Prevalence and associated factors of caesarean section among mothers who gave birth across Eastern Africa countries: Systematic review and meta-analysis study.

Background: Caesarean section (CS) rate increased dramatically worldwide, exceeding the World Health Organization's benchmark (10-15 %) in many countries. This rate varies in different regions of the continent. Using various study designs, researchers from across East African countries investigated the prevalence of caesarean section and the factor associated with it but no study shows a pooled prevalence of caesarean section in the Eastern African region. Therefore, this review aimed to systematically summarize and estimate the pooled prevalence of caesarean section and its associated factors in Eastern Africa, 2023. Methods: PubMed, Web of Science, EMBASE, Scopus and CINAHL were rigorously searched to find relevant studies. All identified observational studies reporting the prevalence of CS and its associated factors in East Africa published till August 2023 were considered. Heterogeneity across the studies was evaluated using the I2 test. Publication bias was assessed by funnel plot and Egger's regression test. Finally, a random effect meta-analysis model was computed to estimate the pooled prevalence of CS and qualitative analysis was employed for associated factors. The study protocol was registered in PROSPERO. Results: This review was assessed using twenty-six eligible studies from a total of 2223 articles with a total of 600,431 participants. In this meta-analysis, the pooled prevalence of caesarean section in Eastern Africa was 24.0 % (95%CI: 22-27 %). The highest pooled prevalence of caesarean section was in Ethiopia, 28.30 % (95%CI; 21.3-35.2 %), and the lowest was seen in Uganda, 11.9 % (95%CI; 7.9-15.9 %). Urban residency, having high level of wealth asset, education level college and above, advanced maternal age, big birth weight, history of previous caesarean section, private institution delivery, multiple pregnancies, pregnancy-induced hypertension, antepartum haemorrhage and fetal malpresentation were linked with a greater likelihood of having CS. Conclusions: and recommendation: The overall pooled prevalence of CS in Eastern Africa was high compared to the WHO proposed recommended range. Therefore, the finding implies that each East African countries Ministry of Health and health care professionals shall be given particular emphasis made on strengthening antenatal care services and ensure more women have access to skilled healthcare professionals during childbirth. This can help in providing appropriate interventions, support to women and reducing the need for emergency and unnecessary CSs. The result of this research are a baseline data for future researchers to conduct further studies to better understand the reasons behind the high rates and identify potential interventions and solutions specific to the African context.PROSPERO protocol number: CRD42023440131.

Job satisfaction among midwives in low and middle-income countries: A protocol for systematic review and meta-analysis.

Objectives: The main objective of this study is to assess the level of midwives' job satisfaction in low- and middle-income countries. Methods: A comprehensive literature search will be carried out using the following databases: Google Scholar, PubMed/Medline, Embase, CINHAL, SCOPUS, Web of Science, and Science Direct. This systematic review and meta-analysis will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All identified observational studies reporting the level of job satisfaction among midwives in low- and middle-income countries will be considered. The extracted quantitative data will be analyzed using STATA version 17. Heterogeneity among the included studies will be assessed through the I2 test statistics. Finally, a random-effects meta-analysis model will be computed to estimate the pooled level of job satisfaction among midwives. Furthermore, publication bias will be assessed using a funnel plot and Egger's regression test, and sensitivity analysis will be conducted to evaluate the stability of the overall effects in the presence of outliers. The protocol has been registered in the PROSPERO-International Prospective Register of Systematic Reviews, with the registration number CRD42023400122. Conclusion: This systematic review and meta-analysis will be an important source to identify the level of job satisfaction among midwives working in the health facilities of low- and middle-income countries. Researchers, stakeholders, and healthcare systems also use these and managers to determine why midwives' levels of job satisfaction are high or low compared to other studies in the future.

Survival of women with cervical cancer in East Africa: a systematic review and meta-analysis.

BACKGROUND: The prognosis for cervical cancer varies greatly between nations. The disparity in cancer survival rates within nations is largely a result of disparities in public knowledge, the accessibility of cancer services, diagnosis and treatment. The purpose of this systematic review and meta-analysis is to assess the survival rate and associated factors among cervical cancer patients in East Africa. METHODS: Literature search was carried out using Google scholar, PubMed/Medline, Embase and CINHAL. Covidence, a web-based program, was used to import studies for review process. PRISMA guidelines were followed. A total of 110 abstracts were identified from electronic sources. There were five duplicate articles removed. We looked at 105 papers' abstracts and titles, and we excluded 78 of them because they did not fit our inclusion criteria. We conducted a full-text analysis of the remaining 27 papers, leaving out 14 researches that did not fit our inclusion requirements. For final review, 13 studies were included. Using the Joanna Briggs Institute (JBI) assessment checklist, methodological quality was evaluated. RESULTS: The included articles were cohort studies. They were conducted in Ethiopia, Uganda, Zimbabwe, Kenya, Sudan, Tanzania and Rwanda. One-year, two-year, three-year, four-year and five-year overall survival rates ranged from 67% to 92%, 55% to 84%, 44% to 53%, 32% to 47%, and 26% to 43%, respectively. CONCLUSIONS: The pooled one-year, two-year, three-year, four-year and five-year survival rates of cervical cancer patients in East Africa were 84%, 71%, 50%, 39% and 36%, respectively. HIV status, late presentation, treatment modalities, older age and presence of comorbidities were the most commonly mentioned prognostic factors for survival. PROSPERO REGISTRATION NUMBER: CRD42023402551.

