Spatial patterns and determinants of low utilization of delivery care service and postnatal check-up within 2 months following birth in Ethiopia: Bivariate analysis.

BACKGROUND: Home delivery is a nonclinical childbirth practice that takes place in one's home with or without traditional birth attendants and postnatal care is the care given to the mother and her newborn baby; according to world health organization (WHO), the postnatal phase, begins one hour after birth and lasts six weeks (42 days). This paper aimed to study the spatial pattern and determinant factors of low utilization of delivery care (DC) services and postnatal check-up (PNC) after live births in Ethiopia. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey data as a source. A total weighted samples of 11023 women-children pairs were included. The bivariate binary logistic regression analyses with spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8 was used for mapping. RESULTS: The spatial distribution of low utilization of delivery care service and postnatal check-up were significantly clustered in Ethiopia (Moran's I statistic 0.378, P-value < 0.001 and 0.177, P-value < 0.001 respectively). Among 11023 children-women pair, the prevalence of home delivery and no postnatal check-up within two months following birth were 72.6% and 91.4% respectively. The Liben, Borena, Guji, Bale, Dolo and Zone 2 were predicted to have high prevalence of home delivery and part of Afder, Shabelle, Korahe, Dolo and Zone 2 were high risk areas of no postnatal checkup. CONCLUSION AND RECOMMENDATIONS: Lack of occupation, region, large family size, higher birth order, low utilization of antenatal care visit, unable to access mass media, big problem of health facility distance and the spatial variable were found to be jointly significant predictors of low utilization of DC and PNC in Ethiopia. Whereas older age, being reside in rural area and low wealth status affects delivery care service utilization. We suggest health providers, policy makers and stakeholders consider those variables with priority given to Liben, Borena, Guji, Bale, Dolo, Zone 2, Afder, Shabelle and Korahe, where home delivery and no PNC were predicted relatively high. We also recommend researchers to conduct further studies using latest survey data set.

Joint modeling of longitudinal changes of pulse rate and body temperature with time to recovery of pneumonia patients under treatment: a prospective cohort study.

BACKGROUND: Pneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. The study aims to identify the determinants of the progress of pulse rate, body temperature and time to recovery of pneumonia patients. METHOD: A prospective cohort study design was used from Felege Hiwot referral hospital on 214 sampled pneumonia patients from March 01, 2022 up to May 31, 2022. The Kaplan-Meier survival estimate and Log-Rank test was used to compare the survival time. Joint model of bivariate longitudinal and time to event model was used to identify factors of longitudinal change of pulse rate and body temperature with time to recovery jointly. RESULT: As the follow up time of pneumonia patient's increase by one hour the average longitudinal change of pulse rate and body temperature were decreased by 0.4236 bpm and 0.0119 [Formula: see text]. The average longitudinal change of pulse rate and body temperature of patients who lived in rural was 1.4602 bpm and 0.1550 [Formula: see text] times less as compared to urban residence. Patients who had dangerous signs are significantly increased the average longitudinal change of pulse rate and body temperature by 2.042 bpm and 0.6031 [Formula: see text] as compared to patients who had no dangerous signs. A patient from rural residence was 1.1336 times more likely to experience the event of recovery as compared to urban residence. The estimated values of the association parameter for pulse rate and body temperature were -0.4236 bpm and -0.0119 respectively, which means pulse rate and body temperature were negatively related with patients recovery time. CONCLUSION: Pulse rate and body temperature significantly affect the time to the first recovery of pneumonia patients who are receiving treatment. Age, residence, danger sign, comorbidity, baseline symptom and visiting time were the joint determinant factors for the longitudinal change of pulse rate, body temperature and time to recovery of pneumonia patients. The joint model approach provides precise dynamic predictions, widespread information about the disease transitions, and better knowledge of disease etiology.

Spatiotemporal distribution and bivariate binary analysis of antenatal and delivery care utilizations in Ethiopia: EDHS 2000-2016.

