Introducing second-trimester anatomic scanning for improved detection and management of congenital anomalies: Experience from a novice center in East Africa.

OBJECTIVES: The aim of the current study was to describe the magnitude and pattern of congenital anomalies on routine second-trimester ultrasound and its practical implication in the management of pregnant women with fetal anomalies at a novice center in East Africa. METHODS: This cross-sectional study was conducted from September 2021 to May 2022 among women who had second-trimester anatomic scanning. Data were collected using a structured questionnaire and analyzed using SPSS version 23.1. Ethical clearance was obtained from the hospital's institutional review board and informed consent was obtained. RESULTS: The number of congenital anomalies was 45 of 1764 (2.55%). Most (41%) were in the age group 26-30 years and multigravida (62%). Average gestational age at anatomic scanning was 24 weeks. One or more risk factors for congenital anomalies were reported in 19 (31.0%) of the mothers. Most sonographic fetal abnormalities (51.7%) were reported in the central nervous system, followed by renal (18.0%) and skeletal (11.5%). Among the central nervous system anomalies, severe ventriculomegaly was the most common (38.7%), followed by Arnold-Chiari malformation (19.4%). Thirty-five (2%) of the mothers had a lethal fetal congenital anomaly and their pregnancy was terminated after counseling and informed consent. CONCLUSIONS: The rate of congenital anomalies in this study is comparable with most international data. The introduction of second-trimester anatomic scanning has led to timely termination of anomalous pregnancies, which contributes to reduction in direct and indirect costs of care and family's psychosocial distress and the stigma associated with the birth of and caring for a child with disability.

Unravelling the complexity of research capacity strengthening for health professionals in low- and middle-income countries: A concept analysis.

AIMS: Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low- and middle-income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence-based decision-making. We seek to move beyond a surface-level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. DESIGN: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. CONCLUSION: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high-quality research and improve healthcare delivery in resource-constrained settings. IMPLICATIONS: RCS aims to empower health professionals to apply evidence-based practices, reduce disparities and enhance the well-being of populations in LMICs. IMPACT: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well-being of populations worldwide.

Premature luteinization and pregnancy outcomes in depot goserelin-downregulated assisted reproductive technology cycles: A cross-sectional study from Ethiopia.

OBJECTIVE: To compare the rate of premature luteinization in depot goserelin-downregulated in vitro fertilization (IVF) cycles with other IVF protocols at a teaching hospital in Ethiopia. METHODS: We conducted a cross-sectional study on the effects of premature luteinization on IVF outcomes at St. Paul's Hospital Millennium Medical College, a tertiary teaching hospital in Ethiopia. Patients who had IVF at this hospital between 2019 and 2020 were included in the study. Patient records were reviewed and collected on Open Data Kit. We used Stata release 15 to analyze the data. A simple descriptive analysis and bivariate analysis  were performed as appropriate. A P-value less than 0.05 was considered as statistically significant. RESULTS: A total of 305 patients (40 cases with premature luteinization and 265 without premature luteinization) were included. There was no difference in the rate of premature luteinization in the depot goserelin long protocol cycles (6.4%), compared to minimal stimulation (14.1%) and antagonist protocols (16.7%), P = 0.19. Embryo transfer was carried out in 27 (67.5%) patients in the premature luteinization group, which was lower than the 86.0% (228/265) in the non-premature luteinization group, P = 0.003. There was no difference in the median number of oocytes retrieved (8.5 [interquartile range 5.0, 13.0] per cycle in the premature luteinization group vs 5.0 [interquartile range 3.0, 10.0] in those without premature luteinization, P = 0.10). CONCLUSION: A depot goserelin-downregulated long protocol for IVF is a cost-effective and convenient option for controlled ovarian hyperstimulation without increased risk of having premature luteinization compared to antagonist and minimal stimulation protocols.

Utilization of third-trimester fetal transcerebellar diameter measurement for gestational age estimation: a comparative study using Bland-Altman analysis.

