Anemia in Children with Congenital Heart Disease: A Finding from Low-Resource Setting Hospitals.

Introduction: Congenital heart disease (CHD) is the most common birth defect. Anemia is the prevailing manifestation of micronutrient deficiency. It has been demonstrated that anemia in children increases morbidity and has a negative impact on psychomotor development. Despite its negative consequences, which have been documented for a long time in clinical practice, the issue does not gain sufficient attention in developing countries, specifically in children with CHD. Thus, this study is aimes to assess the prevalence of anemia and the factors associated in children with CHD. Methods: Institutional-based cross-sectional study was conducted on CHD children at selected governmental hospitals in Addis Ababa, Ethiopia, from February to March 2021. During this period, 373 children with acyanotic and cyanotic heart disease between 0 months and 15 years of age were included in this study. All children were assessed using structured questionnaires and anthropometric measurements. Recent hemoglobin results that are avaliable in the medical charts of children were used to diagnose anemia. The data were analyzed using SPSS version 25. Results: From randomly included 373 children with CHD, 298 (79.9%) had acyanotic congenital heart disease (ACHD) and 75 (20.1%) had cyanotic congenital heart disease (CCHD). Twenty-five (33.3%) CCHD and 192 (64.4%) ACHD cases of children were malnourished. The most common type of CCHD and ACHD defects were ventricular septal defects and tetralogy of fallout, respectively. Overall, the prevalence of anemia in ACHD and CCHD was 24.5% and 72%, respectively. In children with ACHD, the frequency of anemia was reported to be significantly higher in the malnourished group than in the well-nourished. Conclusions: A high prevalence of anemia is observed in children with CHD. This study highly suggests further evaluation to determine the frequency and complications of blood indices and other hematological impairments in ACHD, CCHD, and children with both problems. Moreover, the findings of this study on illness profiles in children with CHD prompt further research into the cellular and molecular mechanisms underlying immune system dysfunction.

Effective breastfeeding techniques and associated factors among lactating women: a community-based study, north east Ethiopia.

Background: Effective breastfeeding techniques, which include proper attachment, positioning, and suckling, offer a range of benefits for both the mother and the infant. These techniques ensure efficient milk transfer, reduce the risk of infections, support optimal infant weight gain, enhance maternal comfort, and foster a strong emotional bond. This study aimed to identify the magnitude and factors associated with effective breastfeeding techniques among lactating women in the Legambo district of South Wollo, Ethiopia, in 2022. Methods: A community-based cross-sectional study was conducted from September to November 2022. Samples were selected using a multi-stage sampling method from 18 wards (kebele). Data were collected using an interviewer-administered structured questionnaire and an observational checklist. The collected data were entered into Epi-Data and then exported to SPSS version 25.0 for analysis. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed to identify the magnitude and associated factors. Variables with a p-value less than 0.05 on multivariable analysis were considered independent factors associated with the outcome variable. Results: Six hundred and ten lactating women were included for observation and interviewed, resulting in a 96.2% response rate. The magnitude of effective breastfeeding technique practice was found to be 25.9% (95% CI: 22.47-29.57%). Factors associated with effective breastfeeding technique practice included being a working woman (AOR = 1.70; 95%CI: 1.07-2.72), age between 26 and 30 years (AOR = 0.37; 95%CI: 0.16-0.84), urban residence (AOR = 1.59; 95%CI: 1.06-2.39), initiating breastfeeding 1 to 2 h after birth (AOR = 0.27; 95%CI: 0.16-0.43), and initiating breastfeeding after 2 h of birth (AOR = 0.34; 95%CI: 0.17-0.67). Additionally, not receiving breastfeeding education (AOR = 0.46; 95%CI: 0.30-0.72) and experiencing current breast problems (AOR = 0.28; 95%CI: 0.28-0.75) were also found to have a significant association with effective breastfeeding technique practice. Conclusion: Only one in four women demonstrated effective breastfeeding techniques, indicating that their practice was below the WHO's recommendations. Therefore, it is crucial to consider the identified variables to improve the practice of effective breastfeeding techniques.

