Development and validation of a nomogram for predicting low birth weight among pregnant women who had antenatal care visits at Debre Markos Comprehensive and Specialized Hospital, Ethiopia

BackgroundBirth weight is a crucial factor linked to a newborn’s survival and can also affect their future health, growth, and development. Earlier, researchers focused on exploring maternal and fetal factors contributing to low birth weight. However, in recent years, there has been a shift toward effectively predicting low birth weight by utilizing a combination of variables. This study aims to develop and validate a nomogram for predicting low birth weight in Ethiopia.MethodsA retrospective follow-up study was conducted, and a total of 1,120 pregnant women were included. Client charts were selected using a simple random sampling technique. Data were extracted using a structured checklist prepared on the KoboToolbox (Cambridge, Massachusetts in the United States) and exported to STATA version 14 (Computing Resource Center in California) and R version 4.2.2 (University of Auckland, New Zealand) for data management and analysis. A nomogram was developed based on a binary logistic model, and its performance was assessed by discrimination power and calibration. Internal validation was performed using bootstrapping. To evaluate the clinical impact, decision curve analysis was applied.ResultsThe nomogram included gestational age, hemoglobin, primigravida, unplanned pregnancy, and preeclampsia. The AUROC of the predicted nomogram was 84.3%, and internal validation was 80.1%. The calibration plot indicated that the nomogram was well calibrated. The model was found to have clinical benefit.ConclusionThe nomogram demonstrates strong discrimination performance and can predict low birth weight clinically. As a result, it can be used in clinical practice, which will help clinicians in making quick and personalized predictions simply and rapidly, enabling the early identification and medical intervention. For broader applicability, the nomogram must be externally validated

Pelvic Floor Disorders and Pelvic Floor Muscle Exercise: A Survey on Knowledge, Attitude, and Practice among Pregnant Women in Northwest Ethiopia

The purpose of the study was to investigate 1: overall knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) as well as knowledge, attitudes, and practice of pelvic floor muscle exercise (PFME); and 2: the association of these factors with parity in pregnant women in Gondar, Ethiopia. A facility-based cross-sectional study was performed in the Central Gondar zone, northwest Ethiopia between February and April 2021. The associations between parity and knowledge of POP and UI, and knowledge, attitude, and practice towards PFME were estimated using logistics regression models and presented as crude and adjusted odds ratios with 95% confidence intervals. Nulliparous women were used as the reference. Adjustments were made for maternal age, antenatal care visits, and level of education. The study sample comprised 502 pregnant women: 133 nulliparous, and 369 multiparous. We found no association between parity and knowledge of POP, UI, or knowledge, attitude, and practice toward PFME. The sum score indicated poor knowledge about both POP, UI, and PFME in the study population, and poor attitude and practice of PFME. Despite a high attendance in antenatal care services, knowledge, attitude, and practice were poor, indicating a need for quality improvement of the services.publishedVersio

Proportion of Maternal Near-Miss and Its Determinants among Northwest Ethiopian Women: A Cross-Sectional Study

Background. Life-threatening situations might arise unexpectedly during pregnancy. Maternal near-miss can be a proxy for maternal death and explained as women who nearly died due to obstetric-related complications. It is recognized as the predictor of level of care and maternal death. Maternal near-miss evaluates life-threatening pregnancy-related complications, and it directs the assessment of the quality of obstetric care. Objective. To determine the proportion and factors associated with maternal near-miss at maternity wards at the University of Gondar Referral Hospital, Northwest Ethiopia, 2019. Methods. A cross-sectional study design was carried out from March 1 to June 20, 2019, using WHO criteria for maternal near-miss at the University of Gondar Referral Hospital. The data are from the interviews and review of 303 systematically selected participants’ medical files at maternity wards. Bivariate and multivariable logistic regression analyses were performed to analyze factors associated with maternal near-miss, including estimation of crude and adjusted odds ratios and their respective 95% confidence intervals and p value less than 0.05 through SPSS version 20. Result. The study revealed that the proportion of maternal near-miss was found to be 15.8% (95%CI=11.9%-20.1%). In the adjusted analyses, maternal near-miss was significantly associated with low (≤1000 ETB) monthly income (AOR=399; 95%CI=1.65, 9.65), seven or more days of hospital stay (AOR=5.43; 95%CI=2.49, 11.83), vaginal bleeding (AOR=2.75, 95%CI=1.17, 6.47), and pregnancy-induced hypertension (AOR=5.13; 95%CI=2.08, 12.6). Conclusion and Recommendation. The near-miss proportion was comparable to that in the region. Associated factors were low monthly income, seven or more days of hospital stay, vaginal bleeding, and pregnancy-induced hypertension. Thus, giving attention on early identification and treatment of these potential factors can be the opportunity in the reduction of maternal morbidity and mortality

