Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study.

INTRODUCTION: The term 'unintended pregnancy' refers to a pregnancy that occurred when no children were desired or occurred earlier than desired. Unintended births account for one out of every three births in Ethiopia, and they are the leading cause of maternal morbidity and mortality. During the coronavirus disease (COVID-19) pandemic, this could be useful. COVID-19 has a significant impact on maternal health care utilization, including family planning services. As a result, this study aimed to assess unintended pregnancy and associated factors in Ethiopia during the COVID-19 pandemic. METHOD: A community-based cross-sectional study was conducted in Gedeo zone, Ethiopia, from April 1 to May 30, 2021. A simple random sampling technique was utilized to get 383 pregnant women from their respective kebeles. A structured questionnaire was used to collect data during a face-to-face interview. The data were coded, cleaned, and entered into Epidemiological Data Version 3.1 before being exported to the Statistical Package for Social Science Version 23.0 for analysis. A bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio, with a 95% confidence interval and a P value of 0.05%, was considered statistically significant. RESULT: A total of 383 pregnant women participated in the study, giving a response rate of 90.8%. During the COVID-19 pandemic, 140 (36.6%) participants stated that their current pregnancy was unintended. Unintended pregnancy was significantly associated with respondents' age (adjusted odds ratio (AOR) = 5.214 (1.449-18.762)), primary decision maker for family planning services (AOR = 9.510 (5.057-17.887)), and fear of COVID-19 to visit a health care facility (AOR = 7.061 (2.665-18.710)). CONCLUSION: During the COVID-19 era, more than one-third of women had unintended pregnancies. Unintended pregnancy was significantly associated with respondents' age, autonomy to use contraceptive methods, and fear of COVID-19, which required them to attend a health care institution.

Acute interstitial nephritis with Prothionamide.

Among drug-related complications, drug-related nephrotoxicity is the commonest. It is the cause for 7% of all drug-related toxicities among inpatients and accounts for 20% to 30% of acute renal failure. Acute interstitial nephritis is one of the drug-related adverse reactions and occurs due to a drug-related type 4 hypersensitivity reaction. In this case report, we reported acute interstitial nephritis that causes acute renal failure (acute kidney injury) in a patient taking Prothionamide therapy. This drug-related side effect had not been reported. In this case report, we report a patient who develops fatigability, rash, and intermittent fever after 14 days of taking the drug Prothionamide. The main aims of this case report are to use it as a pharmacovigilance report for drug-producing companies and to consider a further study on this side effect. It is also an alert for clinicians to consider this side effect when patients develop acute interstitial nephritis while taking Prothionamide.

Perceived physical accessibility, mother's perception of quality of care, and utilization of skilled delivery service in rural Ethiopia.

OBJECTIVE: Despite the concerted effort to improve skilled delivery service utilization in Ethiopia, a considerable proportion of births still occur at home by traditional birth attendants, notably in a rural setting. Hence, the aim of this study was to investigate whether mother's perceived service quality and physical accessibility affect skilled delivery service utilization. METHODS: A community-based cross-sectional study was conducted from 1 July 2019 to 30 August 2019, among mothers who gave birth in the last 12 months before the study, in selected five districts of Kaffa Zone, Ethiopia. RESULT: In this study, 262 (70.1%) of mothers utilized skilled delivery service in their recent childbirth. Mothers regarding the nearby health facility's physical environment as "Good" (adjusted odds ratio = 2.48, 95% confidence interval = 1.44, 4.25), mothers mentioning time to reach to the nearby health facility "<1 h" (adjusted odds ratio = 1.92, 95% confidence interval = 1.11, 3.34), and mothers regarding prompt transport service from home to the nearby health facility "Available" (adjusted odds ratio = 2.01, 95% confidence interval = 1.11, 3.63) were positively associated with skilled delivery services' utilization. Furthermore, completing secondary education and above, attending three and more antenatal care visits, and having good knowledge of danger signs during pregnancy showed a significant association. CONCLUSION: Although the study evidenced statistically significant association between perceived physical accessibility and perceived service quality, further study is recommended to investigate the relationship between actual physical accessibility and actual service quality. Targeted health education program intended to improve skilled delivery service utilization should give due emphasis on enhancing antenatal care service uptake, and raising mothers' awareness on danger signs during pregnancy, with particular focus on those mothers with low schooling.