BACKGROUND: Several studies show that gestational age estimation during the third trimester of pregnancy using fetal transcerebellar diameter is superior to that measured using fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length). However, the conclusion of the studies stemmed from findings of correlation and regression statistical tests, which are not the recommended statistical analysis methods for comparing the values of 1 variable as measured by 2 different methods. OBJECTIVE: This study aimed to compare the accuracy of gestational age estimation using transcerebellar diameter to that using fetal biometry during the third trimester of pregnancy using Bland-Altman statistical analysis. STUDY DESIGN: This was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester of pregnancy (28-41 weeks of gestation) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on the Open Data Kit. The primary outcome of our study was the mean bias of gestational age estimation (error in estimating gestational age) using transcerebellar diameter and composite fetal biometry (composite gestational age). Data were analyzed using Stata (version 15; StataCorp, College Station, TX). Simple descriptive analysis, Bland-Altman analysis, and the Kendall τa discordance measurement were performed as appropriate. The mean bias (error) and limits of agreement were used to present the significance of the finding. RESULTS: A total of 104 pregnant women in the third trimester were included in the study. The mean error (bias) when transcerebellar diameter was used to estimate the gestational age was 0.65 weeks vs a bias of 1.1 weeks using composite biometry, compared with the gold standard method from crown-lump length (in both cases). The calculated estimated limit of agreement was narrower in the case of transcerebellar diameter than in the case of composite fetal biometry (-3.56 to 2.25 vs -4.73 to 2.53). The Kendall τa discordance measurement revealed that gestational age estimations using composite biometry and crown-lump length were 51% to 70%, respectively, more likely to agree than disagree and that gestational age estimations using transcerebellar diameter and crown-lump length were 62% to 77%, respectively, more likely to agree than to disagree (P≤.001). CONCLUSION: Gestational age estimation using transcerebellar diameter is more accurate than gestational age estimation using composite gestational age (biparietal diameter, head circumference, femur diaphysis length, and abdominal circumference). Transcerebellar diameter should be used to date third-trimester pregnancies with unknown gestational age (unknown last normal menstrual period with no early ultrasound milestone).

The practice of breast self-examination and associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda: a cross sectional study.

BACKGROUND: Breast self-examination (BSE) is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years considering that breast cancer among women globally contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare professionals is low in many developing countries and it is not well known in Rwanda. Therefore, this research was intended to measure the level of breast self-examination practice and its associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda. METHODS: A cross-sectional study was conducted among 221 randomly selected female healthcare professionals in four district hospitals in Kigali, Rwanda. A self-administered structured questionnaire was used as data collection instrument. The predictor variables were socio-demographic and obstetrics variables, knowledge on breast cancer and breast self-examination as well as attitude towards breast cancer and breast self-examination. Sample statistics such as frequencies, proportions and mean were used to recapitulate the findings in univariate analysis. Multiple logistic regression analysis was employed to identify statistically significant variables that predict breast self-examination practice. Adjusted odds ratio with 95% confidence level were reported. P-value < 0.05 was used to declare statistical significance. RESULTS: Breast self-examination was practiced by 43.5% of female healthcare professionals. This prevalence is low compared to other studies. Attitude towards breast self-examination and breast cancer was the only predictor variable that was significantly associated with breast self-examination practice [AOR = 1.032; 95% CI (1.001, 1.065), p-value = 0.042]. However, number of pregnancy and number of children were not significantly associated with BSE practice in the multi-variate analysis. In addition, there was a positive linear link between knowledge and attitude, with a correlation coefficient (r) of 0.186 (p = 0.005). CONCLUSIONS: The breast self-examination practice among healthcare professionals was found to be low. Attitude towards breast cancer and breast self-examination was positively associated with BSE practice. Moreover, attitude and knowledge were positively correlated. This suggests the need for continuous medical education on breast self-examination and breast cancer to increase the knowledge & BSE practice level of female healthcare professionals.

Cesarean delivery surgical techniques in Africa: A survey study from Ethiopia.

