge of preconception care. Among respondents' characteristics, the odds of having a good level of knowledge on preconception care were significantly associated with: male healthcare providers (AOR: 2.25, 95% CI: 1.28–3.95); bachelor of science degree and above holders (AOR: 2.77, 95% CI: 1.4-5.52); medical doctors (AOR: 5.16, 95% CI: 1.6-16.57); midwives (AOR: 3.75, 95% CI: 1.52-9.3); urban extension workers (AOR: 0.34, 95% CI: 0.13-0.89); internet users (AOR: 2.73, 95% CI: 1.44-5.2) and access to a national preconception care protocol (AOR: 1.92, 95% CI: 1.07-3.44). Conclusion : More than half of healthcare providers in Adama town public health facilities were knowledgeable about preconception care. Male healthcare providers, BSc degree holders, medical doctors, midwives, urban extension workers, internet users, and access to the national preconception care protocol were found to be significantly associated factors. The Regional Health Bureau and Ministry of Health should prepare comprehensive preconception care guidelines and provide learning opportunities for urban health extension workers, diploma health care providers to upgrade their education level and provide continuous pre-service and in-service training on preconception care for all health care providers. Adama Ethiopia health care providers knowledge Oromia preconception care public health institutions Figures Figure 1 Introduction The World Health Organization (WHO) defines preconception care as the provision of biomedical, behavioral, and social health interventions to women and couples before pregnancy occurs. Aimed at improving their health status, reducing individual behavior and environmental factors, that contribute to poor maternal and child health outcomes in both the short and long term. Generally, preconception care and its boundaries are defined as: "any preventive, promotive, or curative health care intervention provided to women of childbearing age" (1-3). A preconception period is a period from "3 months before conception" to "a minimum of 1–2 years before the initiation of any unprotected sexual intercourse that could possibly result in a pregnancy" (4, 5). Preconception care (PCC) packages include screening and intervention for chronic illness, nutritional conditions, genetic and environmental conditions, infertility, family planning, violence, unintended pregnancy, sexually transmitted infections (STI), including human immunodeficiency virus (HIV), mental health, substance use, vaccine preventable disease, and female genital mutilation, to reduce maternal and child mortality, and improve maternal and child health outcomes. Preconception care is an important component of maternal health care to improve maternal and child health (MCH) outcomes and address the Sustainable Development Goal (SDG) plan in 2030 (6, 7). Providing preconception care is the responsibility of all healthcare providers (HCP), especially in primary care, and is not limited to clinicians in maternity care. Asking a woman or couple a simple question like "Are you considering pregnancy in the near future, or could you possibly become pregnant soon?" can initiate several preconception care interventions, such as a discussion about the clients readiness for pregnancy, an evaluation of overall health and opportunities for improvement in health condition, and the implementation of preventive measures (8, 9). The most recently identified but effective evidence-based intervention among the continuum of the spectrum of maternal and child health services is preconception care. It is a unique and innovative approach that identifies couples contemplating pregnancy before conception and modifies biomedical, behavioral, social, and environmental risk factors leading to adverse pregnancy outcomes (APOs). Except for its proven benefits, so far, there is no existing evidence depicting the disadvantages of PCC. Conscious of this fact, the CDC in 2006 and the WHO in November 2012 gave a recommendation for the implementation of preconception and inter conception care interventions as part of the overall national and international health system (1, 4, 6, 10, 11). Reproductive planning has the potential to considerably reduce maternal, new born, infant and child deaths. It could decrease 71% of unwanted pregnancies, thereby eliminating 22 million unplanned births, 25 million induced abortions and 7 million miscarriages. Reproductive planning has other far-reaching effects. By supporting women to make well-informed and well-considered decisions about their fertility and their health, preconception care contributes to the social and economic development of families and communities. By creating awareness of the importance of men’s health and men’s behaviors on maternal and child health outcomes, and by promoting male involvement, preconception care has additional benefits (8, 12). In the United States of America (USA), approximately 50% of pregnancies are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental exposures, chronic and acute illnesses, and ingestion of teratogens that can negatively affect the fetus may occur during these early weeks of pregnancy. Some chronic disease effects and lifestyle behaviors that affect the fetus can be adjusted prior to conception. Because of this, the health of a woman and her partner prior to pregnancy is of utmost importance (13). Nearly all of the adverse pregnancy outcomes (APOs) are reported from low-income countries. For instance, the vast majority (99%) of all maternal deaths, more than 60% of preterm births, 96.5% of low birth weight, 98% of stillbirths, and 99% of neonatal deaths are happening in developing countries, especially in Sub-Saharan Africa, where Ethiopia is located. Most of the factors contributing to APOs are avoidable. The most widely known APOs preventive interventions include antenatal care, institutional delivery, and postnatal care. These packages of maternal health care services have been shown to be effective over the last three to four decades, but they cannot address all APOs. With these interventions, the healthcare providers (HCPs) are acting too late after the conception has happened and the woman is aware of her pregnancy after critical embryonic phase was passed (7, 14). Essential health interventions provided once a woman and her partner decide to have a child will be too late in 40% of pregnancies. Up to 35% of pregnancies among women with untreated gonococcal infections result in low-birth weight infants and premature deliveries, and up to 10% result in perinatal death. Maternal under nutrition and iron deficiency anemia increase the risk of maternal death, accounting for at least 20% of maternal mortality worldwide. Women with epilepsy and diabetes are at an increased risk of having babies with congenital anomalies (both the disease and the medications given for its control may have adverse effects on the baby). Female genital mutilation raises the risk of neonatal death from 15% to 55%, mother-to-child HIV transmission without intervention from 15% to 45%, and smoking causes of sudden infant death syndrome from 23% to 24% globally (15, 16). Unfortunately, the first antenatal care visit happens after 12 weeks of gestation. The early gestational weeks are missed periods, which are critical to the development of the fetal organs. Irreversible and major damage to the fetus occurs during this critical period. That is why the existing interventions are too late to prevent APOs from happening during this critical period. In addition, these interventions are not totally designed to target the preconception risk factors leading to the development of APOs happening within the critical period mentioned (4, 12). Despite the fact that all babies and children male and female had the right to survive, grow, and develop in good health. Similarly, all women and men have the right to be healthy physically, mentally, and socially. For this to happen, strong public health programs that use a life-course perspective from infancy through childhood and adolescence to adulthood are needed. The reality is that such preconception care does not exist or is very weak in most low and middle-income countries (10, 17). Globally, level of healthcare providers’ knowledge about preconception care varies among countries. In USA, 87% of physicians think PCC is important and 94% of them are almost always recommend it to women planning a pregnancy (18). In Dutch, 93% of community midwives were familiar with the concept of PCC (19). In Iran, 63.6% of physicians, 68% of health technicians and 74.6% of healthcare social workers had moderate knowledge and 66.7% of Bachelors of Science in family health had a good knowledge about PCC (20). In Nepal, among bachelor level nursing Students; only 9.4% had adequate level of knowledge on PCC (21). A Study conducted in Nepal among bachelor nursing students of selected nursing campuses of Tribhuvan University showed that level of knowledge about PCC was significantly associated with Job training (19). In Iran, among HCPs there was a significant correlation between work experience and knowledge in relation to PCC (22). A study Nigeria, among nurses and women’s there was no significant association between nurses’ knowledge of PCC and their willingness to practice and also the nurses’ workplace had no significant effect on knowledge of PCC (23). There is no available literature that shows the association between knowledge of HCPs about PCC in east African countries rather than in Ethiopia, but according to the study conducted in Kenya among women of reproductive age on utilization of preconception care services, shows that level of mothers' knowledge on PCC, age of a woman, and occupation of a woman were significantly associated with PCC service utilization (24). Data shows that developed countries have better knowledge and implementation, whereas HCP in some Asian and all African countries have little knowledge of PCC. It is available in a number of African countries, including Egypt, Nigeria, Sudan, Kenya, and South Africa (1, 9, 25, 26). Studies in Africa, in Nigerian, 83.3% of Doctors and nurses had heard about PCC, and 91.6% defined it correctly and only 23% of HCPs knew more than 75% of the components of PCC(27). And 65.8% of nurses had good knowledge of PCC and 82.9% agreed that it was a primary strategy that to prevent APOs (23). In Egypt, 22% of HCPs have good knowledge and 48.5% of them have positive attitude towards PCC (28). Studies in Ethiopia, in Hawassa town, 43% of HCPs had lower or poor, and 26% had medium PCC knowledge and 31% had high knowledge on PCC (29). Similarly in North West Ethiopia, Awi zone, 52% of HCPs had good knowledge on PCC (30). In North Wollo zone, 50.9% of the HCPs had low, 45.3% had medium, and only 3.7% had high knowledge on PCC service (31). In Eastern Ethiopia (Harar and Dire Dawa town) 32.0% of HCPs had high, 28.8% had moderate, and 39.3% had poor knowledge of PCC (32). In Tikur Anbessa Hospital, among physicians’, 69.2% had good, 26.9% had moderate, and 3.8% had poor knowledge about PCC (33). In Ethiopia PCC service is not included in the health care provider’s pre-service training curriculum except obstetrics/gynecology specialty. 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 with its full components, Even though one way of improving women’s awareness and utilization of PCC services is by improving health care provider’s knowledge and practice (34, 35). This necessitates an investigation into the knowledge of healthcare providers on PCC in a study area where there have been few studies on the subject, with the majority of other studies focused on assessing women's knowledge in a situation where in a country almost no PCC services are available. There are no published documents that address this topic to our knowledge, so the purpose of this study was to document the level of knowledge on preconception care and assess associated factors among healthcare providers working in public health institutions in study area. Thus, this study seeks to fill the knowledge gap and establish a foundational dataset to inform targeted strategies for improving the preconception care in the specific context of public health institutions in Adama town. Methods Study area and period The study was conducted in Adama town, public health facilities, which is located 91 km to the south-east of the capital city (Addis Ababa) of Ethiopia. According to the data from Adama health office in 2021; Adama has an estimated population of 448,462 (222,355 males and 226,107 females) Adama has one government comprehensive specialized hospital as well as eight government health centers providing all levels of healthcare services for the town’s residents and its surroundings. During the study period, 863 healthcare providers were working in public health institutions. Of all the HCPs, the majority of them are nurses (358), doctors (94), health extension workers (91), midwives (83), public health officers (68), pharmacists (65), and laboratory technologists (52) identified respectively. The MCH service in Adama town health facilities includes antenatal care, institutional delivery, and postnatal care services. These services are provided in every health facility by all HCPs, but mainly by midwives and gynecologists. PCC is not a specified area of care in any of these facilities. (Data from Adama town health office and Adama hospital medical college/AHMC, unpublished). This study was conducted from February, 01 to 28, 2022. Study design, study population, and inclusion criteria An institutional-based cross-sectional study design was used. All healthcare providers working in Adama town