Prevalence and determinants of pregnancy termination in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: This review aims to determine the prevalence of pregnancy termination and its determinant factors in Ethiopia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Relevant articles were retrieved from databases such as PubMed, EMBASE, Medline and other search engines. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The research design for this study had no restrictions, allowing for the inclusion of cross-sectional and case-control studies that examined the prevalence or determinants of pregnancy termination. However, case reports, case series, reviews, editorials and studies published as abstracts only were excluded from the analysis. DATA EXTRACTION AND SYNTHESIS: The review was precisely in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and the quality of the review was assessed using the Joanna Briggs Institute critical appraisal checklist. Heterogeneity was indicated by the p value for I2 statistics less than 0.05. Data were entered into Microsoft Excel, and the analysis was conducted by using Stata V.16. RESULTS: The pooled prevalence of pregnancy termination in Ethiopia was 21.52% (95% CI 15.01% to 28.03%). Women who had their first sexual initiation before the age of 18 (OR 1.78; 95% CI 1.13 to 2.82, p=0.14), had irregular menstrual bleeding (OR 1.86; 95% CI 1.25 to 2.77, p=0.76), being a student (OR 4.85; 95% CI 1.98 to 11.91, p=0.20) and had multiple sexual partners (OR 4.88; 95% CI 3.43 to 6.93, p=0.33) were significantly associated with pregnancy termination. CONCLUSIONS: One in five women terminated their pregnancies, which is higher than in other sub-Saharan countries. Being a student, irregular menstrual bleeding, early initiation of sexual intercourse and multiple sexual partners were determinants of pregnancy termination. Special attention is needed in avoiding early sexual initiation and in reducing sexual risk behaviours.

Common Mental Disorder and Associated Factors among Women Attending Antenatal Care Follow-Up in North Wollo Public Health Facilities, Amhara Region, Northeast Ethiopia: A Cross-Sectional Study.

Introduction: Common mental health disorders (CMD) during pregnancy are a public health concern because of the implications for the mother and infant's health during pregnancy and after birth. The prevalence and factors related to common mental disorders vary globally. Therefore, this study assessed the magnitude and factors associated with common mental disorder among pregnant women attending ANC follow-up in North Wollo Zone, Northeast Ethiopia. Methods: An institutional-based cross-sectional study was conducted in North Wollo, Amhara Region, Northeast Ethiopia. A multistage sampling technique was used to select 777 study participants. The common mental disorder was assessed by using SRQ-20. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Logistic regression analysis was done to identify the independent variables associated with common mental disorders. Independent variables with a p value less than 0.05 were considered significantly associated with CMD. Results: The magnitude of CMD was 18.1% (95% CI: 15.5, 21.0). Factors significantly associated with CMD were the educational level of participants (AOR = 0.17, 95% CI: 0.06, 0.48), husband's educational status (AOR = 11.13, 95%: 4.18, 29.66), unplanned pregnancy (AOR = 2.54, 95% CI: 1.26, 5.09), self-reported complication on the current pregnancy (AOR = 0.11, 95% CI: 0.05, 0.21), self-reported complication during the previous delivery (AOR = 3.38, 95% CI: 1.39, 8.18), undernutrition (AOR = 2.19, 95%: 1.26, 3.81), high psychosocial risk (AOR = 20.55, 95% CI: 9.69, 43.59), having a legal issue (AOR = 2.06, 95%: 1.12, 3.79), and relationship problem (AOR = 7.22, 95% CI: 3.59, 14.53). Conclusions and Recommendation. One in five pregnant women has common mental disorder. Educational status of the participants and their spouses, unplanned pregnancy, self-reported complication during current and previous pregnancy, psychosocial risk, and legal and relationship problems were the main determinants of common mental disorders. Therefore, screening pregnant women for mental disorders and provision of necessary mental health services are recommended to minimize the adverse health outcome of CMD during pregnancy.

