Safe Motherhood: Severe maternal morbidity and mortality in eastern Ethiopia

Het doel van dit proefschrift was om de frequentie van en factoren geassocieerd met ernstige maternale morbiditeit en mortaliteit in Oost-Ethiopië te beoordelen. Het omvatte studies naar de toepasbaarheid van de WHO-criteria voor het identificeren van ernstige maternale morbiditeit en het suggereren van aanpassingen om deze in sub-Sahara Afrika te vergroten. Bovendien bevat het bevindingen over de prestaties van de aangepaste tool in het oosten van Ethiopië.Met de wereldwijde vermindering van het aantal maternale sterftes, is de behoefte aan onderzoek naar vrouwen met ernstige complicaties tijdens de zwangerschap en de bevalling toegenomen. Dergelijke studies leden aan het gebrek aan uniforme identificatiecriteria tot de publicatie van de WHO MNM-tool van 2009. Helaas waren deze criteria moeilijk te gebruiken in verschillende low-resource settings en ontstond de behoefte om de criteria aan de lokale context aan te passen. Uit een raadpleging van deskundigen op dit gebied is een nieuwe tool voorgesteld. Het aangepaste hulpmiddel functioneerde goed bij het identificeren van gevallen van ernstige morbiditeit en sterfgevallen in twee ziekenhuizen in Oost-Ethiopië. De tool ving ook een aanzienlijk aantal gevallen niet geïdentificeerd door de WHO-criteria. Bovendien was het aantal doodgeborenen en vroege neonatale sterftes hoog onder vrouwen in de WHO-groep. Dit houdt in dat strategieën voor het verbeteren van de gezondheid van moeders en kinderen de aangepaste criteria moeten gebruiken. Naast het bestuderen van de omvang van ernstige maternale morbiditeit en sterfgevallen, is het belangrijk om de zorg voor deze vrouwen grondig te evalueren, wil men een zinvolle verbetering van de kwaliteit van de zorg bereiken.The objective of this thesis was to assess the frequency of and factors associated with severe maternal morbidity and mortality in eastern Ethiopia. It included studies reviewing applicability of the World Health Organization (WHO) criteria for identifying severe maternal morbidity, and suggest adaptations to increase its applicability in sub-Saharan Africa. Moreover, it contains findings about the performance of the adapted tool in eastern Ethiopia. With the global reduction in number of maternal deaths, the need to study woman who with severe complications during pregnancy and childbirth has emerged. Such studies suffered from lack of uniform identification criteria until the publication of the 2009 WHO MNM tool. Unfortunately, these criteria were difficult for use in several low-resource settings and a need to adapt the criteria to the local context emerged. From a consultation of experts in the field, a new tool was suggested. The adapted tool functioned well in identifying cases of severe morbidity and deaths in two hospitals in eastern Ethiopia. The tool also captured significant number of cases not identified by the WHO criteria. In addition, proportion of stillbirth and early neonatal deaths was high among woman in the WHO group. This implies that strategies for improving maternal and child health should use the adapted criteria. In addition to studying the magnitude of severe maternal morbidity and deaths, it is important to thoroughly evaluate care provided to these women if meaningful improvement in quality of care is to be achieved

The prevalence of infertility and factors associated with infertility in Ethiopia:Analysis of Ethiopian Demographic and Health Survey (EDHS)

