Antenatal Care Reduces Neonatal Mortality in Ethiopia: A Systematic Review and Meta-Analysis of Observational Studies.

BACKGROUND: Neonatal deaths remain a serious public health concern in Ethiopia; being one of the top five countries contributing to half of the neonatal deaths worldwide. Although antenatal care (ANC) is assumed as one of the viable options that contribute to neonatal survival, findings from original studies indicated disparities in the effect of ANC on neonatal mortality. Thus, this review aimed to determine the pooled effect of ANC on neonatal mortality in Ethiopia. METHODS: Databases such as PubMed, EMBASE, CINAHL, HINARI, and Cochrane Central Library were searched for articles using keywords. Selection of eligible articles and data extraction were conducted by an independent author. The risk of a bias assessment tool for non-randomized studies was used to assess the quality of the articles. Comprehensive meta-analysis version 2 software was used for meta-analysis. Heterogeneity and publication bias of included studies were assessed using I2 test statistic and Egger test, respectively. The random-effect model was employed; an outcome is reported using a risk ratio with a 95% confidence interval. RESULTS: Of 28 included studies, 20 showed receiving at least one ANC visit had a significant association with neonatal mortality. Accordingly, the estimated pooled risk ratio for neonatal mortality was 0.59 (95% CI 0.45, 0.77) among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visits. CONCLUSION: This finding indicated that neonatal mortality was decreased among infants born to women who had at least one ANC visit compared to infants born to women who had no ANC visit. Therefore, promoting and strengthening ANC service utilization during pregnancy would accelerate the reduction of neonatal mortality in Ethiopia.

In some studies, providing ANC services reduces the risk of neonatal mortality, in others, the ANC visits did not significantly decrease neonatal mortality in Ethiopia, which represents a dismal picture of neonatal mortality (NM) in sub-Saharan Africa (SSA) region. Therefore, evidence emanated from comprehensive searches of review performed with several studies represented from various regions of the country which determine the effect of ANC on NM is essential to reinforce strategies that could help for newborn survival and wellbeing of neonates in Ethiopia. Hence, this study aimed to systematically examine the effect of ANC on NM by combining a wide range of reviews, to provide concrete evidence for policymakers.

Vitamin A deficiency among pregnant women in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Vitamin A deficiency (VAD) during pregnancy is a public health challenge in low-income countries. There are inconsistent findings that can affect policy in planning appropriate intervention. This systematic review and meta-analysis were conducted to summarize the evidence in order to identify existing gaps and propose strategies to reduce VAD during pregnancy in Ethiopia. METHODS: This study included published and unpublished observational studies searched from different databases (PubMed, CINHAL [EBSCO], Embase, Google Scholar, Directory of Open Access Journals, Web of Sciences, MEDLINE, Cochrane Library, Scopus, Google Search and MedNar). Statistical analysis was conducted using Stata version 14 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled prevalence using the random effects model. RESULTS: A total of 37 618 pregnant women from 15 studies were included. The overall pooled prevalence of VAD was 29% (95% confidence interval 21 to 36) with I2=99.67% and p<0.001. Socio-economic and sociodemographic factors were identified as affecting vitamin A deficiencies among pregnant women. CONCLUSIONS: Nearly one-third of pregnant women in Ethiopia had VAD. Strengthening intervention modalities that aimed to increase the uptake of vitamin A-rich foods can avert VAD among pregnant women in Ethiopia.

Determinants of premature rupture of membrane among pregnant women in Harar town, Eastern Ethiopia: A case-control study.

