Health Related Quality of Life and its predictors among Postpartum Mother in Southeast Ethiopia: A Cross sectional study

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This study aimed to assess the HRQOL and its predictors among postpartum women in Southeast Ethiopia. Methods : Between March and May 2022, an institutional-based cross-sectional study was conducted among a simply randomly selected sample of 794 postpartum women who were attending immunization services in public health facilities in Southeast Ethiopia. The pretested interviewer-administered structured, Short Form 36 (SF-36), validated questionnaire was used to collect data and to assess the HRQOL. This Descriptive statistics were computed and the bivariable and multivariable logistic regression model was fitted to predictors of HRQOL. Odds ratio (OR), along with a 95% confidence interval (CI), were used to estimate the strength of the associations. Results: The mean scores (mean ± SD) of overall HRQOL, physical component summary (PCS) and mental component summary (MCS) of quality of life were 43.80 ± 27.88, 45.39 ± 28.58 and 42.20 ± 28.15) respectively. Walking to the health facility [(AOR = 2.09; 95% CI: (1.31,3.31)], using public transport (AOR=2.58; 95% CI=1.69–3.93), giving birth to ≤ 3 deliveries (AOR = 1.81; 95% CI: 1.36 –2.65), having health facility admission history during the recent baby’s pregnancy (AOR=1.62; 95% CI=1.08–2.44), having postpartum depression (PPD) (AOR=2.13; 95% CI=1.57–2.89) and having the fear of COVID-19 (AOR=1.46; 95% CI=1.08–1.99) were predictors of a lower level of HRQOL among postpartum women. Conclusion : This study revealed that nearly half of the postpartum women had a lower HRQOL. Means of transport used, the number of total deliveries they had, admission history during the recent baby pregnancy, PPD and Fear of COVID 19 ( FCV 19) showed a statistically significant association with the lower overall HRQOL. To improve the HRQOL among postpartum women in Ethiopia, programs should be implemented by applying appropriate strategies that address the identified factors. HRQOL (Health-related quality of life) postpartum women Bale Zone PPD (Postpartum Depression) FCV 19 (Fear of COVID-19) Introduction The health-related quality of life (HRQOL) is a multidimensional concept that comprises health fields related to physical, psychological and social functioning (1, 2) providing beyond a comprehensive measure of population health, life expectancy, causes of death and individuals’ functioning capacity(3). It has been established that the HRQOL was a fundamental contributor to an exhaustive measure of health status in transition to motherhood, in addition to physical and social life, and it assesses the positive facets of people’s life such as positive emotions and life fulfillment (4, 5). Postpartum-related morbidity has been reported in studies from several countries (6), (7), (8). Changes that occur after childbirth affect women’s HRQOL and have significant impacts on their overall well-being (9, 10),(11). Recently, HRQOL has attracted greater attention as it refers to a wider view of the health status of women during their childbearing experience. It well recognized that even in uneventful pregnancies, during the reproductive and childbearing times, women undergo experiences that may change their capacity to conduct their usual activities, which may affect their overall HRQOL. The additional changes that occur in expectant mothers, during both the perinatal and the postpartum periods, may lead to significant increases in psychological health problems such as psychosis and depression (12). A few studies have highlighted that the level of HRQOL in the postpartum women varies among different settings. Examples of these studies with respective HRQOL scores in brackets have included postpartum women from nations including Kuwait (mean score of 53.7), Iran (66.32±13.7), Spain (71.94±17.48), and Brazil (86.86 ± 10.6).(13-16). Additionally, even within the same nation, the HRQOL scores differ according to conditions within populations. For example, a study in Kuwait showed that the HRQOL overall mean score was (47.4±10.3) among women with PPD and (59.2±13.1) among women without PPD (15). It has also been reported that sociodemographic factors may influence the HRQOL of populations. For example, a study conducted in Arba Minch town in Ethiopia showed that about (62.3%) of participants had a lower level of HRQOL, mean ± SD 45.15±8, and the overall mean score of HRQOL was 45.15±8.13. Moreover, in this Ethiopian study, age group 17–24 years and no formal education were factors associated with the lower overall HRQOL (17). Additional factors including: married or living with a partner, registered students, 30 - 40 years of age, living without physical complaints, having at least an 8th-grade education, being Caucasian were predictors of having the best health related quality of life.(18) Huang and colleagues also found that husband’s lower education level and male gender of the infant were significantly associated with poor quality of life (19). Another study reported that women older than 40, separated/divorced, or widowed, had significantly lower HRQOL scores compared to women who had completed upper secondary or had a university level education (20). Most of the previous studies were conducted in developed countries, and it is well acknowledged that HRQOL is a concept that is affected by culture and social systems, indicating that the cultural differentials between developed and developing settings may have implications for HRQOL. As such, it is not justifiable to inform policy and strategy initiatives for developing settings, using evidence from studies conducted in developed countries. However, although there have been limited studies indicating the impact of postnatal discomfort and problems on women’s HRQOL, their results have been inconsistent and not comprehensive. Additionally, most of the previous studies in Ethiopia, except the study done in Arba Mich town, were investigated the quality of life among pregnant mothers rather than postpartum women. The current study aimed to assess the level of HRQOL and its predictors among postpartum women in the Southeast Ethiopia. Methods and materials Study design, setting and populations Between 10 th March and 8 th May 2022, institutional-based cross-sectional study was conducted in the health facilities in the Bale Zones, South East Ethiopia. The Bale zone is located in the Southeastern part of the Oromia Regional National State. The zone health facilities are categorized as hospitals or health centres. During the study period, the zone had five hospitals namely: (i) Goba Referral Hospital, (ii) Robe General Hospital, (iii) Delomena General Hospital, (iv) Madda Walabu Primary Hospital, and (v) Goro Primary Hospital. However, the last hospital (Goro Primary Hospital) was not fully functional during study period and was excluded from study. In addition, there were 18 urban health centers and 37 rural health centers within the zone. According to the 2020/21 Bale zone health office report, the estimated total population of the Bale zone was 1,299,394 of which 636,703 were men,662,691 females and total number of reproductive-age women was 285,867(Unpublished Bale zone health report). The estimated number of pregnant women in Bale zones was 44,179, and the total number of mothers on postnatal follow-up was 42,880. All postpartum mothers who were attending immunization at all health facilities in the Bale Zone were the source population. To be eligible, women were required to be: in the postpartum period or less than six months after delivery, aged ≥18 years, voluntarily willing to participate in the study, and living in Bale zone for at least six months. However, women with obstetric/neonatal complications related to the recent birth, diagnosed with postpartum depression, and mothers with disability were excluded from the study. Sample size determination By using the single population proportion formula and considering P = 62.3% of postpartum mothers who had a low level of quality of life from the previous study in Arba Minch (17) , d = 5%, design effect = 2, and non-response rate of 10%, the current study final sample size was 794. Sampling techniques The purpose was to have a representative sample of postpartum mothers who were attending child immunization clinic in Bale zone public health facility. Of the total public health facilities in Bale zones, at first step, public health facilities were categorized into hospitals and health centers. Of the four fully functional hospitals in the Bale zone, Robe General Hospital, Delomena General Hospital, and Madda Walabu Primary Hospital were providing child immunization services, and Madda Walabu University Goba Referral hospital was out of service. Since child immunization, service given at those hospitals was by similar guidelines, Robe General Hospital was included in the study site by lottery method. In addition, 5 urban health centers and 11 rural health centers were chosen at random from the 18 urban health centers and 37 rural health centers respectively. Based on the simple random technique, the total number of selected participants was proportionally drawn from each selected health facility based on the total number of postpartum mothers attending immunization clinics (Table 1). Table 1 : Proportionally Allocated Sample Size for The Study Of HRQOL In Southeast Ethiopia Health institution Area Average PPM who attends child immunization clinic in the past two months Proportionally allocated sample size n = (Sample size(794) * PPM attending immunization clinic at each selected health institution) / Total(1497)) Dinsho HC Urban 100 53 Agarfa HC Urban 100 53 Gasara HC Urban 101 54 Dambal Hc Urban 98 52 Harawa Sinja HC Urban 105 56 Homma HC Rural 82 43 Qaso Manso HC Rural 88 47 Hawo HC Rural 91 48 Buluk HC Rural 97 51 Wacho HC Rural 76 40 Warre HC Rural 87 46 Cirri HC Rural 88 47 K/Golba HC Rural 85 45 Birbirsa HC Rural 69 37 M/burka HC Rural 70 37 Mexi HC Rural 50 27 Robe GH Hospital 110 58 Total 1,497 794 Study variables Dependent variable : Health related Quality of life (HRQOL Independent variables : Includes; Sociodemographic, obstetrics related characteristics, postpartum depression related characteristics, and Fear of COVID 19 related characteristics. Data collection techniques and instrument A pretested interviewer-administered structured questionnaire (Short-Form 36 (SF-36)), a widely validated tool and one of the most widely used HRQOL scales in the world was used to collect data. The SF-36 which is a multicultural scale and a widely validated in different languages tool, has been applied in different countries for the study of the maternal quality of life, including in Ethiopia (21),(20),(14),(17),(22). The SF-36 tool consists 36 questions categorized into eight-domain profile of scores and two component summaries including physical (PCS) and mental (MCS) health. The SF 36 as a multidimensional multi-item scale, assesses eight health conceptual domains with associated components as follows: (i) Physical functioning (PF),10 items; (ii) role physical (RP), 5 items; (iii) general health (GH), 4 items; (iv) bodily pain (BP), 2 items; (v) social functioning (SF), 2 items; (vi) vitality (VT), 4 items; (vii) role emotional (RE), 3 items; and (viii) mental health (MH), 5 items. For each domain, a score ranging from 0 to 100 was assessed, with a higher score indicating better health (23, 24). The questionnaire has five parts: (i) socio-demographics, (ii) obstetrics-related characteristics, (iii) postpartum depression-related characteristics, (iv) quality-of-life-related characteristics, and (v) fear of COVID 19 (FCV 19) study scale. We used the Ethiopian version of validated tool, termed Medical Outcome Study Short Form 36 (MOS-SF-36), to study HRQOL. The current study tool was validated and translated for Ethiopia with Cronbach’s alpha score of greater than 0.7 (17, 22). Edinburgh postnatal depression scale (EPDS) which contains ten questions was used as the tool to assess patients at risk of postnatal depression (23). The EPDS indicates how the mother felt during the previous seven days. According to a validation study in Addis Ababa, respectively, EPDS generated the sensitivity and specificity of 78.9% and 75.3% (23, 25). Data quality control The