Association of stress management behavior and diabetic self-care practice among diabetes type II patients in North Shoa Zone: a cross-sectional study.

BACKGROUND: The cornerstone of diabetes management is the self-care behavior of diabetics. However, many people with diabetes do not fully engage in these activities. Effective stress management behaviors have a positive impact on diabetes self-care. The purpose of this study was to investigate the relationship between self-care behaviors in people with diabetes and stress coping behaviors in people with type II diabetes. METHOD: A facility-based cross-sectional study was undertaken in the North Shoa zone from March 2 to 29, 2022. The study involved 432 types II diabetic patients who were chosen at random from eight public hospitals. Eight item stress coping techniques tools was used to measure stress management behavior. Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data for continuous variables were reported as means and standard deviations and percentages for categorical variables. Descriptive statistic was used to summarize study variables. Binary logistic regression models were used to assess associations between sociodemographic variables, stress-coping behaviors, and self-care behaviors. Binary logistic regression model was used investigate the association between diabetic self-care behaviors and stress-coping behaviors. A p-value ≤ 0.05 and an OR with a 95% CI are considered statistically significant associations. RESULT: the study showed that stress management behavior was observed in more than half of the patients (51.2; 95% CI; (46.5, 55.6). The study found that stress management behavior was associated with diabetic self-care practice (X2, 17.7; p < 0.0001). Patients with good stress management behavior (AOR = 2.0, 95% CI = (1.3, 3.0)), good perception (AOR = 2.3, 95% CI = (1.5, 3.4)), and family support (AOR = 2.3, 95% CI = (1.5, 3.6)) were more likely to conduct diabetes self-care. CONCLUSION: This study shows that stress management behaviors and coping techniques are associated with self-care behavior and lead to significant improvements in diabetes self-care practices. Stress management and coping skills should be included in current systems as a common therapeutic service/treatment. Diabetes care practitioners should consider these factors when discussing diabetes self-management during consultations.

Effect of nutritional promotion intervention on dietary adherence among type II diabetes patients in North Shoa Zone Amhara Region: quasi-experimental study.

BACKGROUND: Diabetes is a major global public health problem that requires self-management behavior. However, this is difficult to implement in practice and requires new approaches. The purpose of this study was to evaluate nutritional promotion interventions for dietary adherence and lessons learned to improve self-management. METHODS: A quasi-experimental study was conducted from January 2020 to February 2021 in North Shoa Zone public hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Study participants were randomly assigned to intervention and control groups at an individual level. Data were measured twice (baseline and end line survey after six months using interviewer-administered questionnaires). Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t tests. A p-value less than 0.05 was considered significant for all statistical tests. RESULTS: A total of 216 type II diabetics participated in this study. Nutritional promotion intervention programs increased adherence to the mean number of days adhering to a healthy diet (p < 0.0001). Specifically, the nutrition promotion program improved daily intake of fruits and vegetables, low glycemic index foods, high fiber foods, healthy fish oils, low sugar foods, and healthy eating plans (p ≤ 0.050). Mean fasting blood glucose levels were significantly decreased after the educational intervention (p ≤ 0.05). CONCLUSION: This study demonstrates that a nutrition-promoting intervention can significantly change patients' adherence to healthy eating behaviors and effectively improve their glycemic control. Health care providers should integrate programs that promote nutrition education into existing health systems service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.

Effect of physical activity promotion program on adherence to physical exercise among patients with type II diabetes in North Shoa Zone Amhara region: a quasi-experimental study.

BACKGROUND: Diabetes is a significant global public health issue that necessitates self-management. However, this is difficult to put into practice and requires a new approach. The purpose of this study was to assess the effects of a physical activity promotion program on adherence to recommended physical activity and lessons to improve self-management. METHODS: A quasi-experimental study was conducted from January 2020 to February 2021 at North Shoa Zone Public Hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t-tests. A p-value less than 0.05 was considered significant for all statistical tests. RESULTS: A total of 216 type II diabetics participated in this study. Physical activity promotion programs increased adherence to the recommended number of days and duration (spending time) of physical activity (p < 0.0001). Participants who engaged in the physical activity promotion program significantly increased the mean scores for exercising moderate-intensity activities and spending time (p < 0.05), walking for at least 10 min continuously and spending time (p < 0.05), exercising moderate-intensity recreational activities and spending time (p < 0.05).There was a significant reduction in mean fasting blood glucose after participating in a physical activity program (p < 0.05). CONCLUSION: This study demonstrates that a physical activity promotion program makes a significant difference in patient compliance with recommended physical activity and effectively improves patient glycemic control. Health care providers should integrate physical activity programs into existing systems as a common therapeutic service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.

