Time to Death and Its Predictors among Neonates Hospitalized with Sepsis in Eastern Ethiopia.

Background: Although neonatal sepsis is a major public health problem contributing to 30-50% of neonatal deaths in low- and middle-income countries, data on predictors of time to death are limited in Eastern Ethiopia. This study is aimed at determining predictors of time to death among neonates with sepsis admitted in public hospitals in Eastern Ethiopia. Methods: An institutional-based retrospective cohort study was conducted among 415 neonates admitted to referral hospitals in Eastern Ethiopia with sepsis from January 1, 2021, to December 31, 2021. Data were collected from medical records by using structured checklist and entered using EpiData 3.1 and analyzed using Stata 17. The Kaplan-Meier curves and log-rank tests were used to describe survival experience among different categories. The proportional hazard assumption and goodness of fit for the Cox regression model were checked. The Cox regression model was used to identify the significant predictors. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated. Finally, statistical significance was set at a p value < 0.05 in the Cox regression analysis. Results: Of the 415 neonates with neonatal sepsis, 71 (17.1%) (95% CI: 13.60-21.08) died at discharge, with a median time to death of 14 days. The overall incidence rate of mortality was 36.5 per 1000 neonate days. Low birthweight (AHR = 2.50; 95% CI: 1.15-5.44), maternal age ≥ 35 years (AHR = 3.17; 95% CI: 1.11, 9.04), low fifth-minute Apgar score (AHR: 2.32; 95% CI: 1.30-4.14), and late initiation of breastfeeding (AHR = 4.82; 95% CI: 1.40-16.65) were independent predictors of mortality among neonates with sepsis. Conclusions: Almost one in five neonates with sepsis died at discharge. Low birthweight, maternal age ≥ 35 years, low fifth-minute Apgar score, and late initiation of breastfeeding were predictors of mortality.

Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study.

BACKGROUND: Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia. METHODS: Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding and merging. The data were thematically synthesized. RESULTS: The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre-referral communication and feedback, using informal communication, incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number of health professions. CONCLUSIONS: The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral are essential to improve maternal referral system.

Approaches to improve and adapt maternal mortality estimations in low- and middle-income countries: A scoping review.

BACKGROUND: In the absence of robust vital registration systems, many low- and middle-income countries (LMICs) rely on national surveys or routine surveillance systems to estimate the maternal mortality ratio (MMR). Although the importance of MMR estimates in ending preventable maternal deaths is acknowledged, there is limited research on how different approaches are used and adapted, and how these adaptations function. OBJECTIVES: To assess methods for estimating maternal mortality in LMICs and the rationale for these modifications. SEARCH STRATEGY: A literature search with the terms "maternal death", "surveys" and "low- and middle-income countries" was performed in Medline, Embase, Web of Science, Scopus, CINAHL, APA PsycINFO, ERIC, and IBSS from January 2013 to March 17, 2023. SELECTION CRITERIA: Studies were eligible if their main focus was to compare, adapt, or assess methods to estimate maternal mortality in LMICs. DATA COLLECTION AND ANALYSIS: Titles and abstracts were screened using Rayyan. Relevant articles were independently reviewed by two reviewers against inclusion criteria. Data were extracted on mortality measurement methods, their context, and results. MAIN RESULTS: Nineteen studies were included, focusing on data completeness, subnational estimates, and community involvement. Routinely generated MMR estimates are more complete when multiple data sources are triangulated, including data from public and private health facilities, the community, and local authorities (e.g. vital registration, police reports). For subnational estimates, existing (e.g. the sisterhood method and reproductive-age mortality surveys [RAMOS]) and adapted methods (e.g. RAMOS 4 + 2 and Pictorial Sisterhood Method) provided reliable confidence intervals. Community engagement in data collection increased community awareness of maternal deaths, provided local ownership, and was expected to reduce implementation costs. However, most studies did not include a cost-effectiveness analysis. CONCLUSION: Household surveys with community involvement and RAMOS can be used to increase data validity, improve local awareness of maternal mortality estimates, and reduce costs in LMICs.

Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low- and middle-income countries: A systematic review of qualitative studies.