public health facilities were the source population. Healthcare providers working in selected public health facilities during the data collection period and who fulfilled the inclusion criteria were considered for the study. The inclusion criteria were all healthcare providers who are working at the period of data collection, excluding healthcare providers who were not permanently recruited and students. Sample size determination and sampling procedure Sample size was calculated using single population proportion formula based on the following parameter: Estimated proportion of healthcare providers with good knowledge of PCC (P) = 31% taken from a study done in Hawassa town (29). The level of confidence within which the proportion of good knowledge of PCC estimated with = 95%. Hence the corresponding standard value Z α/2= 1.96. The required sample size (n). The maximum tolerable margin of error (d) taken as 4% to increase the sample size. Then, sample size is determined as: Since the sampling procedure is multistage, the design effect is taken as 1.5 and the sample size is multiplied as 514*1.5 = 771 (total sample size after design effect is multiplied). Since the total population studied was less than 10,000 so, the final sample correction formula was applied as follows: Where: n= is the non-corrected sample size; N= is the size of the source population The corrected sample size was 408 by adding a 5% non-response rate, the final sample size was 429. Sampling procedure A two-stage stratified sampling technique was applied to select a total of 429 HCPs. The first sampling unit was health facilities, and first, the facilities were stratified into hospitals and health centers. Then, from all the public health facilities in Adama town (one comprehensive specialized hospital and eight health centers), randomly, one hospital and five health centers were selected. The second sampling unit was the profession and working department. The study participants were selected from each stratum using the probability proportional to size method. HCPs were selected by using a systematic random sampling method using an employer’s employee registry document as a sampling frame. The sampling procedure for HCPs in Adama town public health institutions is depicted schematically ( Figure 1 ). Study variables Dependent variable Knowledge of healthcare providers on preconception care. Independent variables Socio-demographic characteristics: age, sex, marital status, education level and salary. Working: profession, patient load, service year, types of health institutions. Access to PCC information: availability of national policy and guide line, use of smart phone and internet, availability of library in the facility, trainings on PCC packages, reading PCC guide line. Operational definition Healthcare providers: In this study, healthcare providers include doctors, nurses, midwives, public health officers, pharmacists, medical laboratories, and health extension workers who are nationally certified and working in public health institutions (30). High PCC knowledge: According to Bloom’s cut off point, respondents who were responding greater than or equal to 80% of the aggregated 18 PCC knowledge questions. Moderate PCC knowledge: According to Bloom’s cut off point, respondents who were responding 60-79% of the aggregated 18 PCC knowledge questions. Low PCC Knowledge: According to Bloom’s cut off point, respondents who were responding to less than 60% of the aggregated 18 PCC knowledge questions. The model using three categories must have to full fill the ordinary regression assumption, but didn't full fill. So, by considering this and based on previous literatures, the model was changed to binary logistic regression by merging blooms high and moderate PCC knowledge classifications into good PCC knowledge and blooms low PCC knowledge classification was taken as it is by renaming as poor level of knowledge on PCC. Good PCC knowledge: Respondents who responded ≥60% of the 18 PCC knowledge questions. Poor PCC knowledge: Respondents who responded <60% of the 18 PCC knowledge questions (31). Data collection tool An interviewer-administered semi-structured questionnaire was used. A data collection tool named "Andarg-Ethio PCC-KAP-Questionnaire for HCPs" was adapted from a study conducted in Hawassa town (29). Its content validity index was 92.4%. Reliability was checked with Cronbach’s test and demonstrated a score of 0.945. And used after some modifications were made. The questionnaire consists of socio-demographic characteristics, access to information, and professional-related questions and 18 true or false questions aimed to assess HCPs’ knowledge on PCC. Each of the knowledge assessment questions had only one correct answer. The questionnaire was originally prepared in English and then translated into the local language (Afan Oromo) and national language (Amharic) were used for data collection, and then translated back to English for data entry and analysis purposes. Data collection procedures The data was collected in the health facilities during the daytime by five experienced and pre-trained BSc nurses. Face-to-face interviews were conducted and all selected HCPs participated after providing informed consent and without coercion. Data quality assurance To ensure data quality, a pre-test was administered to 5% (22) of the sample size in Olenchiti hospital and health center, which are located 25 km from Adama town, and then some corrections were made before the actual data collection. One-day training for data collectors on the contents of questions, informed consent, the objective of the study, and the method of data collection was given before the execution of the entire data collection process. In addition, supervision was done during the period of data collection by two supervisors and the principal investigator. During the data collection process, each questionnaire was checked daily by the principal investigator and supervisors for its completeness, accuracy, and consistency, and correction feedback was offered to data collectors accordingly during the data collection period on a daily basis. Double data entry was performed by Epi-info software version 7.2 before further analysis was performed. Data processing and analysis The collected data was coded and entered into Epi-info version 7.2 and then exported to Statistical Package for Social Sciences (SPSS) version 22.0 for analysis. After normality assumption was checked and full field, descriptive statistics were performed by computing summary statistics like frequency, percentages, mean and standard deviation to characterize the study participants. The results were presented in tables. Binary logistic regression was used to identify factors associated with knowledge of PCC. First, the assumptions for binary logistic regression were checked before analysis. A standard model building approach was used to fit the regression model. In the process of fitting the model, first, a simple logistic regression analysis was performed to assess the crude relationship between the independent variables and the dependent variable. Variables having a P-value of less than 0.25 were considered as candidates for multivariable logistic regression. The fitness final model was assessed for multi-collinearity among the independent variables using variance inflation factors (VIF) and goodness of fit using the Hosmer and Lemishow tests, which found that VIF values of less than 5 or no multicollinearity were detected, and the p value for goodness of fit was found to be greater than the significance level (p value = 0.05) and was accepted. Then all candidate variables were subjected to multivariable logistic regression to identify the variables which had significant associations with knowledge of PCC. After controlling for the effect of possible confounding effects, the magnitude of the association between PCC knowledge and independent variables was estimated using an adjusted odds ratio (AOR) and 95% CI, with significance declared at a P value less than 0.05. Results Socio-demographic characteristics of the study participants Among a planned sample of 429 health care providers, 426 participants participated in the study. This makes the response rate of 99.3%. Among the study participants, 177 (41.5%) were aged between 26 and 30. 261 (60.8%) of the HCPs were female. Concerning the level of education, 266 (62%) of HCPs were BSc degree holders ( Table 1 ). Table 1. Socio-demographic characteristics of HCPs working in public health facilities in Adama town, Oromia, Ethiopia. Category Number Percent (%) Age 21-25 46 10.8 26-30 177 41.5 31-35 119 27.9 ≥36 84 19.7 Sex Male 165 38.7 Female 261 61.3 Marital status Single 139 32.6 Married 272 63.8 Divorced/widowed/living together 15 3.5 Religion Orthodox 221 51.9 Protestant 115 27 Muslim 83 19.5 Other* 7 1.6 Educational Status Diploma 75 17.6 BSc degree 266 62.4 Masters 31 7.3 General practitioner 20 4.7 Specialist 34 8 Profession Medical doctor 55 12.9 Nurse 180 42.3 Midwife 49 11.5 Public health officer 26 6.1 Urban extension worker 41 9.6 Pharmacist & druggist 24 6.6 Laboratory technician &technologist 26 6.1 Other** 21 4.9 Experience Below 5 184 43.2 5 & above 242 56.8 Monthly salary Below 5000 ETB 23 5.4 5000 & above ETB 403 94.6 * = Wakefata; ** = Druggist, Physiotherapist; ETB = Ethiopian birr Access to preconception care information and working factors Among the study participants, 303 (70.6%) of the respondents were worked in a hospital, and 103 (23.5%) of HCPs were worked in the departments of obstetrics and gynecology. Two hundred forty nine (58.5%) of HCPs had no procedural documents that guided PCC in their institution. Two hundred eighty eight (67.6%) of participants had no access to Ethiopian ministry of health PCC guidelines or protocol, and 262 (61.5%) of HCPs had no HCPs practicing or providing PCC in their facility, and also 374 (87.8%) of HCPs hadn’t received PCC training until this study was conducted ( Table 2 ). Table 2: Access to preconception care information and working factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia. Variables Number Percent (%) Type of health institution Hospital Health center 303 70.6 123 28.7 Department of currently working OB/Gyn Internal Medicine Pediatrics Surgery Laboratory Pharmacy Operation room ART room Radiology Other* 100 23.5 96 22.5 32 7.5 41 9.6 27 6.3 29 6.8 31 7.3 17 4 12 2.8 41 9.6 Average patient/client load per day per provider 1-15 16-30 ≥31 214 50.2 105 24.6 107 25.2 Access to internet Yes No 344 80.9 81 19.1 Use of smart phone in clinical practice Yes No 293 68.8 133 31.2 Have library in the institution Yes No 231 53.8 195 45.5 Presence of procedural document guiding about PCC in institution Yes No 177 41.5 249 58.5 Access to national guideline or protocol prepared by EFMOH Yes No 138 32.4 288 67.6 Presence of any HCPs practicing PCC in the health facility Yes No 164 38.5 262 61.5 Have you receive PCC training Yes No 52 12.2 374 87.8 * indicates ophthalmology, dermatology, oncology, psychiatry, gastroenterology, physiotherapy, dentistry. Abbreviation: OB/Gyn = obstetrics and gynecology, ART = anti-retroviral therapy Knowledge questions response Among the healthcare providers who participated in this study, out of the all (18) PCC knowledge assessment questions, 367 (86.2%) of HCPs correctly answered the question "the recommended routine preconception laboratory tests include Hgb, HBV, HIV, and RPR or VDRL tests" and, similarly, 363 (85.2%) of HCPs correctly answered the question "women planning pregnancy should be advised to delay pregnancy until reducing drug, alcohol, and tobacco use." On the other hand, out of 18 aggregated PCC knowledge questions, only 117 (27.7%) of HCPs were correctly answered for a question; "women with asthma planning pregnancy should avoid taking Salbutamol one month before and after conception" and 139 (32.6%) of HCPs were correctly answered for a question; "The recommended test that guarantees good preconception blood sugar control for a woman with pre-gestational diabetes is the RBS test" ( Table 3 ). Table 3: Shows aggregates of 18 PCC knowledge assessment questions among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia. S.N Preconception care knowledge questions Correctly answered Not correctly answered (%) (%) 1 The eligible clients for PCC include all adolescents and reproductive-aged individuals 308(72.3) 118(27.7) 2 To be effective, PCC should start 4 weeks before conception 238(55.9) 188(44.1) 3 Periodontal disease is a risk factor for adverse pregnancy outcomes 204(47.9) 222(52.1) 4 Women with body mass index ≤ 18.4 planning pregnancy are at risk of developing adverse pregnancy outcomes. 233(54.7) 193(45.3) 5 All women of reproductive age should take 0.4 mg (400 mcg) of folic acid daily. 195(45.8) 231(54.2) 6 The recommended routine preconception laboratory tests include Hgb, HBV, HIV, and VDRL tests. 367(86.2) 59(13.8) 7 Preconception genetic counseling and screening include recommending carrier screening tests for client with sickle cell hemoglobinopathies. 246(57.7) 180(42.3) 8 A clinician providing PCC for clients with diabetes mellitus and chronic hypertension should recommend genetic screening testing 269(63.1) 157(36.9) 9 Isotretinions, Valproic acid, and Warfarin are medications requires preconception modification. 206(48.4) 202(51.6) 10 Women with asthma planning pregnancy should avoid taking Salbutamol one month before and after conception. 118(27.7) 308(72.3) 11 Early identification and treatment of diseases like depression, seizure disorder, and phenylketonuria during the preconception period reduce the occurrence of adverse pregnancy outcomes. 