Predictors of pregnant women's intention to vaccinate against coronavirus disease 2019: A facility-based cross-sectional study in southwest Ethiopia.

OBJECTIVE: Ethiopia is planning to vaccinate 20% of its population against the coronavirus disease 2019 pandemic by the end of 2021-however, there is no single piece of evidence regarding pregnant women's intention to be vaccinated against coronavirus disease 2019; hence, the objective of this study was to investigate predicting factors of intention to be vaccinated against coronavirus disease 2019 among pregnant women in Bench-Sheko Zone, southwest Ethiopia. METHODS: Facility-based cross-sectional study was undertaken from 1 February to 1 March 2021 in southwest Ethiopia. The study was carried out among pregnant women who came for antenatal care service in the selected public health facilities. Interviewer-administered structured tool was used to collect the data. Data were entered into EpiData (version 3.1) and then analyzed using SPSS (version 20). RESULTS: The study revealed that only 31.3% (95% confidence interval: 26.7-35.2) of the participants had an intention to be vaccinated against coronavirus disease 2019 when the vaccine will be made available in Ethiopia. Participants' intention to be vaccinated against coronavirus disease 2019 was significantly associated with attaining secondary school and above (adjusted odds ratio = 4.24, 95% confidence interval: 2.23-9.32), residing in urban areas (adjusted odds ratio = 2.57, 95% confidence interval: 1.22-5.40), being compliant with coronavirus disease 2019 guidelines (adjusted odds ratio = 5.86, 95% confidence interval: 3.40-10.09), and having good perception toward coronavirus disease 2019 vaccine (adjusted odds ratio = 3.04, 95% confidence interval: 1.64-5.62). CONCLUSION: Above all, in this study, pregnant women's intention to vaccinate against coronavirus disease 2019 was very low when compared with previous studies. Hence, before commencing the coronavirus disease 2019 vaccination program in Ethiopia, it is essential to launch a widespread public health education campaign that could improve people's perception of the vaccine. Besides, the upcoming public health intervention programs better put special emphasis on community members with lower educational attainment backgrounds and rural residents.

Individual, socio-cultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia: A mixed method study.

INTRODUCTION: Traditionally, men are not supposed to take part in maternal health issues in many cultures. Nevertheless, pregnancy care and childbirth are the most crucial matters of reproductive health influenced by men. Hence, the aim of this study was to identify individual, sociocultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia. OBJECTIVES: The aim of this study was to identify individual, sociocultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia. METHODS: A community-based cross-sectional study accompanied with a qualitative method was carried out from 1 July to 30 August 2019. A multistage cluster sampling technique was employed to recruit study participants. Descriptive statistics, frequencies, proportions, and mean were calculated, and the results of the analysis were presented in text, tables, and graphs. A multivariate logistic regression model was fitted to investigate the independent effect of each explanatory variable on the likelihood of men's involvement in facility-based childbirth. Qualitative data were analyzed thematically using OpenCode 4.0 software. RESULTS: Out of 800 men, only 36.5% (95% confidence interval: 33.3%-39.6%) were found to have involved in facility-based childbirth. Several factors were associated with men's involvement in facility-based childbirth of this, being in the age group of 40-49 (adjusted odds ratio 5.04, 95% confidence interval: 2.49-10.20), attaining secondary education and above (adjusted odds ratio 2.14, 95% confidence interval: 1.53-5.60), and having sufficient knowledge of danger signs during pregnancy (adjusted odds ratio 5.65, 95% confidence interval: 3.25-7.46) associated with men's involvement in facility-based childbirth. CONCLUSION: Relevant entities had better design-specific educational programs targeting younger age groups, those with lower schooling, and had previous bad obstetrics outcomes. Involving elders and religious leaders in the reproductive health program could also help in overcoming the existing cultural barriers. Moreover, creating a men-friendly facility environment and extensively engaging medias are suggested to improve men's involvement in the study area.

