Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity.

BACKGROUND: Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE: This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS: MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS: All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION: There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.

Knowledge, Attitude and Associated Factors Towards Vasectomy Among Married Men in Arba Minch Town, Southern Ethiopia, 2021; A Cross-Sectional Study.

Background: Vasectomy is a safe and effective permanent contraceptive method. In Ethiopia, this method underutilized since the focus has been on contraceptive methods available for women rather than men. Few studies have examined this method in Ethiopia so far, so it is important to note that there is a lack of data about the method in the study area regarding married men's knowledge and attitudes toward vasectomy. Methods: A community-based cross-sectional study conducted from May 2 to June 2, 2021, at Arba Minch town. A simple random sampling technique used to select 624 study participants. Data collected via the face-to-face interview technique using a semi-structured and pretested questionnaire. Data entered in EpiData 3.1, cleaned, and analyzed using SPSS for Windows version 25.0. Descriptive statistics and bivariable and multivariable logistic regression analyses were performed. An adjusted odds ratio (AOR) with 95% CI and a p-value < 0.05 estimated to identify statistically significant variables associated with knowledge and attitude towards vasectomy. Results: From the total of 624 study subjects, 600 had completed the questionnaire, giving a response rate of 96.2%. From those who heard about vasectomy (36.8%), only 60.6% of men had good knowledge, and 48.4% had a positive attitude towards vasectomy. Men's knowledge of vasectomy was significantly associated with college or university attendance (AOR = 4.05, 95% CI: 1.720-9.521), age 31-40 years (AOR = 2.308, 95% CI: 1.081-4.929), and age ≥41 years (AOR = 2.671, 95% CI: 1.159-6.156). Age ≥41 years (AOR=4.735 95% CI 2.015-11.129), age of last child (AOR=3.868 CI 1.554-9.632) and discussing family planning with wife (AOR=2.821 95% CI 1.559-5.105) were significantly associated with attitude of men towards vasectomy. Conclusion: In this study area, six out of ten and half of the married men had good knowledge and a positive attitude towards vasectomy, respectively.

Benefits, barriers and enablers of maternity waiting homes utilization in Ethiopia: an integrative review of national implementation experience to date.

BACKGROUND: Though Ethiopia has expanded Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, the utilization rate is low. To maximize the use of MWH, policymakers must be aware of the barriers and benefits of using MWH. This review aimed to describe the evidence on the barriers and benefits to access and use of MWHs in Ethiopia. METHODS: Data were sourced from PubMed, Google Scholars and Dimensions. Thirty-one studies were identified as the best evidence for inclusion in this review. We adopted an integrative review process based on the five-stage process proposed by Whittemore and Knafl. RESULTS: The key themes identified were the benefits, barriers and enablers of MWH utilization with 10 sub-themes. The themes about benefits of MWHs were lower incidence rate of perinatal death and complications, the low incidence rate of maternal complications and death, and good access to maternal health care. The themes associated with barriers to staying at MWH were distance, transportation, financial costs (higher out-of-pocket payments), the physical aspects of MWHs, cultural constraints and lack of awareness regarding MWHs, women's perceptions of the quality of care at MWHs, and poor provider interaction to women staying at MWH. Enablers to pregnant women to stay at MWHs were availability of MWHs which are attached with obstetric services with quality and compassionate care. CONCLUSION: This study synthesized research evidence on MWH implementation, aiming to identify benefits, barriers, and enablers for MWH implementation in Ethiopia. Despite the limited and variable evidence, the implementation of the MWH strategy is an appropriate strategy to improve access to skilled birth attendance in rural Ethiopia.

Assessment of Knowledge About Human Papillomavirus Vaccination Among Primary School Girls in Arba Minch Town, South Ethiopia, 2020 an Institution-Based Cross-Sectional Study.