Association between illness perception and medication adherence in patients with diabetes mellitus in North Shoa, Zone: cross-sectional study.

Background: Although the impact of illness perception on medication adherence is well-established, its specific influence on medication adherence in Ethiopia remains unclear. Consequently, the objective of this study was to examine the association between illness perception and medication adherence among patients with diabetes mellitus in the North Shoa Zone. Methods: An institution-based cross-sectional study was conducted from 24 May to 25 June 2022 in the North Shoa zone. The study included a random sample of 552 individuals with diabetes from four public hospitals. Data was collected and entered into Epi Data V.3.1, and analysis was performed using SPSS version 22. Descriptive statistics were used to summarize continuous variables as means with standard deviations, while categorical variables were presented as percentages. The study variables were analyzed using binary logistic regression models to assess the associations between illness perception and medication adherence. In the bivariable analysis, variables with p-values less than 0.20 were entered into a multivariable logistic regression model. Associations with a p-value ≤0.05 and an odds ratio with a 95% confidence interval were considered statistically significant. Results: The study results revealed that medication adherence was 64.4% (95% CI: 60.1, 67.9), while illness perception was 54.7% (95% CI, 41.2, 49.4). There was a significant and strong association between illness perception and medication adherence (p < 0.0001). In the adjusted model, the illness perception components of consequence showed a significant association with medication adherence (AOR = 3.10, 95% CI: 2.11, 4.55). Similarly, personal control (AOR = 1.77, 95% CI: 1.20, 2.61) and emotional representation of diabetes (AOR = 2.26, 95% CI: 1.54, 3.32) were also significantly associated with medication adherence in patients with diabetes. Conclusion: The findings of this study indicate a positive association between higher illness perception and increased medication adherence and practice. Therefore, when engaging in discussions about diabetic self-management, diabetes educators should employ psychoeducational approaches that take into account the illness perceptions of patients.

Fatal Road Traffic Accidents and Associated Factors in North Shewa Zone, Central Ethiopia: A Cross-Sectional Study.

Background: Road traffic accidents (RTAs) are among the top three global causes of death among people aged 15 to 44 years. More importantly, it is the main cause of death and permanent disability among young people aged 15 to 29 years. This study aimed to assess the magnitude of fatal traffic accidents and the factors associated with them in the North Shewa Zone, Central Ethiopia, from 2013 to 2018. Method: An institution-based cross-sectional study was conducted in all registered RTAs from July 2013 to June 2018 that had full documentation. The data extraction tool was developed based on the daily RTA registration book format that was utilized. Data was entered into Epi-data version 3.1 and then exported to SPSS version 21 for analysis. Logistic regression analysis was used to assess the relationship between the factors and the fatality of RTA. P-values less than 0.05 were reported as statistically significant. Results: Among 846 RTAs studied, 351 (41.5%) were found fatal, while 495 (58.5%) caused non-fatal injuries. Failure to give priority to pedestrians was 2.8 times (AOR = 2.8, 95% CI: 1.3, 5.9) more likely to cause fatal RTAs than drivers who failed to maintain distance between vehicles. Pedestrians were 2.7 times (AOR = 2.7, 95% CI: 1.1, 6.7) more likely to die in RTAs than drivers. Conclusion: The fatality of RTA was high. Failure to give priority to pedestrians and being a pedestrian were strong predictors of death. The North Shewa Zone Traffic Police Department and police officers should focus on enforcing traffic safety laws.

Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study.

