Global burden of potentially life-threatening maternal conditions: a systematic review and meta-analysis.

BACKGROUND: Potentially life-threatening maternal conditions (PLTCs) is an important proxy indicator of maternal mortality and the quality of maternal health services. It is helpful to monitor the rates of severe maternal morbidity to evaluate the quality of maternal care, particularly in low- and lower-middle-income countries. This study aims to systematically identify and synthesize available evidence on PLTCs. METHODS: We searched studies in English from 2009‒2023 in PubMed, the National Library of Medicine (NLM) Gateway, the POPLINE database, and the Science Direct website. The study team independently reviewed the illegibility criteria of the articles. Two reviewers independently appraised the included articles using the Joanna Briggs Instrument for observational studies. Disputes between the reviewers were resolved by consensus with a third reviewer. Meta-analysis was conducted in Stata version 16. The pooled proportion of PLTCs was calculated using the random effects model. The heterogeneity test was performed using the Cochrane Q test, and its level was determined using the I2 statistical result. Using Egger's test, the publication bias was assessed. RESULT: Thirty-two cross-sectional, five case-control, and seven cohort studies published from 2009 to 2023 were included in the meta-analysis. The highest proportion of PLTC was 17.55% (95% CI: 15.51, 19.79) in Ethiopia, and the lowest was 0.83% (95% CI: 0.73, 0.95) in Iraq. The pooled proportion of PLTC was 6.98% (95% CI: 5.98-7.98). In the subgroup analysis, the pooled prevalence varied based on country income level: in low-income 13.44% (95% CI: 11.88-15.00) I2 = 89.90%, low-middle income 7.42% (95% CI: 5.99-8.86) I2 = 99.71%, upper-middle income 6.35% (95% CI: 4.21-8.50) I2 = 99.92%, and high-income 2.67% (95% CI: 2.34-2.99) I2 = 99.57%. Similarly, it varied based on the diagnosis criteria; WHO diagnosis criteria used 7.77% (95% CI: 6.10-9.44) I2 = 99.96% at P = 0.00, while the Centers for Disease Controls (CDC) diagnosis criteria used 2.19% (95% CI: 1.89-2.50) I2 = 99.41% at P = 0.00. CONCLUSION: The pooled prevalence of PLTC is high globally, predominantly in low-income countries. The large disparity of potentially life-threatening conditions among different areas needs targeted intervention, particularly for women residing in low-income countries. The WHO diagnosis criteria minimize the underreporting of severe maternal morbidity. TRIAL REGISTRATION: CRD42023409229.

The effect of catchment based mentorship on quality of maternal and newborn care in primary health care facilities in Tigray Region, Northern Ethiopia: A controlled quasi-experimental study.

