Health-related quality of life among postpartum women with preeclampsia, southern Ethiopia: a prospective cohort study.

BACKGROUND: Preeclampsia affects the health of the mother and the fetus during pregnancy and childbirth. To date, little is known about the impact of preeclampsia on postpartum health-related to quality of life (HRQoL) in the Sidama region of southern Ethiopia. This study aimed to measure the HRQoL and its contributing factors among postpartum women with preeclampsia in the Sidama region. METHODS: A prospective cohort study was conducted by enrolling pregnant women at ≥20 weeks of gestation up until the 37th week of gestation. We then followed them until 12 weeks after delivery. A locally validated, World Health Organization Quality-of-Life-BREF (WHOQOL-BREF) tool was used to assess participants' HRQoL at two time points; the 6th and 12th weeks postpartum. Assessment of HRQoL of participants was based on total scores on the WHOQoL-BREF. Higher scores on the WHOQoL-BREF reflected a higher HRQoL. Multiple linear regression analyses were performed to evaluate the contributing factors to HRQoL. The level of significance was determined at a p-value of < 0.05. RESULTS: The HRQoL of postpartum women with preeclampsia significantly improved over time from 6 (151 ± 17) to 12 weeks (167 ± 18), p < 0.001). However, the overall HRQoL scores were lower (156 ± 16, p < 0.001) among women with preeclampsia compared to normotensive women (181 ± 21). An experience of early neonatal death was found to have a significant negative effect on the HRQoL of women with preeclampsia [ß = - 2.1, 95% CI: - 3.43- - 0.85] compared to normotensive women who did not have early neonatal death. At 6 weeks of the postpartum period, the physical domain was found to have a significantly higher contribution to the lower HRQoL [ß = 1.04, 95% CI: 0.88-1.12] compared to normotensive women, while other factors were constant. CONCLUSIONS: The HRQoL of women with preeclampsia improved over time from 6 to 12 weeks in the postpartum period. Lower HRQoL was observed among postpartum women with preeclampsia, especially among those who experienced preterm birth or early neonatal death. The effects of preeclampsia on the HRQoL of postpartum women should be considered in redesigning postnatal care intervention services.

Cultural adaptation and validation of the Sidamic version of the World Health Organization Quality-of-Life-Bref Scale measuring the quality of life of women with severe preeclampsia in southern Ethiopia, 2020.

BACKGROUND: Women with severe preeclampsia often present with more health complaints compared to those with uncomplicated pregnancies. Estimating the quality of life of women affected with severe preeclampsia could provide direction for further interventions. However, the current measurement of the quality of life has not been culturally adapted and validated for this population. This study aimed to translate, culturally adapt, and test the reliability and validity of the World Health Organization Quality-of-Life-Bref Scale (WHOQOL-BREF) in southern Ethiopia among women with severe preeclampsia. METHODS: An institutional-based cross-sectional study was conducted in southern Ethiopia in selected hospitals with randomly recruited women with severe preeclampsia. Cultural adaptation and validation techniques were used to translate and adapt the WHOQOL-BREF scale. Face, content validity, forward and backward translations, and synthesis were computed using an expert panel. The scale was pretested and adjusted accordingly. Internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient = ICC) were examined. Confirmatory factor analysis (CFA) was computed to test the fit of the structure to the local setting before conducting exploratory factor analysis (EFA). Multiple methods for determining the number of factors extracted (scree test, eigenvalues) were used. We compared the original English structure with the new structure in the study setting and extracted a new structure using EFA. RESULTS: The internal consistency reliabilities ranged from 0.8045 to 0.9123 indicating good-to-excellent reliability. The item­level content validity ranged from 0.86 to 1.00; the scale­level content validity index was 0.97. In CFA, the model fit indices were unacceptable (Comparative Fit Index (CFI = 0.87), Root Mean Square Error of Approximation (RMSEA = 0.23), Standardized Root Mean Square Residual (SRMR = 0.38), Tucker Lewis Index (TLI = 0.85) and (PCLOSE = 0.00). Three new factor structures were extracted using EFA for current research with a total variance was 91%. CONCLUSIONS: The failure of the original scale in this study population highlights the importance of culturally adapting tool to local settings. EFA confirmed a three-factor structure, inconsistent with the original English structure.