Background: Ethiopia has implemented a community-based health insurance (CBHI) program to provide coverage to 80% of the population and shield underprivileged individuals from the detrimental effects of exorbitant medical expenses. However, there is a paucity of data regarding its utilization and pertinent concerns. This study aimed to evaluate the utilization of CBHI and its associated factors among informal workers in Berek District. Methods: This community-based cross-sectional study was conducted between June 15 and July 15, 2022. The sample population comprised 538 households selected using a multistage sampling approach. Data analysis was done using SPSS Version 26. Variables with P-values of less than 0.25 during the bivariate analysis were selected for multivariate analysis using binary logistic regression. The statistical significance threshold was set at a p-value of 0.05. Results: The utilization of Community-Based Health Insurance (CBHI) was 49.8%. Age between 30 and 39 years, monthly earnings of less than 1500 Ethiopian Birr, presence of chronic illness, membership in social organization, and possessing adequate knowledge were found to have a statistically significant association with the use of CBHI. Conclusion: The utilization of CBHI was low within the confines of this district Age, income, social group membership, and chronic illnesses were significantly associated with CBHI utilization.

Essential newborn care practice and associated factors among health care providers in Northeast Ethiopia: a cross-sectional study.

BACKGROUND: Globally, 2.7 million children die during the neonatal period annually. Ethiopia is one of the ten countries with the highest number of neonatal deaths. The practice of poor essential newborn care contributes to the problem. Hence the study was conducted to assess the essential newborn care practice and associated factors among health care providers from selected health facilities in Northeast Ethiopia. METHODS: Facility-based cross-sectional study was conducted among health care providers working in selected health facilities in Northeast Ethiopia from February-25 to March-25, 2019. Data were collected by a pre-tested questionnaire and an observational checklist. Then data were edited into Epi-data-7.2.0.1 and analyzed by using SPSS-25 software. The degree of association was assessed using binary logistic regression analysis. P-value < 0.05 was considered statistically significant. RESULTS: A total of 256 health care providers were included in the study. Overall, 62.9% (95%CI: 57.0-68.8%), and 73.8% (95%CI: 68.4-79.2%) of the health care providers had adequate knowledge and good practice on essential newborn care activities, respectively. The presence of supportive supervision (AOR = 2.09, 95%CI = 1.07-4.11), the interest of health care providers to work at delivery room (AOR = 1.97, 95%CI = 1.00-3.88), and availability of vitamin-K (AOR = 4.81, 95%CI = 1.07-21.64) were significantly associated with essential newborn care practices. CONCLUSIONS: A significant number of health care providers had inadequate knowledge and poor practice of essential newborn care. Availability of vitamin-K, the interest of the health care providers to work in the delivery room and the presence of supportive supervision were the factors affecting essential newborn care practice. Hence, giving in-service training, supportive supervision, and providing supplies should be strengthened to enhance essential newborn care activities.

Magnitude and risk of neonatal death in neonatal intensive care unit at referral hospital in Godeo Zone: a prospective cohort study.

INTRODUCTION: even though newborn health is apriority agenda in Ethiopia, neonates' risk of dying is unacceptable and one of the ten countries which accounts to two-third of global neonatal death. The magnitude and risk of death in the referral care facility was not well studied in the study area. This study was aimed to estimate neonatal death and its determinant. METHODS: a prospective cohort study was conducted from November 2016 to January 2018 among neonates admitted to Dilla University Referral Hospital Neonatal Intensive Care Unit. We generated descriptive statistics and Cox-proportional hazard model to identify independent risk factors of neonatal death. RESULTS: we identified 913 neonates with 6836 person-days of follow-up. Overall, 11.6% (n = 106) deaths of neonates were recorded. The estimated hazard ratios of neonatal death were higher among neonates whose mothers did not attend ANC follow up (HR=3.23), delivery assisted by TBA (HR=2.19), and maternal age ≥ 30 years at birth (HR=2.04). Urban residence [HR=0.54], family size of ≤ 3 (HR=0.47) and family size of 4 - 6 (HR=0.49), absence of abortion (HR=0.55), absence of illness during pregnancy (HR=0.47), iron folate intake (HR=0.29), birth weight ≥ 2500 grams (HR=0.43) were found to be protective factors. CONCLUSION: neonatal death at referral neonatal intensive care unit was relatively high. Early management of complications, improving quality of services at neonatal intensive care unit and ensuring maternal continuum of care are recommended to increase survival of neonates. Besides, maternal and neonatal health-related factors were among the independent risk factors that need to design context-based policy and interventions.

