Association between the stage of labour during caesarean delivery with adverse maternal and neonatal outcomes among referred mothers to tertiary centres in resource-limited settings.

OBJECTIVE: Although the caesarean delivery (CD) rate has substantially increased, little is known about its impacts when performed in the first and second stages of labour on fetomaternal outcomes, especially among referred mothers. Thus, this study aimed to investigate the association between CDs performed during the first and second stages of labour and poor maternal and neonatal outcomes among mothers referred to tertiary centres. SETTING: This retrospective cohort study analysed medical records of mother-infant pairs from September 2020 to May 2023 in Southern Ethiopia. PARTICIPANTS: We retrospectively collected data from 848 participants who underwent emergency CD on a referral basis during the study period. PRIMARY OUTCOME MEASURE: The primary outcomes of interest were adverse maternal and neonatal outcomes. Data were analysed using descriptive and inferential statistics. RESULTS: Of the 848 CDs, 722 (85.2%) and 126 (14.8%) were performed at the first and second stages of labour, respectively. Caesarean sections performed at the second stage were higher with nulliparity, increased maternal age, and birth weight. Compared with the first-stage CD, the second-stage CD was associated with a significantly increased risk of adverse maternal (OR 3.7, 95% CI 2.4 to 5.7) and neonatal outcomes (OR 2.0; 95% CI 1.3 to 2.9), including neonatal death. CONCLUSION: Second-stage CDs have an increased risk of adverse maternal and neonatal outcomes. Strengthening and improving obstetric emergency surgical services and intensive neonatal care for those populations would help decrease the maternal and fetal negative consequences.

Exploring factors influencing skin incision to the delivery time and their impact on neonatal outcomes among emergency cesarean deliveries indicated for non-reassured fetal heart rate status.

Background: The time interval between skin incision and delivery (S-D) is crucial in determining neonatal outcome; however, little is known about the influencing factors and their impact on neonatal outcomes, particularly among emergency cesarean deliveries (ECD) indicated for fetal distress. This study investigated the factors influencing S-D time and their effects on neonatal outcomes among mothers who underwent ECD for non-reassured fetal heart rate status. Methods: This retrospective cohort study involved 426 mother-infant pairs over four years. We retrieved data from the medical records, including baseline characteristics, perioperative data, and neonatal outcomes. Using multivariable logistic regression analysis, adjusted odd ratios, and a 95% confidence interval, potential factors influencing S-D time and their impacts on neonatal outcomes were assessed. A p-value of less than 0.05 was considered statistically significant. Results: Factors independently associated with longer S-D time (>8 min) were mothers who had previous CD (AOR 5.9: 95% CI 2.2-16.1), obese mothers (AOR 6.2: 95% CI 1.6-24.5), and the second stage of labor (AOR 5.3: 95% CI 2.4-11.7). Adverse neonatal outcomes, including a 5th minute Apgar score of less than 7, the need for NICU admission, and neonatal death, were significantly higher in the longer S-D time interval [47.7% vs. 8.9%; p-value 0.001], [21.9% vs. 9.1%; p-value 0.001], and [32% vs. 11.8%; p-value = 0.004], respectively. Obese mothers and the second stage of labor, but not previous CD, adversely impact neonatal outcomes. Conclusion: Longer S-D times are significantly associated with adverse neonatal outcomes. Factors that prolong the time interval between skin incision and delivery may or may not necessarily be associated with adverse neonatal outcomes. Considering surgical techniques that shorten the incision-delivery time and preparation for advanced neonatal care for risky subjects would help reduce detrimental neonatal consequences.

Determinants of term premature rupture of membrane: case-control study in Saint Paul's Millennium Medical College Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications. OBJECTIVES: This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia. METHODS: This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul's hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05. RESULTS: Factors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane. CONCLUSION: Proper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.

Preterm Birth Among Intrapartum Cesarean Deliveries at Public Hospitals in Southern Ethiopia: A Multicenter Retrospective Analysis of Risk Factors.

