The discrepancy of antemortem clinical diagnosis and postmortem autopsy diagnosis of lung pathologies in under-five deaths and the reasons for discrepancies: a case series analysis.

BACKGROUND: Diagnostic autopsy is the most reliable approach to definitively ascertain the cause of death and evaluate the accuracy of antemortem clinical diagnoses. Identifying diagnostic discrepancies is vital to understanding common gaps in antemortem clinical diagnoses and modifying antemortem diagnostic approaches to increase the accuracy of clinical diagnosis. The objective of this study was to determine the frequency of diagnostic discrepancies between antemortem clinical diagnoses and postmortem autopsies on lung pathologies and to understand the reasons for diagnostic discrepancies among cases included in Child Health and Mortality Prevention Surveillance (CHAMPS) in Ethiopia. METHODS: A clinical case series study of deaths among children under-five in the CHAMPS study at three sites in Ethiopia between October 2019 and April 2022 was conducted. The antemortem clinical diagnoses and postmortem pathological diagnoses of the lung were compared for each case. Two senior physicians assessed the findings for both agreement and disagreement. McNemar's test was used to assess for statistically significant differences between antemortem and postmortem diagnoses. RESULTS: Seventy-five cases were included (73.3% male). Over half (54.7%) died between the 1st and 7th day of life. Sepsis (66.7%), pneumonia (6.7%), and meconium aspiration syndrome (5.0%) were the most common immediate causes of death. Half (52%) of cases were correctly diagnosed antemortem. The magnitude of diagnostic discrepancy was 35% (95% CI: 20-47%). The most common contributing factors to diagnostic discrepancy were gaps in knowledge (22/75, 35.5%) and problems in consultation and teamwork (22/75, 35.5%). CONCLUSIONS: Misdiagnoses were common among young children who died with positive lung pathology findings. In-service education initiatives and multidisciplinary collaboration are needed to mitigate high rates of diagnostic discrepancies among young children to potentially prevent future deaths.

Early Postnatal Care Utilization and Associated Factors Among Women Who Give Birth in the Last Six Weeks in Hosanna Town, Southern Ethiopia, 2022.

Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7-30.0). No formal and primary educational level of husband (AOR = 0.05, 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13, 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (AOR = 0.3, 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08, 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication.

Association between antenatal common mental disorders symptoms, and adverse obstetric and perinatal outcomes: A community-based prospective cohort study in Eastern Ethiopia.

BACKGROUND: Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia. METHODS: A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes. RESULTS: Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74). LIMITATION: The indirect effects of some potential mediators and moderators were not assessed in this study. CONCLUSION: The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes.

Prevalence of food insecurity amid COVID-19 lockdowns and sociodemographic indicators of household vulnerability in Harar and Kersa, Ethiopia.

BACKGROUND: The COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in resource-limited countries, we examine food insecurity during the pandemic period. METHODS: We conducted a cross-sectional study and used logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. The study is set in two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and included a random sample of 880 households. RESULTS: Roughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income. CONCLUSIONS: After taking individual and household level sociodemographic characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings suggest a need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.

Predictor of anemia among pregnant women attending antenatal clinics at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: a case-control study.

BACKGROUND: Anemia during pregnancy is a public health problem and is related to negative birth outcomes, especially in developing countries. The main aim of this study was to assess predictors of anemia among pregnant women attending antenatal clinics at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia. METHODS: Unmatched case-control study design was employed among 352 individuals. A face-to-face interview was used to gather data, and each pregnant woman's antenatal care follow-up record cards were reviewed in addition to the interview. EpiData version 3.1 and IBM SPSS version 26 was used for data entry and analysis, respectively. Bivariable and multivariable analyses were conducted to identify predictors of anemia, a p-value of <0.05 was considered a statistically significant association. RESULT: The common determinants for anemia in pregnant mothers were: rural residency (AOR = 2.25, 95% CI: 1.14-4.8), no formal education (AOR = 4.4, 95% CI: 1.94-9.9), inter-pregnancy interval (AOR = 2.7, 95% CI: 1.24-5.8), and mid-upper arm circumference (AOR = 5.0, 95% CI: 2.0-12.7). CONCLUSION: In this study, the identified determinant factors for anemia were: rural residency, maternal educational status, inter-pregnancy-interval, and mid-upper arm circumference. Therefore, providing health education and promotion for pregnant women regarding anemia by focusing on rural residents and counseling to lengthen their birth spacing is an important task. Moreover, counseling on taking iron supplementation as suggested and consuming a diet rich in iron during antenatal care will be recommended.