OBJECTIVE: To describe the surgical techniques of Caesarean delivery (CD) practiced by Ethiopian Obstetricians and Gynecologists. METHODS: A descriptive survey study was conducted in Ethiopia from March 1, 2021 to April 30, 2021. Members of the Ethiopian Society of Obstetrician and Gynecologists were randomly selected and their Cesarean delivery surgical techniques were explored. Data were analyzed using IBM SPSS statistics 22. Simple descriptive analysis were employed and frequencies and percentage were calculated to present the data. RESULTS: A total of 258 obstetricians and Gynecologists practicing in Ethiopia were approached with a response rate of 97.3% (251/258). Double layer closure of uterine incision (98.4%) and subcuticular closure of skin wound (96.4%) are practiced by most of the participants. There was a large difference in practice of blunt versus sharp fascia extension (43.3 vs 55.8%), cephalo-caudad versus lateral uterine incision extension (58 vs.39%), and closure versus non-closure of pelvic and parietal peritoneum (57.4 vs 42.6, and 39.8 versus 60.2%). CONCLUSIONS: Blunt and sharp fascia extension, cephalo-caudad and lateral uterine incision extension, closure and non-closure of the pelvic and parietal peritoneum are practiced by similar numbers of Ethiopian Obstetricians and Gynecologists. This demonstrates a wide variation exists in the techniques of Cesarean Delivery across Ethiopia.

Incidence, indications, and maternal outcomes of emergency peripartum hysterectomy at a tertiary hospital in Ethiopia: A retrospective review.

OBJECTIVE: To determine the incidence, indications, and maternal outcomes of emergency peripartum hysterectomy (EPH) at a tertiary setting in Ethiopia. MATERIALS AND METHODS: A 4-year retrospective review of EPH cases was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from January 2016 to December 2019. Data were collected by reviewing maternal charts of EPH cases using a structured data extraction format. Stata Statistical Software, release 14, was used for data analysis. Frequency and percentages are used to present the significance of results. RESULTS: Among 39 629 deliveries during the study period, there were 105 EPH, making the incidence rate 2.6 per 1000 deliveries. The common indications for EPH were uterine rupture (63/105; 60%), intractable uterine atony (23/105; 21.9%), and placenta accreta spectrum (14/105; 14.7%). The most common complications were anemia (85/105; 80.9%), puerperal fever (13/105; 12.4%), acute kidney injury (10/105; 9.5%), and relaparotomy (7/105; 6.7%). CONCLUSION: The incidence of EPH observed in our institution is high. Appropriate patient selection for vaginal delivery and strict labor follow up with early intervention for labor abnormalities should be the guiding principles of optimal obstetrical care to alleviate the burden of uterine rupture.

Time to early cessation of exclusive breast feeding and associated factors among 6-12 months old children: Survival analysis.

BACKGROUND: WHO and UNICEF (1990) have recommended EBF for six months, followed by an introduction of complementary foods at the age of six months with continued breastfeeding for the first 24 months or more. Exclusive breastfeeding (EBF) during the first 6 months of life reduces infant morbidity and mortality. According to Ethiopia Demographic Health Survey (DHS), only 58% of children were exclusively breastfed during the first 6 months of age. OBJECTIVE: The study aimed to identify time to early cessation of EBF and associated factors among 6-12 months old children in Lanfuro Woreda, Silte Zone. METHODS: A community-based cross-sectional study was conducted in Lanfuro Woreda, Silte Zone, from March to April 2017. A total of 636 mothers with 6-12 months old infants from ten randomly selected kebeles were included. Both quantitative and subjective information assortment techniques were utilized. The Kaplan-Meier curve with log-rank test was used to compare the survival difference by the selected covariates. Both bivariate (P < 0.25) and multivariable (P < 0.05) Cox Proportional Hazards model were fitted to identify factors predicting time to early cessation of EBF. RESULTS: The median duration of exclusive breastfeeding was 6.22 months. The highest proportion of cessation of exclusive breastfeeding occurred during the first four to five months. Early cessation of exclusive breastfeeding was observed in 295 (48%). Place of residence (AHR: 1.6; 95% CI = 1.14-2.20), knowledge on EBF (AHR = 1.31; 95% CI = 1.02-1.68), type of delivery (AHR: 2.41; 95% CI = 2.24-3.68), pre-lacteal feeding (AHR = 1.8; 95% CI = 1.32-2.36) and household food insecurity (AHR = 5.02; 95% CI = 3.89-6.50) were significant independent factors which were associated with time to early cessation of exclusive breastfeeding. CONCLUSION AND RECOMMENDATION: There are still sizable proportions of children not enjoying exclusive breastfeeding for the first full six months. Being an urban resident and coming from food-insecure households, giving birth by CS, having low knowledge on EBF, and giving pre-lacteal feeding were factors associated with time to early cessation of EBF. Multi-sectoral action should be taken for respective predictors of time to early cessation of EBF.

