Determinants of low birth weight among newborns delivered in public hospitals of North Shewa Zone, Amhara region, Ethiopia: A case-control study (2023).

BACKGROUND: Low birth weight (LBW), defined as a birth weight less than 2500 g, irrespective of gestational age, poses a significant health concern for newborns. Despite efforts, the incidence of LBW in sub-Saharan Africa has remained stagnant over the past decade, warranting attention from healthcare providers, policymakers, and researchers. OBJECTIVE: This study aimed to identify factors associated with LBW among newborns delivered in public hospitals of North Shewa Zone, Amhara Region, Ethiopia, from May 2 to June 10, 2023. METHODS AND MATERIALS: An unmatched case-control study was conducted from May 2 to June 10, 2023, involving 318 participants (106 cases and 212 controls). Data were collected using pretested interviewer-administered structured questionnaires, medical record reviews, and direct anthropometric measurements. Bivariate analyses were conducted, and variables with a p-value ≤ 0.25 were included in a multivariable logistic regression model to determine significant determinants of LBW. A significance level of p < 0.05 was used. RESULTS: A total of 309 newborns (103 cases and 206 controls) were included, yielding a response rate of 97.2%. Among the findings, females exhibited a higher risk of LBW (adjusted odds ratio [AOR]: 3.13, 95% CI: 1.34, 7.32, p = 0.008), as did mothers aged 20 or younger (AOR: 3.42, 95% CI: 1.35, 8.66, p = 0.009). Lack of formal education was associated with increased risk (AOR: 6.82, 95% CI: 2.94, 15.3, p < 0.001), as were unplanned pregnancies (AOR: 3.08, 95% CI: 1.38, 6.84, p = 0.006) and missed antenatal care visits (AOR: 2.74, 95% CI: 1.16, 6.49, p = 0.021). No significant associations were found with residency type or maternal age above 35. CONCLUSION: Mothers aged ≤ 20 years, with inadequate minimum dietary diversity, lack of antenatal care attendance, and unplanned pregnancies, faced heightened risks of LBW. Addressing these factors is vital for reducing LBW occurrences and improving newborn health outcomes in Ethiopia.

Determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia: A case-control study.

Background: A maternal near-miss (MNM) refers to a woman who presents with life-threatening complications during pregnancy, childbirth, or within 42 days of termination of pregnancy but survived by chance or due to the standard care she received. It is recognized as a valuable indicator to examine the quality of obstetrics care as it follows similar predictors with maternal death. Ethiopia is one of the sub-Saharan African countries with the highest rate of maternal mortality and morbidity. Thus, studying the cause and predictors of maternal near-miss is vital to improving the quality of obstetric care, particularly in low-income countries. Objective: To identify determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia, 2020. Methods: A facility-based unmatched case-control study was conducted on 264 women (88 cases and 176 controls) from February to April 2020. Data were collected using pretested interviewer-administered questionnaires and a review of medical records. Data were entered into Epi-data version 4.2.2 and exported to SPSS version 25 for analysis. Variables with a p-value <0.25 in the bivariable analysis were further analyzed using multivariable logistic regression analysis. Finally, variables with a p-value <0.05 were considered statistically significant. Result: Severe pre-eclampsia (49.5%) and postpartum hemorrhage (28.3%) were the main reasons for admission of cases. Educational level of women (AOR = 4.80, 95% CI: 1.78-12.90), education level of husbands (AOR = 5.26; 95% CI: 1.46-18.90), being referred from other health facilities (AOR = 4.73, 95% CI: 1.78-12.55), antenatal care visit (AOR = 2.75, 95% CI: 1.13-6.72), cesarean section (AOR = 3.70, 95% CI: 1.42-9.60), and medical disorder during pregnancy (AOR = 12.06, 95% CI: 2.82-51.55) were found to significantly increase the risk of maternal near-miss. Whereas, the younger age of women significantly decreased the risk of maternal near miss (AOR = 0.26, 95% CI: 0.09-0.75). Conclusion: Age, educational level, antenatal care follow-ups, medical disorder during pregnancy, mode of admission, and mode of delivery were significant predictors of maternal near-miss. Socio-demographic development, use of ANC services, early detection and management of medical diseases, reducing cesarean section, and improving the referral systems are crucial to minimizing the maternal near-miss.

Midwife-led continuity of care increases women's satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: The provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women's satisfaction with care in a low-income/resource setting. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women's home at the end of the postpartum period. The study's outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest). FINDINGS: Compared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18-1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22-1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88-1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54-1.94)). CONCLUSION: MLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: In a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FINDINGS: Women in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101-1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227-0.683)). CONCLUSION: In this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.

Health care providers' perceptions and experiences related to Midwife-led continuity of care-A qualitative study.

BACKGROUND: Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. OBJECTIVE: The aim of this study was to explore health care providers' perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia. METHODS: A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. FINDING: The main theme extracted was "Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload". The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. CONCLUSION: In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model.

Half-time evaluation of a new 4-year Ph.D. program in nursing and midwifery at the University of Gondar, Ethiopia.

A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.

Immunization coverage and its determinant factors among children aged 12-23 months in Ethiopia: a systematic review, and Meta- analysis of cross-sectional studies.