Pelvic organ prolapse surgery and health-related quality of life: a follow-up study.

BACKGROUND: Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. METHODS: A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. RESULTS: In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant's mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. CONCLUSIONS: Surgical repair for prolapse effectively improves patient's HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.

Molecular characterization of Streptococcus agalactiae isolated from pregnant women and newborns at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Streptococcus agalctiae (Group B Streptococcus, GBS) is a perinatal pathogen and a leading cause of neonatal infections worldwide. Serotype, sequence type, clonality, antibiotic resistance genes and surface protein profiles of GBS are scarce in Ethiopia, a reason that this study was planned to investigate. . METHODS: Sixteen colonizing GBS isolates obtained from recto-vaginal swabs of pregnant women and body surfaces of newborns were further analyzed. Minimum inhibitory concentration (MIC) test, and whole genome sequence (WGS) methods were done for antibiotic susceptibility test, and molecular characterization of the isolates. RESULTS: All the GBS isolates analyzed were belonged to four capsular serotypes: II, 11/16(68.8%), V, 3/16(18.8%), Ia and VI each with 1/16(6.3%) and five sequence type (ST-2, ST-10, ST-14, ST-569 and ST-933). Sequence type-10 was the most predominant ST followed by ST-569. The five STs were grouped into the four clonal complexes (CC - 1, CC-10, CC-19, and CC-23). Different surface proteins and pili families such as ALP1, ALPHA, ALP23, PI-1 / PI-2A1, PI-1 / PI-2B, and Srr1 were detected from WGS data. All isolates were found to be susceptible to the tested antibiotics except for tetracycline in MIC and WGS test methods used. Tetracycline resistant determinant genes such as TETM and TETL / TETM combination were identified. CONCLUSION: Further studies on serotype and molecular epidemiology will provide a comprehensive data of the GBS capsular serotype and clones available in Ethiopia.

Pelvic organ prolapse in Northwest Ethiopia: a population-based study.

INTRODUCTION AND HYPOTHESIS: Epidemiological studies aimed at pelvic organ prolapse and its risk factors can help to identify women at a higher risk and therefore promote prevention strategies. We aimed to assess the prevalence of and factors associated with symptomatic prolapse. METHODS: A community-based study was conducted in Dabat district, Northwest Ethiopia. Initially, women were interviewed on their prolapse symptoms using validated questionnaires at their home. Subsequently, they were invited for pelvic examination and examined by gynecologists using the simplified pelvic organ prolapse quantification. Symptomatic prolapse was assessed by pelvic examination findings and patient-reported symptoms. Multivariate logistic regression was used to assess the factors associated with symptomatic prolapse. RESULTS: A total of 880 women were interviewed and invited for pelvic examination, of whom 824 (93.6%) showed up for examination. Of the 824 women examined, 464 (56.3%) had POP stages II-IV and 145 (17.6%) had POP stages III-IV. The overall prevalence of symptomatic prolapse was 46.7% (217 out of 464). Of these, 41.0%, 42.8%, and 3.2% accounted for stage II, III, and IV respectively. Increasing age, multiparity, and heavy lifting/carrying significantly increased the odds of developing symptomatic prolapse. CONCLUSIONS: Symptomatic prolapse affects a substantial proportion of women in the study area and increased with age. Multiparity and carrying heavy objects are associated with prolapse, all of which have the potential to be modified. More attention is needed to improve prevention, diagnosis, and treatment services to mitigate the health burden of these at-risk women.

Translation, transcultural adaptation, reliability and validation of the pelvic organ prolapse quality of life (P-QoL) in Amharic.

