Intimate partner violence during pregnancy and preterm birth among mothers who gave birth in public hospitals, Amhara Region, Ethiopia: A case-control study

Background: Preterm birth (PTB) is an important and under-reported public health problem in developing nations such as Ethiopia. Limited research has been conducted to date to address the effect of intimate partner violence (IPV) during pregnancy on PTB. This study was conducted to assess the association between IPV during pregnancy and PTB. Methods: A case control study was conducted on 138 cases and 276 controls in four randomly selected public hospitals from February to April 2018. Mothers who gave birth before 37 completed weeks of gestation were included as cases, and mothers who gave birth at 37 and above completed weeks of gestation were deemed as controls. A simple random sampling technique was employed to select the two consecutive controls. Bivariate and multivariate logistic regression analyses were done. Results: In this study, the prevalence of any IPV during pregnancy was 44.8% among cases and 25% among controls. Any IPV during pregnancy was significantly associated with PTB [AOR = 2.85; 95% CI: 1.42-6.22]. In addition, women who were exposed to emotional violence during the recent pregnancy were three times more likely to have a PTB compared to those who were not violated [AOR = 3.05; 95% CI: 1.35-6.91]. Similarly, women who experienced physical IPV during pregnancy were 2.6 times [AOR = 2.56; 95% CI: 1.27-6.78] more at risk of PTB compared to those who had no physical IPV. Conclusion: This study found that IPV during pregnancy is significantly associated with PTB. Hence, IPV screening needs to be integrated into routine antenatal care (ANC) services. [Ethiop. J. Health Dev. 2020; 34(1):44-53] Key words: Intimate partner violence, pregnancy, preterm birth, Ethiopi

COVID-19: Initial synthesis of the epidemiology, pathogenesis, diagnosis, treatment, and public health control approaches

Introduction: The coronavirus disease (abbreviated COVID-19) pandemic caused by SARS-CoV-2 has devastated the world in the space of just a few months. Since it was first reported in December 31, 2019 in the Hubei province of China, at the time of writing, over 2 million people have been infected, with over 127,598 deaths in 202 countries and territories. Records of global distribution show a steady increase, although the USA is leading in its distribution, with Italy reporting close to 20,000 deaths. The purpose of this rapid review is to synthesize available evidence on the epidemiology, pathogenesis, diagnosis and public health control measures to inform policy, programs and research on COVID-19. Methods: A rapid review method was employed using PubMed and Google Scholar search engines. Journal articles, reports and government documents were included in our search, which is focused on the disease epidemiology, advancements in diagnostics, treatment and vaccines, public health control measures, and psychosocial interventions for health care providers. The contents of the identified articles were examined and abstracted by a team of investigators. The concepts represented by the individual reviews were collated to give a complete picture of COVID-19 based on the evidence we have so far. The search period spanned December 30, 2019 to April 15, 2020. Findings: The severity of the disease and its fast spread, three times faster than the flu, has challenged the health systems of almost every country in the world. Although, for now, the case burden remains low in Africa, the impact of COVID-19 is anticipated to be severe if it becomes widespread. Efforts to curb the pandemic, involving prevention, disease surveillance, contact tracing, clinical management and the development of new treatments and diagnostics, is ongoing across the globe. While writing this review, more than 73 vaccines are at the exploratory or preclinical stage, while two are in phase I clinical trialsYet, non-pharmaceutical interventions are critical to stopping the spread of the virus. Africa, in particular, should put extra effort into making preventive public health measures work, because health systems in the continent are too weak to withstand the effect of the pandemic should it hit hard, and the economic implications of extreme control measures following a delayed response would be severe. On the bright side, the lessons drawn from this pandemic are likely to improve the preparedness and response to similar future outbreaks and pandemics. [Ethiop. J. Health Dev. 2020; 34(2):129-140] Key words: Coronavirus, COVID-19, pandemic, SARS-CoV-

Validity and reliability of the Amharic version of supportive care needs survey - short form 34 among cancer patients in Ethiopia

Objectives: Supportive care needs survey short form has a total of 34 items that have 5 domains that measure the unmet needs of cancer patients. It is important to validate this tool since there are differences in culture, geographic areas, and clinical care service which influence patients’ needs. Therefore, this study aimed to assess the construct validity and reliability of the tool. Methods: The study was conducted among 170 cancer patients from April 1st to 30th 2019 in Hawassa hospital, South Ethiopia. Confirmatory factor analysis was done using fit indices. Convergent and discriminant validity was evaluated using average variance extracted and maximum shared variance respectively. Known group validity was checked using the Mann-Whitney U test. The reliability of the instrument was examined using Cronbach’s alpha. Results: Domains except for health system and information, and patient care and support maintained convergent and divergent validity. The remaining validity was maintained after removing items that were redundant and double loading. The average variance extracted of domains varied from 0.52–0.81. The Square of correlation between constructs was lower than the average variance extracted for the constructs. The tool had reliability r = 0.932. The root mean square error of approximation was 0.057, comparative fit index 0.954, and the other fit indices were also indicating a good fit. Known groups difference was seen by age and type of treatment taken across the different domains. Conclusion: After the health system and information, and patient care, and support domain validity issues were corrected by removing 8 items, the reduced tool was found to be a valid and reliable tool. The validated tool will be valuable if included in routine cancer care in our clinical settings