Late request for safe abortion care at a tertiary hospital in Ethiopia; the role of emotional factors: A cross-sectional study.

OBJECTIVE: To determine the prevalence of second-trimester safe abortion care and to examine its association with emotional factors. METHODS: We conducted a cross-sectional study on second-trimester safe abortion care clients from June 1, 2020 to December 31, 2020 at St. Paul's Hospital Millennium Medical College. Data were collected using an interviewer-administered questionnaire on Open Data Kit and analyzed using STATA release 15. Variables with P value <0.2 on bivariate analysis were entered for multivariable regression analysis. Odds ratio with 95%CI and P value below 0.05 were used to present the significance of study findings. RESULTS: The prevalence of induced second-trimester abortion among safe abortion clients was 64%. Women who had no emotional factors, who had no interpersonal problems, who were married, and who had middle or high incomes were less likely to make a late request for safe abortion care (aOR 0.31, 95% CI 0.15-0.67; aOR 0.55, 95% CI 0.32-0.97; aOR 0.37, 95% CI 0.17-0.77; and aOR 0.51, 95% CI 0.27-0.96, respectively). CONCLUSION: Sixty-four percent of safe abortion-care clients made a late request (second trimester presentation) for safe abortion care. Women who had no emotional factors had a low risk of making such a late request. Likewise, married women who had no interpersonal factors and had middle or high income were at low risk of seeking safe abortion care in the second trimester.

Exposure of infants to organochlorine pesticides from breast milk consumption in southwestern Ethiopia.

Breast milk is often used as an environmental bioindicator since it serves as an important medium to accumulate organochlorine pesticides. The main aim of this study is to determine the level of organochlorine pesticides in human breast milk collected from three districts of southwestern Ethiopia (Asendabo, Deneba, and Serbo) at three times points baselines (1st month), midline ( six months), and end line (12 months) and risk of infants' exposure. A longitudinal study was conducted to assess pesticide residues in human breast milk samples and evaluate the risk-exposure of infants to these pesticides from consumption of mother's milk in Ethiopia. Breast milk samples were collected from 168 mothers at three time points and pesticides were extracted using the quick, easy, cheap, effective, rugged, and safe (QuEChERS) method. The level of pesticide residues in human milk samples and exposure of infants to the pesticides was evaluated by calculating the estimated daily intake and compared with the provisional tolerable daily intake of the pesticides under study. The results indicated that, from the eight organochlorine pesticides analyzed in 447 breast milk samples at three sampling times, DDT and its metabolites were detected. p,p'-DDE and p,p'-DDT were detected in all (100%) of the breast milk samples while, p,p-DDD, and o,p-DDT were detected in 53.9%, and 42.7%, respectively. The mean concentration of total DDT at three time points(baseline, midline and endline) were 2.25, 1.68 and 1.32 µg/g milk fat, respectively. The mean concentration of total DDT from the three districts was 1.85 µg/g milk fat which is above the maximum residue limit (MRL = 0.02 µg/g milk fat set by FAO/WHO). The mean ratio of DDT/DDE for the three areas was calculated less than five (< 5) indicates historical DDT use in the study area. The estimated daily intake of infants at the first month of breastfeeding was 11.24 µg/kg-BW/day, above the provisional tolerable daily intake (PTDI) for total DDT set by FAO/WHO, which is 10 µg/kg body weight. An intake of OCPs is a big concern for infants' health in Ethiopia and countries with a similar condition, particularly at the first month of lactation. Strict regulations of the health-threatening pesticide by the regulatory body (Environment, Forest and Climate Change Commission) at the country and regional levels is advocated.

Comparison of surgical versus medical termination of pregnancy between 13-20 weeks of gestation in Ethiopia: A quasi-experimental study.