Background Despite having a high fertility rate, low-resource countries are also home to couples with infertility problems. Although many couples are suffering from the psychological impacts of infertility, its level and determinants are not adequately known. The main objective of this study is to assess the prevalence and factors associated with infertility among couples in Ethiopia using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. Method The study employed a cross-sectional study design extracting variables from the 2016 EDHS. The study included all married or cohabitating women aged 15 to 49 years in the Couples Recode (CR) file data set. Weighted samples of 6141 respondents were analyzed. We used Stata 14 software for analyzing the data. The association of selected independent variables with primary, secondary, and total infertility was analyzed using a logistic regression model. We presented the results using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) and a p-value &lt;0.05 as a cut-off point for declaring statistical significance. Results The prevalence of infertility in the past 12 months was 24.2% (95% CI: 23.1-25.3%), of which the majority (90.7%) was secondary infertility. Greater than 35 years of age (AOR = 2.45, 95% CI (1.58-3.79)), rural residence (AOR = 1.06, 95% CI (1.01-1.39)), smoking (AOR = 2.29, 95% CI (1.39-3.77)), and &lt;18.5 Body Mass Index (BMI) (AOR = 1.71, 95% CI (1.43-2.04)) were significantly associated with infertility. Conversely, infertility was less likely among women with formal education and better wealth index. Primary infertility was significantly higher among women whose partners drink alcohol (AOR = 1.55; 95% CI 1.06-2.28)) and chew khat (AOR = 1.62; 95% CI (1.12-2.36)). Secondary infertility was significantly higher among women with &lt;18.5 BMI (AOR = 1.59, 95% CI (1.37-1.84)), &gt;30 BMI (AOR = 1.54; 95% CI 1.01-2.35)), and &lt;15 years of age at first birth (AOR = 1.40; 95% CI 1.15-1.69)). Conclusion More than one in five couples in Ethiopia has an infertility problem. Both male and femalerelated factors are associated with infertility. Primary infertility was significantly higher among women whose partner chews khat and drinks alcohol. Secondary infertility was significantly associated with being underweight, obese, smoking, and young age at first birth. Hence, taking action on preventable factors is the most critical treatment approach and will improve the health status of the couples in other ways.</p

Food taboos among pregnant women and associated factors in eastern Ethiopia:A community-based cross-sectional study

OBJECTIVE: The main aim of this study was to assess food taboos and associated factors among pregnant women in eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected 422 pregnant women at Haramaya Demographic Surveillance System from Haramaya District, eastern Ethiopia. Data on sociodemographic conditions, the presence of food taboos, and perceived reasons were collected using the face-to-face interview method by trained data collectors through arranged home visits. Collected data were entered into EpiData 3.1 and exported to statistical package for social sciences version 23 for cleaning and analysis. Descriptive, binary, and multiple logistic regression analyses were carried out to determine the relationship between explanatory and outcome variables. Adjusted odds ratio (AOR) with 95% confidence interval (CI) at p value less than 0.05 was used to declare significant association. RESULTS: Approximately half (48%, 95% CI: 43%, 52%) of the pregnant women reported the presence of pregnancy-related food taboos. Pregnant women who have heard about food taboos (AOR: 3.58; 95% CI: 1.89, 6.83), pregnant women had friends who avoided food (AOR: 1.91; 95% CI: 1.22, 2.99), women’s monthly income ⩽840 ETB (AOR: 1.73; 95% CI: 1.10, 2.73), and pregnant women who had not attended formal education (AOR: 1.95; 95% CI: 1.18, 3.23) were more likely to report food taboos. The odds of pregnant women who had attended uptake of immunization services were less likely to have food taboos (AOR: 0.35; 95% CI: 0.21, 0.58). CONCLUSION: Pregnancy-related food taboos among pregnant women are unacceptably high. Therefore, awareness creation and nutritional counseling at health service delivery points are imperative actions for pregnant women to avoid food taboos norms. Further research should be done to understand the social and cultural ground of food taboos during pregnancy

Factors Affecting Parent-Adolescent Discussion on Reproductive Health Issues in Harar, Eastern Ethiopia: A Cross-Sectional Study

Background. Open family discussion on reproductive health (RH) issues often leads to increased awareness on RH matters and reduces risky behaviors among adolescents. This study was conducted to assess factors affecting parent-adolescent discussion on RH issues in Harar, Ethiopia. Methods. A cross-sectional survey using face to face interview supplemented with focus group discussion (FGD) was conducted on 751 randomly selected parents of 10–19-year-old adolescents. Data was analyzed using SPSS version 15. Results. More than one-fourth (28.76%) of parents reported discussing RH issues with their adolescents during the last six months. In the logistic regression, parents who have demonstrated good RH knowledge and positive attitude towards RH were almost six times and seventy percent (AOR 5.69, 95% CI: 3.67–8.82; AOR 1.70, 95% CI: 1.08–2.68) higher in discussing RH with their adolescents than their counterparts, respectively. Conclusion. Parent-adolescent discussion about RH issues rarely occurs and is bounded by lack of knowledge, sociocultural norms, and parental concern that discussion would encourage premarital sex. Reproductive health programs should target on improving awareness of parents and addressing sociocultural norms surrounding reproductive health issues

Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia:A cross-sectional study design

Objective: This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul's Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients' medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value Results: Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m(2), respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease. Conclusion: Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia:A Cross-Sectional Study