BACKGROUND: In Ethiopia, quality of maternal and newborn care is poor. This situation has persisted, despite the wide implementation of several capacity building-oriented interventions including clinical mentoring for skilled birth attendants that were anticipated to translate in to high-quality maternal and newborn care on each encounter. The effectiveness of mentoring programs is not yet well documented in the research literature. Therefore, we evaluated the effect of a catchment based clinical mentorship in improving the quality of maternal and newborn care in primary level facilities of Tigray, Northern Ethiopia. METHODS: We conducted a controlled quasi-experimental pre-post study among 19 primary health care facilities, with 10 facilities assigned to the group where the catchment based clinical mentorship program was implemented (intervention group), and 9 facilities to the control group. We assigned the group based on administrative criteria, number of deliveries in each facility, accessibility, and ease of implementation of the intervention. A sample of 1320 women(662 at baseline; 658 at post intervention) and 233 skilled birth attendants(121 at baseline and 112 at end line) were included. We collected data from mothers, skilled birth attendants and facilities. The first round of data collection (baseline) took place two weeks prior the inauguration of the intervention, 05 October to 04 November 2019. The end line data collection occurred from 22 May to 03 July 2020. The primary Outcome was "receipt quality of maternal/newborn care". We analyzed the data using difference in differences (DiD) and logistic regression with Generalized Estimating Equation. The level of significance of predictors was declared at p-value less than 0.05in the multivariable analysis. INTERVENTION: We deployed a team of local clinical mentors working at primary hospitals to provide clinical mentorship, and direct feedback in routine and emergency obstetrical and newborn care to the mentees (all skilled birth attendants performing maternal and newborn health services) functioning in their catchment rural health centers for duration of six months. While visiting a facility, mentors remain at the facility each lasting at least five to seven days per month, over the course of intervention period. RESULTS: A significantly higher proportion of women at intervention facilities received quality of care services, compared with women at comparison facilities. (DiD = 18.4%, p<0.001). Moreover, following the implementation of the intervention we detected a difference in the occurrences of maternal complication outcome during delivery and immediately after birth. This was decreased by 4.5%, with significant differences between intervention and comparison sites (DiD = 4.5%, p = 0.013). We also found a favorable difference in occurrences of neonatal obstetric complications, with a decrease of 4.8% in the intervention site and almost no change in the comparison site (DiD = 4.8%, p = 0.002). Among the determinants of quality of care, we found that providers' job satisfaction (AoR = 2.95, 95%CI: 1.26 to 6.91), and making case presentation at regular basis(AoR = 1.89, 95%CI: 1.05 to 3.39) were significantly associated to improve the quality of care. However, delivery load(AoR = 0.95, 95%CI: 0.93 to 0.98) was negatively associated with quality of care. CONCLUSIONS: We conclude that the catchment based clinical mentorship intervention is effective to improve quality of care and reduce childbirth complications in northern Ethiopia. This finding further elaborated that incorporating maternal and newborn health catchment based clinical mentorship activities into the existing health system strengthening strategies can catalyze improvement processes to quality practice and health systems. This is seen as a necessary step to achieve the effective quality universal health care required to meet the health-related Sustainable Development Goals. Besides, more attention needs to be given to develop interventions and strategies that directly enhance providers' job satisfaction and reduce delivery work load.

Effect of health facility linkage with community using postnatal card on postnatal home visit coverage and newborn care practices in rural Ethiopia: A controlled quasi-experimental study design.

BACKGROUND: Postnatal home visit has the potential to improve maternal and newborn health, but it remains as a missed opportunity in many low-and middle-income countries. This study examines the effect of health extension worker administered postnatal card combined with health facility strengthening intervention on postnatal home visit coverage, newborn care practices, and knowledge of newborn danger signs in rural Ethiopia. METHODS: We employed quasi-experimental design using controlled before-and-after study in intervention and comparison districts of rural Tigray, northern Ethiopia. Training of health extension workers (HEWs) on postnatal home visit (PNHV), training of healthcare providers on maternal and newborn care, and capacity building of healthcare authorities on leadership, management and governance together with health system strengthening were the implemented interventions. Baseline (n = 705) and end line (n = 980) data were collected from mothers who delivered a year before the commencement of the actual data collection in the respective surveys. We used difference-in-differences (DiD) analysis to assess the effect of the intervention on PNHV coverage, essential newborn care practices and maternal knowledge of newborn danger signs. RESULTS: A total of 1685 (100%) mothers participated in this study. In all districts, more than 1/3rd of the mothers 633(37.57%) were in the age of 30-39 years. The difference-in-differences estimator showed an average of 23.5% increase in coverage of PNHVs within three days (DiD, p<0.001) and the provision of most postnatal contents significantly increased in the intervention district in the end line survey. The knowledge of at least three danger signs increased by 13.6% (p = 0.012).The DiD estimator showed an average of 27.6% increase to check the mothers for heavy bleeding (DiD, p = 0.011). This study also revealed that the checking of maternal blood pressure increased from 5.8% to 11.8% in the comparison districts and from 9.4% to 93.3% in the intervention district. The difference-in-differences estimator result showed a 9% difference in clean cord care practices among the participants (p = 0.025), 12.2% in skin to skin care (p = 0.022), and borderline significant increase in early initiation of breastfeeding (10.5%, p = 0.051). CONCLUSION: We conclude that the intervention package was effective in improving the coverage of PNHV, increase in knowledge of newborn danger sign and essential newborn care practices. Hence, further strengthening the linkages between health facilities and community is imperative to improve the coverage of essential lifesaving maternal and newborn care services by HEWs at home.