Purpose: Although the underlying causes for preterm birth are thought to be multifactorial irrespective of delivery mode, no study investigated its risk factors amongst cesarean deliveries (CD). Thus, we aimed to identify potential risk factors for the occurrence of preterm birth (PTB) among intrapartum CD. Methods: Data from 1659 singleton intrapartum CDs were retrospectively recruited using medical records and an obstetric database. Gestational age was calculated using the last menstrual period (LMP) and ultrasound report of early onset pregnancy. A multivariable logistic regression analysis was performed to identify potential risk factors associated with PTB. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used. Statistical analysis was performed using SPSS version 26.0. Results: In this study, the prevalence of PTB among intrapartum CD was 6.1% (95% CI: 4.9, 7.2%). In the multivariable logistic regression model; grand parity ≥5 (adjusted odds ratio (AOR) = 2.43, 95% CI: 1.72-4.73), maternal age <20 years (AOR=2.63, 95% CI, 1.03-6.71), maternal age ≥35 years (AOR=3.83, 95% CI, 1.49-5.35), cesarean section scar ≥2 (AOR=4.86, 95% CI: 2.68-8.94), antepartum hemorrhage (AOR=4.37, 95% CI: 2.22-8.63), pregnancy-induced hypertension (AOR=2.92, 95% CI: 1.41-6.04), and premature rupture of membranes (AOR=4.56; 95% CI: 1.95-10.65) were significantly associated with PTB. Conclusion: The current study showed an association between PTB and a multitude of obstetric variables, including grand parity ≥5, CS scar ≥2, antepartum hemorrhage, pregnancy-induced hypertension, and premature rupture of the membrane. Understanding these factors could help to implement improved quality of obstetric and neonatal care to increase survival and reduce morbidity among preterm birth.

Prevalence and predictors of postpartum anemia after caesarean delivery in Ethiopia: A retrospective analysis of risk factors.

BACKGROUND: Despite the burden of anemia during pregnancy has been extensively studied, the magnitude of postpartum anemia (PPA) and its predictors, especially after caesarean delivery remains unexplored. Therefore, we investigated the prevalence of postpartum anemia, and its predictors among women who underwent cesarean delivery. METHODS: A retrospective study was conducted among women who underwent caesarean delivery in Southern Ethiopia. Data were retrospectively retrieved from the medical records of the participants. Multivariate logistic regression analysis identified independent predictors associated with postpartum anemia. An adjusted odd ratio (AOR), and a 95% confidence interval (CI), were used to identify associations. A p-value < 0.05 is considered statistically significant. RESULTS: A total of 368 women who underwent caesarean delivery were included in this study. The overall incidence of PPA using a cut-off value of hemoglobin level < 11 g/dl after cesarean delivery was 103(28%). Multiple logistic regression analysis showed that the predictors of PPA were more likely among women with Prepartum Anemia (AOR=5.46: 95% CI=2.09-14.31), Grand parity (AOR=3.98: 95% CI=1.45-10.90), Placenta previa (AOR=7.73: 95% CI=1.91-31.38), ANC follow-up < 3 times (AOR=2.33: 95% CI=1.07-3.47), and those who developed Postpartum Hemorrhage (AOR=2.73: 95% CI=1.51-4.93). CONCLUSION: More than one-fourth of women who underwent caesarean delivery in Southern Ethiopia had PPA. Poor ANC- follow-up, grand parity, placenta previa, Prepartum anemia, and PPH were the best predictors of PPA. Therefore, implementing strategies that consider the identified predictors could help to reduce the prevalence of PPA and its complications.

The incidence and determinants of the meconium-aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section: A prospective cross-sectional study in a specialized hospital, south Ethiopia.

