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

Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa

Objective To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Design Diagnostic accuracy study. Setting Ethiopia, India and South Africa. METHODS: Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. RESULTS: Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. CONCLUSION: The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability

Unintended pregnancies and the use of maternal health services in southwestern Ethiopia

Background: The benefits of maternal health care to maternal and neonatal health outcomes have been well documented. Antenatal care attendance, institutional delivery and skilled attendance at delivery all help to improve maternal and neonatal health. However, use of maternal health services is still very low in developing countries with high maternal mortality including Ethiopia. This study examines the association of unintended pregnancy with the use of maternal health services in Southwestern Ethiopia. Methods: Data for this study come from a survey conducted among 1370 women with a recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern Ethiopia. An interviewer administered questionnaire was used to gather data on maternal health care, pregnancy intention and other explanatory variables. Data were analyzed using STATA 11, and both bivariate and multivariate analyses were done. Multivariate logistic regression was used to assess the association of pregnancy intention with the use of antenatal and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported. Results: More than one third (35%) of women reported that their most recent pregnancy was unintended. With regards to maternal health care, only 42% of women made at least one antenatal care visit during pregnancy, while 17% had four or more visits. Institutional delivery was only 12%. Unintended pregnancy was significantly (OR: 0.75, 95% CI, 0.58–0.97) associated with use of antenatal care services and receiving adequate antenatal care (OR: 0.67, 95% CI, 0.46–0.96), even after adjusting for other socio-demographic factors. However, for delivery care, the association with pregnancy intention was attenuated after adjustment. Other factors associated with antenatal care and delivery care include women\u27s education, urban residence, wealth and distance from health facility. Conclusions: Women with unintended pregnancies were less likely to access or receive adequate antenatal care. Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women\u27s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care

The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: Evidence from rural southwestern Ethiopia

Background: Depression in pregnancy has adverse health outcomes for mothers and children. The magnitude and risk factors of maternal depression during pregnancy is less known in developing countries. This study examines the association between pregnancy intention, social support and depressive symptoms in pregnancy in Ethiopia. Methods: Data for this study comes from a baseline survey conducted as part of a community-based cohort study that involved 627 pregnant women from a Demographic Surveillance Site (DSS) in Southwestern Ethiopia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during pregnancy. Data on depressive symptoms, pregnancy intention, social support and other explanatory variables were gathered using an interviewer-administered structured questionnaire. The association between independent variables and depressive symptom during pregnancy was assessed using multivariable logistic regression. Results: The prevalence of depressive symptoms during pregnancy was 19.9% (95% CI, 16.8–23.1), using EPDS cut off point of 13 and above. The mean score on the EPDS was 8, ranging from 0 to 25 (SD ±5.4). Women reporting that the pregnancy was unwanted were almost twice as likely to experience depressive symptoms compared with women with a wanted pregnancy. (Adjusted Odds Ratio (AOR) = 1.96, 95% Confidence Interval (CI) 1.04–3.69) Women who reported moderate (AOR = 0.27; 95% CI 0.14–0.53) and high (AOR = 0.23, 95% CI 0.11–0.47) social support during pregnancy were significantly less likely to report depressive symptoms. Women who experienced household food insecurity and intimate partner physical violence during pregnancy were also more likely to report depressive symptoms. Conclusion: About one in five pregnant women in the study area reported symptoms of depression. While unwanted pregnancy increases women\u27s risk of depression, increased social support plays a buffering role from depression. Thus, identifying women\u27s pregnancy intention and the extent of social support they receive during antenatal care visits is needed to provide appropriate counseling and improve women\u27s mental health during pregnancy

Childhood vaccination in rural southwestern Ethiopia: The nexus with demographic factors and women\u27s autonomy

Introduction: Vaccination can reduce child mortality significantly and is a cost effective way to improve child health. Worldwide, more than 22 million children do not receive the basic recommended vaccinations. Vaccination coverage in Ethiopia remains low. Research on child health has focused on socio-economic factors such as maternal education and access to health care, but little attention has been given to demographic factors and women\u27s autonomy within the household. The purpose of this study was to examine the influences of demographic factors and women\u27s autonomy on the completion of childhood vaccination in rural Ethiopia. Methods: A cross-sectional community-based study was conducted in a Health and Demographic Survelliance System (HDSS) in southwestern Ethiopia. Data were drawn from a random sample of women with children aged 12-24 months (n=889). Information on maternal socio-demographic characteristics and household variables were collected using an interviewer-administered structured questionnaire. Vaccination data were obtained from vaccination cards or mother\u27s recall. Multivariate logistic regression was used to assess the association of independent variables with completion of childhood vaccination. Results: Of 889 children aged 12-24 months, 690 (78%) had received at least one vaccination. Only 37% (95% CI, 33.5-39.9) were fully vaccinated. Women\u27s decision making autonomy, number of under-five children in the household, mother\u27s education, use of antenatal care services and proximity to health facility were the main factors associated with full vaccination status. Conclusion: Completion of basic vaccination series is very low in the study area. Initiatives that enhance women\u27s autonomy within the household and that promote healthy timing and spacing of pregnancies may help in improving child health through vaccination

Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia.