Objective: Despite implementation of different strategies, postpartum hemorrhage (PPH) continued to account for a substantial proportion of maternal deaths in Ethiopia. The objective of this study was to assess the magnitude of PPH and its associated factors among women who gave birth in a university hospital in eastern Ethiopia from 1 to 31 March 2020. Methods: An institution-based cross-sectional study was conducted. A review of 653 randomly selected medical records of all deliveries from 1 March 2018 to 29 February 2020 in Hiwot Fana Specialized University Hospital (HFSUH), a university hospital in eastern Ethiopia, was conducted. Data were collected on sociodemographic characteristics, obstetric and reproductive health conditions, and presence of PPH. Data were coded, checked for completeness and entered using EpiData 3.1 and exported to SPSS 20 for analysis. Results were expressed using frequencies, tables and figures. Binary and multiple logistic regression were fitted to identify factors associated with PPH and associations were described using adjusted odds ratio (aOR) along with 95% confidence intervals (CI). Associations with p35 years (aOR = 3.08; 95% CI 1.56, 6.07), no antenatal care (aOR = 3.65; 95% CI 1.97, 6.76), history of PPH (aOR = 4.18; 95% CI 1.99, 8.82), and being grand multigravida (aOR = 3.33; 95% CI 1.14, 9.74) were significantly associated with having PPH. Conclusion: A high proportion of women who gave birth in HFSUH experienced PPH. Prevention and management of PPH should focus on improving antenatal care and prioritize grand multigravida, older women, and women with a previous history of PPH.</p

Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia:A Cross-Sectional Study

Objective: Despite implementation of different strategies, postpartum hemorrhage (PPH) continued to account for a substantial proportion of maternal deaths in Ethiopia. The objective of this study was to assess the magnitude of PPH and its associated factors among women who gave birth in a university hospital in eastern Ethiopia from 1 to 31 March 2020. Methods: An institution-based cross-sectional study was conducted. A review of 653 randomly selected medical records of all deliveries from 1 March 2018 to 29 February 2020 in Hiwot Fana Specialized University Hospital (HFSUH), a university hospital in eastern Ethiopia, was conducted. Data were collected on sociodemographic characteristics, obstetric and reproductive health conditions, and presence of PPH. Data were coded, checked for completeness and entered using EpiData 3.1 and exported to SPSS 20 for analysis. Results were expressed using frequencies, tables and figures. Binary and multiple logistic regression were fitted to identify factors associated with PPH and associations were described using adjusted odds ratio (aOR) along with 95% confidence intervals (CI). Associations with p35 years (aOR = 3.08; 95% CI 1.56, 6.07), no antenatal care (aOR = 3.65; 95% CI 1.97, 6.76), history of PPH (aOR = 4.18; 95% CI 1.99, 8.82), and being grand multigravida (aOR = 3.33; 95% CI 1.14, 9.74) were significantly associated with having PPH. Conclusion: A high proportion of women who gave birth in HFSUH experienced PPH. Prevention and management of PPH should focus on improving antenatal care and prioritize grand multigravida, older women, and women with a previous history of PPH

Undernutrition among Pregnant Women in Rural Communities in Southern Ethiopia

Background: Maternal undernutrition rates in Ethiopia are among the highest in the world. In addition, a huge inequity exists within the country, with pregnant women in rural communities being at increased risk. This study assessed the prevalence of undernutrition and its associated factors among pregnant women in a rural community in southern Ethiopia. Methods: A community-based cross-sectional study was conducted among 376 randomly selected pregnant women. Data were collected through face-to-face interview followed by mid-upper arm circumference measurement. Household food insecurity and minimum dietary diversity for women were assessed. Data were entered into EpiData 3.1 and exported to SPSS 20 for analysis. Logistic regression models were fitted to check associations between independent variables and undernutrition. Statistical significance was set at p Results: The prevalence of undernutrition was 41.2% (95% CI 36.3%-46.3%). Unintended pregnancy (AOR 2.06, 95% CI 1.27-3.36) and not participating in Wome's Health Development Army meetings (AOR 3.64, 95% CI 1.51-8.77) were independent predictors of undernutrition. However, minimum dietary diversity for women of five or more food groups (AOR 0.24, 95% CI 0.07-0.82), having at least one antenatal care visit (AOR 0.46, 95% CI 0.27-0.78), age at first pregnancy >= 20 years (AOR 0.39, 95% CI 0.21-0.76), and being from food-secure households (AOR 0.26, 95% CI 0.16-0.43) were independent protective factors against undernutrition. Conclusion: Undernutrition among pregnant women was highly prevalent in the study area. Interventions aiming to reduce undernutrition should focus on discouraging teenage and unintended pregnancy, reducing household food insecurity, and promoting antenatal care visits and encouraging consumption of diversified diets by women. Strengthening the existing network of the Women's Health Development Army seems to be very important