MOS-SF-36 used for this stud was prepared in English and translated to Afan Oromo, one of the local languages spoken in the study setting. The tool was checked by Afan Oromo speaking English language expert, and was re-checked to ensure that it maintained its consistency. The pretesting of the tool was conducted to improve the clarity, understandability and simplicity of the messages before the actual data collection. Before the actual data collection, data collectors ( who were selected from midwifery and/or nursing professionals) and supervisors were trained for two days on the objectives, method, sampling technique, ethical issues, data collection instrument and data collection procedures. All of questionnaires were checked for completeness and accuracy during and after data collection. Operational definitions Scoring the SF 36-Item Health Survey is a two-step process. In the first step: a pre-coded numeric values (values on questionnaires’) were recoded according to scoring guide for SF 36 tools. It is worthy noting that all items were scored so that a high score defined a more favorable health state. In addition, domain scores were calculated by summing up each item under each domain. Then each raw scale score was transformed from 0 to 100 (0–100 scale) by using the formula of transformed scale item which was scored in a 0 to 100 range, so that the lowest and highest possible scores were 0 and 100, respectively. Scores represented the percentage of the total possible score achieved. In the second step, items on the same scale were averaged together to create the 8 scale scores. Table 2 of the scoring guide for SF 36 tools lists the items averaged together to create each scale. Items that were left blank (missing data) were not taken into account when calculating the scale scores. Hence, scale scores represented the average of all items on the scale that the respondents answered (17, 22, 26).. Health Related Quality of Life (HRQOL) is the post-delivery maternal quality of life assessed by using an Ethiopian validated tool called the Medical Outcome Study Short-Form 36 (MOS SF-36). The MOS-SF-36 contains eight domains comprising two main categories namely, physical and mental HRQOL. Physical QOL (PCS) mean score is the arithmetic average of the transformed scores of physical functioning, role physical, bodily pain, and general health domains (22, 27). Mental QOL (MSC) mean score is the arithmetic average of the transformed scores of social functioning, mental health; role emotional, and vitality domains (17, 22, 23). Overall HRQOL mean score is the arithmetic average of the transformed score of the eight domains (23) (17, 23). Higher HRQOL is when participants scored greater than or equal to the standardized mean value of 50 (22, 23). Lower HRQOL is when participants scored less than the standardized mean value of 50 (22, 23). Postpartum Partum depression : was assessed by using the Edinburgh Postnatal Depression Scale (EPDS). According to the EDPS, study participants who scored ≥13 are considered as having postpartum depression (23). Fear of COVID 19(FCV 19) : was measured by validated 7 items five-likert scale ranges from strongly disagree to strongly agree. Scoring each item together, minimum score is 7 and maximum score is 35, Mean score is 7.5. If participants score greater than or equal to mean they classified as having FCV 19 and as has no FCV 19 if less than mean (28, 29). Data processing and analysis The collected data were checked for completeness, coded and then entered into Epi Data 4.6.2.0. Then, data were exported to SPSS version 26 and cleaned before analysis. Descriptive statistics were calculated for the variables and the analysis was performed as per developer guides for scoring for SF-36 questionnaires(30, 31). First, pre-coded numeric values were recorded in which all items were scored so that a high score defines a more favorable health state. In addition, each item was scored on a 0 to 100 range, so that the lowest and highest possible scores are 0 and 100, respectively. Secondly, items on the same scale were averaged together to create the 8-scale scores. An item that was left blank (missing data) was not taken into account when calculating the scale scores. Hence, scale scores represented the average of all items on the scale that the respondent answered. The Physical QOL (PCS) mean was computed from physical functioning, role physical, bodily pain, and general health domain transformed scores. The Mental QOL (MCS) mean was computed from social functioning, mental health, vitality, and the role emotional domain transformed score. The overall HRQOL mean was computed from the eight domains' transformed scores. Using the standardized mean score of 50, overall HRQOL, physical HRQOL, and mental HRQOL were dichotomized into higher and lower HRQOL. Generally, scoring SF 36 questionnaires was done by strictly following the guide for scoring SF 36. Bivariable logistic regression analysis was used to examine the statistical association between the overall HRQOL and the predictors. Then variables with a P -value less than 0.25 in the bivariable logistic regression analysis were considered candidates for the multivariable logistic regression analysis. In the multivariable logistic regression model, variables with a P -value less than 0.05 were considered significantly associated with the outcome variable. The odds ratio (OR), along with a 95% confidence interval (CI), were used to estimate the strength of the associations . Multicollinearity was checked among all predictors. The Hosmer and Lemeshow’s goodness-of-fit test were checked. Results Socio-demographic and economic characteristics of the respondents Seven hundred ninety-two respondents were interviewed, a response rate of 99.75%. Nearly seventy three percent 72.5% (574) of respondents were homemakers, and 77% (610) of them lived with their partner. More than half (52.4%) (415) of the study participants lived in rural area (Table 2). Table 2: Socio-demographic and economic characteristics of postpartum women in Southeast Ethiopia, 2022 (N = 792) Characteristics Frequency (n) Percent (%) Age 15-19 37 4.7 20-24 221 27.9 25-29 300 37.9 30-34 148 18.7 >=35 86 10.9 Ethnicity Oromo 644 81.3 Amhara 126 15.9 Others[1] 22 2.8 Residence Rural 415 52.4 Urban 377 47.6 Partner education No formal education 305 38.5 Primary education 232 29.3 Secondary education 185 23.4 College/university 70 8.8 Marital type Live without partner[2] 182 23.0 Live with partner 610 77.0 Partner education No formal education 200 25.3 Primary education 232 29.3 Secondary education 208 26.3 College/university 152 19.2 Mothers occupation Housewife 574 72.5 Merchant 196 24.7 Employed 22 2.8 Partner occupation Farmer 230 29.0 Merchant 288 36.4 Employed 274 34.6 Non-government employee 257 32.4 Labor worker 17 2.1 Religion Muslim 493 62.2 Orthodox 170 21.5 Protestant 110 13.9 Others[3] 19 2.4 Average monthly income Below median 357 45.1 Above median 435 54.9 Types of transport used Walk. 213 26.9 Public transport (bus, taxi) 436 55.1 Private Vehicle 143 18.1 Time taken from home to reach health facility 1-30 minutes 536 67.7 >30 minutes 256 32.3 Obstetric history of the respondents Nearly seventy percent 69.4% (550) of the respondents had up to three total deliveries. Of the total deliveries, 58.9% (245) gave birth in health institution. More than half (52.5%) (416) of the study, participants were over three months post delivery of the current baby. More than half 57.3% (454) of the respondents had no postpartum depression while nearly fifty eight percent 57.5% (455) of the study participants had no fear of COVID 19 (Table 3). Table 3: Obstetrics and postnatal Characteristics of postpartum women in Southeast Ethiopia, 2022 (N = 792) Characteristics Frequency(n) Percent (%) Total number of delivery you had ≤3 550 69.4 >3 242 30.6 Total delivery at health institution(N=416) <3 245 58.9 ≥3 171 41.1 Place of delivery Home 376 47.5 Health facility 416 52.5 Planned pregnancy Yes 653 82.4 No 139 17.6 ANC follow up Yes 551 69.6 No 241 30.4 Number of ANC visits 3 months 416 52.5 Mode of last delivery Normal delivery 455 57.4 Caesarean delivery 337 42.6 Have you experienced any complications during your recent delivery? Yes 146 18.4 No 646 81.6 Had you get postnatal check-up within 6 months of your recent delivery? Yes 386 48.7 No 406 51.3 Postnatal depression(PPD) Have PPD 338 42.7 No PPD 454 57.3 Fear of COVID 19(FCV19) Yes 337 42.6 No 455 57.5 Health related quality of life among respondents Nearly half (382) of the study participants had lower overall HRQOL, while respectively, about 48.7% (386) and 49.6% (396) of the participants had lower physical and mental HRQOL respectively. From the eight domains of HRQOL assessment, the highest mean score was found in the role emotional dimension with mean ± SD of 49.33 ± 48.05; and the lowest mean ± SD score was in the social functioning (SF), with 30.97±21.65 mean ± SD. Moreover, the physical component summary (PCS) mean ± SD) score and the mental component summary (MCS) mean ± SD score were 45.39 ± 28.58 and 42.20 ± 28.15), respectively (Table 4). Table 4: Health Related Quality Of Life of Postpartum Mothers in Southeast Ethiopia, 2022 (N = 792) Components Mean ± SD 95% Confidence Interval Physical functioning(PF) 49.21±46.22 45.98751 52.43573 Role physical (RP) 48.88±48.67 45.18446 51.97463 Role emotional (RE) 49.33±48.05 45.97502 52.67818 Vitality (VT) 43.53±18.79 42.21798 44.8401 Mental health (MH) 44.99±32.19 42.74451 47.23528 Social functioning (SF) 30.97±21.65 29.45557 32.47625 Bodily pain (BP) 46.28±12.24 45.42574 47.1336 General health (GH) 37.52±25.03 35.77829 39.2707 Physical Component Summary (PCS) 45.39±28.58 43.40543 47.39224 Mental Component Summary (MCS) 42.20±28.15 40.23961 44.16611 Overall HRQOL 43.80±27.88 41.85614 45.74555 Factors associated with overall HRQL of the respondents In the binary logistic regression model, variables with p-value less than 0.25 were selected as candidate variables for multivariable logistic regression analysis. Variables such as average monthly income, means of transport used, number of total number of deliveries they have until study period time, admission history to a health institution (HI) during recent pregnancy, mode of delivery of the recent baby, complications faced during the recent baby’s delivery,, postpartum depression (PPD), and fear of COVID-19 (FCV 19s) were included in the binary logistic regression analysis. In the multivariable logistic regression analysis, walking to the health facility [(AOR = 2.09; 95% CI: (1.31,3.31)], using public transport (AOR=2.58; 95% CI=1.69–3.93), giving birth to ≤ 3 deliveries (AOR = 1.81; 95% CI: 1.36 –2.65), having admission history during a recent baby’s pregnancy (AOR=1.62; 95% CI=1.08–2.44), having PPD (AOR=2.13; 95% CI=1.57–2.89), and having the fear of COVID-19 (AOR=1.46; 95% CI=1.08–1.99) were predictors of a lower level of HRQOL among postpartum women(Table 5). Table 5: Bivariable and multivariable logistic regression analysis for factors associated with overall health-related quality-of-life among postpartum mothers Southeast Ethiopia, 2022 (N = 792) Overall HRQOL Lower Higher Count (%) Count (%) COR (95% CI) AOR (95% CI) P value Average monthly income Below median 188(49.2) 169(41.2) 1 1 Above median 194(50.8) 241(58.8) 1.38(1.04,1.83) 1.06(0.78,1.45) 0.695 Means of transport used Walking 255(62.2) 181(47.7) 2.21(1.42, 3.44) 2.09(1.31,3.31) 0.002 Public transport 109(26.6) 104(27.2) 2.97(1.99, 4.43) 2.58(1.69,3.93) 0.001 Private vehicle 46(11.2) 97(25.4) 1 Number of total delivery you had 3 240(62.8) 310(75.6) 1 1 Admission history to HI during recent baby’s pregnancy No 85(22.3) 58(14.1) 1 1 Yes 297(77.7) 352(85.9) 1.74(1.20,2.51) 1.62(1.08,2.44) 0.020 Mode of last baby’s delivery Normal delivery 179(46.9) 158(38.5) 1.41(1.06,1.87) 1.37(0.99,1.88) 0.051 Caesarean delivery 203(53.1) 252(61.5) 1 1 1 Faced complications during recent baby’s delivery Yes 86(22.5) 60(14.6) 1 1 No 296(77.5) 350(85.4) 1.69(1.18, 2.44) 1.19(0.79,1.79) 0.403 PPD[4] Have PPD 258(67.5) 196(47.8) 2.27(1.70, 3.03) 2.13(1.57,2.89) 0.001 No PPD 124(32.5) 214(52.2) 1 FCV 19[5] Have FCV19 239(62.6) 216(52.7) 1.50(1.13, 1.99) 1.46(1.08,1.99) 0.015 No FCV19 143(37.4) 194(47.3) 1 1 1 Discussion The purpose of this study was to assess the level of health related quality of life (HRQOL) and its