BACKGROUND: Maternal and Perinatal Death Surveillance and Review (MPDSR) can reduce mortality but its implementation is often suboptimal, especially in low- and middle-income countries (LMICs). OBJECTIVES: To understand the determinants of behaviors influencing implementation of MPDSR in LMICs (through a systematic review of qualitative studies), in order to plan an intervention to improve its implementation. SEARCH STRATEGY: Terms for maternal or perinatal death reviews and qualitative studies. SELECTION CRITERIA: Qualitative studies regarding implementation of MPDSR in LMICs. DATA COLLECTION AND ANALYSIS: We coded the included studies using the Theoretical Domains Framework and COM-B model of behavior change (Capability, Opportunity, Motivation). We developed guiding principles for interventions to improve implementation of MPDSR. MAIN RESULTS: Fifty-nine studies met our inclusion criteria. Capabilities required to conduct MPDSR (knowledge and technical/leadership skills) increase cumulatively from community to health facility and leadership levels. Physical and social opportunities depend on adequate data, human and financial resources, and a blame-free environment. All stakeholders were motivated to avoid negative consequences (blame, litigation, disciplinary action). CONCLUSIONS: Implementation of MPDSR could be improved by (1) introducing structural changes to reduce negative consequences, (2) strengthening data collection tools and information systems, (3) mobilizing adequate resources, and (4) building capabilities of all stakeholders.

Characteristics and outcomes of pregnant women hospitalized with severe maternal outcomes in eastern Ethiopia: Results from the Ethiopian Obstetric Surveillance System study.

OBJECTIVE: The aim of the present study was to identify facility-based incidence of severe obstetric complications through a newly established obstetric surveillance system in eastern Ethiopia. METHODS: Monthly registration of obstetric hemorrhage, eclampsia, uterine rupture, severe anemia and sepsis was introduced in 13 maternity units in eastern Ethiopia. At each hospital, a designated clinician reported details of women admitted during pregnancy, childbirth or within 42 days of termination of pregnancy from April 01, 2021 to March 31, 2022 developing any of these conditions. Detailed data on sociodemographic characteristics, obstetric complications and status at discharge were collected by trained research assistants. RESULTS: Among 38 782 maternities during the study period, 2043 (5.3%) women had any of the five conditions. Seventy women died, representing a case fatality rate of 3.4%. The three leading reasons for admission were obstetric hemorrhage (972; 47.6%), severe anemia (727; 35.6%), and eclampsia (438; 21.4%). The majority of the maternal deaths were from obstetric hemorrhage (27/70; 38.6%) followed by eclampsia (17/70; 24.3%). CONCLUSION: Obstetric hemorrhage, severe anemia and eclampsia were the leading causes of severe obstetric complications in eastern Ethiopia. Almost one in 29 women admitted with obstetric complications died. Audit of quality of care is indicated to design tailored interventions to improve maternal survival and obstetric complications.

The prevalence of infertility and factors associated with infertility in Ethiopia: Analysis of Ethiopian Demographic and Health Survey (EDHS).

BACKGROUND: Despite having a high fertility rate, low-resource countries are also home to couples with infertility problems. Although many couples are suffering from the psychological impacts of infertility, its level and determinants are not adequately known. The main objective of this study is to assess the prevalence and factors associated with infertility among couples in Ethiopia using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. METHOD: The study employed a cross-sectional study design extracting variables from the 2016 EDHS. The study included all married or cohabitating women aged 15 to 49 years in the Couples Recode (CR) file data set. Weighted samples of 6141 respondents were analyzed. We used Stata 14 software for analyzing the data. The association of selected independent variables with primary, secondary, and total infertility was analyzed using a logistic regression model. We presented the results using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) and a p-value <0.05 as a cut-off point for declaring statistical significance. RESULTS: The prevalence of infertility in the past 12 months was 24.2% (95% CI: 23.1-25.3%), of which the majority (90.7%) was secondary infertility. Greater than 35 years of age (AOR = 2.45, 95% CI (1.58-3.79)), rural residence (AOR = 1.06, 95% CI (1.01-1.39)), smoking (AOR = 2.29, 95% CI (1.39-3.77)), and <18.5 Body Mass Index (BMI) (AOR = 1.71, 95% CI (1.43-2.04)) were significantly associated with infertility. Conversely, infertility was less likely among women with formal education and better wealth index. Primary infertility was significantly higher among women whose partners drink alcohol (AOR = 1.55; 95% CI 1.06-2.28)) and chew khat (AOR = 1.62; 95% CI (1.12-2.36)). Secondary infertility was significantly higher among women with <18.5 BMI (AOR = 1.59, 95% CI (1.37-1.84)), >30 BMI (AOR = 1.54; 95% CI 1.01-2.35)), and <15 years of age at first birth (AOR = 1.40; 95% CI 1.15-1.69)). CONCLUSION: More than one in five couples in Ethiopia has an infertility problem. Both male and female-related factors are associated with infertility. Primary infertility was significantly higher among women whose partner chews khat and drinks alcohol. Secondary infertility was significantly associated with being underweight, obese, smoking, and young age at first birth. Hence, taking action on preventable factors is the most critical treatment approach and will improve the health status of the couples in other ways.

Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study.

BACKGROUND: Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. METHODS: A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. RESULT: Of 510 neonates enrolled, 130(25.5%; 95% CI: 22-29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2-56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4-12.65), primipara (AHR: 2.3; 95% CI: 1.16-4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94-6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28-0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36-19.9) were predictors of preterm neonatal death. CONCLUSION: Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.

Effectiveness of Lactational Amenorrhea Method in Ethiopia: A Multi-Center Prospective Cohort Study.

Background: Although the lactational amenorrhea method (LAM) is one of the most commonly used contraception methods during the first six months of a woman's postpartum period, there has been little research on its effectiveness in general and particularly in Ethiopia. The purpose of this study was to evaluate the effectiveness of LAM and the experiences of Ethiopian women who used it. Methods: This was a multi-center prospective cohort study of postpartum women from five Ethiopian regions and one city administration. All pregnant women who gave birth in these randomly selected hospitals and five health centers directly referring to the hospitals were invited to the study if they selected LAM and were followed monthly at home. Each month, trained researchers visited the woman at her home and collected information about breast feeding, the return of menses, the resumption of sex, the use of another contraceptive, and a pregnancy test using urine human chorionic gonadotropin (hCG). Women who reported starting new contraceptive methods, resumption of menses, starting complementary feeding, neonatal death, getting pregnant, or refusing were excluded from the cohort. The data were collected using ODK Collect and exported to Stata 14 for analysis. Results: Among the 2162 women who selected LAM as a contraceptive, 2022 were enrolled in the cohort study, and 901 completed the follow-up. At the end of the sixth month, eight women got pregnant, corresponding to an effectiveness of 99.1%. More than half of the cohort were excluded from the follow-up for reasons of transitioning to other types of contraception, resumption of menses, or refusal to follow-up. Conclusion: The effectiveness of LAM is high and should be recommended for postpartum women, with proper counseling provided. A study should be conducted to examine the effectiveness of breast feeding as a contraceptive beyond the Bellagio consensus.

Knowledge of lactation amenorrhea method among postpartum women in Ethiopia: a facility-based cross-sectional study.

While the importance of knowledge about contraceptives in improving their utilization and thereby reducing the risk of unintended pregnancies is well documented, there are limited studies documented about the Lactational Amenorrhea Method (LAM). Thus, understanding the knowledge of postpartum mothers about LAM is essential for designing tailored interventions. This study assessed the level of knowledge about LAM and its associated factors among postpartum mothers in Ethiopia. A facility-based cross-sectional study was conducted among 3148 randomly selected postpartum participants. The study utilized multistage sampling approach in hospitals located across five regions and one city administration in Ethiopia. Data were collected using face-to-face interviews at discharge. A participant was categorized as having knowledge of LAM if she correctly answered the three LAM criteria: amenorrhea, the first 6 months, and exclusive breast feeding. A binary logistic regression model was used to identify factors associated with knowledge of LAM. Variables with p < 0.25 in the binary logistic regression were included in the multiple logistic regression. Then, associations were described using the adjusted odds ratio (AOR) along with the 95% confidence interval (CI), and statistical significance was declared at p < 0.05. Only four in 10 participants (40.6%; 95% CI 38.9-42.3) had knowledge of LAM. Participants who attended college or above educational level (AOR = 2.1, 95% CI 1.5-2.8), those with parity of two (AOR = 2.3; 95% CI 1.6-3.6) or more than two (AOR = 2.4; 95% CI 1.5-4.0), those who expressed a desire for further fertility (AOR = 1.3; 95% CI 1.1-1.5), individuals who received counselling on LAM (AOR = 3.0; 95% CI 2.6-3.7), and those who gave birth in hospital (AOR = 2.6; 95% CI 1.4-2.6) had higher odds of knowledge about LAM, compared to their counter parts. In contrary, participants resided far away from health facilities had 30% lower odd of knowledge about LAM compared to those resided near the health facilities (AOR = 0.70; 95% CI 0.6-0.8). The proportion of participants who had knowledge of LAM was low. Strengthening counseling about LAM during antenatal care and delivery with due attention to women with limited access to health facilities should be considered for increasing their level of knowledge on LAM.