Most women in developing countries present with advanced disease, often untreatable or suitable only for palliation. In East Africa, cervical cancer makes up 40% of all cases of cancer detected in women. This largely highlights the inadequacy of national cancer control initiatives in most African nations, including immunization, screening, and early detection. Cervical cancer survival rates vary throughout the world and are commonly associated with the country's development status. The pooled five-year survival rate for cervical cancer patients in East Africa was 36%, according to this systematic review and meta-analysis, which is much lower than the rates in developed countries like the United States, Japan, and Australia but comparable to studies conducted in India.

Late antenatal care booking and associated factors among pregnant women in Mizan-Aman town, South West Ethiopia, 2021.

BACKGROUND: Antenatal care (ANC) is one of the most important ways to reduce maternal and neonatal morbidity and mortality. According to data from poor countries, the majority of pregnant women attend ANC when they are in their later stages of pregnancy. In this regard, limited information is currently known about the factors that determine ANC scheduling and the type of care for pregnant women in the town of Mizan-Aman in southwestern Ethiopia. Therefore, the purpose of this study was to determine late antenatal care booking and associated factors among pregnant women in the Town. METHOD: The institutional-based cross-sectional study design was conducted in Mizan-Aman town using a systematic random sampling method through structured questions from February 15 to March 25, 2021. The collected data was entered into EPI info-7 which later on, was exported to SPSS version 20 for statistical analysis. Binary and multiple logistic regressions were used to identify associated factors and p-value <0.05 was considered for statistical significance. RESULTS: A total of 425 female pregnant women participated, making a 100% response rate. The prevalence of delayed first ANC bookings in this study was 70.0% [95.0%, CI = 65.65-74.35]. Multivariate analysis revealed that unplanned pregnancy [AOR = 2.63, 95% CI: 1.18, 5.85], inappropriate perception of ANC starting time [AOR = 4.1, 95% CI: 1.9, 8.83], pregnant women who were unaware of pregnancy-related danger signs [AOR = 6.76, 95% CI: 2.83, 16.1], and pregnant women who were unaware of service delivery during working hours in the institution [AOR = 0.44, 95% CI: 0.19, 0.98]. CONCLUSION: The current study showed a greater prevalence of delayed ANC beginnings, and the factors for this were having an unplanned pregnancy, lack of awareness about pregnancy danger signs, inappropriate perception of ANC starting time, and pregnant women who were unaware of service delivery during working hours at the institution. Responsible bodies working in maternal and child health care better create awareness of the benefits of early ANC booking and appropriate ANC starting times. Further, each health institution's MCH clinic should deliver the service through working hours.

Option B+ prevention of mother-to-child transmission of HIV/AIDS service intervention outcomes in selected health facilities, Adama town, Ethiopia.

Background: Vertical HIV transmission from mother-to-child accounts for more than 90% of pediatric HIV/AIDS infection. Virtual elimination of mother-to-child transmission (MTCT) of HIV is possible by giving comprehensive prevention of HIV/AIDS mother-to-child transmission (PMTCT) care. The objective of this study was to assess Option B+ (initiation of antiretroviral therapy for all pregnant mothers) PMTCT service intervention and outcomes in selected health facilities of Adama town, Ethiopia. Methods: A retrospective study was employed. A total of 248 medical records of mother-infant cohorts were included. Data wer collected from logbooks and/or records and individual medical records using a data abstraction tool. Results: Mean±SD age of mothers was 26.8±4.3 years. Half (50.8%) of the mothers were enrolled in PMTCT at 13-24 weeks of gestational age. The majority (79.6%) of mothers' CD4 counts were ≥351/mm3. Most of the mothers (71%) were on a tenofovir-lamivudine-evafrenz regimen. One-quarter of mothers were prescribed co-trimoxazole prophylactic therapy. Loss to follow-up from the Option B+ continuum was 10 (4.2%). Almost all (98.4%) of the infants were prescribed nevirapine prophylaxis. Nearly 90% (n=223) of the HIV-exposed infants were discharged as HIV negative. Conclusions: The Option B+ PMTCT service can minimize the chances of MTCT of HIV infection if used optimally. The magnitudes of loss to follow-up and death were lower than in comparable studies. Initiating all pregnant mothers on antiretroviral therapy irrespective of their clinical stage and CD4 count may have contributed to the optimal retention in care and near elimination of MTCT of HIV infection.

Risk factors associated with precancerous cervical lesion among women screened at Marie Stops Ethiopia, Adama town, Ethiopia 2017: a case control study.

OBJECTIVE: Although cervical cancer is a preventable disease, it remains a leading cause of death among women in developing countries. In this unmatched case control design, 55 cases and 109 controls were included. The main objective of this study was to assess the risk factors of precancerous cervical lesion in Adama town. RESULTS: A total of 164 participants were recruited in this study. Of the 109 controls, 64 (61%) and 41 (39%) of cases were using oral contraception. Women who were using oral contraception were two times at risk for developing precancerous cervical lesion than who were not using (COR = 2.059 95% CI 1.006, 4.216; AOR = 2.342). Out of 55 cases, 21 (38.2%) cases had a history STI and out of 109 controls, 24 (22.2%) controls had a history of STI. It was revealed that STI has a significant association for developing of precancerous lesion. Women who had a history of STI were two times at risk of developing precancerous cervical lesion than who had no (COR = 2.187; AOR = 2.485). It was found that initiation of sexual intercourse before the age of 15 years has 5.6 risks to develop precancerous cervical lesion (COR = 5.625 AOR = 6.703).