"Mothers will be lucky if utmost receive a single scheduled postnatal home visit": An exploratory qualitative study, Northern Ethiopia.

BACKGROUND: Postnatal home visits (PNHVs) have been endorsed as strategy for delivery of postnatal care (PNC) to reduce newborn mortality and improve maternal outcomes. Despite the important role of the Health Extension Workers (HEWs) in improving the overall healthcare coverage, PNHV remains as a missed opportunity in rural Ethiopia. Thus, this study aimed to explore the barriers and facilitators of scheduled postnatal home visits in Northern Ethiopia. METHODS: We conducted an exploratory qualitative study on a total of 16 in-depth interviews with HEWs and mothers who gave birth one year prior to the study. In addition, focus group discussions were conducted with HEWs and key informant interviews were conducted with women development group leaders, supervisors, and healthcare authorities from April to June 2019 in two rural districts of Northern Ethiopia. Discussions and interviews were audio recorded and transcribed verbatim in the local language (Tigrigna) and translated into English. The translated scripts were thematically coded using Atlas ti scientific software. Field notes were also taken during the discussion and while conducting the interviews. RESULTS: Health system factors, community context, and individual level factors were considered as the barriers and facilitators of scheduled PNHVs. Leadership, governance, management, support and supervision, referral linkages, overwhelming workload, capacity building, logistics and supplies are the major sub-themes identified as health system factors. Physical characteristics like geographical location and topography, distance, and coverage of the catchment; and community support and participation like support from women's development groups (WDGs), awareness of the community on the presence of the service and cultural and traditional beliefs were community contexts that affect PNHVs. Self-motivation to support and intrinsic job satisfaction were individual level factors that were considered as barriers and facilitators. CONCLUSION: The finding of this study suggested that the major barriers of postnatal home visits were poor attention of healthcare authorities of the government bodies, lack of effective supervision, poor functional linkages, inadequate logistics and supplies, unrealistic catchment area coverage, poor community participation and support, and lack of motivation of HEWs. Henceforth, to achieve the scheduled PNHV in rural Ethiopia, there should be strong political commitment and healthcare authorities should provide attention to postnatal care both at facility and home with a strong controlling system.

Incidence and predictors of first-year unplanned discontinuation of Implanon at Ayder comprehensive specialized hospital, northern Ethiopia: A retrospective follow-up study.

BACKGROUND: Discontinuing contraception without switching to a different type of family planning (FP) method contributes to unwanted pregnancy and unsafe abortion. Unplanned discontinuation of Implanon (which is discontinuation of Implanon without switching, but not for reasons of wanting to get pregnant) during the first year and its possible determinants have not been well investigated in Ethiopia. Therefore, this study aimed to determine the incidence and predictors of unplanned discontinuation of Implanon during the first year. METHODS: A retrospective follow-up study was conducted among 413 consecutive series of eligible women at Ayder Comprehensive Specialized Hospital in Northern Ethiopia. Data were drawn from both FP initiation and removal registration books and from contacting users by phone over a one-year period (April 2016 and March 2017). The inclusion of the categorical predictor in the final Cox model was considered if the test had a P-value of <0.25 in the log-rank test. We identified predictors of time to unplanned discontinuation using a multivariable Cox regression analysis. Adjusted hazard ratios with 95% confidence intervals (CI) were used to assess the association of covariates with the risk of discontinuation. There were no statistically significant interaction terms and proportionality assumption was fulfilled. RESULTS: The unplanned discontinuation rate of Implanon during the first year was 18.2%, with an incidence density of 16.3 discontinuations/1000 women-months. Compared with those under 20 years of age, women aged 20 to 24 years (AHR = 0.42; 95% CI: 0.19-0.91) had a protective effect against discontinuation. On the other hand, clients whose partner's educational level was lower than secondary (AHR = 2.20; 95% CI: 1.08-4.49) and who had never used any modern contraception method before (AHR = 3.26; 95% CI: 1.61-6.61) had a higher risk of discontinuation. CONCLUSIONS: Our findings have significant implications for understanding why Implanon is discontinued in an unplanned manner, and will help policy makers plan the interventions needed to improve Implanon continuity by overcoming identified barriers. Providers in similar settings should pay more attention to clients whose partners have lower educational status and who are new acceptors.

Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study.

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.

Beyond health system contact: measuring and validating quality of childbirth care indicators in primary level facilities of northern Ethiopia.

BACKGROUND: Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia. METHODS: A validation study was conducted by comparing women's self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n = 478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis. FINDINGS: 455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93-basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC > 0.60 and 0.75 < IF< 1.25). Few of the valid indicators were: whether women and their companion were greeted respectfully, whether an HIV test was offered, and whether severe bleeding (hemorrhage) was experienced by the woman. An additional 21(28.4%) indicators accurately measure at the facility or individual level, but the indicators under or over estimate at population level. Thirteen other indicators could accurately measure at population level. Eight (8.6%) indicators didn't meet either of the validity criteria. CONCLUSION: Women were able to accurately report on several indicators of quality for basic child birth care. For those few indicators that required a technical understanding tended to have higher don't know response from the women. Therefore, valid indicators should be included as a potential measurement of quality for the childbirth care process to ensure that essential interventions are delivered.

Postnatal home visits by health extension workers in rural areas of Ethiopia: a cross-sectional study design.

BACKGROUND: In low-income countries like Ethiopia, where families have poor access to or do not utilize the services of formal health care systems, community health workers provide postnatal care services through home visits. However, the extent and effectiveness of home-based postnatal visits by community health workers such as the Ethiopian health extension workers (HEWs) are not well explored. This community -based study aimed to determine the coverage, contents of postnatal home visits and associated factors by health extension workers in Northern Ethiopia. METHODS: We conducted a community based cross-sectional study in the rural Districts in Northern Ethiopia from August to September 2018. A total of 705 mothers who gave a live birth in the year preceding the survey were selected using multistage random sampling. A structured questionnaire was applied to collect data by interviewing the mothers. Data were analyzed using SPSS version 22 statistical software. Association of postnatal home visits with possible explanatory variables was investigated using logistic regression. RESULTS: One hundred and two (14.5%) mothers and newborns received PNC home visit within three days after birth from HEW and 170(24.1%) reported postnatal home visits within 42 days. Among the mothers who received postnatal home visits, 6.5% measured their blood pressure, 11.2% measured their temperature, 20% counseled about family planning, 16.5% counseled on newborn danger signs, 11.2% counseled on the skin to skincare of the newborn and 14.1% of their newborns were measured their weight at home. Mothers who received at least one home visit during pregnancy (AOR, 7.49; CI 3.55-15.80), participated in pregnant women forum (AOR, 3.16; CI 1.67-5.99), notified their birth (AOR, 6.16; CI 3.50-10.84) and those members of community health insurance (AOR, 1.87; CI 1.13-3.10) were factors associated with postnatal home visit by a health extension worker. CONCLUSION: The coverage of postnatal home visits by health extension workers remains low in rural districts of Northern Ethiopia. The existing health systems should consider interventions that improve pregnancy and birth notification strategies and more efforts should be made at improving community-based participation and linkages with community health workers.

Community-Based Essential Newborn Care Practices and Associated Factors among Women of Enderta, Tigray, Ethiopia, 2018.

