Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5?km from TB treatment health facility [AOR = 1.6, 95% CI (1.1-2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake

Linking midwives and hospital morbidity data to investigate the effect of interpregnancy interval on gestational diabetes: a 35-year cohort study in Western Australia

Introduction Interpregnancy interval (IPI) is a potentially modifiable risk factor for preganncy outcomes, and short and long IPI may be associated with increased rik of pregnancy complications. Record linkage provides the only practiacble means to investigate IPI effects, which requires large generalisable sample sizes and long follow-up time. Objectives and Approach This study examines the effect of IPI on gestational diabetes in Western Australia, with the aim to inform the evidence-base for IPI recommendations in high-income countries. A longitudinal population-based retrospective cohort study was conducted using de-identified, probabilistically-linked records for all births in Western Australia from 1980 to 2015 (inclusive) from the state’s Midwives Notification System and the WA Hospital Morbidity Data Collection. Logistic regression model was used to estimate the odds of gestational diabetes by IPI category. Analyses included all women with at least two consecutive singleton live births at 20-44 weeks of gestation. Results A cohort of 320,616 women were included in the study. Of these, 13,680 (4\%) had an IPI > 120 months (AOR:1.53, 95\% CI 1.38-1.70) as compared to 18-23 months. Conclusion/Implications Our findings show that both short and long IPIs may be associated with increased risk of gestational diabetes in a high-income setting. In this study, data linkage improved ascertainment of the outcome measure. Results suggest 18-23 months following a previous livebirth may be optimal for avoiding complications in future pregnancies

Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and metaanalysis

Background Late presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care. Methods Quantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome:late HIV testing',late HIV diagnosis' andlate presentation for HIV care after testing'. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta-Analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value. Results Ten studies from low-And middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-Analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6±3.6, I2 = 79%). Conclusions High perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should play a key role in informing and counselling patients on the benefits of early HIV testing or early entry to HIV care. Additionally, linking the systems and positive case tracing after HIV testing should be strengthened

Short interpregnancy interval and its predictors in Ethiopia: implications for policy and practice.

Introduction: interpregnancy interval (IPI) is the time elapsed between the birth of one live child and the conception of subsequent pregnancies. Several studies in Ethiopia indicated a high prevalence of a short interbirth interval - a proxy indicator of IPI. However, these studies were prone to selection bias as they did not include women who did not go on to have another pregnancy. Therefore, this study estimated the incidence of short IPI (< 24 months) and its risk factors among women who had at least one child in Ethiopia. Methods: we used a retrospective analysis of a cross-sectional study from the nationally representative Ethiopian Mini Demographic and Health Survey (EMDHS) conducted in 2019. The event was defined as the conception of the subsequent pregnancy within 24 months following the last child. A weighted Cox Proportional Hazard model was used to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CIs). Results: the incidence of short IPI was 6%. Rural residence, being young age, low educational attainment, having the last child died and having female last birth were the risk factors for short IPI. However, having higher parity, attending Antenatal Care (ANC) visits, being delivered at a health facility, and receiving Postnatal Care (PNC) visits were the protective factors for short IPI. Conclusion: the incidence of short IPI in Ethiopia was considerable. Sociodemographic and health service-related factors determine the short IPI. Hence, considering the immediate and long-term health and socioeconomic consequences of short IPI, the Ethiopian government should implement holistic and multisectoral interventions

Associations between endometriosis and adverse pregnancy and perinatal outcomes: a population-based cohort study.