Purpose: This study aimed to determine the knowledge of human papillomavirus vaccination (PHV) and associated factors among primary school girls in Arba Minch town, South Ethiopia, in 2020. Hence, the levels of knowledge towards the HPV vaccination of girls were assessed and recommended to the concerned bodies. Clinically, this study could increase the acceptance of HPV vaccination after the intervention of the concerned bodies to improve adolescents' knowledge levels. As a result, it could decrease the incidence of cervical cancer. Socially, this study may increase the research involvement of adolescents, communities, and stakeholder groups. Patients and Methods: A school-based cross-sectional study involving 537 female students was conducted on January 24, 2020. The study participants were selected by a simple random sampling technique. A pre-tested questionnaire was used to collect the data. The logistic regression model was used to identify the statistically significant variables for knowledge of the human papillomavirus vaccination. Results: The overall knowledge level of the participants in this study was 71.7%. Their main source of information is social media (41.74%), followed by medical staff (29.69%). Age ≥15 years old, AOR =3.74, 95% CI (2.20_6.37), P-value <0.001, grade level of 7 and 8, AOR =3.98, 95% CI (2.40_6.58), P-value <0.001, mother's educational status of secondary and more than secondary, and father's educational status of more than secondary, AOR=13.60, 95% CI (5.69_32.53) P-value <0.001, 22.27, 95% CI (8.23_60.30), P-value<0.001, 2.18, 95% CI (1.09_4.35), P-value 0.03, respectively, and access to HPV vaccination information (AOR = 8.65, 95% CI (3.92_19.07), P-value 0.001) were associated with overall knowledge. Conclusion: Nearly three-fourths of the study participants were knowledgeable about human papillomavirus vaccination. Knowledge about the human papillomavirus vaccination shows a positive association with age, education level, parents' educational status, and access to information sources.

Factors associated with antenatal exercise in Arba Minch town, Southern Ethiopia: A community-based cross-sectional study.

BACKGROUND: Many health risks in pregnant women and their foetuses can be reduced by practicing antenatal exercise. However, the adequate practice of antenatal exercise among pregnant women is low in Ethiopia. Therefore, this study aimed to assess the practice of antenatal exercise and its associated factors among pregnant women in Arba Minch town. METHODS: A community-based cross-sectional study design was conducted. Data were collected by using a structured questionnaire from 422 pregnant women selected by a simple random sampling technique. Descriptive statistics were computed and a binary logistic regression model was fitted. In multivariable logistic-regression adjusted odds ratio (AOR) with 95% confidence intervals were used to determine the strength of associations. The significance level was declared at a p-value < 0.05. RESULTS: Among 410 participants, 32.9% (95% CI 28%-37%) adequately practiced antenatal exercise. Factors negatively associated with an adequate antenatal exercise were husband's primary school level [Adjusted odds ratio (AOR) = 0.3, (95% CI: 0.1, 0.7)], history of miscarriage [AOR = 0.3, (95% CI: 0.1, 0.7)], inadequate knowledge [AOR = 0.2, (95% CI: 0.1, 0.3)], and unfavorable attitude [AOR = 0.3, (95% CI 0.2, 0.5)]. Whereas, factors positively associated with an adequate antenatal exercise were employment status of women [AOR = 4.8, (95% CI: 1.8, 13.1)], and a practice of regular exercise before current pregnancy [AOR = 1.9, (95% CI: 1.1, 3.2)]. CONCLUSIONS: The findings of this study indicated that adequate practice of antenatal exercise was found to be low. Appropriate measures should be taken to improve the husband's educational level, mother's occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given to those with a history of miscarriage and women should be encouraged to practice regular exercise before pregnancy.

Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis.

The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.

The Effect of Lifestyle Intervention on Diabetes Prevention by Ethnicity: A Systematic Review of Intervention Characteristics Using the TIDieR Framework.

Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (≥12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.

Fear of childbirth among pregnant women attending antenatal care in Arba Minch town, southern Ethiopia: a cross-sectional study.