Background: Meconium aspiration syndrome is respiratory distress diagnosed in neonates delivered with meconium-stained amniotic fluid that is unexplained by other pathologies. It has severe neonatal respiratory complications and a significant impact on the prevalence of neonatal mortality. Objective: To identify the incidence and determinants associated with meconium aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section in Wolkite University specialized hospitals in Ethiopia from September 1, 2021, to August 30, 2022. Method: An institution-based cross-sectional study was done prospectively through meticulous chart review and interviews with 275 mothers with meconium-stained amniotic fluid who gave birth with an emergency cesarean section. Data were entered using EpiData 7 and analyzed with SPSS 26. The association between independent variables and the meconium-aspiration syndrome was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at a p-value of 0.05. Result: The prevalence of the meconium-aspiration syndrome is 28.7%. The factors associated are: latent phase (AOR: 2.580; 95% CI: 1.126, 5.913), low 1st minute APGAR score (AOR: 2.43; 95% CI: 0.892, 6.625), and thick meconium (AOR: 31.018; 95% CI: 9.982, 96.390). The neonatal death rate associated with meconium aspiration syndrome is 1.8%, and thick meconium contributed to 65% of admissions to the neonatal intensive care unit and all deaths. Conclusion: The incidence of meconium aspiration syndrome is high, and thick meconium, meconium at early labor, and low APGAR scores all contributed to this. Thick meconium has a substantial effect on neonatal mortality and morbidity. Therefore, an improvement in the quality of obstetric and neonatal care through early intervention in the case of thick meconium and meconium in the early phase of labor is recommended.

Incidence and predictors of severe postpartum hemorrhage after cesarean delivery in South Central Ethiopia: a retrospective cohort study.

Severe postpartum hemorrhage is an obstetric emergency that needs immediate intervention and is a leading cause of maternal death. Despite its significant health burden, little is known, about its magnitude and risk factors, especially after cesarean delivery in Ethiopia. This study aimed to evaluate the incidence and predictors of severe postpartum hemorrhage following cesarean section. This study was conducted on 728 women who underwent cesarean section. We retrospectively collected data from the medical records, including baseline characteristics, obstetrics, and perioperative data. Potential predictors were investigated using multivariate logistic regression analyses, adjusted odd ratios, and a 95% confidence interval to see associations. A p-value < 0.05 is considered statistically significant. The incidence of severe postpartum hemorrhage was 26 (3.6%). The independently associated factors were previous CS scar ≥ 2 (AOR 4.08: 95% CI 1.20-13.86), antepartum hemorrhage (AOR 2.89: 95% CI 1.01-8.16), severe preeclampsia (AOR 4.52: 95% CI 1.24-16.46), maternal age ≥ 35 years (AOR 2.77: 95% CI 1.02-7.52), general anesthesia (AOR 4.05: 95% CI 1.37-11.95) and classic incision (AOR 6.01: 95% CI 1.51-23.98). One in 25 women who gave birth during cesarean section experienced severe postpartum hemorrhage. Considering appropriate uterotonic agents and less invasive hemostatic interventions for high-risk mothers would help to decrease its overall rate and related morbidity.

Case-control study on determinants of uterine rupture among mothers who gave birth at Hawassa University comprehensive specialized hospital.

BACKGROUND: Uterine rupture is defined as tearing of the uterine wall during pregnancy or delivery. It can occur during pregnancy or labor and delivery. Rupture of the uterus is a catastrophic event resulting in the death of the baby, and severe maternal morbidity and mortality Despite different interventions done by stakeholders, it remained one of the leading public problems in developing countries like Ethiopia. OBJECTIVE: This study assessed the prevalence and determinants of uterine rupture among mothers who gave birth at Hawassa University comprehensive specialized hospital from July 2015 to June 2020G.C. METHOD: A case-control study was conducted by reviewing data from a total of 582 patient charts which include 194 cases and 388 controls with a case-to-control ratio of 1:2. Then the data was extracted using a pre-tested and structured data extraction sheet. Data were entered using Epi data 3.1 and exported to SPSS and analyzed using SPSS 20. The association between independent variables and uterine rupture was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at P-value < 0.05. RESULT: There were a total of 22,586 deliveries and 247 confirmed cases of uterine rupture which makes the prevalence 1.09%. Lack of ANC (Ante-natal care) (AOR = 7.5; 95% CI: 1.9-30.3) inadequate ANC (AOR = 2.45; 95% CI: 1.1-5.57), gravidity ≥5 (AOR = 3.3; 95% CI: 1.36-8.12), obstructed labor (AOR = 38.3; 95% CI: 17.8-82.4) and fetal macrosomia (AOR = 8; 95% CI: 17.8-82.4) are variables which increase the odds of developing uterine rupture. Mothers without additional medical or obstetric conditions are more likely (AOR = 4.2; 95% CI: 2.1-8.65) to develop uterine rupture than mothers with additional medical or obstetric conditions. CONCLUSION: The prevalence of uterine rupture is high in the study area. The study also revealed that a decrease in ANC follow-up, gravidity of ≥5, obstructed labor, and fetal weight of >4kg are significantly associated with uterine rupture. Improving the quality of ANC follow-up, intrapartum follow-up and proper estimation of fetal weight are recommended interventions from the study.