Fertility desires of antiretroviral therapy-attending HIV-positive women and its associated factors in Harari region, Ethiopia.

BACKGROUND: The desire to have children among mothers living with HIV remains a serious public health issue in nations with low coverage for antiretroviral therapy and the prevention of mother-to-child transmission, even if it is feasible to have an HIV-negative child. Therefore, this study aimed to assess fertility desire and associated factors among antiretroviral therapy-attending HIV-positive women at Hiwot Fana Specialized University Hospital, in Harari, Ethiopia. METHODS: A facility-based cross-sectional study design was employed among 639 anti retro-viral therapy attending HIV - positive women by systematic random sampling method selected from June 15 to November 30, 2020. A binary logistic regression model was fitted to identify the associated factors with fertility desire. Descriptive results were presented in percentages, whereas analytical results were reported in adjusted ORs (AORs) with a 95% CI. At p=0.05, statistical significance was declared. RESULTS: A total of 639 participants were included in the study; 69.5%(95% CI 65.7 to 72.9%) of the participants had fertility desire. Younger age (<35 years) (AOR=2.35, 95% CI 1.27 to 4.35), married women (AOR=3.02, 95% CI 1.32 to 12.25), childless women (AOR=2.86, 95% CI 1.17 to 4.82) and women whose duration of HIV diagnosis was ≤5 years (AOR=0.41, 95% CI 0.20 to 0.71) were significantly associated with fertility desire. CONCLUSION: The majority of the study participants have a desire to have children. In light of the high prevalence of fertility desire among antiretroviral therapy-attending HIV-positive women, it is recommended to counsel younger women on reproductive planning and encourage partner testing.

Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa: an analysis of verbal autopsy data from six countries.

OBJECTIVE: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum. DESIGN: Open population cohort (Health and Demographic Surveillance Systems). SETTING: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. POPULATION: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. METHODS: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43-365 days postpartum adjusting for HDSS and time period (2000-2009 and 2010-2019). MAIN OUTCOME MEASURES: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). RESULTS: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000-2009 and 2010-2019. CONCLUSIONS: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.

HIV treatment cascade among female sex workers in Ethiopia: Assessment against the UNAIDS 90-90-90 targets.

BACKGROUND: HIV treatment cascades for HIV-positive female sex workers (FSWs) have been challenged by the overlapping stigma and discrimination associated with both their sex work and HIV status. This study aims to assess the proportion of HIV-positive FSWs who access care and treatment in Ethiopia. METHOD: A cross-sectional study with a respondent-driven sampling technique was used to enroll 6,085 female sex workers from January to June 2020. Interviews were conducted to assess the FSWs' HIV status awareness and access to ART. A blood sample was drawn to determine the current HIV status and viral load level. Logistic regression was run to identify factors associated with FSWs' HIV status awareness. RESULTS: Of the total 1140 HIV-positive FSWs, 50.38% knew they were HIV positive; 92.88% of those who knew their status were on ART, and 91.68% of those on ART had attained viral suppression of less than 1000 copies per milliliter. The adjusted odds of knowing HIV status was 3.20 (95% CI; 2.00, 5.13) among those aged 35 years and older, 1.81 (95% CI; 1.05, 3.12) among widowed, and 1.73 (95% CI; 1.28, 2.32) in those who did not perceive the risk of HIV acquisition. CONCLUSION: Only about half of HIV-positive FSWs knew they were HIV positive. More than 90% of those who knew their status were put on ART and achieved viral suppression. The weakest point in achieving HIV control among FSWs is the identification of those living with HIV.

Cervical cancer screening uptake and associated factors among Women Living with Human Immunodeficiency Virus in public hospitals, eastern Ethiopia.

