Home delivery among antenatal care booked women in their last pregnancy and associated factors: community-based cross sectional study in Debremarkos town, North West Ethiopia, January 2016.

BACKGROUND: In Ethiopia, nearly half of the mothers who were booked for antenatal care, who supposed to have institutional delivery, gave home delivery nationally. Home delivery accounts majority while few of childbirth were attended by the skilled provider in Amhara regional state. This study aimed to determine the proportion of home delivery and associated factors among antenatal care booked women who gave childbirth in the past 1 year in Debremarkos Town, Northwest Ethiopia. METHODS: A community-based Cross sectional study was conducted from January 1st- 25th 2016. Epi Info version 7 was used to determine a total sample size of 518 and simple random sampling procedure was employed. Data was collected through an interview by using pretested structured questionnaire. Data were entered into Epi Info version 7, cleaned and exported to SPSS version 21 for analysis. A p-value less than or equals to 0.05 at 95% Confidence Intervals of odds ratio were taken as significance level in the multivariable model. RESULTS: A total of 127 (25.3%) women gave childbirth at home. Un-attending formal education (Adjusted Odds Ratio = 7.56, 95% CI: [3.28, 17.44]), absence of health facility within 30 min distance (AOR = 3.41, 95% CI: [1.42, 8.20]), not exposed to media (AOR = 4.46, 95% CI: [2.09, 9.49]), Unplanned pregnancy (AOR = 3.47, 95% CI [1.82, 6.61]), attending ANC at health post (AOR = 5.45, 95% CI: (1.21, 24.49) and health center (AOR = 2.74, 95% CI [1.29, 5.82]), perceived privacy during ANC (AOR = 3.69[1.25, 10.91]) and less than four times ANC visit (AOR = 5.04, 95% CI (2.30, 11.04]) were significantly associated with home delivery. CONCLUSIONS: Home delivery in this study was found to be low. Educational level, media exposure, geographic access to a health facility, Unplanned pregnancy, an institution where ANC was booked, perceived privacy during ANC and number of ANC visit were found to be determinants of home delivery. Health institutions, health professionals, policy makers, community leaders and all concerned with the planning and implementation of maternity care in Ethiopia need to consider these associations in implementing services and providing care, for pregnant women

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation

Proportion and Factors Associated with late Antenatal Care Booking among Pregnant Mothers in Gondar Town, North West Ethiopia

The proportion of pregnant women initiating prenatal care during first trimester pregnancy is one of the standard clinical performance measures to assess the quality of maternal health care. Aiming to assess the proportion and factors associated with late booking at antenatal care, this health-institution based cross-sectional study was conducted from April to June 2012 among 390 pregnant mothers in Gondar town. The proportion of late entry to antenatal care was 64.9% with the mean time being 4.5 ± 1.8 months of pregnancy. Multiple logistic regression analysis showed that respondents who didn’t get information on correct time of booking, perceived the right time of booking beyond 12 weeks of pregnancy, were not autonomous to use antenatal care and recognized their pregnancy by missing periods were more likely to book late. Late booking was high in the study area. Empowering women and providing information, education and communication with emphasis on timely booking is important. Key words: Late booking, Antenatal care, Gondar Town.RésuméLa proportion de femmes enceintes qui commencent à fréquenter les centre des soins prénatals au cours du premier trimestre de grossesse est l'une des mesures de la performance clinique standard pour évaluer la qualité des soins de santé maternelle. Visant à évaluer la proportion et les facteurs associés à la réservation tardive pendant les soins prénatals, cette étude transversale basée sur la santé des institutions a été menée d'avril à juin 2012 Parmi 390 femmes enceintes de la ville de Gondar. La proportion de l'entrée tardive de soins prénatals était de 64,9% avec le temps moyen étant de 4,5 ± 1,8 mois de la grossesse. L’analyse de régression logistique multiple a montré que les interrogées qui ne reçoivent pas d'informations sur le bon moment pour faire la réservation, ont perçus le bon moment de la réservation au-delà de 12 semaines de grossesse, n’étaient pas autonomes à utiliser les soins prénatals et ont reconnu leur grossesse par des périodes manquantes, étaient plus susceptibles de faire une réservation tardive. Les cas de réservation tardive était élevé dans la zone de l’étude. Il est important d'autonomiser les femmes et de leurs fournir des informations, de l'éducation et de la communication en mettant l'accent sur la réservation en temps opportun. Mots-clés: réservation tardive, soins prénatals, Gondar Ville