Antenatal depression and its correlates on northwestern Ethiopian women: community-based cross-sectional study

Introduction: mental health during pregnancy is a very important but neglected problem in most African countries including Ethiopia. In general, there was a scarce of studies on antenatal depression at the community level in Ethiopia. Therefore, this study was aimed at assessing the prevalence and correlates of antenatal depression among postpartum women in Gondar city, Northwest Ethiopia. Methods: a community-based cross-sectional study was conducted in Gondar city among 526 women from July 01st to 30th/2018. A cluster sampling technique was employed and an interviewer-administered semi-structured questionnaire was utilized to collect the data. The data were entered into Epi-info version 7.0 and exported to SPSS version 20. Both bivariate and multivariable logistic regression analyses were performed. The level of statistical significance was declared based on the AOR with 95% CI and P-value ≤0.05. Results: the prevalence of ante partum depression was 24.1% (95% CI: 20.5-27.5) and it was independently predicted by relatives´ mental illness (AOR = 2.30; 95% CI: 1.17-4.53), sex preference (AOR = 1.80; 95% CI: 1.07-3.02), lack of relatives´ support (AOR = 2.07; 95% CI: 1.12-3.87), unhappy marriage (AOR = 2.94; 95% CI: 1.81-4.76), history of depression (AOR = 5.23; 95% CI: 2.87-9.50) and no or one alive child (AOR = 1.78; 95% CI: 1.13-2.79). Conclusion: the prevalence of ante partum depression was high and connected to poor psycho-social experiences. Therefore, building-up of family's network, fortifying relatives' support, resolving unhappy spousal relationships, and assuming early screening and intervention would degrade its burden

Prevalence and Predictors of Postpartum Depression: Northwest Ethiopia

Background. Postpartum depression is an umbrella, which encompasses several mood disorders that follow childbirth within 6 weeks. Screening for postpartum depression would improve the ability to recognize these disorders and enhance care that ensures improved clinical outcomes. Early identification of postpartum depression is important in order to plan for implementation strategies that allow for timely treatment and support of women with postpartum depression. Objective. To determine the prevalence and associated factors of postpartum depression among women who gave birth in the last six weeks in Gondar town, Northwest Ethiopia, 2018. Methods. A community based cross-sectional study was conducted among 526 women who gave birth in the last 6 weeks from July 1 to 30, 2018 in Gondar town. Cluster sampling technique was used. Data were collected by semi-structured and pretested questionnaire and entered into epi-Info version 7.0 and then analyzed by SPSS version 20.0. Both bivariate and multivariable logistic regression model were fitted. Adjusted odds ratio with 95% confidence interval has been computed and variables with p-value <0.05 were considered statistically significant. Results. The prevalence of postpartum depression among 526 postnatal women was 25% (95% CI: 21, 28). Abortion history (AOR = 1.79, 95% CI: 1.07, 2.97), birth weight <2.5 kg (AOR = 3.12, 95% CI: 1.78, 5.48), gestational age below 36 weeks (AOR = 2.18, 95% CI: 1.22, 3.88) unplanned pregnancy (AOR = 2.02, 95% CI: 1.24, 3.31), relatives’ mental illness (AOR = 1.20: 1.09–3.05), had no antenatal visit (AOR = 4.05, 95% CI: 1.81, 9.05), had no postnatal visit (AOR = 1.82, 95% CI: 1.11, 3.00) were factors significantly associated with postpartum depression. Conclusion and Recommendations. The prevalence of PPD was found to be higher. Variables like abortion history, low birth weight, gestational age below 36 weeks, unplanned pregnancy, relatives’ mental illness, had no antenatal visit, and had no postnatal visit were predisposing factors to postpartum depression. Preventive measures to avoid low birth weight and pregnancy complications are also identified as proactive ways to reduce postpartum depression. Early identification and treatment of depression during ANC and postpartum care can mitigate the impact of PPD on the mother-baby dyad. Emphasis must be given women to have ANC and PNC follow up