BACKGROUND: Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. METHODS: This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. RESULTS: Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. CONCLUSION: Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care

Effects of maternal pregnancy intention, depressive symptoms and social support on risk of low birth weight: a prospective study from southwestern Ethiopia.

BACKGROUND: Low birth weight (LBW) is the principal risk factor for neonatal and infant mortality in developing countries. This study examines the effects of unwanted pregnancy, prenatal depression and social support on the risk of low birth weight in rural southwestern Ethiopia. We hypothesized that unwanted pregnancy and prenatal depression increase the risk of low birth weight, while social support mediates this association. METHODS: Data for the study comes from a prospective study in which women were followed from pregnancy through to delivery. Six hundred twenty two women were followed and 537 birth weights were measured within 72 hours. Multivariable log binomial regression was used to model the risk of low birth weight. RESULTS: The mean birth weight was 2989 grams (SD ± 504 grams), and the incidence of LBW was 17.88%. The mean birth weight of babies after unwanted pregnancy was 114 g lower compared to births from intended pregnancy. Similarly, mean birth weight for babies among women with symptoms of antenatal depression was 116 grams lower. Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with LBW. The relationship between antenatal depressive symptoms and LBW was mediated by the presence of social support, while the association between LBW and unwanted pregnancy remained after multivariable adjustment. CONCLUSION: The incidence of low birth weight is high in the study area. Poverty, nonuse of antenatal care, low social support and unwanted pregnancy contribute to this high incidence of low birth weight. Hence, identifying women's pregnancy intention during antenatal care visits, and providing appropriate counseling and social support will help improve birth outcomes

Incidence and causes of maternal near-miss in selected hospitals of Addis Ababa, Ethiopia

BACKGROUND: Because maternal mortality is a rare event, it is important to study maternal near-miss as a complement to evaluate and improve the quality of obstetric care. Thus, the study was conducted with the aim of assessing the incidence and causes of maternal near-miss. METHODS: A facility-based cross-sectional study was conducted in five selected public hospitals of Addis Ababa, Ethiopia from May 1, 2015 to April 30, 2016. All maternal near-miss cases admitted to the selected hospitals during the study period were prospectively recruited. World Health Organization criteria were used to identify maternal near-miss cases. The number of maternal near-miss cases over one year per 1000 live births occurring during the same year was calculated to determine the incidence of maternal near-miss. Underlying and contributing causes of maternal near-miss were documented from each participant's record. RESULTS: During the one-year period, there were a total of 238 maternal near-miss cases and 29,697 live births in all participating hospitals, which provides a maternal near-miss incidence ratio of 8.01 per 1000 live births. The underlying causes of the majority of maternal near-miss cases were hypertensive disorders and obstetric hemorrhage. Anemia was the major contributing cause reported for maternal near-miss. Most of the maternal near-miss cases occurred before the women's arrival at the participating hospitals. CONCLUSION: The study demonstrated a lower maternal near-miss incidence ratio compared to previous country-level studies. The majority of the near-miss cases occurred before the women's arrival at the participating hospitals, which underscores the importance of improving pre-hospital barriers. Efforts made toward improvement in the management of life-threatening obstetric complications could reduce the occurrence of maternal near-miss problems that occur during hospitalization

Distant and proximate factors associated with maternal near-miss: : a nested case-control study in selected public hospitals of Addis Ababa, Ethiopia

Background: Ethiopia is one of the sub-Saharan Africa countries with the highest maternal mortality. Maternalnear-misses are more common than deaths and statistically stronger for a comprehensive analysis of thedeterminants. The study aimed to identify the factors associated with maternal near-miss in selected publichospitals of Addis Ababa, Ethiopia. Methods: We conducted a nested case-control study in five selected public hospitals of Addis Ababa, Ethiopiafrom May 1, 2015 to April 30, 2016. Participants were interviewed by well-trained data collectors using pre-testedquestionnaire. Medical records were also reviewed to gather relevant information. World Health Organizationcriteria were used to identify maternal near-miss cases. A total of three controls matched for age and study areawas selected for each maternal near-miss case. Bivariate and multivariable conditional logistic regressions wereperformed using Stata version 13.0. Results: A total of 216 maternal near-miss cases and 648 controls were included in the study. The main factorsassociated with maternal near-miss were: history of chronic hypertension (AOR = 10.80,95% CI; 5.16–22.60), ruralresidency (AOR = 10.60,95% CI;4.59–24.46), history of stillbirth (AOR = 6.03,95% CI;2.09–17.41), no antenatal careattendance (AOR = 5.58,95% CI;1.94–16.07) and history of anemia (AOR = 5.26,95% CI;2.89–9.57). Conclusions: There is a need for appropriate interventions in order to improve the identified factors. The factorscan be modified through a better access to medical and maternity care, scaling up of antenatal care in rural areas,improve in infrastructure to fulfill referral chain from primary level to secondary and tertiary health care levels, andhealth education to pregnant women