Incidence of extubation failure and its predictors among adult patients in intensive care unit of low-resource setting: A prospective observational study.

BACKGROUND: Previous studies have found an association between various predictors and extubation failure (EF) in intensive care units (ICUs). However, this problem remains unexplored in low-resource settings, where predicting the extubation outcomes are more challenging. This study investigates the incidence of EF and its predictors among patients who received mechanical ventilation (MV). METHODS: This is a prospective observational study of 123 patients' ≥ 18 years of age receiving MV for ≥ 48 hours and tolerated spontaneous breathing trials (SBTs) in the ICU of a low-resource setting. We collected data on the baseline characteristics and clinical profiles before and after SBTs. Patients were categorized into extubation failure (EF) and extubation success (ES) groups. Multivariate logistic regression analyses were performed to identify independent predictors for EF. A p-value < 0.05 is considered statistically significant. RESULTS: We included 123 patients, and 42 (34.15%) had developed EF. The identified predictors for EF: Moderate to copious secretions (adjusted odds ratio [AOR]: 3.483 [95% confidence interval [CI] 1.10-11.4]), age > 60 years of age ([AOR]: 4.157 [95% CI 1.38-12.48]), and prolonged duration of MV ≥ 10 days ([AOR]: 4.77 [95% CI 1.55-14.66]). CONCLUSION: Moderate to copious secretions, patients > 60 years of age, and prolonged duration of MV ≥ 10 days were the best predictors of EF. Based on our findings, we recommend that the identified predictors could help in the decision-making process of extubation from MV.

Management of patient presenting with breast fibroadenoma and medullary thyroid cancer in a young male: A case report and review of the literature.

Introduction and importance: Fibroadenoma of the male breast is a rarely diagnosed lesion that often occurs concurrently with gynecomastia and the intake of medications that alter sex hormone levels. Herein, we report the first case of fibroadenoma of the male breast, presenting with medullary thyroid cancer. In addition, we reviewed the current management strategies for fibroadenoma of the male breast in the literature. Case presentation: A 25-year-old male patient presented to our surgical unit with medullary thyroid cancer (MTC). The physical examination revealed an unnoticed lump in his left breast. We delayed the planned thyroid surgery to determine whether the breast mass was associated with metastasis from MTC. We performed pathological tests from excised breast mass and confirmed the diagnosis of fibroadenoma. After confirming the benign nature of the breast mass, the patient underwent total thyroidectomy with selective neck dissection for MTC. Clinical discussion: Fibroadenoma of the male breast was diagnosed based on clinical presentation and histopathological findings. Fibroadenoma of the male breast is a rarely diagnosed lesion: and is often associated with gynecomastia and altered serum sex hormone level. The presentation of this case without those concurrences is even rarer, as revealed in our case. The management for suspected fibroadenoma of the male breast presented with MTC should include delaying the thyroid surgery to rule out the presence of malignancy and metastasis. Conclusion: The finding indicates that fibroadenoma can be considered a differential diagnosis in the male breast even in the absence of those concurrences. The timely diagnosis and orderly management of fibroadenoma of the male breast and MTC could help to improve the patient outcome.

Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study.

