Pelvic Organ Prolapse in Jimma University Specialized Hospital, Southwest Ethiopia

Background: Pelvic organ prolapse is the down ward descent of female organs including the bladder, small and large bowel resulting in protrusion of the vagina, uterus or both. It is a disorder exclusive to women and one of the most common indications for gynecologic surgery.Methods: This hospital based retrospective descriptive study was conducted to assess the magnitude of pelvic organ prolapse and risk factors for it. All cases of pelvic organ prolapse admitted and treated in Jimma University Specialized Hospital from July 1, 2008 to June 30, 2011 were included. The collected data were analyzed using SPSS computer software version 16.0. Chi-square test was used and was considered to be significant when p<0.05.Results: Pelvic organ prolapse accounted for 40.7% of major gynecologic operations. Mean age of patients was 42.43 ± 10.4 years and there was a significant association between prolapse and age of patients (p <0.05). Mean parity of patients was 6.5± 2.64 with a significant association between prolapse and parity (p < 0.05). Majority of them (80.6%) lived in rural area and there was a significant association between prolapse and residence area. Farmers accounted for 68.2% of the patients and there was a significant association between prolapse and occupation (p < 0.05). Risk factors identified were chronic cough (20.9%), constipation (30.2%) with some having more than one risk factor while none was identified in 59.7%.Conclusion: Prolapse is common among rural, farmer, parous and older women where most of them delivered at home with prolonged labor. Age, parity and occupation were associated with the stage of prolapse. Awareness creation on risk factors of pelvic organ prolapse and use of contraception to reduce parity is recommended. Health institution delivery should be advocated to minimize the rate of home deliveries and hence of prolonged labor.Keywords: Pelvic organ prolapse, uterovaginal prolapse, vaginal hysterectomy.Ethiop J Health Sci. Vol. 22, No. 2 July 201

Incidence, Causes and Outcome of Obstructed Labor in Jimma University Specialized Hospital

BACKGROUND: Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital. METHODS: Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0. RESULTS: The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score. CONCLUSION: The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications

Hypertensive Disorders of Pregnancy in Jimma University Specialized Hospital

Background: Hypertensive disorders represent the most common medical complications of pregnancy with a reported incidence between 5 and 10%. The disorders are major causes of maternal and perinatal morbidities and mortalities. This study was conducted to determine the pattern and outcomes of pregnancies complicated by hypertensive disorders.Methods: Hospital based cross-sectional study was conducted on all mothers who gave birth in the labor ward of Jimma University Specialized Hospital from April 1, 2009 to March 31, 2010. Data was collected by interviewing the mothers and review of their medical records using structured questionnaire and checklist, respectively. Data analysis was performed using SPSS for windows version 16.0. Result: Majority (52.5%) of the mothers were in the age group of 25 - 34 years. The overall prevalence of hypertensive disorders of pregnancy was 8.5%. Severe preeclampsia accounted for 51.9% of the cases followed by eclampsia (23.4%). Residential area of the mothers (urban/rural) was found to have statistically significant association with severity of the disorder. Most (66.5% and 74.7%) of the mothers were nulliparous and had antenatal care follow-up during the index pregnancy, respectively. Antenatal care follow-up and parity had no statistically significant association with severity of the disease. The case fatality rate of hypertensive disorders of pregnancy was 1.3% with perinatal mortality of 317.1/1000 births.Conclusion: Pregnancies complicated by hypertensive disorders have poor maternal and perinatal outcomes and rural women were more affected. Quality antenatal care services with good obstetric and neonatal care at delivery are essential for early recognition and management of hypertensive disorders of pregnancy.Keywords: Hypertensive disorders, Hypertension, Pregnancy, EclampsiaEthiop J Health Sci. Vol. 21, No. 3 November 201

Incidence, Contributing Factors and Outcomes of Antepartum Hemorrhage in Jimma University Specialized Hospital, Southwest Ethiopia

Abstract Background: Antepartum haemorrhage complicates three to five percent of pregnancies contributing to perinatal and maternal morbidity and mortality. Timely access to quality obstetric services is the major determinant of both maternal and newborn outcomes after antepartum haemorrhage. In Ethiopia, the magnitude and consequences of antepartum haemorrhage are not well studied. The objective of this study was to determine the incidence, factors associated with and maternal and perinatal outcomes of antepartum haemorrhage in Jimma University Specialized Hospital. Methods: A hospital-based prospective cohort study was conducted in Jimma University Specialized Hospital, from January 1 to December 31, 2013. Data were collected by reviewing medical records and interviewing mothers. Cumulative incidence of antepartum hemorrhage among mothers who gave birth and odds of adverse outcomes among mothers with and without antepartum hemorrhage were calculated. Odds ratio was calculated to estimate the effect of antepartum hemorrhage on maternal and new born adverse outcomes. Results: Between January and December 2013, 3854 women gave birth in JUSH. The incidence of antepartum hemorrhage was 5.1% (n=195) in 2013. The major causes of antepartum hemorrhage were abruptio placentae and placenta previa occurring in 127(65.1%) and 52(26.7%) of cases, respectively. Six (3.1%) of the patients with antepartum hemorrhage died. Of the 206 babies born, 63 (30.6%) were stillborn and additional 13 (6.3%) newborns died during the first seven days of life making perinatal mortality rate of 36.9%. Conclusion: Antepartum hemorrhage is a common complication of pregnancy and cause of maternal and perinatal mortality in Jimma University Specialized Hospital. The risk of adverse outcomes is very high compared to other countries. Efforts to improve access and quality of comprehensive emergency obstetric care services are required