Introduction: Premature rupture of membrane is a disruption of fetal membrane followed by passage of watery fluid gush before the onset of labor any time beyond 28 weeks of gestation. It is a significant cause of perinatal morbidity and mortality. Many studies were conducted on the pre-labor rupture of membrane, yet limited evidence is available on its determinants. This study aimed to identify determinants of premature rupture of membrane among pregnant women in Harar Town, Eastern Ethiopia. Method: ology; Hospital-based unmatched case control study was conducted on 115 cases and 230 controls from 15th May to 15th July 2021. The study was conducted on two public hospitals in Harar town. All cases admitted at the time of data collection were included until the required sample size was obtained and controls were selected by using simple random sampling among all non -cases. Data were collected using interviewer-guided semi-structured questionnaires. The data were entered into Epi-data version 3.1 and exported to SPSS version 22.0 for analysis. Binary logistic regression was used to identify determinants of the outcome and statistical significance declared at a p-value less than 0.05. Multicollinearity was checked and model fitness was assessed by Hosmer Lemeshow test. Results: Abnormal vaginal discharge [AOR 2.15 (2.53, 22.46), history of cesarean delivery [AOR 2.06 (1.11, 6.78)], history of premature rupture of membrane [AOR 4.62 (2.06, 11.52)] and history of abortion [AOR 2.81 (1.04, 6.23)] increase the odds of the outcome. Conclusion: Bad obstetric histories in the current and previous pregnancies are related to premature rupture of membrane. Therefore, it is recommended that health care providers should take attention to women with past and current pregnancy complications.

Utilization of pharmacological labour analgesia: a survey of obstetric care providers in eastern Ethiopia.

BACKGROUND: Despite a crucial role played by obstetric care providers (OCPs) in providing pain relief methods during labour, the evidence suggests that there is a large number of women in Ethiopia who did not have access to pain relief methods. Moreover, to the best of the investigators' knowledge, evidence is scarce regarding the utilization of pharmacological labour pain management methods in the study area. Thus this study was carried out to determine the practice of pharmacological labour pain management methods among OCPs in Harari regional state health facilities in Ethiopia. METHODS: A facility-based cross-sectional study was conducted from 20 May to 10 June 2021 in Harari regional state health facilities. All (n=464) OCPs in Harari regional state health facilities were included in the study. Data were collected using a structured questionnaire adapted from previous studies. The data were entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out using SPSS for Windows version 22. Bivariate and multivariate logistic regression analyses were employed to determine the association between independent variables and the outcome variable. A p-value <0.05 was used to establish statistical significance. RESULTS: In this study, 464 OCPs participated. The overall utilization of pharmacological labour pain relief methods was 50.9% (95% confidence interval [CI] 45.8 to 55.8). The main barriers to labouring mothers receiving pain relief include high patient flow (54.4%), the limited number of staff (51.9%) and a lack of knowledge and skill (32.9%). Being female (adjusted odds ratio [AOR] 2.07 [95% CI 1.31 to 3.26]), not having training (AOR 1.60 [95% CI 1.02 to 2.53]) and having an unfavourable attitude (AOR 9.1 [95% CI 5.34 to 15.35]) were the predictors of utilization of pharmacological labour pain management methods. CONCLUSIONS: The study revealed that half of the OCPs utilized the pharmacological labour pain management method. In general, this study identified that variables like sex, training and the attitude of OCPs were factors associated with the utilization of pharmacological labour pain management methods. The health facilities should provide training to enhance the skill of OCPs and equip themselves with sufficient analgesic drugs.

Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Obstetric fistula has been a major maternal health challenges in low and middle-income countries, especially in Ethiopia, due to high child marriage and poor access to healthcare. Obstetric fistula is common among teenage mothers that results in a vast social, economic and cultural sequel. In Ethiopia, there is a paucity of research evidence on women's knowledge about obstetric fistula. Therefore, this study aimed to assess women's knowledge about obstetric fistula and its associated factors at Banja District, Northwestern Ethiopia. METHODS: A community-based cross-sectional study design was conducted from 1st -21th July 2021. Systematic sampling method was used to recruit 784 women in the reproductive age from six rural and one urban sub-districts. Two days of training was given to research assistants regarding the objective of the study, inclusion and exclusion criteria, checking completeness and ways of protecting confidentiality. Data were collected using face-to-face interview method. Collected data were entered into EpiData and exported into SPSS version 24 for cleaning and analysis. Descriptive statistics, binary and multivariable logistic regression analysis were performed to identify associated factors. Adjusted odds ratio (AOR) at 95% CI with p < 0.05 was used to declare significant association with women's knowledge of obstetric fistula. RESULTS: A total of 773 women gave a complete response with response rate of 98.6% (773/784). One-third (36.4%; 95%CI: 32.9-39.7%) had good knowledge about obstetric fistula. Women who had completed primary education (AOR:3.47, 95%CI:2.01-5.98), secondary and above (AOR:3.30, 95%CI:1.88-5.80), being a student (AOR: 6.78, 95%CI:3.88-11.86), get counseling about obstetric fistula (AOR:6.22, 95%CI: 3.78-10.24), participated in pregnant women's discussion forum (AOR:3.36, 95%CI: 1.99-5.66), had antenatal care follow-up (AOR: 2.40, 95% CI: 1.39-4.13), being an urban resident (AOR: 3.19, 95% CI: 1.33-7.66), and having access to Television/Radio (AOR:1.68, 95%CI:1.10-2.60) were significantly associated with women's good knowledge about obstetric fistula. CONCLUSION: Women's knowledge about obstetric fistula is unacceptably low. Therefore, concerned stakeholders should enhance awareness creation programs, strengthen antenatal care, counselling and women's discussion forum that could substantially optimize women's knowledge about obstetric fistula and its risk factors of obstetric fistula.

Factors associated with neonatal near miss among neonates admitted to public hospitals in dire Dawa administration, Eastern Ethiopia: A case-control study.

INTRODUCTION: The neonatal near-miss cases are subject to factors that are major causes of early neonatal deaths. For every death, more newborns suffer a life-threatening complication. Nearly 98% of neonatal death unduly existed in developing countries. Though there were few prior studies in other regions, they failed in identifying the factors of NNM. Besides, there has been no prior study in the study area. Therefore, this study aimed to assess factors associated with neonatal near-miss. METHODS: A case-control study was employed on a total of 252 cases and 756 controls using a systematic random sampling technique. Data were collected using pre-tested and interview administered questionnaires adapted from similar studies and medical records from December 2020 -March 2021. Pragmatic and management criteria definition of neonatal near miss were utilized. Epi-Data version 3.1 and SPSS version 23 were used for data entry and analysis respectively. Bivariable and multivariable analyses were done to identify factors associated with a neonatal near-miss by using COR and AOR with a 95% confidence interval. Finally, the statistical significance was declared at a p-value < 0.05. RESULTS: There were a response rate of 100% for both cases, and controls. Factors that affects neonatal near miss were non-governmental/private employee (AOR, 1.72[95%CI: 1.037, 2.859]), referral in (AOR, 1.51[95%CI: 1.079, 2.108]), multiple birth (AOR, 2.50[95%CI: 1.387, 4.501]), instrumental assisted delivery (AOR, 4.11[95%CI: 1.681, 10.034]), hypertensive during pregnancy (AOR, 3.32[95%CI: 1.987, 5.530]), and male neonates (AOR, 1.71[95%CI: 1.230, 2.373]), paternal education of secondary school (AOR, 0.43[95%CI: 0.210, 0.868]) and college/above (AOR, 0.25[95%CI: 0.109, 0.578]), monthly income (1500-3500 birr) (AOR, 0.29[95%CI: 0.105, 0.809]) and >3500 birr (AOR, 0.34[95%CI: 0.124, 0.906]). CONCLUSION: Maternal occupation, paternal education, income, referral, multiple births, mode of delivery, hypertension during pregnancy, and sex of the neonate have identified factors with neonatal near-miss. Better to create job opportunities, improving education, and income generation. Counseling on multiple birth and hypertension, and minimizing instrumental delivery should be done at the health facility level.

Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study.

