Traditional Ethiopian Coffee Ceremony in a Rural Ethiopian Hospital to Increase Hospital-Based Delivery Rates: A Randomized Controlled Trial

AbstractWord count: 250   Background Ethiopia has an estimated maternal mortality ratio of 353 per 100,000 live births. In an effort to improve acceptability of hospital-based deliveries, health facilities have adopted traditional practices in the labor ward. We hypothesized that offering postpartum coffee ceremonies to antenatal care patients would increase the hospital-based delivery rate.   Trial design     Non-blinded randomized controlled trial   Methods  From April to June 2015, pregnant patients presenting for their first antenatal care visit were block-randomized per day to receive a postpartum coffee ceremony, compared to not receiving coffee postpartum. The primary outcome was presentation for delivery at Gambo Hospital.   Results    254 Patients were randomized to the ceremony group and 185 to the no-ceremony group. There was no significant difference in hospital-based delivery rates between the randomized groups (32.1% versus 31.7%; relative risk 1.01; 95% CI, 0.76 to 1.35). Results were likely compromised by patients’ misunderstanding of the randomization process. 12.7% of patients self-reported that the postpartum coffee ceremony served as motivation to deliver in the hospital. Hospital delivery was positively associated with shorter travel time, higher education grade, and previous delivery at a health-facility. It was negatively associated with previous home delivery and a higher number of antenatal care visits.   Conclusions   The likely flawed randomization process undercuts our ability to draw conclusions about the effect of this sociocultural intervention on the observed hospital-based delivery increase. This study exemplifies the difficulty of applying conventional research concepts to sociocultural interventions, especially in a setting of low educational levels, language barriers, and limited research capacity.