Multilevel analysis of individual and community level factors associated with institutional delivery in Ethiopia.

BACKGROUND: Improving maternal health is one of the eight millennium development goals to reduce maternal mortality (MM) by three quarters between 1990 and 2015. Institutional delivery is considered to be the most critical intervention in reducing MM and ensuring safe motherhood. However, the level of maternal morbidity and mortality in Ethiopia are among the highest in the world and the proportion of births occurring at health facilities is very low. This study examined the individual and community level factors associated with institutional delivery in Ethiopia. METHODS: Data from the 2011 Ethiopian demographic and health survey were used to identify individual and community level factors associated with institutional delivery among women who had a live birth during the 5 years preceding the survey. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 7757 women nested with in 595 communities. RESULTS: At the individual level; higher educational level of the women (AOR = 3.60; 95% CI 2.491-5.214), women from richest households (AOR = 1.74; 95% CI 1.143-2.648) and increased ante natal care attendance (AOR = 4.43; 95% CI 3.405-5.751) were associated with institutional delivery. Additionally, at the community level; urban residence (AOR = 4.74; 95% CI 3.196-7.039), residing in communities with high proportion of educated women (AOR = 1.71; 95% CI 1.256-2.319) and residing in communities with high ANC utilization rate (AOR = 1.55; 95% CI 1.132-2.127) had a significant effect on institutional delivery. Also region and distance to health facility showed significant association with institutional delivery. The random effects showed that the variation in institutional delivery service utilization between communities was statistically significant. CONCLUSION: Both individual and community level factors are associated with institutional delivery service uptake. As a result, further research is needed to better understand why these factors may affect institutional delivery.

Update on bacterial nosocomial infections.

With increasing use of antimicrobial agents and advance in lifesaving medical practices which expose the patients for invasive procedures, are associated with the ever increasing of nosocomial infections. Despite an effort in hospital infection control measures, health care associated infections are associated with significant morbidity and mortality adding additional health care expenditure which may leads to an economic crisis. The problem is further complicated with the emergence of difficult to treat multidrug resistant (MDR) microorganism in the hospital environment. Virtually every pathogen has the potential to cause infection in hospitalized patients but only limited number of both gram positive and gram negative bacteria are responsible for the majority of nosocomial infection. Among them Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Enterococci takes the leading. Many intrinsic and extrinsic factors predispose hospitalized patients for these pathogens. Following simple hospital hygienic practices and strictly following standard medical procedures greatly reduces infection to a significant level although not all nosocomial infections are avoidable. The clinical spectrum caused by nosocomial pathogens depend on body site of infection, the involving pathogen and the patient's underlying condition. Structural and non structural virulence factors associated with the bacteria are responsible for the observed clinical manifestation. Bacteria isolation and characterization from appropriate clinical materials with antimicrobial susceptibility testing is the standard of laboratory diagnosis.

Prevalence and predictors of traditional medicine utilization among persons living with AIDS (PLWA) on antiretroviral (ARV) and prophylaxis treatment in both rural and urban areas in South Africa.

Previous studies have reported that majority of antiretroviral (ARV) treatment-naïve patients use traditional medicine (TM). Given that TM use is ubiquitous in South Africa especially for chronic conditions, there is a potential for ARV non-adherence and serious drug interactions among patients with HIV/AIDs who use TM. The motivating factors for TM use in HIV/AIDS patients on ARV and prophylaxis treatment have not been well defined in South Africa. This study aimed to investigate the prevalence, facilitators, predictors, and types of TM used among persons living with HIV/AIDS on antiretroviral treatment. The study was a cross-sectional survey which involved 100 participants enrolled at ARV clinics in two South African provinces. Univariate and bivariate analyses were performed to assess the relationships between variables and potential predictors of TM. Sixteen percent of participants on ARV reported TM use. Seventy-nine percent used TM prior to a diagnosis of HIV. Participants were more likely to use TM if they were from a rural province, female, older, unmarried, employed, had limited education, or were HIV-positive for less than five years. TM users reported utilizing herbal or medicinal mixtures that were claimed to heal all conditions. This study provides insights into the treatment modalities selected by patients with HIV/AIDS in South Africa who are receiving ARV. This study revealed that less than 20% of participants co-used TM and ARV. However, close to 80% of participants utilize TM before contracting HIV, which is in keeping with approximate estimates by the WHO.

Status of bovine tuberculosis in Addis Ababa dairy farms.

The study was conducted to determine the status of bovine tuberculosis in Addis Ababa, Ethiopia, by a comparative intradermal tuberculin test of 1,869 animals in 106 farms. Epidemiological information was also collected, taking into account factors chosen for their epidemiological significance and local livestock husbandry characteristics. In addition, milk samples were collected from tuberculin reactors for mycobacterial isolation and characterisation. Chi-square statistic, simple regression and multiple stepwise logistic regression were used to analyse the data. Of the 106 farms examined, 46 (95% confidence interval [CI]: 33.8% to 53.4%) contained comparative skin test reactors. Of the 1,869 animals, 443 (95% CI: 21.8% to 25.7%) were comparative skin test reactors. Furthermore, about 8.5% of tuberculin sensitive cows (12 of a sample of 141) secreted acid-fast bacteria in their milk. The microbes are described in more detail in the paper. Factors identified as possibly increasing the risk of bovine tuberculosis in Addis Ababa were herd size (large herd), farming (housing) condition (poor), and age (older animals). Similarly, as body condition scores improved from poor to medium and then to good, the likelihood of positive results significantly decreased (OR = 0.54; p < 0.01). Other factors including breed, sex, and physiological status of animals did not seem to significantly contribute to tuberculin sensitivity. The finding that large-size and intensively (often poorly) managed herds were at greater risk of bovine tuberculosis suggests that the significance of bovine tuberculosis is increasing in Addis Ababa parallel to an increasing dairy operation. If measures are not taken promptly, the impact on the economy and public health could be enormous.