Effect of community based nutritional education on knowledge, attitude and compliance to IFA supplementation among pregnant women in rural areas of southwest Ethiopia: a quasi experimental study.

BACKGROUND: Compliance with the iron folic acid supplementation is low and not at the required level to prevent anaemia during pregnancy in many countries, including Ethiopia, even though an iron-folic acid supplementation program is being implemented. The aims of this study were to determine the effect of community-based nutritional education on knowledge, attitude, and compliance to IFA supplementation in Ilu Aba Bor zone of southwest Ethiopia. METHOD: A pretest-posttest quasi-experimental study design consisting of intervention and control group was conducted among pregnant women. The total sample size of 472, therefore, 236 pregnant women for each interventional and control group from 16 kebeles were randomly selected in two districts. A multi-stage sampling technique was used to select the study participants. Then, individual study units were selected using a simple random sampling technique and followed until the end of the study period. Effect of community-based nutritional education on knowledge, attitude, and compliance to IFA supplementation among pregnant women in rural areas were measured. RESULTS: A total of 472 pregnant women participated in the study during the baseline and 437 (92.6%) were in the study until the end. The majority (49.2%) of respondents were 21-25 years of age, with a mean age of 23.4 (SD = 3.7) years. Community-based nutrition has resulted in a statistically significant increase in levels of maternal knowledge of IFAS by 15.2% in the intervention group compared to 5.1% in the control group. Similarly, the intervention group had odds of developing a positive attitude toward IFA 5.6 (4.01, 7.85) times higher than the control group. Moreover, in this study, the odds of compliance towards IFA supplementation were 3.9 (2.67, 5.57) times higher among those who received nutrition education than those women who did not. CONCLUSION: This study revealed that community-based nutritional education can result in a significant change in knowledge, attitude, and compliance towards IFA supplementation and supports the literature suggesting the importance of the intervention to overcome the problem of poor compliance and its associated consequences.

Why health system diagnosis delay among tuberculosis patients in Illubabor, Oromia region, South West Ethiopia? A qualitative study.

BACKGROUND: The main target of tuberculosis control and prevention is to detect incident cases as quickly as possible and also to prevent the occurrence of disease. It is also the responsibility of the health facility to screen the contacts, identifying children for prophylactic therapy. However, the target is difficult to meet due to issues within health facilities that cause health system diagnostic delays. Despite this, there is no information explored why health system diagnostic delays among tuberculosis patients. METHOD: A qualitative study was conducted by using different data collection methods and sources. Seventeen DOT providers, five laboratory professionals, six program managers, and seven Tuberculosis patients were interviewed. In addition, 22 governmental health facilities were observed for the availability of resources. Data obtained from the in-depth interviews was transcribed, coded, categorized, and thematized manually. RESULT: Health system Diagnosis delays reasons were related with sample collection procedures, poor competency of health professionals, in addition to absences or scarcity of health professionals, medical products, and basic infrastructure. We found 18 health facilities without skilled personnel in the OPD, 7 health facilities with a broken microscope, and almost all health facilities without a separate room for sputum examination. Furthermore, 12 (54.5%) and 14 (63.6%) health facilities lacked access to water and electric power, respectively. CONCLUSION: Many reasons for TB diagnosis delays have been identified in the study area. Poor competence of health workers and scarcity of resources were identified. Depending on the finding, we suggest strengthening the health workers' training. Concrete strategies need to be designed to retain professionals. Training on human resource planning and budget preparation is needed for front-line managers. Managers have to work on the maintenance of diagnostic tools and facilitate transportation. The rural health facilities need to use another alternative power source.

Access to maternal health services during COVID-19 pandemic, re-examining the three delays among pregnant women in Ilubabor zone, southwest Ethiopia: A cross-sectional study.

BACKGROUND: All women require access to high-quality care during pregnancy, labor, and after childbirth. The occurrence of delay at any stage is one of the major causes of maternal mortality. There is, however, a scarcity of data on women's access to maternal health services during the COVID-19 pandemic. Therefore, the goal of this study was to assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic. METHODS: A facility-based cross-sectional study was conducted among 402 pregnant women selected by systematic random sampling. Data were analyzed using IBM SPSS Statistics version 26. Descriptive and summary statistics were used to describe the study population. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with the outcome variables. Adjusted odds ratio with respective 95% CI was used to report significant covariates. RESULTS: A total of 402 pregnant women participated in this study. The median age of the respondents was 25 years (IQR = 8). On average, a woman stays 1.76 hours (SD = 1.2) to make a decision to seek care. The prevalence of first, second and third delay were 51%, 48%, and 33.3%, respectively. Being unmarried [AOR (95% CI)], [0.145 (0.046-0.452)], being unemployed [AOR (95% CI)], [4.824 (1.685-13.814)], age [AOR (95% CI)], [0.227 (0.089-0.0579)], fear of COVID-19 [AOR (95% CI)], [1.112 (1.036-1.193)], urban residence [AOR (95% CI)], [0.517 (0.295-0.909)], and lack of birth preparedness [AOR (95% CI)], [6.526 (1.954-21.789)] were significantly associated with first delay. Being unmarried [AOR (95% CI)], [5.984 (2.930-12.223)], being unemployed [AOR (95% CI)], [26.978 (3.477-209.308)], and age [AOR (95% CI)], [0.438 (0.226-0.848)] were significantly associated with second delay. Having lengthy admission [AOR (95% CI)], [7.5 (4.053-13.878)] and non-spontaneous vaginal delivery [AOR (95% CI)], [1.471 (1.018-1.999)] were significantly associated with third delay. CONCLUSION: This study identified a significant proportion of mothers experiencing delays, although there were no data to suggest exacerbated delays in utilizing maternal health services due to fear of the COVID-19 pandemic. The proportion of maternal delay varies with different factors. Improving the decision-making capacity of women is, therefore, essential.

Predictors of adverse perinatal outcome among women who gave birth at Medical Center of Southwest Ethiopia: a retrospective cohort study.

OBJECTIVES: The aim of this study was to determine predictors of adverse perinatal outcome among women who gave birth at Medical Center of Southwest Ethiopia. SETTING: Institutional based retrospective cohort study was conducted among women who gave birth at Medical Center of Southwest Ethiopia. PARTICIPANTS: Medical record of 777 women was included in the study by using maternity HMIS logbook as entry point. Simple random sampling technique without replacement was employed to select individual medical record using computer generated random numbers. PRIMARY OUTCOME MEASURED: Predictors of adverse perinatal outcome were examined using modified Poisson regression with a robust SE. RESULTS: Majority, 74.1% of the participants were in the age group of 21-34 years and the median age was 26 (IQR=7) years. More than one-third, 35.9% of the mothers were primigravida and only 21.2% of them had above four antenatal cares (ANC) visit. The overall incidence of adverse perinatal outcome was 31.5% (95% CI: 28.3 to 34.9). Maternal age less than 20 years (adjusted risk ratio, aRR=1.3; 95% CI: 1.01 to 1.5), rural residence (aRR=1.27; 95% CI: 1.04 to 1.59), presence of antepartum haemorrhage in current pregnancy (aRR=1.7; 95% CI: 1.38 to 2.07), maternal anaemia (aRR=1.25; 95% CI: 1.03 to 1.53), lack of ANC visit (aRR=2.29; 95% CI: 1.35 to 3.90), induced labour (aRR=1.77; 95% CI: 1.43 to 2.19) and being positive for venereal disease research laboratory (VDRL) test in current pregnancy (aRR=2.0; 95% CI: 1.16 to 3.38) were found to be significantly associated with adverse perinatal outcome. CONCLUSION: The incidence of adverse perinatal outcome in the study area is high and maternal age less than 20, rural residency, maternal anaemia, antepartum haemorrhage in the current pregnancy, inadequate ANC visit, induction of labour and being positive for VDRL test were found to predict occurrence of adverse perinatal outcome. Majority of these problems can be managed by providing quality antenatal, intrapartum and post-natal care.