Undernutrition among khat-chewer and non-chewer lactating women in Chiro district, eastern Ethiopia: Comparative cross-sectional study.

Objectives: This study aims to assess the prevalence of undernutrition and factors associated with it among khat-chewer and non-chewer lactating women at Chiro district, west Hararghe zone, eastern Ethiopia. Methods: A community-based comparative cross-sectional study was conducted among 446 (223 khat chewers and 223 non-chewers) randomly selected lactating women who have children aged 6 and 23 months. Data were collected through face-to-face interviews using structured questionnaires followed by weight and height measurements to calculate and categorize nutritional status based on body mass index (kg/m2). Data were entered into EpiData version 3.1 and analyzed using STATA version 14.2. A binary logistic regression model was fitted to check the association between independent variables and undernutrition. The level of statistical significance was declared at a p-value less than 0.05. Results: The overall prevalence of undernutrition among lactating women was 30.7% (95% confidence interval = 26.6, 35.2). Undernutrition was significantly higher among khat chewers, 39.0% (95% confidence interval = 32.8, 45.6) than non-chewers, 22.4% (95% confidence interval = 17.4, 28.4), (χ2 (degree of freedom) = 14.4231, p < 0.0001). Chewing daily (adjusted odds ratio = 3.14, 95% confidence interval = 1.08, 9.15), reducing number of meals after chewing (adjusted odds ratio = 3.45, 95% confidence interval = 1.29, 9.20), and unavailability of latrine (adjusted odds ratio = 2.98, 95% confidence interval = 1.02, 8.75) were significantly associated with undernutrition among khat-chewer lactating women. Furthermore, age at first pregnancy (<18 years) (adjusted odds ratio = 3.17, 95% confidence interval = 1.17, 8.60), not taking any additional meals (adjusted odds ratio = 3.41, 95% confidence interval = 1.08, 10.7), and hand washing after toilet use (adjusted odds ratio = 6.10, 95% confidence interval = 2.51, 14.8) were significantly associated with undernutrition among non-chewer lactating women. Conclusion: The overall prevalence of undernutrition is higher than previous studies and is alarming among khat-chewer lactating mothers. Thus, nutritional and public health interventions should target khat-chewer lactating mothers particularly focusing on daily chewer either to improve their dietary practice during and after chewing or to stop khat chewing if possible, in order to reduce the effect of khat on food absorption. Besides, improving latrine coverage and use, and prevention of early pregnancy are of paramount importance in reducing undernutrition among lactating mothers.

Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study.

OBJECTIVE: The rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia. DESIGN: Cross-sectional study. SETTING: Two major private hospitals in eastern Ethiopia. PARTICIPANTS: All women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files. RESULTS: Of 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%). CONCLUSION: More than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: A Cross-Sectional Study.

OBJECTIVE: Despite implementation of different strategies, postpartum hemorrhage (PPH) continued to account for a substantial proportion of maternal deaths in Ethiopia. The objective of this study was to assess the magnitude of PPH and its associated factors among women who gave birth in a university hospital in eastern Ethiopia from 1 to 31 March 2020. METHODS: An institution-based cross-sectional study was conducted. A review of 653 randomly selected medical records of all deliveries from 1 March 2018 to 29 February 2020 in Hiwot Fana Specialized University Hospital (HFSUH), a university hospital in eastern Ethiopia, was conducted. Data were collected on sociodemographic characteristics, obstetric and reproductive health conditions, and presence of PPH. Data were coded, checked for completeness and entered using EpiData 3.1 and exported to SPSS 20 for analysis. Results were expressed using frequencies, tables and figures. Binary and multiple logistic regression were fitted to identify factors associated with PPH and associations were described using adjusted odds ratio (aOR) along with 95% confidence intervals (CI). Associations with p<0.05 in the multivariable logistic regression were declared as statistically significant. RESULTS: From a total of 642 (98.3%) women included in this study, 83 (12.9%; 95% CI 10.4-15.6) had PPH. Maternal age >35 years (aOR = 3.08; 95% CI 1.56, 6.07), no antenatal care (aOR = 3.65; 95% CI 1.97, 6.76), history of PPH (aOR = 4.18; 95% CI 1.99, 8.82), and being grand multigravida (aOR = 3.33; 95% CI 1.14, 9.74) were significantly associated with having PPH. CONCLUSION: A high proportion of women who gave birth in HFSUH experienced PPH. Prevention and management of PPH should focus on improving antenatal care and prioritize grand multigravida, older women, and women with a previous history of PPH.

A Third of Pregnant Women are Affected by Anemia in Eastern Ethiopia: A Facility-Based Study.