323(75.8) 103(24.2) 12 The recommended test that guarantees good preconception blood sugar control for a woman with pre-gestational diabetes is RBS test. 139(32.6) 287(67.4) 13 Except Influenza vaccine, vaccines such as Human Papilloma virus, Rubella, and Varicella are all vaccines contraindicated during pregnancy. 173(40.6) 253(59.4) 14 Recommending regular exercise is an important preconception counseling point. Thus, a women planning pregnancy should aim 30 minutes of moderate exercise 5 days a week. 239(56.1) 187(43.9) 15 Women planning pregnancy should be advised to delay pregnancy until reducing drug, alcohol and tobacco use. 363(85.2) 63(14.8) 16 Avoidance of exposure to environmental hazards or toxin such as ionizing radiation, pesticide, lead, mercury, & pets is a concern for a woman with established first trimester pregnancy not for couples planning pregnancy. 224(52.6) 202(47.4) 17 A clinician attending clients with previous caesarian section should advise the client to delay the next pregnancy for at least 18 months before next conception. 295(69.2) 131(30.8) 18 Infertility screening and management is not the concern of preconception care. 260(61) 166(39) Hgb = hemoglobin, HBV = hepatitis B virus, VDRL = venereal disease research laboratory, RBS = random blood sugar. Level of knowledge on preconception care Out of 18 true/false PCC knowledge questions, the minimum knowledge score of the respondents was 0 points (4 participants), and the maximum score was 18 points (only 1 participant). The mean score of HCP's knowledge on PCC was 10.3 points (95% CI: SD ± 3.560). Among participated healthcare providers 261 (61.3%) (95% CI: 56.8%-66.2%) had good level of knowledge on PCC. Factors associated with knowledge o n preconception care A binary logistic regression analysis was conducted to identify factors associated with the HCPs' knowledge of PCC. First simple regression analysis was performed, and then accordingly variables of:- provider`s sex, service year, profession, level of education, monthly salary, types of public health institution, presence of the library in the institution, using a smart-phone to share e-resources, access to internet, and accessing national PCC guidelines were significantly associated with HCPs’ knowledge on PCC at p-value < 0.25. And then these variables were subjected to multiple regression analysis. After adjusting for possible confounding effects in the multiple regression model, sex of respondents, profession, educational status, use of smart phones, internet access, and access to national PCC protocol were identified among variables which had statistically significant associations with knowledge of PCC among HCPs at p-value less than 0.05. According to the study findings, male HCPs had 2.25 times the odds of having a good level of PCC knowledge as compared to female healthcare providers (AOR: 2.25, 95% CI: 1.28-3.95). Medical doctors were 5.16 and midwives were 3.75 times more knowledgeable about PCC than nurse professionals, with an (AOR of 5.16, 95% CI: 1.6-16.57) and (AOR: 3.75, 95% CI: 1.52-9.3), respectively. But the odds of having knowledgeable on PCC were lesser among urban health extension workers as compared to nurses with an (AOR: 0.34 95% CI 0.13-0.89). Similarly, HCPs with a BSc degree or higher educational level had 2.77 times more knowledge on PCC as compared to diploma holders (AOR: 2.77, 95% CI: 1.4-5.52). HCPs who had internet access had 2.73 times higher odds of having good knowledge of PCC than those who had no access (AOR: 2.73, 95% CI: 1.44-5.2). And also, HCPs who had national PCC protocol in their health facility were 1.92 times higher odds to have good knowledge of PCC than those who had no PCC guidelines (AOR: 1.92, 95% CI: 1.07-3.44) ( Table 4 ). Table 4: Factors associated with knowledge of preconception care among HCPs working in public health facilities in Adama town, Oromia, Ethiopia. Variables Knowledge on PCC COR(95%CI) AOR(95%CI) Good (%) Poor (%) Sex Male 123 (74.5) 42 (25.5) 2.61 (1.7-3.8) 2.25 (1.28-3.95)** Female 138 (52.9) 123 (47.1) 1 Profession Nurse 103 (57.2) 77 (42.8) 1 Medical doctor 51 (92.7) 4 (7.3) 9.5 (3.30-27.5) 5.16 (1.6-16.57)** Midwife 42 (85.7) 7 (14.3) 4.5 (1.91-10.52) 3.75 (1.52-9.3)** Public health officer 18 (69.2) 8 (30.8) 1.7 (0.7-4.07) 0.95 (0.35-2.58) Urban extension 12 (29.3) 29 (70.7) 0.31 (0.14-0.65) 0.34 (0.13-0.89)** Pharmacist & druggist 17 (60.7) 11 (39.3) 1.15 (0.51-2.60) 0.9 (0.36-2.21) Laboratory technologist 12 (46.2) 14 (53.8) 0.64 (0.28-1.46) 0.43 (0.16-1.11) Educational status Diploma 30 (40) 45 (60) 1 BSc degree and above 231 (65.8) 120 (34.2) 2.88 (1.73-4.81) 2.77 (1.4-5.52)** Salary <5000 ETB 15 (65.2) 8 (34.8) 1 ≥5000 ETB 246 (61) 157 (39) 0.84 (0.34-2.01) 0.19 (0.55-0.65) Year of experience <5 115 (62.5) 69 (37.5) 1 ≥5 146 (60.3) 96 (39.7) 0.9 (0.61-1.35) 1.78 (0.95-3.3) Types of PHI Hospital 198 (65.3) 105 (34.7) 1.8 (1.2-2.7) 0.94 (0.5-1.76) Health center 63 (51.2) 60 (48.8) 1 Use of smart phone for CR Yes 201 (68.6) 92 (31.4) 2.6 (1.74-4.050 1.7 (0.99-2.85) No 60 (45.1) 73 (54.9) 1 Presence of library Yes 153 (66.2) 78 (33.8) 1.6 (1.06-2.34) 0.9 (0.53-1.56) No 108 (55.4) 87 (44.6) 1 Internet access for CR Yes 227 (66) 117 (34) 2.82 (1.72-4.64) 2.73 (1.44-5.2)** No 33 (40.7) 48 (59.3) 1 Access to national PCC protocol Yes 97 (70.3) 41 (29.7) 1.79 (1.16-2.76) 1.92 (1.07-3.44)** No 164 (56.9) 124 (43.1) 1 ** = p value < 0.05, CR = clinical resource, ETB = Ethiopian birr, PHI = public health institution, 1 = reference category. Discussion Healthcare providers don’t usually practice what they don’t know, so the level of healthcare providers' knowledge is the most critical point in providing PCC service ( 26 ). This study found that 61.3% (95% CI: 56.8–66.2%) of HCPs had a good level of knowledge on PCC. This finding is nearly identical to the finding of an Eastern Ethiopian study, which discovered that 60.8% of HCPs had a high level of PCC knowledge ( 32 ). And also, similarly, consistent with the study conducted in Nigeria, 65.8% of the HCPs had good knowledge of PCC ( 27 ). However, the result of this study is lower than the studies done in Awi Zone (52% of HCPs had good knowledge of PCC) and North Wollo (50.9%) of HCPs had good knowledge of PCC) ( 30 ) and also higher than the study done in Egypt ( 28 ). A possible explanation could be due to differences in the types of working institutions (in this study, the majority of healthcare providers were from the teaching hospital) and study period (could be in the availability of PCC guidelines and protocol while the study was conducted). According to the study findings, male HCPs, healthcare providers with internet access, HCPs with the professions of medical doctor and midwife, urban extension workers, HCPs with a BSc degree or higher, and access to national PCC protocol in public health facilities were found to have a statistically significant association with knowledge of PCC. Regarding the sex of study participants, it was found that males were 2.25 times higher odds of having good knowledge of PCC as compared to female healthcare providers. This finding is in line with studies conducted in Hawas town. but not supported, according to a study report conducted in Egypt ( 28 ). The difference may be due to the discrepancy in the distribution of HCPs in public health institutions and unequal opportunities for educational advancement between male and female HCPs. Healthcare providers with a bachelor's degree or higher were 2.77 times higher odds of having good knowledge on PCC than diploma holders. This result is supported by a study conducted among HCPs in the North Wollo zone ( 31 ) and eastern Ethiopia ( 32 ). This is due to the fact that HCPs with higher education may have more exposure to health information and better knowledge about PCC components and due to the difference in the curriculum contents of the training programs given at diploma, degree, and specialty level to bring improvement in the level of practice as they advance from one level to another. According to this study result, HCPs with a medical doctor were 5.16 times higher odds of having good knowledge on PCC, Similarly; midwives were also 3.75 times more knowledgeable than nurse’s professionals. A similar finding was witnessed in study conducted among HCPs in public health institutions in the north Wollo zone( 31 ). But the odds of having good knowledge on PCC were lesser among urban health extension workers as compared to nurse`s professionals this finding was consistent with the study conducted in North Wollo ( 31 ). The findings of the study revealed that healthcare providers using the internet for accessing, downloading, and reading clinical resources had better knowledge of preconception care than healthcare providers who did not use the internet. This finding was in agreement with the study done in Hawassa town ( 29 ). The utilization of the traditional library available at the health institutions did not enable access to updated scientific evidence for clinical cases as quickly as possible. As a result, using the internet improves healthcare providers' knowledge in resource-constrained settings and during the globalization era, which contributes to knowledge on preconception. This study found that healthcare providers who were accessed national PCC protocol were 1.9 times more knowledgeable on preconception care than those who had no PCC guideline and who didn’t read previously, which was consistent with a study conducted in Hawassa ( 29 ). The reason for this is that the guidelines provide updated step-by-step activities on components of PCC services as well as on the identification, prevention, and management of adverse pregnancy outcomes, which may have contributed to healthcare providers' knowledge increment on PCC. Strength and limitation of the study This study has not been conducted previously in this study area, and therefore may provide information for future researchers and other concerned bodies. The lack of similar literatures made it difficult for further discussion and comparison. The study was not also triangulated with qualitative methods. Conclusion More than half of healthcare providers in Adama town public health facilities were knowledgeable about preconception care. Male healthcare providers, BSc degree and higher holders, medical doctors, midwives, healthcare providers with internet access to share clinical resources, as well as healthcare providers who had access to national preconception care protocols, were significantly and positively associated with a good level of preconception care knowledge, whereas urban extension workers were significantly and negatively associated with a good level of preconception care knowledge. Urban health extension workers and others with limited knowledge of preconception care participate in knowledge improvement activities. Health centers should provide more knowledge improvement activities for urban health extension workers on PCC. Give more emphasis to urban health extension workers, female HCPs, and diploma holders' healthcare providers to give PCC knowledge improvement activities. The Regional Health Bureau and Ministry of Health should prepare comprehensive PCC guidelines and provide learning opportunities for urban health extension workers, diploma HCPs to upgrade their education level and provide continuous pre-service and in-service training on PCC for all HCPs. Abbreviations AHMC: Adama hospital medical college; AOR: adjusted odds ratio; APOs: adverse pregnancy outcomes; BSc: Bachelor of Science; CDC: centers for disease control and prevention; CI: confidence interval; HIV: human immunodeficiency virus; HCPs: healthcare providers; MCH: maternal and child health; NTD: neural tube defect; OR: odds ratio; PCC: preconception care; RPL: reproductive life plan; RTIs: reproductive tract infections; SDG: sustainable development goal; SPSS: statistical package for social sciences; STI: sexually transmitted infections; TB: tuberculosis; VIF: variance inflation factors; WHO: world health organization Declarations Acknowledgement We would like to express our sincere gratitude and deep appreciation to the School of Public Health at Adama Hospital Medical College for the approval of ethical clearance. We would also like to extend our gratitude to the Oromia Health Bureau Research IRB (institutional review board) and Adama Health Office for their letter of permission to conduct the study. Finally, our special thanks goes to the data collectors, supervisors, and participants. Authors’ contributions GG was involved in the study conception, design, analysis, and interpretation. GDF was involved in the review of the study design, analysis, interpretation, and was a major contributor in writing the manuscript and substantially modified it. Both authors read and approved the final manuscript. Funding Not applicable. Availability of data and materials The datasets generated and/or analyzed are available upon reasonable request from the corresponding author. Ethics approval and consent to participate First, ethical clearance was obtained from the Research Ethical Committee (REC) of the School of Public Health at Adama Hospital Medical College (Ref. No, 0916/KJ). Then, letters of permission were sought from Oromia Health Bureau Research IRB (Ref. No, BEFO/HBTFH/1-6/8064) and Adama Health Office (Ref. No, WEFBMA 2712/14). Following approval of ethical clearance and permission, formal letters were secured from Adama health office to each of the selected health facilities. After being permitted to conduct the research at the selected facilities, informed consent was obtained from each respondent before the actual data collection. Each respondent was informed about the objective of the study. The participants were told that their participation was purely voluntary and that their rights to not respond at all were respected and their confidentiality strictly maintained. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References WHO. Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva, Switzerland: WHO, 2013 2013. Report No. Pregancy birth and baby [Internet]. 2021 [cited 11/18/2021]. Available from: https://www.pregnancybirthbaby.org.au/planning-for-your-pregnancy. Organization WH. 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. 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 Suppl 3(Suppl 3):S1. Stephenson J, Heslehurst N, Hall J, Schoenaker D, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet (London, England). 2018;391(10132):1830-41. Organization WH. Pre-conception care: maximizing the gains for maternal and child health. Policy brief. 2013. 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Fuehrer L, Buckler E, Bowman E, Gregory T, McDaniel J. Promoting preconception health in primary care. Journal of the American Academy of PAs. 2015;28(8):27-32. Posner SF, Broussard DL, Sappenfield WM, Streeter N, Zapata LB, Peck MG. Where are the data to drive policy changes for preconception health and health care? Women's health issues : official publication of the Jacobs Institute of Women's Health. 2008;18(6 Suppl):S81-6. Lassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure. Reproductive health. 2014;11 Suppl 3(Suppl 3):S6. Lassi ZS, Kedzior SG, Das JK, Bhutta ZA. PROTOCOL: Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐and middle‐income countries: A systematic review. Immunology. 2019;15(1-2). Moller AB, Patten JH, Hanson C, Morgan A, Say L, Diaz T, et al. 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Awareness of primary health care providers in el-minia governorate about preconception care, Egypt. el-minia med bull. EL-MINIA MED BULL. 2012;13:1. 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. 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;2020:6978171. Belay, Teketay, Debalkie. Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020. Research Squar. 2020. Sori SATR, K. Yadeta, T. A. Jiru, H. D. Metebo, K. N. Weldekidan, H. A. Regassa, L. D. Knowledge of preconception care and associated factors among maternal health care providers working in urban public health institutions of Eastern Ethiopia. Women's health (London, England). 2021;17:17455065211046139. Alemu W, Sisay S, Waji T. Knowledge, Attitude and practice of physicians at Tikur Anbesa Hospital on Preconception care. Ethiop Med J. 2019;57:02. Ayele AD, Belay HG, Kassa BG, Worke MD. Knowledge and utilisation of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reproductive health. 2021;18(1):78. AK B. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care(PCC) in the health system of Ethiopia plose one. 2017. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-5455142","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379562046,"identity":"91e33105-0f13-4481-bfc8-8bcc8045ee92","order_by":0,"name":"Gemechu Dereje Feyissa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYLACxgYQYmAwYKiQkAMJHHhAvJYzNsZgLQnEamFgbEtLBDPwaZF370588HPHYdl+6cMHCj6cOZw+P+zwQ6AtdnK6Ddi1GJ45u9mw98xh45l9aQmGMyoO5268nWYA1JJsbHYAh5YZudukGdsOJ244w2NgzHMGqGV2AkjLgcRtuLTMf7v9N0jL/jP8H4z/th1ON5yd/gGvFnkJ3m3MYFt4eBiMgd5PkJfOwW+LAU/uZsnetnTjGWfYDAx7ztgYbpDOKTiQYIDbL/LtZzd++NlmLdvfw/zM4EeFhLz87PTNHz5U2Mnh0mKAJM5mgBAxwK4cbEsDgs38AF1kFIyCUTAKRgEIAABvHWxi97RJiQAAAABJRU5ErkJggg==","orcid":"","institution":"Rift Valley University, Faculty of Health Sciences, Public Health Department, Adama","correspondingAuthor":true,"prefix":"","firstName":"Gemechu","middleName":"Dereje","lastName":"Feyissa","suffix":""},{"id":379562047,"identity":"3ac7b8ce-b014-49ab-ada2-b661bbdab294","order_by":1,"name":"Gemechis Girma","email":"","orcid":"","institution":"Adama Hospital Medical College, Department of Reproductive Health, Adama","correspondingAuthor":false,"prefix":"","firstName":"Gemechis","middleName":"","lastName":"Girma","suffix":""}],"badges":[],"createdAt":"2024-11-14 15:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5455142/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5455142/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72909272,"identity":"c6379548-b735-4a55-bb3a-2e82f294c694","added_by":"auto","created_at":"2025-01-03 14:30:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37271,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of sampling procedure for healthcare providers in Adama town public health institutions.\u003c/p\u003e\n\u003cp\u003eN= number of healthcare providers working in each health facilities; n= number of healthcare providers required from each health facilities\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5455142/v1/af76b365550d533c07e7871a.png"},{"id":72910053,"identity":"52eabff4-b0c5-4e67-9032-eeb9bae7e4eb","added_by":"auto","created_at":"2025-01-03 14:38:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1069339,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5455142/v1/8c2f9640-f5a1-4aac-a8d0-c5182ac9c296.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Level of knowledge on preconception care and associated factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) defines preconception care as the provision of biomedical, behavioral, and social health interventions to women and couples before pregnancy occurs. Aimed at improving their health status, reducing individual behavior and environmental factors, that contribute to poor maternal and child health outcomes in both the short and long term. Generally, preconception care and its boundaries are defined as: \u0026quot;any preventive, promotive, or curative health care intervention provided to women of childbearing age\u0026quot; (1-3). A preconception period is a period from \u0026quot;3 months before conception\u0026quot; to \u0026quot;a minimum of 1\u0026ndash;2 years before the initiation of any unprotected sexual intercourse that could possibly result in a pregnancy\u0026quot; (4, 5).\u003c/p\u003e\n\u003cp\u003ePreconception care (PCC) packages include screening and intervention for chronic illness, nutritional conditions, genetic and environmental conditions, infertility, family planning, violence, unintended pregnancy, sexually transmitted infections (STI), including human immunodeficiency virus (HIV), mental health, substance use, vaccine preventable disease, and female genital mutilation, to reduce maternal and child mortality, and improve maternal and child health outcomes. Preconception care is an important component of maternal health care to improve maternal and child health (MCH) outcomes and address the Sustainable Development Goal (SDG) plan in 2030 (6, 7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProviding preconception care is the responsibility of all healthcare providers (HCP), especially in primary care, and is not limited to clinicians in maternity care. Asking a woman or couple a simple question like \u0026quot;Are you considering pregnancy in the near future, or could you possibly become pregnant soon?\u0026quot; can initiate several preconception care interventions, such as a discussion about the clients readiness for pregnancy, an evaluation of overall health and opportunities for improvement in health condition, and the implementation of preventive measures (8, 9).\u003c/p\u003e\n\u003cp\u003eThe most recently identified but effective evidence-based intervention among the continuum of the spectrum of maternal and child health services is preconception care. It is a unique and innovative approach that identifies couples contemplating pregnancy before conception and modifies biomedical, behavioral, social, and environmental risk factors leading to adverse pregnancy outcomes (APOs). Except for its proven benefits, so far, there is no existing evidence depicting the disadvantages of PCC. Conscious of this fact, the CDC in 2006 and the WHO in November 2012 gave a recommendation for the implementation of preconception and inter conception care interventions as part of the overall national and international health system (1, 4, 6, 10, 11).\u003c/p\u003e\n\u003cp\u003eReproductive planning has the potential to considerably reduce maternal, new born, infant and child deaths. It could decrease 71% of unwanted pregnancies, thereby eliminating 22 million unplanned births, 25 million induced abortions and 7 million miscarriages. Reproductive planning has other far-reaching effects. By supporting women to make well-informed and well-considered decisions about their fertility and their health, preconception care contributes to the social and economic development of families and communities. By creating awareness of the importance of men\u0026rsquo;s health and men\u0026rsquo;s behaviors on maternal and child health outcomes, and by promoting male involvement, preconception care has additional benefits (8, 12).\u003c/p\u003e\n\u003cp\u003eIn the United States of America (USA), approximately 50% of pregnancies are unintended. Most pregnancies are not diagnosed until after the period of organogenesis. Environmental exposures, chronic and acute illnesses, and ingestion of teratogens that can negatively affect the fetus may occur during these early weeks of pregnancy. Some chronic disease effects and lifestyle behaviors that affect the fetus can be adjusted prior to conception. Because of this, the health of a woman and her partner prior to pregnancy is of utmost importance (13).\u003c/p\u003e\n\u003cp\u003eNearly all of the adverse pregnancy outcomes (APOs) are reported from low-income countries. For instance, the vast majority (99%) of all maternal deaths, more than 60% of preterm births, 96.5% of low birth weight, 98% of stillbirths, and 99% of neonatal deaths are happening in developing countries, especially in Sub-Saharan Africa, where Ethiopia is located. Most of the factors contributing to APOs are avoidable. The most widely known APOs preventive interventions include antenatal care, institutional delivery, and postnatal care. These packages of maternal health care services have been shown to be effective over the last three to four decades, but they cannot address all APOs. With these interventions, the healthcare providers (HCPs) are acting too late after the conception has happened and the woman is aware of her pregnancy after critical embryonic phase was passed (7, 14).\u003c/p\u003e\n\u003cp\u003eEssential health interventions provided once a woman and her partner decide to have a child will be too late in 40% of pregnancies. Up to 35% of pregnancies among women with untreated gonococcal infections result in low-birth weight infants and premature deliveries, and up to 10% result in perinatal death. Maternal under nutrition and iron deficiency anemia increase the risk of maternal death, accounting for at least 20% of maternal mortality worldwide. Women with epilepsy and diabetes are at an increased risk of having babies with congenital anomalies (both the disease and the medications given for its control may have adverse effects on the baby). Female genital mutilation raises the risk of neonatal death from 15% to 55%, mother-to-child HIV transmission without intervention from 15% to 45%, and smoking causes of sudden infant death syndrome from 23% to 24% globally (15, 16).\u003c/p\u003e\n\u003cp\u003eUnfortunately, the first antenatal care visit happens after 12 weeks of gestation. The early gestational weeks are missed periods, which are critical to the development of the fetal organs. Irreversible and major damage to the fetus occurs during this critical period. That is why the existing interventions are too late to prevent APOs from happening during this critical period. In addition, these interventions are not totally designed to target the preconception risk factors leading to the development of APOs happening within the critical period mentioned (4, 12).\u003c/p\u003e\n\u003cp\u003eDespite the fact that all babies and children male and female had the right to survive, grow, and develop in good health. Similarly, all women and men have the right to be healthy physically, mentally, and socially. For this to happen, strong public health programs that use a life-course perspective from infancy through childhood and adolescence to adulthood are needed. The reality is that such preconception care does not exist or is very weak in most low and middle-income countries (10, 17).\u003c/p\u003e\n\u003cp\u003eGlobally, level of healthcare providers\u0026rsquo; knowledge about preconception care varies among countries. In USA, 87% of physicians think PCC is important and 94% of them are almost always recommend it to women planning a pregnancy (18). In Dutch, 93% of community midwives were familiar with the concept of PCC (19). In Iran, 63.6% of physicians, 68% of health technicians and 74.6% of healthcare social workers had moderate knowledge and 66.7% of Bachelors of Science in family health had a good knowledge about PCC (20). In Nepal, among bachelor level nursing Students; only 9.4% had adequate level of knowledge on PCC (21).\u003c/p\u003e\n\u003cp\u003eA Study conducted in Nepal among bachelor nursing students of selected nursing campuses of Tribhuvan University showed that level of knowledge about PCC was significantly associated with Job training (19). In Iran, among HCPs there was a significant correlation between work experience and knowledge in relation to PCC (22). A study Nigeria, among nurses and women\u0026rsquo;s there was no significant association between nurses\u0026rsquo; knowledge of PCC and their willingness to practice and also the nurses\u0026rsquo; workplace had no significant effect on knowledge of PCC (23).