Effects of therapeutic hypothermia on death among asphyxiated neonates with hypoxic-ischemic encephalopathy: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Hypoxic perinatal brain injury is caused by lack of oxygen to baby's brain and can lead to death or permanent brain damage. However, the effectiveness of therapeutic hypothermia in birth asphyxiated infants with encephalopathy is uncertain. This systematic review and meta-analysis was aimed to estimate the pooled relative risk of mortality among birth asphyxiated neonates with hypoxic-ischemic encephalopathy in a global context. METHODS: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search randomized control trials from electronic databases (PubMed, Cochrane library, Google Scholar, MEDLINE, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and meta register of Current Controlled Trials (mCRT)). The authors extracted the author's name, year of publication, country, method of cooling, the severity of encephalopathy, the sample size in the hypothermic, and non-hypothermic groups, and the number of deaths in the intervention and control groups. A weighted inverse variance fixed-effects model was used to estimate the pooled relative risk of mortality. The subgroup analysis was done by economic classification of countries, methods of cooling, and cooling devices. Publication bias was assessed with a funnel plot and Eggers test. A sensitivity analysis was also done. RESULTS: A total of 28 randomized control trials with a total sample of 35, 92 (1832 hypothermic 1760 non-hypothermic) patients with hypoxic-ischemic encephalopathy were used for the analysis. The pooled relative risk of mortality after implementation of therapeutic hypothermia was found to be 0.74 (95%CI; 0.67, 0.80; I2 = 0.0%; p<0.996). The subgroup analysis revealed that the pooled relative risk of mortality in low, low middle, upper-middle and high income countries was 0.32 (95%CI; -0.95, 1.60; I2 = 0.0%; p<0.813), 0.5 (95%CI; 0.14, 0.86; I2 = 0.0%; p<0.998), 0.62 (95%CI; 0.41-0.83; I2 = 0.0%; p<0.634) and 0.76 (95%CI; 0.69-0.83; I2 = 0.0%; p<0.975) respectively. The relative risk of mortality was the same in selective head cooling and whole-body cooling method which was 0.74. Regarding the cooling device, the pooled relative risk of mortality is the same between the cooling cap and cooling blanket (0.74). However, it is slightly lower (0.73) in a cold gel pack. CONCLUSIONS: Therapeutic hypothermia reduces the risk of death in neonates with moderate to severe hypoxic-ischemic encephalopathy. Both selective head cooling and whole-body cooling method are effective in reducing the mortality of infants with this condition. Moreover, low income countries benefit the most from the therapy. Therefore, health professionals should consider offering therapeutic hypothermia as part of routine clinical care to newborns with hypoxic-ischemic encephalopathy especially in low-income countries.

Prevalence of Underweight and Its Associated Factors among Reproductive Age Group Women in Ethiopia: Analysis of the 2016 Ethiopian Demographic and Health Survey Data.

Background: Underweight is defined as being below the healthy weight range. Underweight in reproductive age group women not only affects women but also increases the risk of an intergenerational cycle of malnutrition and child mortality. Various factors are linked with underweight among women. However, studies on the prevalence of underweight and its associated factors among women are limited in Ethiopia. Hence, this study aimed to assess the prevalence of underweight and its associated factors among reproductive age group women in Ethiopia. Methods: For this study, data were drawn from the 2016 Ethiopian demographic and health survey (EDHS). From the total, 15,683 women participants of the 2016 EDHS; a subsample of 2,848 participants aged 15-49 years who had a complete response to all variables of interest were selected and utilized for analysis. Data were analyzed using SPSS version 20 software program. Pearson's chi-squared test was used to assess the frequency distribution of underweight and is presented with different sociodemographic characteristics. Logistic regression models were applied for analysis. A two-sided p value of less than 0.05 was used to declare a statistically significant association between the independent variables and underweight among women. Results: The prevalence of underweight among reproductive age group women in Ethiopia was 17.6%. The majority, 78.3% of underweight women, were rural dwellers. The odds of being underweight was higher among the young aged women, among those residing in rural areas, in those with higher educational status, and in those who have one or more children. On the other hand, the odds of underweight among respondents living in Benishangul, SNNPR, and Addis Ababa were less compared to those living in Dire Dawa. Similarly, the odds of underweight among participants with a higher level of husband or partner educational status and among those who chew Khat were less compared to their counterparts. Conclusion: Underweight among reproductive age group women in Ethiopia is still a major public health problem, particularly among rural dwellers. Underweight was significantly associated with different sociodemographic variables. Hence, context-based awareness creation programs need to be designed on the prevention methods of underweight in Ethiopia, giving especial emphasis to those residing in rural areas.

Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data.

BACKGROUND: Globally, the prevalence of overweight and obesity is escalating, particularly among women and wealthier people. In many developed countries, overweight and obesity are more prevalent in persons with lower socioeconomic status. In contrast, studies in developing countries have reported a higher prevalence rate of overweight and obesity among women with higher educational status. Hence, this study aimed to assess the association between education and the prevalence of overweight and obesity among reproductive age group women in Ethiopia. METHODS: This cross-sectional study was done based on the 2016 Ethiopian demographic and health survey (EDHS) data. From the total 15,683 women participants of the 2016 EDHS, 2848 reproductive age group women aged 15-49 years old who had a complete response to all variables of interest were selected and retained for analysis. Data were analyzed using SPSS version 20 software program. Both descriptive and logistic regression models were used for analysis. RESULTS: The prevalence of overweight and obesity among the study participants was 11.5 and 3.4% respectively. The combined prevalence of overweight and obesity was 14.9%. From the total participants who are overweight and, or obese, majority, 83.3% were urban dwellers and the remaining 16.7% were rural dwellers. Education was positively associated with overweight and obesity among women. Besides, increased age, region, living in urban areas, being in rich quintile, increased frequency of watching television, and frequency of using internet were significantly associated with the odds of being overweight and obese among reproductive age group women in Ethiopia. CONCLUSIONS: The prevalence of overweight and obesity among reproductive age group women in Ethiopia is increasing compared to previous studies. Education was found to be a risk factor for overweight and obesity among women. Hence, context based interventions on the prevention and control methods of overweight and obesity are required.