BACKGROUND: Antenatal care (ANC) is a maternal health care service given by skilled health professionals to pregnant women. Women may give birth at home or in health institutions. Home delivery care (DC) increases the likelihood of mortality of the mother and the newborn. Globally, each year nearly 303,000 maternal deaths occurred from complications of pregnancy and childbirth. Ethiopia alone accounted for 13,000 deaths, which disproportionately affects women living in different places of the country. Thus, this study aimed to assess the spatiotemporal patterns and associated factors of antenatal and delivery care utilization in Ethiopia. METHOD: This study used the 2000 to 2016 EDHS (Ethiopian and Demographic Health Survey) data as a source. A total weighted sample of 30,762 women (7966 in 2000, 7297 in 2005, 7908 in 2011, and 7591 in 2016) was used. The separate and bivariate logistic regression analyses with and without the spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8. RESULTS: The spatial distribution of ANC and DC was non-random in Ethiopia. The overall odds ratio of ANC and DC was 2.09. In 2016, 31.8% and 33.2% of women had ANC and DC respectively. The estimated odds of following ANC among mothers from middle and rich households were 1.346 and 1.679 times the estimated odds of following ANC among mothers from poor households respectively. Women who had attained higher education were 1.56 and 2.03 times more likely to have ANC and DC respectively compared to women who had no formal education. CONCLUSIONS: Despite the government's report that women now have better access to maternal health care, a sizable proportion of women continue to give birth at home without going to the advised antenatal care appointment. Women and husbands with low education, having non-working partners, religion, regions of dwelling, residing in rural, lower birth order, low birth interval, unable to access mass media, low wealth status, and earlier EDHS survey years were significant predictors that hinder antenatal and delivery care utilization simultaneously in Ethiopia. Whereas the spatial variable significantly affects antenatal care and being unable to access mobile phones lead to low utilization of delivery care. We recommend that policymakers, planners, and researchers consider these variables and the spatiotemporal distribution of ANC and DC to reduce maternal mortality in Ethiopia. Besides, it is recommended that further studies use the latest EDHS survey data.

Joint modeling of longitudinal changes of blood pressure and time to remission of hypertensive patients receiving treatment: Bayesian approach.

INTRODUCTION: Hypertension is a widespread condition when the blood's force on the artery walls is extremely high to develop adverse health effects. This paper aimed to jointly model the longitudinal change of blood pressures (systolic and diastolic) and time to the first remission of hypertensive outpatients receiving treatment. METHODS: A retrospective study design was used to collect appropriate data on longitudinal changes in blood pressure and time-to-event from the medical charts of 301 hypertensive outpatients under follow-up at Felege Hiwot referral hospital, Ethiopia. The data exploration was done using summary statistics measures, individual profile plots, Kaplan-Meier plots, and log-rank tests. To get wide-ranging information about the progression, joint multivariate models were employed. RESULTS: A total of 301 hypertensive patients who take treatment was taken from Felege Hiwot referral hospital recorded between Sep. 2018 to Feb. 2021. Of this 153 (50.8%) were male, and 124 (49.2%) were residents from rural areas. About 83(27.6%), 58 (19.3%), 82 (27.2%), and 25 (8.3%) have a history of diabetes mellitus, cardiovascular disease, stroke, and HIV respectively. The median time of hypertensive patients to have first remission time was 11 months. The hazard of the patient's first remission time for males was 0.63 times less likely than the hazard for females. The time to attain the first remission for patients who had a history of diabetes mellitus was 46% lower than for those who had no history of diabetes mellitus. CONCLUSION: Blood pressure dynamics significantly affect the time to the first remission of hypertensive outpatients receiving treatment. The patients who had a good follow-up, lower BUN, lower serum calcium, lower serum sodium, lower hemoglobin, and take the treatment enalapril showed an opportunity in decreasing their blood pressure. This compels patients to experience the first remission early. Besides, age, patient's history of diabetes, patient's history of cardiovascular disease, and treatment type were the joint determinant factors for the longitudinal change of BP and the first remission time. The Bayesian joint model approach provides specific dynamic predictions, wide-ranging information about the disease transitions, and better knowledge of disease etiology.

Prevalence and associated factors of neonatal mortality in Ethiopia.