\u003c/p\u003e\n\u003cp\u003eThere is no available literature that shows the association between knowledge of HCPs about PCC in east African countries rather than in Ethiopia, but according to the study conducted in Kenya among women of reproductive age on utilization of preconception care services, shows that level of mothers\u0026apos; knowledge on PCC, age of a woman, and occupation of a woman were significantly associated with PCC service utilization (24).\u003c/p\u003e\n\u003cp\u003eData shows that developed countries have better knowledge and implementation, whereas HCP in some Asian and all African countries have little knowledge of PCC. It is available in a number of African countries, including Egypt, Nigeria, Sudan, Kenya, and South Africa (1, 9, 25, 26). Studies in Africa, in Nigerian, 83.3% of Doctors and nurses had heard about PCC, and 91.6% defined it correctly and only 23% of HCPs knew more than 75% of the components of PCC(27). And 65.8% of nurses had good knowledge of PCC and 82.9% agreed that it was a primary strategy that to prevent APOs (23). In Egypt, 22% of HCPs have good knowledge and 48.5% of them have positive attitude towards PCC (28).\u003c/p\u003e\n\u003cp\u003eStudies in Ethiopia, in Hawassa town, 43% of HCPs had lower or poor, and 26% had medium PCC knowledge and 31% had high knowledge on PCC (29). Similarly in North West Ethiopia, Awi zone, 52% of HCPs had good knowledge on PCC (30). In North Wollo zone, 50.9% of the HCPs had low, 45.3% had medium, and only 3.7% had high knowledge on PCC service (31). In Eastern Ethiopia (Harar and Dire Dawa town) 32.0% of HCPs had high, 28.8% had moderate, and 39.3% had poor knowledge of PCC (32). In Tikur Anbessa Hospital, among physicians\u0026rsquo;, 69.2% had good, 26.9% had moderate, and 3.8% had poor knowledge about PCC (33).\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. 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 with its full components, Even though one way of improving women\u0026rsquo;s awareness and utilization of PCC services is by improving health care provider\u0026rsquo;s knowledge and practice (34, 35).\u003c/p\u003e\n\u003cp\u003eThis necessitates an investigation into the knowledge of healthcare providers on PCC in a study area where there have been few studies on the subject, with the majority of other studies focused on assessing women\u0026apos;s knowledge in a situation where in a country almost no PCC services are available. There are no published documents that address this topic to our knowledge, so the purpose of this study was to document the level of knowledge on preconception care and assess associated factors among healthcare providers working in public health institutions in study area. Thus, this study seeks to fill the knowledge gap and establish a foundational dataset to inform targeted strategies for improving the preconception care in the specific context of public health institutions in Adama town.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy area and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in Adama town, public health facilities, which is located 91 km to the south-east of the capital city (Addis Ababa) of Ethiopia. According to the data from Adama health office in 2021; Adama has an estimated population of 448,462 (222,355 males and 226,107 females) Adama has one government comprehensive specialized hospital as well as eight government health centers providing all levels of healthcare services for the town\u0026rsquo;s residents and its surroundings. During the study period, 863 healthcare providers were working in public health institutions. Of all the HCPs, the majority of them are nurses (358), doctors (94), health extension workers (91), midwives (83), public health officers (68), pharmacists (65), and laboratory technologists (52) identified respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe MCH service in Adama town health facilities includes antenatal care, institutional delivery, and postnatal care services. These services are provided in every health facility by all HCPs, but mainly by midwives and gynecologists. PCC is not a specified area of care in any of these facilities. (Data from Adama town health office and Adama hospital medical college/AHMC, unpublished). This study was conducted from February, 01 to 28, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design, study population, and inclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn institutional-based cross-sectional study design was used. All healthcare providers working in Adama town public health facilities were the source population. Healthcare providers working in selected public health facilities during the data collection period and who fulfilled the inclusion criteria were considered for the study. The inclusion criteria were all healthcare providers who are working at the period of data collection, excluding healthcare providers who were not permanently recruited and students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size was calculated using single population proportion formula based on the following parameter: Estimated proportion of healthcare providers with good knowledge of PCC (P) = 31% taken from a study done in Hawassa town (29). The level of confidence within which the proportion of good knowledge of PCC estimated with = 95%. Hence the corresponding standard value Z \u0026alpha;/2= 1.96. The required sample size (n). The maximum tolerable margin of error (d) taken as 4% to increase the sample size. Then, sample size is determined as:\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003eSince the sampling procedure is multistage, the design effect is taken as 1.5 and the sample size is multiplied as 514*1.5 = 771 (total sample size after design effect is multiplied). Since the total population studied was less than 10,000 so, the final sample correction formula was applied as follows: Where: n= is the non-corrected sample size; N= is the size of the source population\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cimg src=\"data:image/png;base64,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\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe corrected sample size was 408 by adding a 5% non-response rate, the final sample size was 429.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling procedure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA two-stage stratified sampling technique was applied to select a total of 429 HCPs. The first sampling unit was health facilities, and first, the facilities were stratified into hospitals and health centers. Then, from all the public health facilities in Adama town (one comprehensive specialized hospital and eight health centers), randomly, one hospital and five health centers were selected. The second sampling unit was the profession and working department. The study participants were selected from each stratum using the probability proportional to size method. HCPs were selected by using a systematic random sampling method using an employer\u0026rsquo;s employee registry document as a sampling frame. The sampling procedure for HCPs in Adama town public health institutions is depicted schematically (\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKnowledge of healthcare providers on preconception care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocio-demographic characteristics: age, sex, marital status, education level and salary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWorking: profession, patient load, service year, types of health institutions.\u003c/p\u003e\n\u003cp\u003eAccess to PCC information: availability of national policy and guide line, use of smart phone and internet, availability of library in the facility, trainings on PCC packages, reading PCC guide line.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare providers:\u003c/strong\u003e In this study, healthcare providers include doctors, nurses, midwives, public health officers, pharmacists, medical laboratories, and health extension workers who are nationally certified and working in public health institutions (30).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigh PCC knowledge:\u003c/strong\u003e According to Bloom\u0026rsquo;s cut off point, respondents who were responding greater than or equal to 80% of the aggregated 18 PCC knowledge questions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerate PCC knowledge:\u003c/strong\u003e According to Bloom\u0026rsquo;s cut off point, respondents who were responding 60-79% of the aggregated 18 PCC knowledge questions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLow PCC Knowledge:\u0026nbsp;\u003c/strong\u003eAccording to Bloom\u0026rsquo;s cut off point, respondents who were responding to less than 60% of the aggregated 18 PCC knowledge questions.\u003c/p\u003e\n\u003cp\u003eThe model using three categories must have to full fill the ordinary regression assumption, but didn\u0026apos;t full fill. So, by considering this and based on previous literatures, the model was changed to binary logistic regression by merging blooms high and moderate PCC knowledge classifications into good PCC knowledge and blooms low PCC knowledge classification was taken as it is by renaming as poor level of knowledge on PCC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGood PCC knowledge:\u003c/strong\u003e Respondents who responded \u0026ge;60% of the 18 PCC knowledge questions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePoor PCC knowledge:\u003c/strong\u003e Respondents who responded \u0026lt;60% of the 18 PCC knowledge questions (31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn interviewer-administered semi-structured questionnaire was used. A data collection tool named \u0026quot;Andarg-Ethio PCC-KAP-Questionnaire for HCPs\u0026quot; was adapted from a study conducted in Hawassa town (29). Its content validity index was 92.4%. Reliability was checked with Cronbach\u0026rsquo;s test and demonstrated a score of 0.945. And used after some modifications were made. The questionnaire consists of socio-demographic characteristics, access to information, and professional-related questions and 18 true or false questions aimed to assess HCPs\u0026rsquo; knowledge on PCC.\u0026nbsp;Each of the knowledge assessment questions had only one correct answer. The questionnaire was originally prepared in English and then translated into the local language (Afan Oromo) and national language (Amharic) were used for data collection, and then translated back to English for data entry and analysis purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was collected in the health facilities during the daytime by five experienced and pre-trained BSc nurses. Face-to-face interviews were conducted and all selected HCPs participated after providing informed consent and without coercion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality assurance\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure data quality, a pre-test was administered to 5% (22) of the sample size in Olenchiti hospital and health center, which are located 25 km from Adama town, and then some corrections were made before the actual data collection. One-day training for data collectors on the contents of questions, informed consent, the objective of the study, and the method of data collection was given before the execution of the entire data collection process. In addition, supervision was done during the period of data collection by two supervisors and the principal investigator. During the data collection process, each questionnaire was checked daily by the principal investigator and supervisors for its completeness, accuracy, and consistency, and correction feedback was offered to data collectors accordingly during the data collection period on a daily basis. Double data entry was performed by Epi-info software version 7.2 before further analysis was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe collected data was coded and entered into Epi-info version 7.2 and then exported to Statistical Package for Social Sciences (SPSS) version 22.0 for analysis. After normality assumption was checked and full field, descriptive statistics were performed by computing summary statistics like frequency, percentages, mean and standard deviation to characterize the study participants. The results were presented in tables. Binary logistic regression was used to identify factors associated with knowledge of PCC. First, the assumptions for binary logistic regression were checked before analysis. A standard model building approach was used to fit the regression model. In the process of fitting the model, first, a simple logistic regression analysis was performed to assess the crude relationship between the independent variables and the dependent variable. Variables having a P-value of less than 0.25 were considered as candidates for multivariable logistic regression.\u003c/p\u003e\n\u003cp\u003eThe fitness final model was assessed for multi-collinearity among the independent variables using variance inflation factors (VIF) and goodness of fit using the Hosmer and Lemishow tests, which found that VIF values of less than 5 or no multicollinearity were detected, and the p value for goodness of fit was found to be greater than the significance level (p value = 0.05) and was accepted. Then all candidate variables were subjected to multivariable logistic regression to identify the variables which had significant associations with knowledge of PCC. After controlling for the effect of possible confounding effects, the magnitude of the association between PCC knowledge and independent variables was estimated using an adjusted odds ratio (AOR) and 95% CI, with significance declared at a P value less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of the study participants\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong a planned sample of 429 health care providers, 426 participants participated in the study.