Prevalence of preterm premature rupture of membrane and associated factors among pregnant women admitted in hiwot fana comprehensive specialized university hospital, eastern ethiopia

BACKGROUND: Preterm premature rupture of membrane (PPROM) affects approximately 3% of all pregnancies and is responsible for one-third of all preterm births. Despite its contribution to maternal and neonatal mortality and morbidity, evidence on the burden of PPROM and its associated factors in the study area is scarce. Therefore, this study was aimed to assess the prevalence and associated factors of PPROM among preterm pregnancies managed from May 2019 to September 2020 at Hiwot Fana Comprehensive Specialized University Hospital University Hospital, Eastern Ethiopia. METHODS: A hospital-based retrospective cross-sectional study was conducted among 449 preterm pregnancies selected by systematic random sampling technique. Data related to socio-demographic variables, obstetric and reproductive health conditions, and labor and related pregnancy outcomes were extracted from their medical records using a structured checklist. Factors associated with PPROM were identified using bivariable and multivariable logistic regression. Association was presented using an adjusted odds ratio (AOR) along with 95% confidence interval (CI). P-value &lt;0.05 in the final model was considered as statistically significant.RESULTS: Of 449 preterm pregnant women included in the study, 64 (14.3%; 95% CI:11.1% -17.5%) had PPROM. Preterm PROM was significantly associated with urinary tract infections (AOR=6.33; 95% CI:3.26-12.29), vaginal bleeding (AOR=2.62; 95% CI:1.23-5.57), history of abortion (AOR= 3.07; 95% CI:1.33-7.06) and mid upper arm circumference &lt;23 (AOR=7.06; 95% CI: 4.02-12.43). A total of 3 (4.3%) stillbirth and 16 (22.9%) early neonatal deaths occurred corresponding with a gross perinatal mortality rate of 271 per 1000 births.CONCLUSION: This study showed that one in seven preterm pregnancies in eastern Ethiopia had PPROM. Urinary tract infection, vaginal bleeding, previous history of abortion, and undernutrition were associated with PPROM. Early screening and treatment of urinary tract infections and nutritional assessments are essential to reduce the risk of PPROM.</p

Prevalence of premature rupture of membrane and its associated factors among pregnant women in Ethiopia:A systematic review and meta-analysis

BACKGROUND: Premature rupture of the membrane is a serious public health problem, especially in low- and middle-income countries with significant maternal and perinatal morbidity and mortality. Despite its substantial contributions to feto-maternal complications, the burden of premature rupture of the membrane was not systematically analyzed in Ethiopia. Hence, this review aimed to identify the burden of premature rupture of the membrane and associated factors among pregnant women in Ethiopia. METHODS: PubMed/Medline, Scopus, and African journal online databases and Google Scholar were searched for articles published in the English language. Independent review authors selected and screened studies. Appraisal for methodological quality of studies was conducted using the Joanna Briggs Institute assessment checklist. RevMan 5.3 software was used for meta-analysis. The I(2) statistical significance and Egger’s test were used to assess heterogeneity and publication bias, respectively. RESULTS: The pooled prevalence of premature rupture of the membrane among pregnant women in Ethiopia was 9.2% (95% confidence interval = 5.0, 16.4). Factors significantly associated with premature rupture of the membrane were no antenatal care visit (odds ratio = 2.87, confidence interval = 1.34, 6.14), history of premature rupture of the membrane (odds ratio = 4.09, 95% confidence interval = 2.82, 5.91), history of abortion (odds ratio = 3.13, confidence interval = 1.63, 6.01), abnormal vaginal discharge (odds ratio = 6.78, confidence interval = 4.11, 11.16), and urinary tract infection (odds ratio = 3.04, confidence interval = 1.21, 7.63). CONCLUSION: Nearly one in ten pregnancies in Ethiopia encounters premature rupture of the membrane complications. The finding highlights improving antenatal care utilization, thus preventing or treating urinary and reproductive tract infections, and tailored interventions for pregnant women with a history of premature rupture of the membrane or abortion contribute to reduced premature rupture of the membrane