Rubella outbreak in the school children, Addis Ababa, Ethiopia: February–April 2018

Abstract Background Rubella is a vaccine-preventable contagious disease causing an estimated 100,000 children to be born with congenital rubella syndrome each year globally. Studies documented that 18 rubella outbreaks were occurred each year in Ethiopia. Yeka sub-city woreda 13 public health emergency management office reported two measles suspected cases on 8 February, 2018. We investigated this outbreak to identify its etiology, describe the outbreak and implement control measures. Methods We described the outbreak using descriptive epidemiology. The study population was defined as students learning in the school where the outbreak occurred. Suspected rubella case was defined as student with generalized rash whereas confirmed case was suspected case tested positive for rubella IgM. Questionnaires, checklists and students record review were used to collect data. We searched for new cases in classes daily and excluded them from classes. The school environment was assessed and the outbreak was described in person and time. Results We identified 58 cases (median age: 4.6 years; IQR: 4–5 years) with six of them rubella IgM positive and 52 epidemiologically linked. The outbreak began on 8 February 2018 having multiple intermittent peaks during its course reaching its highest peak at 2 April, 2018 and ended on 20 April, 2018. Index cases were reported from two classes; however, cases were occurred in 13/15(86.67%) of the classes during the entire outbreak. Fifty five percent (32/58) and 45/58(77.59%) of the cases were females and 3–5 years children, respectively. Overall attack rate was 58/531(4.05%). Attack rate was higher in females 32/252 (12.7%) than in males 26/279 (9.32%), and higher 45/275(16.36%) in 3–5 years than those in 5–8 years 13/256(5.08%) children. Case fatality ratio was zero. All cases were vaccinated against measles but unvaccinated against rubella. Conclusions Attack rate was higher in females than in males and higher in 3–5 years than 5–8 years children. We recommended establishing rubella surveillance system, conducting sero-prevalence of rubella among child bearing age females and establishing CRS surveillance among young infants to provide evidence-based information for RCV introduction. It was also recommended to develop a national rubella surveillance guideline which aid to exclude rubella cases from schools during outbreak

Factors associated with preeclampsia among pregnant women in Gojjam zones, Amhara region, Ethiopia: a case-control study

Purpose Little is known about the factors contributing to preeclampsia in Ethiopia. Therefore, this study was conducted to determine factors associated with preeclampsia among pregnant women in public hospitals. Methods and materials An institution based unmatched case-control study was conducted. Women with preeclampsia were cases, and those without preeclampsia were controls. The study participants were selected using the consecutive sampling method with a case-to-control ratio of 1:2. The data were collected through measurements and a face-to-face interview. Then the data were entered using Epi Info and exported to STATA 14 for analysis. The findings were presented in text, tables, and figures. Results About 51 (46.4%) of cases and 81 (36.8%) of controls had no formal education. Multiple gestational pregnancies (AOR = 2.75; 95% CI: 1.20–6.28); history of abortion (AOR = 3.17, 95% CI: 1.31–7.70); change of paternity (AOR = 3.16, 95% CI: 1.47–6.83); previous use of implants (AOR = 0.41; 95% CI: 0.13–0.96); and fruit intake during pregnancy (AOR = 0.36, 95% CI: 0.18–0.72) were associated factors of preeclampsia. Conclusion History of abortion, change of paternity, and multiple gestational pregnancies were risk factors for preeclampsia. Fruit intake during pregnancy and previous use of implant contraceptives were negatively associated with preeclampsia. Further studies should be conducted regarding the effect of prior implant use on preeclampsia. Healthcare providers should give special attention to women with a history of abortion and multiple gestational pregnancies during the ANC follow-up period

Is health related quality of life influenced by diabetic neuropathic pain among type II diabetes mellitus patients in Ethiopia?