Challenges Faced by Female Out-of-School Adolescents in Accessing and Utilizing Sexual and Reproductive Health Service: A Qualitative Exploratory Study in Southwest, Ethiopia.

INTRODUCTION: Due to the limited access to sexual and reproductive health service, out-of-school-adolescents become at a higher risk for early marriage, early pregnancy early parenthood, and poor health outcomes over their life course. Hence, the aim of this study was to explore the challenges faced by female out-of-school adolescents in accessing sexual and reproductive health service in Bench-Sheko zone. METHODS: A community-based qualitative exploratory study was carried out from November 01/2020 to December 01/2020 among selected out-of-school adolescents residing in rural and urban districts of Bench-Sheko Zone, and healthcare professionals working in the local health centers. FGD participants and healthcare providers were purposely selected for this study. Eight focus group discussions and 8 in-depth interviews were conducted among female out-of-school adolescents, and health care professionals, respectively. RESULT: The study revealed that out-of-school adolescents encounter several challenges in accessing sexual reproductive health service which includes socio-cultural barriers, health system barriers, perceived legal barrier, inadequate information regarding sexual reproductive health service, and low parent-adolescent communication. CONCLUSION: The finding suggests the need to engage community influencers (religious leaders, community leaders, and elders) in overcoming the socio-cultural barriers. Program planners and policy makers have better make an effort to create adolescent friendly environments in SRH service areas. Furthermore, implementing community-based awareness raising programs, parental involvement in sexual reproductive health programs, and encouraging parent-adolescent communication on sexual reproductive health issues could improve sexual reproductive health service utilization by out-of-school adolescents in the study area.

Exploring COVID-19 Related Factors Influencing Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Southwest Ethiopia.

INTRODUCTION: Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia. METHODS: A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software. RESULT: The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone. CONCLUSION: COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.

Preparedness and Readiness Against COVID-19 Pandemic in Prison Institutions and Detention Centers in Southwest Ethiopia.

BACKGROUND: Prisons and detention centers in Ethiopia lack adequate hand washing, personal protective equipment, and quarantine areas. As a result, they are vulnerable to the expansion of the COVID-19 pandemic. Despite its high risk for the COVID-19 pandemic, no study has been made to assess the preparedness and readiness in prison institutions and detention centers. METHODS: A cross-sectional study design mixed with a qualitative approach was conducted from May 1 to June 30, 2020. A total of four prison institutions and 17 detention centers were included in the study. A simple random sampling technique was employed to select the institutions. The data were entered into the EpiData and exported to SPSS Windows version 22 for data management and analysis. Descriptive statistics was employed for the quantitative section and content analysis was used to analyze the qualitative data. RESULTS: Five out of 17 detention centers and three out of four prison facilities did not fulfill the standards related to human rights. Almost all detention centers and prison facilities did not implement recommended activities of risk assessment and management of COVID-19. In addition, none of the prison facilities and detention centers had quick access to laboratory tests for suspected cases. Neither the prison facilities nor the detention centers had a contingency plan for the COVID-19 pandemic. Moreover, all staff working in prison facilities and detention centers mentioned that training regarding COVID-19 had not yet been given. However, in all prisons and detention centers, preventive measures such as physical distancing, utilization of hand washing facilities, wearing masks, and keeping respiratory hygiene were not practiced.

Knowledge of COVID-19 and preventive behaviors among waiters working in food and drinking establishments in Southwest Ethiopia.