Objectives: Although neonatal near miss is an emerging concept and a tool for improving neonatal care, its magnitude and associated factors are less researched in Ethiopia. Thus, this study was aimed to uncover the magnitude of neonatal near miss and its associated factors in public hospitals in Eastern Ethiopia. Methods: A facility-based cross-sectional study was employed on a randomly selected 405 mother-neonate pairs. An interview using a structured questionnaire accompanied by review of medical records was used to collect data from the mothers and records of the neonates. Neonatal near miss was defined as having any of the pragmatic (gestational age < 33 weeks, birth weight < 1750 g, and fifth minutes Apgar score < 7) or management criteria. Crude and adjusted logistic regression analysis was done to identify associated factors and presented with adjusted odds ratio with 95% confidence interval. Results: Of 401 mother-neonate pairs included in the study, 126 (31.4%, 95% confidence interval = [26.9, 36.2]) neonates had at least one neonatal near miss event at discharge. Neonatal near miss was more likely among neonates from referred women (adjusted odds ratio = 2.24, 95% confidence interval = [1.25, 4.03]), no antenatal care (adjusted odds ratio = 2.08, 95% confidence interval = [1.10, 3.93]), antepartum hemorrhage (adjusted odds ratio = 4.29, 95% confidence interval = [2.16, 8.53]), premature rupture of membrane (adjusted odds ratio = 4.07, 95% confidence interval = [2.05, 8.07]), obstructed labor (adjusted odds ratio = 2.61, 95% confidence interval = [1.23, 5.52]), non-vertex presentation (adjusted odds ratio = 3.03, 95% confidence interval = [1.54, 5.95]), and primiparous (adjusted odd ratio = 2.67, 95% confidence interval = [1.49, 4.77]). Conclusions: In this study, we found that neonatal near miss is higher than previous findings in Ethiopia. Improving neonatal near miss requires promoting antenatal care, maternal referral system, and early identification and management of obstetric complications.

Prevalence of Group B Streptococcus Recto-Vaginal Colonization, Vertical Transmission, and Antibiotic Susceptibility Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

Background: Maternal Group B Streptococcus (GBS) recto-vaginal colonization is the most common route for early onset neonatal GBS diseases. A good understanding of the rate of maternal GBS colonization, vertical transmission rate, and antibiotic susceptibility profiles is needed to formulate a broad protection mechanism, like vaccine preparation. For that reason, this meta-analysis aimed at determining the pooled prevalence of GBS recto-vaginal colonization, vertical transmission rate, and antibiotic susceptibility profiles in Ethiopia. Methods: Both published and unpublished studies were searched from MEDLINE/PubMed, CINAHL (EBSCO), Embase, Cochrane Library, SCOPUS, Web of Sciences databases, and Google Scholar. Independent selection was then carried out by the authors based on the eligibility criteria and data extraction using Microsoft excel. The authors then used STATA version 14.1 software for further cleaning and analysis. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Using the random-effect model, the prevalence with a 95% confidence interval (CI) and forest plot were used to present the findings. Besides, the studies' heterogeneity was assessed using Cochrane chi-square (I2) statistics, while Egger intercept was used to assess publication bias. Results: This review included nineteen studies. The pooled prevalence of recto-vaginal colonization was 15% (95% CI: 11, 19), while the prevalence of vertical transmission was 51% (95% CI: 45, 58) and highest-level susceptibility to vancomycin was 99% (95% CI: 98, 100). However, the GBS susceptibility to tetracycline was 23% (95% CI: 9, 36). Conclusions: Nearly one out of seven pregnant women in Ethiopia had recto-vaginal colonization of GBS. As a result, half of the pregnancies end with vertical transmission of GBS. Hence, the review emphasizes that policy and programs should consider planning and implementing prophylactic programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287540.

Respectful maternity care among laboring women in public hospitals of Benishangul Gumuz Region, Ethiopia: A mixed cross-sectional study with direct observations.