associated factors among postpartum women in southeastern Ethiopia. The HRQOL among postpartum women was assessed using the Medical Outcome Study Short-Form 36 (MOS SF-36), which is an Ethiopian adaptation of SF 36 validated tool. The study indicated that postpartum women had a lower overall quality of life, with a mean score of HRQOL of 43.80±27.88. This finding is comparable with a studies conducted in Ethiopia which had a mean score of 45.15±8.13 (32), and Kuwait with a mean score of 53.7 (15), but was lower than studies conducted elsewhere including: Iran (Ilam province in the west of Iran) with mean score of 66.32±13.7 (33), Spain with mean score of 71.94±17.48 (34), Iran (Dezful City, Khuzestan province) with mean score of 68.38 ± 13.6 (35), and Brazil with mean score of 86.86 ±10.6 (13). While all these studies were conducted in postpartum women, the HRQOL seemed to differ. It is reasonable to allude that the differences in HRQOL might be due to the socioeconomic and other variations among study participants. While in the current study, the majority of the study participants had low socioeconomic status (from rural areas), the previous studies were conducted in areas of relatively higher socioeconomic status. For example, the study conducted in Ilam province, west Iran and Iran (Dezful City, Khuzestan province) drew participants who resided only in urban areas who may have had higher socioeconomic status. Consistent with the World Health Organisation (WHO) social determinants of health framework (36), we hypothesize that a higher socioeconomic status favors a higher quality of life or physical health, mental health, social activities, public health, and vitality (36). Moreover, we recognize that other studies have also correlated socioeconomic status with the quality of life (37, 38), indicating that populations with higher social economic status have better quality of life. Another difference in HRQOL between these studies might be due to differences in the study population, noting that in the current study we included women who gave birth in the last six months (postpartum mothers), whilst the study conducted in Spain included women who gave birth a year before the survey. For women who gave birth a year before the study, it is possible that the women would have recovered from the impact of childbirth, which may not be the case in our study population. It is also possible that the discrepancy between our study and the two studies (Brazil and Iran) could be due to a variation in the tool used to assess the quality of life. In the current study, we used the adaptation on SF-36 questionnaires, but studies conducted in Brazil and Iran used the World Health Organization Quality-of-life Assessment-Bref (WHOQoL-Bref) tool. Additionally, the variation of findings between the current study and other studies conducted in Ethiopia could be due to the differences in the study areas whereby the previous studies were conducted in urban areas and the current study was conducted in both rural and urban areas, but the majority of participants were from rural areas. It is also reasonable to hypothesis that urban areas even in Ethiopia have a better socioeconomic status than in rural areas, which could translate to better health outcomes, noting that poverty and rurality are known significant social determinants of health (36). This study also showed that post-partum mothers who walked as a means of transport to reach health facilities were 2.09 times more likely to have lower overall HRQOL when compared with women who were private vehicle users. Moreover, postpartum mothers who used public transports were 2.6 times more likely to have lower overall HRQOL than private vehicle users. Again this could be due to the effect of poor socioeconomic status, assuming that the private vehicles users were able to pay high cost of transport or they (or family) owned the vehicles, and recognizing the significance that the burden of poverty has on the quality of life (36). The current study findings are therefore in support of others that have stated poor families tend to have poorer or lower quality of life (39). On the other hand, postpartum mothers who gave birth to less than or equal to three deliveries were 1.81 times more likely to have lower overall HRQOL than those who gave birth to greater than three deliveries. This finding is in agreement with the study done somewhere else (40). The possible explanation of why women with less number of children would have a lower HRQOL could be because primiparous women struggle with maternal identity and the demands of motherhood for the first time, resulting in more stress during postpartum than multiparous women (who would have had more than three total deliveries) (41). However, this finding will need to be explored further, given that large families ( with more than three children) would need more resources to meet their needs, and without further interventions or changed circumstance, mother with a large number of children could become more stressed under unmet family needs. Postpartum mothers who had an admission history during a recent pregnancy were 1.6 times more likely to have a lower overall HRQOL score than those who had no admission history. This finding is consistent with the study conducted in Iran that reported an absence of history of disease in pregnancy to be associated with higher women's QOL (42). However, this is not surprising because women, who would have been admitted to hospitals prenatally, could have been admitted due to conditions that would negatively affect their health, and which could be carried over postnatally, contributing to poor correlate of lower HRQOL during the postpartum period. This study showed that postpartum mothers who had PPD were also 2.13 times more likely to have lower overall HRQOL than those who had no PPD. Similar findings were found in other studies in which PPD was negatively correlated with HRQOL (15, 43). Consistent with previous studies conducted in Nigeria (44), Carolina state, USA (45), and Iran (46),(42), the current study found women with mental health to have poor HRQOL. The reason might be that depression harms mental health (negatively affecting the SF, MH; RE, and VT domains of quality of life); and depression by itself is known to affect women’s ability to: function well, have good relationships with their child, have good interpersonal relationships, have good sleeping patterns, and good social engagement, thus lowering the overall and mental HRQOL (47). In the meanwhile, postpartum mothers who had a fear of COVID-19 were 1.46 times more likely to have lower HRQOL than those who had no fear of COVID-19. The reason for this might be because the Covid-19 pandemics has disrupted life across the globe, and fear of it (especially during the early period of the pandemic) has also become a pandemic itself(48). Evidence exists that the pandemic has induced different disturbances including anxiety, stress, and depression that could disturb HRQOL in many aspects (49-54), supporting the findings observed in the current study. Limitation of the study The finding in this study must be interpreted by considering the following limitations. Firstly, due to the cross-sectional nature of the study, a cause-effect relationship cannot be established between the risk factors and HRQOL. Secondly, perceptions of mothers regarding services in health facility and/or health worker related factors that might affect the quality life among postpartum mothers were not assessed. To assess such type of factors qualitative study might be helpful. Additionally, this study did not address the quality of life based on time difference during postpartum period (Follow up cohort study might needed). Conclusion This study found that nearly half of the study participants had lower overall HRQOL, while fifty percent of the respondents had low mental HRQOL. Of the eight domains of HRQOL, social functioning (SF) was the most compromised component of quality of life. The mode of transportation used, the total number of deliveries, admission history during the most recent pregnancy, PPD, and FCV 19 had statistically significant associations with lower overall HRQOL. The study findings highlight the fact that the quality of life of postpartum women needs much attention. Evidence exists that vulnerability to depression increases during pregnancy and childbirth, which may partly be attributable to hormonal change, social factors such as luck of support, and economic deprivation for women in low-income countries (55-57). As such, policymakers, program planners, other concerned bodies and organizations should emphasize the need provide high care to postpartum mothers’ social, mental, and physical quality of life given the vulnerability to depression of women in perinatal period especially postpartum period. Further studies on time series (types of postnatal periods) or follow-up studies might be needed to study the quality of life among postpartum mothers. Abbreviations ANC: Ante Natal Care; BP: Bodily Pain; CS: Cesarean Section delivery; EPDS: Edinburgh Postnatal Depression Scale; GH: General Health; HF: Health Facility; HRQOL: Health Related Quality Of Life; MCS: Mental component score/ mental health; MH: Mental Health; MOS SF 36: Medical Outcome Study Short Form 36; MWU: Madda Walabu University; PCS: Physical component score/physical health; PF: Physical Functioning; PPD: Post-Partum Depression; PPM: Post-Partum Mothers; QOL: Quality of Life; RE: Role Emotional; RP: Role Physical; SD: Standard Deviation; SF: Social Functioning; SF 36: Short Form 36; SPSS: Statistical Package for Social Science; VT: Vitality; WHO: World Health Organization. Declarations Ethics approval and informed consent Ethical clearance was obtained from MWU's Research and Development Directorate (RDD). Subsequently, a letter of permission was received from the management of the Bale Zone Health official. After explaining the objectives of the study in detail, written consent was obtained from each study participant by reading the informed consent format attached to the questionnaires. During data collection, the study participant had the right to refuse, stop, or withdraw from participation. Confidentiality of the data and their responses were guaranteed throughout the study period, and information was provided at the end of the interview in case of any misunderstanding. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests" in this section. Funding Not applicable Authors' contributions All authors have made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas. Have drafted or written, or substantially revised or critically reviewed the article. Have agreed on the journal to which the article be submitted. Reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. Agree to take responsibility and be accountable for the contents of the article. All authors read and approved the final manuscript. ACKNOWLEDGEMENT We would like to express our gratitude to Madda Walabu University for creating the opportunity for us to conduct this research. We would also like to extend our heartfelt appreciation to the Bale Zone Health Office for providing important background data on the study area. Lastly, we would like to acknowledge the scholars whose work is used in this research paper work as references. References Symon A. A review of mothers' prenatal and postnatal quality of life. Health and Quality of Life Outcomes. 2003;1(1):1-8. Peterson S, Bredow TS. Middle range theories: Application to nursing research and practice: Lippincott Williams & Wilkins; 2019. Emmanuel EN, Sun J. Health related quality of life across the perinatal period among Australian women. Journal of clinical nursing. 2014;23(11-12):1611-9. Jomeen J. The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a multidimensional construct: A literature review. Clinical Effectiveness in Nursing. 2004;8(3-4):143-55. Karimi M, Brazier J. 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Health and Quality of Life Outcomes. 2022;20(1):58. Keyvanara M, Khasti BY, Zadeh MR, Modaber F. Study of the relationship between quality of life and socioeconomic status in Isfahan at 2011. Journal of education and health promotion. 2015;4:92-. Wan Puteh SE, Siwar C, Zaidi MAS, Abdul Kadir H. Health related quality of life (HRQOL) among low socioeconomic population in Malaysia. BMC Public Health. 