Immunization coverage and its determinant factors among children aged 12-23 months in Ethiopia: a systematic review, and Meta- analysis of cross-sectional studies.

BACKGROUND: Immunization is the process by which a person is made immune or resistant to an infectious disease, typically by the administration of vaccine. Vaccination coverage for other single vaccines ranged from 49.1% for PCV to 69.2% for BCG vaccine. The vaccination coverage for basic vaccinations was 39.7% in Ethiopia. There have been epidemiological studies available on immunization in Ethiopia. Yet, these studies revealed a wide variation over time and across geographical areas. This systematic review and Meta-analysis aim to estimate the overall immunization coverage among 12-23 months children in Ethiopia. METHODS: Cross-sectional studies that reported on immunization coverage from 2003 to August 2019 were systematically searched. Searches were conducted using PubMed, Google Scholar, Cochrane library, and gray literature. Information was extracted using a standardized form of Joanna Briggs Institute. The search was updated 20 Jan 2020 to decrease time-lag bias. The quality of studies assessed using Joanna Briggs Institute cross-sectional study quality assessment criteria. I-squared statistics applied to check the heterogeneity of studies. A funnel plot, Begg's test, and Egger's regression test was used to check for publication bias. RESULTS: Out of 206 studies, 30 studies with 21,672 children with mothers were included in the Meta-analysis. The pooled full immunization coverage using the random-effect model in Ethiopia was 58.92% (95% CI: 51.26-66.58%). The trend of immunization coverage was improved from time to time, but there were great disparities among different regions. Amhara region had the highest pooled fully immunized coverage, 72.48 (95%CI: 62.81-82.16). The I2 statistics was I2 = 99.4% (p = 0.0001). A subgroup meta-analysis showed that region and study years were not the sources of heterogeneity. CONCLUSION: This review showed that full immunization coverage in Ethiopia was 58.92% (95% CI: 51.26-66.58%). The study suggests that the child routine immunization program needs to discuss this low immunization coverage and the current practice needs revision.

When Do Newborns Die? Timing and Cause-Specific Neonatal Death in Neonatal Intensive Care Unit at Referral Hospital in Gedeo Zone: A Prospective Cohort Study.

BACKGROUND: Maternal, newborn, and child health have a high stake in the global health agenda, however, neonates' risk of dying is unacceptable in the world. Ethiopia is one of the countries with high burden of neonatal morbidity and mortality. Yet, timing and cause-specific neonatal death are under-investigated. The present study aimed to determine the timing and cause-specific neonatal death. METHODS: We conducted a prospective cohort study at Dilla University Referral Hospital Neonatal Care Unit from November 2016 to January 2018. All admitted neonates to the neonatal care unit were followed from cohort entry up to the occurrence of an event (death) or end of follow-up. We generated descriptive statistics to determine the timing of neonatal death and the cause of deaths. RESULTS: Overall, 11.6% of neonates died during the follow-up. We found that 34.0% and 64.3% of deaths occurred during the first and second weeks of neonatal life, respectively. Neonatal sepsis and low birth weight were the main causes of death and hospital admission. Jaundices and low birth weight were the most common causes of death during the early neonatal period, whereas birth asphyxia, low birth weight, and sepsis were during late neonatal life. However, for other causes of death, the slight difference was seen between the death patterns in early and late neonatal periods. CONCLUSIONS: The timing and cause-specific neonatal deaths were varying among different time of the neonatal periods that needs to design context-based policy and interventions.

Newborn Care Practices and Associated Factors Among Lactating Mothers at Home in the Rural Districts of Gedeo Zone, Southern Ethiopia.