OBJECTIVES: Promoting respectful maternity care is a fundamental strategy for enhancing facility birth, which significantly reduces maternal and newborn mortality and morbidity. Despite these effects, disrespect and abusive childbirth care remain a challenge in Ethiopia. Therefore, this study aimed to determine the prevalence of respectful maternity care and its associated factors among laboring women in public hospitals of Benishangul Gumuz region, Ethiopia. METHODS: A facility-based cross-sectional study design was employed, and trained external assessors observed the care provided to 404 laboring women in public hospitals using structured observation checklists. A focus group discussion and two key informant interviews were also conducted. A structured pre-tested questionnaire and a semi-structured guide were used to generate quantitative and qualitative data, respectively. Seven verification criteria were employed, and the mean value and above for each criterion were used to measure respectful maternity care. RESULTS: Of the 404 client-provider interaction observations during childbirth, only 12.6% (n = 51) participants received respectful maternity care. Being from an urban area (adjusted odds ratio = 3.34, 95% confidence interval: 1.39, 8.08), giving childbirth at daytime (adjusted odds ratio = 2.59, 95% confidence interval: 1.26, 5.33), receiving the service from compassionate and respectful care trained provider (adjusted odds ratio = 4.54, 95% confidence interval: 1.63, 12.66), giving childbirth at general hospital (adjusted odds ratio = 3.03, 95% confidence interval: 1.39, 6.65) were positively associated with respectful maternity care. Staff workload, shortage of supply and equipment, partiality in providing timely care, yelling and insulting at clients and birth companions were also barriers to respectful maternity care. CONCLUSION: The observed respectful maternity care practices were low in the study area. Therefore, the findings of this study suggest that addressing respectful maternity care would require increased compassionate and respectful care trained providers, and sustained efforts to improve access to basic equipment and supply for maternity care with an emphasis on primary hospitals. Tailored interventions aimed at improving respectful maternity care should also target rural residents and nighttime parturients.

Postabortion Contraceptive Acceptance Rate and Its Determinants among Women Receiving Abortion Service before Discharge from the Health Facilities in Harar, Eastern Ethiopia.

BACKGROUND: Annually, around 121 million unintended pregnancies occur in the world and more than 73 million encountered abortion. Ethiopia is also losing 19.6% of mothers due to unsafe abortion. Despite that postabortion contraceptive service is a climactic entry point for the prevention of unwanted pregnancy and associated deaths, the service magnitude and determinants immediately before discharge are not characterized well in Ethiopia. Hence, this study aimed to assess the magnitude of postabortion contraceptive utilization and associated factors among women receiving abortion care service before being discharged from health facilities in Harar, Eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among 390 women receiving abortion care services. At discharge, data about contraceptive acceptance and related maternal characteristics were collected. A binary logistic regression model was used to assess the association between independent and dependent variables (postabortion contraceptive utilization). Analysis was done with SPSS 22. Statistical significance was considered at P < 0.05. RESULT: The overall prevalence of postabortion contraceptive utilization was 81.5% (95% CI: 77.9, 85.4). Being unmarried (AOR, 0.05; 95% CI (0.02, 0.16)), having no history of previous abortion (AOR, 0.11; 95% CI (0.04, 0.34)), being multigravida (AOR 8.1; 95% CI (2.20, 13.40), lacking desire to have an additional child (AOR, 6.3; 95% CI (2.65, 15.34), and history of family planning use (AOR, 17.20; 95% CI (6.5, 38.60)) were determinants of postabortion contraceptive utilization before being discharged from the health facilities. CONCLUSION: Postabortion contraceptive utilization in Harar health facilities still needs improvement as per the WHO and national recommendations. Therefore, the family planning provision strategies should be convincing and friendly, especially for unmarried mothers, and those who had no history of abortion should be counseled in friendly and systematically convincing schemes for enabling them to take the service before discharge from the health facility.