Readiness of Primary Hospitals in Providing Neonatal Intensive Care Services in Ethiopia

BACKGROUND፡ The Ethiopian neonatal mortality has not shown much progress over the years. In light of this, the country has introduced interventions such as the utilization of newborn corners and neonatal intensive care units to avert preventable neonatal deaths. This study was conducted to assess readiness of primary hospitals in providing neonatal intensive care services.METHODS: A health facility based cross-sectional study design was employed where data were collected using both prospective and retrospective techniques using a format adapted from national documents. SPSS version 25 was used for data entry and analysis using descriptive statistics.RESULTS: Data were collected from 107 of 113 (94.7%) primary hospitals due to inaccessibility of some primary hospitals. The minimum national standard requirement of a level one neonatal intensive care unit for infrastructure was met by 63% (68/107) and 44% (47/107) had fulfilled the requirements for kangaroo mother care units. The average number of neonatal intensive care unit trained nurses per primary hospital was 2.6, 0.8 for general practitioners and 2.9 support staff; all of which is less than the minimum recommended national standard. The minimum national requirement for medical equipment and renewables for primary hospital level was fulfilled by 24% (26/107) of the hospitals, 65% (70/107) for essential laboratory tests, and 87% (93/107) for clinical services and procedures. The average number of admissions during the six months prior to the data collection was 87.2 sick newborns per facility with a ‘discharged improved’ rate of 71.5%, referral out rate of 18.4% and level one neonatal intensive care unit death rate of 6.6%. The remaining newborns had either left against medical advice or were still undergoing treatment during data collection.CONCLUSIONS: The overall readiness of primary hospitals to deliver neonatal intensive care services in terms of infrastructure, human resource, medical equipment, and laboratory tests was found to be low. There is a need to fill gaps in infrastructure, medical equipment, renewables, human resource, laboratory reagents, drugs and other supplies of neonatal intensive care units of primary hospitals to garner better quality of service delivery

Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia : a cross sectional study design

Background: There are compelling theoretical and empirical reasons that link household food insecurity to mental distress in the setting where both problems are common. However, little is known about their association during pregnancy in Ethiopia. Methods: A cross-sectional study was conducted to examine the association of household food insecurity with mental distress during pregnancy. Six hundred and forty-two pregnant women were recruited from 11 health centers and one hospital. Probability proportional to size (PPS) and consecutive sampling techniques were employed to recruit study subjects until the desired sample size was obtained. The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress and a 9-item Household Food Insecurity Access Scale was used to measure food security status. Descriptive and inferential statistics were computed accordingly. Multivariate logistic regression was used to estimate the effect of food insecurity on mental distress. Results: Fifty eight of the respondents (9 %) were moderately food insecure and 144 of the respondents (22.4 %) had mental distress. Food insecurity was also associated with mental distress. Pregnant women living in food insecure households were 4 times more likely to have mental distress than their counterparts (COR = 3.77, 95 % CI: 2.17, 6.55). After controlling for confounders, a multivariate logistic regression model supported a link between food insecurity and mental distress (AOR = 4.15, 95 % CI: 1.67, 10.32). Conclusion: The study found a significant association between food insecurity and mental distress. However, the mechanism by which food insecurity is associated with mental distress is not clear. Further investigation is therefore needed to understand either how food insecurity during pregnancy leads to mental distress or weather mental distress is a contributing factor in the development of food insecurity

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Uterine Rupture in Pregnancy following Fall from a Motorcycle: A Horrid Accident in Pregnancy—A Case Report and Review of the Literature

Uterine rupture is one of the most catastrophic complications during pregnancy. It is a rare complication in developed countries but a frequent cause of maternal and perinatal morbidity and mortality in Africa. Uterine rupture occurs in 1.6% of patients suffering blunt abdominal trauma. Here we report a unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectomy and survived, though fetus died before intervention. We also reviewed similar cases reported from different parts of Africa. This is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits

Health seeking behavior for cervical cancer in Ethiopia: a qualitative study.

BACKGROUND: Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease. METHODS: Focus group discussions were conducted with men, women, and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Data were captured using voice recorders, and field notes were transcribed verbatim from the local languages into English language. Key categories and thematic frameworks were identified using the health belief model as a framework, and presented in narratives using the respondents own words as an illustration. RESULTS: Participants had very low awareness of cervical cancer. However, once the symptoms were explained, participants had a high perception of the severity of the disease. The etiology of cervical cancer was thought to be due to breaching social taboos or undertaking unacceptable behaviors. As a result, the perceived benefits of modern treatment were very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behavior and alternated between traditional remedies and modern treatment methods. CONCLUSION: Lack of awareness and health seeking behavior for cervical cancer was common due to misconceptions about the cause of the disease. Profound social consequences and exclusion were common. Access to services for diagnosis and treatment were poor for a variety of psycho-social, and health system reasons. Prior to the introduction or scale up of cervical cancer prevention programs, socio-cultural barriers and health service related factors that influence health seeking behavior must be addressed through appropriate community level behavior change communications