Modelling the effects of surgical obstetric fistula repairs on the severity of depression and anxiety among women with obstetric fistula in Ethiopia

Obstetric surgical repair is the common therapeutic intervention available to women with obstetrical fistula. While surgical repair can address the physical symptoms, it may not end the psychological challenges that women with fistula face. This longitudinal study investigated the effects of surgical obstetric fistula repairs on the severity of depression and anxiety associated with obstetric fistula among 219 women admitted at six fistula hospitals in Ethiopia. Data was collected through structured Likert-scale questionnaire both on admission (prior to surgical obstetric fistula repairs) and on discharge (post obstetric fistula repairs).. Statistical Package for Social Science plus Analysis of Moment Structures (SPSS-AMOS) version 20 was used for data analysis. Findings indicate that women with obstetric fistula have higher psychological distress such as depression (91%) and anxiety (78%) pre-surgical repair than post-surgical repair. These psychological distresses were exacerbated by poor social and psychological support of women with obstetric fistula by the family and health care professionals. The findings were used to develop integrated mental health treatment model for women with obstetric fistula in order to address psychological health needs of this population.Health StudiesD. Litt. et Phil. (Health Studies

Effects of surgical repair of obstetric fistula on severity of depression and anxiety in Ethiopia

Abstract Background The surgical repair of fistula can address the physical symptoms, but may not end the psychological challenges that women with fistula face. There are a few studies that focus on women with this condition in Ethiopia. Hence, the aim of this study was to determine the effects of surgical repair of obstetric fistula on the severity of depression and anxiety in women with obstetric fistula in Ethiopia. Method The study employed a longitudinal study design to investigate the changes in 219 women with obstetric fistula admitted to six fistula management hospitals in Ethiopia. The data were collected on admission of the patients for obstetric fistula surgical repair and at the end of six-month post repair. A structured questionnaire was used to obtain socio-demographic information and medical history of the respondents. Depression and anxiety symptoms were measured using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. The data was entered using Epi-Data software and then exported to SPSS for further analysis. The Mann-Whitney-U test, the Kruskal-Wallis test and Paired t-test were performed to measure the change in psychological symptoms after surgical repair. Result Though 219 respondents were interviewed pre-obstetric fistula surgical repair, only 200 completed their follow up. On admission, the prevalence of depression and anxiety symptoms were 91 and 79% respectively. After surgical repair, the prevalence rate was 27 and 26%. The differences in the prevalence of screen-positive women were statistically significant (P < 0.001). Conclusion The study concluded that the severity of depression and anxiety symptoms decrease post-obstetric fistula surgical repair. However, a woman with continued leaking after surgery seems to have higher psychological distress than those who are fully cured. Clinicians should manage women with obstetric fistula through targeted and integrated mental health interventions to address their mental health needs

Utilization and determinants of modern family planning among women of reproductive age group in Ethiopia: results from Integrated Family Health Program.

Background: Family planning improves community health and wellbeing by helping women to space and/or limit the number of children they want until they are physically and financially prepared.Objective: The aim of this study was to assess utilization and determinants of modern family planning among women of reproductive age in Ethiopia.Methods: A cross-sectional household survey was conducted in four major regions of Ethiopia (Tigray, Amhara, Oromia and Southern Nations, Nationalities and Peoples (SNNP)) from April 28 to May 30, 2013. 2,404 women of reproductive age were interviewed Samples were selected using a two-stage stratified sampling process. Descriptive and logistic regression methods of analysis were used to analyze utilization of modern family planning and the factors associated with it.Result: The mean age of respondents’ was 28.6 years (S.D=8.67). The most commonly used methods of family planning are injectable. Multivariable analysis showed that discussion with partner/husband about family planning practice in the last 6 months (AOR=6.1, 95%CI=4.73-7.81) and respondents knew health extension workers providing family planning services (AOR=1.57, 95% CI=1.23-2.01) were significantly associated with the use of modern family planning methods.Conclusion: Results of this study revealed that the number of respondents who have discussed with husband/partner about family planning and respondents who knew the family planning service providers were high utilizers of modern family planning methods. Our findings also indicated that current use of modern family planning increases with women’s education, and creating a conductive environment for women’s education is critical. Additional efforts are required to promote modern family planning utilization, partner participation, and couple counselling for join to decision making to improve modern family planning use. Key words: Family planning, Modern methods, Utilization, Reproductive age, Partner discussio

Psychological distress in women with obstetric fistula in Ethiopia: a multi-center, facility-based, cross-sectional study