2019;19(4):551. Singh S, Kaur R, Singh S. Relationship of parity and health related quality of life among women. Human Biology Review. 2015;4(2):159-66. das Neves Carvalho JM, Ribeiro Fonseca Gaspar MF, Ramos Cardoso AM. Challenges of motherhood in the voice of primiparous mothers: initial difficulties. Investigacion y educacion en enfermeria. 2017;35(3):285-94. Rezaei N, Azadi A, Zargousi R, Sadoughi Z, Tavalaee Z, Rezayati M. Maternal health-related quality of life and its predicting factors in the postpartum period in Iran. Scientifica. 2016;2016. Choi S-Y, Gu H-J, Ryu E-J. Effects of fatigue and postpartum depression on maternal perceived quality of life (MAPP-QOL) in early postpartum mothers. Korean Journal of Women Health Nursing. 2011;17(2):118-25. Darcy JM, Grzywacz JG, Stephens RL, Leng I, Clinch CR, Arcury TA. Maternal depressive symptomatology: 16-month follow-up of infant and maternal health-related quality of life. The Journal of the American Board of Family Medicine. 2011;24(3):249-57. Mortazavi F, Mousavi SA, Chaman R, Khosravi A. Maternal quality of life during the transition to motherhood. Iran Red Crescent Med J. 2014;16(5). Tungchama FP, Piwuna CG, Armiya'u AY, Maigari YT, Davou FJ, Umar MU, et al. Relationship between quality of life and postpartum depression among women in North-Central, Nigeria. depression. 2017;15:16. Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Women's health (London, England). 2019;15:1745506519844044. Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. Journal of anxiety disorders. 2020;74:102258. Dule A, Hajure M, Mohammedhussein M, Abdu Z. Health‐related quality of life among Ethiopian pregnant women during COVID‐19 pandemic. Brain and Behavior. 2021;11(4):e02045. Li S, Wang Y, Xue J, Zhao N, Zhu T. The impact of COVID-19 epidemic declaration on psychological consequences: a study on active Weibo users. International journal of environmental research and public health. 2020;17(6):2032. Micelli E, Cito G, Cocci A, Polloni G, Russo GI, Minervini A, et al. Desire for parenthood at the time of COVID-19 pandemic: an insight into the Italian situation. Journal of psychosomatic obstetrics and gynaecology. 2020;41(3):183-90. Nguyen HT, Do BN, Pham KM, Kim GB, Dam HT, Nguyen TT, et al. Fear of COVID-19 scale—associations of its scores with health literacy and health-related behaviors among medical students. International journal of environmental research and public health. 2020;17(11):4164. Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: A cross-sectional study. International journal of environmental research and public health. 2020;17(7):2381. Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 factors and psychological factors associated with elevated psychological distress among dentists and dental hygienists in Israel. International journal of environmental research and public health. 2020;17(8):2900. Dadi AF, Miller ER, Bisetegn TA, Mwanri L. Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC Public Health. 2020;20(1):173. Fekadu Dadi A, Miller ER, Mwanri L. Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis. PLoS One. 2020;15(1):e0227323. Wadhwa PD, Glynn L, Hobel CJ, Garite TJ, Porto M, Chicz-DeMet A, et al. Behavioral perinatology: biobehavioral processes in human fetal development. Regulatory peptides. 2002;108(2-3):149-57. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Mar, 2024 Read the published version in Heliyon → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2037336","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":135029629,"identity":"e65bc6f1-ab5b-4b07-a49c-f173a146ac35","order_by":0,"name":"Degefa 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10:59:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2037336/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2037336/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1016/j.heliyon.2024.e27843","type":"published","date":"2024-03-01T10:36:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53382907,"identity":"caee8be5-1cf6-45e9-8af7-9ad0be551df2","added_by":"auto","created_at":"2024-03-25 10:36:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":413890,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2037336/v1/00ed57dc-6597-49a6-b9e0-2ea6f3496038.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Related Quality of Life and its predictors among Postpartum Mother in Southeast Ethiopia: A Cross sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe health-related quality of life (HRQOL) is \u0026nbsp;a multidimensional concept that comprises health fields related to physical, psychological and social functioning \u0026nbsp;(1, 2) providing \u0026nbsp;beyond a comprehensive measure of population health, life expectancy, causes of death and individuals\u0026rsquo; functioning capacity(3). It has been established that the HRQOL was a fundamental contributor to an exhaustive measure of health status in transition to motherhood, in addition to physical and social life, and it assesses the positive facets of people\u0026rsquo;s life such as positive emotions and life fulfillment (4, 5). Postpartum-related morbidity has been reported in studies from several countries (6), (7), (8).\u003c/p\u003e\n\u003cp\u003eChanges that occur after childbirth affect women\u0026rsquo;s HRQOL and have significant impacts on their overall well-being (9, 10),(11). Recently, HRQOL has attracted greater attention as it refers to a wider view of the health status of women during their childbearing experience. It well recognized that even in uneventful pregnancies, during the reproductive and childbearing times, women undergo experiences that may change their capacity to conduct their usual activities, which may affect their overall HRQOL. The additional changes that occur in expectant mothers, during \u0026nbsp;both the perinatal and the postpartum periods, may lead to significant increases in psychological health problems such as psychosis and depression (12).\u003c/p\u003e\n\u003cp\u003eA few studies have highlighted that the level of HRQOL in the postpartum women varies among different settings. \u0026nbsp;Examples of these studies with respective HRQOL scores in brackets have included postpartum women from nations including Kuwait (mean score of 53.7), Iran (66.32\u0026plusmn;13.7), Spain (71.94\u0026plusmn;17.48), and Brazil (86.86 \u0026plusmn; 10.6).(13-16). Additionally, even within the same nation, the HRQOL scores differ according to conditions within populations. For example, a study in Kuwait showed that the HRQOL overall mean score was (47.4\u0026plusmn;10.3) among women with PPD \u0026nbsp;and (59.2\u0026plusmn;13.1) among women without PPD (15). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt has also been reported that sociodemographic factors may influence the HRQOL of populations. For example, a \u0026nbsp;study conducted in Arba Minch town in Ethiopia showed that about (62.3%) of participants had a lower level of HRQOL, mean \u0026plusmn; SD 45.15\u0026plusmn;8, and the overall mean score of HRQOL was 45.15\u0026plusmn;8.13. Moreover, in this Ethiopian study, age group 17\u0026ndash;24 years and no formal education were factors associated with the lower overall HRQOL (17). Additional factors including: married or living with a partner, registered students, 30 - 40 years of age, living without physical complaints, having at least an 8th-grade education, being Caucasian were predictors of having the best health related quality of life.(18)\u0026nbsp;Huang and colleagues also found that husband\u0026rsquo;s lower education level and male gender of the infant were significantly associated \u0026nbsp; with poor quality of life (19).\u0026nbsp;Another study reported that women older than 40, separated/divorced, or widowed, had significantly lower HRQOL scores compared to women who had completed upper secondary or had a university level education\u0026nbsp;(20).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost of the previous studies were conducted in developed countries, and it is well acknowledged that HRQOL is a concept that is affected by culture and social systems, indicating that the cultural differentials between developed and developing settings may have implications for HRQOL. As such, it is not justifiable to inform policy and strategy initiatives for developing settings, using evidence from studies conducted in developed countries. However, although there have been limited studies indicating the impact of postnatal discomfort and problems on women\u0026rsquo;s HRQOL, their results have been inconsistent and not comprehensive. Additionally, most of the previous studies in Ethiopia, except the study done in Arba Mich town, were investigated the quality of life among pregnant mothers rather than postpartum women. \u0026nbsp;The current study aimed to assess the level of HRQOL and its predictors among postpartum women in the Southeast Ethiopia.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eStudy design, setting and populations\u003c/span\u003e\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eBetween 10\u003csup\u003eth\u003c/sup\u003e March and 8\u003csup\u003eth\u003c/sup\u003e May 2022, institutional-based cross-sectional study was conducted in the health facilities in the Bale Zones, South East Ethiopia. The Bale zone is located in the \u003cspan class=\"red-underline\"\u003eSoutheastern\u003c/span\u003e part of the Oromia Regional National State. The zone health facilities are categorized as hospitals or health centres. \u0026nbsp;During the study period, the zone had five hospitals namely: (i) Goba Referral Hospital, (ii) Robe General Hospital, (iii) Delomena General Hospital, (iv) Madda Walabu Primary Hospital, and (v) Goro Primary Hospital. However, the last hospital (Goro Primary Hospital) was not fully functional during study period and was excluded from study. In addition, there were 18 urban health centers and 37 rural health centers within the zone.\u003c/p\u003e\n\u003cp class=\"MsoCommentText\"\u003eAccording to the 2020/21 Bale zone health office report, the estimated total population of the Bale zone was \u003cspan class=\"red-underline\"\u003e1,299,394\u003c/span\u003e of which 636,703 were men,662,691 females and total number of reproductive-age women was 285,867(Unpublished Bale zone health report).\u0026nbsp;\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe estimated number of pregnant women in Bale zones was 44,179, and the total number of mothers on postnatal follow-up was 42,880. All postpartum mothers who were attending immunization at all health facilities in the Bale Zone were the source population. To be eligible, women were required to be: in the postpartum period or less than six months after delivery, aged \u0026ge;18 years, voluntarily willing to participate in the study, and living in Bale zone for at least six months. However, women with obstetric/neonatal complications related to the recent birth, diagnosed with postpartum depression, and mothers with disability were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eSample size determination\u003c/span\u003e\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eBy using the single population proportion formula \u0026nbsp; and \u0026nbsp; considering P = 62.3% of postpartum mothers who had a low level of quality of life from the previous study in Arba Minch \u003cspan class=\"Heading2Char\"\u003e(17)\u003c/span\u003e\u003cspan class=\"Heading2Char\"\u003e,\u0026nbsp;\u003c/span\u003e d = 5%, design effect = 2, and non-response rate of 10%, the current study final sample size was 794.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eSampling techniques\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe purpose was to have a representative sample of postpartum mothers who were attending child immunization clinic in Bale zone public health facility. Of the total public health facilities in Bale zones, at first step, public health facilities were categorized into hospitals and health centers. Of the four fully functional hospitals in the Bale zone, Robe General Hospital, Delomena General Hospital, and Madda Walabu Primary Hospital were providing child immunization services, and Madda Walabu University Goba Referral hospital was out of service. Since child immunization, service given at those hospitals was by similar guidelines, Robe General Hospital was included in the study site by lottery method. In addition, 5 urban health centers and 11 rural health centers were chosen at random from the 18 urban health centers and 37 rural health centers respectively. Based on the simple random technique, the total number of selected participants was proportionally drawn from each selected health facility based on the total number of postpartum mothers attending immunization clinics (Table 1).