Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

PROPORTION OF EARLY ANTENATAL CARE BOOKING AND ASSOCIATED FACTORS IN MEKELLE CITY, PUBLIC HEALTH INSTITUTIONS, NORTHERN ETHIOPIA, 2015

 Objective: The objective of this study was to assess the proportion and associated factors for early initiation of antenatal care visit in Mekelle City, Tigray, Northern Ethiopia, 2015.Method: An institution-based cross-sectional study was employed among 391 pregnant women's in Mekelle special zone. A systematic sampling technique was used to select study participants. Pretested structured questionnaire was used to collect the data through interview. Data were entered into EPI info version 7 and analyzed using SPSS version 20, respectively. Bivariate and multivariate logistic regression was done to see significant variables with p<0.05 at 95% confidence interval (CI).Result: The proportion of pregnant women who initiate early antenatal care (ANC) visit was found to be 41.1%. Perceived correct time of initiation before 4 months (adjusted odds ratio [AOR]=3.261, 95% CI 1.391–7.645) and correct time told by others before 4 months with (AOR=6.617, 95% CI 2.580, 16.971) were found to have statistically significant positive outcomes association with early initiation of antenatal care visit.Conclusion: The proportion of early ANC initiation in Mekelle is lower than the World Health Organization recommendation which is <16 weeks gestation. Therefore, providing information to the community, initiation counseling, and providing health education on the benefits early ANC is crucial to improving maternal, neonatal, and child health outcomes

Clinical and economic burden of healthcare-associated infections: A prospective cohort study

Introduction Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. Objective To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. Materials and methods A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar’s test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. Results A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, PConclusion HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units

Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey

Abstract Background Postnatal care service enables health professionals to identify post-delivery problems including potential complications for the mother with her baby and to provide treatments promptly. In Ethiopia, postnatal care service is made accessible to all women for free however the utilization of the service is very low. This study assessed the utilization of postnatal care services of urban women and the factors associated in public health facilities in Mekelle city, Tigrai Region, Northern Ethiopia. Methods A facility based cross sectional study design was used to assess post natal service utilization. Using simple random sampling 367 women who visited maternal and child health clinics in Mekelle city for postnatal care services during January 27 to April 2014 were selected. Data was entered and analyzed using SPSS Version 20.0 software. A binary and multivariable logistic regression was used to identify risk factors associated with the outcome variables. P-value less than 0.05 is used to declare statistical significance. Results The prevalence of women who utilized postnatal care service was low (32.2%). Women who were private employees and business women were more likely to utilize postnatal care services (AOR = 6.46, 95% CI: 1.91–21.86) and (3.35, 95% CI: 1.10–10.19) respectively compared to house wives., Women who had history of one pregnancy were more likely to utilize the service (AOR = 3.19, 95% CI: 1.06–9.57) compared to women who had history of four and above pregnancies. Women who had knowledge of postnatal care service were also more likely to utilize postnatal care service (AOR = 14.46, 95% CI: 7.55–27.75) than women who lacked knowledge about the services. Conclusions Postnatal care utilization in the study area is low. Knowledge on postnatal care services and occupation of women had positive impact on postnatal care service utilization. The Mekelle city administration health office and other stakeholders should support and encourage urban health extension workers and health facilities to strengthen providing health education to improve the knowledge of the women about the importance of postnatal care services

Clinical and economic burden of healthcare-associated infections: A prospective cohort study.

IntroductionHealthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs.ObjectiveTo assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital.Materials and methodsA prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses.ResultsA total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, PConclusionHAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units

Assessment of partograph utilization and associated factors among obstetric care givers at public health institutions in central zone, Tigray, Ethiopia

Abstract Objectives Partograph is one of the best effective obstetric tools used to monitoring labor and prevent prolonged or obstructed labor which accounts for about 22% of maternal deaths in Ethiopia. This study was aimed to assess partograph utilization and associated factors among obstetric care givers. Facility based cross sectional study was used in the randomly selected health facilities. Total 220 obstetric care givers were selected using simple random sampling technique. Data were entered and analyzed using SPSS version 22.0. Bivariate and multivariate logistic regression analysis was used to identify the associations of each explanatory variable with the outcome variable. Finally, odds ratio with its 95% confidence interval and p-value of 0.05 was used to identify significant variables. Result Out of 198 obstetric care providers, 73.3% used partograph to monitor progress of labor. Those who were diploma holders (AOR = 3.8, CI = 2.2–6.2), receiving basic emergency obstetrics and new born care training (AOR = 5.6, CI 1.1–28.5), age between 20 and 29 years-old (AOR = 0.1, CI = 0.01–0.50), and male health care providers (AOR = 0.37, CI = 0.44–0.95) were factors significantly associated with partograph utilization. Partograph utilization in this study was below the WHO recommendation. Especial emphasizes and interventions should be given to increase partograph utilization

Additional file 1: of Postnatal care utilization among urban women in northern Ethiopia: cross-sectional survey

English Version Questionnaire. (DOC 220 kb

Timing of first focused antenatal care booking and associated factors among pregnant mothers who attend antenatal care in Central Zone, Tigray, Ethiopia

Abstract Objective Focused antenatal care became the recommended type of antenatal care following the publication of a World Health Organization trial on antenatal care where it was discovered that the traditional antenatal care approach do not necessarily improve pregnancy out-come. This study was aimed to assess timing of first focused antenatal care booking and associated factors among pregnant mothers. Facility based cross sectional study was used in the randomly selected health facilities. Total 239 pregnant women who visited antenatal clinic were selected using simple random sampling technique and data were entered and analyzed using SPSS version 20.0 software. Results The study shows that only 41% of pregnant mothers booked timely antenatal care and the median duration of pregnancy at the first visit was 5 months. Multivariate logistic regression analysis showed that gravidity and information received on correct time of antenatal care booking from health care provider were significantly associated with timely initiation of antenatal care. Late antenatal care booking remains high in the study area and this indicated that provide information, education and communication to create community awareness is remarkable and implementing community based discussion up to the local level will be crucial

Assessing the competence of midwives to provide care during labor, childbirth and the immediate postpartum period - A cross sectional study in Tigray region, Ethiopia.

BACKGROUND:The availability of a skilled birth attendant is widely recognized as a critical factor in reducing maternal and newborn mortality. Competence of maternal healthcare providers directly affects quality of care and health outcomes. This study assessed competence of midwives and associated factors in provision of care during labor, and the immediate postpartum period at public health facilities in Tigray, Ethiopia. METHODS:A cross-sectional study design was employed to collect data through direct observation of the performance of 144 midwives selected from 57 health facilities. Data were collected from January to February 2015 by 12 experienced midwives who were trained on basic emergency obstetric care and had previous experience with data collection. Using a standardized competence checklist, adapted from International confederation of midwives, data collectors interviewed and directly observed the performance of midwives from admission of laboring mothers to six hours after delivery. Multivariable linear regression was used to identify predicators associated with overall clinical competence of midwives. RESULT:The mean competence score of midwives was found to be 51%. In multivariable linear regression, male midwifery professionals (p = 0.022), availability of up to date job aids in work place (p = 0.04) and being recognized for improved performance (p = 0.005) were significantly associated with competence of midwives in the provision of care during labor, childbirth and immediate postpartum period. CONCLUSION:Competence of midwives was found to be low to provide safe and quality maternity care in the region. Male gender, availability of complete job aids and receiving recognition/awards for better performance were predicted competence. This requires attention and investment from Tigray regional health bureau and health development partners working on maternal and child health. Competence based in-service training, on-the-job mentoring, availing up to dated standard job aids, recognition of high performing midwives are recommended to improve the quality of maternity care in public health facilities of the region. Moreover, affirmative actions including on-the-job training and supervision are needed to improve the competence of female midwives