BACKGROUND: Waiters working in different food and drinking establishments have a higher risk of contracting COVID-19 and transmitting the infection to others because they interact with many people. Most COVID-19 related studies in Ethiopia mainly focused on the general population, whereas, this study aimed to assess the knowledge of COVID-19 and preventive behaviors among waiters in Southwest Ethiopia. METHODS: A cross-sectional study was conducted from June 1 to June 15, 2020, among waiters working in food and drinking establishments found in Mizan-Aman, Jemu, and Masha towns in Southwest Ethiopia. A total of 422 waiters were selected using a simple random sampling technique, and the data were collected through face-to-face interviews using a structured questionnaire. The data were entered into Epi-data manager version 4.0.2 and analyzed using SPSS version 22. Multivariable binary logistic regression analysis was carried out to identify predictors of good preventive behaviors at a p-value of less than 0.05. RESULTS: Four hundred and sixteen respondents participated in this study, with a response rate of 98.6%. A significant proportion of participants know the cause, route of transmission, symptoms, and prevention methods of COVID-19 virus. However, very few (21.2%) had good preventive behaviors. The study showed that good preventive behavior was positively associated with female sex (AOR = 2.33, 95% CI: 1.38-3.94), higher schooling (AOR = 0.39, 95% CI: 0.17-0.88), high-risk perception (AOR = 2.26, 95% CI: 1.51-4.32), and high perceived self-efficacy (AOR = 1.1.75, 95% CI: 1.05-2.90). CONCLUSIONS: A significant proportion of waiters know common symptoms of COVID 19, route of transmission, and its prevention methods. However, the preventive behavior was very low. Thus, all concerned bodies working on the prevention and control of COVID-19 should give attention to this population group to enhance compliance with recommended preventive behaviors.

Risk Perception Towards COVID-19 and Its Associated Factors Among Waiters in Selected Towns of Southwest Ethiopia.

BACKGROUND: Waiters working in hotels, pensions, restaurants, and cafeteria are more susceptible to COVID-19 and easily transmit the virus to others because they interact with almost all individuals who enter those establishments. However, information regarding their risk perception is scarce; hence, this study aimed to assess risk perception regarding COVID-19 and its associated factors among waiters working in the selected towns of southwest Ethiopia. METHODS: A cross-sectional study was conducted from June 1 to 15, 2020. The interview-administered structured questionnaire was used to collect data. Data were entered into Epi data manager version 4.0.2 and exported to SPSS version 24 for analysis. Multiple linear regression analysis was done to identify factors associated with risk perception. A p-value of less than 0.05 was used as a level of significance. RESULTS: A total of 416 waiters were interviewed, with a 98.6% response rate. The mean age of respondents was 27.26 (SD=8.35) years. More than half (53.4%) agreed that COVID-19 causes more deaths than other respiratory diseases. Regarding overall risk perception, two hundred twenty-two (53.4%) participants had high-risk perceptions concerning COVID-19. Risk perception was associated with age (ß= 0.10; 95% CI: 0.02, 0.18), knowledge of COVID-19 (ß=0.50, 95% CI: 0.23, 0.76) and preventive behaviors (ß=0.62; 95% CI: 0.33, 0.90). CONCLUSION: A higher level of risk perception was found regarding the COVID-19. Proper risk communication to promote protective behaviors is very essential since waiters are more at risk to be infected with COVID-19 and their infection with the virus has important public health implications.

Mother's Satisfaction towards Childbirth Care at Public Health Centers in Bench-Maji Zone, Ethiopia: A Facility-Based Cross-Sectional Study.

BACKGROUND: Assessing the level of maternal satisfaction towards maternal health care services has a paramount importance in improving the service quality and enhancing service utilization. Hence, the aim of this study was to assess maternal satisfaction towards childbirth care and its determinants at public health facilities in Bench-Maji Zone, Ethiopia. METHODS: A facility-based cross-sectional study was conducted from May 20, 2018, to July 11, 2018 in Bench-Maji Zone, Ethiopia. A total of 845 mothers were selected by employing a systematic random sampling technique. Data were collected using a pretested and structured questionnaire. Satisfaction was measured by the five-point Likert scale from very dissatisfied (1) to very satisfied (5). Data were entered in to Epi data version 3.1 and analyzed using SPSS version 20. A P value < 0.05 was considered to declare statistical significance. RESULT: About 506 (63.25%) of the mothers were satisfied by the overall care provided during childbirth. Factors associated with mothers' satisfaction with childbirth care includes attending no formal education [AOR = 3.69; 95% CI (1.99, 7.91)], rural residency [AOR = 2.63; 95% CI (1.43, 5.80)], perceived measure taken to assure privacy [AOR = 3.56; 95% CI (1.25, 7.41)], and attending antenatal care [AOR = 6.23; 95% CI (3.42, 12.87)]. CONCLUSION: The overall satisfaction of mothers with childbirth care in public health centers of Bench-Maji Zone is low when compared with other studies. Hence, understanding mothers' expectations, assuring privacy, and enhancing antenatal care attendance might improve maternal satisfaction with childbirth care.