BACKGROUND: The Prolapse Quality of Life (P-QoL) is a disease-specific instrument designed to measure the health-related quality of life in women with prolapse; however, there is no Amharic version of the instrument. The aim of this study were to translate the P-QoL into Amharic and evaluate its psychometric properties among adult women. METHODS: We followed an intercultural adaptation procedure to translate and adapt the P-QoL. A forward-backward translation, face validity interviews with experts and cognitive debriefing of the translated version with ten adults from the target group were performed. The Amharic version was then completed by 230 adult women with and without POP symptoms. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system. We examined internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient = ICC). Confirmatory factor analysis (CFA) was conducted and model fit was discussed. We extracted a new factor structure by exploratory factor analysis (EFA). Criterion validity was also assessed against the SPOP-Q stage. RESULTS: The translated measure was found acceptable by the experts and target group, with only minor adaptations required for the Amharic context. It had high internal consistency (α = 0.96) and test-retest reliability (ICC = 0.87; p <  0.001). In CFA results, the model fit indices were unacceptable (CFI = 0.69, RMSEA = 0.17, SRMR = 0.43, TLI = 0.65, and PCLOSE = 0.00). EFA extracted three-factor with satisfactory convergent and discriminant validity. The P-QoL median scores were significantly higher in symptomatic women (Mann-Whitney U Test; p <  0.001). The score was also significantly correlated with stage of prolapse (Spearman's correlation coefficient = 0.42 to 0.64, p <  0.001). CONCLUSIONS: The P-QoL scale was successfully translated to Amharic and appears feasible, reliable and valid for Amharic-speaking women. Factor analysis confirmed a three-factor structure, inconsistent with the original English version. Further studies are needed to evaluate responsiveness of the Amharic P-QoL score.

Streptococcus agalactiae from Ethiopian pregnant women; prevalence, associated factors and antimicrobial resistance: alarming for prophylaxis.

BACKGROUND: Maternal Streptococcus agalactiae (Group B Streptococcus, GBS) colonization rates and its antibiotic resistance patterns provide important information useful in guiding prevention strategies. There is a paucity of evidence about GBS in the Amhara National Regional State, Ethiopia. OBJECTIVE: To determine colonization prevalence, associated risk factors, and antibiotics resistance including inducible clindamycin resistance patterns of GBS among Ethiopian pregnant women. METHODS: A prospective cross-sectional study was conducted from 1st December 2016 to 30th November 2017 at the University of Gondar Referral hospital delivery ward. Combined recto-vaginal swabs were collected from 385 pregnant women and analyzed at the University of Gondar Bacteriology Laboratory by using LIM broth and 5% defibrinated sheep blood agar culture methods. Isolates were identified by using colony morphology, gram reaction, hemolysis, and CAMP test. Antibiotic susceptibility test was done using the disc diffusion method. Double disc diffusion method was used to identify inducible clindamycin resistance isolates. Data were analyzed by SPSS version 20 software. p ≤ 0.05 was considered as statistically significant. RESULTS: The overall prevalence of maternal GBS colonization was 25.5% (95% CI 21-29.5%). Experiencing meconium stained amniotic fluid (AOR = 3.018, 95% CI 1.225, 7.437), and longer duration of premature rupture of membrane (AOR = 1.897, 95% CI 1.014, 3.417) were statistically significant to maternal colonization. Furthermore, GBS resistant to 0 (8.2%), 1 (25.5%) and 3 (39.8%) or more antibiotics were identified. A D-test showed 15.2% inducible clindamycin resistant GBS. Constitutive macrolide lincosamide-streptograminB, L-, and M-phenotypes were also detected. CONCLUSIONS: Maternal GBS colonization rate in this study was higher compared to the previous reports in Ethiopia. This much prevalence and antibiotics resistance results are the clue to which attention shall be given to this bacterium during management of pregnant women and the newborns.

A systematic review of the psychometric properties of the cross-cultural adaptations and translations of the Prolapse Quality of Life (P-QoL) questionnaire.