Introduction. Neonatal mortality contributes a higher percentage of infant mortality, especially in developing countries including Ethiopia where the rate of institutional delivery is low. In Ethiopia, scientific evidences on the level of community-based essential newborn care practice were scanty and inconclusive. OBJECTIVES: The aim of the study was to assess community-based essential newborn care practices and associated factors among women who have infant < 12 months. METHODS: A community-based cross-sectional study was employed among 634 randomly selected women who have infant < 12 months from June 23, 2017, to August 29, 2017, at Enderta district. Data was collected by a face-to-face interview through structured questionnaires, and it was coded, entered, and cleaned using EpiData version 3.1. Then, the data was exported to SPSS version 21 for analysis. Odds ratios and p value were computed to know the association between the independent variables with the dependent variable. Finally, a variable at p value were computed to know the association between the independent variables with the dependent variable. Finally, a variable at p value were computed to know the association between the independent variables with the dependent variable. Finally, a variable at. RESULT: The overall community-based essential newborn care practice was found 40.7%. Educational status (AOR = 6.6, 95% CI, 2.49-11.97), previous ANC follow-up (AOR = 1.7, 95% CI, 1.2-3.80), weight of the child during birth (AOR = 1.3, 95% CI, 1.12-2.98), and place of delivery (AOR = 2.1, 95% CI, 1.50-4.63) were found to be significantly associated with community-based essential newborn care. Even though overall newborn practice was found to be good, the cord care practices were found to be poor that indicated there is a need to rise community awareness.

Epidemiology of childhood tuberculosis and factors associated with unsuccessful treatment outcomes in Tigray, Ethiopia: a ten-year retrospective cross sectional study.

BACKGROUND: Childhood TB is an indicator of a recent transmission of the disease in a community and it is estimated to constitute 15-20% of all TB cases in many of developing countries. However, only few studies which dominated by industrial countries were engaged to assess the situation. Therefore, this study was aimed to see epidemiology of childhood TB and factors associated with poor treatment outcome in developing country. METHOD: Using retrospective cross-sectional study design; Socio-demographic and clinical data of children aged less than 15 years old, treated for all forms of TB in the past 10 years (2007-2016) was collected from randomly selected eight public hospitals of Tigray. Then, Univariate logistic regression and adjusted multivariate logistic regressions was done to identify variables which had association with unsuccessful treatment outcomes at P-value less than 0.05. RESULT: In the past 10 years, a total of 13,345 Tuberculosis cases were observed. Of these, 1086 (8.1%) cases were children aged less than 15 years old. Sixty seven (6.2%) cases were smear positive. Among those that tested for HIV, 69 (8.3%) cases were TB/HIV co-infected. Of those with treatment outcome record 746 (88.7%) were successfully treated. Factors like being female (AOR, 1.79; 95% CI, 1.07-3.00), Age 0-5 years (AOR, 3.35; 95% CI, 2.11-5.33), Unknown HIV status (AOR, 2.44; 95% CI, 1.51-3.95) and pulmonary positive case (AOR, 2.56; 95% CI, 1.13-5.77), were more likely to have unsuccessful treatment outcome than their counterparts. CONCLUSION: In Tigray 8.1% all TB cases were children age less than 15 years old. Childhood TB treatment outcome varied with sex, age and HIV status.

Predictors of teenage pregnancy in Ethiopia: a multilevel analysis.

BACKGROUND: In Ethiopia, pregnancy, and childbearing begin at an early age. Teenage pregnancy has long-term implications for girls, their families, and communities. However, multilevel predictors of teenage pregnancy are not well studied yet. Several studies are focused only on the effects of individual-level characteristics but ignored the community level effect. This, in turn, could result in biased estimation of predictors of teenage pregnancy. Therefore, this study aimed to identify the individual and community level factors that determine teenage pregnancy in Ethiopia. METHOD: The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample from 645 clusters of 2679 (weighted) women aged 20-24 years. The data were collected using a two-stage cluster design that includes selection of enumeration areas as a first stage and selection of households as a second stage. A two-level mixed-effect logistic regression model was fitted to determine the individual and community level factors associated with teenage pregnancy. RESULT: The study revealed that 2134(79.6%) of women aged 20-24 years experienced pregnancy during their adolescent stage. Being sexually active before age 15[AOR = 7.9; 95%CI: 4.5, 13.8]; being married before age 15[AOR = 30; 9%CI: 16.7, 53.9] and being a rural dweller [AOR = 2.2; 95%CI: 1.4, 3.6] were positively associated with teenage pregnancy. A woman living in a community with a lower proportion of contraceptive users [AOR = 2.3; 95%CI: 1.5, 3.5]; had also a statistically significant association with teenage pregnancy. CONCLUSIONS AND RECOMMENDATION: Various factors at both the individual and community level determined teenage pregnancy. Therefore, the government should work on the prevention of early marriage, early sexual initiation and on improving the utilization of family planning in the community to protect them from pregnancy that occur at early age.

