High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress.

AIM: To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress. METHODS: We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4. RESULTS: Of the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score-based treatment. CONCLUSION: Incorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near-perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score-based treatment recommendations. These results highlight an opportunity for task-shifting assessments and empowering nurses.

Practice of Kangaroo Mother Care Among Low-Birth-Weight Infants Discharged from Health Facilities and Its Outcome in Mekelle City, Tigray, Northern Ethiopia.

Background: Kangaroo mother care is a proven intervention shown to be effective in reducing neonatal mortality among low-birth-weight infants. The paucity of evidence regarding the practice at home can be highlighted. This study aimed to assess the practice and outcome of kangaroo mother care at home among mothers having low-birth-weight infants discharged from two hospitals in Mekelle, Tigray, Ethiopia. Methods: A prospective cohort study was conducted among 101 paired mothers and low-birth-weight neonates discharged from Ayder and Mekelle Hospitals. Non-probability purposive sampling was used to select 101 infants. Data were collected from patient charts in both hospitals using interviewer-administered structured questionnaire, anthropometric measurements and were then analyzed using SPSS version 20. Characteristics were analyzed using descriptive statistics. Bivariate analysis was used, and variables with p-value <0.25 were exported to multivariable logistic regression and statistical significance was set at a p-value <0.05. Results: Kangaroo mother care was continued at home in 99% of the infants. Three of the 101 infants died before the age of 4 months with a possible cause of death from respiratory failure. Exclusive breastfeeding was provided for 67% of the infants, and it was higher in infants who started kangaroo mother care within 24 hours of life (AOR 3.8, 95% CI 1.07-13.25). Malnutrition was higher in those with birth weight <1500 grams (AOR 7.3,95% CI 1.63-32.59); small for gestational age (AOR 4.8,95% CI 1.41-16.31) and those provided kangaroo mother care for <8 hours per day (AOR 4.5,95% CI 1.40-16.31). Conclusion: Early initiation and prolonged duration of kangaroo mother care were associated with increased exclusive breastfeeding practice and decreased incidence of malnutrition. Kangaroo mother care should be promoted at the community level.

Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research.

Background: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC. Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software. Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home. Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Prevalence and Factors Associated with Neonatal Mortality at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. A Cross-Sectional Study.

BACKGROUND: The neonatal period is the most vulnerable time of human life for diseases. Neonatal morbidity and mortality are significant contributors to under-five morbidity and mortality in sub-Saharan Africa. OBJECTIVE: To assess prevalence and factors associated with neonatal mortality at Ayder Comprehensive Specialized Hospital. METHODS: A facility-based cross-sectional study was conducted on neonates admitted to the neonatal intensive care unit of Ayder Comprehensive Specialized Hospital from June 1, 2018 to May 30, 2019. Data were taken retrospectively from patient records during admission, discharge, and death certificate issue. The data were entered and analyzed using SPSS version 23. Descriptive and logistic regression analysis was done to describe and identify associated factors with neonatal mortality. P-values <0.05 were considered statistically significant. RESULTS: During the study period, 1785 neonates were seen and 1069 (60%) were males. Neonatal mortality rate was 298 (16.7%). Of all the deaths, 98.3% occurred during the first 7 days of age. Respiratory distress syndrome (AOR: 12.56; 95% CI: 6.40-24.66:), perinatal asphyxia (AOR: 19.64; 95% CI: 12.35-31.24), congenital anomaly (AOR: 2.42; 95% CI: (1.48-4.01), early neonatal sepsis (AOR: 3.68; 95% CI: 2.32-5.81), late onset sepsis (AOR: 8.9; 95% CI: 4.14-19.21), gestational age, 34-36+6 weeks (AOR: 0.09; 95% CI: 0.014-0.59), 3741+6 weeks (AOR: 0.025; 95% CI: 0.0030.218), >42 weeks (AOR: 0.039; 95% CI: 0.004-0.4250), parity (AOR: 0.64; 95% CI: 0.44-0.93) and hospital stay (AOR: 0.09; 95% CI: 0.05-0.14) were significantly associated with neonatal mortality. Neonates with a birth weight of less than 1500 g were at 49%, 70%, and 80% increased odds of mortality compared to those 1500-2499 g, 2500-3999 g, and more than 4000 g, respectively. CONCLUSION: In this study neonatal mortality was significantly high. Neonatal mortality was highly associated with primipara, prematurity, low birth weight, perinatal asphyxia, respiratory distress syndrome, congenital anomaly, neonatal sepsis and duration of hospital stay. Many of those cases could be prevented by improving antenatal care follow up, emergency obstetric services, and the enhancement of neonatal resuscitation skills and management of sick neonates.

Effect of osteoporosis treatment agents on the cortical bone osteocyte microenvironment in adult estrogen-deficient, osteopenic rats.