Prevalence of premature rupture of membrane and its associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Premature rupture of the membrane is a serious public health problem, especially in low- and middle-income countries with significant maternal and perinatal morbidity and mortality. Despite its substantial contributions to feto-maternal complications, the burden of premature rupture of the membrane was not systematically analyzed in Ethiopia. Hence, this review aimed to identify the burden of premature rupture of the membrane and associated factors among pregnant women in Ethiopia. METHODS: PubMed/Medline, Scopus, and African journal online databases and Google Scholar were searched for articles published in the English language. Independent review authors selected and screened studies. Appraisal for methodological quality of studies was conducted using the Joanna Briggs Institute assessment checklist. RevMan 5.3 software was used for meta-analysis. The I 2 statistical significance and Egger's test were used to assess heterogeneity and publication bias, respectively. RESULTS: The pooled prevalence of premature rupture of the membrane among pregnant women in Ethiopia was 9.2% (95% confidence interval = 5.0, 16.4). Factors significantly associated with premature rupture of the membrane were no antenatal care visit (odds ratio = 2.87, confidence interval = 1.34, 6.14), history of premature rupture of the membrane (odds ratio = 4.09, 95% confidence interval = 2.82, 5.91), history of abortion (odds ratio = 3.13, confidence interval = 1.63, 6.01), abnormal vaginal discharge (odds ratio = 6.78, confidence interval = 4.11, 11.16), and urinary tract infection (odds ratio = 3.04, confidence interval = 1.21, 7.63). CONCLUSION: Nearly one in ten pregnancies in Ethiopia encounters premature rupture of the membrane complications. The finding highlights improving antenatal care utilization, thus preventing or treating urinary and reproductive tract infections, and tailored interventions for pregnant women with a history of premature rupture of the membrane or abortion contribute to reduced premature rupture of the membrane.

A Third of Pregnant Women are Affected by Anemia in Eastern Ethiopia: A Facility-Based Study.

BACKGROUND: Although it is a public health problem of pregnant women in low, middle and high-income countries, the highest prevalence rate of anemia is found among pregnant women of low-income countries, particularly in Africa. Therefore, this study has aimed to determine the magnitude of the anemia and its associated factors among pregnant women admitted to labor wards of public hospitals in eastern Ethiopia. METHODS AND MATERIALS: A health facility-based cross-sectional study was conducted among 405 pregnant women admitted to labor wards in four public hospitals of Harar town and Dire Dawa City Administration. A systematic random sampling technique was used to select the study participants. Data were collected through an interview using a structured questionnaire. The hemoglobin level was measured for each study participant. Binary and multivariable logistic regression models were fitted and statistical significance was declared at P<0.05. RESULTS: The magnitude of anemia was 33.1% (95% CI: 28.4%, 37.8%). Being from rural areas (AOR: 3.8; 95% CI: 1.81, 7.94), no antenatal care (ANC) follow-up (AOR: 3.4; 95% CI: 1.34, 8.79), a habit of drinking milk with tea after meals (AOR: 2.8; 95% CI: 1.48, 5.61), taking a meal only 1-2 times per day (AOR: 3.9; 95% CI: 1.69, 8.97), experiencing no blood loss in the current pregnancy (AOR: 0.25; 95% CI: 0.06, 0.96) and a habit of eating leafy vegetables (AOR: 0.12; 95% CI: 0.06, 0.24) were significantly associated with anemia. CONCLUSION: About one in three pregnant women were anemic and anemia was a moderate public health problem in the study settings. Interventions targeting reducing or preventing anemia should focus on pregnant women in rural areas, promoting the benefits of ANC follow-up, reducing the habit of drinking milk with tea after meals, enhancing the consumption of leafy vegetables and increasing meal frequency per day to minimize or prevent anemia and its consequences during pregnancy.

Clients' Satisfaction with Services for Prevention of Mother-to-Child Transmission of HIV in Public Health Facilities in Diredawa City, Eastern Ethiopia.