Background: Cervical cancer, the second leading cancer in Ethiopia women, is six times higher among women infected with the Human Immune Virus 1-infected women. Its screening provides protective advantages, and is linked to a decrease in the incidence of invasive cervical cancer and mortality. Although cancer screening has great advantages for early treatment and prevention of further complications, cervical cancer screening uptake is low among women in developing countries. Cervical cancer screening uptake among Women Living with Human Immunodeficiency Virus (WLHIV) is not well known in Eastern Ethiopia. Thus, we aimed to assess cervical cancer screening uptake and its associated factors among WLHIV in public hospitals in Harar, eastern Ethiopia. Methods: An institution-based cross-sectional study was carried out on 412 randomly selected HIV-positive women from March 20 to April 20, 2022. The results of the study were presented descriptively in percentages and analytically in odds ratio. Bivariate and multivariable logistic regression analyses were used to determine the presence and degree of association between dependent and independent variables. In the multivariable logistic analysis, a p-value of 0.05, and an adjusted odds ratio with a 95% confidence interval were considered to determine independent predictors for the uptake of cervical cancer screening. Results: Cervical cancer screening uptake among WLHIV was 57.5% (95% CI: 52.5, 62.9%). The uptake of cervical cancer screening was significantly associated with age between 20-29 years (AOR = 7.33; 95% CI: 1.98, 27.1), 40-49 years (AOR = 4.37; 95% CI: 1.48, 12.89), tertiary level of education (AOR = 0.197; 95% CI: 0.041, 0.946), good knowledge (AOR = 3.591; 95% CI: 2.123, 6.073), and monthly income of 2501(45.52 $) and above Ethiopian Birr (AOR = 0.389; 95% CI: 0.158, 0.959). Conclusions: More than half of the participants had undergone cervical cancer screening. Age, marital status, educational status, monthly income, and awareness of cancer screening uptake were all factors related to cervical cancer screening. To maximize uptake, it is necessary to create specific counseling and education programs that target HIV-positive women.

The effect of drop-in centers on access to HIV testing, case finding, and condom use among female sex workers in Addis Ababa, Ethiopia.

Background: Varied HIV prevention interventions involving multiple strategies has been instrumental in the effort to contain and lessen the prevalence of HIV around the globe. However, female sex workers (FSWs) often face stigma and discriminatory challenges, resulting in lower access to the HIV prevention initiatives. This study has aimed to assess the effect of one of the HIV service delivery models, the Drop-in Centers (DICs), which is designed to overcome the service uptake barriers of FSWs. Method: A quasi-experimental study design was employed. A respondent-driven sampling technique was used to recruit 1,366 FSWs from January to June 2020. A propensity score matching technique was used to balance the potential confounders between FSWs who had access to DICs and those who had never accessed DICs. Comparisons of the effect of DIC on the outcome of interest was made using a logit regression model at a 5% level of significance. Results: A total of 1,366 FSWs took part in the study. The analysis estimated the average treatment effects of access to DICs on four key outcomes: ever-testing to know HIV status, finding HIV-positive FSWs, awareness of HIV-positive status, and consistent condom use. A significant effect of DIC was seen at a 95% confidence interval on each outcome. Access to DIC produced a 7.58% increase in the probability of testing to know HIV status (P < 0.001), a 7.02% increment in finding HIV-positive FSWs (P = 0.003), an increase of 6.93% in awareness of HIV status among HIV positive FSWs (P = 0.001), and a 4.39% rise in consistent condom use (P = 0.01). Conclusions: Ensuring access of FSWs to DICs has led to an upsurge in HIV testing among FSWs, raising HIV status awareness among those who are HIV positive, and encouraged consistent condom use. To provide effective HIV prevention services, particularly to those FSWs living with HIV, it is essential to strengthen the services provided in DICs and expand the centers. This will ensure that the entire network of FSWs is reached with appropriate HIV prevention services.

Household hardships and responses to COVID-19 pandemic-related shocks in Eastern Ethiopia.

BACKGROUND: COVID-19 resulted in enormous disruption to life around the world. To quell disease spread, governments implemented lockdowns that likely created hardships for households. To improve knowledge of consequences, we examine how the pandemic period was associated with household hardships and assess factors associated with these hardships. METHODS: We conducted a cross-sectional study using quasi-Poisson regression to examine factors associated with household hardships. Data were collected between August and September of 2021 from a random sample of 880 households living within a Health and Demographic Surveillance System (HDSS) located in the Harari Region and the District of Kersa, both in Eastern Ethiopia. RESULTS: Having a head of household with no education, residing in a rural area, larger household size, lower income and/or wealth, and community responses to COVID-19, including lockdowns and travel restrictions, were independently associated with experiencing household hardships. CONCLUSIONS: Our results identify characteristics of groups at-risk for household hardships during the pandemic; these findings may inform efforts to mitigate the consequences of COVID-19 and future disease outbreaks.