INTRODUCTION: Globally, approximately three million neonates die in the first month of life. Neonatal mortality is a public problem in low and middle-income counties. Home-based good newborn care practice by lactating mothers is vital to improve newborns' health. In Ethiopia, home-based cultural newborn care practice among lactating mothers is very common, in contrast to standard essential newborn care practice. Thus, this study aimed to assess home-based newborn care practices among lactating mothers and associated factors in rural districts of Gedeo Zone, Southern Ethiopia, in 2018. METHODS: A community-based cross-sectional study was conducted in the rural districts of Gedeo Zone, Southern Ethiopia. A single population formula was used to determine the sample size, and 834 lactating mothers were enrolled in the study. Multistage sampling techniques were used to select study participants. Data were collected using a pre-tested interviewer-administered structured questionnaire and analyzed by SPSS version 22 software (IBM Corporation, Armonk, NY, USA). To determine associated factors with good newborn care practice among lactating mothers, the odds ratio with 95% confidence interval was used. RESULTS: The level of good newborn care practice among lactating mothers at home was 24.1% with 95% CI: 2.5-9.7. The factors significantly associated were maternal education (adjusted OR=2.6; 95% CI: 1.8-3.9), maternal employment (adjusted OR=2.1; 95% CI: 1.4-3.1), pregnancy intention (adjusted OR=1.7, 95% CI: 1.2-2.2), antenatal care visit (adjusted OR=5.7, 95% CI 3.9-7.9), and birth interval (adjusted OR=1.9, 95% CI: 1.3-2.8). CONCLUSION: The level of good newborn care practices among lactating mothers at home was found to be low. Thus, advancing women's education and employment in the community, and providing quality prenatal care are suggested to scale up good newborn care practice among lactating mothers at home. Additionally, an observational study might be needed to identify further associated factors.

Adolescent-Parent Communication on Sexual and Reproductive Health issues in Ethiopia: A Systematic Review and Meta-analysis.

Adolescent-parent sexual communication is an effective strategy to make healthy decisions, delay and protect from risky behavior. Thus, this systematic review and meta-analysis aimed to synthesize and estimate the level of adolescent- parent communication on sexual and reproductive health issues in Ethiopia. METHODS: Cross-sectional studies were systematically searched using databases such as PubMed, Google Scholar, Cochrane Library and gray literature. Information was extracted using a standardized form of JBI. Data were analyzed using the 'meta' packages of the Stata software (version 11.0). I-squared statistic was applied to check the heterogeneity of studies. Funnel plot and Egger's test were used to check for publication bias. P-value <0.05 on the Egger test was considered indicative of statistically significant publication bias. RESULTS: A total of 359 articles were identified, of which 19 were eligible for meta-analysis. Adolescent-parent communications on SRH issues were significantly reported within the range of 25.3% to 36.9% and more preferred to discuss with their friends. The overall pooled level of adolescent parent communication was 40.70 (95%CI: 34.26-47.15). Adolescents who lived in urban areas, having good knowledge of SRH issues, adolescents who agreed on the importance of discussion and adolescents who ever had sexual intercourse were more likely to discuss SRH issues with their parents. CONCLUSION: The overall pooled level of adolescent-parent communication was 40.70%, and also adolescent-parent communications were dominantly reported with the ranges of 25.3% to 36.9%. Being urban dweller, being knowledgeable, and being agreed on the importance of discussion were significantly associated with adolescent-parent communication. Cultural taboo, shame and lack of communication skills were reasons that hindered communication between parents and adolescents. Therefore, program implementers should work to increase adolescent-parent communication.