BACKGROUND: Ethiopia has a very high burden of HIV infection among children, contracted from their mothers, and nearly two-thirds of pregnant women do not receive prevention of mother-to-child transmission (PMTCT) services. Ensuring clients' satisfaction with PMTCT services is one of the bases to scale up service utilization and mitigate MTCT of HIV. However, in Ethiopia, particularly in the study area, evidence related to clients' satisfaction with PMTCT services is scanty. METHODS: A facility-based cross-sectional study was conducted among women attending antenatal care in Diredawa city. Systematic random sampling was used to select 517 study participants. Interviewer-administered structured and pretested questionnaires were used to collect data. Statistical significance was regarded as P≤0.05 with a 95% CI. RESULTS: Client satisfaction with PMTCT services was 82.2% (95% CI 66.4%-94.3). Receiving the service from a hospital (AOR 2.34; 95% CI 1.5, 3.98), no formal education (AOR 2.53, 95% CI 1.52-4.2), primary education (AOR 2.17 95% CI 1.17-4.04), receiving pre- and post-HIV test counseling from the same provider (AOR 4.93, 95% CI 2.98-7.17), gestational age above first trimester (AOR 1.74, 95% CI 1.12-2.71), and waiting time ≤15 minutes (AOR 2.31, 95% CI 1.28-4.16) were positively associated with client satisfaction with PMTCT services. CONCLUSION: Client satisfaction with PMTCT services is relatively high. Receiving the service from a hospital, no formal education or only primary education, gestational age above first trimester, getting pre- and post-HIV test counseling from the same provider, and waiting time ≤15 minutes to receive services were factors associated with client satisfaction. A greater number of skilled PMTCT-service providers would improve service quality and hasten its delivery. Furthermore, providing mentoring and supportive supervision of health centers with PMTCT programs and keeping the same provider in posttest counseling is also mandatory.

Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained: An observational study.

BACKGROUND: Neonatal resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Worldwide, four million neonate deaths happen annually, and birth asphyxia accounts for one million deaths. Improving providers' neonatal resuscitation skills is critical for delivering quality care and for morbidity and mortality reduction. However, retention of these skills has been challenging in developing countries, including Ethiopia. Hence, this study aimed to assess neonatal resuscitation skills retention and associated factors among midwives and nurses in Eastern Ethiopia. METHODS: An institution-based cross-sectional study was conducted using a pre-tested, structured, observational checklist. A total of 427 midwives and nurses were included from 28 public health facilities by cluster sampling and simple random sampling methods. Data were collected on facility type, availability of essential resuscitation equipment, socio-demographic characteristics of participants, current working unit, years of professional experience, whether a nurse or midwife received refresher training, and skills and knowledge related to neonatal resuscitation. Binary logistic regression was used to analyse the association between neonatal resuscitation skill retention and independent variables. RESULTS: About 11.2% of nurses and midwives were found to have retention of neonatal resuscitation skills. Being a midwife (AOR, 7.39 [95% CI: 2.25, 24.24]), ever performing neonatal resuscitation (AOR, 3.33 [95% CI: 1.09, 10.15]), bachelor sciences degree or above (AOR, 4.21 [95% CI: 1.60, 11.00]), and good knowledge of neonatal resuscitation (AOR, 3.31 [95% CI: 1.41, 7.73]) were significantly associated with skill retention of midwives and nurses. CONCLUSION: Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained. This could increase the death of neonates due to asphyxia. Being a midwife, Bachelor Sciences degree or above educational status, ever performing neonatal resuscitation, and good knowledge were associated with skill retention. Providers should be encouraged to upgrade their educational level to build their skill retention and expose themselves to NR. Further, understanding factors affecting how midwives and nurses gain and retain skills using high-level methodology are essential.

Knowledge of Basic Neonatal Resuscitation and Associated Factors Among Midwives and Nurses in Public Health Institutions in Eastern Ethiopia.