Perception and practice of 'healthy' diet in relation to noncommunicable diseases among the urban and rural people in northern Ethiopia: a community-based qualitative study.

Dietary habits are related to the risks of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, of which burdens are increasing in low-income countries including Ethiopia. Although several epidemiological studies of NCD risk factors were conducted in Ethiopia, qualitative studies on people's dietary habit in relation to NCDs have not been conducted yet. This study aims to describe people's perception and practice of 'healthy' diet, and barriers to practice 'healthy' diet, paying attention to the dynamics between the perception and practice. We conducted 16 key informant interviews and eight focus group discussions in an urban and a rural areas in northern Ethiopia between November 2014 and January 2016. Audio-records in local language were transcribed word-for-word, and translated into English. English text data were analyzed qualitatively, through constant comparative analysis following the principles of the grounded theory. Three themes have emerged: (1) dietary habit perceived as 'good' or 'bad' for health; (2) reasons for continuing current 'unhealthy' dietary habit; and (3) current dietary habit perceived as 'traditional.' People's practice was mostly consistent with their perception, while they sometimes practiced contrary to the perception because of personal preference and physical or financial obstacles. People were often indifferent of health implications of their habitual dietary practice, such as drinking a lot of sweet coffee. We showed dynamics between perception and practice of 'healthy' diet among people in northern Ethiopia. It is needed to increase awareness of NCDs both among the urban and rural people and to improve the social environment for removing the obstacles.

Non-communicable disease risk factor profile among public employees in a regional city in northern Ethiopia.

The burden of non-communicable diseases (NCDs) is increasing in Ethiopia. This study aims to describe the prevalence of NCD risk factors of public employees in a regional city in northern Ethiopia. We conducted a cross-sectional epidemiological study targeting men and women aged 25-64 years employed by public offices in Mekelle. The prevalence was age-standardized to the Ethiopian 2007 population. Among the 1380 subjects (823 men and 557 women), 68.7% had less than 1 serving of fruits and vegetables per day, 41.0% were physically inactive, and 57.3% observed religious fast. The age-standardised prevalence of abdominal obesity was 29.3% in men and 58.5% in women, but that of metabolic syndrome was comparable between men (39.2%) and women (39.0%). The prevalence of diabetes was underestimated if only fasting blood glucose (FBG) was used for the diagnosis compared to combination of FBG and glycated haemoglobin (HbA1c) (6.7% in men and 3.8% in women vs. 12.1% in men and 5.6% in women). More than a quarter (26.1%) of men and 8.7% of women had estimated 10-year risk of cardiovascular disease of 10% or more. This study revealed the high prevalence of NCD metabolic risk factors among the urban public employees in the highland of Ethiopia.

Awareness, treatment, and control of hypertension is low among adults in Aksum town, northern Ethiopia: A sequential quantitative-qualitative study.