\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eTable 1 : \u0026nbsp; Proportionally Allocated Sample Size for The Study Of HRQOL In Southeast Ethiopia\u003c/p\u003e\n\u003ctable class=\"MsoNormalTable\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003eHealth institution\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eArea\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eAverage PPM who attends child immunization clinic in the past two months\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cstrong\u003eProportionally allocated sample size\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;= (Sample size(794) \u003cstrong\u003e*\u003c/strong\u003ePPM attending immunization clinic at each selected health institution)\u003cstrong\u003e/\u003c/strong\u003eTotal(1497))\u0026nbsp;\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eDinsho HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e100\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eAgarfa HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e100\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eGasara HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e101\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e54\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eDambal Hc\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e98\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e52\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eHarawa Sinja HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eUrban\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e105\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e56\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eHomma HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e82\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e43\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eQaso Manso HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e88\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e47\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eHawo HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e91\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eBuluk HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e97\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e51\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eWacho HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e76\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e40\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eWarre HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e87\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e46\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eCirri HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e88\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e47\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eK/Golba HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e85\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e45\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eBirbirsa HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e69\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e37\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eM/burka HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e70\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e37\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eMexi HC\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eRural\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e50\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e27\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003eRobe GH\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003eHospital\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e110\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e58\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cstrong\u003e1,497\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cstrong\u003e794\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eStudy variables\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eDependent variable\u003c/span\u003e\u003cspan class=\"Heading2Char\"\u003e\u003cem\u003e:\u003c/em\u003e\u003c/span\u003eHealth related Quality of life (HRQOL\u003c/p\u003e\n\u003cp\u003eIndependent variables\u003cspan class=\"Heading2Char\"\u003e:\u003c/span\u003eIncludes; Sociodemographic, obstetrics related characteristics, postpartum depression related characteristics, and Fear of COVID 19 related characteristics. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Heading2Char\"\u003eData collection techniques and instrument\u003c/span\u003e\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eA pretested interviewer-administered structured questionnaire (Short-Form 36 (SF-36)), a widely validated tool and one of the most widely used HRQOL scales in the world was used to collect data. The SF-36 which is a multicultural scale and a widely validated in different languages tool, has been applied in different countries for the study of the maternal quality of life, including in \u0026nbsp;Ethiopia (21),(20),(14),(17),(22).\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe SF-36 tool consists 36 questions categorized into eight-domain profile of scores and two component summaries including physical (PCS) and mental (MCS) health. The SF 36 as a multidimensional multi-item scale, assesses eight health conceptual domains with associated components as follows: (i) \u0026nbsp;Physical functioning (PF),10 items; (ii) role physical (RP), 5 items; (iii) general health (GH), 4 items; (iv) bodily pain (BP), 2 items; (v) social functioning (SF), 2 items; (vi) vitality (VT), 4 items; (vii) role emotional (RE), 3 items; and (viii) mental health (MH), 5 items. For each domain, a score ranging from 0 to 100 was assessed, with a higher score indicating better health (23, 24).\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe questionnaire has five parts: (i) socio-demographics, (ii) obstetrics-related characteristics, (iii) postpartum depression-related characteristics, (iv) quality-of-life-related characteristics, and (v) fear of COVID 19 (FCV 19) study scale. We used the Ethiopian version of validated tool, termed Medical Outcome Study Short Form 36 (MOS-SF-36), to study HRQOL. The current study tool was validated and translated for Ethiopia with Cronbach\u0026rsquo;s alpha score of greater than 0.7 (17, 22). Edinburgh postnatal depression scale (EPDS) which contains ten questions was used as the tool to assess patients at risk of postnatal depression (23). The EPDS indicates how the mother felt during the previous seven days. \u0026nbsp;According to a validation study in Addis Ababa, respectively, EPDS generated the sensitivity and specificity of 78.9% and 75.3% (23, 25).\u003c/p\u003e\n\u003cp\u003eData quality control\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe MOS-SF-36 used for this stud was prepared in English and translated to Afan Oromo, one of the local languages spoken in the study setting. The tool was checked by Afan Oromo speaking English language expert, and was re-checked to ensure that it maintained its consistency. The pretesting of the tool was conducted to improve the clarity, understandability and simplicity of the messages before the actual data collection. Before the actual data collection, data collectors ( who were selected from midwifery and/or nursing professionals) and supervisors were trained for two days on the objectives, method, sampling technique, ethical issues, data collection instrument and data collection procedures. All of questionnaires were checked for completeness and accuracy during and after data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOperational definitions\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eScoring the SF 36-Item Health Survey is a two-step process. In the first step: a pre-coded numeric values (values on questionnaires\u0026rsquo;) were recoded according to scoring guide for SF 36 tools. It is worthy noting that all items were scored so that a high score defined a more favorable health state. In addition, domain scores were calculated by summing up each item under each domain. Then each raw scale score was transformed from 0 to 100 (0\u0026ndash;100 scale) by using the formula of transformed scale item which was scored in a 0 to 100 range, so that the lowest and highest possible scores were 0 and 100, respectively. Scores represented the percentage of the total possible score achieved. In the second step, items on the same scale were averaged together to create the 8 scale scores. Table 2 of the scoring guide for SF 36 tools lists the items averaged together to create each scale. Items that were left blank (missing data) were not taken into account when calculating the scale scores. Hence, scale scores represented the average of all items on the scale that the respondents answered\u0026nbsp;(17, 22, 26)..\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003e\u003cstrong\u003eHealth Related Quality of Life (HRQOL)\u003c/strong\u003e is the post-delivery maternal quality of life assessed by using an Ethiopian validated tool called the Medical Outcome Study Short-Form 36 (MOS SF-36). The MOS-SF-36 contains eight domains comprising two main categories namely, physical and mental HRQOL.\u003c/p\u003e\n\u003cp class=\"Default\"\u003e\u003cstrong\u003ePhysical QOL\u003c/strong\u003e (PCS) mean score is the arithmetic average of the transformed scores of physical functioning, role physical, bodily pain, and general health domains (22, 27).\u003c/p\u003e\n\u003cp class=\"Default\"\u003e\u003cstrong\u003eMental QOL\u003c/strong\u003e (MSC) mean score is the arithmetic average of the transformed scores of social functioning, mental health; role emotional, and vitality domains (17, 22, 23).\u003c/p\u003e\n\u003cp class=\"Default\"\u003e\u003cstrong\u003eOverall HRQOL\u0026nbsp;\u003c/strong\u003emean score is the arithmetic average of the transformed score of the eight domains (23) (17, 23).\u003c/p\u003e\n\u003cp class=\"Default\"\u003e\u003cstrong\u003eHigher HRQOL\u0026nbsp;\u003c/strong\u003eis when participants scored greater than or equal to the standardized mean value of 50 (22, 23).\u003c/p\u003e\n\u003cp class=\"Default\"\u003e\u003cstrong\u003eLower HRQOL\u003c/strong\u003e is when participants scored less than the standardized mean value of 50 (22, 23).\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003e\u003cstrong\u003ePostpartum Partum depression\u003c/strong\u003e: was assessed by using the Edinburgh Postnatal Depression Scale (EPDS). According to the EDPS, study participants who scored \u0026ge;13 are considered as having postpartum depression (23).\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003e\u003cstrong\u003eFear of COVID 19(FCV 19)\u003c/strong\u003e: was measured by validated 7 items five-likert scale ranges from strongly disagree to strongly agree. Scoring each item together, minimum score is 7 and maximum score is 35, Mean score is 7.5. If participants score greater than or equal to mean they classified as having FCV 19 and as has no FCV 19 if less than mean (28, 29).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData processing and analysis\u0026nbsp;\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe collected data were checked for completeness, coded and then entered into Epi Data 4.6.2.0. Then, \u0026nbsp;data were exported to SPSS version 26 and cleaned before analysis. Descriptive statistics were calculated for the variables\u003cspan class=\"red-underline\"\u003e\u0026nbsp;and the\u003c/span\u003e analysis was performed \u0026nbsp;as per developer guides for scoring for SF-36 questionnaires(30, 31). First, pre-coded numeric values were recorded in which all items were scored so that a high score defines a more favorable health state. In addition, each item was scored on a 0 to 100 range, so that the lowest and highest possible scores are 0 and 100, respectively. Secondly, items on the same scale were averaged together to create the 8-scale scores. An item that was left blank (missing data) was not taken into account when calculating the scale scores. Hence, scale scores represented the average of all items on the scale that the respondent answered.