BACKGROUND: Fear of childbirth is one of the life challenges the women encounter during pregnancy. It is an important source of distress for the women and their families and also increases the odds of obstetric complications during childbirth. The aim of this study was to assess the magnitude of fear of childbirth and associated factors among pregnant women attending antenatal care at public health facilities in Arba Minch town, southern Ethiopia. METHODS: Institution-based cross-sectional study was carried out among pregnant women who attended antenatal care at public health facilities in Arba Minch from November 1st - 30th 2019. A systematic random sampling technique was employed to include the participants. Data were collected through a face-to-face interview by using a structured and pretested questionnaire. Wijma Delivery Expectancy Questionnaire was used to score fear of childbirth. Epi Data version 3.1 and Statistical Package for the Social Sciences version 25.0 software were used for data management. Descriptive and analytic analyses were done and statistical significance was declared at a p-value < 0.05 and 95% confidence level in multivariable analysis. RESULTS: A total of 387 pregnant women have participated in this study. Forty (10.3%) of the pregnant women had a low degree fear, 154(39.8%) had a moderate degree fear, 98(25.3%) had a high degree fear, and 95(24.5%) had severe degree fear of childbirth. Unplanned pregnancy (AOR = 2.30, 95% CI: 1.12, 4.74), current pregnancy-related complications (AOR = 6.24, 95% CI: 2.72, 14.29), and poor social support (AOR = 1.93, 95%CI: 1.01, 3.68) were factors significantly associated with severe degree fear of childbirth. CONCLUSIONS: Almost three-fourth of the pregnant women in this study area had moderate to severe degree fear of childbirth. Tailoring counseling during antenatal care visits is needed to address those women who are at a high risk of considerable childbirth fear and its health consequences.

Utilization of companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia.

BACKGROUND: Companionship during delivery is an important feature of compassionate and respectful maternity care. It has a positive impact on delivery and birth outcomes. In low resource countries like Ethiopia lack of companionship discourages women from accessing facility-based delivery care. Therefore, this study aimed to assess the utilization of companionship during delivery and associated factors. METHODS: Health facility-based cross-sectional study design was done from October to November 2019. Interviewer administered questionnaires were used to collect the data from 418 study participants. The data were entered with Epi data version 4.4 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for analysis. Binary logistic regression was done. Statistical significance was declared at P- values < 0.05 with a 95% confidence level. RESULTS: The finding of the study showed that only 13.8% of mothers utilize companionship during delivery. Variables such as having a desire to have companionship during delivery in the health facilities (AOR = 5.17, CI 95% 2.63, 10.16), having complication during the labor and delivery (AOR = 3.48, CI 95%, 1.81, 6.70), and being primipara (AOR = 2.05, CI 95% 1.09, 3.87) were the independent factors associated with companionship utilization. CONCLUSIONS: The finding of the study showed that the utilization of companionship during delivery was low. Permitting women to have a companion of choice during labor and childbirth can be a cost-effective intervention to improve the quality of maternity care, facing complications during delivery, having a desire to have companionship during delivery and primiparous women were more likely to utilize companionship. To improve this low utilization of companionship institutions and care providers should provide information about companionship during antenatal care attendance. Besides, there is a need for clear guidelines to govern the practice of companions.

The Burden of Malnutrition among Adults Residing in Arba Minch Health and Demographic Surveillance Site (HDSS): A WHO STEPS Survey.

BACKGROUND: Malnutrition is one of the main underlying risk factors for the deaths due to different diseases. The aim of this study was to assess the prevalence and factors associated with underweight and overweight among adults residing in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. METHODS: A community-based cross-sectional survey was conducted from April to June 2017. The data collection procedures and 3,368 calculated sample size were based on the World Health Organization (WHO) STEPwise approach to Surveillance guideline. Using the surveillance data of Arba Minch HDSS, simple random sampling technique was implemented to identify individuals for the study. To assess the presence of association, the multinomial logistic regression model was used. RESULTS: The mean (SD) body mass index of the participants was 21.5 4.90 kg/m2. From 3,346 participants, 23.3% of the study participants were affected by malnutrition (10.8% and 12.5% were overweight and underweight, respectively). The prevalence of underweight was increased significantly among individuals aged 45-54 years and 55-64 years (adjusted odds ratio (AOR) 1.70 and 1.93, respectively) compared with those who were 25-34 years old. Belonging to households with higher wealth index quintile (2nd quintile AOR is 0.58 and 4th quintile AOR is 0.66) has decreased the chance of adult individual to be underweight compared with the poorest households. On the other hand, the prevalence of overweight was significantly higher among females (AOR 1.60), urban residents (AOR 1.72), those with formal education (primary AOR 1.89 and secondary and above AOR 1.94), and higher wealth index (5th quintile AOR 1.87). CONCLUSION: One in five adult individuals was malnourished in the study area. The double burden of malnutrition at the population level is becoming a challenge for this community, as both underweight and overweight are becoming prevalent. Sex, age, residency, educational status, current tobacco use, occupation, and wealth index were identified as important determinates of under- and overweight.

