Pediatric Shock: The Magnitude, Its Determinants and Short-Term Outcome on Patients. A Cross-Sectional Hospital-Based Study.

Background: Pediatric shock is a potentially fatal illness which develops after a systemic circulatory system failure in children. It appears to be a common emergency in children and produces substantial morbidity and mortality particularly if there is no early identification and therapy. The extent and causes of shock-induced death among children in Ethiopia have not been sufficiently studied. Objective: This study was conducted to evaluate the magnitude, determinants and short-term outcome of shock in pediatric patients who visited Ayder Comprehensive Specialized Hospital in Tigray, Northern Ethiopia. Methods: From October 1, 2020, to July 30, 2022, an observational cross-sectional study was carried out at Ayder Comprehensive Specialized Hospital. The study included 132 children from the age of 1 month to 18 years. According to pediatric advanced life support guidelines, shock was diagnosed among patients. To gather information, a pretested questionnaire was employed. To examine the relationship between the independent variables and shock outcome, bivariate logistic regression was performed, and statistical significance was defined as a P-value of 0.05 or lower. Results: The prevalence of shock was 2.2%. This study revealed 70.5% decompensated stage of shock. Mortality rate of shock was 45.5% (95% CI: 37.1-53.8). A delayed presentation by more than one week with an adjusted odd ratio (AOR) of 16.9 (95% CI: 2.3-123), type of shock other than hypovolemic shock with AOR of 8.3 (95% CI: 1.4-48), stage of shock with AOR of 27.8 (95% CI: 2.8-157), requirement of mechanical ventilation with AOR of 11 (95% CI: 2.6-53) and length of hospital stay less than three days with AOR of 9 (95% CI: 1.7-48) were identified as a predictor of mortality by shock in children. Conclusion: According to this study, shock causes a high rate of child mortality. Independent predictors of mortality included delayed presentation, shock type, stage of shock, the need for mechanical ventilation, and brief hospital stay (less than three days).

Maternal mortality during war time in Tigray, Ethiopia: A community-based study.

OBJECTIVE: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. DESIGN: Community-based cross-sectional study. SETTING: Tigray region of Northern Ethiopia, between November 2020 and May 2022. POPULATION: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. METHODS: The study was conducted in two phases. In the first phase, reproductive-age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. MAIN OUTCOME MEASURES: Maternal mortality ratio level and cause-specific mortality. RESULTS: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739-914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy-induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. CONCLUSIONS: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre-war level of 186/100 000. Furthermore, potentially many of the pregnancy-related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence.

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.

Achieving high coverage of Kangaroo mother care practice is possible: Lessons from implementation research for accelerating scale-up in Tigray Region, Ethiopia.

AIM: To evaluate coverage of effective Kangaroo mother care (KMC) by developing a model that would result in high coverage (≥80%) of KMC for newborn weighing less than 2000 g at birth in Tigray region, Ethiopia. METHODS: The study used formative research and continuous programme learning in iterative cycles of model development and modification conducted in close collaboration with the Tigray Regional Health Bureau. Quantitative methods were used to evaluate the various models. All study facilities were enrolled simultaneously, and hospitals and health centres were considered to become KMC-providers. RESULTS: The final scalable model implemented in two rural districts and one special urban zone of Tigray region attained the desired objective, with coverage of effective KMC of 82.3% at discharge. CONCLUSION: Achieving high coverage of KMC is possible through the design of context-specific implementation strategies. The key factors for success were the commitment and strong leadership from the regional health bureau, strong linkages within the health system and between different departments within health facilities, improved health worker knowledge, skills and attitudes, hospitals and health centres that supported KMC performance, and systematic generation and use of data for continuous quality improvement.

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.

Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study.

OBJECTIVES: Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. DESIGN: This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. PARTICIPANTS: 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. MAIN OUTCOME MEASURES: The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. RESULTS: Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%-86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%-65% of infants in all sites, except Oromia (38%) and Karnataka (36%). CONCLUSIONS: This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers' conviction that KMC is the standard of care, women's and families' acceptance of KMC, and changes in infrastructure, policy, skills and practice. TRIAL REGISTRATION NUMBERS: ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.

Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation.

INTRODUCTION: Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. METHODS AND ANALYSIS: This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge. ETHICS AND DISSEMINATION: Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination. STUDY STATUS: WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019. TRIAL REGISTRATION NUMBER: Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698).

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.