\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eThe Physical QOL (PCS) mean was computed from physical functioning, role physical, bodily pain, and general health domain transformed scores. The Mental QOL (MCS) mean was computed from social functioning, mental health, vitality, and the role emotional domain transformed score. The overall HRQOL mean was computed from the eight domains\u0026apos; transformed scores. Using the standardized mean score of 50, \u003cspan class=\"red-underline\"\u003eoverall\u003c/span\u003e HRQOL, physical HRQOL, and mental HRQOL were dichotomized into higher and lower HRQOL. Generally, scoring SF 36 questionnaires was done by strictly following the guide for scoring SF 36.\u003c/p\u003e\n\u003cp class=\"MsoNormal\"\u003eBivariable logistic regression analysis was used to examine the statistical association between the overall HRQOL and the predictors. Then variables with a \u003cem\u003eP\u003c/em\u003e-value less than 0.25 in the bivariable logistic regression analysis were considered candidates for the multivariable logistic regression analysis. In the multivariable logistic regression model, variables with a \u003cem\u003eP\u003c/em\u003e-value less than 0.05 were considered significantly associated with the outcome variable. The odds ratio (OR), along with a 95% confidence interval (CI), were used to estimate the strength of the associations\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eMulticollinearity was checked among all predictors. The Hosmer and Lemeshow\u0026rsquo;s goodness-of-fit test were checked.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio-demographic and economic characteristics of the respondents\u003c/h2\u003e\n\u003cp\u003eSeven hundred ninety-two respondents were interviewed, a response rate of 99.75%. Nearly seventy three percent 72.5% (574) of respondents were homemakers, and 77% (610) of them lived with their partner. More than half (52.4%) (415) of the study participants lived in rural area (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Socio-demographic and economic characteristics of postpartum women in Southeast Ethiopia, 2022 (N = 792)\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"67.34693877551021%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"18.367346938775512%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e25-29 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e\u0026gt;=35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eOthers[1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003ePartner education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eCollege/university\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eMarital type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eLive without partner[2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eLive with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e77.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003ePartner education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eCollege/university\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eMothers occupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e72.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003ePartner occupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eNon-government employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eLabor worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eOthers[3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eAverage monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eBelow median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eAbove median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eTypes of transport used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003eWalk.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003ePublic transport (bus, taxi)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003ePrivate Vehicle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"34.02061855670103%\"\u003e\n \u003cp\u003eTime taken from home to reach health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.98969072164948%\"\u003e\n \u003cp\u003e1-30 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e\u0026gt;30 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.875%\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"28.125%\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eObstetric history of the respondents\u003c/h2\u003e\n\u003cp\u003eNearly seventy percent 69.4% (550) of the respondents had up to three total deliveries. Of the total deliveries, 58.9% (245) gave birth in health institution. More than half (52.5%) (416) of the study, participants were over three months post delivery of the current baby. More than half 57.3% (454) of the respondents had no postpartum depression while nearly fifty eight percent 57.5% (455) of the study participants had no fear of COVID 19 (Table 3). \u003c/p\u003e\n\u003cp\u003eTable 3: Obstetrics and postnatal Characteristics of postpartum women in Southeast Ethiopia, 2022 (N = 792)\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" width=\"61.111111111111114%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eTotal number of delivery you had \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003e\u0026le;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eTotal delivery at health institution(N=416)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003ePlace of delivery \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eHealth facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003ePlanned pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eANC follow up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eNumber of ANC visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003e\u0026lt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e46.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e\u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eAdmission history to health institution during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e81.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eDuration since the delivery of last baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003e\u0026le; 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003e\u0026gt;3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eMode of last delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eNormal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eCaesarean delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eHave you experienced any complications during your recent delivery?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eHad you get postnatal check-up within 6 months of your recent delivery?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003ePostnatal depression(PPD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eHave PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"37.77777777777778%\"\u003e\n \u003cp\u003eFear of COVID 19(FCV19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20%\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.88888888888889%\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"37.5%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.142857142857146%\"\u003e\n \u003cp\u003e455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"30.357142857142858%\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eHealth related quality of life among respondents\u003c/h2\u003e\n\u003cp\u003eNearly half (382) of the study participants had lower overall HRQOL, while respectively, about 48.7% (386) and 49.6% (396) of the participants had lower physical and mental HRQOL respectively. From the eight domains of HRQOL assessment, the highest mean score was found in the role emotional dimension with mean \u0026plusmn; SD of 49.33 \u0026plusmn; 48.05; and the lowest mean \u0026plusmn; SD score was in the social functioning (SF), with 30.97\u0026plusmn;21.65 mean \u0026plusmn; SD. Moreover, the physical component summary (PCS) mean \u0026plusmn; SD) score and the mental component summary (MCS) mean \u0026plusmn; SD score were 45.39 \u0026plusmn; 28.58 and 42.20 \u0026plusmn; 28.15), respectively (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: Health Related Quality Of Life of Postpartum Mothers in Southeast Ethiopia, 2022 (N = 792)\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eComponents \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u003c/strong\u003e\u0026plusmn; \u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"35.35528596187175%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003ePhysical functioning(PF) \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e49.21\u0026plusmn;46.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e45.98751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e52.43573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eRole physical (RP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e48.88\u0026plusmn;48.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e45.18446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e51.97463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eRole emotional (RE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e49.33\u0026plusmn;48.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e45.97502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e52.67818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eVitality (VT) \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e43.53\u0026plusmn;18.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e42.21798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e44.8401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eMental health (MH)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e44.99\u0026plusmn;32.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e42.74451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e47.23528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eSocial functioning (SF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e30.97\u0026plusmn;21.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e29.45557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e32.47625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eBodily pain (BP) \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e46.28\u0026plusmn;12.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e45.42574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e47.1336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eGeneral health (GH)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e37.52\u0026plusmn;25.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e35.77829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e39.2707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003ePhysical Component Summary (PCS) \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e45.39\u0026plusmn;28.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e43.40543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e47.39224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eMental Component Summary (MCS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e42.20\u0026plusmn;28.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e40.23961\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e44.16611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.88734835355286%\"\u003e\n \u003cp\u003eOverall HRQOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e43.80\u0026plusmn;27.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.59792027729636%\"\u003e\n \u003cp\u003e41.85614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.75736568457539%\"\u003e\n \u003cp\u003e45.74555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eFactors associated with overall HRQL of the respondents\u003c/h2\u003e\n\u003cp\u003eIn the binary logistic regression model, variables with p-value less than 0.25 were selected as candidate variables for multivariable logistic regression analysis. Variables such as average monthly income, means of transport used, number of total number of deliveries they have until study period time, admission history to a health institution (HI) during recent pregnancy, mode of delivery of the recent baby, complications faced during the recent baby\u0026rsquo;s delivery,, postpartum depression (PPD), and fear of COVID-19 (FCV 19s) were included in the binary logistic regression analysis.