BACKGROUND: Neonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It is a single intervention of birth asphyxia. Over 1.2 million African babies are supposed to die in the first four weeks of their life and many of them in the first 24 hours of birth in Sub-Saharan Africa. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. However, there is limited evidence on midwives' and nurses' knowledge of neonatal resuscitation in the study area. Therefore, this study aimed to assess the knowledge of midwives and nurses about neonatal resuscitation and its associated factors. METHODS: This facility-based cross-sectional study was done on 427 midwives and nurses, who were selected using simple random sampling technique. Data were collected on facility type, availability of essential equipment, socio-demographic characteristics, working unit, professional experience, in-service training, and knowledge of neonatal resuscitation. First-degree holder midwives collected the data using a pre-tested face-to-face interviewer-administered questionnaire. Bivariate and multivariate logistic regression was used to analyze the association between the dependent and independent variables. RESULTS: The study showed that 9.8% of the study participants had good knowledge about neonatal resuscitation. Factors significantly associated with knowledge of neonatal resuscitation were being trained on newborn resuscitation (AOR = 3.79, 95% CI: 1.73, 8.32), being unmarried (AOR = 2.36, 95% CI: 1.11, 5.02), holding bachelor sciences degree or above (AOR = 2.67, 95% CI: 1.11, 6.47), and working under West Hararghe health institutions (AOR = 0.30, 95% CI: 0.10, 0.88). CONCLUSION: The study participants had low knowledge of neonatal resuscitation. Being unmarried, holding bachelor sciences degree or above, being trained on neonatal resuscitation, and working under West Hararghe health institutions were factors associated with the knowledge of the study participants on neonatal resuscitation.

Breastfeeding technique and associated factors among breastfeeding mothers in Harar city, Eastern Ethiopia.

BACKGROUND: Ineffective breastfeeding technique is one of the factors contributing to mothers practicing non-exclusive breastfeeding. Inappropriate breastfeeding technique is the leading cause of nipple pain in Ethiopia, as in other countries. However, no studies have examined breastfeeding technique and associated factors in eastern Ethiopia. Therefore, this study was conducted with the aim of assessing breastfeeding technique and associated factors among breastfeeding mothers. METHOD: We conducted an institution based cross-sectional study in selected governmental health facilities of Harar city, Eastern, Ethiopia, from January to February 2017. Systematic random sampling technique was used to select 422 study participants. Data were collected using pretested observational checklist and interviewer administered questionnaires containing sociodemographic, maternal and infant characteristics. The variables, positioning, attachment and suckling, were used to assess the outcome variable of breastfeeding technique. Descriptive, bivariate and multivariate logistic regression analysis was done to identify independent predictors of BFT after controlling for confounding variables. RESULT: The proportion of mothers practicing an effective breastfeeding technique was 43.4% (179/412). Effective breastfeeding technique was 2.3 times more common among mothers with at least secondary school educational status compared to mothers with no formal education (Adjusted Odds Ratio [AOR] 2.3; 95% Confidence Interval [CI] 1.1, 3.9). The practice of effective breastfeeding technique was significantly associated with mothers who had immediate breastfeeding technique counseling after birth (AOR 1.7, 95% CI 1.1, 2.8) and at least two postnatal visits (AOR 5.9; 95% CI 2.1, 15.9) compared to one visit. Absence of breast problems and having previous breastfeeding experience were also associated with the likelihood of effective breastfeeding technique practice (AOR 4.0; 95% CI 1.4, 10.9) and (AOR 3.3; 95% CI 1.1, 10.7) respectively. CONCLUSION: The practice of effective breastfeeding technique was low. Effective breastfeeding technique practice was associated with higher educational status, previous information about breastfeeding technique, previous breastfeeding experience, absence of breast problems, receiving breastfeeding technique counseling immediately after birth and at least two postnatal visits. Therefore; health services should provide education about effective breastfeeding techniques and ensure postnatal care for all women, particularly primipara.