Background: Previous studies have found an association between various predictors and perforated appendicitis. However, there is limited evidence of studies determining the severity of acute appendicitis (AA) in resource-limited settings. Thus, this study aimed to identify predictors and outcomes of perforated appendicitis (PA) in sub-Saharan countries. Methods: This is a retrospective cohort study of 298 adult patients who underwent surgical intervention for acute appendicitis. Demographic characteristics, clinical parameters, intraoperative findings, length of hospital stay, and postoperative complications were collected. We computed multivariate logistic regression to identify predictors of PA. P-value <0.05 was considered statistically significant. Results: Of 298 patients, PA was 142(47.65%). The identified risk factors for PA are referred patients (AOR = 3.932; 95% CI (2.201-7.027), fever >38 °C (AOR = 4.569; 95% CI (2.249-9.282), and duration of symptoms >2 days (AOR = 2.704; 95% CI (1.400-5.222). Perforation was associated with an increased rate of postoperative complications (45.07vs. 6.41%; P < 0.001) and a longer length of hospital stay (3 vs. 5 days; P < 0.001). Conclusions: The incidences of PA in our study are consistent with other reports in developing countries. Referred patients, longer duration of symptoms >2 days, and presence of fever >38 °C were the best predictors of PA. The overall total postoperative complications and the length of hospital stays were higher in PA. Based on our findings, we recommend that the identified predictors should be considered during the preoperative diagnosis and subsequent management.

Uptake of Immediate Postpartum LARCs and Associated Factors among Mothers Who Gave Birth at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

Background: Postpartum family planning is an effective strategy for reducing maternal and childhood morbidity and mortality by preventing unintended pregnancy and short interpregnancy intervals. Despite the paramount advantages of long-acting reversible contraceptives (LARC), their uptake remains low in Ethiopia. Therefore, the aim of this study was to assess the uptake of immediate postpartum LARC methods and its associated factors among women who gave birth in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Southern Ethiopia. Methods: An institution-based cross-sectional study was conducted among 418 eligible mothers who were in the immediate postpartum period. Data were collected using a pretested structured questionnaire before their discharge from the hospital and analyzed by using SPSS version 20. The statistical significance was declared at P value less than 0.05. Results: The uptake LARCs among immediate postpartum mothers was 25.4%. The most commonly reported reasons for not using LARC were preference to start contraception after six weeks of delivery (43.3%) and the need to use other methods of contraception (26%). Having unplanned birth (AOR: 1.97; 95% CI: 1.04-3.71) and receiving family planning counselling on LARCs during the postpartum period (AOR: 21.1; 95% CI: 6.49-68.66) were factors significantly associated with immediate postpartum LARC use. Conclusion: Low utilization of immediate postpartum LARC uptake was found in the current study setting. There was increased utilization of immediate postpartum LARC among mothers who received family planning counselling during the postpartum period. Therefore, strengthening family planning counselling during the immediate postpartum period is crucial to enhance postpartum LARC use.

Incidence and factors associated with post-anesthesia care unit complications in resource-limited settings: An observational study.

Background and aims: Postoperative complications are frequent encounters in the patients admitted to postanesthesia care units (PACU). The main aim of this study was to assess the incidence of complications and associated factors among surgical patients admitted in limited-resource settings of the PACU. Methods: This is an observational study of 396 surgical patients admitted to PACU. This study was conducted from February 1 to March 30, 2021, in Ethiopia. Study participants' demographics, anesthesia, and surgery-related parameters, PACU complications, and length of stay in PACU were documented. Multivariate and bivariate logistic regression analyses, the odds ratio (OR), and 95% confidence interval (CI) were calculated. p-value < 0.05 was considered as statistically significant. Results: The incidence of complications among surgical patients admitted to PACU was 54.8%. Of these, respiratory-related complications and postoperative nausea/vomiting were the most common types of PACU complications. Being a female (adjusted odds ratio [AOR] = 2.928; 95% CI: 1.899-4.512) was significantly associated with an increased risk of developing PACU complications. Duration of anesthesia >4 h (AOR = 5.406; 95% CI: 2.418-12.088) revealed an increased risk of association with PACU complications. The occurrences of intraoperative complications (AOR = 2.238; 95% CI: 0.991-5.056) during surgery were also associated with PACU complications. Patients who develop PACU complications were strongly associated with length of PACU stay for >4 h (AOR = 2.177; 95% CI: 0.741-6.401). Conclusion: The identified risk factors for complications in surgical patients admitted to PACU are female sex, longer duration of anesthesia, and intraoperative complications occurrences. Patients who developed complications had a long time of stay in PACU. Based on our findings, we recommend the PACU team needs to develop area-specific institutional guidelines and protocols to improve the patients' quality of care and outcomes in PACU.

