Risky sexual behavior and predisposing factors among students of Jimma University, Ethiopia

BACKGROUND: Students of higher institutions are assumed to be exposed to many risky sexual behaviors. However, little has been explored about the magnitude of risky behavior and predisposing factors in the context of higher education institutions in Ethiopia. Thus, the objective of this study was to assess the pattern of risky sexual behaviors and predisposing factors among Jimma University students. METHODS: This cross-sectional study was conducted in November 2009 involving quantitative and qualitative methods. The quantitative study was conducted on 1010 students selected by multistage cluster sampling technique. The data were collected using self-administered questionnaire and analyzed using SPSS V.16.0. Multi-variate logistic regression was used to see association between variables. The qualitative part involved 10 focus group discussions and 17 key-informant interviews selected purposively. The qualitative data were analyzed by thematic areas. RESULTS: Among the respondents, 267(26.9%) ever had sexual intercourse. The mean age at first sexual intercourse was 17.7±2.7 years. Most, 75.6%, started sexual intercourse during secondary school. Among whoever had sex, 51.0% had sex in the last 12 months and 28.3% had multiple sexual partners. Consistent condom use with non-regular partner in the last 12 months was 69.1%. Lack of parental control, substance use, peer pressure, campus and outside environment were identified as predisposing factors. CONCLUSION: Risky sexual behaviour such as having multiple sexual partner and sexual practice without condom with non- regular partner exists. The university and local health bodies should work together to address the identified risky behaviours with particular focus on Behaviour change communication.Keywords: risky behaviour, Jimma University, University students, predisposing factors, HIV/AIDSEthiopian Journal of Health Sciences vol 22 (3) 201

A Mediation Analysis of Determinants of New-born Care Practices in Four Regions of Ethiopia

Background: Despite a substantial decline in under-five mortality in Ethiopia, neonatal mortality declined steadily and the contribution of the insignificant decline of neonatal mortality to under-five mortality grew from 29.5% in 2000 to 43.3% in 2016. The slow fall of neonatal mortality implies the need for an approach that addresses the main causes of new-born deaths. The World Health Organization recommends essential new-born care practices to save new-borns from morbidity and mortality. The aim of this study was to assess determinants of new-born care practice in the four regions of Ethiopia.Method: The study is part of an intervention project that attempts to investigate the impact of Optimising Health Extension Project on health service utilisation of mothers and children below the age of five years. Data for 590 births that occurred in the twelve months preceding the survey was extracted from the main study data and utilized for the present study. The outcome variable of our study is the number of new-born care practices performed by women that delivered recently. Thus, Poisson regression analysis was used, and a goodness of fit test showed that the model fits the data well. Maternal healthcare utilisation is considered as a mediating variable and a difference approach was used to test whether the effects of socio-economic and demographic variables were mediated. STATA 14 was used for data management and analysis and 5% level of significance was used to declare statistical significance.Results: Clothing (88.1%) and drying (75.2%) are the most frequently accomplished thermal care practices. Cutting the cord with a clean and sharp material was practiced for 83.0% of the births. For more than two third of the births (68.5%), timely initiation of breastfeeding was performed as a new-born care practice. Immunization of the new-born for polio 0 was the least performed new-born care practice for 25.8% of the births. Maternal healthcare utilisation beyond ANC was observed to be beneficial to new-born care practice. The total effect of birth preparedness and complication readiness (0.15 (0.08, 0.22)) was split to direct and indirect effect. Both the direct (0.08 (95% CI (0.01, 0.15))) and indirect (0.07 (95% CI (0.02, 0.12))) effects were statistically significant. The predictive power of birth preparedness and complication readiness through its influence on maternal healthcare utilization accounted for 45.3% (95% CI (15.6, 75.0)) of its total effect.Conclusion: New-born care practice is inadequate in general. However, birth preparedness and complication readiness have dual benefit of enhancing both maternal healthcare utilization and new-born care practices. Therefore, women shall be provided with information on benefits of facility delivery and getting professional assistance during delivery to improve new-born care practices.[Ethiop. J. Health Dev. 2021; 35(2):000-000