Early Implanon Discontinuation and Associated Factors among Implanon User Women in Debre Tabor Town, Public Health Facilities, Northwest Ethiopia, 2016

Background. Implanon discontinuation closely related to higher rates of overall fertility rate, unwanted pregnancies, and induced abortion. This might have social and economic consequences. In Ethiopia the magnitude of early Implanon discontinuation and contributing factors is not well studied. Objective. To assess early Implanon discontinuation and associated factors among Implanon user women in Debre Tabor town, 2016. Methods. A facility based cross-sectional study was conducted from May 1 to August 2016 through face-to-face interview. A total of 449 Implanon user women were selected by systematic random sampling technique. Epi Info version 7 and SPSS version 20 were used for data entry and analysis, respectively. Factors associated with early Implanon discontinuation were analyzed using binary and multivariable logistic regression model. Variables with p value of <0.05 and 95% confidence interval were considered as statistically significant. Results. The overall proportion of early Implanon discontinuation among mothers was 65 % (95%, CI: 60.4%–69.5%). Having no children (AOR = 2.0, 95% CI = [1.3–4.5]), being not counseled for possible side effects (AOR = 1.50, 95% CI = [1.1–3.4]), having no appointment for follow-up (AOR = 2.6, 95% CI = [1.2–4.3]), and having developing side effects (AOR = 1.7, 95% CI = [1.5–4.4]) were found to be statistically significant factors associated with early Implanon discontinuation. Conclusion and Recommendation. Early Implanon discontinuation among mothers was found to be high. Hence, counseling about Implanon side effects and appointment for follow-up of Implanon users should be made to increase Implanon retention

Mixed Infant Feeding Practice and Associated Factors among HIV-Positive Women under Care in Gondar City’s Public Health Facilities within Two Years Postpartum: A Cross-Sectional Study

Background. Mixed infant feeding practice remains a major setback for effective prevention of mother to child transmission of HIV program and updated evidences on this issue is essential for better interventions. Therefore, this study was aimed at assessing the proportion and associated factors of mixed infant feeding practice among HIV-positive women under care in public health institutions in Gondar city within two years postpartum, Ethiopia, 2017. Methods. A cross-sectional study was conducted on 485 HIV-positive women under care in Gondar City’s health facilities from May 1 to June 30/2017. Data were collected via interviewer administered questionnaire supplemented with chart review, entered into Epinfo version 7.0 and then exported to SPSS version 20.0. Both bivariable and multivariable analyses were done, and the statistical significance of each variable was claimed based on the adjusted odds ratio (AOR) with 95% confidence interval (CI) and its P value ≤0.05. Result. The proportion of HIV-positive women practicing mixed infant feeding was 21.6%. Whereas, about 73.8% and 4.5% of the mothers demonstrated exclusive breastfeeding and exclusive replacement feeding, respectively. Mixed infant feeding practice was independently predicted by lack of antenatal care (AOR=6.9; 95% CI: 3.4, 14.1) and home delivery (AOR=2.8; 95% CI: 1.4, 5.4). Conclusion. The magnitude of mixed infant feeding practice was higher than the reports of many other studies, and its predictors were connected to poor adherence to maternal health care service utilization. Hence, stakeholders need to work more on ANC and facility delivery service coverage

Assessment of content validity for a Neonatal Near miss Scale in the context of Ethiopia.