Assessing the health consequences of northern Ethiopian armed conflict, 2022.

Armed conflict is a complicated topic with multidimensional impact on population health. This study aimed to assess of the health consequences of the northern Ethiopian conflict, 2022. We used a mixed method study design with a retrospective cross-sectional study supplemented by a qualitative study conducted from May to June 2022. We interviewed 1806 individuals from 423 households and conducted 100 in-depth interviews and focused group discussion. We identified 224 people who self-reported cases of illness (124/1000 people) with only 48 (21%) people who fell ill visited a health institution. We also detected 27 cases of deaths (15/1000 people) during the conflict. The collapse of the health system, evacuation of health personnel, and shortage of medical supplies, and instability with a lack of transportation were consequences of the conflict. The northern Ethiopian conflict has greatly affected the community's health through the breakdown of the health system and health-supporting structures.

Assessment of Place of Delivery and Associated Factors among Pastoralists in Ethiopia: A Systematic Review and Meta-Analysis Evaluation.

Background: Pastoralist communities rely on their livestock for at least 50% of their food supply and source of income. Home births raise the risk of maternal morbidity and death, whereas institutional births lessen the likelihood of difficulties during labor. Around 70% of labors in pastoralist regions of Ethiopia were assisted by traditional birth attendants. Methods: Studies done from January 2004 to January 2023, accessed in PubMed, EMBASE, Medline, and other search engines, were included. PRISMA guidelines and JBI critical appraisal checklist were used to assure the quality of the review. Ten articles were included in this review. Data were extracted with Excel and exported to STATA 16 for analysis. Heterogeneity of literatures was evaluated using I2 statistics and publication bias using the Egger regression asymmetry test and the Duval and Tweedie trim-fill analysis. Statistical significance was declared at p value less than 0.05. Result: The pooled estimate of institutional delivery among the pastoralist community in Ethiopia is 21.2% (95% CI: 16.2-26.1). Husbands who were involved to decide place of delivery (OR = 3.47; 95% CI: 1.61, 7.50), women with good knowledge of MCH services (OR = 2.283; 95% CI: 1.51, 3.44), women who had a positive attitude towards MCH services (OR = 1.69; 95% CI: 0.79, 3.6), availability of health institutions (OR = 2.6; 95% CI: 0.95, 7.20), and women who had an ANC follow-up (OR = 2.78; 95% CI: 2.07, 3.73) were higher institutional delivery prevalence among pastoralist women. Moreover, institutional delivery among women who were educated above the college level was more than two times (OR = 2.56; 95% CI: 1.985, 3.304) higher than among women who were not educated. Conclusion: Pastoralist women in Ethiopia were found to be a disadvantaged group for institutional delivery at national level. Husband involvement, educational level, ANC visit, knowledge and attitude for MCH service, and health facility distance were identified to have significant association with institutional delivery.

Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study.

BACKGROUND: Conflict is a complicated topic with a multidimensional consequences for community health. Its effects have a broad pattern, starting from direct war-related morbidity and mortality caused by bullets and bombs to indirect consequences due to the interruption of the delivery of preventive and curative health services. This study aimed to explore the health consequences of the northern Ethiopian conflict in the North Wollo zone, northeast Ethiopia, in 2022. METHODS: This descriptive qualitative study was conducted from May to June 2022 on six conflict-affected Woredas in the north Wollo zone. A total of 100 purposively selected participants, which included patients, pregnant women, elders, community and religious leaders, and health professionals, were interviewed using IDI and FGD. The data was entered, coded, and analyzed using Open Code version 4.03. Thematic analysis approach employed to conduct the interpretation. Data was presented using descriptive statistics in the form of texts and tables. RESULTS: The findings indicate that the conflict has caused a profound consequence on population health. It has resulted in a wide range of direct and indirect consequences, ranging from war-related casualties, famine, and disruptions of supply chains and forced displacement to instances of violence and rape associated with insecurity. The conflict also caused a breakdown in the health system by causing distraction of health infrastructure, fleeing of health workers and shortage of medication, together with insecurity and lack of transportation, which greatly affected the provision and utilization of health services. Additionally, the conflict has resulted in long-term consequences, such as the destruction of health facilities, interruption of immunization services, posttraumatic stress disorders, and lifelong disabilities. The coping strategies utilized were using available traditional medicines and home remedies, obtaining medications from conflict-unaffected areas, and implementing home-to-home healthcare services using available supplies. CONCLUSION: The Northern Ethiopian conflict has an impact on community health both directly and indirectly through conflict-related causalities and the breakdown of the health system and health-supporting structures. Therefore, this study recommends immediate rehabilitation interventions for damaged health infrastructure and affected individuals.