Factors affecting birth preparedness and complication readiness in Jimma Zone, Southwest Ethiopia: a multilevel analysis

Introduction: birth preparedness and complication readiness have been considered as comprehensive strategy aimed at promoting the timely utilization of skilled maternal health care. However, its status and affecting factors have not been well studied at different levels in the study area. Thus, this study was aimed to fill this gap by conducting community based study. Methods: a cross-sectional study was conducted among randomly selected 3612 pregnant women from June-September 2012. The data were collected by interviewer-administered structured questionnaire and analyzed by SPSS V.20.0 and STATA 13. Mixed-effects multilevel logistic regression model was used to identify factors affecting birth preparedness and complication readiness. Results: the status of birth preparedness and complication readiness was 23.3% (95% CI: 21.8%, 24.9%). Being in urban residence and having health center within two hours distance were among the higher level factors increasing birth preparedness and complication readiness. Educational status of primary or above, husband's occupation of employed or merchant, third or above wealth quintiles, knowledge of key danger signs during labor, attitude and frequency of antenatal care visits were among the lower level factors found to increase the likelihood of preparation for birth and its complications. Conclusion: the status of birth preparedness and complication readiness was low in the study area. Both community level and individual level factors had important program implications. Socio demographic, economic, knowledge of key danger signs, attitude and antenatal care use were identified as associated factors. Improving antenatal care, giving special emphasis to danger signs and community based health education are recommended

The effects of adherence to recommended antenatal services on adverse pregnancy outcomes in Northwest Ethiopia: multilevel and propensity score matching (PSM) modeling

IntroductionAdverse pregnancy outcomes are a personal and social crisis caused by easily preventable pregnancy-related problems. Despite that, studies on the effectiveness of adherence to the continuity of antenatal care (ANC) services are scarce. Therefore, this study aims to determine the effectiveness of the continuity of ANC services and the determinants of adverse pregnancy outcomes.MethodsA prospective follow-up study design was conducted from March 2020 to January 2021 in Northwest Ethiopia among randomly selected study subjects. Data were collected by trained data collectors using pre-tested structured questionnaires and analyzed using STATA Software version 14. A multilevel regression model was used to identify determinant factors, whereas the propensity score matching (PSM) model was used to look at the effectiveness of adherence to ANC services on adverse pregnancy outcomes.ResultsAmong 2,198 study participants, 26.8% had adverse pregnancy outcomes, with 95% CI: 24.9–28.7 [abortion (6.1%; 95% CI: 5.1–7.1), low birth weight (11.5%; 95% CI: 10.2–12.9), and preterm birth (10.9; 95% CI: 9.6–12.3)]. Determinant factors were iron-folic acid supplementation (AOR = 0.52; 95% CI: 0.41, 0.68), delayed initiation of ANC visits at 4–6 months (AOR = 0.5; 95% CI: 0.32, 0.8), initiation of ANC visits after 6 months (AOR = 0.2; 95% CI: 0.06, 0.66), received four ANC visits (AOR = 0.36; 95% CI: 0.24, 0.49), an average time of rupture of the amniotic membrane of between 1 and 12 h (AOR = 0.66; 95% CI: 0.45, 0.97), and pregnancy-related problems (AOR = 1.89; 95% CI: 1.24, 2.9). As a treatment effect, completion of a continuum of visit-based ANC (ATET; β = −0.1, 95% CI: −0.15, −0.05), and continuum of care via space dimension (ATET; β = −0.11, 95% CI: −0.15, −0.07) were statistically significant on the reduction of adverse pregnancy outcomes.ConclusionIn the study area, the rate of adverse pregnancy outcomes was high. Even though adherence to the continuity of ANC services via time and space dimensions is effective in the prevention of adverse pregnancy outcomes, programmatically important factors were also detected. Therefore, key strategies for promoting the uptake of antenatal services and strengthening iron-folic acid supplementation are strongly recommended

Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, southern Ethiopia.