COVID-19 impact data for the CHAMPS HDSS network: Data from Harar and Kersa, Ethiopia.

Data were collected as part of the Child Health and Mortality Prevention Surveillance (CHAMPS) network to learn about the effects of COVID-19 lockdowns on child health and access to care. Data were collected between August and September 2021 through a Health and Demographic Surveillance System (HDSS) operating in Eastern Ethiopia using a survey instrument focused on knowledge about COVID-19 and changes in food availability and healthcare services during the COVID-19 related lockdown. The data are representative of two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and consist of a random sample of 880 households.

Active management of the third stage of labor and associated factors among maternity care providers in public health facilities in Eastern Ethiopia: a multi-center study.

INTRODUCTION: The third stage of labor is the shortest, most critical, and hazardous stage as it is linked with postpartum hemorrhage, the leading cause of maternal mortality and morbidity. Postpartum hemorrhage can be prevented by 60% with active management of the third stage of labor (AMTSL). Few studies have been conducted in different parts of Ethiopia showing rates of AMTSL ranging from 16.7% to 43.3%. Limited information, however, exists about its practice in our study area. Thus, we aimed to assess the practice of AMTSL and associated factors among maternity care providers in public health facilities in eastern Ethiopia. METHODS: An institution-based cross-sectional study design was used among 270 maternity care providers in public health facilities in eastern Ethiopia. They were recruited using cluster sampling techniques in their health facilities from July 15-October 30/2021. Pretested self-administered questionnaires and an observational checklist were used to collect data. Descriptive, binary, and multivariable logistic regression analyses were performed. Adjusted odds ratios with 95% confidence intervals were used for statistically significant associations. RESULTS: Good practice of AMTSL occurred in 40.3% (95% CI: 34.5%-46.1%) of births. Being trained (aOR 3.02; 95% CI 1.60-5.70); presence of birth assistance (aOR 2.9; 95% CI 1.42-6.04); having the highest educational level (aOR 4.21; 95% CI 1.08-16.40); and having good knowledge (aOR 3.00; 95% CI 1.45-6.20) were factors statistically associated with maternity care providers' good practice of AMTSL. CONCLUSION: Active management of the third stage of labor was practiced with low rates in the study area. Therefore, we suggest that the stakeholders could enhance the presence of birth assistance during all births and provide education to attain higher educational levels and continuously update the maternity care providers' level of knowledge through comprehensive and on-the-job training to increase the good practice of the third stage of labor.

Determinants of neural tube defects among newborns in public referral hospitals in Eastern Ethiopia.

BACKGROUND: Neural tube defects (NTDs) are serious brain and spine birth defects. Although NTDs are primarily pregnancy complications, such as abortion and stillbirth, they also contribute to under-five morbidity and mortality, as well as long-term disability and psychological impact. Despite these negative outcomes, the determinants of NTDs are not widely studied in Ethiopia, particularly in the country's east. As a result, we sought to identify the risk factors for NTDs in neonates born in public referral hospitals in eastern Ethiopia. METHODS: A facility-based unmatched case-control study was carried out at Hiwot Fana Comprehensive Specialized Hospital and Sheik Hassen Yabare Jigjiga University Referral Hospital in Eastern Ethiopia. We included 59 cases identified in the selected facilities between September 10, 2021, and February 5, 2022, and 118 control neonates, with a case-to-control ratio of 1:2. Data were gathered through the use of interviewer-administered questionnaires and medical record review. To identify determinant factors of NTDs, a multivariable logistic regression model was used, which included all predictor variables from the bivariable analysis. The results were reported using an Adjusted Odds Ratio (AOR) with a 95% confidence interval. A p-value of < 0.05 was considered statistically significant. RESULTS: In total, 59 cases of NTDs were identified out of 2915 live birth total births registered in the two hospitals, making the incidence of NTDs 202.4/10,000 births. In the final model analysis, determinant factors such as gender of newborn [AOR = 2.97; 95%CI(1.27, 6.92)], having no history of antenatal care[AOR = 4.45;95%CI(1.30,15.20)], having a poor food consumption score (AOR = 3.38;95% CI;1.06,10.72), having history of monotonous diet consumption (AOR = 4.80; 95%CI: 1.09, 9.08; P = 0.038), and coffee consumption of three or more cups per day during pregnancy (AOR = 3.84:95% CI: 1.23, 11.97) were statistically associated with NTDs. CONCLUSION: Modifiable and non-modifiable determinants were identified as major contributors of neural tube defect in this study. Early screening, dietary intervention counseling to increase consumption of a healthy diet, coffee consumption reduction, and pre-pregnancy supplementation programs should be developed to reduce NTDs in Ethiopia.

Erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. A cross-sectional study design.

Background: The global prevalence of erectile dysfunction among patients with diabetes is high. It is the most underestimated problem but has a great physical, psychological, and social impact on the individual with the disease, family, and society in general. Thus, this study aimed to assess the magnitude of erectile dysfunction and associated factors among patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia. Methods: Facility-based cross-sectional study was conducted on selected 210 adult male patients with diabetes attending follow-up at a public hospital, Harar, Eastern Ethiopia, from 1 February to 30 March 2020. Simple random sampling was used to select study participants. A pre-tested interviewer-administered structured questionnaire was used to collect the data. The data were entered to EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable binary logistic regression were carried out, and a P-value of <0.05 was taken as statistically significant. Result: A total of 210 adult male patients with diabetes participated in the study. The overall magnitude of erectile dysfunction was 83.8%, with 26.7% suffering from mild, 37.5% mild to moderate, 29% moderate, and 6.8% severe erectile dysfunctions. Age 46-59 years [adjusted odds ratio (AOR): 2.560; 95% confidence interval (CI) (1.73, 6.53)], age ≥ 60 years [AOR: 2.9; 95% CI (1.48, 5.67)], and poor glycemic control [AOR: 2.140; 95% CI (1.9, 7.44)] were significantly associated with erectile dysfunction among patients with diabetes. Conclusion: The present study revealed a high magnitude of erectile dysfunction among population with diabetes. The age categories of 46-59 and ≥60 and having poor glycemic control were the only variables significantly associated with erectile dysfunction. Thus, routine screening and management for erectile dysfunction in patients with diabetes should be part of routine medical care particularly for adult male patients and those with poor glycemic control.

One-sixth of women experienced obstructed labor among those delivered at public hospitals in Southern Ethiopia: A multicenter study.

Objective: The study aimed to assess the prevalence of obstructed labor and associated factors among women delivered at public hospitals in Southern Ethiopia. Methods: Institution-based cross-sectional study was employed among 704 systematically selected postnatal women. The data were collected by the structured and pre-tested interviewer-administered questionnaire and analyzed by Statistical Package for Social Science version 20. Multivariable logistic regression with a 95% confidence level was used to determine the associated factors. Statistical significance was declared at p < 0.05. Result: The prevalence of obstructed labor was 15.8% (95% confidence interval: 13.1-18.5). Age (adjusted odds ratio = 5.23, 95% confidence interval: 2.98-11.12), antenatal care follow-up (adjusted odds ratio = 1.8, 95% confidence interval: 1.10-3.39), duration of labor (adjusted odds ratio = 4.41, 95% confidence interval: 2.56-7.67), and experiencing complications (adjusted odds ratio = 4.21, 95% confidence interval: 2.63-6.98) were significantly associated with obstructed labor. Conclusion: The study revealed that one-sixth of women experienced obstructed labor. Regional health sectors and non-governmental organizations need to collaborate with healthcare providers in providing improved maternal health services with special emphasis on teenage women with optimum and proper follow-up throughout the pregnancy, by early identifying complications during labor and delivery to manage the problem early.

Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: a prospective cohort study.

Despite the availability of prophylactic antibiotics prior to skin incisions, surgical site infection (SSI) following cesarean section (CS) remains an unresolved health issue. As a result, this study aimed to assess the incidence and predictors of SSI after a CS. Methods: The authors conducted a prospective cohort study in eastern Ethiopia. The women were serially enrolled until the desired sample size was reached. A structured questionnaire was used to collect data. Women were followed at the hospital during their weekly visits. Culture-based microbiological methods were used to identify causal agents. A binary logistic regression model was used to identify the predictors of SSI after CS. Results: Among serially enrolled women, 336 were followed for 30 days. The incidence of SSI was 7.74% (95% CI: 7.68-7.80). Rupture of the membrane before operation [adjusted odds ratio (AOR)=3.75, 95% CI: 1.85-16.6], labor duration greater than 24 h (AOR=4.04, 95% CI: 1.52-10.79), and postoperative hemoglobin less than 11 g/dl (AOR=3.42, 95% CI: 1.32-8.87) were all significantly associated with SSI. The most common isolated pathogen was Staphylococcus aureus, followed by Escherichia coli. Conclusions: Nearly one-tenth of the women developed SSIs. Factors such as rupture of the membrane before the operation, absence of antenatal care, labor duration greater than 24 h, a midline skin incision, and postoperative hemoglobin less than 11 g/dl were the predictors of SSI. To reduce the incidence of SSI, policymakers should consider the importance of high-quality antenatal care, shorten the duration of labor, and maintain women's hemodynamics in future SSI prevention bundles.