INTRODUCTION: Hypertension is a major risk factor of cardiovascular diseases which are the leading causes of deaths from chronic non-communicable diseases in Ethiopia. However, little is documented in the issue. Therefore, this study aimed to assess the prevalence, associated factors, awareness, treatment and control of hypertension among adults 18 years old or above in Aksum town, Tigray region, North Ethiopia. METHODS: A sequential quantitative-qualitative study was conducted among adults aged 18 years and above in Aksum town. A multi stage sampling procedure was used to select the study participants for the quantitative study whilst convenience sampling technique was used for the qualitative part. A pre-tested and structured questionnaire was used to collect quantitative data, and an interview guide was used to collect the qualitative data. The logistic regression model was fitted to identify factors independently associated with hypertension using SPSS Version 20. P-values of < 0.05 were considered statistically significant. For the qualitative data, iterative hearing of the discussions verbatim interpretation was followed by categorizing similar ideas into themes and finally triangulated with the quantitative results. RESULTS: The overall prevalence of hypertension was 16.5% (95% CI: 13.4, 20.0). Awareness, treatment and control of hypertension were 43%, 2.1% and 18.2%, respectively. Being unable to read and write [AOR = 4.73, 95% CI:1.11, 20.23], not consuming fruit [AOR = 4.31, 95% CI:1.74, 10.66], being physically inactive [AOR = 20.11, 95% CI:8.75, 6.20], not knowing physical inactivity is a risk factor of hypertension [AOR = 3.57, 95% CI: 1.69, 7.69] and being overweight/obese [AOR = 9.2, 95% CI:4.54, 18.67] were significantly associated with hypertension. Remarkably, all identified hypertensive cases were linked to the nearby hospital for confirmation of diagnosis, care and follow-up and all of them were found to be hypertensive. This suggests that implementing primary health care approach integrated with the urban health extension package may be effective in the prevention and control of hypertension in poor settings. CONCLUSION AND RECOMMENDATION: Prevalence of hypertension among adults was very high, but awareness, treatment and control of hypertension was very low. Being unable to read and write, not consuming fruit, being physically inactive, overweight/obesity and not knowing physical inactivity is a risk factor for hypertension were independently associated with hypertension. Policy makers need to consider integrating prevention and control of hypertension with health extension package. Appropriate information, education and communication strategies should also be designed and implemented to avoid unhealthy lifestyles and promote healthy practices.

Individual and community-level factors associated with introduction of prelacteal feeding in Ethiopia.

BACKGROUND: Ethiopia is a country with low optimal breast feeding practice, and prelacteal feeding is still a norm. Introduction of prelacteal feeding is a known barrier for optimal breast feeding practices. However, knowledge on determinants of introduction of prelacteal feeding is minimal. This study aimed to identify the effects of individual and community-level factors in the introduction of prelacteal feeding in Ethiopia. METHODS: Data for this study was extracted from the nationally representative 2011 Ethiopia Demographic and Health Survey (EDHS) and focused on a sample from child data, with a sample from 576 clusters of 7692 children who were last-born in the past five years preceding the survey. The data was collected using two-stage cluster design, in which enumeration areas forming the first stage and households making the second stage. A two-level mixed effect multivariable logistic regression model was fitted to determine the individual and community-level factors associated with introduction of prelacteal feeding. RESULTS: From the total sample of children 28.92 % were fed prelacteals. Butter (n = 1143), plain water (n = 395) and milk-other than breast milk (n = 323) were commonly used prelacteals. In multivariable two-level mixed effect model; caesarean mode of delivery (Adjusted odds ratio (AOR) = 1.87; 95 % CI 1.28, 2.73), and late initiation of breastfeeding (AOR = 5.32; 95 % CI 4.65, 6.09) were both positively associated with the odds of giving prelacteals. Higher economic status 28 % (AOR = 0.72; 95 % CI 0.54, 0.98), giving birth at hand of non-health personnel birth assistance (AOR = 0.68; 95 % CI 0.54, 0.87), large birth size of child (AOR = 0.80; 95 % CI 0.68, 0.95) and high community antenatal care use (AOR = 0.58; 95 % CI 0.38, 0.87) were negatively associated with the odds of giving prelacteals. Significant variation in prelacteal feeding practice was also seen among ethnic and religious groups, and across regions. CONCLUSIONS: The prevalence of prelacteal feeding was high that remained a challenge for optimal breastfeeding in Ethiopia. Not only individual-level factors, but also community-level factors contribute to prelacteal feeding practice. Increasing access to health education through increasing maternal health care service coverage and community involvement is crucial.