BACKGROUND: Although it is a public health problem of pregnant women in low, middle and high-income countries, the highest prevalence rate of anemia is found among pregnant women of low-income countries, particularly in Africa. Therefore, this study has aimed to determine the magnitude of the anemia and its associated factors among pregnant women admitted to labor wards of public hospitals in eastern Ethiopia. METHODS AND MATERIALS: A health facility-based cross-sectional study was conducted among 405 pregnant women admitted to labor wards in four public hospitals of Harar town and Dire Dawa City Administration. A systematic random sampling technique was used to select the study participants. Data were collected through an interview using a structured questionnaire. The hemoglobin level was measured for each study participant. Binary and multivariable logistic regression models were fitted and statistical significance was declared at P<0.05. RESULTS: The magnitude of anemia was 33.1% (95% CI: 28.4%, 37.8%). Being from rural areas (AOR: 3.8; 95% CI: 1.81, 7.94), no antenatal care (ANC) follow-up (AOR: 3.4; 95% CI: 1.34, 8.79), a habit of drinking milk with tea after meals (AOR: 2.8; 95% CI: 1.48, 5.61), taking a meal only 1-2 times per day (AOR: 3.9; 95% CI: 1.69, 8.97), experiencing no blood loss in the current pregnancy (AOR: 0.25; 95% CI: 0.06, 0.96) and a habit of eating leafy vegetables (AOR: 0.12; 95% CI: 0.06, 0.24) were significantly associated with anemia. CONCLUSION: About one in three pregnant women were anemic and anemia was a moderate public health problem in the study settings. Interventions targeting reducing or preventing anemia should focus on pregnant women in rural areas, promoting the benefits of ANC follow-up, reducing the habit of drinking milk with tea after meals, enhancing the consumption of leafy vegetables and increasing meal frequency per day to minimize or prevent anemia and its consequences during pregnancy.

Undernutrition among Institutionalized School-age Orphans in Harari Regional State, Eastern Ethiopia: A Cross-sectional Study.

BACKGROUND: Although orphans are at increased risk of undernutrition, studies assessing prevalence of undernutrition are limited to orphans residing with their relatives or on street. This study was conducted to assess magnitude of undernutrition and its associated factors among institutionalized school-age orphans in Harari Regional State, eastern Ethiopia. METHODS: An institution based cross-sectional study was conducted among all school-age (6-12 years) orphans living in all orphan centers in Harari Regional State, eastern Ethiopia. Data were collected by using a structured pretested questionnaire supplemented with anthropometric measurements. Data were entered using EpiData 3.1 and analyzed using SPSS 22. Logistic regression models were fitted to identify factors associated with undernutrition. Statistical significance was declared at P-value <.05. RESULTS: A total of 265 orphans residing in all orphan centers in the region were included. The prevalence of stunting, wasting, and underweight were 15.8% (95% CI: 11.9, 20.7), 10.9% (95% CI: 7.7, 15.3), and 8.7% (95% CI: 4.3, 10.5), respectively. Staying in orphan center for 6 to 10 years (AOR = 6.2; 95% CI: 2.6, 15.10), having recent illness (AOR = 3.9; 95% CI: 1.4, 10.4), and being aged 10 to 12 years (AOR = 11.2; 95% CI: 3.5, 35.4) were significantly associated with stunting whereas having recent illness (AOR = 4.3; 95% CI: 1.4, 7.3) and being aged 6 to 7 years (AOR: 10.4; 95% CI: 3.2, 33.6) were significantly associated with wasting. Underweight was more likely (AOR: 8.9; 95% CI: 2.7, 29.5) among children with recent illness. CONCLUSIONS: Almost 1 in 6, 1 in 9, and 1 in 11 institutionalized school-age orphans in Harari Regional State were stunted, wasted, and underweight respectively. Younger children and those with recent illness were more likely to be undernourished. Underlying reasons for undernutrition among orphans being cared in orphan centers should be further explored.

Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study.

BACKGROUND: Although anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia. METHODS: A health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05. RESULTS: The magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia. CONCLUSION: Anemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients' quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.

Undernutrition among Pregnant Women in Rural Communities in Southern Ethiopia.

BACKGROUND: Maternal undernutrition rates in Ethiopia are among the highest in the world. In addition, a huge inequity exists within the country, with pregnant women in rural communities being at increased risk. This study assessed the prevalence of undernutrition and its associated factors among pregnant women in a rural community in southern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 376 randomly selected pregnant women. Data were collected through face-to-face interview followed by mid-upper arm circumference measurement. Household food insecurity and minimum dietary diversity for women were assessed. Data were entered into EpiData 3.1 and exported to SPSS 20 for analysis. Logistic regression models were fitted to check associations between independent variables and undernutrition. Statistical significance was set at p<0.05. RESULTS: The prevalence of undernutrition was 41.2% (95% CI 36.3%-46.3%). Unintended pregnancy (AOR 2.06, 95% CI 1.27-3.36) and not participating in Wome's Health Development Army meetings (AOR 3.64, 95% CI 1.51-8.77) were independent predictors of undernutrition. However, minimum dietary diversity for women of five or more food groups (AOR 0.24, 95% CI 0.07-0.82), having at least one antenatal care visit (AOR 0.46, 95% CI 0.27-0.78), age at first pregnancy ≥20 years (AOR 0.39, 95% CI 0.21-0.76), and being from food-secure households (AOR 0.26, 95% CI 0.16-0.43) were independent protective factors against undernutrition. CONCLUSION: Undernutrition among pregnant women was highly prevalent in the study area. Interventions aiming to reduce undernutrition should focus on discouraging teenage and unintended pregnancy, reducing household food insecurity, and promoting antenatal care visits and encouraging consumption of diversified diets by women. Strengthening the existing network of the Women's Health Development Army seems to be very important.

Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations.

With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.

Prevalence of Anemia and Its Associated Factors Among Female Adolescents in Ambo Town, West Shewa, Ethiopia.

OBJECTIVE: This study assessed the prevalence of anemia among female adolescents and factors associated with it in Ambo town, West Shewa, Ethiopia. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among 523 randomly selected female adolescents living in Ambo town, Ethiopia from August 5-29, 2018. Data were collected through structured interview using a structured questionnaire. Anthropometric measurements were done and the hemoglobin value was measured on the field and adjusted for the altitude. Logistic regression analysis was done to identify predictors of anemia. Level of statistical significance was declared at P<0.05. RESULTS: In this study, 39% (95% CI= 34.8-43%) participants were anemic, of which 63 (30.9%) and 46 (22.5%) female adolescents were stunted and wasted, respectively. Anemia was considerably high among female adolescents with high dietary diversity score. Adolescents born to mothers who were unable to read and write (AOR= 3.27; 95% CI=1.79-5.97), who always take tea and/or coffee within 30 minutes after meal (AOR= 6.19; 95% CI=3.32-11.48), who were wasted (AOR=1.67; 95% CI=1.11-2.52), and who had already attained their menses (AOR=1.93; 95% CI=1.19-3.13) were more likely to be anemic compared to their counterparts. CONCLUSION: Nearly four in ten female adolescents in the study setting were anemic. Anemia among female adolescents was a moderate public health problem. Adolescents born to mothers who were unable to read and write, who consumed tea/coffee within 30 minutes after a meal, who were wasted, and who had already attained menses should be prioritized for interventions aiming at addressing iron-deficiency anemia in female adolescents.

Anemia among School Adolescents in Haramaya Town, Eastern Ethiopia: Cross-Sectional Study.

BACKGROUND: Anemia is a condition characterized by reduction in the number of red blood cells and/or hemoglobin concentration. It affects 24.8% of the world population. There is little evidence on burden of anemia among adolescents in low income countries like Ethiopia. Thus, this study aimed to assess the magnitude of anemia and factors associated with anemia among school adolescents in eastern Ethiopia. METHODS: School based cross-sectional study was conducted among 493 school adolescents in Haramaya town during February 1 to 28, 2017. Multi stage cluster sampling technique was used. We collected anthropometric data (weight and height) and hemoglobin level of all study participants. The hemoglobin level was adjusted for altitude. Data were entered into EpiData and exported to SPSS version 20 for analysis. Logistic regression model was fitted to identify factors associated with anemia. Level of statistical significance was declared at P < .05. RESULTS: In this study, the prevalence of anemia was 29.4% [95% CI: (25.6, 33.5)]. Being female adolescent (AOR = 2.31, 95 % CI: [1.51, 3.54]), adolescents attending grades 9th to 10th (AOR = 1.66, 95% CI: [1.004, 2.77]), adolescents born to illiterate mothers [AOR = 2.23, 95% CI: (1.02, 4.89)], and low dietary diversity score (AOR = 2.33, 95% CI: [1.12, 4.86]) were factors that increased the likelihood of getting anemia. CONCLUSION: Anemia among school adolescents was a moderate public health problem in the study area. Being female, lower grade levels (9th to 10th), low dietary diversity score and illiterate maternal educational status increased the likelihood of getting anemia. School based Iron/Folic acid supplementation, nutrition education and promotion of diversified foods consumption should be given attention with particular focus on female adolescents.

Low Back Pain Among Nurses Working at Public Hospitals in Eastern Ethiopia.

OBJECTIVE: This study assessed the prevalence of low back pain and factors associated with it among nurses working at public hospitals in eastern Ethiopia. MATERIALS AND METHODS: Institutional-based cross-sectional study was conducted from February 1 to March 20, 2018 among randomly selected 404 nurses working in public hospitals of Harari region and Dire Dawa city administration. Six trained nurses collected the data through a self-administered data collection technique. All variables that yield p< 0.25 in bivariable logistic regression were subjects for multivariable logistic regression analysis. The direction and strength of statistical association were measured by odds ratio with the corresponding 95% confidence interval (CI). Finally, statistical significance was declared at p < 0.05. RESULTS: The 12-month prevalence of low back pain was 38.1% [95% CI: 32.7-42.7%]. It was more prevalent among females (65%). More than 5 years of work experience [adjusted odds ratio (AOR) =3.135; 95% CI (1.292-7.605)], manual lifting of weight >10kg [AOR=5.260; 95% CI (1.869-14.805)] and working in awkward posture [AOR=3.93; 95% CI (1.109-13.924)] were variables significantly associated with low back pain among nurses. CONCLUSION: About two in five nurses working at public hospitals in Harari region and Dire Dawa city administration were suffering from low back pain. So, tailored intervention is needed to prevent nurses from further injury and retain experienced nurses.