Appendiceal knotting causing small bowel obstruction: A rare case report.

INTRODUCTION AND IMPORTANCE: Appendicitis causing intestinal obstruction by forming a knot around a small bowel is uncommon. Preoperative diagnosis is challenging as the typical presentations of appendicitis are not usually seen. The diagnosis of appendicular knotting is usually an intraoperative surprise. CASE PRESENTATION: A 34-year-old male patient (BMI-20.86 kg/m2) presented to the surgical emergency unit with colicky central abdominal pain of 2-days duration, which later involved the whole abdomen. In association with this, he had a history of frequent vomiting of ingested matter which later became bilious. The abdominal examination revealed diffuse abdominal tenderness with guarding and rigidity. On midline exploratory laparotomy, the inflamed appendix which was adherent to the distal part of the ileum was observed. The appendix and the encircled segment of the distal ileum were both gangrenous, and the patient underwent resection of the bowel segment in addition to appendectomy. CLINICAL DISCUSSION: Whenever an appendix wraps around an intestine or its tip adheres with small bowel, cecum, or posterior peritoneum forming a ring-like structure, and a segment of a bowel herniates through an opening can cause a closed-loop obstruction with or without strangulation. The management for ileo-appendicular knotting associated with gangrenous bowel could be appendectomy and resection of the bowel segment. Postoperatively, the patient had developed diarrhea caused by ileocecal resection, which later subsided by medication. CONCLUSION: Ileo-appendicular knotting is a rare cause of small intestinal obstruction, and it's challenging to diagnose during the preoperative period. As surgeons dealing with acute abdomen in routine clinical practice, knowledge of this unusual case is helpful for clinical suspicion and evidence-based management.

Determinants of early neonatal outcomes after emergency cesarean delivery at Hawassa University comprehensive specialised hospital, Hawassa, Ethiopia.

BACKGROUND: Neonatal mortality after cesarean delivery is three folds higher than mortality after vaginal births. Post cesarean early neonatal outcomes are associated with preoperative and intraoperative fetomaternal factors which are preventable in the majority of cases. OBJECTIVE: To identify determinants of early neonatal outcomes after emergency cesarean delivery at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. METHOD: Institution based cross sectional study was conducted on 270 emergency cesarean deliveries. Data were collected by using a pretested questionnaire by trained data collectors. Descriptive analysis was used to see the nature of the characteristics of interests. Pearson chi-square-test was used to check presence of association between independent and outcome variables. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using odds ratio with 95% CI and p value < 0.05. RESULTS: The prevalence of adverse early neonatal outcome after emergency cesarean delivery was 26.7%. Around 11% of newborns had low (<7) fifth minute Apgar score and more than one-third (34.8%) of them admitted to neonatal intensive care unit for more than 24 hours. Fifteen (5.6%) newborns died within their first seven days of life. Neonates with a preoperative meconium-stained amniotic fluid and low birth weight (< 2500 grams) had greater odds of having adverse early neonatal outcome with (AOR = 6.37; 95% CI: 2.64, 15.34) and (AOR = 14.00; 95% CI: 3.64, 53.84) respectively. CONCLUSION: The prevalence of adverse early neonatal outcome is high in this study and meconium-stained amniotic fluid during labor as well as low birth weight were the leading predictors of adverse early neonatal outcome during emergency cesarean delivery.

