ABSTRACT
BACKGROUND: Vaginal birth after caesarean section (VBAC) is an alternative to a caesarean section (CS) in the absence of repeat or new indications for primary CS. There is a knowledge gap regarding the trend and successful VBAC in Ethiopia. Therefore this systematic review and meta-analysis aimed to assess the trend, pooled prevalence of successful VBAC and its predictors in Ethiopia. METHODS: Electronic databases (SCOPUS, CINAHL, Embase, PubMed and Web of Science), Google Scholar and lists of references were used to search works of literature in Ethiopia. Stata version 14 was used for analysis and the odds ratios of the outcome variable were determined using the random effects model. Heterogeneity among the studies was assessed by computing values for I2 and p-values. Also, sensitivity analyses and funnel plots were done to assess the stability of pooled values to outliers and publication bias, respectively. RESULTS: A total of 12 studies with a sample size of 2080 were included in this study. The overall success rate of VBAC was 52% (95% confidence interval 42 to 65). Cervical dilatation ≥4 cm at admission, having a prior successful vaginal delivery and VBAC were the predictors of successful VBAC. CONCLUSIONS: Meta-analyses and sensitivity analyses showed the stability of the pooled odds ratios and the funnel plots did not show publication bias. The pooled prevalence of successful VBAC was relatively low compared with existing evidence. However, the rate was increasing over the last 3 decades, which implies it needs more strengthening and focus to decrease maternal morbidity and mortality by CS complications. Promoting VBAC by emphasizing factors favourable for its success during counselling mothers who previously delivered by CS to enhance the prevalence of VBAC.
ABSTRACT
Introduction: Fear of COVID-19 makes tuberculosis (TB) patients seek health care after complications of the case. This can be the reason for serious illness, increased length of infectiousness, poor treatment outcomes, and economic crisis for families and the health system. Despite this, no study has been conducted in Ethiopia and in other African countries with the factor "fear of COVID-19." Identified preventable factor and other covariates are used to reduce the healthcare-seeking delay. Objective: This study assessed the association of fear of COVID-19 with healthcare-seeking delay among TB patients in Ilu Ababor Zone health facilities, south-western Ethiopia. Methods and materials: A health institution-based cross-sectional study was conducted among TB patients from October 15, 2020, to March 1, 2021. Using a systematic sampling method, 403 TB patients were selected for face-to-face interviews. The association of fear of getting COVID-19 with healthcare-seeking delay was assessed by a chi-square test. Variables with a p-value <0.25 in the bi-variable binary logistic regression were entered into the multivariable binary logistic regression model. The level of statistical significance in multivariable binary logistic regression was declared at a p-value <0.05. Result: In this study, the proportion of patient healthcare-seeking delay was 46.7%. Chi-square test of the association of fear of COVID-19 with healthcare-seeking delay among TB patients showed a significant association (p-value = 0.042). After controlling for covariates, patients living in rural area (adjusted odds ratio (AOR) = 2.437, 95% confidence interval (CI): 1.385-4.286), patients with poor knowledge (AOR = 3.300, 95% CI: 1.792-6.078), earning monthly income <200 Ethiopian birr (ETB) (AOR = 3.912 95% CI: 1.951-7.841), traveling greater than 30 min (AOR = 2.127, 95% CI: 1.301-3.476), and fear of COVID-19 pandemic (AOR = 3.124, 95% CI: 1.029-9.479) were significantly associated with patient healthcare-seeking delay. Conclusion: The study found that healthcare-seeking delay among TB patients was substantial. Patient healthcare-seeking delay was significantly associated with fear of COVID-19.
