Does Combining Antenatal Care Visits at Health Posts and Health Centers Improve Antenatal Care Quality in Rural Ethiopia?

Background: Even though quality maternal care is crucial for the well-being of women and their newborns, the inferior quality of antenatal care in rural Ethiopia is a timely concern. This study aimed to investigate the effects of combining antenatal care visits at health posts and health centers on improving antenatal care quality in rural Ethiopia. Methods: Using the 2019 Ethiopia Health Extension Program assessment done by MERQ, we extracted and analyzed the survey responses of 2,660 women who had received at least one antenatal visit from a primary health care unit. We measured the cumulative count of quality of antenatal care using the Donabedian model. To model the differences in the quality of antenatal care at health posts and health centers, we used zero-truncated Poisson regression and reported incidence risk ratios with their 95% confidence intervals. Results: The quality of antenatal care increased by 20% (adjusted IRR= 1.20 [1.12-1.28]) when antenatal care reception was mixed at health posts and health centers, compared to those who received all antenatal care only from health posts. Quality differences based on socioeconomic status and setting variations were observed as predictors of quality of care, even if women received antenatal care at both health posts and health centers. Conclusions: Combining antenatal care provision from health posts and health centers should be sustained as one of the antenatal care quality improvement strategies in rural parts of Ethiopia while ensuring the equitable provision of quality care across socioeconomic groups and between agrarian and pastoral settings.

Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis.

Background: Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes. Methods: Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Results: Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I2 = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07-21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14-0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34-0.77) were found to have significant association with CKD. Conclusion: The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.

Knowledge, Attitude and Practice Toward Corona virus Infection Among Pregnant Women Attending Antenatal Care at Public Hospitals in Three Wollega Zones, Ethiopia.

BACKGROUND: Pregnancy is an immune-suppressed state which makes pregnant women generally more susceptible to COVID-19 infection and severe illness. Extensive precautions have been recommended to avoid exposure to the virus. Knowledge and attitude toward the disease play an integral role in readiness to accept public health measures. This study aimed to assess the knowledge, attitude and practice towards COVID-19 among pregnant women attending antenatal clinics in three Wollega zones, Ethiopia. METHODS: Institution-based cross-sectional study was employed among 415 pregnant women attending antenatal care at public hospitals in three Wollega zones, Ethiopia from July to August 2020. The data were collected using an interviewer-administered structured questionnaire. The level of knowledge was assessed using 12 multiple choice questions; the score of above or equal to mean was considered as adequate knowledge. Binary logistic regression was performed and the adjusted odds ratio with P-value ≤0.05 at 95% CI was taken as statistically significant. RESULTS: This study indicates that more than two-thirds (75.4%; 95% CI: 71.1-79.3%) and 43.6% of the pregnant women had adequate knowledge and good practice about the coronavirus pandemic, respectively. The pregnant women who attended secondary school and above and were urban residents were more likely to have good knowledge, AOR = 2.99 (1.7-5.0) and 1.6 (1.2-2.7), respectively. Maternal age ≤ 25 yearsand being an urban resident were the two predictors of good practice of preventive measures, AOR = 1.7 (1.2-2.6) and 2.3 (1.3-4.0), respectively. CONCLUSIONS AND RECOMMENDATIONS: The target population demonstrated acceptable knowledge and poor practice toward COVID-19. Health-care providers should give more attention to educating pregnant women at any point of contact; legal enforcement should be implemented to improve practice of preventive measures. Special consideration should be given to those who are from rural areas, and to less-educated pregnant women.

Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia.

BACKGROUND: Surgical site infection (SSI) is a serious public health problem due to its impacts on maternal morbidity and mortality and it can have a significant effect on quality of life for the patient. However, little has been studied regarding the magnitude and factors associated with SSI among women underwent cesarean delivery (CD) in study area. Therefore, the aim of this study was to assess the magnitude and factors associated with SSI among women underwent cesarean delivery in Nekemte Town Public Hospitals 2020. METHODS: An institution based cross-sectional study was conducted from January 1/2018 to January 1/2020. A simple random sampling technique was employed to select 401 patient cards from all records women underwent CD from January 1/2018 to January 1/2020. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A logistic regression model was used to determine the association of independent variables with the outcome variable and adjusted odds ratios (AOR) with 95% confidence interval was used to estimate the strength of the association. RESULTS: Three hundred eight two (382) cards of women were selected for analysis making a response rate of 95.2%. The mean (±SD) age of the mothers was 25.9 (±4.8) years. The prevalence of SSIs was 8.9% (95% CI: 6.03, 11.76). Age > 35 years (AOR = 5.03, 95% CI:1.69, 14.95), pregnancy-induced hypertension (AOR = 5.63, 95%CI:1.88, 16.79), prolonged labor (AOR = 4.12, 95% CI:1.01, 32.19), receiving general anesthesia (AOR = 3.96 95% CI:1.02, 15.29), and post-operative hemoglobin less than 11 g/dl (AOR = 4.51 95% CI:1.84, 11.07) were significantly associated with the occurrence of SSI after cesarean delivery. CONCLUSIONS AND RECOMMENDATIONS: The magnitude of post CD SSI in this study was comparable with the sphere standards of CDC guidelines for SSI after CD. Concerned bodies should give due attention the proper utilization of partograph to prevent prolonged labor, and provision of iron folate to increase the hemoglobin level of pregnant mothers in all health institution. In addition, we would recommend the use of spinal anesthesia over general anesthesia.