Successful surgical closure and continence rate of obstetric fistula in Africa: systematic review and meta-analysis.

Background: A female genital fistula is an abnormal connection between a woman's reproductive tract and her urinary tract or rectum. While numerous studies have aimed to determine the success rate of obstetric fistula closure in different health settings, there remains a significant scarcity of data on closure success rates and incontinence rates for various types of fistulas at the regional and sub-regional levels. The success rate reflects the continent's healthcare setup in regard to the World Health Organization standards. Thus, this study aims to determine the success of surgical closure and the continence rate of obstetric fistula in Africa. Methods: This systematic review and meta-analysis review includes studies conducted up to February 2023. Search engines like EMBBASE, Medline, Google, PubMed, Google Scholar, African Journals Online, and ScienceDirect databases were utilized to find articles. The Joanna Briggs Institute critical evaluation checklist was used to evaluate the quality of our review, which was conducted in accordance with PRISMA criteria. Heterogeneity was indicated by a p-value for I2 statistics of less than 0.05. Publication bias was assessed using the Egger regression asymmetry test. Data were entered into Microsoft Excel and analyzed using STATA 16. Result: This review includes 85 studies. A total of 24 countries from East, West, Central, North, and Southern African sub-regions were included. The overall pooled estimated rate of successful obstetric fistula closure is 86.15 (95% CI: 83.88-88.42). Moreover, the pooled estimated rate of successfully closed vesico-vaginal fistulas but with ongoing or residual incontinence (wet) was revealed as 13.41% (95% CI: 11.15-15.68). The pooled estimated rate of successfully closed rectovaginal fistulas and combined VVF and RVF are 91.06% (95% CI: 86.08-96.03) and 62.21% (95% CI: 48.94-75.49), respectively. Conclusions: The rate of successful obstetric fistula closure in Africa is 86.15, which is higher than the WHO target. However, the surgical closure rate of a combined VVF and RVF is 62.2%, which is significantly lower than the WHO target.

Prevalence and factors associated with restless legs syndrome among pregnant women in middle-income countries: a systematic review and meta-analysis.

Introduction: Restless legs syndrome (RLS) is a debilitating condition characterized by uncomfortable sensations in the legs, typically occurring during periods of rest or sleep. It is more prevalent during pregnancy and is linked to sleep disturbances, diminished quality of life, and pregnancy complications. However, previous studies yielded inconsistent findings among pregnant women in middle-income countries. Consequently, this systematic review and meta-analysis sought to determine the pooled prevalence of restless legs syndrome and its associated factors in these populations. Method: A systematic review and meta-analysis was conducted on published studies from middle-income countries until May 2023. The review strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant search terms were used to search for studies in PubMed, MEDLINE, EMBASE, and Google Scholar. Data extraction was performed using the Joanna Briggs Institute tool for prevalence studies. The meta-analysis was conducted using STATA 17 software, and heterogeneity was assessed using the I2 test, while publication bias was evaluated using Egger's test. Forest plots were also used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) using the random-effects model. Result: This review included 22 studies from nine countries with a total of 17, 580 study participants. The overall pooled prevalence of RLS among pregnant women in middle-income countries was 13.82% (95% CI: 13.31, 14.32), and having low hemoglobin level (AOR: 1.68, 95% CI: 1.29, 2.18), history of RLS (AOR: 7.54, 95% CI: 3.02, 18.79), muscle cramps (AOR: 3.58, 95% CI: 1.21, 10.61), excessive day time sleepiness (AOR: 4.02, 95% CI: 1.34, 12.04), preeclampsia (AOR: 2.06, 95% CI: 1.28, 3.30), and taking prophylactic iron supplementation (AOR: 0.59, 95% CI: 0.50, 0.69) were the identified factors associated with it. Conclusion: Generally, nearly one in every eight pregnant women in middle-income countries develop restless legs syndrome during pregnancy. Having low hemoglobin level, a history of RLS, muscle cramps, excessive daytime sleepiness, preeclampsia, and taking prophylactic iron supplementation were the identified factors associated with it. These findings underscore the importance of addressing the identified factors associated with RLS in order to effectively mitigate its occurrence among pregnant women.