Magnitude and Risk of Dying among Low Birth Weight Neonates in Rural Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Even if remarkable progress has been made in reducing preventable child deaths worldwide, neonatal mortality reduction has remained unsatisfactory. Low birth weight (LBW) is the major risk factor for child deaths during the neonatal period, yet only 5% of babies are weighed at birth in Ethiopia. The aim of the present study was to determine the magnitude and risk of dying among low birth weight neonates in rural Gedeo, Southern Ethiopia. METHODS: Community-based mixed-method approach design was employed between September and October 2016 to identify and enroll study participants in rural Gedeo, Southern Ethiopia. Records of 17,503 live birth babies, of whom 2,065 (11.8%) had LBW, born in the last 12 months were screened to identify 885 (42.8%) biological mother-LBW neonate pairs from eight health centers. The study subjects were randomly selected using a multistage stratified cluster sampling technique. Cox proportional hazards regression model was used to predict maternal and neonatal risk factors associated with the risk of neonatal death. RESULTS: The overall neonatal mortality rate (NMR) among LBW infants was 110 per 1000 live births (95% confidence interval: 75 -228). Close to half, 374 (42.3%), of the LBW neonates died during the first week of life. The estimated hazard ratios of mortality were higher among neonates whose mothers did not attend antenatal care (ANC) (HR=1.58, 95 % CI: 1.02-2.43), gave birth by assisted or cesarean delivery (HR=1.81 and 3.72; 95% CI: 1.10 - 3.02 and 2.11-6.55), and experienced some form of illness during pregnancy (HH=3.34, 95 % CI: 2.11-5.29), respectively. Similarly, neonates born with very low (<2000gm) birth weight and born prematurely (before 37 weeks of gestation) carried a higher (HR= 1.90 and 1.47; 95 % CI: 1.22 - 2.96 and 1.07-2.28) risk of death. On the other hand, maternal formal education was found to be the single protective factor (HR= 0.65,95 % CI: 0.43-0.99). CONCLUSION: Nearly one in every ten (11%) of neonates die before celebrating their firth month of life, mainly during the first week in rural Ethiopia. The risk of dying from LBW during the neonatal period is almost fourfold of the current estimated national NMR. Maternal obstetric characteristics and fetal maturity were predictors of mortality.

Magnitude of Severe Head Injury and Its Associated Factors among Head Injury Patients in Gedeo Zone, Southern Ethiopia: A Two-Year Retrospective Study.

BACKGROUND: Severe head injury is a major public health threat that is the main cause of morbidity and mortality in all age groups of the world's populations including Ethiopia. In view of this, this study was assessed the severity of head injury and its contributing factors. METHODS: A Two-year retrospective study was conducted at Dilla University Referral Hospital, from December 2014 to November 2016. All head injury patients admitted to the surgical ward were included. Bivariate and multivariate regression analyses were used to identify factors associated with severity of head injury. RESULTS: A total of 106 eligible head injury patient charts were reviewed. The magnitude of severe head injury was 32.1%. Young populations, mainly males, were the highest risk groups, and road traffic accident was the main cause of severe head injury. In adjusted analysis, age interval greater than 45 years (aOR, 5.41; 95% CI:1.05-29.09), alcohol consumption before the trauma (aOR, 4.16, 95%CI: 1.18, 14.61), delayed presentation (beyond 24 hours) after injury (aOR, 4.717; 95% CI: 1.02-21.81), and respiratory rate greater than 30 breaths per minute (aOR, 7.34; 95% CI: 1.88-28.73) were significantly associated with severe head injury. CONCLUSIONS: Severe head injury remains an important public health problem. Young adults were the highest risk groups of populations. Prevention of road traffic accidents, continuous awareness creation about the consequences of road traffic accident and close neurological monitoring offered by neuro-intensive care unit are recommended.

Where we should focus? Myths and misconceptions of long acting contraceptives in southern nations, nationalities and People's region, Ethiopia: qualitative study.

BACKGROUND: Despite its wider benefits and access made at community level, contraceptive methods are one of underutilized services in study area and it is believed to be influenced by misconceptions and socio cultural values. This study was designed to explore women's perceptions, myths and misconception to inform program implementers. METHODS: Study was conducted in Southern Nations, Nationalities and People's Region, Ethiopia in 2015. Five focus group discussions with 50 women of reproductive age and 10 key informant interviews with providers and program officers were done. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually using framework analysis with deductive and descriptive approaches. RESULTS: Improving community awareness about contraceptives and benefits of contraceptive utilization were acknowledged by majority of participants. Long acting methods were less preferred due to perceived side effects, myths and misconceptions and desire to have more children. Additionally, socio-economic status and partner influence were listed as reason for non-use. Poor provider-client interaction on available methods was also reported as system related gap. CONCLUSION: Program implementers need to address fears, myths and misconceptions. Quality of family planning counselling should be monitored.