INTRODUCTION AND HYPOTHESIS: Due to linguistic and cultural differences, there is a need to test the psychometrics of the translated versions of any patient-reported outcome measures. We investigated the psychometric properties of the Prolapse Quality of Life (P-QoL) questionnaire for non-English-speaking populations by conducting a systematic review of studies that examined the psychometric properties of non-English versions. METHODS: We searched PubMed, Latin American and Caribbean Health Science Information Center (LILACS), and Science Direct databases for articles published in English up to February 2018. Methodological quality and quality of psychometric properties were assessed by two independent reviewers using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and validated quality assessment criteria. The two assessments were combined to produce the best level of evidence per language/translation. RESULTS: Sixteen articles in 13 languages were retrieved. Most (n = 9; 56.3%) were not rigorously translated or reported, and there was poor evidence for structural validity. Internal consistency was reported in all studies, and all studies had good methodological quality. There was fair evidence for construct and good to fair for criterion validity. Evidence for responsiveness was good, although this was evaluated only in three studies. CONCLUSIONS: There is limited evidence supporting the psychometric robustness of the original validation and translated versions of P-QoL. Cross-cultural adaptations are insufficient. Given this variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error, and cutoff values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions.

Validation of the Amharic version of the Pelvic Organ Prolapse Symptom Score (POP-SS).

INTRODUCTION AND HYPOTHESIS: We aimed to translate and culturally adapt the Pelvic Organ Prolapse Symptom Score (POP-SS) into Amharic and evaluate its psychometric properties. METHODS: We followed an intercultural adaptation procedure to translate and adapt the POP-SS. One hundred and eighty-six women with POP symptoms completed the Amharic POP-SS and Prolapse Quality of Life (P-QoL) questionnaires. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system and were divided into four groups based on the POP-Q scores as stage 1, 2, 3, and 4. Internal consistency and test-retest reliability were determined using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. Criterion validity was assessed against the SPOP-Q stage and the P-QoL scale. Furthermore, we tested construct validity using exploratory factor analysis. RESULTS: The POP-SS score was successfully translated and achieved good content validity. It had high internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (ICC = 0.81; p < 0.001). There was a statistically significant difference among four groups of stages in POP-SS score. and women with stage 3 had the highest median score (Kruskal-Wallis test; p < 0.05). The POP-SS score was also significantly correlated with the P-QoL score (Spearman's correlation coefficient = 0.28, p < 0.001). The exploratory factor analysis identified two factors, namely, physical symptoms and evacuation symptoms. CONCLUSIONS: The POP-SS scale was successfully translated to Amharic and appears reliable and valid for women with symptoms of POP. However, further studies are needed to evaluate its responsiveness.

Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis.

BACKGROUND: It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. METHOD: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. RESULTS: We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). CONCLUSION: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].

Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia.

BACKGROUND: Women living in resource constrained settings often have limited knowledge of and access to surgical treatment for pelvic organ prolapse. Additionally, little is known about experiences during recovery periods or about the reintegration process for women who do gain access to medical services, including surgery. This study aimed to explore women's experiences related to recovery and reintegration after free surgical treatment for pelvic organ prolapse in a resource-constrained setting. METHODS: The study had a qualitative design and used in-depth interviews in the data collection with a purposive sample of 25 participants, including 12 women with pelvic organ prolapse. Recruitment took place at the University of Gondar Hospital, Ethiopia, where women with pelvic organ prolapse had been admitted for free surgical treatment. In-depth interviews were carried out with women at the hospital prior to surgery and in their homes 5-9 months following surgery. Interviews were also conducted with health-care providers (8), representatives from relevant organizations (3), and health authorities (2). The fieldwork was carried out in close collaboration with a local female interpreter. RESULTS: The majority of the women experienced a transformation after prolapse surgery. They went from a life dominated by fear of disclosure, discrimination, and divorce due to what was perceived as a shameful and strongly prohibitive condition both physically and socially, to a life of gradually regained physical health and reintegration into a social life. The strong mobilization of family-networks for most of the women facilitated work-related help and social support during the immediate post-surgery period as well as on a long-term basis. The women with less extensive social networks expressed greater challenges, and some struggled to meet their basic needs. All the women openly disclosed their health condition after surgery, and several actively engaged in creating awareness about the condition. CONCLUSIONS: Free surgical treatment substantially improved the health and social life for most of the study participants. The impact of the surgery extended to the communities in which the women lived through increased openness and awareness and thus had the potential to ensure increased disclosure among other women who suffer from this treatable condition.

Newborn colonization and antibiotic susceptibility patterns of Streptococcus agalactiae at the University of Gondar Referral Hospital, Northwest Ethiopia.