In 2015 the maternal mortality ratio for Ethiopia was 353 per 100,000 live births. Large numbers of women do not use maternal health services. This study aimed to identify factors influencing the use of maternal health services at the primary health care unit (PHCU) level in rural communities in Sidama zone, south Ethiopia in order to design quality improvement interventions. We conducted a qualitative study in six woredas in 2013: 14 focus group discussions (FGDs) and 44 in-depth interviews with purposefully selected community members (women, male, traditional birth attendants, local kebele administrators), health professionals and health extension workers (HEWs) at PHCUs. We digitally recorded, transcribed and thematically analysed the interviews and FGDs using Nvivo. The 'three delay model' informed the analytical process and discussion of barriers to the use of maternal health services. Lack of knowledge on danger signs and benefits of maternal health services; cultural and traditional beliefs; trust in TBAs; lack of decision making power of women, previous negative experiences with health facilities; fear of going to an unfamiliar setting; lack of privacy and perceived costs of maternal health services were the main factors causing the first delay in deciding to seek care. Transport problems in inaccessible areas were the main contributing factor for the second delay on reaching care facilities. Lack of logistic supplies and equipment, insufficient knowledge and skills and unprofessional behaviour of health workers were key factors for the third delay in accessing quality care. Use of maternal health services at the PHCU level in Sidama zone is influenced by complex factors within the community and health system. PHCUs should continue to implement awareness creation activities to improve knowledge of the community on complications of pregnancy and benefits of maternal health services. The health system has to be responsive to community's cultural norms and practices. The mangers of the woreda health office and health centres should take into account the available budgets; work on ensuring the necessary logistics and supplies to be in place at PHCU

Magnitude and Determinants of Perinatal Mortality in Southwest Ethiopia

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p<0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR=0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR=0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR=0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR=3.38; 95% CI: 1.90, 6.00), twin births (AOR=5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR=3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR=4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications

Safe Delivery Service Utilization in Metekel Zone, NorthWest Ethiopia

No abstract - Available on PD

The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis

Abstract Background Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality. Methods The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. Results A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87) for health facility delivery as compared to home delivery. Conclusion Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are essential in areas where home delivery is a common practice.</p

Contraceptive Method Utilization and Determinant Factors among Young Women (15-24) in Ethiopia: A Mixed-Effects Multilevel Logistic Regression Analysis of the Performance Monitoring for Action 2018 Household Survey

Despite highly effective modern contraceptive methods (both short and long acting) are made widely available and accessible globally, their utilization remains low among young women in low- and middle-income countries, including Ethiopia. Hence, this study is aimed at determining its status and identifying the determinant factors by using nationally representative data. A multilevel analysis of the nationwide Performance Monitoring for Action 2018 of Ethiopia round 6 data, collected from June to July, 2018, was conducted. A total of 982 both married and unmarried young women (15-24) were included in the analysis. Descriptive statistics was used to describe the status of contraceptive method utilization and unmet need across regions. A mixed-effects multilevel logistic regression model was used to identify the determinants of the contraceptive method utilization. Adjusted odds ratios with corresponding 95% confidence intervals were used to show the significance of the associations at p<0.05. The status of contraceptive method utilization was 54.8% (95% CI: 51.7%, 57.9%), and 18.6% (95% CI: 16.3%, 21.2%) had unmet need. Afar (12.3%), Harari (12.5%), and Ethiopian Somali (20.0%) regions had the lowest contraceptive method utilization. Wealth quintiles and religion were the higher level variables affecting contraceptive method utilization among the young women. Age, marital status, parity, future birth intention, and knowledge of contraceptive methods were the individual level factors identified as determinants of contraceptive method use among the young women. In conclusion, the status of contraceptive method utilization among the young women in Ethiopia is promising as compared to the national target of 55% for 2020; however, still high unmet need exists. The factors also exist both at the contextual and at individual levels. Hence, multilevel interventions need to be in place giving special emphasis to the low performing regions. Besides, region-specific behavioral interventions and family planning services that will be able to reach the young women need to be designed