Background: Women with obstetric fistula share a common experience of physical and psychosocial morbidity, social isolation, and rejection by family and local society. However, there are only a few studies that focus on women with this condition in Ethiopia. Accordingly, the aim of this study was to examine the presence of psychological distress in women with obstetric fistula in Ethiopia. Methods: The study employed a multi-center, facility-based, cross-sectional study design. The study was conducted at six fistula repair hospitals in Ethiopia and 219 women with obstetric fistula took part in the study. The data were collected during the women’s admission for obstetric fistula surgical repair. A structured questionnaire was used to obtain socio-demographic information and the medical history of the respondents. Symptoms of depression and anxiety over the past two weeks were measured using the Patient Health Questionnaire and the Generalized Anxiety Disorder scales, respectively. We chose the score cut-off point of 10 or above to define the symptoms over the past two weeks. The data were entered into Epi-Data version 3.2 software and exported to SPSS version 20 for further analysis. Results: Of the 219 women interviewed, 58% and 47% reported a history of symptoms of depression and anxiety, respectively. They also reported significantly lower social support. Symptoms of anxiety and depression were significantly associated with social support (P = 0.008, P = 0.001). Conclusions: Women with obstetric fistula are predisposed to high levels of psychological distress. Clinicians should manage women with obstetric fistula through targeted and integrated mental health interventions to address their mental health needs.College of Human Science

Leveraging maternity waiting homes to increase the uptake of immediate postpartum family planning in primary health care facilities in Ethiopia

AbstractBackground: Maternity waiting homes within primary health care facilities are ideal platforms to reach women with family planning education and counselling. Maternity waiting home users interact with health care providers on a regular basis throughout their waiting period and can prepare to initiate the family planning method of their choice immediately after childbirth. To date, there has been no clear evidence about the use of maternity waiting homes to increase the uptake of immediate postpartum family planning. The aim of this study is to assess the contribution of maternity waiting homes to increase the uptake of immediate postpartum family planning among women who deliver in primary health care facilities in Ethiopia. Methods: A comparative cross-sectional study design was conducted to collect quantitative data from women who gave birth within 12 months prior to the study. Multi-stage random sampling procedures were employed to select 884 women. Descriptive summaries and logistic regressions with 95% confidence intervals were conducted using Stata version14 to analyze the data. Results: The prevalence of immediate postpartum family planning use among women who used maternity waiting homes was 44%, while among those who did not use maternity waiting homes it was 36%. The use of maternity waiting homes significantly contributed to an increase in the immediate uptake of postpartum family planning (OR = 0.69, 95% CI = 0.51-0.95, p&lt;0.022). Conclusions and recommendations: This study showed that maternity waiting homes significantly contributed to improved uptake of immediate postpartum family planning within 10 minute or 48 hours after delivery. Developing a comprehensive package of maternal care services in maternity waiting homes has the potential to improve the uptake of family planning among postpartum women. [Ethiop. J. Health Dev. 2021; 35(1):9-17] Key words: Ethiopia, family planning, immediate postpartum, maternity waiting home, primary health care facilitie

Factors associated with mortality of TB/HIV co-infected patients in Ethiopia

Background: Despite the large number of TB patients on ART in Ethiopia, their mortality remains high. This study reports the effect of TB on HIV related mortality and determinants of TB/HIV co-infection related mortality.Methods: A longitudinal study design was employed as part of the Advanced Clinical Monitoring of ART (ACM) in Ethiopia. All patients started on ART at or after January 1, 2005 were included. Survival analysis was done to compare survival patterns of HIV patients with TB against HIV patients without TB. In addition, determinants of survival among TB/HIV co-infected patients were analyzed. Adjusted effects of the different factors on time to death were generated using Cox-proportional hazards regression.Results: A total of 3,889 patients were enrolled in the ACM study, of which 355 TB cases were identified, making the crude prevalence 9% (95% CI 8.3 – 10.2). Overall, incidence of TB was 2.2 (95% CI 1.9-2.4) per 100 person-years. TB was highest in the first 2 months and declined with time on ART to reach 1 per 100 person years after 24 months on ART. TB was significantly associated with mortality among HIV patients on HAART (AHR 2.0, 95% CI 1.47-2.75). Male gender was associated with mortality among TB/HIV co-infected patients.Conclusion: Tuberculosis plays a key role in HIV associated mortality. Targeted interventions which can keep patients free of TB in the early stages of their treatment are required to reduce TB related mortality.Key Words: Tuberculosis, Antiretroviral therapy, Mortalit

From Illusive to all-Inclusive: How Pathfinder International amplified learning by doing scientific writing training

Knowledge and practices of scientific writing are no longer limited to academic environments (1). Developments in the use of evidence-based program implementation involve rigorous evidence generation, with clear and effective communication of whether an intervention or practice is proven to have achieved high impact (2). Operational and implementation research has increasingly promoted research findings to better healthcare delivery and management while considering contextual factors (3,4). Most program implementors have limited scientific writing exposure. As a result, they miss opportunities to share experiences obtained from their program implementation due to limited scientific writing skills. While program implementors are not expected to "publish or perish," publication in scientific journals remains one of the best markers of scientific achievement. Many people in scientific professionals are not trained with soft writing skills, and the peer-review process focuses more on veracity of data than its legibility or accessibility. Nevertheless, scientific information not communicated or published often fails to garner the attention it deserves

Factors Associated with Long-acting Reversible Contraceptive Use in the Immediate Postpartum Period in Ethiopia

AbstractBackground: Factors influencing commitments to postpartum family planning such as the use of reversible contraceptives taken immediately after childbirth (within 10 minutes to 48 hours) have not been adequately studied. This study aims at contributing towards evidence, based on factors that influence long-acting reversible contraceptives use during immediate postpartum period among women who delivered in health facilities.Methods: A cross-sectional study design was used to collect quantitative data from a sample of 884 women who delivered in selected health centers during 12 months prior to the survey. Women who delivered in the facility were traced by community health workers and interviewed in their homes with the communities. Data was analyzed using descriptive statistics (graph and table) and logistic regressions with 95% confidence intervals was computed using Stata version 14.Results: Immediate postpartum contraceptive use among women who delivered in studied health facilities was 39%, while 36% used LARC. The study found that prior postpartum family planning information (AOR=0.46, 95% CI, 0.30-0.71) and counselling (AOR=0.23, 95% CI, 0.14-0.37), staying in a health facility maternity waiting homes before delivery (AOR=0.67, 95% CI, 0.49-0.91), and getting child immunization services (AOR=0.38, 95% CI, 0.21-0.67), were significantly associated with immediate postpartum LARC use.Conclusion: Immediate use of long-acting reversible counteractive after childbirth was influenced by different factors such as family planning information and counselling, staying in maternity waiting homes before delivery and getting child immunization services. Stakeholders working in family planning programs need further investigation about why women prefer long-acting reversible counteractive following a childbirth in health facilities. [Ethiop. J. Health Dev. 2021;35(SI-5):11-19]Keywords: Ethiopia, Family Planning, Postpartum Family Planning, Long-Acting Reversible Contraceptio

Role and contribution of peer educators in youth-friendly health services in Ethiopia: evidence from programmatic experience with a peer education intervention

AbstractBackground: Ethiopia has been integrating peer education program as a key element of its adolescent and youth reproductive health program. The aim of this study was to describe the roles and contributions of peer educators in promoting healthy behavior, generating demand for and uptake of youth-friendly services (YFS), and serving as change agents in their communities.Methods: A facility-based mixed method cross-sectional study was conducted from May 6-21, 2019. Exit interviews were conducted with 353 YFS clients and key informant interviews were done with 56 sampled individuals who had previous experience with peer education and YFS. A descriptive statistic was used to analyze the data using SPSS v.20 and qualitative data were analyzed manually and summarized based on emerging themes.Results: Of the 353 YFS clients, 61% were female, 65% were single, and 52% were in school. More than half of the respondents (61%) had never heard about YFS before coming to the health facility on the day of the survey. Among those who had heard about YFS (39%), the most common source of information was peer educators (38%) followed by 30% school clubs, and the remaining respondents (32%) were from parents, siblings, colleagues. Furthermore, the study also indicated that most of the respondents (78%) were aware of the work of peer educators, of which 45% had met with a peer educator and 55% knew about peer educators. The key informant interviews revealed peer educators were respected for sharing health information with their peers and for their willingness to provide community services.Conclusions: The findings show that peer educators play an important role in their communities by providing and dispensing different sexual and reproductive health information. More efforts need to be put towards reaching out-of-school youth so that they too can benefit from the program. [Ethiop. J. Health Dev. 2021;35(SI-5):37-44]Key words: peer educator; peer education; youth-friendly health service; adolescent and youth health service; Ethiopi

Time to fertility return after discontinuation of Intra-uterine contraceptive device: A systematic review and meta-analysis

AbstractBackground: Time to fertility return and rate of pregnancy after discontinuation of contraceptive is important to provide effective family planning counseling on the method-specific choice and designing a strategy to avert such concerns and problems. The aim of this study was to determine the time to fertility return and rate of pregnancy after discontinuation of Intra-uterine contraceptive.Methods: The review was conducted through a systematic search of published articles in English language between 1967- 2017. Information was extracted using a standardized form of Joana Brigg‘s Institute guidelines. After cleaning and sorting, analysis was performed using STATA version 11. Heterogeneity was assessed by the I2 and publication bias through funnel plot.Results: A total of 27 studies with 8,037 women who discontinued contraceptive methods for pregnancy desire were included for analysis. The pooled time interval from contraceptive discontinuation to conception was 3.1 months for Intra-uterine contraceptive device. On the other hand, the pooled pregnancy rate was 84.5% at one year and 90% at two years after Intra-uterine contraceptive device removal.Conclusion: Intra-uterine contraceptive users experienced a slight delay in fertility return compared with those who did not use contraception but not sustained in the long term. This study recommends a family planning counseling approach that includes time for fertility return after discontinuation to avoid confusion of contraceptive users. [Ethiop. J. Health Dev. 2021;35(SI-5):45-54]Keywords: time to fertility return, pregnancy rate, IUCD, contraceptive, meta-analysi