\u003c/p\u003e\n\u003cp\u003eIn the multivariable logistic regression analysis, walking to the health facility [(AOR = 2.09; 95% CI: (1.31,3.31)], using public transport (AOR=2.58; 95% CI=1.69\u0026ndash;3.93), giving birth to \u0026le; 3 deliveries (AOR = 1.81; 95% CI: 1.36 \u0026ndash;2.65), having admission history during a recent baby\u0026rsquo;s pregnancy (AOR=1.62; 95% CI=1.08\u0026ndash;2.44), having PPD (AOR=2.13; 95% CI=1.57\u0026ndash;2.89), and having the fear of COVID-19 (AOR=1.46; 95% CI=1.08\u0026ndash;1.99) were predictors of a lower level of HRQOL among postpartum women(Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5: Bivariable and multivariable logistic regression analysis for factors associated with overall health-related quality-of-life among postpartum mothers Southeast Ethiopia, 2022 (N = 792) \u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"bottom\" width=\"30.612244897959183%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" width=\"60.204081632653065%\"\u003e\n \u003cp\u003e\u003cstrong\u003e Overall HRQOL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.183673469387756%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"16.417910447761194%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.91044776119403%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigher\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"25.37313432835821%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"26.865671641791046%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.432835820895523%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"16.417910447761194%\"\u003e\n \u003cp\u003eCount (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"17.91044776119403%\"\u003e\n \u003cp\u003eCount (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"25.37313432835821%\"\u003e\n \u003cp\u003eCOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"26.865671641791046%\"\u003e\n \u003cp\u003eAOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.432835820895523%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eAverage monthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eBelow median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e188(49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e169(41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eAbove median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e194(50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e241(58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1.38(1.04,1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1.06(0.78,1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eMeans of transport\u003c/p\u003e\n \u003cp\u003eused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eWalking \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e255(62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e181(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e2.21(1.42, 3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e2.09(1.31,3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003ePublic transport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e109(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e104(27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e2.97(1.99, 4.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e2.58(1.69,3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003ePrivate vehicle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e46(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e97(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eNumber of total delivery you had\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003e\u0026lt;=3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e142(37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e100(24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1.83(1.35,2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.81(1.36,2.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e240(62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e310(75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eAdmission history to HI during recent baby\u0026rsquo;s pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e85(22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e58(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e297(77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e352(85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1.74(1.20,2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1.62(1.08,2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eMode of last baby\u0026rsquo;s delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eNormal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e179(46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e158(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1.41(1.06,1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.37(0.99,1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eCaesarean delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e203(53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e252(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eFaced complications during recent baby\u0026rsquo;s delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e86(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e60(14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e296(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e350(85.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1.69(1.18, 2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1.19(0.79,1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003ePPD[4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eHave PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e258(67.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e196(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e2.27(1.70, 3.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e2.13(1.57,2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e124(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e214(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"20.61855670103093%\"\u003e\n \u003cp\u003eFCV 19[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003eHave FCV19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e239(62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e216(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.52577319587629%\"\u003e\n \u003cp\u003e1.50(1.13, 1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.556701030927837%\"\u003e\n \u003cp\u003e1.46(1.08,1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.278350515463918%\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.987012987012987%\"\u003e\n \u003cp\u003eNo FCV19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e143(37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.584415584415584%\"\u003e\n \u003cp\u003e194(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"22.07792207792208%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.376623376623378%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.688311688311689%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this study was to assess the level of health related quality of life (HRQOL) and its associated factors among postpartum women in southeastern Ethiopia. The HRQOL among postpartum women was assessed using the Medical Outcome Study Short-Form 36 (MOS SF-36), which is an Ethiopian adaptation of SF 36 validated tool. The study indicated that postpartum women had a lower overall quality of life, with a mean score of HRQOL of 43.80\u0026plusmn;27.88. This finding is comparable with a studies conducted in Ethiopia which had a mean score of \u0026nbsp;45.15\u0026plusmn;8.13 (32), and Kuwait with a mean score of 53.7 (15), but was \u0026nbsp;lower than studies conducted elsewhere including: Iran (Ilam province in the west of Iran) with mean score of 66.32\u0026plusmn;13.7 (33), Spain with mean score of 71.94\u0026plusmn;17.48 (34), Iran (Dezful City, Khuzestan province) with mean score of 68.38 \u0026plusmn; 13.6 (35), \u0026nbsp;and Brazil \u0026nbsp;with mean score of 86.86 \u0026plusmn;10.6 (13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile all these studies were conducted in postpartum women, the HRQOL seemed to differ. It is reasonable to allude that the differences in HRQOL might be due to the socioeconomic and other variations among study participants. While in the current study, the majority of the study participants had low socioeconomic status (from rural areas), the previous studies were conducted in areas of relatively higher socioeconomic status. For example, the study conducted in Ilam province, west Iran and Iran (Dezful City, Khuzestan province) drew participants who resided only in urban areas who may have had higher socioeconomic status. Consistent with the World Health Organisation (WHO) social determinants of health framework (36), we hypothesize that a higher socioeconomic status favors a higher quality of life or physical health, mental health, social activities, public health, and vitality (36). Moreover, we recognize that other studies have also correlated socioeconomic status with the quality of life (37, 38), indicating that populations with higher social economic status have better quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother difference in HRQOL between these studies might be due to differences in the study population, noting that in the current study we included women who gave birth in the last six months (postpartum mothers), whilst the study conducted in Spain included women who gave birth a year before the survey. For women who gave birth a year before the study, it is possible that the women would have recovered from the impact of childbirth, which may not be the case in our study population. It is also possible that the discrepancy between our study and the two studies (Brazil and Iran) could be due to a variation in the tool used to assess the quality of life. In the current study, we used the adaptation on SF-36 questionnaires, but studies conducted in Brazil and Iran used the World Health Organization Quality-of-life Assessment-Bref (WHOQoL-Bref) tool. Additionally, the variation of findings between the current study and other studies conducted in Ethiopia could be due to the differences in the study areas whereby the previous studies were conducted in urban areas and the current study was conducted in both rural and urban areas, but the majority of participants were from rural areas. It is also reasonable to hypothesis that urban areas even in Ethiopia have a better socioeconomic status than in rural areas, which could translate to better health outcomes, noting that poverty and rurality are known significant social determinants of health (36).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also showed that post-partum mothers who walked as a means of transport to reach health facilities were 2.09 times more likely to have lower overall HRQOL when compared with women who were private vehicle users. Moreover, postpartum mothers who used public transports were 2.6 times more likely to have lower overall HRQOL than private vehicle users. Again this could be \u0026nbsp;due to the effect of poor socioeconomic status, assuming that the private vehicles users were able to pay high cost of transport or they (or family) owned the vehicles, and recognizing the significance that the burden of poverty has on the quality of life (36). The \u0026nbsp; current study findings are therefore in support of \u0026nbsp;others that have stated poor families tend to have poorer or lower quality of life (39).\u003c/p\u003e\n\u003cp\u003eOn the other hand, postpartum mothers who gave birth to less than or equal to three \u0026nbsp;deliveries were 1.81 times more likely to have lower overall HRQOL than those who gave birth to greater than three deliveries. This finding is in agreement with the study done somewhere else (40). The possible explanation of why women with less number of children would have a lower HRQOL \u0026nbsp;could be because primiparous women struggle with maternal identity and the demands of motherhood for the first time, resulting in more stress during postpartum than multiparous women (who would have had more than three total deliveries) (41). However, this finding will need to be explored further, given that large families ( with more than three children) would need more resources to meet their needs, and without further interventions or changed circumstance, mother with a large number of children could become more stressed under unmet family needs.