BACKGROUND: Group B Streptococcus (GBS) that asymptomatically colonizing the recto-vaginal area of women is the most important cause of neonatal colonization. There is paucity of evidence about newborn colonization with GBS in Ethiopia. Thus, this study was aimed to determine the prevalence of newborn colonization with GBS, antibiotic susceptibility patterns of the isolates and associated risk factors at the University of Gondar Referral Hospital in Northwest Ethiopia METHODS: A prospective cross sectional study was conducted from December 2016 to November 2017. A total of 1,155 swabs from nasal, ear and umbilical areas of the newborns were collected from the 385 newborns. Identifications of the isolates and antibiotic susceptibility testing were done by using conventional methods. RESULTS: Sixty two (16.1%, 95% CI: 12.2% - 20%) of the newborns were colonized by GBS. Seven percent of the total specimens were positive for GBS. The antibiotics susceptibility rates of GBS (average of the three body sites tested) were 95.1%, 89.6%, 88.9%, 85.7%, 85.3%, 81.3%, 76.9%, 76.1%, 73.8%, and 34.4% to ampicillin, penicillin, ciprofloxacin, chloramphenicol, vancomycin, azitromycin, erythromycin, clindamycin, ceftriaxone, and tetracycline, respectively. A multilogistic regression analyses were shown that the newborns that were from mothers whose education status was below tertiary level, and newborns from mothers who were: being employed, being nullipara and multigravida were at risk for colonization with GBS. CONCLUSION: Prevalence of neonatal colonization with GBS was higher than it was reported in three decades ago in Ethiopia. Ciprofloxacin, chloramphenicol, vancomycin and azithromycin were identified as the drug of choice next to ampicillin and penicillin.

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 low-income 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 low-income setting. The condition is perceived to be both caused by and aggravated by the heavy physical burdens of daily work.

Factors associated with utilization of long-acting and permanent contraceptive methods among women who have decided not to have more children in Gondar city.

BACKGROUND: Despite the fact that long acting family planning methods reduce population growth and improve maternal health, their utilization remains poor. Therefore, this study assessed the prevalence of long acting and permanent family planning method utilization and associated factors among women in reproductive age groups who have decided not to have more children in Gondar city, northwest Ethiopia. METHOD: An institution based cross-sectional study was conducted from August to October, 2015. Three hundred seventeen women who have decided not to have more children were selected consecutively into the study. A structured and pretested questionnaire was used to collect data. Both bivariate and multi-variable logistic regressions analyses were used to identify factors associated with utilization of long acting and permanent family planning methods. The multi-variable logistic regression analysis was used to investigate factors associated with the utilization of long acting and permanent family planning methods. The Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of associations, and variables with a P-value of <0.05 were considered statistically significant. RESULTS: In this study, the overall prevalence of long acting and permanent contraceptive (LAPCM) method utilization was 34.7% (95% CI: 29.5-39.9). According to the multi-variable logistic regression analysis, utilization of long acting and permanent contraceptive methods was significantly associated with women who had secondary school, (AOR: 2279, 95% CI: 1.17, 4.44), college, and above education (AOR: 2.91, 95% CI: 1.36, 6.24), history of previous utilization (AOR: 3.02, 95% CI: 1.69, 5.38), and information about LAPCM (AOR: 8.85, 95% CI: 2.04, 38.41). CONCLUSION: In this study the prevalence of long acting and permanent family planning method utilization among women who have decided not to have more children was high compared with previous studies conducted elsewhere. Advanced educational status, previous utilization of LAPCM, and information on LAPCM were significantly associated with the utilization of LAPCM. As a result, strengthening behavioral change communication channels to make information accessible is highly recommended.

Reasons for delay in decision making and reaching health facility among obstetric fistula and pelvic organ prolapse patients in Gondar University hospital, Northwest Ethiopia.

