A randomized controlled trial of sequential vs simultaneous use of Foley balloon catheter and oxytocin for induction of labor in nulliparous pregnant women.

BACKGROUND: Although recent evidence suggests the simultaneous approach use of oxytocin for induction of labor in nullipara, there is limited data from low-income settings that support this. OBJECTIVE: This study aimed to determine whether induction of labor with simultaneous use of oxytocin and a Foley balloon catheter decreases the induction of labor to delivery interval in nulliparous women, compared with sequential use of a Foley balloon catheter followed by oxytocin. STUDY DESIGN: This was a randomized controlled trial of nulliparous women with singleton pregnancies presenting for induction of labor at >28 weeks of gestation at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia). The participants were randomly assigned to either the simultaneous group (the use of oxytocin and a Foley balloon catheter for induction of labor) or the sequential group (overnight intracervical Foley balloon catheter placement followed by the use of oxytocin the next morning). The primary outcome was induction of labor to delivery interval. Comparisons between the groups were made using the Student t test or Wilcoxon rank-sum test and chi-square test on Stata (version 15; StataCorp LLC, College Station, TX). This study is registered with the Pan African Clinical Trials Registry (identifier: PACTR201709002509200). RESULTS: From November 2019 to March 2020, a total of 140 women were randomly assigned to the simultaneous group (70 women) or the sequential group (70 women). The median oxytocin initiation to delivery intervals were 6.09 hours (range, 4.03-10.7) in the sequential group and 8.1 hours (range, 4.7-11.6) in the simultaneous group (P=.46). The mean Foley balloon catheter insertion to delivery intervals were 16.09±5.7 hours in the sequential group and 8.06±4.2 hours in the simultaneous group (P<.001). Cesarean delivery rate, composite neonatal outcomes, and chorioamnionitis were not different between the 2 groups. CONCLUSION: In nulliparous pregnant women, induction of labor using the simultaneous approach did not shorten the oxytocin initiation to delivery interval compared with the sequential approach. Moreover, both approaches showed no difference in the rates of adverse maternal and neonatal outcomes.

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia.

Background: Postpartum Family Planning (PPFP), which aims to prevent high risk unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. This study aimed to assess the combined effect of a package of interventions on the use and quality of PPFP services at Y12HMC, Addis Ababa Ethiopia. Method: Cross-sectional study design was conducted to evaluate the effect of the package of chosen interventions: creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and Long Acting Contraceptive Methods (LACM). Interviews were conducted with 470 women (235 before and 235 after the intervention). Frequency tables and graphs were used to describe the study variables and statistical significance between pre and post intervention indicators was declared at P value <.05. Results: From 470 participants, 421 respondents participated which makes response rate of 90%. The majority of the participants were in the age category 20 to 29 years, married/lived together, completed at least primary education and had more than one child both at baseline and post intervention. The proportion of women who chose PPFP increased from 55.8% at baseline to 69% after the intervention. The most preferred contraceptive method was implant. The overall service satisfaction level of the study participants was 95.4% post intervention, significantly higher than at baseline (78%, P < .05). Providers indicated that clients are satisfied with the service and that the institutional structure is appropriate for delivering integrated services following the intervention. Conclusion: This study demonstrated that quality improvement interventions like creating a private counseling space and providing training using WHO decision tool kit can achieve significant improvement on satisfaction of clients and PPFP uptake.

Preference of homebirth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia.

