Why do women prefer home births in Ethiopia?

Background: Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost. Methods: The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions. Results: Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization. Conclusions: The study indicated the crucial role of proper health care provider-client communication and providing a more client centered and culturally sensitive care if utilization of existing health facilities is to be maximized. Implications of findings for maternal health programs and further research are discussed

Comparison of two adult mosquito sampling methods with human landing catches in south-central Ethiopia.

BACKGROUND: The human landing catch (HLC) is the standard reference method for measuring human exposure to mosquito bites. However, HLC is labour-intensive, exposes collectors to infectious mosquito bites and is subjected to collector bias. These necessitate local calibration and application of alternative methods. This study was undertaken to determine the relative sampling efficiency (RSE) of light traps with or without yeast-produced carbon dioxide bait vs. HLC in south-central Ethiopia. METHODS: The experiment was conducted for 39 nights in a 3 × 3 Latin square randomized design with Anopheles arabiensis as the target species in the period between July and November 2014 in Edo Kontola village, south-central Ethiopia. Center for Disease Control and Prevention light trap catches (LTC) and yeast-generated carbon dioxide-baited light trap catches (CB-LTC) were each evaluated against HLC. The total nightly mosquito catches for each Anopheles species in either method was compared with HLC by Pearson correlation and simple linear regression analysis on log-transformed [log10(x + 1)] values. To test if the RSE of each alternative method was affected by mosquito density, the ratio of the number of mosquitoes in each method to the number of mosquitoes in HLC was plotted against the average mosquito abundance. RESULTS: Overall, 7606 Anopheles females were collected by the three sampling methods. Among these 5228 (68.7%) were Anopheles ziemanni, 1153 (15.2%) An. arabiensis, 883 (11.6%) Anopheles funestus s.l., and 342 (4.5%) Anopheles pharoensis. HLC yielded 3392 (44.6%), CB-LTC 2150 (28.3%), and LTC 2064 (27.1%) Anopheles females. The RSEs of LTC and HLC for An. arabiensis were significantly correlated (p < 0.001) and density independent (p = 0.65). However, for outdoor collection of the same species, RSEs of LTC and CB-LTC were density dependent (p < 0.001). It was estimated that on average, indoor LTC and CB-LTC each caught 0.35 and 0.44 times that of indoor HLC for An. arabiensis respectively. CONCLUSIONS: Results showed that HLC was the most efficient method for sampling An. arabiensis. LTC can be used for large-scale indoor An. arabiensis surveillance and monitoring when it is difficult to use HLC. CB-LTC does not substantially improve sampling of this major vector compared to LTC in this setting. Trial registration PACTR201411000882128 (retrospectively registered 8 September, 2014)

Human-biting activities of Anopheles species in south-central Ethiopia.

BACKGROUND: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are the key malaria vector control interventions in Ethiopia. The success of these interventions rely on their efficacy to repel or kill indoor feeding and resting mosquitoes. This study was undertaken to monitor human-biting patterns of Anopheles species in south-central Ethiopia. METHODS: Human-biting patterns of anophelines were monitored for 40 nights in three houses using human landing catches (HLC) both indoors and outdoors between July and November 2014, in Edo Kontola village, south-central Ethiopia. This time coincides with the major malaria transmission season in Ethiopia, which is usually between September and November. Adult mosquitoes were collected from 19:00 to 06:00 h and identified to species. Comparisons of HLC data were done using incidence rate ratio (IRR) calculated by negative binomial regression. The nocturnal biting activities of each Anopheles species was expressed as mean number of mosquitoes landing per person per hour. To assess malaria infections in Anopheles mosquitoes the presence of Plasmodium falciparum and P. vivax circumsporozoite proteins (CSP) were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Altogether 3,408 adult female anophelines were collected, 2,610 (76.6 %) outdoors and 798 (23.4 %) indoors. Anopheles zeimanni was the predominant species (66.5 %) followed by An. arabiensis (24.8 %), An. pharoensis (6.8 %) and An. funestus (s.l.) (1.8 %). The overall mean anopheline density was 3.3 times higher outdoors than indoors (65.3 vs 19.9/person/night, IRR: 3.3, 95 % CI: 1.1-5.1, P = 0.001). The mean density of An. zeimanni, An. pharoensis and An. funestus (s.l.) collected outdoors was significantly higher than indoors for each species (P < 0.05). However, the mean An. arabiensis density outdoors was similar to that indoors (11.8 vs 9.4/person/night, IRR: 1.3, 95 % CI: 0.8-1.9, P = 0.335). The mean hourly human-biting density of An. arabiensis was greater outdoors than indoors and peaked between 21:00 and 22:00 h. However, An. arabiensis parous population showed high indoor man biting activities during bedtimes (22:00 to 05:00 h) when the local people were indoor and potentially protected by IRS and LLINs. All mosquito samples tested for CSP antigen were found negative to malaria parasites. CONCLUSIONS: Results show much greater mosquito human-biting activities occurring outdoors than indoors and during early parts of the night, implying higher outdoor malaria transmission potential in the area. However, high bedtime (22:00 to 05:00 h) indoor biting activities of parous An. arabiensis suggest high potential intervention impact of IRS and LLINs on indoor malaria transmission

