Standard basic emergency obstetric and neonatal care training in Addis Ababa; trainees reaction and knowledge acquisition

Background: In 2010, the Federal Ministry of Health of Ethiopia (FMOH) has developed standard Basic Emergency Obstetric and Neonatal Care (BEmONC) in-service training curricula to respond to the high demand for competency in EmONC. However, the effectiveness of the training curricula has not been well documented. A collaborative intervention project in Addis Ababa has trained providers using the standard BEmONC curricula where this paper presents Krikpartick level 1 and level 2 evaluation of the training. Methods: The project has been conducted in 10 randomly selected public health centers (HC) in Addis Ababa. Providers working in the labour wards of the selected HCs have received the standard BEmONC training between May and July 2013. Using standard tools, trainees’ reaction to the course and factual knowledge during the immediate post-course and six months after the training were assessed. Descriptive statistics and t-tests were done. Results: Of the total 82 providers who received the training, 30 (36.6%) were male, 61 (74.4%) were midwives. Providers’ work experiences ranged from 1 month to 37 years. Seventy-four (89%) providers reported that the training was appropriate for their work, 95% reported that the training have updated their knowledge & skills, while 27 (32.9%) reported that the training facilities & arrangements were unsatisfactory. The mean immediate post-course knowledge score was 83.5% and 33 (40%) providers did not achieve knowledge-based mastery in their first attempt. The midwives were more likely to achieve knowledge-based mastery than the nurses (p < 0.05). The mean knowledge score six-months post-training was 80.2% and 40% have scored knowledge based mastery. Conclusions: Being one of the first papers reporting the implementation of the standard in-service BEmONC training curriculum, we have identified an important limitation on the course evaluations of the curriculum, which need urgent consideration. The majority of the trainees has reported favourable reaction to the training, but many of them did not achieve knowledge-based mastery in the immediate post training although the knowledge retention six months post training was encouraging

Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study

Background: Emergency obstetric and neonatal care (EmONC) is a high impact priority intervention highly recommended for improving maternal and neonatal health outcomes. In 2008, Ethiopia conducted a national EmONC survey that revealed implementation gaps, mainly due to resource constraints and poor competence among providers. As part of an ongoing project, this paper examined progress in the implementation of the basic EmONC (BEmONC) in Addis Ababa and compared with the 2008 survey. Methods: A facility based intervention project was conducted in 10 randomly selected public health centers (HCs) in Addis Ababa and baseline data collected on BEmONC status from January to March 2013. Retrospective routine record reviews and facility observations were done in 29 HCs in 2008 and in10 HCs in 2013. Twenty-five providers in 2008 and 24 in 2013 participated in BEmONC knowledge and skills assessment. All the data were collected using standard tools. Descriptive statistics and t-tests were used. Results: In 2013, all the surveyed HCs had continuous water supply, reliable access to telephone, logbooks & phartograph. Fifty precent of the HCs in 2013 and 34% in 2008 had access to 24 hours ambulance services. The ratio of midwives to 100 expected births were 0.26 in 2008 and 10.3 in 2013. In 2008, 67% of the HCs had a formal fee waiver system while all the surveyed HCs had it in 2013. HCs reporting a consistent supply of uterotonic drugs were 85% in 2008 and 100% in 2013. The majority of the providers who participated in both surveys reported to have insufficient knowledge in diagnosing postpartum haemorrhage (PPH) and birth asphyxia as well as poor skills in neonatal resuscitation. Comparing with the 2008 survey, no significant improvements were observed in providers’ knowledge and competence in 2013 on PPH management and essential newborn care (p > 0.05). Conclusion: There are advances in infrastructure, medical supplies and personnel for EmONC provision, yet poor providers’ competences have persisted contributing to the quality gaps on BEmONC in Addis Ababa. Considering short-term in-service trainings using novel approaches for ensuring desired competences for large number of providers in short time period is imperative

Musculoskeletal sequelae in patients with obstetric fistula - a case-control study