BACKGROUND: Home birth preference is the need of pregnant women to give birth at their home with the help of traditional (unskilled) birth attendants. Homebirth with unskilled birth attendants during childbirth is the main leading indicator for maternal and newborn death. In Ethiopia, numbers of women prefer homebirth which is assisted by unskilled personal. However, there is no information regarding the problem in the Arba Minch zuria woreda. Therefore, it is important to identify prevalence of preference of homebirth and associated factors. OBJECTIVES: This study aimed to assess the preference of home birth and associated factors among pregnant women in Arba Minch health and demographic surveillance site. METHOD AND MATERIALS: A community-based cross-sectional study was conducted among pregnant women in Arba Minch health and demographic surveillance site, from May 1 to June 1, 2021. Using simple random sampling technique, 416 study samples were selected. Data were collected by interviewer-administered questionnaire. Data were coded and entered into Epi-Data version 4.4.2.1 computer software and exported to Statistical Package for Social Sciences software version 25 for analysis. Bi-variable binary logistic regression for the selection of potential candidate variables at p-value < 0.25 for multivariable analysis and multivariable binary logistic regression to identify the association between homebirth preference and independent variables were carried out. The level of statistical significance was declared at a p-value < 0.05. RESULT: In this study, in Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24% [95%CI: (19.9%-28.2%)] The factors significantly associated with the preference of home birth were husband involvement in decision making [AOR: 0.14 (0.05-0.38)], no access of road for transportation [AOR: 2.4 (1.2-5.18)], not heard about the benefit of institutional birth [AOR: 5.3 (2.3-12.2)], poor knowledge about danger signs [AOR: 3 (1.16-7.6)], negative attitude toward services [AOR: 3.1 (1.19-8.02)], and high fear to give birth at institution [AOR: 5.12 (2.4-10.91)]. CONCLUSIONS: In Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24%. Husband involvement in decision making, no access of road for transportation, not heard about the benefit of institutional birth, poor knowledge about danger signs, negative attitude toward services, and high fear to give birth at health institutions were factors significantly associated with the preference of home birth.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) IgG-antibody seroprevalence among quarantined population, during the first wave of COVID-19 pandemic, In North West Ethiopia (from 30 April to 30 May 2020).

OBJECTIVE: The spread of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths as compared with other regions of the Sub-Saharan African (SSA) countries. We aimed to investigate the seroprevalence of SARS-CoV-2 specific IgG antibodies, using the Abbott anti-nucleocapsid IgG chemiluminescent microparticle immunoassay, in two COVID-19 diagnosed and treatment centers of quarantined population during the first wave of the COVID-19 pandemic (since 30 April-30 May 2020). METHODS: We analyzed data of 446 quarantined individuals during the first wave of COVID-19 pandemic. The data were collected using both interviewed and blood sample collection. Participants asked about demographic characteristics, COVID-19 infection symptoms, and its practice of preventive measures. Seroprevalence was determined using the severe acute respiratory syndrome coronavirus 2 IgG test. RESULTS: The mean (± standard deviation) age of the respondent was 37.5 (±18.5) years. The estimated SARS-CoV-2 infection seroprevalence was found 4.7% (95% confidence interval: 3.1-6.2) with no significant difference on age and gender of participants. Severe acute respiratory syndrome coronavirus 2 antibody seroprevalence was significantly associated with individuals who have been worked by moving from home to work area (adjusted odds ratio = 7.8, 95% confidence interval: 4.2-14.3, p < 0.019), not wearing masks (adjusted odds ratio = 2.4, 95% confidence interval: 1.9-3.8, p < 0.02), and baseline comorbidity (adjusted odds ratio = 6.3, 95% confidence interval: 2.3-17.1, p < 0.01) as compared to their counter groups, respectively. CONCLUSION: Our study concluded that lower coronavirus disease 2019 seroprevalence, yet the large population in the community to be infected and insignificant proportion of seroprevalence, was observed between age and sex of respondents. Protective measures like contact tracing, face covering, and social distancing are therefore vital to demote the risk of community-strengthening factors should be continued as effect modification of anticipation for severe course of coronavirus disease 2019.

Time to Develop and Predictors for Incidence of Tuberculosis among Children Receiving Antiretroviral Therapy.

Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 (IQR = ±19) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) (AHR = 2.5; 95% CI, 1.4-4.7, P < 0.021), being severely stunted (AHR = 2.9: 95% CI, 1.2-7.8, P < 0.03), and having low hemoglobin level (AHR = 4.0; 95% CI, 2.1-8.1, P < 0.001) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.

Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021.

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005. Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89-6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84-4.74, P < 0.022), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04-7.03, P < 0.048), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97-9.97, P < 0.001), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12-3.74, P < 0.022), and CD4 count ≤100 cells/µl (AHR = 3.96, 95% CI: 1.52-10.34, P < 0.005) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.

Exploring the variability of soil nutrient outflows as influenced by land use and management practices in contrasting agro-ecological environments.