Cancellation of elective surgery and associated factors among patients scheduled for elective surgeries in public hospitals in Harari regional state, Eastern Ethiopia.

Background: Canceling elective surgeries is a significant problem in many hospitals leading to patient dissatisfaction, increased costs, and emotional trauma for patients and their families. Despite this, there is limited information about the cancellation of elective surgeries in Ethiopia, mainly in the study area. Objective: This study aimed to assess the magnitude of cancellation and associated factors among patients scheduled for elective surgeries in public hospitals in the Harari Regional State, Eastern Ethiopia, from 1 August to 30 August 2021. Methods: A hospital-based cross-sectional study was conducted on 378 patients scheduled for elective surgeries. Data were gathered using a non-random sequential sampling approach. In addition, a structured face-to-face interviewer-administered questionnaire was employed. The gathered information was input into Epidata version 3.1 and then exported to Statistical Package for Social Software version 26. To find the variables associated with the cancellation of elective surgeries, binary and multi-variable logistic regression analyses were conducted. In the binary analysis, all variables with a p-value of less than 0.25 were included in the multivariable analysis. Finally, a 0.05 p-value with a 95% confidence interval and an adjusted odds ratio was used to declare a significant association. Results: This study included 378 patients scheduled for elective surgeries. Among those, 35.2% of the surgeries were canceled (95% confidence interval: 29.4-39.6). Being female (adjusted odds ratio: 2.46; 95% confidence interval: 1.44-4.203), lack of formal education (adjusted odds ratio: 2.03; 95% confidence interval: 1.15-3.58), place of residence (adjusted odds ratio: 1.70; 95% confidence interval: 1.03-2.81), increase in blood pressure (adjusted odds ratio: 5.09; 95% confidence interval:1.90-13.59), and ophthalmologic surgery (adjusted odds ratio: 3.76; 95% confidence interval: 1.41-10.0) were factors associated with the cancellation of elective surgeries. Conclusion: In this study, nearly one third of scheduled elective surgery was canceled. The primary contributing variables to the surgery cancellations were being female, lack of formal education, place of residence, ophthalmologic surgery, and increased blood pressure. Therefore, timely evidence-based reporting through the supervision team was advised to decrease cancellations.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study.

INTRODUCTION: Fear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System-an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression. RESULTS: Of a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81). CONCLUSION: A quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Maternal satisfaction on delivery care services and associated factors at public hospitals in eastern Ethiopia.

BACKGROUND: Maternal healthcare services satisfaction has been widely recognized as a critical indicator of quality in healthcare systems. Thus this study aimed to assess maternal satisfaction with delivery care services. METHODS: An institutional-based cross-sectional study design was utilized among 400 randomly selected postnatal mothers from 1 to 30 February 2018. The data were entered into EpiData version 4.2.0 and computed using SPSS version 20. Bivariate and multivariate analyses were done using binary logistic regression to identify associations of factors. RESULTS: A total of 400 participants were included, with a response rate of 98.8%. The overall delivery services satisfaction level of mothers was 80% (95% confidence interval [CI] 75.8 to 84.0). Delivery through caesarean section (adjusted odds ratio [AOR] 2.85 [95% CI 1.21 to 6.72]), privacy assured (AOR 3.73 [95% CI 1.79 to 7.75]), duration of labour (AOR 3.03 [95% CI 1.50 to 6.14]), waiting time (AOR 4.31 [95% CI 2.24 to 8.29]) and foetal outcome (AOR 4.33 [95% CI 1.94 to 9.66]) were associated with satisfaction with delivery care services. CONCLUSION: The study revealed that four-fifths of mothers were satisfied with the delivery care services provided in public hospitals. Much effort is needed from hospital administrators and health professionals to improve delivery services satisfaction by minimizing waiting time, maintaining privacy and securing waiting areas.