Decision To Delivery Time and Its Predictors Among Mothers Who Underwent Emergency Cesarean Delivery At Selected Hospitals of Northwest Ethiopia, 2023: Prospective Cohort Study

Beker Ahmed Hussein,1 Beyene Sisay Damtew,1 Hinsermu Bayu Abdi,1 Temesgen Worku Gudayu2 1Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia; 2Department of Clinical Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Beker Ahmed Hussein, Email [email protected]: The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists recommend that the decision to delivery time interval is less than 30 min. Additionally, the decision to delivery time varies across institutions and countries.Objective: The aim of this study was to determine the decision to delivery time and its predictors among women who underwent emergency cesarean delivery at selected hospitals of Northwest Ethiopia, 2023.Methods: An institutional-based prospective cohort study was conducted at selected hospitals of Northwest Ethiopia, among women who underwent emergency cesarean delivery from November 1 to January 30, 2023. A total of 285 participants were enrolled, and data collected using structured and pre-tested questionnaires. A systematic sampling technique was used. Data were entered into Epi-Data version 4.6 and then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using the Kaplan–Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors.Results: From 285 participants, 56 (21.8%) women delivered within the recommended 30 min. The overall median survival time was undetermined and the restricted mean survival time was 48.9 min (95% CI: 47.4– 50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02– 1.25), cord prolapses (AHR: 1.36, 95% CI: 0.46– 3.94), rank of surgeon (AHR: 0.42. 95% CI: 0.42– 1.08), no free operation room table (AHR: 0.27, 95% CI: 0.28– 0.94), regional anesthesia (AHR: 0.56, 95% CI: 0.25– 1.28), and use of a bladder flap (AHR: 0.33, 95% CI: 0.16– 0.85).Conclusion: Overall decision to delivery times among women who underwent emergency cesarean section at selected hospitals were longer than the recommended time.Keywords: decision time, emergency cesarean deliver

Effect of Decision-to-Delivery Time of Emergency Cesarean Section on Adverse Newborn Outcomes at East Gojjam Zone Public Hospital, Ethiopia, March 2023: Multicenter Prospective Observational Study Design

Beyene Sisay Damtew,1 Temesgen Worku Gudayu,2 Wubedle Zelalem Temesgan,2 Alemu Merga Hailu3 1Department of Midwifery, Arsi University, Assela, Ethiopia; 2Department of Midwifery, University of Gondar, Gondar, Ethiopia; 3Department of Midwifery, Wollega University, Nekemte, EthiopiaCorrespondence: Beyene Sisay Damtew, Email [email protected]: An emergency cesarean section requires prompt delivery to reduce the risk for a pregnant woman or newborn. Studies have been conducted to investigate the relationship between decision-to-delivery time and neonatal outcomes, but the findings are contradictory. Therefore, this study aimed to assess the average of decision-to-delivery time of an emergency cesarean section and its effect on adverse neonatal outcomes at East Gojjam Zone Public Hospital.Methods: A multicenter prospective study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 352 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. Measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.Results: Decision-to-delivery time interval within 30 minute was seen in 21.9% of emergency cesarean delivery. The study found a significant relationship between the first-minute low Apgar score and the delayed decision-to-delivery time interval (OR = 2.6, 95% CI: 1.1– 6, p = 0.03). In addition, determinant factors for poor 1st-minute Apgar scores include danger signs during pregnancy (AOR: 2.9, 95% CI: 1.1– 7.8, p = 0.03), women referred from another facility (AOR: 2.6, 95% CI: 1.5– 4.6, p = 001), and non-reassuring fetal heart rate (AOR: 4.2, 95% CI: 1.1– 17, p = 0.04). A delayed decision-to-delivery time interval is not statistically significantly associated with a low 5th-minute Apgar score or neonatal intensive care unit (NICU) admission.Conclusion: The study found unfavorable 1st-minute Apgar score and a longer decision-to-delivery period than recommended. This duration and negative newborn outcomes may be reduced by increasing and involving comprehensive obstetric and neonatal care facilities with skilled emergency obstetric surgeons, such as clinical midwife, integrated emergency surgeon officers, and physician.Keywords: decision-to-delivery time, cesarean delivery, fetal outcomes, Ethiopi