Correlates of adverse outcomes of adolescent pregnancy in Sidama region, Ethiopia. An unmatched case-control study.

INTRODUCTION: Adolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia. METHODS: A hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies. RESULTS: A monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21-9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97-9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16-3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes. CONCLUSION: Several socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy.

Community-Based Health Education Led by Women's Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial.

OBJECTIVE: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. METHODS: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. RESULTS: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). CONCLUSION: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. TRIAL REGISTRATION NUMBER: NCT05865873.

Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis.

BACKGROUND: Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia. OBJECTIVES: This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia. DESIGN: A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region. METHODS: Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization. RESULTS: Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73). CONCLUSION: Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.

Reliability and validity of the Sidaamu Afoo version of the pelvic organ prolapse symptom score questionnaire.

BACKGROUND: Both for clinical and research purposes, it is critical that clinicians and researchers use a tool that is trans-culturally adapted and tested for its psychometric properties. The English version of the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire was developed in 2000. Since then it has been translated into other languages and verified. However, the tool has not been adapted for use in Sidaamu Afoo language in the Sidama Region of Ethiopia. OBJECTIVE: This study aimed to translate and adapt the Pelvic Organ Prolapse Symptom Score questionnaire into Sidaamu Afoo and evaluate its psychometric properties. METHODS: A total of 100 women with symptomatic prolapse completed version-2 of the POP-SS questionnaire during the first round of interviews, and 61 of them completed the questionnaire during the second round of interviews (to establish the test-retest reliability). We adapted the scale translation process recommended by Beaton and his colleagues. The content validity was assessed using the content validity index and the construct validity was done based on exploratory factor analysis using the principal component analysis model. The criterion validity was evaluated by using the Kruskal-Wallis test based on stages of the prolapse established via pelvic examination. The internal consistency reliability of the scale was assessed using Cronbach's alpha value, and test-retest reliability was evaluated using the intraclass correlation coefficient. RESULTS: The questionnaire was successfully translated to Sidaamu Afoo, and achieved a good content validity index (0.88), high internal consistency (Cronbach's alpha of 0.79), and test-retest reliability (an intraclass correlation coefficient of 0.83). The exploratory factor analysis revealed two factors based on an eigenvalue of 1. The two factors explained 70.6% of the common variance, and each item loaded well (0.61 to 0.92) to its corresponding factor. There is a significant difference in the median score of prolapse symptoms across different stages of prolapse (Kruskal-Wallis χ2, 17.5, p < 0.001). CONCLUSION: The Sidaamu Afoo version of the POP-SS tool is valid and reliable. Further studies that involve a balanced number of women in each stage of prolapse are needed to avoid the ceiling and floor effects.

Effectiveness of midwifery-led care on pregnancy outcomes in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Midwifery-led care is an evidence-based practice in which a qualified midwife provides comprehensive care for low-risk pregnant women and new-borns throughout pregnancy, birth, and the postnatal period. Evidence indicates that midwifery-led care has positive impacts on various outcomes, which include preventing preterm births, reducing the need for interventions, and improving clinical outcomes. This is, however, mainly based on studies from high-income countries. Therefore, this systematic review and meta-analysis aimed to assess the effectiveness of midwifery-led care on pregnancy outcomes in low- and middle-income countries. METHODS: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Three electronic databases (PubMed, CINAHL, and EMBASE) were searched. The search results were systematically screened by two independent researchers. Two authors independently extracted all relevant data using a structured data extraction format. Data analysis for the meta-analysis was done using STATA Version 16 software. A weighted inverse variance random-effects model was used to estimate the effectiveness of midwifery-led care on pregnancy outcomes. Odds ratio with a 95% confidence interval (CI) was presented using a forest plot. RESULTS: Ten studies were eligible for inclusion in this systematic review, of which five studies were eligible for inclusion in the meta-analysis. Women receiving midwifery-led care had a significantly lower rate of postpartum haemorrhage and a reduced rate of birth asphyxia. The meta-analysis further showed a significantly reduced risk of emergency Caesarean section (OR = 0.49; 95% CI: 0.27-0.72), increased odds of vaginal birth (OR = 1.14; 95% CI: 1.04-1.23), decreased use of episiotomy (OR = 0.46; 95% CI: 0.10-0.82), and decreased average neonatal admission time in neonatal intensive care unit (OR = 0.59; 95% CI: 0.44-0.75). CONCLUSIONS: This systematic review indicated that midwifery-led care has a significant positive impact on improving various maternal and neonatal outcomes in low- and middle-income countries. We therefore advise widespread implementation of midwifery-led care in low- and middle-income countries.

Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: a systematic review and narrative synthesis.

INTRODUCTION: Pelvic organ prolapse (POP) affects women's quality of life in various aspects. However, evidence on the healthcare-seeking behavior of women with POP is limited. Therefore, this review aimed to identify and synthesize the existing evidence on the healthcare-seeking behavior among women with POP. METHODS: This systematic review and narrative synthesis of the literature on healthcare-seeking behavior among women with POP was conducted from 20 June to 07 July 2022. The electronic databases PubMed, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus and Directory of Open Access Journal, and Google Scholar were searched for relevant literature published from 1996 to April 2022. The retrieved evidence was synthesized using a narrative synthesis approach. The characteristics of included studies and the level of healthcare-seeking behavior were summarized in a table and texts. Error bar was used to show the variability across different studies. RESULTS: A total of 966 articles were retrieved of which only eight studies with 23,501 women (2,683 women with pelvic organ prolapse) were included in the synthesis. The level of healthcare-seeking behavior ranges from 21.3% in Pakistan to 73.4% in California, USA. The studies were conducted in four different populations, used both secondary and primary data, and were conducted in six different countries. The error bar shows variation in healthcare-seeking behavior. CONCLUSIONS: The level of health-care seeking behavior among women with POP is low in low-income countries. There is substantial variability in the characteristics of the reviewed studies. We recommend a large-scale and robust study which will help to better understand the healthcare-seeking behavior among women with POP.