BACKGROUND: Dilation and evacuation is a method of second trimester pregnancy termination introduced recently in Ethiopia. However, little is known about the safety and effectiveness of this method in an Ethiopian setting. Therefore, the study is intended to determine the safety and effectiveness of dilation and evacuation for surgical abortion as compared to medical abortion between 13-20 weeks' gestational age. METHODS: This is a quasi-experimental study of women receiving second trimester termination of pregnancy between 13-20 weeks. Patients were allocated to either medical or surgical abortion based on their preference. A structured questionnaire was used to collect demographic information and clinical data upon admission. Procedure related information was collected after the procedure was completed and before the patient was discharged. Additionally, women were contacted 2 weeks after the procedure to evaluate for post-procedural complications. The primary outcome of the study was a composite complication rate. Data were collected using Open Data Kit and then analyzed using Stata version 14.2. Univariate analyses were performed using means (standard deviation), or medians (interquartile range) when the distribution was not normal. Multiple logistic regression was also performed to control for confounders. RESULTS: Two hundred nineteen women chose medical abortion and 60 chose surgical abortion. The composite complication rate is not significantly different among medical and surgical abortion patients (15% versus 10%; p = 0.52). Nine patients (4.1%) in the medical arm required additional intervention to complete the abortion, while none of the surgical abortion patients required additional intervention. Median (IQR) hospital stay was significantly longer in the medical group at 24 (12-24) hours versus 6(4-6) hours in the surgical group p<0.001. CONCLUSION: From the current study findings, we concluded that there is no difference in safety between surgical and medical methods of abortion. This study demonstrates that surgical abortion can be used as a safe and effective alternative to medical abortion and should be offered equivalently with medical abortion, per the patient's preference.

Post-abortion contraceptive adoption in Ethiopia.

OBJECTIVE: To assess the effect of couple counseling on modern contraception adoption among women receiving abortions. METHODS: A cross-sectional study was conducted between October 2019 and May 2020 at the abortion clinic of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Women receiving abortion care were interviewed using Open Data Kit. Logistic regression was used to assess predictors of modern contraception adoption. RESULTS: During the study period, a total of 326 women receiving abortion care were interviewed and 112 (34.4%) received couple counseling. Of the 112, 89 (79.5%) adopted modern contraception. The odds of using a modern contraceptive method were 2.34 times higher among women whose partner approved (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.05-5.22) compared with those without partner approval. The odds of using a modern contraceptive method was 1.78 times higher among women who believed they had partner support (aOR 1.78; 95% CI 1.03-3.10) compared with women without support. CONCLUSION: Few women received couple counseling for contraception. Partner approval and a woman's belief that her partner supports her contraception decision were associated with contraception adoption.

Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: a randomized controlled trial in rural Ethiopia.

BACKGROUND: For infants and young children in low-income settings, human milk (HM) is the main source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). However, the n-3 LCPs concentrations of HM show wide variability, largely depending on the maternal intake of marine foods. This may put children living far from coastal areas at risk of inadequate intake. We evaluated the efficacy of fish-oil (FO) supplementation of lactating mothers on HM n-3 LCPs concentrations in a rural setting from Ethiopia. METHODS: Mothers (n = 360) with children 6-12 months old were randomized to receive either intervention FO capsules (215 mg DHA + 285 mg EPA) or control corn-oil capsules (without n-3 LCPs). In a random subsample of 154 participants, we analyzed LCPs in HM and child capillary blood using gas chromatography. RESULTS: Compared to the control, FO supplementation increased HM concentrations of DHA by 39.0% (95% CI: 20.6, 57.5%; P < 0.001) and EPA by 36.2% (95% CI: 16.0, 56.4%; P < 0.001), whereas the arachidonic acid (AA)/(DHA + EPA) ratio decreased by 53.5% (95% CI: -70.2, -36.7%; P < 0.001). We also found statistically significant association between the changes in (DHA + EPA)/AA ratio in HM and child capillary blood (P < 0.001). However, HM DHA concentrations remained lower than international norms after FO supplementation. CONCLUSIONS: FO supplementation improves n-3 LCPs content of HM. Future studies should evaluate different doses of n-3 LCPs and consider potential effect modifiers such as genetic polymorphism and diet. This trial was registered at clinicaltrials.gov as NCT01817634.