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study.

Background: Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government's claim of providing free maternal health-care services. Methods: A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association. Results: The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (ß=1.13; 95% CI: 1.00, 1.26), distance from hospital (ß=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (ß=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (ß=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (ß=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (ß=0.86; 95% CI = 0.77-0.97). Conclusion: Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

Co-occurrence of iron, folate, and vitamin A deficiency among pregnant women in eastern Ethiopia: a community-based study.

BACKGROUND: It is well known that the magnitude of undernutrition in Ethiopia is unacceptably high. The burden of co-occurrence of iron, folate, and vitamin A deficiency, on the other hand, has received less attention. Thus, in this study, we looked at the prevalence of iron, folate, and vitamin A deficiency in pregnant women in eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 397 pregnant women in Haramaya district, eastern Ethiopia. An interview-assisted questionnaire and blood serum were collected from pregnant women using standard techniques and shipped to an EPHI for micronutrient analysis. Factors associated with the co-occurrence of iron, folate, and vitamin A deficiency were identified using binary and multiple logistic regressions. RESULTS: According to this study, 81.6% of the participants were deficient in at least one micronutrient, and 53.53.2% were deficient in two or more. Women who did not receive iron-folic acid supplementation (AOR = 2.44; 95% CI = 1.52-3.92), did not attend Antenatal care (ANC) follow up (AOR = 2.88; 95% CI = 1.81-4.61), and reported low consumption of diversified diet (AOR = 2.18 (95% CI = 1.35-3.51) had a higher risk of co-occurrence of iron, folate, and vitamin A deficiency. CONCLUSION: This study found that more than half of pregnant women were in multiple micronutrients, indicating a major public health issue. In addition to the IFA supplementation programs that are already in place, there is a need for multiple micronutrient supplementation.

The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis.

INTRODUCTION: Nine in ten of the world's 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa. METHODS: A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used. RESULTS: This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further. CONCLUSIONS: Our meta-analysis and systematic review revealed that knowledge of one's HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.

Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study.

BACKGROUND: Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. METHODS: We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. RESULTS: Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. CONCLUSIONS: In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.

Factors associated with undernutrition among pregnant women in Haramaya district, Eastern Ethiopia: A community-based study.

INTRODUCTION: Although undernutrition in pregnancy has continued to get global attention as pregnancy is considered a critical period in the life cycle owed to increase the metabolic and physiological demands, evidence is scarce on undernutrition and associated factors among pregnant women in eastern Ethiopia. Therefore, this study assessed the undernutrition and associated factors among pregnant women in Haramaya district, Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. Data were collected through face-to-face interviews, anthropometric measurement, and hemoglobin analysis by trained research assistants. An adjusted Prevalence ratio (aPR), and a 95% confidence interval (CI), were used to report associations. Poisson regression analysis model with a robust variance estimate identified variables associated with undernutrition. Data were double entered using Epi-data 3.1 and cleaned, coded, checked for missing and outliers, and analyzed using Stata 14 (College Station, Texas 77845 USA. Finally, the p-value <0.05 was the cut-off point for the significant association. RESULTS: A total of 448 pregnant women with a mean age of 25.68 (± 5.16) were included in the study. The prevalence of undernutrition among pregnant women was 47.9% (95% CI: 43%-53%). From the analysis, the undernutrition was more likely higher among respondents who had five or more family members (APR = 1.19; 95% CI = 1.02-1.40), lower dietary diversity (APR = 1.58; 95% CI = 1.13-2.21) and those who were anemic (APR = 4.27; 95% CI = 3.17-5.76). CONCLUSION: Nearly half of the pregnant women in study area were undernourished. High prevalence was found among women who had large family sizes, low dietary diversity and anemia during pregnancy. Improving dietary diversity, strengthening family planning services and giving special attention to pregnant women, supplementation of iron and folic acid, and early detection and treatment of anemia is essential to improve the high burden of undernutrition and the adverse effect on pregnant women and the fetus.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study.