\u003c/p\u003e\n\u003cp\u003ePostpartum mothers who had an admission history during a recent pregnancy were 1.6 times more likely to have a lower overall HRQOL score than those who had no admission history. This finding is consistent with the study conducted \u0026nbsp;in Iran that \u0026nbsp; reported an absence of history of disease in pregnancy to be associated with higher women\u0026apos;s QOL (42). However, this is not surprising because women, who would have been admitted to hospitals prenatally, could have been admitted due to conditions that would negatively affect their health, and which could be carried over postnatally, contributing to poor correlate of lower HRQOL during the postpartum period.\u003c/p\u003e\n\u003cp\u003eThis study showed that postpartum mothers who had PPD were also 2.13 times more likely to have lower overall HRQOL than those who had no PPD. Similar findings were found in other studies in which PPD was negatively correlated with HRQOL (15, 43). Consistent with \u0026nbsp;previous studies conducted \u0026nbsp;in Nigeria (44), Carolina state, USA (45), and Iran (46),(42), the current study found women with mental health \u0026nbsp;to have poor HRQOL. The reason might be that depression harms mental health (negatively affecting the SF, MH; RE, and VT domains of quality of life); \u0026nbsp;and depression by itself is known to affect women\u0026rsquo;s ability to: function well, have good relationships with their child, have good interpersonal relationships, have good sleeping patterns, and good social engagement, thus lowering the overall and mental HRQOL (47).\u003c/p\u003e\n\u003cp\u003eIn the meanwhile, postpartum mothers who had a fear of COVID-19 were 1.46 times more likely to have lower HRQOL than those who had no fear of COVID-19. The reason for this might be because the Covid-19 pandemics has \u0026nbsp;disrupted life across the globe, and fear of it (especially during the early period of the pandemic) has also become a pandemic itself(48). Evidence exists that the pandemic has induced different disturbances including anxiety, stress, and depression that could disturb HRQOL in many aspects (49-54), supporting the findings observed in the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe finding in this study must be interpreted by considering the following limitations. Firstly, due to the cross-sectional nature of the study, a cause-effect relationship cannot be established between the risk factors and HRQOL. Secondly, perceptions of mothers regarding services in health facility and/or health worker related factors that might affect the quality life among postpartum mothers were not assessed. To assess such type of factors qualitative study might be helpful. Additionally, this study did not address the quality of life based on time difference during postpartum period (Follow up cohort study might needed).\u003c/p\u003e"},{"header":"Conclusion","content":"This study found that nearly half of the study participants had lower overall HRQOL, while fifty percent of the respondents had low mental HRQOL. Of the eight domains of HRQOL, social functioning (SF) was the most compromised component of quality of life. The mode of transportation used, the total number of deliveries, admission history during the most recent pregnancy, PPD, and FCV 19 had statistically significant associations with lower overall HRQOL. The study findings highlight the fact that the quality of life of postpartum women needs much attention. Evidence exists that vulnerability to depression increases during pregnancy and childbirth, which may partly be attributable to hormonal change, social factors such as luck of support, and economic deprivation for women in low-income countries (55-57). As such, policymakers, program planners, other concerned bodies and organizations should emphasize the need provide high care to postpartum mothers’ social, mental, and physical quality of life given the vulnerability to depression of women in perinatal period especially postpartum period. Further studies on time series (types of postnatal periods) or follow-up studies might be needed to study the quality of life among postpartum mothers. "},{"header":"Abbreviations","content":"\u003cp\u003eANC:\u0026nbsp;Ante Natal Care; BP: Bodily Pain; CS: Cesarean Section delivery; EPDS: Edinburgh Postnatal Depression Scale; GH: General Health; HF: Health Facility; HRQOL: \u0026nbsp;Health Related Quality Of Life; MCS: Mental component score/ mental health;\u003c/p\u003e\n\u003cp\u003eMH: \u0026nbsp;Mental Health; \u0026nbsp;MOS SF 36: \u0026nbsp;Medical Outcome Study Short Form 36; MWU: Madda Walabu University; PCS: Physical component score/physical health; PF: Physical Functioning; PPD: Post-Partum Depression; PPM: Post-Partum Mothers; QOL: Quality of Life; RE: Role Emotional; RP: Role Physical; SD: Standard Deviation; SF: Social Functioning; SF 36: Short Form 36; SPSS: Statistical Package for Social Science; VT: \u0026nbsp;Vitality; WHO: World Health Organization.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from MWU\u0026apos;s Research and Development Directorate (RDD). Subsequently, a letter of permission was received from the management of the Bale Zone Health official. After explaining the objectives of the study in detail, written consent was obtained from each study participant by reading the informed consent format attached to the questionnaires. During data collection, the study participant had the right to refuse, stop, or withdraw from participation. Confidentiality of the data and their responses were guaranteed throughout the study period, and information was provided at the end of the interview in case of any misunderstanding.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026quot; in this section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eAll authors have made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas. Have drafted or written, or substantially revised or critically reviewed the article. Have agreed on the journal to which the article be submitted. Reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. Agree to take responsibility and be accountable for the contents of the article. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eACKNOWLEDGEMENT\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to Madda Walabu University for creating the opportunity for us to conduct this research. We would also like to extend our heartfelt appreciation to the Bale Zone Health Office for providing important background data on the study area. Lastly, we would like to acknowledge the scholars whose work is used in this research paper work as references.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSymon A. A review of mothers' prenatal and postnatal quality of life. Health and Quality of Life Outcomes. 2003;1(1):1-8.\u003c/li\u003e\n\u003cli\u003ePeterson S, Bredow TS. Middle range theories: Application to nursing research and practice: Lippincott Williams \u0026amp; Wilkins; 2019.\u003c/li\u003e\n\u003cli\u003eEmmanuel EN, Sun J. Health related quality of life across the perinatal period among Australian women. Journal of clinical nursing. 2014;23(11-12):1611-9.\u003c/li\u003e\n\u003cli\u003eJomeen J. The importance of assessing psychological status during pregnancy, childbirth and the postnatal period as a multidimensional construct: A literature review. Clinical Effectiveness in Nursing. 2004;8(3-4):143-55.\u003c/li\u003e\n\u003cli\u003eKarimi M, Brazier J. 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International journal of environmental research and public health. 2020;17(8):2900.\u003c/li\u003e\n\u003cli\u003eDadi AF, Miller ER, Bisetegn TA, Mwanri L. Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC Public Health. 2020;20(1):173.\u003c/li\u003e\n\u003cli\u003eFekadu Dadi A, Miller ER, Mwanri L. Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis. PLoS One. 2020;15(1):e0227323.\u003c/li\u003e\n\u003cli\u003eWadhwa PD, Glynn L, Hobel CJ, Garite TJ, Porto M, Chicz-DeMet A, et al. Behavioral perinatology: biobehavioral processes in human fetal development. Regulatory peptides. 2002;108(2-3):149-57.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"HRQOL (Health-related quality of life), postpartum women, Bale Zone, PPD (Postpartum Depression), FCV 19 (Fear of COVID-19)","lastPublishedDoi":"10.21203/rs.3.rs-2037336/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2037336/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Impaired Health related quality of life (HRQOL) after women's childbirth affects women in a wide range of ways including limiting their daily activity, reducing self-care capacity, impairing childcare including effective breastfeeding and baby weaning, and increasing the cost of medical care, both for women and for their newborn babies. This study aimed to assess the HRQOL and its predictors among postpartum women in Southeast Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Between March and May 2022, an institutional-based cross-sectional study was conducted among a simply randomly selected sample of 794 postpartum women who were attending immunization services in public health facilities in Southeast Ethiopia. The pretested interviewer-administered structured, Short Form 36 (SF-36), validated questionnaire was used to collect data and to assess the HRQOL. This Descriptive statistics were computed and the bivariable and multivariable logistic regression model was fitted to predictors of HRQOL. Odds ratio (OR), along with a 95% confidence interval (CI), were used to estimate the strength of the associations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean scores (mean ± SD) of overall HRQOL, physical component summary (PCS) and mental component summary (MCS) of quality of life were 43.80 ± 27.88, 45.39 ± 28.58 and 42.20 ± 28.15) respectively. Walking to the health facility [(AOR = 2.09; 95% CI: (1.31,3.31)], using public transport (AOR=2.58; 95% CI=1.69–3.93), giving birth to ≤ 3 deliveries (AOR = 1.81; 95% CI: 1.36 –2.65), having health facility admission history during the recent baby’s pregnancy (AOR=1.62; 95% CI=1.08–2.44), having postpartum depression (PPD) (AOR=2.13; 95% CI=1.57–2.89) and having the fear of COVID-19 (AOR=1.46; 95% CI=1.08–1.99) were predictors of a lower level of HRQOL among postpartum women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study revealed that nearly half of the postpartum women had a lower HRQOL. Means of transport used, the number of total deliveries they had, admission history during the recent baby pregnancy, PPD and Fear of COVID 19\u003cstrong\u003e (\u003c/strong\u003eFCV 19) showed a statistically significant association with the lower overall HRQOL. To improve the HRQOL among postpartum women in Ethiopia, programs should be implemented by applying appropriate strategies that address the identified factors.\u003c/p\u003e","manuscriptTitle":"Health Related Quality of Life and its predictors among Postpartum Mother in Southeast Ethiopia: A Cross sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-12 14:41:58","doi":"10.21203/rs.3.rs-2037336/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":"f56bf8cb-b961-4dd4-976c-e3c586b98844","owner":[],"postedDate":"September 12th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-25T10:36:47+00:00","versionOfRecord":{"articleIdentity":"rs-2037336","link":"https://doi.org/10.1016/j.heliyon.2024.e27843","journal":{"identity":"heliyon","isVorOnly":true,"title":"Heliyon"},"publishedOn":"2024-03-01 10:36:47","publishedOnDateReadable":"March 1st, 2024"},"versionCreatedAt":"2022-09-12 14:41:58","video":"","vorDoi":"10.1016/j.heliyon.2024.e27843","vorDoiUrl":"https://doi.org/10.1016/j.heliyon.2024.e27843","workflowStages":[]},"version":"v1","identity":"rs-2037336","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2037336","identity":"rs-2037336","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}