Low Tuberculosis (TB) Case Detection: A Health Facility-Based Study of Possible Obstacles in Kaffa Zone, Southwest District of Ethiopia.

BACKGROUND: In Ethiopia, the national TB case detection rate is becoming improved; still some districts are not able to meet their case detection targets which leads to ongoing spread of TB infections to family members and communities. This study was intended to assess possible obstacles contributing to low TB case detection in Kaffa zone, Southwest Ethiopia. METHODS: A cross-sectional descriptive study involving qualitative and quantitative data was conducted from Mar. to Sep. 2019. Sociodemographic characteristics and data on duration of cough, whether sputum smear microscopy was requested or not, and data on TB knowledge and health care-seeking practice were collected from outpatients. Health care delivery barrier for TB case detection was also explored by using in-depth interview and FGD of health staff. RESULTS: From 802 outpatients with coughing for 2 or more weeks of duration, 334 (41.6%) of them were not requested to have TB microscopic diagnosis. Of these, 11/324 (3.4%) of them were positive for TB after sputum smear microscopy. Only 24.2% of the outpatients were aware as they have had health education on TB disease. Twenty-eight percent of patients perceived that TB was due to exposure to cold air, and 13.5% could not mention any sign or symptom of TB. Amazingly, 54.2% of them did not have any information as current TB diagnosis and treatment is free. Thirty-five percent of the patients were taking antibiotics before visiting the health facility. The interrupted supply of TB diagnostic reagents, frequent electricity interruption, shortage of trained TB care providers, weak health information system, and weak active case finding practice were explored as the factors contributing to low TB case detection. CONCLUSION: Interrupted functioning of diagnostic centers, shortage of trained care providers, limited active TB case finding practice, weak health information system, and inadequate knowledge and health care-seeking practice of the patients were identified as contributors for low TB case detection. Thus, improving functioning of diagnostic centers, active TB case finding activities, and expanding health education on TB disease will help to improve TB case detection in the districts.

Prevalence of Self-Reported Symptoms of Sexually Transmitted Infection among Establishment-Based Female Sex Workers in Ethiopia.

INTRODUCTION: In spite of the fact that female sex workers being regarded as core transmitters of sexually transmitted infections to the general population, previous studies undertaken around STIs in Ethiopia fail to consider this segment of the population. Hence, the present study investigated the prevalence of self-reported symptoms of STIs and the risk factors among FSWs in Adama Town, Ethiopia. METHOD: A cross-sectional study was conducted from May 01, 2017, to April 30, 2017, in Adama Town. Three hundred ninety female sex workers were selected from 120 licensed drinking establishments by using simple random sampling technique. The interviewer-administered structured tool was used to collect data. Data were entered using EPI data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression analyses were used to identify factors associated with the outcome variable. RESULT: Among the requested 423 female sex workers, 390 willingly responded to the interviewer-administered structured questionnaires making a response rate of 92.2%. One hundred thirty-nine (35.6%, 95% CI (33.8%-37.4%) of the female sex workers reported one or more STI symptoms. Several risk factors were identified including inconsistent condom use with a nonpaying client (AOR = 5.43, 95% CI: 2.73, 10.80), alcohol use before sex (AOR = 2.41, 95% CI: 1.35, 4.30), longer duration of sex work (AOR = 2.27, 95% CI: 1.26, 4.08), and having poor knowledge of STIs (AOR = 2.44, 95% CI: 1.31, 4.54). CONCLUSION: Self-reported symptom of STI among female sex workers in Adama Town is relatively high when compared with previous studies. Hence, health education programs should address the issue of inconsistent condom use with nonpaying clients, alcohol consumption before sex, and knowledge of STIs, with a particular emphasis on those female sex workers who stayed longer in the business.