Postpartum depression and associated factors among postpartum women in Ethiopia: a systematic review and meta-analysis, 2020.

INTRODUCTION: The postpartum period is recognized as a high-risk period for the development of various mood disorders like postpartum depression. Globally, postnatal depression is a serious public health problem that has a negative impact on the mother's health and child development, especially in developing countries. In Ethiopia, even though there are different primary studies conducted on postpartum depression, there is no nationally representative evidence. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence and associated factors of postpartum depression in Ethiopia. METHODS: Published and unpublished articles from various electronic databases and digital libraries were accessed. This systematic review included studies that were conducted on the magnitude and factors associated with postpartum depression among postnatal women in Ethiopia. A random-effect model was used to estimate the pooled magnitude of postpartum depression with a 95% confidence interval (CI). Inverse variance (I2) was used to visualize the presence of heterogeneity, and forest plot was used to estimate the pooled magnitude of postpartum depression. Publication bias was assessed by funnel plots and Egger's statistical tests. A meta-regression and subgroup analysis were computed to minimize underlying heterogeneity. RESULT: Initially, a total of 764 studies were accessed. Twenty-eight full articles were assessed for eligibility criteria, of which twelve studies fulfilled inclusion criteria were included in the final meta-analysis. The overall pooled magnitude of postpartum depression was 22.89% (95% CI 17.75%, 28.03%) with the lowest (12.20%) and highest (33.82%) in the Southern nations region. Unplanned pregnancy, domestic violence, lack of social support, previous history of depression, infant loss, and dissatisfaction in marriage showed a statistically significant association with postpartum depression. CONCLUSIONS: In the current analysis, the prevalence of postpartum depression was high as compared with other developing countries. Routine screening of mothers in the postpartum period and integrating mental health with maternal health care is highly recommended.

Predictors of health-related quality of life among patients with diabetes on follow-up at Nekemte specialised Hospital, Western Ethiopia: a cross-sectional study.

OBJECTIVE: To assess health-related quality of life (HRQoL) and its predictors among patients with diabetes on follow-up at Nekemte Specialised Hospital in Western Ethiopia. DESIGN, SETTING AND PARTICIPANTS: This facility-based cross sectional study was conducted among 224 patients with diabetes mellitus (types I and II) on follow-up at one of the public hospitals in western Ethiopia. Respondents were selected by systematic random sampling and interviewed with the aid of a questionnaire. MAIN OUTCOME MEASURED: HRQoL was measured by using the Medical outcomes study 36-item Short Form (SF-36) Health Survey from 15 April to 5 June 2019. A structured questionnaire was used for data collection from participants selected by systematic random sampling. Multiple linear regression was used for the final model. RESULT: A total of 215 patients with diabetes consented and completed the study, giving a response rate of 96%. The mean score of the overall HRQoL of the study participants was 50.3±18.1. The highest mean score was obtained in the physical functioning domain and the lowest mean score in the general health domain. Age, education status, history of smoking, feeling of stigmatisation and body mass index were inversely associated with the overall HRQoL. Gender (male), marital status (currently married), absence of comorbidity and absence of chronic complications related to diabetes mellitus were positively associated with overall HRQoL. CONCLUSION: The overall HRQoL of patients with diabetes on follow-up at the study area was found to be moderate. General health, mental health, bodily pain and vitality were the most affected domains. Both the mental and physical components need to be considered when caring for the patients with diabetes on follow-up beyond provision of treatment.

Poor nutrition for under-five children from poor households in Ethiopia: Evidence from 2016 Demographic and Health Survey.

BACKGROUND: Ethiopia is commonly affected by drought and famine, and this has taken quite a toll on citizens of the country, particularly the under-five children. Undernutrition among under-five children in Ethiopia is a prominent public health concern, and it lacked attention for decades. However, the government of Ethiopia, together with other stakeholders, committed to overcoming the impact of malnutrition through the transformational plan. Here we show the magnitude of undernutrition among under-five children and the factors predicting the achievement of global nutrition targets set for 2025 at the World Health Assembly. METHODS: Ethiopian Demographic and Health Survey (EDHS) 2016 was used for this study. A total of 9494 child-mother pairs were included in this analysis. The nutritional status indicators (Height-for-age, Weight-for-height and Weight-for-age) of children were measured and categorized based on the World Health Organization child growth standards. A multilevel logistic regression model adjusted for clusters and sampling weights were used to identify factors associated with stunting, underweight, and wasting. The independent variables were assessed by calculating the odds ratios with 95% confidence interval (CI). RESULT: The prevalence of stunting was 38.3% (95% CI: 36.4% to 40.2%), under-weight 23.3% (95%CI: 21.9% to 24.9%) and wasting 10.1% (95%, CI: 9.1% to 11.2%). Sex of the child (male), children older than 24 months, recent experience of diarrhea, household wealth index (poorest), and administrative regions (Tigray, Amhara and developing regions) had a higher risk of undernutrition. On the other hand, children born from overweight mothers and educated mother (primary, secondary or higher) had a lower risk of undernutrition. CONCLUSION: The burden of undernutrition is still considerably high in Ethiopia. Implimentation of strategies and policies that focus on improving the socioeconomic educatiional status of the community need to be sustained. Generally, actions targeted on factors contributing to undernutrition among under-five children demands immediate attention to achieve national and global nutrition target.