\u0026nbsp;This makes the response rate of 99.3%. Among the study participants, 177 (41.5%) were aged between 26 and 30. 261 (60.8%) of the HCPs were female. Concerning the level of education, 266 (62%) of HCPs were BSc degree holders (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1. Socio-demographic characteristics of HCPs working in public health facilities in Adama town, Oromia, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e21-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e26-30 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e31-35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u0026ge;36 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e61.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e63.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eDivorced/widowed/living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eOrthodox \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e51.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eProtestant \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eOther*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eBSc degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMasters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eGeneral practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eSpecialist\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMedical doctor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eNurse \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003ePublic health officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eUrban extension worker \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003ePharmacist \u0026amp; druggist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eLaboratory technician \u0026amp;technologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eOther**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eBelow 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e5 \u0026amp; above\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly salary\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003eBelow 5000 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 312px;\"\u003e\n \u003cp\u003e5000 \u0026amp; above ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 141px;\"\u003e\n \u003cp\u003e94.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;* = Wakefata; ** = Druggist, Physiotherapist; ETB = Ethiopian birr\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccess to preconception care information and working factors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the study participants, 303 (70.6%) of the respondents were worked in a hospital, and 103 (23.5%) of HCPs were worked in the departments of obstetrics and gynecology. Two hundred forty nine (58.5%) of HCPs had no procedural documents that guided PCC in their institution. Two hundred eighty eight (67.6%) of participants had no access to Ethiopian ministry of health PCC guidelines or protocol, and 262 (61.5%) of HCPs had no HCPs practicing or providing PCC in their facility, and also 374 (87.8%) of HCPs hadn\u0026rsquo;t received PCC training until this study was conducted (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e2: Access to preconception care information and working factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of health institution \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHospital \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHealth center \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e28.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment of currently working \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eOB/Gyn \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eInternal Medicine \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePediatrics\u003c/p\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003cp\u003eLaboratory\u003c/p\u003e\n \u003cp\u003ePharmacy\u003c/p\u003e\n \u003cp\u003eOperation room \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eART room \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRadiology \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOther*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage patient/client load per day\u003c/strong\u003e \u003cstrong\u003eper provider \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1-15\u003c/p\u003e\n \u003cp\u003e16-30\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026ge;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to internet\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of smart phone in clinical practice\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave library in the institution\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of procedural document guiding about PCC in institution\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to national guideline or protocol prepared by EFMOH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of any HCPs practicing PCC in the health facility\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 439px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you receive PCC training\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e87.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* indicates ophthalmology, dermatology, oncology, psychiatry, gastroenterology, physiotherapy, dentistry. Abbreviation: OB/Gyn = obstetrics and gynecology, ART = anti-retroviral therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge questions response\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the healthcare providers who participated in this study, out of the all (18) PCC knowledge assessment questions, 367 (86.2%) of HCPs correctly answered the question \u0026quot;the recommended routine preconception laboratory tests include Hgb, HBV, HIV, and RPR or VDRL tests\u0026quot; and, similarly, 363 (85.2%) of HCPs correctly answered the question \u0026quot;women planning pregnancy should be advised to delay pregnancy until reducing drug, alcohol, and tobacco use.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the other hand, out of 18 aggregated PCC knowledge questions, only 117 (27.7%) of HCPs were correctly answered for a question; \u0026quot;women with asthma planning pregnancy should avoid taking Salbutamol one month before and after conception\u0026quot; and 139 (32.6%) of HCPs were correctly answered for a question; \u0026quot;The recommended test that guarantees good preconception blood sugar control for a woman with pre-gestational diabetes is the RBS test\u0026quot; (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTable 3: Shows aggregates of 18 PCC knowledge assessment questions among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"644\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS.N\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreconception care knowledge questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrectly answered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot correctly answered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(%) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eThe eligible clients for PCC include all adolescents and reproductive-aged individuals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e308(72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e118(27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eTo be effective, PCC should start 4 weeks before conception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e238(55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e188(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003ePeriodontal disease is a risk factor for adverse pregnancy outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e204(47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e222(52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eWomen with body mass index \u0026le; 18.4 planning pregnancy are at risk of developing adverse pregnancy outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e233(54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e193(45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eAll women of reproductive age should take 0.4 mg (400 mcg) of folic acid daily.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e195(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e231(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eThe recommended routine preconception laboratory tests include Hgb, HBV, HIV, and VDRL tests.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e367(86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e59(13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003ePreconception genetic counseling and screening include recommending carrier screening tests for client with sickle cell hemoglobinopathies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e246(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e180(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eA clinician providing PCC for clients with diabetes mellitus and chronic hypertension should recommend genetic screening testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e269(63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e157(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eIsotretinions, Valproic acid, and Warfarin are medications requires preconception modification.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e206(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e202(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eWomen with asthma planning pregnancy should avoid taking Salbutamol one month before and after conception.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e118(27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e308(72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eEarly identification and treatment of diseases like depression, seizure disorder, and phenylketonuria during the preconception period reduce the occurrence of adverse pregnancy outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e323(75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e103(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eThe recommended test that guarantees good preconception blood sugar control for a woman with pre-gestational diabetes is RBS test.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e139(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e287(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eExcept Influenza vaccine, vaccines such as Human Papilloma virus, Rubella, and Varicella are all vaccines contraindicated during pregnancy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e173(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e253(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eRecommending regular exercise is an important preconception counseling point. Thus, a women planning pregnancy should aim 30 minutes of moderate exercise 5 days a week.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e239(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e187(43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eWomen planning pregnancy should be advised to delay pregnancy until reducing drug, alcohol and tobacco use.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e363(85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e63(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eAvoidance of exposure to environmental hazards or toxin such as ionizing radiation, pesticide, lead, mercury, \u0026amp; pets is a concern for a woman with established first trimester pregnancy not for couples planning pregnancy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e224(52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e202(47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eA clinician attending clients with previous caesarian section should advise the client to delay the next pregnancy for at least 18 months before next conception.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e295(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e131(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003eInfertility screening and management is not the concern of preconception care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e260(61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e166(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHgb = hemoglobin, HBV = hepatitis B virus, VDRL = venereal disease research laboratory, RBS = random blood sugar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of knowledge on preconception care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 18 true/false PCC knowledge questions, the minimum knowledge score of the respondents was 0 points (4 participants), and the maximum score was 18 points (only 1 participant). The mean score of HCP\u0026apos;s knowledge on PCC was 10.3 points (95% CI: SD \u0026plusmn; 3.560). Among participated healthcare providers 261 (61.3%) (95% CI: 56.8%-66.2%) had good level of knowledge on PCC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with knowledge o\u003c/strong\u003e\u003cstrong\u003en preconception care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA binary logistic regression analysis was conducted to identify factors associated with the HCPs\u0026apos; knowledge of PCC. First simple regression analysis was performed, and then accordingly variables of:- provider`s sex, service year, profession, level of education, monthly salary, types of public health institution, presence of the library in the institution, using a smart-phone to share e-resources, access to internet, and accessing national PCC guidelines were significantly associated with HCPs\u0026rsquo; knowledge on PCC at p-value \u0026lt; 0.25. And then these variables were subjected to multiple regression analysis.