The practice of procedural pain assessment and management in neonatal intensive care unit in Ethiopia: Cross-sectional study.

BACKGROUND AND AIMS: Neonates in intensive care units undergo frequent painful procedures for diagnostic or care-related purposes. Untreated pain has serious short-term and long-term complications. This study aims to evaluate the frequency of painful procedures, pain assessment, and their analgesic management practice among neonates admitted to the NICU. METHODS: The present study is a hospital-based cross-sectional study of neonates admitted at level II NICU of St. Paul hospital millennium medical college in Ethiopia between March and August 2019. Data were collected from medical charts of neonates and bedside observation using a checklist. The parameters included were demographic characteristics, types of painful procedures, pain assessment practice, and analgesic intervention provided during painful procedures. Descriptive statistics, Mann-Whitney U-test, and Kruskal-Wallis test were used to compare the number of painful procedures and influencing factors. P-value < .05 was considered statistically significant. RESULTS: Of the 325 neonates included in this study, a median of 4 (3-7) painful procedures were performed per neonate in the first 24 hours of NICU stay. Heel lance 280 (20.7%) and Venipuncture 249 (18.41%) were the most commonly performed painful procedures. Of the 1352 painful procedures, none of the neonates received any form of analgesic intervention and none of the neonate's pain scores were documented on their medical chart. The higher number of painful procedures were associated with gestational age between 28 and 31 weeks, birth weight less than 1500 g, and use of CPAP respiratory support P-value <.001, <.001, and .0015, respectively. CONCLUSION: Painful procedures were frequently performed in NICU without any form of analgesic intervention. Strategies to introduce neonatal pain assessment and their analgesic management for clinical practice are necessary.

The Prevalence of Alcohol Consumption Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Evidence indicates that a significant proportion of women drink alcohol during pregnancy. Studies have also suggested that prenatal alcohol consumption was associated with a wide range of adverse outcomes. To the best of our knowledge, this is the first systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of alcohol consumption among pregnant women in Ethiopia and suggest evidence based recommendations for future clinical practice. METHODS: This systematic review and meta-analysis was followed the PRISMA guidelines. PubMed, SCOPUS and EMBASE databases were searched to identify relevant articles that assessed alcohol consumption among pregnant women in Ethiopia. The Comprehensive Meta-Analysis software version 3.0 was used to conduct a meta-analysis using the random-effect model. Cochran's Q- and I2-tests were used to assess the heterogeneity of the included studies. RESULTS: A total of 6361 pregnant women from fifteen primary studies were included in the final analysis. The pooled prevalence estimate of alcohol consumption among pregnant women in Ethiopia was found to be 14.1%. The pooled prevalence of alcohol consumption among pregnant women in Ethiopia was reported to be lower in the studies that used the standardized alcohol consumption assessment tools (9.4%) when compared to the studies that did not use standardized tools (17%). The pooled prevalence of alcohol consumption among pregnant women ranged between 12.8% and 15.5% in leave-one-out sensitivity analysis. CONCLUSION: A considerable number of women in Ethiopia consume alcohol during pregnancy. Therefore, early identification and intervention strategies are highly recommended.

Sexual and Reproductive Health Services Utilization among Wolaita Sodo University Students, Ethiopia: A Mixed Method Approach.

BACKGROUND: Youths have been facing different sexual and reproductive health problems such as HIV infections and unplanned pregnancies. Therefore, this study aimed to assess reproductive health services utilization and their associated factors among Wolaita Sodo University students in Wolaita Sodo, Ethiopia. METHODS: We conducted an institutionally-based mixed-method study among 759 regular undergraduate university students. Multistage random sampling and purposive sampling techniques have been used to recruit students for the quantitative and qualitative studies, respectively. A pretested self-administered questionnaire was used to collect the data. A logistic regression model was used for quantitative data analysis, whereas thematic analysis was used for qualitative data. We used open-code software-assisted qualitative data analysis. The statistical significance was declared at a P value less than 0.05. RESULTS: We found that 378 (49.8%) (95% CI: 46.20-53.34) of respondents had utilized sexual and reproductive health services within the 12 months preceding the current survey. Being a first-year student (AOR = 1.57, 95% CI: 1.01-2.46), having ever had sexual intercourse (AOR = 5.12, 95% CI: 3.31, 7.96), participating in peer-to-peer discussion (AOR = 1.46, 95% CI: 1.02-2.02), and having ever had sexual transmitted infection syndrome (AOR = 3.91, 95% CI: 1.41-10.85) have increased the odds of using sexual and reproductive health services. CONCLUSION: Sexual and reproductive health services utilization among university students was inadequate and affected by several factors. Therefore, strengthening peer support networks and addressing the gap in services were highly recommended.