Analysis of cesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: Cesarean section (CS) is an important indicator of access to, and quality of maternal health services. The World Health Organization recommends the Robson ten group classification system as a global standard for assessing, monitoring and comparing CS rates at all levels. This study aimed to assess the rate of CS and perform an analysis based on Robson classification system. METHODS: A facility-based cross-sectional study was conducted at a tertiary hospital in Addis Ababa, Ethiopia. Data were collected from medical charts of all women who delivered from January-June 2018. The overall CS rate was calculated then women were categorized into one of the ten Robson groups. Relative size of each group, contribution of each group to the overall CS rate, and CS rate within each group were calculated. RESULTS: A total of 4,200 deliveries were analyzed. Of these 1,459 (34.7%) were CS. The largest contributors to the overall CS rate were Group 10 (19.1%), Group 2 (18.3%), Group 5 (17.1%), and Group 4 (15.8%). There was also a high rate of pre-labor CS in Group 2, Group 4, and Group 10. CONCLUSION: Through implementation of the Robson ten group classification system, we identified the contribution of each group to the overall CS rate as well as the CS rate within each group. Group 10 was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low-risk groups. These target groups require more in-depth analysis to identify possible modifiable factors and to apply specific interventions to reduce the CS rate. Evaluation of existing management protocols and further studies into indications of CS and outcomes are needed to design tailored strategies and improve outcomes.

Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial.

BACKGROUND: The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM. METHOD: Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital. The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations. RESULTS: The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes. CONCLUSION: Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available. TRIAL REGISTRATION: The trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) # NCT03036176 .

Neither n-3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia.

BACKGROUND: The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. OBJECTIVE: We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. METHODS: We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). RESULTS: The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (ß: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). CONCLUSIONS: n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.

Effects of n-3 long-chain PUFA supplementation to lactating mothers and their breastfed children on child growth and morbidity: a 2 × 2 factorial randomized controlled trial in rural Ethiopia.

Background: Recurrent infections and inflammation contribute to growth faltering in low-income countries. n-3 (ω-3) Long-chain polyunsaturated fatty-acids (LC-PUFAs) may improve immune maturation, resistance to infections, and growth in young children who are at risk. Objective: We evaluated the independent and combined effects of fish oil (500 mg n-3 LC-PUFAs/d) supplementation to lactating mothers and their breastfed children, aged 6-24 mo, on child morbidity, systemic inflammation, and growth in southwest Ethiopia. Design: A 4-arm double-blind randomized controlled trial was conducted by enrolling 360 mother-infant pairs with infants 6-12 mo old. Study arms were both the lactating mother and child receiving fish oil intervention (MCI), only the lactating mother receiving fish oil intervention and child receiving placebo control (MI), only the child receiving intervention and mother receiving placebo control (CI), and both mother and child receiving a placebo supplement or control (C). The primary study outcome was linear growth using monthly changes in length-for-age z score. Anthropometric measurements were taken monthly, and hemoglobin, C-reactive protein, and blood LC-PUFAs were measured at baseline and after 6 and 12 mo of follow-up. Weekly morbidity surveillance was conducted throughout the study. Results: Fish-oil supplementation significantly increased blood n-3 LC-PUFA concentration (P < 0.01) and decreased the arachidonic acid:(docosahexaenoic acid + eicosapentaenoic acid) ratio (P < 0.001) in all intervention arms. No significant intervention effect was found on linear growth, morbidity, or systemic inflammation. Compared to the control group, a small positive effect on monthly changes in weight-for-length z scores was found in the CI arm (effect size: 0.022/mo; 95% CI: 0.005, 0.039/mo; P = 0.012) and the MCI arm (effect size: 0.018/mo; 95% CI: 0.001, 0.034/mo; P = 0.041). Conclusions: n-3 LC-PUFA supplementation of lactating mothers and children did not affect child linear growth and morbidity in a low-income setting. n-3 LC-PUFA supplementation given directly to children modestly increased relative weight gain. This trial was registered at clinicaltrials.gov as NCT01817634.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

BACKGROUND: Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. METHODS: A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. RESULTS: Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. CONCLUSION: Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty: a randomized single-blind controlled trial.