BACKGROUND: Immunization is the process by which a person is made immune or resistant to an infectious disease, typically by the administration of vaccine. Vaccination coverage for other single vaccines ranged from 49.1% for PCV to 69.2% for BCG vaccine. The vaccination coverage for basic vaccinations was 39.7% in Ethiopia. There have been epidemiological studies available on immunization in Ethiopia. Yet, these studies revealed a wide variation over time and across geographical areas. This systematic review and Meta-analysis aim to estimate the overall immunization coverage among 12-23 months children in Ethiopia. METHODS: Cross-sectional studies that reported on immunization coverage from 2003 to August 2019 were systematically searched. Searches were conducted using PubMed, Google Scholar, Cochrane library, and gray literature. Information was extracted using a standardized form of Joanna Briggs Institute. The search was updated 20 Jan 2020 to decrease time-lag bias. The quality of studies assessed using Joanna Briggs Institute cross-sectional study quality assessment criteria. I-squared statistics applied to check the heterogeneity of studies. A funnel plot, Begg's test, and Egger's regression test was used to check for publication bias. RESULTS: Out of 206 studies, 30 studies with 21,672 children with mothers were included in the Meta-analysis. The pooled full immunization coverage using the random-effect model in Ethiopia was 58.92% (95% CI: 51.26-66.58%). The trend of immunization coverage was improved from time to time, but there were great disparities among different regions. Amhara region had the highest pooled fully immunized coverage, 72.48 (95%CI: 62.81-82.16). The I2 statistics was I2 = 99.4% (p = 0.0001). A subgroup meta-analysis showed that region and study years were not the sources of heterogeneity. CONCLUSION: This review showed that full immunization coverage in Ethiopia was 58.92% (95% CI: 51.26-66.58%). The study suggests that the child routine immunization program needs to discuss this low immunization coverage and the current practice needs revision.

Retrospective assessment of the status and determinants of tuberculosis treatment outcome among patients treated in government hospitals in North Shoa Administrative Zone, Amhara Regional State, Ethiopia.

BACKGROUND: One of the specific targets of Directly Observed Treatment, Short-course detailed in the updated Global Plan (2011-2015) was to achieve a treatment success rate of 87% by 2015. This strategy was introduced to Ethiopia in 1995 to reach full coverage in 2005; however, by 2009, treatment had not been as successful as expected. OBJECTIVE: This study was conducted to determine treatment success rate and identify risk factors for tuberculosis (TB) treatment outcomes in North Shoa Administrative Zone, Amhara Regional State, Ethiopia. METHODS: A retrospective cohort study was conducted on all TB patients (739) who registered for TB treatment from September 1, 2012 to August 31, 2014 at public hospitals in North Shoa Administrative Zone, Ethiopia. Data were gathered by using a pretested structured medical record checklist. Four data collectors and two supervisors were involved in gathering the data. The data were analyzed using descriptive statistics and logistic regression and were entered into Epi Info and analyzed by using the SPSS software package version 20. RESULTS: This study revealed that the TB treatment success rate was 86.1% (169 [22.9%] cured and 467 [63.2%] completed). In addition, 22 (3%) of the study participants defaulted their treatment of which 19 (86.4%) withdrew during the intensive phase. The multiple logistic regression model revealed that the study year of treatment, sputum smear positivity at the second-month follow-up, history of treatment default, and subsequent hospitalization were significantly associated with the TB treatment outcome. CONCLUSION: The TB treatment success rate in the study area was low compared to that estimated by World Health Organization to achieve by 2015. Therefore, Federal Ministry of Health and Regional and Zonal Health Office have to strengthen the interventions on minimizing anti-TB treatment default rate through well-organized documentation, follow-up on TB patients, and awareness-creation programs.

Primary dysmenorrhea magnitude, associated risk factors, and its effect on academic performance: evidence from female university students in Ethiopia.

BACKGROUND: Primary dysmenorrhea (PD) is the most common gynecologic compliant among adolescent females. There is a wide variation in the estimate of PD, which ranges from 50% to 90%, and the disorder is the most common cause of work and school absenteeism in adolescent females. OBJECTIVE: To assess the prevalence and associated risk factors of PD among female university students and understand its effects on students' academic performance. METHODS: A cross-sectional study was employed in 440 research participants. A multistage stratified sampling technique was employed to select the study units. Structured and pretested self-administered questionnaires were used and weight and height measurements were conducted. The severity of dysmenorrheal pain was assessed by using a verbal multidimensional scoring system and visual analog scale. The data were double entered in Epi Info version 3.1 and analyzed using SPSS version 17. Descriptive statistics, chi-square test, and logistic regression analysis were performed. RESULTS: A total of 440 students participated in this study. The prevalence of PD was 368 (85.4%). Of these, 123 (28.5%) had mild, 164 (38.1%) moderate, and 81 (18.8%) severe primary dysmenorrheal pain. Among students with PD, 88.3% reported that PD had a negative effect on their academic performance. Of these, 80% reported school absence, 66.8% reported loss of class concentration, 56.3% reported class absence, 47.4% reported loss of class participation, 37.8% reported limited sport participation, 31.7% reported limitation in going out with friends, and 21% reported inability to do homework. Based on the multivariate logistic regression, PD was statistically significant with those who had lower monthly stipends, a history of attempt to lose weight, a history of depression or anxiety, disruption of social network of family, friends or people they love, who consumed more than four glasses of tea per day, who drunk one or more Coca-Cola or Pepsi per day, in nullipara, and students with a family history of dysmenorrhea. CONCLUSION: PD is more prevalent among female students attending university. It has a significant negative impact on students' academic performance. Thus, it needs medical attention. There are various identified associated risk factors and considering them in the management of the disorder is fundamental. It is also wise to recommend future studies to better identify risk factors for PD and lighten its effect on students' academic performance at a larger scale in the country.