\u003c/p\u003e\n\u003cp\u003eAfter adjusting for possible confounding effects in the multiple regression model, sex of respondents, profession, educational status, use of smart phones, internet access, and access to national PCC protocol were identified among variables which had statistically significant associations with knowledge of PCC among HCPs at p-value less than 0.05.\u003c/p\u003e\n\u003cp\u003eAccording to the study findings, male HCPs had 2.25 times the odds of having a good level of PCC knowledge as compared to female healthcare providers (AOR: 2.25, 95% CI: 1.28-3.95). Medical doctors were 5.16 and midwives were 3.75 times more knowledgeable about PCC than nurse professionals, with an (AOR of 5.16, 95% CI: 1.6-16.57) and (AOR: 3.75, 95% CI: 1.52-9.3), respectively. But the odds of having knowledgeable on PCC were lesser among urban health extension workers as compared to nurses with an (AOR: 0.34 95% CI 0.13-0.89).\u003c/p\u003e\n\u003cp\u003eSimilarly, HCPs with a BSc degree or higher educational level had 2.77 times more knowledge on PCC as compared to diploma holders (AOR: 2.77, 95% CI: 1.4-5.52). HCPs who had internet access had 2.73 times higher odds of having good knowledge of PCC than those who had no access (AOR: 2.73, 95% CI: 1.44-5.2). And also, HCPs who had national PCC protocol in their health facility were 1.92 times higher odds to have good knowledge of PCC than those who had no PCC guidelines (AOR: 1.92, 95% CI: 1.07-3.44) (\u003cstrong\u003eTable 4\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e4: Factors associated with knowledge of preconception care among HCPs working in public health facilities in Adama town, Oromia, Ethiopia.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge on PCC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e123 (74.5) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.61 (1.7-3.8) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.25 (1.28-3.95)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e138 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e123 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u0026nbsp;\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e103 (57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMedical doctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e51 (92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e9.5 (3.30-27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.16 (1.6-16.57)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e42 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e4.5 (1.91-10.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3.75 (1.52-9.3)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePublic health officer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e18 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1.7 (0.7-4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.95 (0.35-2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eUrban extension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.31 (0.14-0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.34 (0.13-0.89)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePharmacist \u0026amp; druggist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e17 (60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1.15 (0.51-2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.9 (0.36-2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eLaboratory technologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.64 (0.28-1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.43 (0.16-1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eBSc degree and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e231 (65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e120 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2.88 (1.73-4.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.77 (1.4-5.52)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSalary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5000 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026ge;5000 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e246 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e157 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.84 (0.34-2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.19 (0.55-0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of experience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e115 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026ge;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e146 (60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e96 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0.9 (0.61-1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.78 (0.95-3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of PHI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e198 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.8 (1.2-2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.94 (0.5-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eHealth center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e63 (51.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e60 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of smart phone for CR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e201 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.6 (1.74-4.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.7 (0.99-2.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e60 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e73 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of library\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e153 (66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.6 (1.06-2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.9 (0.53-1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e108 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e87 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInternet access for CR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e227 (66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e117 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.82 (1.72-4.64) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.73 (1.44-5.2)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e33 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e48 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to national PCC protocol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e97 (70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.79 (1.16-2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.92 (1.07-3.44)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e164 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e124 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e** = p value \u0026lt; 0.05,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eCR =\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eclinical resource, ETB = Ethiopian birr, PHI = public health institution, 1 = reference category.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHealthcare providers don\u0026rsquo;t usually practice what they don\u0026rsquo;t know, so the level of healthcare providers' knowledge is the most critical point in providing PCC service (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This study found that 61.3% (95% CI: 56.8\u0026ndash;66.2%) of HCPs had a good level of knowledge on PCC. This finding is nearly identical to the finding of an Eastern Ethiopian study, which discovered that 60.8% of HCPs had a high level of PCC knowledge (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). And also, similarly, consistent with the study conducted in Nigeria, 65.8% of the HCPs had good knowledge of PCC (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, the result of this study is lower than the studies done in Awi Zone (52% of HCPs had good knowledge of PCC) and North Wollo (50.9%) of HCPs had good knowledge of PCC) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and also higher than the study done in Egypt (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). A possible explanation could be due to differences in the types of working institutions (in this study, the majority of healthcare providers were from the teaching hospital) and study period (could be in the availability of PCC guidelines and protocol while the study was conducted).\u003c/p\u003e \u003cp\u003eAccording to the study findings, male HCPs, healthcare providers with internet access, HCPs with the professions of medical doctor and midwife, urban extension workers, HCPs with a BSc degree or higher, and access to national PCC protocol in public health facilities were found to have a statistically significant association with knowledge of PCC.\u003c/p\u003e \u003cp\u003eRegarding the sex of study participants, it was found that males were 2.25 times higher odds of having good knowledge of PCC as compared to female healthcare providers. This finding is in line with studies conducted in Hawas town. but not supported, according to a study report conducted in Egypt (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The difference may be due to the discrepancy in the distribution of HCPs in public health institutions and unequal opportunities for educational advancement between male and female HCPs.\u003c/p\u003e \u003cp\u003eHealthcare providers with a bachelor's degree or higher were 2.77 times higher odds of having good knowledge on PCC than diploma holders. This result is supported by a study conducted among HCPs in the North Wollo zone (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and eastern Ethiopia (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This is due to the fact that HCPs with higher education may have more exposure to health information and better knowledge about PCC components and due to the difference in the curriculum contents of the training programs given at diploma, degree, and specialty level to bring improvement in the level of practice as they advance from one level to another.\u003c/p\u003e \u003cp\u003eAccording to this study result, HCPs with a medical doctor were 5.16 times higher odds of having good knowledge on PCC, Similarly; midwives were also 3.75 times more knowledgeable than nurse\u0026rsquo;s professionals. A similar finding was witnessed in study conducted among HCPs in public health institutions in the north Wollo zone(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). But the odds of having good knowledge on PCC were lesser among urban health extension workers as compared to nurse`s professionals this finding was consistent with the study conducted in North Wollo (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of the study revealed that healthcare providers using the internet for accessing, downloading, and reading clinical resources had better knowledge of preconception care than healthcare providers who did not use the internet. This finding was in agreement with the study done in Hawassa town (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The utilization of the traditional library available at the health institutions did not enable access to updated scientific evidence for clinical cases as quickly as possible. As a result, using the internet improves healthcare providers' knowledge in resource-constrained settings and during the globalization era, which contributes to knowledge on preconception.\u003c/p\u003e \u003cp\u003eThis study found that healthcare providers who were accessed national PCC protocol were 1.9 times more knowledgeable on preconception care than those who had no PCC guideline and who didn\u0026rsquo;t read previously, which was consistent with a study conducted in Hawassa (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The reason for this is that the guidelines provide updated step-by-step activities on components of PCC services as well as on the identification, prevention, and management of adverse pregnancy outcomes, which may have contributed to healthcare providers' knowledge increment on PCC.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitation of the study\u003c/h2\u003e \u003cp\u003eThis study has not been conducted previously in this study area, and therefore may provide information for future researchers and other concerned bodies. The lack of similar literatures made it difficult for further discussion and comparison. The study was not also triangulated with qualitative methods.