BACKGROUND: Children living with foster families in a resource-limited setting such as Ethiopia are at risk of developmental problems. It is not yet clear whether intensive home-based developmental stimulation assisted by play can reduce these problems. The main objective of this study was to examine the effects of play-assisted intervention integrated into basic services on the developmental performance of children living with foster families in extreme poverty. METHODS: A randomized single-blind (investigator) controlled trial design was used. The study was conducted in Jimma, South West Ethiopia. Using computer-generated codes, eligible children of 3-59 months in age were randomly allocated to intervention (n = 39) and control (n = 39) groups at a 1:1 ratio. Children in the intervention group received home-based play-assisted stimulation in addition to the basic services provided to children in both groups. The intervention consisted of an hour of play stimulation conducted during a weekly home visit over the course of six months. Personal-social, language, fine and gross motor outcomes were assessed using Denver II-Jimma, and social-emotional outcome was obtained using an adapted Ages and Stages Questionnaire: Social-Emotional (ASQ: SE). Information about sociodemographic characteristics was collected using a structured questionnaire. Anthropometric methods were used to determine nutritional status. The effects of the intervention on the abovementioned outcomes over the study period and group differences in change over time were examined using Generalized Estimating Equations (GEE). RESULTS: Statistically significant intervention effects were found for language (P = 0.0014), personal-social (P = 0.0087) and social-emotional (P <  0.0001) performances. At the midline of the study, language (effect size = 0.34) and social-emotional (effect size = - 0.603) benefits from the play-assisted stimulation had already been observed for the children in the intervention group. For language, the intervention effect depended on the child's sex (P = 0.0100) and for personal-social performance, on family income (P = 0.0300). CONCLUSIONS: Intensive home-based play-assisted stimulation reduced the developmental problems of children in foster families in the context of extreme poverty. Longer follow-up may reveal further improvements in the developmental performance of the children. TRIAL REGISTRATION: The study was retrospectively registered on ClinicalTrials.gov on 17 November 2016, Study Identifier: NCT02988180 .

Factors associated with birth preparedness and complication readiness in Southern Ethiopia: a community based cross-sectional study.

BACKGROUND: Birth preparedness and complication readiness (BP/CR) is a strategy to promote use of skilled maternal and neonatal care so that they can get timely skilled care, particularly during child birth. There is minimal evidence on the factors associated with BP/CR among pregnant women in Ethiopia. Hence, this study aimed to assess the factors influencing BP/CR among pregnant women in Southern Ethiopia for the purpose of improving utilization of skilled attendant at birth. METHODS: A community based cross-sectional study was conducted among 707 pregnant women in Southern Ethiopia in March 2015. Both quantitative and qualitative methods of data collection were used. For the quantitative study, the study subjects were included in the study by employing multi-stage sampling. Data was entered into Epidata version 3.1 and analyzed using IBM SPSS statistics 20. Level of statistical significance was declared at a p- value of <0.05. For the qualitative study, six FGDs were conducted and analyzed based on the thematic areas. RESULT: The prevalence of BP /CR in Arba Minch Zuria Woreda was found to be 30%. The odds of being prepared for birth and its complications was higher among women from high economic class (AOR = 2.29, 95% CI = 1.16, 4.54), with frequency of antenatal care(ANC) > = 4 (AOR = 4.52, 95% CI = 2.26, 9.02), who received advice on BP &CR (AOR = 1.84, 95% CI = 1.13, 3.01),and who were knowledgeable on labor and delivery(LAD) danger signs (AOR = 1.85, 95% CI = 1.01, 3.44). However, it was lower among women with parity of 2 - 4(AOR = .0.51, 95% CI = 0.31, 0.84) and >4 (AOR = 0.51, 95% CI = 0.31, 0.84) than primiparous women. It was also lower among women from food insecure households (AOR = 0.26, 95% CI = 0.16, 0.42) than their counterparts. Lack of awareness on BP/CR, privacy and respect in health institutions were mentioned by the FGD discussants as barriers to women's preparation for birth. CONCLUSIONS: The study showed that BP/CR is inadequate among pregnant women in the study area. Improving socio-economic and food security status of women, strengthening community-based education on complete attendance of ANC, and conforming to professional ethical standards were recommended.