Breeding Sites of Aedes aegypti

Background and Objectives. Entomological survey was carried out from May-June to September-October 2014 to investigate the presence of dengue vectors in discarded tires and artificial water containers in houses and peridomestic areas. Methods. A cross-sectional immature stage survey was done indoors and outdoors in 301 houses. Mosquito larval sampling was conducted using pipette or dipper depending on container types. Larvae were identified morphologically and larval indices were also calculated. Results. A total of 750 containers were inspected, and of these 405 were positive for mosquito larvae. A total of 1,873 larvae were collected and morphologically identified as Aedes aegypti (n=1580: 84.4%) and Culex (n=293: 15.6%). The larval indices, house index, container index, and breteau index, varied from 33.3 to 86.2, from 23.2 to 73.9, and from 56.5 to 188.9, respectively. Conclusion. Aedes aegypti is breeding in a wide range of artificial containers. To control these mosquitoes, the integration of different methods should be taken into consideration

Factors influencing child immunization coverage in a rural District of Ethiopia, 2000

Background: Immunization coverage in many parts of Ethiopia is less than desired to prevent the spread of target diseases. Objective: To identify factors influencing urban and rural immunization coverage. Methods: A community-based cross-sectional survey was conducted in 220 households with children 12-13 months of age in 7 villages and 4 urban centres selected by stratified multistage cluster sampling. Trained nurses were used to collect relevant information for the study. Result: Fifty-one percent were validly fully immunized for age. Immunization coverage as assessed by card plus history was BCG 99.1%, DPT1/OPV1 97.3%, DPT3/OPV3 92.7%, measles 75.5%, and BCG to measles defaulter 23.9%. The mean Mother Immunization Awareness Score (MIAS) was higher for mothers of children fully immunized for age (6.2+1.6 vs 5.5+2.2, p=0.01), and was significantly correlated with child age at DPT3 (r=-0.337, p=0.001) and measles dose (r=-0.266, p=0.014). Multiple logistic regression analysis indicated that residence and mother's education were significant predictors of immunization status of children, children from rural areas and whose mothers were literate had higher immunization coverage. Conclusion: Community mobilization and efforts to raise the awareness of mothers are important strategies to increase immunization coverage in urban as well as rural areas. [Ethiop.J.Health Dev. 2003;17(2):105-110