Improving our understanding of how different land uses and management practices affect soil nutrient outflows in sub-Saharan Africa could aid in developing sustainable practices. The objective of this study was to analyse the variation in outflows of soil total nitrogen (TN) and available phosphorus (Pav) as influenced by land use types (cropland, grazing land, and bushland) and land management practices (soil bunds for cropland and exclosures for non-croplands) in the three contrasting agro-ecological zones of the Upper Blue Nile basin, Ethiopia. Field data were collected for TN and Pav outflows by water erosion (Eo), leaching (Lo), product harvest (Ho), and gaseous emissions (Go) from 18 runoff plots (30 m × 6 m) for two years (2018-2019). TN and Pav losses significantly varied (p < 0.05, p < 0.01) among agro-ecological zones, land use types, and management practices. Losses of TN ranged from 39.6 to 55.5 kg ha-1 yr-1 and those of Pav from 4.1 to 5.9 kg ha-1 yr-1, with a total replacement cost of US$26-38 ha-1 yr-1. Nutrient losses and cost generally increased from lowland (Dibatie) to midland (Aba Gerima) to highland (Guder), although the highland and midland sites did not differ significantly (p > 0.05) in nutrient losses. Cropland showed significantly higher TN and Pav losses than other land use types, but TN loss did not differ significantly between grazing and bushland. In all land use types at all sites, the magnitude of nutrient losses was Ho >Eo >Lo >Go. In plots with land management practices, TN and Pav losses associated with Eo, Lo, and Go were reduced on average by 44-76%, 9-47%, and 1%-36%, respectively. These practices were most effective to reduce Eo nutrient losses. Further study is required to analyzing the soil nutrient balance and identify priority areas for implementing mitigation measures.

Patient preferences for prenatal testing and termination of pregnancy for congenital anomalies and genetic diseases in Ethiopia.

OBJECTIVE: As prenatal diagnostic services expand throughout low-income countries, an important consideration is the appropriateness of these services for patients. In these countries, services now include prenatal ultrasound and occasionally genetic testing. To assess patient interest, we surveyed pregnant patients at a hospital in Addis Ababa, Ethiopia, on their preferences for prenatal testing and termination of affected pregnancies for congenital anomalies and genetic diseases. METHOD: One hundred one pregnant patients were surveyed on their preferences for prenatal testing and termination of affected pregnancies using a survey covering various congenital anomalies and genetic diseases. RESULTS: Eighty-nine percent of patients reported interest in testing for all conditions. Three percent of patients were not interested in any testing. Over 60% of patients reported interest in termination for anencephaly, early infant death, severe intellectual disability, hemoglobinopathy, and amelia. Patients were more likely to express interest in prenatal testing and termination for conditions associated with a shortened lifespan. CONCLUSION: Ethiopian patients were interested in prenatal testing and termination of pregnancy for many conditions. Advancing prenatal diagnostic capacities is a potential strategy for addressing the incidence of congenital anomalies and genetic disease in Ethiopia. Importantly, there exist many factors and technological limitations to consider before implementation.

A survey of healthcare providers' knowledge and attitudes regarding pain relief in labor for women in Ethiopia.

BACKGROUND: To explore healthcare providers' knowledge and attitudes to the need for pain relief for women in labor. METHODS: A structured questionnaire (n = 200) distributed to healthcare providers working in the obstetric departments, including theatres, of three public hospitals in different settings (rural, peri-urban and urban) in Ethiopia. Descriptive analysis was performed using Excel 2013 and SPSS version 22 for associations. RESULTS: The response rate was 81.5% with 164 questionnaires completed. The majority, 79% of respondents, understood that women can feel moderate to severe pain in labor and 77% were of the opinion that labor pain should be relieved. However, common practices included only supportive measures such as breathing and relaxation exercises, back massage and support from family. The general attitude of healthcare providers is that labor is a natural process, women should be able to cope and that pain relief is not a priority for women in labor. More than half, 52% of healthcare providers had safety concerns with using pharmacological methods to relieve pain in labor. CONCLUSION: The majority of healthcare providers understand that women suffer significant pain during labor. However, providing effective pain relief is currently not provided as part of routine intra-partum care in Ethiopia.