BACKGROUND: Obstetric fistula and pelvic organ prolapse remain highly prevalent in sub-Saharan Africa, where women have poor access to modern health care. Women having these problems tend to stay at home for years before getting treatment. However, information regarding the reasons contributing to late presentation to treatment is scarce, especially at the study area. The objective of this study was to assess the reasons whywomen with obstetric fistula and pelvic organ prolapse at Gondar University Hospital delay treatment. METHOD: A hospital based cross-sectional study was conducted among 384 women. Delay was evaluated by calculating symptom onset and time of arrival to get treatment at Gondar University Hospital. Regression analysis was conducted to elicit predictors of delay for treatment. RESULT: Of the total 384 participants, 311 (80.9%) had pelvic organ prolapse and 73(19.1%) obstetric fistula. The proportion of women who delayed treatment of pelvic organ prolapse was 82.9% and that of obstetric fistula 60.9%. Fear of disclosing illness due to social stigma (AOR = 2; 1.03, 3.9) and lack of money (AOR = 1.97; 1.01, 3.86) were associated with the delay of treatment for pelvic organ prolapse,while increasing age (AOR =1.12; 1.01, 1.24) and divorce (AOR = 16.9; 1.75, 165.5) were were responsible for delaying treatment forobstetric fistula. CONCLUSION: A large numberof women with pelvic organ prolapse and obstetric fistula delayed treatment. Fear of disclosure due to social stigma and lack of moneywere the major factors that contributed to thedelay to seek treatment for pelvic organ prolapse,while increasing age and divorce were the predictors for delaying treatment for obstetric fistula.

Urinary incontinence among pregnant women, following antenatal care at University of Gondar Hospital, North West Ethiopia.

BACKGROUND: Urinary incontinence is defined as a complaint of any involuntary leakage of urine. During pregnancy, the prevalence of urinary incontinence ranges from 32 to 64 %. Different factors like demographic factors, obstetric factors, and other external factors affect urinary incontinence. In Ethiopia, there is no study conducted so far on the magnitude of urinary incontinence and factors associated among pregnant women. The objective of this study was to determine the prevalence of urinary incontinence and associated factors among pregnant women following antenatal care at the University of Gondar Hospital. METHODS: Institution based cross- sectional study was conducted among 422 pregnant women following antenatal care at the University of Gondar Hospital. Data was collected using a structured questionnaire and analyzed using SPSS version 20. Descriptive, bivariate, and multivariate analyses were performed. The results were considered significant at p-value < 0.05. RESULT: The overall prevalence of urinary incontinence among the participants was 11.4 % [48]. After adjustment episiotomy, constipation, obese women, chronic cough/sneezing, asthma/allergies/sinusitis was associated with urinary incontinence. CONCLUSIONS: In this study, a lower prevalence was found than that of previous studies. There was a significant association of urinary incontinence with a previous history of episiotomy, constipation, maternal BMI, and respiratory problems.

Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study.

In Ethiopia maternal and perinatal morbidity and mortality remains high. Timely access to quality emergency obstetric and neonatal care is essential for the prevention of adverse outcomes. Training healthcare providers can play an important role in improving quality of care, thereby reducing maternal and perinatal mortality and morbidity. The aim of this study was to evaluate change of knowledge, skills and behaviour in health workers who attended a postgraduate Emergency Obstetric and Newborn Care training in Gondar, Ethiopia. A descriptive study with before-after approach, using a mix of quantitative and qualitative data, based on Kirkpatrick's model for training evaluation was conducted. The evaluation focussed on reaction, knowledge, skills, and change in behaviour in clinical practice of health care providers and facilitator's perspectives on performance. A 'lessons learned approach' was included to summarize facilitators' perspectives. Health care providers reacted positively to the Emergency Obstetric and Newborn Care training with significant improvement in knowledge and skills. Of the 56 participants who attended the training, 44 (79%) were midwives. The main evaluation score for lectures was 4,51 (SD 0,19) and for breakout sessions was 4,52 (SD 0.18) on scale of 1-5. There was a statistically significant difference in the pre and post knowledge (n = 28, mean difference 13.8%, SD 13.5, t = 6.216, p<0.001) and skills assessments (n = 23, mean difference 27.4%, SD 22.1%, t = 5.941, p<0.001). The results were the same for every component of the skills and knowledge assessment. Overall, they felt more confident in performing skills after being trained. Local sustainability, participant commitment and local context were identified as challenging factors after introducing a new training program. In Gondar Ethiopia, the Emergency Obstetric and Newborn Care training has the potential to increase skilled attendance at birth and improve quality of care, both vital to the reduction of maternal and perinatal mortality and morbidity.