Time to recovery from neonatal sepsis and its determinants among neonates admitted in Woldia comprehensive specialized hospital, Northeast Ethiopia: a retrospective cohort study.

Background: Neonatal sepsis is the most serious problem in neonates. It is the leading cause of neonatal death in developing countries, particularly in sub-Saharan Africa. The Ethiopian 2016 Demographic Health Survey report revealed that a high number of neonatal deaths are associated with neonatal sepsis. However, limited studies are available on exposure and time to recovery inferences in Ethiopia. Therefore, this study aimed to assess the time to recovery from neonatal sepsis and its determinants among neonates admitted to Woldia Comprehensive Specialized Hospital (WCSH), Northeast Ethiopia. Methods: A retrospective cohort study was conducted, including 351 neonates, using systematic random sampling at WCSH from 7 to 30 March 2023. The data were entered into Epi data version 4.6 and exported to STATA 14 for analysis. Cox regression was used to identify the determinants of time to recovery from neonatal sepsis, and a variable with a p-value of less than 0.05, was used to declare significant association at a 95% confidence interval. Result: Among 351 neonates with sepsis, 276 (78.63%) recovered, and the median time to recovery was 6 days. Induced labor (AHR = 0.54, 95% CI: 0.369, 0.78) and resuscitation at birth (AHR = 0.7, 95% CI: 0.51, 0.974) were significantly associated with the recovery time of neonatal sepsis. Conclusions and recommendation: The time to recovery from neonatal sepsis is comparable to previous studies' results. The 25th and 75th percentiles were 4 and 8 days, respectively. Health professionals working in the NICU need to pay special attention to neonates born from mothers who had induced labor and those who were resuscitated at birth.

Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study.

BACKGROUND: Advanced maternal age generally denotes age after 35 years during the time of delivery. Despite the fact that being pregnant at any reproductive age is not risk-free, older gravidity usually culminates with adverse outcomes both to the mother and fetus or neonate. This study aimed to determine the association of adverse obstetrical and perinatal outcomes with advanced maternal age pregnancy. The study was conducted in Ayder comprehensive specialized hospital, north Ethiopia, from 2015 to 2017. METHODS: chart review comparative cross-sectional study was employed. Data were retrieved from medical charts of 752 pregnant mothers (376 each for both the study;> 35-year-old and reference group;20-34 year old). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was run to determine the association of independent variables with dependent variables. RESULTS: This study revealed that advanced maternal age pregnancy was significantly associated with pregnancy induced hypertension [AOR 4.15, 95% CI (2.272-7.575), p <  0.001], ante partum hemorrhage [AOR 2.54, 95% CI (1.32-4.91), P = 0.005] & cesarean delivery [AOR 2.722, 95% CI (1.777-4.170), p <  0.001]. Furthermore, advanced maternal age pregnancy was also increasingly associated with adverse perinatal outcomes like preterm delivery [AOR 3.622, 95% CI (1.469-8.930), p = 0.005], low birth weight [AOR 3.137, 95% CI (1.324-7.433), p = 0.009], perinatal death [AOR 2.54, 95% CI (1.141-5.635), p = 0.022] and low fifth minute APGAR score [AOR 7.507, 95% CI (3.134-17.98), p <  0.001]. Notwithstanding this, maternal age was not found to be associated with amniotic fluid disturbances, premature rupture of membranes and post-term pregnancy. CONCLUSIONS: Advanced maternal age is markedly linked with adverse obstetrical and perinatal outcomes. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy. In addition, health care workers need to emphasize on how to improve advanced age mothers' health through the utilization of contraception to reduce pregnancy in this age group.