Prevalence and factors associated with neonatal hypothermia on admission to neonatal intensive care units in Southwest Ethiopia - A cross-sectional study.

INTRODUCTION: Neonatal hypothermia is one of the main underlying factors associated with neonatal deaths. OBJECTIVE: The objective of this study was to assess the prevalence and factors associated with neonatal hypothermia on admission to neonatal intensive care units in Southwest Ethiopia. METHODS: Institution-based cross-sectional study design was employed between February to September 2017 at intensive care units of Arba Minch and Jinka General Hospitals. All neonates admitted to the two neonatal intensive care units during the study period were included in the study. Data were collected by four nurses who were working in the units of the hospitals through semi-structured pre-tested questionnaire and checklist. Multi-variable logistic regression was used to analyze the relationship between the dependent and independent variables using odds ratio with a confidence interval of 95% and a p-value of 0.05. RESULTS: The prevalence of neonatal hypothermia on admission to the neonatal intensive care units in this study area was 50.3%. Admission weight below 2500 gm. (AOR = 3.61, 95% CI: 2.10, 6.18), delay in initiation of breastfeeding (AOR = 2.42, 95% CI: 1.45, 4.02), early bathing (AOR = 2.63, 95% CI: 1.23, 5.63), admissions during cold season (AOR = 1.72, 95% CI: 1.04, 2.84), and presence of obstetrical complication(s) during pregnancy/labor (AOR = 2.46, 95% CI: 1.07, 5.66) were factors significantly associated with hypothermia on admission to the neonatal intensive care units. CONCLUSIONS: The prevalence of neonatal hypothermia on admission to the intensive care units was high. There is a need to create awareness among the community members about the dangers of early bathing and late initiation of breastfeeding. It is also important to give attention to the newborns of mothers with obstetric complications, low-birth-weight babies and babies delivered during the cold season.

Disrespect and abuse of women during childbirth in public health facilities in Arba Minch town, south Ethiopia - a cross-sectional study.

INTRODUCTION: Disrespect and abuse of women during childbirth is one of the deterring factors to skilled childbirth utilization, especially in low and middle-income countries. OBJECTIVE: The objective of this study was to assess the prevalence of women's disrespect and abuse during childbirth in public health facilities in Arba Minch town, south Ethiopia. METHODS: Institution-based cross-sectional study design was employed at all public health institutions in Arba Minch town, south Ethiopia. A systematic random sampling method was used to include 281 women who had given birth at public health institutions between January 01 and February 28, 2017. Data were collected through face to face interview by four data collectors and they were supervised by the principal investigator during the entire period of data collection. A semi-structured pretested questionnaire was used to collect the data. Epi info version 7.1.2.0 and SPSS version 24 were used to enter and analyze the data, respectively. RESULTS: The overall prevalence of non-respectful care was 98.9%. The women's right to information and informed consent was the most frequently violated right with a prevalence of 92.5% (95% CI: 90.9, 94.1) followed by non-dignified care (36.7, 95% CI: 34.9, 38.5), physical abuse (29.5%, 95% CI: 24.2, 34.8), discrimination (18.1%, 95% CI: 13.6, 22.6), non-confidential care (17.1%, 95% CI: 12.7, 21.5) and abandonment of care (4.3%, 95% CI: 3.1, 5.5). Rural residence, giving birth in the hospital, having no or low educational status and giving birth by cesarean route were factors significantly associated with specific women's rights violations. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of women's disrespect and abuse during childbirth at the health care facilities in this study area is very high. Therefore, health managers need to work hard to tackle the problem.