The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study.

Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.

Incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia, southern Ethiopia: a prospective open cohort study.

BACKGROUND: In Ethiopia, in 2021, more than 80% of all newborn deaths were caused by preventable and treatable conditions. This study aimed to measure the incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia in the Sidama region of southern Ethiopia. METHODS: A prospective open cohort study was conducted from 8 August 2019 to 1 October 2020. We enrolled 363 women with pre-eclampsia and 367 normotensive women at ≥20 weeks of gestation and followed them until the 37th week. We then followed them until the seventh day after delivery up to the last perinatal outcome status was ascertained. A log-binomial logistic regression model was used to estimate the incidence of adverse perinatal outcomes and its risk factors among women with pre-eclampsia. Relative risk (RR) with a 95% CI was reported. A p<0.05 was considered statistically significant. RESULTS: There were 224 adverse perinatal outcomes observed in the 363 women with pre-eclampsia compared with 136 adverse perinatal outcomes in the 367 normotensive women (p<0.001). There were 23 early neonatal deaths in the pre-eclampsia group compared with six deaths in the normotensive group (p<0.001). There were 35 perinatal deaths in the pre-eclampsia group compared with 16 deaths in the normotensive group (p<0.05). Women with severe features of pre-eclampsia had a 46% (adjusted RR 1.46, 95% CI 1.38 to 2.77) higher risk for adverse perinatal outcomes compared with women without severe features of pre-eclampsia. CONCLUSIONS: In this study, more adverse perinatal outcomes occurred among women with pre-eclampsia after controlling for confounders. A higher perinatal outcome observed among women with pre-eclampsia, especially among women with severe features of pre-eclampsia, and those admitted to hospital at <34 weeks. This paper highlights the significantly elevated perinatal risks associated with pre-eclampsia, especially when it has severe features.

Molecular diversity of hepatitis B virus among pregnant women in Amhara National Regional State, Ethiopia.

BACKGROUND: Despite the availability of effective vaccines and treatments for hepatitis B virus (HBV), it continues to be a major public health problem in sub-Saharan Africa including Ethiopia. Routine screening for HBV in pregnant women is widely recommended, but there is lack of screening for HBV during pregnancy in Ethiopia. Therefore, this study aimed to assess viral load, and genetic diversity among pregnant women in the Amhara National Regional State, Ethiopia. MATERIALS AND METHODS: Hepatitis B surface antigen (HBsAg) testing was performed on 1846 pregnant women, 85 of who tested positive were included in this study. HBV DNA was isolated from 85 positive sera, and the partial surface/polymerase gene was amplified and sequenced. HBV genotypes, sub-genotypes, serotypes and mutations in surface genes and polymerase were studied. RESULTS: Out of 85 pregnant women`s HBsAg positive sera, 59(69.4%) had detectable viral DNA. The median viral load was 3.4 log IU/ml ranging from 2.6 to7.6 and 46 samples were successfully sequenced and genotyped. Genotypes A and D were identified in 39 (84.8%) and 7 (15.2%); respectively. All genotype A isolates were further classified into sub-genotype A1 and serotype adw2 (84.8%) whereas genotype D isolates were further classified into three sub genotypes; 2 (4.3%) D2, 1(2.2%) D4, and 4 (8.7%) D10 with serotypes ayw2 (10.9%), and ayw3 (4.3%). There were 19 (41.3%) surface gene mutations in the major hydrophilic region (MHR). Six (13.1%) of them were discovered in MHR`s `a'-determinant region. Six polymerase gene mutations (13%) were identified. CONCLUSION: Genotype A was the predominant genotype in the Amhara National Regional State. The surface and polymerase gene mutations identified in this study may lead to immune therapy failure, diagnostics escape and drug resistance. Thus, the data generated in this study will contribute to the planning of HBV diagnosis, vaccination and treatment, and most importantly to the prevention of vertical transmission of HBV in Ethiopia. Therefore, further molecular studies on HBV are warranted and continuous surveillance is important for patient management and for the prevention and control of HBV infection in the country.