INTRODUCTION: Fear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System-an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression. RESULTS: Of a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81). CONCLUSION: A quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Food taboos among pregnant women and associated factors in eastern Ethiopia: A community-based cross-sectional study.

Objective: The main aim of this study was to assess food taboos and associated factors among pregnant women in eastern Ethiopia. Methods: A community-based cross-sectional study was conducted among randomly selected 422 pregnant women at Haramaya Demographic Surveillance System from Haramaya District, eastern Ethiopia. Data on sociodemographic conditions, the presence of food taboos, and perceived reasons were collected using the face-to-face interview method by trained data collectors through arranged home visits. Collected data were entered into EpiData 3.1 and exported to statistical package for social sciences version 23 for cleaning and analysis. Descriptive, binary, and multiple logistic regression analyses were carried out to determine the relationship between explanatory and outcome variables. Adjusted odds ratio (AOR) with 95% confidence interval (CI) at p value less than 0.05 was used to declare significant association. Results: Approximately half (48%, 95% CI: 43%, 52%) of the pregnant women reported the presence of pregnancy-related food taboos. Pregnant women who have heard about food taboos (AOR: 3.58; 95% CI: 1.89, 6.83), pregnant women had friends who avoided food (AOR: 1.91; 95% CI: 1.22, 2.99), women's monthly income ⩽840 ETB (AOR: 1.73; 95% CI: 1.10, 2.73), and pregnant women who had not attended formal education (AOR: 1.95; 95% CI: 1.18, 3.23) were more likely to report food taboos. The odds of pregnant women who had attended uptake of immunization services were less likely to have food taboos (AOR: 0.35; 95% CI: 0.21, 0.58). Conclusion: Pregnancy-related food taboos among pregnant women are unacceptably high. Therefore, awareness creation and nutritional counseling at health service delivery points are imperative actions for pregnant women to avoid food taboos norms. Further research should be done to understand the social and cultural ground of food taboos during pregnancy.

Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia: A cross-sectional study design.

Objective: This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul's Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients' medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value <0.05 was considered to declare an association between chronic kidney disease and independent variables. Results: Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m2, respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease. Conclusion: Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced.

Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study.

BACKGROUND: Although the high burden of anemia among pregnant women in low-resource settings like Ethiopia is well documented, evidence is scarce on the underlying causes using biochemical tests. Therefore, this study assessed the iron status and factors associated with iron deficiency (ID) using serum ferritin concentration among pregnant women in Haramaya district, eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. The serum ferritin (SF) concentration was measured in the National Biochemical Laboratory of Ethiopia on a fully automated Cobas e411 (German, Japan Cobas 4000 analyzer series) immunoassay analyzer using the electro-chemiluminescence (ECL) method and standard procedures. A log-binomial regression analysis identified variables associated with iron deficiency, and defined as serum ferritin concentration < 15 µg/L (per the World Health Organization recommendation in developing countries). An adjusted risk ratio (aRR), and a 95% confidence interval (CI), were used to report associations. Finally, the p-value < 0.05 was the cut-off point for the significant association. RESULTS: A total of 446 pregnant women with a mean age of 24.78 (+ 5.20) were included in the study. A total of 236 (52.91%; 95% CI: 48.16-57.63) had iron deficiency. The overall prevalence of anemia and iron deficiency anemia (IDA) was 45.96% (95% CI: 41.32-50.71) and 28.03% (95% CI: 21.27-32.44), respectively. The risk of iron deficiency was more likely among women with low dietary diversity (aRR = 1.36; 95% CI = 1.07-1.72) and those who skipped meals (aRR = 1.29; 95% CI = 1.05-1.57), but less among women who had antenatal care (aRR = 0.73 (95% CI = 0.61-0.88). CONCLUSION: More than half of the pregnant women in eastern Ethiopia had iron deficiency. Improving dietary diversity, meal frequency, and prenatal follow-up is essential to improve the high burden of ID and the adverse effect on pregnant women and the fetus. Moreover, a prospective study comparing maternal and perinatal outcomes among these spectra-iron depletion, ID, and IDA-is crucial for understanding their impact on maternal and perinatal mortality and morbidity.