Erfarenheter av depressiva symptom efter stroke

Background: Many people become ill due to stroke every year in Sweden. Stroke survivors can suffer from depressive symptoms due to the consequences that come with a stroke. Depressive symptoms can lead to negative quality of life and can lead to an unsustainable life situation. Problem: Depressive symptoms in stroke patients contributes with many different consequences that can cause unhealth and impaired quality of life. In order for nurses to be able to perform their role and being there to support both patients and relatives, more knowledge is required in this area and it can increase the quality of life and health of the patients. Objective: The purpose is to describe patient’s experiences of depressive symptoms after stroke. Method: A general literature review. 10 articles where of 6 had a quantitative approach and 4 a qualitative approach. These then became the result. Result: In the result, three categories were summarized describing experiences of depressive symptoms after stroke. Losing oneself, Losing control and Experiences of vulnerability. Conclusion: It appeared that the experience of depressive symptoms was common after a stroke and could be related to consequences such as physical barriers, difficulty in managing emotions, loneliness and fatigue. This summarized experiences of depressive symptoms after stroke.Bakgrund: Många människor insjuknar i stroke varje år i Sverige. Patienter som har överlevt en stroke kan lida av depressiva symtom på grund av konsekvenserna som medföljer efter en stroke. Depressiva symtom kan leda till att livskvalitén blir påverkad negativt och det kan medföra en ohållbar livssituation. Problem: Depressiva symptom hos patienter med stroke bidrar till många olika konsekvenser som kan orsaka ohälsa och försämrad livskvalité. För att sjuksköterskor ska kunna utföra sin roll och finnas där som stöd för både patienterna samt anhöriga behövs mer kunskap inom detta område. Bredare kunskap kan öka patienternas livskvalité och hälsa. Syfte: Syftet är att beskriva patienters erfarenheter av depressiva symtom efter en stroke. Metod: En allmän litteraturöversikt. 10 artiklar varav 6 hade en kvantitativ ansats och 4 en kvalitativ ansats. Resultat: I resultatet sammanställdes tre kategorier som beskrev erfarenheter av depressiva symptom efter stroke. Att förlora sig själv, Förlorad kontroll och Erfarenheter av sårbarhet. Slutsats: Det framgick att erfarenheten av depressiva symptom var vanligt efter en stroke och att det kunde relateras till följder såsom fysiska hinder, svårigheter att hantera känslor, ensamhet och trötthet. Detta summerade erfarenheter av depressiva symptom efter stroke

Erfarenheter av depressiva symptom efter stroke

Background: Many people become ill due to stroke every year in Sweden. Stroke survivors can suffer from depressive symptoms due to the consequences that come with a stroke. Depressive symptoms can lead to negative quality of life and can lead to an unsustainable life situation. Problem: Depressive symptoms in stroke patients contributes with many different consequences that can cause unhealth and impaired quality of life. In order for nurses to be able to perform their role and being there to support both patients and relatives, more knowledge is required in this area and it can increase the quality of life and health of the patients. Objective: The purpose is to describe patient’s experiences of depressive symptoms after stroke. Method: A general literature review. 10 articles where of 6 had a quantitative approach and 4 a qualitative approach. These then became the result. Result: In the result, three categories were summarized describing experiences of depressive symptoms after stroke. Losing oneself, Losing control and Experiences of vulnerability. Conclusion: It appeared that the experience of depressive symptoms was common after a stroke and could be related to consequences such as physical barriers, difficulty in managing emotions, loneliness and fatigue. This summarized experiences of depressive symptoms after stroke.Bakgrund: Många människor insjuknar i stroke varje år i Sverige. Patienter som har överlevt en stroke kan lida av depressiva symtom på grund av konsekvenserna som medföljer efter en stroke. Depressiva symtom kan leda till att livskvalitén blir påverkad negativt och det kan medföra en ohållbar livssituation. Problem: Depressiva symptom hos patienter med stroke bidrar till många olika konsekvenser som kan orsaka ohälsa och försämrad livskvalité. För att sjuksköterskor ska kunna utföra sin roll och finnas där som stöd för både patienterna samt anhöriga behövs mer kunskap inom detta område. Bredare kunskap kan öka patienternas livskvalité och hälsa. Syfte: Syftet är att beskriva patienters erfarenheter av depressiva symtom efter en stroke. Metod: En allmän litteraturöversikt. 10 artiklar varav 6 hade en kvantitativ ansats och 4 en kvalitativ ansats. Resultat: I resultatet sammanställdes tre kategorier som beskrev erfarenheter av depressiva symptom efter stroke. Att förlora sig själv, Förlorad kontroll och Erfarenheter av sårbarhet. Slutsats: Det framgick att erfarenheten av depressiva symptom var vanligt efter en stroke och att det kunde relateras till följder såsom fysiska hinder, svårigheter att hantera känslor, ensamhet och trötthet. Detta summerade erfarenheter av depressiva symptom efter stroke