Neonatal mortality is the death of a live-born baby within the first 28 days of birth. For the selected households, neonatal mortality was collected from children aged 0-28 days and women aged 15-49. The neonatal period is a significant 4-week period in human life because it carries a greater mortality risk. To identify the determinant factors of neonatal mortality in Ethiopia based on EDHS 2016 data with the application of count regression models. In this study, all neonates in Ethiopia were born within the 5 years preceding EDHS 2016 of the source population in the selected EAs from September to December 2015. Count regression models were used to analyze the data. A total of 10,641 live-born neonates within the previous 5 years of EDHS 2016 had neonatal mortality of women aged 15-49, which was considered in the study to be 7193. The data were found to have excess zeros (96.6%), and the variance (0.052) was higher than its mean (0.04). The count regression model (ZINB) was best fitted to the data with maximum likelihood parameter estimation methods. The average neonatal mortality difference in multiple births was increased by IRR = 8.53 times compared with a single birth. The average number of neonatal deaths experienced during breastfeeding was lower (IRR = 0.38) than that experienced by mothers who did not experience breastfeeding their child. The average neonatal mortality difference in rural residences was increased by IRR = 3.99 times compared to urban mothers' residences. In this study, the prevalence of Neonatal mortality in Ethiopia was higher. For selected ZINB count regression models of explanatory variables, such as multiple birth types, having rural residence factors of neonatal mortality increased the risk of death. However, having early breastfeeding, a female household head, and antenatal visits (1-4) and (5-10) during pregnancy decrease the risk of neonatal death.

Determining the effect of time dependent and time independent factors on pneumonia of children under five in North west Ethiopia.

BACKGROUND: Lower Respiratory Tract Infections including pneumonia are the fourth cause of death globally. In Ethiopia, pneumonia is the leading cause of death for children under five. However, so far, only a few studies that used longitudinal design and time dependent covariates determined the significant factors of pneumonia. This study sought to determine whether respiratory rate changes differed for under five-year-old pneumonia patients who had been receiving different treatments over time and whether the change was effected by time dependent and independent covariates. METHODS: A longitudinal study design involving marginal Poisson regression models and conditional Poisson regression models was used. After comparing the two, the final interpretation was made using a conditional Poisson regression model owing to its relative powerfulness. RESULTS: Four hundred and fifty-three under five pneumonia patients were included, of which 44.37% were female. It is found that, compared to rural children, urban children had an estimated mean respiratory rate decrease of 3%. It is also found that, compared to children whose mother practiced only exclusive breastfeeding in the first six months, children whose mother practiced both breastfed and complementary were more likely to be exposed to pneumonia. The estimated mean respiratory rate of children having asthma was 1.073 times that of children who had diarrhea. CONCLUSIONS: In northwest Ethiopia, weight, residence, previous disease history, breastfeeding and temperature are significant factors of pneumonia among children under five. The effectiveness of treatments was dependent on the number of times children visited the hospital. A significant variation of baseline pneumonia status among under five pneumonia patient children was noted in the hospital.

Trends and Determinants of Underweight among Under-Five Children in Ethiopia: Data from EDHS.

BACKGROUND AND AIMS: Malnutrition among under-five children is one of the major causes of death in low-income countries. Accordingly, health sectors in developing countries are providing renewed attention to the status of children's nutrition. This study sought to explore the trends and identify the determinants of underweight Ethiopian under-five children across time. METHODS: The data in the study was obtained from the 2000, 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys (EDHS). The study involved 27564 under-five children across Ethiopian regions. The status of underweight is determined using weight for age. This anthropometric index has been categorized as "underweight" (Z-score less than -2) and "not underweight" (Z-score greater or equal to -2). Logistic regression was used for each survey to detect significant determinants of underweight, while multivariate decomposition was used to determine the trends and identified the child, maternal, and household characteristics that are associated with underweight. RESULT: The survey in 2000, 2005, 2011, and 2016 showed that 41, 33, 29, and 24% of sampled under-five children were underweight, respectively, and after adjusting for confounders, children were more likely to be underweight if they were male (OR = 1.16, 95%CI = 1.02, 1.33) in 2016 EDHS. Children whose mother's age is below 20 (OR = 5.75, 95%CI = 1.44, 23.1)) were more likely to be underweight compared with children whose mother's age is above 45. Children whose mothers had no education and primary education only (OR = 1.65, 95% CI 1.05, 2.59 and OR = 1.43, 95% CI 1.15, 1.78, respectively) were more likely underweight compared to children whose mothers had higher education. CONCLUSION: Children's age, birth weight, mother's education status, and children's gender were the most common significant factors of underweight. The prevalence of underweight among under-five children declined over time which leads to an achievement in terms of meeting millennium development goals and nutritional targets. Government and concerned stakeholders should work to maintain this achievement for further reduction of underweight among under-five children.