Magnitude and effects of food cravings on nutritional status of pregnant women in Southern Ethiopia: A community-based cross sectional study.

BACKGROUND: Food cravings is a strong and intense urge to consume a specific food and reported as being associated with overweight and overall caloric intake in pregnant women. However, the nutritional and anthropometric consequences are not well recognized. Therefore, this study aimed to assess magnitude and effects of food cravings on nutritional status of pregnant women in Southern Ethiopia. METHODS: A community-based cross-sectional study conducted among 586 randomly selected pregnant mothers at Sidama Regional State from June 1-20, 2019. Pre-tested and semistructured face-to-face interview questionnaires used to collect the data. The data were cleaned, coded, and entered into Epi Data version 3.1 and analysed using SPSS IBM version 20. The bi-variable and multivariable logistic regression used to identify the possible factors of food cravings. Principal component analysis used to determine the wealth status of the study participants. Adjusted Odds Ratio (AOR) together with 95% Confidence Intervals (CIs) used to declare statistical significance. RESULTS: The study found that nearly three in five, 309 (58.3%) [95%, CI: 54.2%-62.8%] of the study participants reported food cravings. Meat (71.5%) and Fruits (41.7%) were the most frequently craved. About one-third, 194 (36.6%) of the study participants were undernourished (MUAC < 23 cm). Age of women (20-34 years), government employed, Antenatal Care (ANC), Pica practice, lowest wealth quintile, and skipping meals were statistically associated with food cravings. Whereas, wealth quintile and ability to consume craved food were factors associated with the nutritional status of pregnant women. Moreover, our study result found that maternal undernutrition and food cravings were statistically associated (p<0.001). CONCLUSION: The prevalence of food cravings in this study is comparable to the global level. However, the magnitude of undernutrition found to be higher. Thus, health care providers need to take every opportunity to encourage women to adopt healthful dietary practices during pregnancy.

Barriers to husbands' involvement in maternal health care in Sidama zone, Southern Ethiopia: a qualitative study.

BACKGROUND: Husbands' involvement in maternal care is considered as a crucial step in scaling up women's utilization of the services. However, the factors related with how husband's involvement in maternal health care have hardly been studied to date in the study areas. Therefore, this study aimed to explore barriers to husbands' involvement in maternal health care, in Sidama zone, Southern Ethiopia. METHODS: The study employed a qualitative method. A pre-tested interview guide questions that prepared in English and translated in to Amharic language were used for data collection. The data were collected using focus group discussions, in-depth interviews and key-informants' interview in April and May 2015. The data were analyzed thematically. RESULTS: The study identified a range of factors that-deterred husbands to involve in their female partners' maternal health care. These are childbirth is a natural process, pregnancy and childbirth are women's business, preference for TBAs' care and husband's involvement in pregnancy and birth care is a new idea were identified as barriers for husbands' involvement in maternal health care, in this study. CONCLUSIONS: A range of factors related with clients' and service delivery factors' were identified as barriers to husbands' involvement in maternal health care. Based on the study findings we recommend a contextual based awareness creation programs about husbands' involvement in maternal health care need to be established.

Husbands' involvement in antenatal care and its association with women's utilization of skilled birth attendants in Sidama zone, Ethiopia: a prospective cohort study.

BACKGROUND: There is limited evidence about husbands' roles on women's utilization of skilled maternity care in Ethiopia, a country with low utilization coverage of skilled birth attendants and high maternal mortality. This study examined the association between husbands' involvement in antenatal care and women's use of skilled birth attendants in Sidama zone, Southern Ethiopia. METHODS: Using a cohort study design, we followed a random sample of 709 antenatal women until delivery from June 01 to November 30, 2015. Main exposure variable was husband's involvement in at least one antenatal care visit, and outcome variable was women's use of skilled attendants during birth. Data were analysed using SPSS software-version20. We computed univariate and bivariate analyses to describe characteristics of the study subjects. A chi-square test with p-value < 0.05 level of significance and logistic regression analyses with odds ratio and 95% confidence interval were computed to test homogeneity of the two groups' baseline characteristics and examine the association between husbands' involvement in antenatal care and women's use of skilled attendants during birth. Model assessment of the regression equation was checked using a likelihood ratio test, score test, and Hosmer-Lemeshow goodness-of-fit test. RESULTS: Women who reported at least one antenatal care visit in which their husbands accompanied them were 6.27 times (95% Confidence interval: 4.2, 9.3) more likely to use skilled birth attendants compared to women attended antenatal care alone. CONCLUSION: There was a strong statistically significant association between husbands' involvement during antenatal care and women's use of skilled attendants during birth. This implies that woman's utilization of skilled attendants during birth can be improved by involving their husbands in at least one antenatal care visit.