Determinants of psychoactive substances use among Woldia University students in Northeastern Ethiopia.

BACKGROUND: Psychoactive substance use has become a major public health problem among students in Ethiopian universities. Hence, this study aimed to investigate the magnitude and determinants of psychoactive substances use (khat chewing, alcohol drinking and cigarette smoking) among undergraduate students of Woldia University, Ethiopia. METHODS: Institution based quantitative cross-sectional study was employed on Woldia University students in April 2015. 730 students were included in the study. Data were collected using self-administered questionnaires. EpiData version 3.02 was used to enter data. Then, data were exported to SPSS version 20 for analysis. RESULTS: The lifetime prevalence of alcohol drinking, khat chewing and cigarette smoking among the study students were 33.1, 13 and 7.9%, respectively. Likewise, the current prevalence of alcohol drinking, khat chewing and cigarette smoking was 27.9, 10.4 and 6.4%, respectively. More than half of the surveyed students (59.1%) were introduced to psychoactive substance use by peer pressure. About 66% of the study participants believed that psychoactive substances are important for relaxation, and 19% to relief from stress. Students who were Muslims [adjusted odds ratio (AOR) 3.74, 95% CI (1.57, 8.91)], Oromo ethnic group [AOR 2.63, 95% CI (1.19, 5.81)], ever drunk alcohol [AOR 6.32, 95% CI (2.96, 13.48)] and ever smoked cigarette [AOR: 9.16, 95% CI (4.33, 19.38)] were positively associated with khat chewing. Furthermore, pocket money and ever khat chewing were associated with alcohol drinking and cigarette smoking. CONCLUSION: This study showed that psychoactive substances use is somewhat prevalent among students in Woldia University. Hence, support of religious institutions in providing education aimed at preventing substance use, establishing and strengthening peer educators in the university are important interventions to tackle psychoactive substances use.

Factors associated with prelacteal feeding in North Eastern Ethiopia: A community based cross-sectional study.

BACKGROUND: In spite of the negative impact of prelacteal feeding on the growth and development of children, it is widely practiced in Ethiopia. This study aimed to assess prelacteal feeding practices and associated factors among mothers of children aged less than 24 months in the North Wello zone. METHODS: A quantitative community based cross-sectional study was employed during March 2015. Eight hundred and forty four (844) mother-child pairs were selected by multi-stage sampling technique. Data were collected by face-to-face interview. Descriptive statistics, binary and multiple logistic regression analyses were employed to identify factors associated with prelacteal feeding practice. Variables with a p-value <0.05 were identified as statistically significant factors. RESULTS: The prevalence of prelacteal feeding was 11.1 % (95 % confidence interval [CI]: 9.0, 13.0). Colostrum discarding (adjusted odds ratio [AOR]: 8.7; 95 % CI (3.8, 20.1)) and lack of counseling about breastfeeding (AOR: 2.6; 95 % CI 1.27, 5.4) were the factors associated with prelacteal feeding. The major reasons stated for providing prelacteal feeds were "culture" and "do not have enough milk". CONCLUSION: Prelacteal feeds are offered to nearly one child in every ten in the North Wello zone. Colostrum removal and lack of counseling on breastfeeding at antenatal care visit are important positive predictors of prelacteal feeding practice. Awareness of the risks associated with prelacteal feeding, promotion of counseling on breastfeeding and the health benefit of colostrum during antenatal care visits are recommended interventions to reduce prelacteal feeding practices in the study areas.