Effectiveness of wound site infiltration for parturients undergoing elective cesarean section in an Ethiopian hospital: A prospective cohort study.

BACKGROUND: Cesarean delivery (CD) is a commonly performed obstetric surgical procedure and causes moderate to severe postoperative pain. Wound site infiltration (WSI) is becoming a technique to provide postoperative analgesia in a limited-resource setting in regardless of controversy on its effectiveness. The current study is to assess its effectiveness as a part of postoperative analgesia for parturients undergoing elective Cesarean section. METHODS: A Hospital-based prospective cohort study was employed on 58 parturients that underwent elective Cesarean section. Study participants were allocated into the Wound site infiltration and Control group based on planned postoperative pain management. A student t-test was used for normally distributed data while non-normally distributed data were analyzed by Mann Whitney U test. Pearson Chi-squared or Fisher's exact test were used to analyzing categorical data as appropriate. A p-value < 0.05 considered as statistically significant. RESULTS: The median time to request the first analgesia was significantly prolonged within Wound site infiltration 314.31 ± 47.71 in minutes compared to control group 216.9 ± 43.18 with a P-value of <0.001. The postoperative verbal NRS score was significantly reduced in Wound site infiltration compared to the control group at 4th and 6th hours with p values of <0.001 and 0.04 respectively. CONCLUSION: Wound site infiltration performed following elective cesarean section under spinal anesthesia significantly prolonged time to request the first analgesia, decreases verbal NRS score, and total analgesic consumption within 24 h in postoperative period compared to control group.

Prevalence of depression among women with obstetric fistula in low-income African countries: a systematic review and meta-analysis.

Depression is one of mental health consequences that present in women with obstetric fistula. It is estimated that over 264 million people of all ages suffer from depression globally. The objective of this systematic review and meta-analysis was to synthesize the epidemiologic evidence from previous studies on the prevalence of depression among women with obstetric fistula in low-income African countries. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines to conduct this meta-analysis. The common databases (PubMed, SCOPUS, EMBASE, Psych INFO, Google Scholar, African Index Medicus, and African Journals Online (AJOL)) were searched for the relevant literature. We used a random-effect meta-analysis model to estimate the overall prevalence of depression and the Q -and I2 -statistics were used to assess the heterogeneity between the studies included in the meta-analysis. Egger's test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias. The pooled estimated prevalence of depression among women with obstetric fistula in low-income African countries was 56.2% (95% CI 43.1-68.4). The prevalence of depression among women with obstetric fistula was 74.4% in Ethiopia, 72.9% in Kenya, 46.0% in Malawi, 41.0% in Sudan, 34.8% in Nigeria, and 27.7% in Tanzania. Furthermore, the prevalence of depression was higher (97.0%) when it was measured by using Beck's Depression Inventory (BDI) when compared with Patient Health Questionnaire (PHQ9) (62.7%), General Health Questionnaire (GHQ-28) (36.7%), Hamilton Depression Rating Scale (HDRS) (41.0%), and Center for Epidemiologic Studies Depression Scale (CES-D) (27.7%). Moreover, the pooled estimated prevalence of depression among women with obstetric fistula was ranged from 48.1 to 57.7% in a leave-one-out sensitivity analysis. The prevalence of depression among women with obstetric fistula in low-income African countries was high. Screening and appropriate management of depression among women with obstetric fistula are warranted.