BACKGROUND:Polyneuropathy is one of the commonest complications of long-standing diabetes. Progressive sensory loss can predispose patients to foot ulcer and the neuropathy oftentimes causes pain. The pain can significantly affect the quality of life of patients. OBJECTIVES:To describes the health-related quality of life of patients with type II diabetes mellitus suffering from painful diabetic peripheral neuropathy at two referral hospitals in Addis Ababa, Ethiopia, 2017. METHODS:An institution based cross sectional study with internal comparison was conducted among a sample of 220 type II diabetes mellitus patients in a 1:1 matched ratio of those with and without diabetes associated peripheral neuropathic pain. All were having regular follow up at two hospitals in Addis Ababa, Ethiopia. The Short Form (SF-36) health-related quality of life instrument was used to collect data on quality of life while basic socio-demographic and other disease specific features were collected using a structured questionnaire. Descriptive statistics was used to examine the mean scores of health related quality of life. Cronbach's alpha coefficient and Pearson's correlation coefficient were applied to estimate the internal consistency, and the level of agreement between the different domains of SF-36, respectively. To measure association between health related quality of life domains and explanatory variables, independent T-test and ANOVA were performed followed by multiple linear regression analyses. RESULTS:The health related quality of life of type II diabetes mellitus patients with peripheral neuropathic pain was poorer than those without pain in all the eight domains and the two summary scores by SF-36 (p < 0.001). Higher mean score difference was observed in Mental Component Summary Score (MCS) (14.6) compared to Physical Component Score (PCS) (9.3). Among the eight domains, the largest mean difference was found with the physical one (39.1) followed by mental health (38.2) and physical functioning (30). Pain intensity had a statistically significant negative correlation with all domains as well as the two summary scores. Younger age, a higher level of education, being single, a higher monthly income, normal body mass index, HbA1c less than seven mmo/L, absence of other diabetic complications and taking only oral hypoglycemic agents were found to predict better health related quality of life. CONCLUSION:The presence of diabetic peripheral neuropathic pain was found to negatively influence the health-related quality of life of type II diabetic patients; the greatest impact being on the 'role physical' and 'mental health' domains. Older age, presence of diabetes related complications, longer duration of illness negatively influenced the health-related quality of life

Predictors of unmet supportive care needs of adult cancer patients in Ethiopia

Objective: Cancer is a global public health issue that continues to increase because of aging and adoption of cancer-causing behaviours. In Ethiopia, cancer belongs to the second most common non-communicable disease. Cancer patients face a range of unmet needs in multiple aspects of their lives. Supportive care is defined as essential care that helps patients to cope with cancer. This study aims to assess the predictors of unmet supportive care needs in adult cancer patients in Ethiopia. Methods: Institution-based cross-sectional study was done from February to March 2019 in adult cancer patients. Three hundred seventy-one patients were interviewed using convenience sampling. Supportive care needs were used as outcome variables, dichotomized as ‘no need’ and ‘unmet needs’. Variables with a p-value of &lt;0.2 were candidates for multivariable logistic regression. Results: From 371 patients, 69.8% were females with a mean age of 47 years; the commonest type of cancer was gynaecological cancer. Information about diagnosis, stage of cancer, time since diagnosis, age, wealth index, employment status, gender, type of treatment, history of recurrence, type of cancer and information about diagnosis modified by the source of information were predictors of unmet supportive care needs. Conclusions: The study emphasised the importance of considering sociodemographic, clinical and information-related factors when dealing with cancer patients. Programmes, guidelines and services that focus on supportive care needs should be established and/or implemented

Factors associated with preeclampsia among pregnant women in Gojjam zones, Amhara region, Ethiopia: a case-control study

Little is known about the factors contributing to preeclampsia in Ethiopia. Therefore, this study was conducted to determine factors associated with preeclampsia among pregnant women in public hospitals. An institution based unmatched case-control study was conducted. Women with preeclampsia were cases, and those without preeclampsia were controls. The study participants were selected using the consecutive sampling method with a case-to-control ratio of 1:2. The data were collected through measurements and a face-to-face interview. Then the data were entered using Epi Info and exported to STATA 14 for analysis. The findings were presented in text, tables, and figures. About 51 (46.4%) of cases and 81 (36.8%) of controls had no formal education. Multiple gestational pregnancies (AOR = 2.75; 95% CI: 1.20–6.28); history of abortion (AOR = 3.17, 95% CI: 1.31–7.70); change of paternity (AOR = 3.16, 95% CI: 1.47–6.83); previous use of implants (AOR = 0.41; 95% CI: 0.13–0.96); and fruit intake during pregnancy (AOR = 0.36, 95% CI: 0.18–0.72) were associated factors of preeclampsia. History of abortion, change of paternity, and multiple gestational pregnancies were risk factors for preeclampsia. Fruit intake during pregnancy and previous use of implant contraceptives were negatively associated with preeclampsia. Further studies should be conducted regarding the effect of prior implant use on preeclampsia. Healthcare providers should give special attention to women with a history of abortion and multiple gestational pregnancies during the ANC follow-up period. Pregnancy-induced hypertension (PIH) is the second leading cause (14.0%) of maternal mortality next to haemorrhage. Preeclampsia is a common pregnancy problem that results in serious maternal and foetal complications. Preeclampsia is associated with an increased risk of adverse foetal, neonatal, and maternal outcomes. The majority of deaths due to preeclampsia could be prevented through timely and effective care provision for pregnant women. There are limited studies conducted on the factors associated with preeclampsia in Ethiopia.</p