Background: Obstetric fistula is essentially a result of pelvic injury caused by prolonged obstructed labour. Foot drop and walking difficulties in some of these women signify that the injury may extend beyond the loss of tissue that led to the fistula. However, these aspects of the pelvic injury are scarcely addressed in the literature. Here we specifically aimed at assessing musculoskeletal function in women with obstetric fistula to appreciate the extent of the sequelae of their pelvic injury. Methods: This case–control study compared 70 patients with obstetric fistula with 100 controls matched for age and years since delivery. The following was recorded: height, weight, past and present walking difficulties, pain, muscle strength and joint range of motion, circumference and reflexes. Differences between groups were analysed using independent sample t-test and chi-square test for independence. Results: A history of leg pain was more common among cases compared to controls, 20% versus 7% (p = 0.02), and 29% of the cases had difficulties walking following the injuring delivery compared to none of the controls (p ≤ 0.001). Of these, four women reported spontaneous recovery. Cases had 7° less range of motion in ankle dorsal flexion (95%CI: −8.1, −4.8), 8° less ankle plantar flexion (95%CI: −10.6, −6.5), 12° less knee flexion (95%CI: −14.1, −8.9), and 4° less knee extension (95%CI: 2.9, 5.0) compared to controls. Twelve % of the cases had lower ankle dorsal flexion strength (p = 0.009). Foot drop was present in three (4.3%) compared with none among controls. Women with fistula had 4° greater movement in hip extension (95%CI: −5.9, −3.1), 2° greater hip lateral rotation (95%CI: 0.7, 3.3) and 9° greater hip abduction (95%CI: 6.4, 10.7). Twelve % of the cases had stronger medial rotation in the hip (p = 0.04), 20% had stronger hip lateral rotation (p ≤ 0.001), 29% had stronger hip extension (p ≤ 0.001), and 15% had stronger hip abduction (p = 0.04) than controls. Conclusions: Women with obstetric fistula commonly experienced walking difficulties after the delivery, had often leg pain and reduced function in the ankle and knee joints that may have been compensated by increased motion and strength in the hip

The potential role of the private sector in expanding postabortion care in Addis Ababa, Amhara and Oromia regions of Ethiopia

Background: Unsafe abortion is a major contributor of maternal mortality and morbidity in Ethiopia. High disease burden and underdeveloped infrastructure entail involvement of all partners in responding to health needs in the country. The private sector has apparently not been exploited to the fullest extent so far. Objective: To assess the potential of private facilities in expanding access to postabortion care (PAC). Methods: A cross-sectional study of private health facilities in Addis Ababa, Amhara and Oromia was conducted in 2001-2, using a pretested questionnaire and a checklist. Results: We assessed 88, 31 and 32 facilities in Addis Ababa, Amhara and Oromia, respectively. Treatment was provided by 44%, 52% and 63% of the eligible facilities in Addis Ababa, Amhara and Oromia, respectively. Manual vacuum aspiration (MVA) was used in treating 61% of Addis Ababa patients whereas sharp curettage was used in over 80% of those in Amhara and Oromia. About 80% of women did not get postabortion family planning methods. Patient-provider interaction was generally satisfactory. High-level disinfection (HLD) of non-autoclavable instruments needed improvement. All medium and above clinics have at least one GP and many have nurse/midwives. The vast majority of facilities not giving the service would like to provide comprehensive PAC if staff are trained and equipment made available in the market. Conclusion: Private health facilities can contribute substantially if given the necessary guidance and support with proper monitoring and evaluation. Ethiop.J.Health Dev. 2003;17(3):157-16

Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia

Introduction: The objective of the study was to explore how women with symptomatic pelvic organ prolapse in a lowincome setting explain, experience, and handle the potential practical and social consequences of the condition. Methods: An explorative qualitative design was employed using in-depth interviews in the data collection. A total of 24 women with different degrees of symptomatic pelvic organ prolapse were included; 18 were recruited at the hospital and 6 from the community. Fieldwork was carried out in the Amhara region of northwest Ethiopia in 2011 and 2015. Results: The informants held that the pelvic organ prolapse was caused by physical strain on their body, such as childbirth, food scarcity or hard physical work, particularly during pregnancy and shortly after delivery. Severe difficulties and pain while carrying out daily chores were common among the women. The informants used a variety of strategies to manage their work while striving to avoid disclosure of their condition. Disclosure was related to embarrassment and fear of discrimination from people living close to them, including the fear of being expelled from the household. Most of the informants, however, experienced substantial support from relatives, friends, and at times also from their husband, after disclosing their condition. Conclusions: The study highlights how symptomatic pelvic organ prolapse may severely affect women’s lives in a lowincome setting. The condition is perceived to be both caused by and aggravated by the heavy physical burdens of daily work

Regional Linkages and Competitiveness of Manufacturing Sector in Tigrai: Challenges and Opportunities

The manufacturing sector is critical for sustained growth, poverty reduction, employment creation, and technology diffusion in Ethiopia. Nevertheless, the performance and contribution of the sector has been unsatisfactory and declining. While there are abundant raw materials the sector is with low production base, low competitiveness, and uses imported inputs. Hence, this study is conducted to analyze the supply chain linkages, raw material, and challenges affecting the competitiveness of the sector in Tigrai. Data collected through a survey questionnaire from 620 enterprises, focus group discussions, and key informant interviews were analyzed using SPSS. The result showed that shortage, inferior quality, and high cost of raw materials, Poor upgrading strategy, and ineffective upstream linkages are the main challenges for the manufacturing sector’s competitiveness. Hence, proper development of the industrial inputs and use of the supply chain linkage in the domestic and export markets should be strategically solved to improve the sector’s competitiveness and growth

Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service.</p> <p>Methods/Design</p> <p>This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site.</p> <p>Discussion</p> <p>If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01428830">NCT01428830</a>.</p