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMore than half of healthcare providers in Adama town public health facilities were knowledgeable about preconception care. Male healthcare providers, BSc degree and higher holders, medical doctors, midwives, healthcare providers with internet access to share clinical resources, as well as healthcare providers who had access to national preconception care protocols, were significantly and positively associated with a good level of preconception care knowledge, whereas urban extension workers were significantly and negatively associated with a good level of preconception care knowledge. Urban health extension workers and others with limited knowledge of preconception care participate in knowledge improvement activities. Health centers should provide more knowledge improvement activities for urban health extension workers on PCC. Give more emphasis to urban health extension workers, female HCPs, and diploma holders' healthcare providers to give PCC knowledge improvement activities. The Regional Health Bureau and Ministry of Health should prepare comprehensive PCC guidelines and provide learning opportunities for urban health extension workers, diploma HCPs to upgrade their education level and provide continuous pre-service and in-service training on PCC for all HCPs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAHMC: Adama hospital medical college; AOR: adjusted odds ratio; APOs: adverse pregnancy outcomes; BSc: Bachelor of Science; CDC: centers for disease control and prevention; CI: confidence interval; HIV: human immunodeficiency virus; HCPs: healthcare providers; MCH: maternal and child health; NTD: neural tube defect; OR: odds ratio; PCC: preconception care; RPL: reproductive life plan; RTIs: reproductive tract infections; SDG: sustainable development goal; SPSS: statistical package for social sciences; STI: sexually transmitted infections; TB: tuberculosis; VIF: variance inflation factors; WHO: world health organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude and deep appreciation to the School of Public Health at Adama Hospital Medical College for the approval of ethical clearance. We would also like to extend our gratitude to the Oromia Health Bureau Research IRB (institutional review board) and Adama Health Office for their letter of permission to conduct the study. Finally, our special thanks goes to the data collectors, supervisors, and participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGG was involved in the study conception, design, analysis, and interpretation. GDF was involved in the review of the study design, analysis, interpretation, and was a major contributor in writing the manuscript and substantially modified it. Both authors read and approved the final manuscript.\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\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, ethical clearance was obtained from the Research Ethical Committee (REC) of the School of Public Health at Adama Hospital Medical College (Ref. No, 0916/KJ). Then, letters of permission were sought from Oromia Health Bureau Research IRB (Ref. No, BEFO/HBTFH/1-6/8064) and Adama Health Office (Ref. No, WEFBMA 2712/14). Following approval of ethical clearance and permission, formal letters were secured from Adama health office to each of the selected health facilities. After being permitted to conduct the research at the selected facilities, informed consent was obtained from each respondent before the actual data collection. Each respondent was informed about the objective of the study. The participants were told that their participation was purely voluntary and that their rights to not respond at all were respected and their confidentiality strictly maintained.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva, Switzerland: WHO, 2013 2013. Report No.\u003c/li\u003e\n \u003cli\u003ePregancy birth and baby [Internet]. 2021 [cited 11/18/2021]. Available from: https://www.pregnancybirthbaby.org.au/planning-for-your-pregnancy.\u003c/li\u003e\n \u003cli\u003eOrganization WH. 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.\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 Suppl 3(Suppl 3):S1.\u003c/li\u003e\n \u003cli\u003eStephenson J, Heslehurst N, Hall J, Schoenaker D, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet (London, England). 2018;391(10132):1830-41.\u003c/li\u003e\n \u003cli\u003eOrganization WH. Pre-conception care: maximizing the gains for maternal and child health. Policy brief. 2013.\u003c/li\u003e\n \u003cli\u003eWHO, UNICEF, UNFPA, Bank TW. Trends in maternal mortality 2019. Available from: https://creativecommons.org/licenses/by-nc-sa/3.0/igo).\u003c/li\u003e\n \u003cli\u003eLassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reproductive health. 2014;11(3):S7.\u003c/li\u003e\n \u003cli\u003eLu MC. Recommendations for preconception care. American family physician. 2007;76(3):397-400.\u003c/li\u003e\n \u003cli\u003eCy nt hia Nyp aver C, PhD, W HNP-B C, Megan Arb our, CNM, PhD, E lizab e t h Nie d ereg ge r, CNM,, MSN. Preconception Care: Improving the Health of Women and Families. Jour na l of Midwife r y \u0026amp; Women\u0026rsquo;s He a lt h. 2016;61:356\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eTemel S, van Voorst SF, de Jong-Potjer LC, Waelput AJ, Cornel MC, de Weerd SR, et al. The Dutch national summit on preconception care: a summary of definitions, evidence and recommendations. Journal of community genetics. 2015;6(1):107-15.\u003c/li\u003e\n \u003cli\u003eNypaver C, Arbour M, Niederegger E. Preconception Care: Improving the Health of Women and Families. Journal of midwifery \u0026amp; women\u0026apos;s health. 2016;61(3):356-64.\u003c/li\u003e\n \u003cli\u003eFuehrer L, Buckler E, Bowman E, Gregory T, McDaniel J. Promoting preconception health in primary care. Journal of the American Academy of PAs. 2015;28(8):27-32.\u003c/li\u003e\n \u003cli\u003ePosner SF, Broussard DL, Sappenfield WM, Streeter N, Zapata LB, Peck MG. Where are the data to drive policy changes for preconception health and health care? Women\u0026apos;s health issues : official publication of the Jacobs Institute of Women\u0026apos;s Health. 2008;18(6 Suppl):S81-6.\u003c/li\u003e\n \u003cli\u003eLassi ZS, Imam AM, Dean SV, Bhutta ZA. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical/radiation exposure. Reproductive health. 2014;11 Suppl 3(Suppl 3):S6.\u003c/li\u003e\n \u003cli\u003eLassi ZS, Kedzior SG, Das JK, Bhutta ZA. PROTOCOL: Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐and middle‐income countries: A systematic review. Immunology. 2019;15(1-2).\u003c/li\u003e\n \u003cli\u003eMoller AB, Patten JH, Hanson C, Morgan A, Say L, Diaz T, et al. Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives. Tropical medicine \u0026amp; international health : TM \u0026amp; IH. 2019;24(12):1342-68.\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\u003ePN VH, S DW, S K, EA S. Dutch community midwives\u0026rsquo; views on preconception care. http://wwwelseviercom/. 2006;22:120-4.\u003c/li\u003e\n \u003cli\u003eRoghieh Bayrami HE, Marzieh Ebrahimi, Mohammad Reza Froutani, Balal Najafzadeh. Health care provider s\u0026rsquo; knowledge, attitude and practice regarding pre-conception care. Journal of Research \u0026amp; Health. 2013;3(4):519\u0026thinsp;- 26.\u003c/li\u003e\n \u003cli\u003eMs.Kamala Uprety MBK. Knowledge on Preconception Care among Bachelor Level Nursing Students of Selected Nursing Campuses of Tribhuvan University, Nepal. Journal of Nursing and Health Science (IOSR-JNHS). 2019;8(5).\u003c/li\u003e\n \u003cli\u003eal. RBe. Health care provider s\u0026rsquo; knowledge, attitude and practice regarding pre-conception carei9. Journal of Research \u0026amp; Health. 2013;3:4.\u003c/li\u003e\n \u003cli\u003eOluwatosin FOAaAO. Nurses\u0026rsquo; knowledge and women\u0026rsquo;s awareness of pre-conception care. AFRICAN JOURNAL OF MIDWIFERY AND WOMEN\u0026rsquo;S HEALTH. 2018.\u003c/li\u003e\n \u003cli\u003eUtilization of preconception care services among women of reproductive age in Kiambu county, Kenya [Internet]. 2018. Available from: http://ir-library.ku.ac.ke/handle/123456789/18676.\u003c/li\u003e\n \u003cli\u003eCDC. Recommendations to Improve Preconception Health and Health Care \u0026mdash; United States. USA: 2006 RR-6.\u003c/li\u003e\n \u003cli\u003eZohra S. Lassi SGEK, Wajeeha Tariq, Yamna Jadoon, Jai K. Das, Zulfiqar A. Bhutta. Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review. Journal of nutrients. 2021.\u003c/li\u003e\n \u003cli\u003eTokunbo O, Abimbola O, Polite I, Gbemiga O. Awareness and perception of preconception care among health workers in Ahmadu Bello University Teaching University, Zaria. Tropical Journal of Obstetrics and Gynaecology. 2016;33(2):149-52.\u003c/li\u003e\n \u003cli\u003eMosalem. Awareness of primary health care providers in el-minia governorate about preconception care, Egypt. el-minia med bull. EL-MINIA MED BULL. 2012;13:1.\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\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;2020:6978171.\u003c/li\u003e\n \u003cli\u003eBelay, Teketay, Debalkie. Knowledge and Attitude Towards Preconception Care and Associated Factors Among Health Care Providers in North Wollo Zone, Amhara Region, Ethiopia, 2020. Research Squar. 2020.\u003c/li\u003e\n \u003cli\u003eSori SATR, K. Yadeta, T. A. Jiru, H. D. Metebo, K. N. Weldekidan, H. A. Regassa, L. D. Knowledge of preconception care and associated factors among maternal health care providers working in urban public health institutions of Eastern Ethiopia. Women\u0026apos;s health (London, England). 2021;17:17455065211046139.\u003c/li\u003e\n \u003cli\u003eAlemu W, Sisay S, Waji T. Knowledge, Attitude and practice of physicians at Tikur Anbesa Hospital on Preconception care. Ethiop Med J. 2019;57:02.\u003c/li\u003e\n \u003cli\u003eAyele AD, Belay HG, Kassa BG, Worke MD. Knowledge and utilisation of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reproductive health. 2021;18(1):78.\u003c/li\u003e\n \u003cli\u003eAK B. Addressing the high adverse pregnancy outcomes through the incorporation of preconception care(PCC) in the health system of Ethiopia plose one. 2017.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Adama, Ethiopia, health care providers, knowledge, Oromia, preconception care, public health institutions","lastPublishedDoi":"10.21203/rs.3.rs-5455142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5455142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Preconception care is the provision of biomedical, behavioral, and social health interventions to women and couples before pregnancy occurs. Preconception care is the most recently identified innovative approach among the spectrum of maternal and child health services to address all adverse pregnancy outcomes and to considerably reduce maternal, new-born, infant, and child morbidity and mortality. Therefore, the findings of this study may be used as preliminary information by concerned bodies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: The study aimed to assess the level of knowledge on preconception care and associated factors among healthcare providers working in public health facilities in Adama town, Oromia, Ethiopia, from February 01 to 28, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An institutional-based cross-sectional study was conducted among 429 health care providers selected using a multistage sampling technique. Data was collected by an interviewer-administered questioner, then entered into Epi-Info version 7.2 and exported to SPSS version 22 for analysis. Descriptive statistics was performed to describe the study population. A simple binary logistic regression analysis was performed, and variables with a p-value \u0026lt; 0.25 were selected for multivariable regression analysis. The association between dependent and independent variables was estimated by an adjusted odds ratio along with a 95% confidence interval (CI). P-value \u0026lt; 0.05 was considered to declare statistical significance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Among the total study participants, 261 (61.3%) (95% CI: 56.8%–66.2%) of healthcare providers had a good level of knowledge of preconception care. Among respondents' characteristics, the odds of having a good level of knowledge on preconception care were significantly associated with: male healthcare providers (AOR: 2.25, 95% CI: 1.28–3.95); bachelor of science degree and above holders (AOR: 2.77, 95% CI: 1.4-5.52); medical doctors (AOR: 5.16, 95% CI: 1.6-16.57); midwives (AOR: 3.75, 95% CI: 1.52-9.3); urban extension workers (AOR: 0.34, 95% CI: 0.13-0.89); internet users (AOR: 2.73, 95% CI: 1.44-5.2) and access to a national preconception care protocol (AOR: 1.92, 95% CI: 1.07-3.44).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: More than half of healthcare providers in Adama town public health facilities were knowledgeable about preconception care. Male healthcare providers, BSc degree holders, medical doctors, midwives, urban extension workers, internet users, and access to the national preconception care protocol were found to be significantly associated factors. The Regional Health Bureau and Ministry of Health should prepare comprehensive preconception care guidelines and provide learning opportunities for urban health extension workers, diploma health care providers to upgrade their education level and provide continuous pre-service and in-service training on preconception care for all health care providers.\u003c/p\u003e","manuscriptTitle":"Level of knowledge on preconception care and associated factors among healthcare providers working in public health institutions in Adama town, Oromia, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-03 14:30:04","doi":"10.21203/rs.3.rs-5455142/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":"c7460350-bc92-449c-b934-e99b9db946d8","owner":[],"postedDate":"January 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-03T14:30:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-03 14:30:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5455142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5455142","identity":"rs-5455142","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}