PURPOSE To examine the association between endometriosis and adverse pregnancy and perinatal outcomes (preeclampsia, placenta previa, and preterm birth). METHODS A population-based retrospective cohort study was conducted among 468,778 eligible women who contributed 912,747 singleton livebirths between 1980 and 2015 in Western Australia (WA). We used probabilistically linked perinatal and hospital separation data from the WA data linkage system's Midwives Notification System and Hospital Morbidity Data Collection databases. We used a doubly robust estimator by combining the inverse probability weighting with the outcome regression model to estimate adjusted risk ratios (RR) and 95% confidence intervals (CIs). RESULTS There were 19,476 singleton livebirths among 8874 women diagnosed with endometriosis. Using a doubly robust estimator, we found pregnancies in women with endometriosis to be associated with an increased risk of preeclampsia with RR of 1.18, 95% CI 1.11-1.26, placenta previa (RR 1.59, 95% CI 1.42-1.79) and preterm birth (RR 1.45, 95% CI 1.37-1.54). The observed association persisted after stratified by the use of Medically Assisted Reproduction, with a slightly elevated risk among pregnancies conceived spontaneously. CONCLUSIONS In this large population-based cohort, endometriosis is associated with an increased risk of preeclampsia, placenta previa, and preterm birth, independent of the use of Medically Assisted Reproduction. This may help to enhance future obstetric care among this population

Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysis

Introduction: Interpregnancy interval (IPI) is the length of time between a birth and conception of the next pregnancy. Evidence suggests that both short and long IPIs are at increased risk of adverse pregnancy and perinatal outcomes. Relatively less attention has been directed towards investigating the effect of IPI on pregnancy complications, and the studies that have been conducted have shown mixed results. This systematic review will aim to provide an update to the most recent available evidence on the effect of IPI on pregnancy complications. Method and Analysis: We will search electronic databases such as Ovid/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and PubMed to identify peer-reviewed articles on the effects of IPI on pregnancy complications. We will include articles published from start of indexing until 12 February 2018 without any restriction to geographic setting. We will limit the search to literature published in English language and human subjects. Two independent reviewers will screen titles and abstracts and select full-text articles that meet the eligibility criteria. The Newcastle-Ottawa tool will be used to assess quality of observational studies. Where data permit, meta-analyses will be performed for individual pregnancy complications. A subgroup analyses by country categories (high-income vs low and middle-income countries) based on World Bank income group will be performed. Where meta-analysis is not possible, we will provide a description of data without further attempt to quantitatively pool results. Ethics and Dissemination: Formal ethical approval is not required as primary data will not be collected. The results will be published in peer-reviewed journals and presented at national and international conferences. Prospero Registration Number: CRD42018088578

Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1-2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care

Effect of interpregnancy interval on gestational diabetes: a retrospective matched cohort study

© 2019 The Authors Purpose: To examine the association between interpregnancy interval (IPI) and gestational diabetes using both within-mother and between-mother comparisons. Methods: A retrospective cohort study of 103,909 women who delivered three or more consecutive singleton births (n = 358,046) between 1 January 1980 and 31 December 2015 in Western Australia. The association between IPI and gestational diabetes was estimated using conditional logistic regression, matching pregnancies to the same mother and adjusted for factors that vary within-mother across pregnancies. For comparison with previous studies, we also applied unmatched logistic regression (between-mother analysis). Results: The conventional between-mother analysis resulted in adjusted odds ratios (aOR) of 1.13 (95% CI, 1.06–1.21) for intervals of 24–59 months and 1.51 (95% CI, 1.33–1.70) for intervals of 120 or more months, compared with IPI of 18–23 months. In addition, short IPIs were associated with lower odds of gestational diabetes with (aOR: 0.89; 95% CI, 0.82–0.97) for 6–11 months and (aOR: 0.92; 95% CI, 0.85–0.99) for 12–17-month. In comparison, the adjusted within-mother matched analyses showed no statistically significant association between IPIs and gestational diabetes. All effect estimates were attenuated using the within-mother matched model. Conclusion: Our findings do not support the hypothesis that short IPI (<6 months) increases the risk of gestational diabetes and suggest that observed associations in previous research might be attributable to confounders that vary between mothers

Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study.

BACKGROUND: Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. METHODS: We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980-2016), Finland (1987-2017), Norway (1980-2016) and the United States (California) (1991-2012). IPI was calculated based on the time difference between two dates-the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). RESULTS: Compared to an IPI of 18-23 months, there was insufficient evidence for an association between IPI 24 month IPIs. CONCLUSIONS: We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries