Infant survivorship and occurrence of multiplebirths: A longitudinal community-based study, south west Ethiopia

Abstract: A one year live-birth cohort was studied in 46 urban and 64 rural ‘kebeles’ in south-west Ethiopia, in 1992-94. In order to recruit all live-births in each of the study kebeles, pregnant women were identified in their second trimester and monitored by trained TBAs and enumerators using house to house visit. Each infant-mother pair of the cohort was visited soon after birth followed by regular bimonthly visit to the end of their first year or to an earlier death. Infant mortality was calculated as a life tables estimate using the ‘survival’ programme in SPSS. There were a total of 8162 births (8050 singletons, 111 twins and one set of triplets) of which 856 died, indicating an infant mortality of 104.8/1000 (estimated probability of surviving to 1 year 0.8952, with s.e. 0.004). The occurrence of multiple-births was 13.6/1000 live births. The infant mortality among them was 446.8/1000 (estimated probability of surviving to 364 days .5532, with s.e. 0.0034). This is a matter of serious concern. This study is the first of its kind based on rigorous study design, bigger sample size comprising different population groups and wider areas. The findings could help to formulate policy and health care programmes. [Ethiop. J. Health Dev. 1997;11(3):283-288

Patterns of Birth Weight at a Community Level in Southwest Ethiopia

BACKGROUND: Birth weight data are not routinely measured and recorded in Ethiopia and most of the analysis were based on births occurred in health institutions but such analysis lack representativeness as most deliveries are occurring at home. To fill this gap and issues related to representativeness a community based study that identified a one-year live birth cohort of 8,273 in Jimma, Illubabor and Keffa zones, South West Ethiopia was undertaken to determine patterns and identify independent factors contributing for birth weight. METHODS: This was a  community-based longitudinal study, which attempts to record birth-weight by using existing net-work of community health workers. RESULTS: The results of the study found an estimated low birth weight rate of 10.0% that varied between residential areas, marital status, monthly family income, parity and mothers' experience of previous child deaths. In addition, number of antenatal clinic attendances, type of birth, sex of the foetus, season of birth, source of drinking water and type of latrine facility showed variation in low birth weight rates. These factors also showed independent and significant effect on birth weight patterns. CONCLUSION: Based on the findings of this study it is recommended that improving antenatal care visits of mother during pregnancy, delaying the age at first delivery, increasing access to safe water supply and access to pit latrine facility to families could improve birth weight patterns that could improve survival and subsequent growth of children.Ethiop J Health Sci. Vol. 14, No. 1 January 200

Contribution of plastic bags to the retention of child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region, Ethiopia

Background: Many vaccines are given more than once, at different ages, and in combinations. Parents are expected to retain immunization cardsfor their children, however in Ethiopia, the retention of child immunization cardsis minimal. For example, the 2005 and 2011 Ethiopian Demographic and Health Surveys showed that 37% and 29% of immunization cards, respectively, were retained. The CORE Group Polio Project developed an innovative approach to keeping home vaccination records for a long time and safely, in the form of a plastic bag designed to hold the immunization card. The pilot project for this innovation was held in GambellaRegion and AssosaZone, Benishangul-Gumuz Region since 2015. Objective: Evaluate the contribution of plastic bagsfor holding and retaining child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region. Methods: The study was a household-based cross-sectional survey and the target population was households with at least one child aged under 2 years who had received at least one vaccination dose. A sample of 239 households (120 from Gambella Region and 119 from Assosa Zone in Benishangul-Gumuz Region) were selected randomly from immunization registration records. Up to 12 kebeles were included from each region, with at least 10 children per kebele. Data were collected using an Amharic language questionnaire and analyzed with STATA version 13.0.Results: Of all 239 respondents, 139 (58.2%) received the plastic bag for retaining immunization cards, while 100 (41.8%) did not receive the bag. Of the139 respondents who received immunization cards, 125 (89.9%) utilized the plastic bag. Of those that utilized the bags to hold immunization cards, 50.4% were from Gambella Region and 49.6% were from Benishangul-GumuzRegion. A total of 125 (58.7%) respondents were presented with the immunization card inside the plastic bag, and 88 (41.3%) respondents received the immunization card with no accompanying plastic bag. However, of all respondents who received the plastic bag, 14 (10%) did not put the card inside it. The reasons given byrespondents were that it was difficult to put the card inside the plastic bag(seven cases, (58.3%)) and that itwas lost/damaged or used for some other purpose (five cases, (41.7%)).A total of 145(70%) respondents reported thatthey placed the plastic bag that contains the immunization card in a secure place, such as in a box, and 53 (25.6%) hung it ona wall.Conclusion: In general, there was 89.5% card retention; 90% of respondents utilized the plastic bag, and 88% of mothers said they would advise others to use the plastic bag.[Ethiop .J. Health Dev. 2019; 33(Special issue):31-36]Key words: Plastic bag, Immunization Card, Retention, Gambella and Benishangul Gumuz

Health Care Seeking Behavior in Southwest Ethiopia

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia. Methods Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05. Results Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3–63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04–15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1–5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4–33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2–8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2–110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1–10.9) among urban households showed statistically significant association. Conclusions The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households

Assessment of Sexual Assault Among Women in Assendabo Town, Oromiya Region, South West Ethiopia

BACKGROUND: Violence against women is increasingly being recognized as important human rights, development and health issue however it is difficult to know its magnitude in Ethiopia. The objective of this study is therefore to assess the magnitude of sexual assault among women in Assendabo town. METHODS: A cross-sectional study was conducted on a sample of 323 women 10 years and above. Data was collected by trained female interviewers using structured questionnaire and entered into computer, tabulation and summarization was done using SPSS. RESULTS: Twenty-six (8.0%) of the respondents were lifetime sexual assault victims and 5 (1.5%) of the respondents were victims of sexual assault in the last one-year prior to data collection. Of lifetime sexual assault victims, majority 19 (73.1%) were victims of rape and five (19.2%) of the victims had encountered sexual assault more than once with mean age at first sexual assault was 15 year. Unwanted pregnancy, unsafe abortion and STD were the major problems reported as consequences of the assault. Thirty-three (10.2%) of the respondents and 21 (80.8%) of the victims prefer to keep quite about the event due to fear of associated social stigma. Most of the respondents, 282 (87.3%), knew the act of rape is punishable by law and 146 (45.2%) respondents believed that penal code of Ethiopia on rape that states maximum of 10 years imprisonment for the act of rape is inadequate. CONCLUSION: sexual assault is an important health and social problem-affecting women. Hence there is a need for more concerted efforts to be made in creating awareness among women to prevent the crime and encourage reporting among victims. Moreover medical care and psychological support should be strengthened to treat consequences of sexual assault.Ethiop J Health Sci. Vol. 14, No. 1 January 200

ANALYSIS OF DELIVERIES IN JIMMA HOSPITAL

ABSTRACT: This study was conducted to analyze the outcome of deliveries in Jimma Hospital between 1985 and 1989. There were a total of 4251 deliveries, 769 of which were abnormal. The maternal morbidity and mortality rates were 84.8 and 11.5 per 1000 live births respectively. The major causes of morbidity were postoperative surgical wounds in 91.8% and postpartum haemorrhage in 4% of cases. The leading causes of death were ruptured uterus (47.7%), puerperal sepsis (27.3%) and postpartum haemorrhage (13.6%). A significant proportion of deaths and illness occur in patients who were referred and among those unable to pay their hospital fees. There were a total of 371 perinatal deaths with a stillbirth to neonatal death ratio of 3.09:1. The perinatal morbidity and mortality rates were 53.5 and 95.9 per 1000 live births respectively. The commonest causes of perinatal death were obstructed labor (22.8%) and ruptured uterus (18.2%). The major reported morbidity were low birth weight 58.9% and low Apgar Score 35.7%. Perinatal mortality is higher in referred mothers and in those who do not pay their hospital fees. Finally the type of intervention received during deliveries are described. The association of maternal characteristics with maternal and perinatal mortality and morbidity are analyzed and recommendations give

Birth Preparedness and Its Association with Skilled Birth Attendance and Postpartum Checkups among Mothers in Gibe Wereda, Hadiya Zone, South Ethiopia

Background. Birth preparedness program was designed to enhance skilled birth attendance and postpartum checkups of women in a developing country to reduce the three delays that lead women and neonates to death and disability. However, the relationship between birth preparedness with skilled birth attendance and postpartum checkups among mothers is not well studied. Therefore this study is intended to assess the association between birth preparedness and skilled birth attendance and postpartum checkups. Methods. A community based cross-sectional study was conducted from March to April 2014. Eight out of 22 Kebeles were selected using probability proportional to size sampling method. Seven hundred and forty-five mothers were selected randomly from the sampling frame, generated from family folders obtained from health posts. Data was collected using pretested questionnaire by face-to-face interview. Data was entered into EpiData version 3.1 database and analyzed by SPSS version 16. Result. Out of 745 sampled mothers 728 (97.7%) participated in the study. One hundred and twelve (15.4%) and 128 (17.6%) mothers got skilled birth attendance and received postpartum checkups for their last child, respectively. Birth preparedness, educational status of women and their husbands, and antenatal care visits of mothers were found to be predictor of skilled birth attendance and postpartum checkups. Mothers well prepared for child birth were 6.7 times more likely to attend skilled birth attendance [AOR = 6.7 (2.7–16.4)] and 3 times more likely to follow postpartum checkups [AOR = 3.0 (1.5–5.9)] than poorly prepared mothers, respectively. Travel time to reach the nearest health facility was found as predictor for postpartum checkups of mothers; mothers who travel ≤ 2 hours were three times more likely to follow postpartum checkups than mothers who travel > 2 hours (AOR (95% CI) = 3.4 (1.5–7.9)). Conclusion and Recommendation. Skilled birth attendance and postpartum checkups were low. Encouraging women to attend recommended antenatal care visits and providing advice and education on birth preparedness and obstetric danger signs are important interventions to increase skilled birth attendance and postpartum checkups

Risk Factors of Active Tuberculosis in People Living with HIV/AIDS in Southwest Ethiopia: A Case Control Study

BACKGROUND: Determinants of active tuberculosis among People Living with HIV/AIDS (PLHA) are not well elucidated in countries with limited resources. The objective of this study was to assess distal and proximate determinants of active tuberculosis among people living with HIV/AIDS in southwest Ethiopia. METHODS: A case-control study was conducted from January to March, 2009 in South West Ethiopia. The study population consisted of 162 cases and 647 controls. Cases were adult people living with HIV/AIDS who developed active pulmonary tuberculosis and controls were people living with HIV/AIDS without active tuberculosis. An interviewer administered structured questionnaire was used to collect information on potential risk factors. RESULTS: After adjustment for potential confounders, male gender (OR=1.7; 95%CI: 1.1, 2.7), a low level of education (OR=2.8; 95% CI: 1.1, 7.1), a body mass index less than 18.5 kg/m2 (OR=4.1; 95% CI: 2.3, 7.4), hemoglobin level less than 10.0 g/dl (OR=2.8; 95%CI: 1.5, 5.2), a CD4 lymphocyte count less than 200 cells/μL (OR=9.8‘95% CI: 5.5, 17.5), a WHO clinical stage IV (OR=4.3; 95% CI: 2.6, 6.8), not taking antiretroviral treatment (OR=3.1; 95%CI: 1.9,4.9), an infection with helminthes (OR=2.2; 95% CI: 1.4, 3.4), a history of contact with a tuberculosis patient in the family (OR=2.0; 95% CI: 1.2, 3.3), and living in a house made of mud wall (OR=3.7; 95% CI: 1.5, 7.5) were independently associated with the development of active tuberculosis in people living with HIV/AIDS. CONCLUSION: All people living with HIV/AIDS should be screened for tuberculosis but in the presence of the risk factors mentioned above, intensified screening is recommended. KEYWORDS: Active TB, HIV, risk factors, case control study, Southwest Ethiopi

Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: An economic evaluation

Background Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia. Methods We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities. Results In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs. Conclusions Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.publishedVersio

Health Care Seeking Behavior in Southwest Ethiopia

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