Though osteoporosis is a significant cause of disability worldwide, treatment with pharmacologic agents decreases risk of fragility fracture. Though these treatments act through the bone remodeling system to improve bone mass, it is unclear if they alter the response of bone to mechanical loading at the level of the osteocyte. This pre-clinical study determined the relationship between microstructural bone tissue properties and osteocyte lacunar size and density to strain around osteocytes with standard osteoporosis treatment or sequential therapies. Six-month-old female ovariectomized (OVX) Sprague-Dawley rats were cycled through various sequences of pharmacological treatments [alendronate (Aln), raloxifene (Ral) and human parathyroid hormone-1,34 (PTH)] for three month intervals, over nine months. Linear nanoindentation mapping was used to determine Young's modulus in perilacunar and bone matrix regions around cortical bone osteocyte lacunae. Measurements of lacunar diameter and density were completed. Treatment-related differences in Young's modulus in the perilacunar and bone matrix regions were not observed. We confirmed previous data that showed that the bone matrix region was stiffer than the perilacunar matrix region. Whole bone material properties were correlated to perilacunar matrix stiffness. Finite element models predicted a range of mechanical strain amplification factors estimated at the osteocyte across treatment groups. In summary, though the perilacunar matrix near cortical osteocyte lacuna is not as stiff as bone matrix further away, osteoporosis treatment agents do not affect the stiffness of bone tissue near osteocyte lacunae.

Effect of replacing concentrate feed with leaves of Oldman saltbush (Atriplex nummularia) on feed intake, weight gain, and carcass parameters of highland sheep fed on wheat straw in northern Ethiopia.

Atriplex nummularia (oldman saltbush) is widely planted on salt-affected land to provide a vegetative cover, which can be used as an alternative feed resource. The study was conducted to evaluate the replacement of commercial concentrate with oldman saltbush (SB) leaf on the feed intake, live weight gain, and carcass parameters of local sheep. Twenty-five sheep with an age of 6 months and weighting 14.60 ± 2.47 kg were used in randomized complete block design and distributed into five equal groups, with five animals each. The selected sheep were fed with the dietary treatments for 2 weeks for adaptation and continued until the end of the study, which lasted for 90 days. In the control treatment (SB-0), sheep were fed 100% concentrate mix, while in SB-5, SB-10, SB-15, and SB-20, 5, 10, 15, and 20% of the concentrate mix was replaced by SB, respectively. Wheat straw and water were given at ad libitum throughout the experiment period. Data on feed intake and live weight gain were recorded daily and weekly, respectively, for 90 days. Three animals from each treatment were slaughtered for carcass analysis. Atriplex nummularia leaf (Oldman saltbush) contained 92.02% dry matter (DM), 21.99% crude protein (CP), 24.77% ash, 58.27% neutral detergent fiber (NDF), and 26.56% acid detergent fiber (ADF). Dry matter intake, live weight gain, and carcass parameter were not statistically different among the treatments. Result indicated that concentrate feed can be replaced with Atriplex nummularia leaf up to 20% in sheep diet without negative effect on growth performance and carcass characteristics.

Foot length, chest and head circumference measurements in detection of Low birth weight neonates in Mekelle, Ethiopia: a hospital based cross sectional study.

BACKGROUND: Low birth weight (Birth weight < 2500 g) is a leading cause of prenatal and neonatal deaths. The early identification of Low birth weight (LBW) neonates is essential for any comprehensive initiative to improve their chance of survival. However, a large proportion of births in developing countries take place at home and birth weight statistics are not available. Therefore, there is a need to develop simple, inexpensive and practical methods to identify low birth weight (LBW) neonates soon after birth. METHODS: This is a hospital based cross sectional study. Four hundred twenty two (422) live born neonates were included and anthropometric measurements were carried out within 24 h of birth by three trained nurses. Birth weight was measured by digital scale. Head and chest circumference were measured by using non extendable measuring tape and foot length with hard transparent plastic ruler. Data was entered into SPSS version 20 for analysis. Characteristics of study participants were analyzed using descriptive statistics such as frequency and percentage for categorical data and mean and standard deviation for continuous data. Correlation with birth weight using Pearson's correlation coefficient and linear regression were used to identify the association between dependent and independent variables. Receiver operating characteristic (ROC) curve was used to evaluate accuracy of the anthropometric measurements to predict LBW. RESULTS: The prevalence of low birth weight was found to be 27%. All anthropometric measurements had a positive correlation with birth weight, chest circumference attaining the highest correlation with birth weight (r = 0.85) and foot length had the weakest correlation (r = 0.74). Head circumference had the highest predictive value for birth weight (AUC = 0.93) followed by Chest circumference (AUC = 0.91). A cut off point of chest circumference 30.15 cm had 84.2% sensitivity, 85.4% specificity and diagnostic accuracy (P < 0.001). A cut off point of head circumference 33.25 had the highest positive predictive value (77%). CONCLUSION: Chest circumference and head circumference were found to be better surrogate measurements to identify low birth weight neonates.