BACKGROUND: The concept of neonatal near miss is used to identify neonates who nearly died but survived a life-threatening complication in the first 28 days of life. Neonatal mortality is the tip of the iceberg. Quality improvement through utilization of a validated scale and reduction in adverse neonatal outcome is a priority for achieving sustainable development goals. OBJECTIVES: To develop and assess the content validity of neonatal near-miss scale in the public health hospitals in Amhara Regional State, northwest Ethiopia. METHODS: A literature review was performed prior to the development of the neonatal near-miss assessment scale. An expert panel committee was formed by health facility practitioners and by the members of the academia. Two rounds of meetings were conducted with the expert panel to reach consensus on the face and content validity. The content validity index, Kappa statistics, and the content validity ratio were computed to estimate the content validity scale of neonatal near miss. RESULTS: In this study, four domains (pragmatic, clinical, management, and lab-investigations) with 32 items were identified. The item-level content validity index ranged from 0.7 to 1. The overall scale content validity (S-CVI) (average) for the domains (pragmatic, clinical, management, and lab-investigations) were 0.98, 0.95, 0.96, and 0.96, respectively. The overall S-CVI (universal) was 0.78 to 1, whereas the overall S-CVI (average) of neonatal near miss assessment scale was found to be 0.96. The content validity ratio and Kappa statistics values ranged from 0.6 to 1 and 0.9 to 1 for the respective domains. CONCLUSION: The identified four domains and the respective items were valid enough (content-wise) to be used as identification criteria for neonatal near-miss cases. The scale will contribute to neonatal near-miss identification and also improve the quality of neonatal management care

Experience and perceptions of healthcare providers on clinical management and care of near-miss infants : a qualitative content analysis

INTRODUCTION: Neonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia. METHODS: Semi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis. RESULTS: The experience and perceptions of healthcare providers was described in the main category "A sense of hopelessness when caring for the baby" capturing a broader emotional and professional aspect, while the subcategories "Unclear responsibilities discharging one's mission", "Provision of kangaroo mother care" and "Quick action required at birth" are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant. CONCLUSION: Unclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers' and parents' attitudes must be changed towards hope rather than hopelessness when caring for NNM infants

Valid and reliable neonatal near-miss assessment scale in Ethiopia : a psychometric validation

BACKGROUND: The concept of a neonatal near miss is used to explain neonates who nearly died but survived a life-threatening complication in the first 28 days of life. We have left many ill surviving (near-miss) neonates, due to a lack of valid and reliable assessment scale, particularly in Ethiopia. AIM: We aim to psychometrically validate the neonatal near-miss assessment scale (NNMAS) for Ethiopia. METHODS: A total of 465 live birth neonates were included with the assumption of a participant-to-item ratio of 15:1. A new contextually validated NNMAS was used to collect data. The Kaiseri--Mayer--Olkin (KMO) measure of sampling adequacy with a cutoff value of ≥0.50 for each item was applied. For reliability and validity of NNMAS, exploratory factor analysis using principal component analysis with oblique varimax rotation was used. Internal consistency and reliability were assessed using Cronbach's alpha. Convergent and discriminant validity was assessed using composite reliability (CR) and average variance extracted (AVE). RESULTS: The Kaiser--Mayer--Olkin (KMO = 0.74) measure of sampling adequacy and Bartlett's Sphericity test for the appropriateness of the identity matrix (χ2 = 2903.9, df = 276, and P = 0.000) were suitable for exploratory factor analysis (EFA). The correlation matrix determinant of the study was 0.002. The principal component analysis (PCA) identified six factors and together explained 54.3% of the variation in the Neonatal Near miss. The Cronbach-alpha coefficient was 0.80 for the entire scale. The composite reliability values of the factors ranged from 0.87 to 0.95. The AVEs, CR, and factor loadings were above 0.5 for all factors indicating that convergent validity was met. The square roots of the AVEs were greater than factor correlation values. It was revealed that discriminated validity was also met. CONCLUSION: The neonatal near-miss assessment scale was found to be valid and reliable in the present context. The scale can be used to identify near-miss neonates in Ethiopia