“How can a woman live without having a breast?” : challenges related to mastectomy in Ethiopia

Background: Although mastectomy is the standard treatment modality for breast cancer patients in Ethiopia, our previous study revealed that one in five patients do not receive the recommended procedure, half due to patient refusal or lack of returning to the hospital. Therefore, this study aimed to explore reasons for refusing mastectomy and identify challenges among breast cancer patients in Ethiopia. Methods: An explorative qualitative study was conducted in four hospitals located in the towns of Woliso, Butajira, Hossana, and Assela. A total of 14 in-depth interviews (IDIs) and eight focus group discussions (FGDs) were held with breast cancer patients, patient relatives, and health professionals. Four semi-structured interview guides were used to facilitate the IDIs and FDGs. All recorded IDIs and FGDs were transcribed and translated verbatim and entered in NVivo 12 software. Emerging ideas were categorised and explained using an inductive content analysis approach. Results: Our participants reported that particularly elderly and very young women refuse to have mastectomy. The main reasons identified in this study were summarised into six themes: (i) fear of the surgical procedure, (ii) religious beliefs and practice, (iii) utilisation of traditional treatments, (iv) in relation to having a baby and breastfeeding their children (young patients often request to remove only the lump, leaving their breast tissue intact), (v) lack of awareness about the disease, and (vi) sociocultural factors and advice from the community that influence women, since breasts are considered an attribute of femininity, beauty, and motherhood. In addition, knowing someone who died after mastectomy emerged as a main reason for not having breast cancer surgery. Conclusions: High refusal rate for mastectomy has direct implication on increased breast cancer mortality. Hence, expansion of radiotherapy service is instrumental to initiate breast-conserving surgery as an alternative surgical procedure, especially for young women with early-stage breast cancer. Involving religious leaders, traditional healers, and breast cancer survivors could be an effective strategy to persuade newly diagnosed breast cancer patients. Addressing individual patient psychosocial needs and preferences may substantially improve retention of breast cancer patients in the health system

The role of health education on cervical cancer screening uptake at selected health centers in Addis Ababa.

IntroductionCervical cancer is one of the most common causes of morbidity and mortality among women in developing countries including Ethiopia. Unlike other types of cancers, the grave outcomes of cervical cancer could be prevented if detected at its early stage. However, in Ethiopia, awareness about the disease and the availability of screening and treatment services is limited. This study aims to determine the role of health education on cervical cancer screening uptake in selected health facilities in Addis Ababa.MethodsTwo-pronged clustered randomized controlled trial was conducted in 2018 at eight public health centers that provide cervical cancer screening services using visual inspection with acetic acid (VIA) in Addis Ababa, Ethiopia. Each of the eight health centers were randomly assigned to serve as either an intervention or a control center. A two-pronged clustered randomized controlled trial was conducted in eight public health care centers. All the selected facilities provided cervical cancer screening services using visual inspection with acetic acid (VIA). Four health centers were randomly assigned to the intervention and control arms. The study participants were women aged 30-49 years who sought care at maternal and child health clinics but who had never been screened for cervical cancer. In the intervention health centers, all eligible women received one-to-one health education and educational brochures about cervical cancer and cervical cancer screening. In the control health centers, participants received standard care. Baseline data were collected at recruitment and follow-up data were collected two months after the baseline. For the follow-up data collection, participants (both in the intervention and control arms) were interviewed over the phone to check whether they were screened for cervical cancer.ResultFrom the 2,140 women who participated in the study, 215 (10%) screened for cervical cancer, where 152(71%) were from the intervention health centers. Seventy-four percent of these participants reported that they learned about the benefits of screening from the one-to-one health education or the brochure. Women from the intervention health centers had higher odds of getting screened (AOR = 2.43,95%CI;1.58-2.90) than the controls. Women with the educational status of the first degree and those who have a history of sexually transmitted infections (STIs) had higher odds of getting screened (AOR = 2.03,95%CI;(1.15-2.58) and (AOR = 1.55,95%CI;1.01-2.36), respectively.Conclusion and recommendationProviding focused health education supported by printed educational materials increased the uptake of cervical cancer screening services. Integrating one-to-one health education and providing a take-home educational material into the existing maternal and child health services can help increase cervical cancer screening uptake