Prevalence and factors associated with rupture of gravid uterus and feto-maternal outcome: a one-year retrospective cohort study

Background: Uterine rupture remains a significant public health problem contributing to 13% of maternal mortality and 74%-92% for perinatal mortality in developing countries. This study assesses the prevalence and factors associated with rupture of gravid uterus and feto-maternal outcome in Ethiopian mothers with uterine rupture.Methods: A retrospective cohort study was conducted to identify risk factors associated with rupture of gravid uterus and feto-maternal outcomes. The data source included clinical records of patients seen at Dilla University Referral Hospital over a one-year period. The data was collected using a structured data collection form developed for the purposes of the study. The study involved a total 2,498 women with a gravid uterus, gestational age of ≥28 weeks and registered in the labor and delivery registration books in the Obstetrics and Gynecology Department. Bivariate and multivariate regression analyses were carried out at 95% Confidence Interval to identify factors independently associated with uterine rupture.Results: Out of 2,498 reviewed deliveries, 46 cases developed uterine rupture making an overall hospital prevalence of 1.8 % or one in 53 deliveries. Malpresentation (80%), contracted pelvis (47.8%), vertex malposition (10.8%), and previous uterine scar (2.1%) were the causes of uterus ruptures. In multivariate analysis, clients' residence, parity, birth weight, Antenatal Care follow-up and duration of labor were statistically significantly associated with uterine rupture. Maternal and fetal case fatality rates were 8.7% and 97.8%, respectively.Conclusion: Uterine rupture remains an important problem in the study area. Patients with identified risk factor(s) should stay close to the hospital in late pregnancy. Besides, strengthening antenatal care follow-up and referral linkage should be considered

Contraceptive utilization and associated factors among women of reproductive age group in Southern Nations Nationalities and Peoples' Region, Ethiopia: cross-sectional survey, mixed-methods.

BACKGROUND: Though contraceptive utilization has comprehensive benefit for women, it was one of underutilized public intervention in Ethiopia and in the study area. Thus, assessing status and factors affecting contraceptive utilization among women of reproductive age group was found key step for program improvement. METHODS: Community based cross-sectional study was conducted from March to April, 2015 in Southern Nations and Nationalities Peoples' Region, Ethiopia. A multistage stratified cluster sampling method was used to select 3205 study subjects. Study used both quantitative and qualitative methods. Statistical Package for Social Sciences version 20 was used to analyze quantitative data. The association between variables was determined using odds ratio at 95% confidence interval. RESULTS: Contraceptive utilization was 53.3% among women of reproductive age groups. Nearly three fourth, (73.6%), of current users were using short-term contraceptive methods. Factors associated with contraception utilization were overall knowledge of and attitude towards contraceptives, age, residence, number of alive children, experience of child death, marital status and deciding number of children. Contraceptive utilization was also affected by various misconceptions. CONCLUSION: Contraceptive utilization was below national Health Sector Development Program IV target. Program implementers need to address socio-cultural barriers. Gender myths and specific roles and power inequalities that can function as a barrier to contraceptive utilization should be assessed.

Women's Joint Decision on Contraceptive Use in Gedeo Zone, Southern Ethiopia: A Community Based Comparative Cross-Sectional Study.

A community based comparative cross-sectional study design was employed to assess the mutual consent of women about family planning use in urban and rural villages of Gedeo zone. Two-thirds (67.4%) of women made joint decision on contraceptive use, varying between urban (70.9%) and rural (63.4%) settings. This difference was statistically significant where women in urban setup had a 41% (AOR, 1.41; 95% CI (1.15, 2.01) added chance of making joint decision than the rural counterpart. In both settings, attitude towards contraceptive method was an independent predictor of joint contraceptive decision (AOR = 2.85) in urban and (AOR = 2.81) rural women. Contrarily, different factors were found to be associated with joint contraceptive decision in either setup. In urban, having better knowledge about contraceptive methods (AOR = 2.9) and having lower age difference (AOR = 2.2) were found to be strong predictors of joint decision on contraceptive use, while having too many children (AOR = 2.2) and paternal support (AOR = 7.1) in rural setups. Lower level of joint decision making on contraceptive use was reported in both setups. Factors associated with joint decision varied between the two setups, except for attitude towards contraceptive methods. Future family planning program should address sociocultural, knowledge and attitude factors.