Time to death and predictors of mortality among early neonates admitted to neonatal intensive care unit of Addis Ababa public Hospitals, Ethiopia: Institutional-based prospective cohort study.

INTRODUCTION: The largest risk of child mortality occurs within the first week after birth. Early neonatal mortality remains a global public health concern, especially in sub-Saharan African countries. More than 75% of neonatal death occurs within the first seven days of birth, but there are limited prospective follow- up studies to determine time to death, incidence and predictors of death in Ethiopia particularly in the study area. The study aimed to determine incidence and predictors of early neonatal mortality among neonates admitted to the neonatal intensive care unit of Addis Ababa public hospitals, Ethiopia 2021. METHODS: Institutional prospective cohort study was conducted in four public hospitals found in Addis Ababa City, Ethiopia from June 7th, 2021 to July 13th, 2021. All early neonates consecutively admitted to the corresponding neonatal intensive care unit of selected hospitals were included in the study and followed until 7 days-old. Data were coded, cleaned, edited, and entered into Epi data version 3.1 and then exported to STATA software version 14.0 for analysis. The Kaplan Meier survival curve with log- rank test was used to compare survival time between groups. Moreover, both bi-variable and multivariable Cox proportional hazard regression model was used to identify the predictors of early neonatal mortality. All variables having P-value ≤0.2 in the bi-variable analysis model were further fitted to the multivariable model. The assumption of the model was checked graphically and using a global test. The goodness of fit of the model was performed using the Cox-Snell residual test and it was adequate. RESULTS: A total of 391 early neonates with their mothers were involved in this study. The incidence rate among admitted early neonates was 33.25 per 1000 neonate day's observation [95% confidence interval (CI): 26.22, 42.17]. Being preterm birth [adjusted hazard ratio (AHR): 6.0 (95% CI 2.02, 17.50)], having low fifth minute Apgar score [AHR: 3.93 (95% CI; 1.5, 6.77)], low temperatures [AHR: 2.67 (95%CI; 1.41, 5.02)] and, resuscitating of early neonate [AHR: 2.80 (95% CI; 1.51,5.10)] were associated with increased hazard of early neonatal death. However, early neonatal crying at birth [AHR: 0.48 (95%CI; 0.26, 0.87)] was associated with reduced hazard of death. CONCLUSIONS: Early neonatal mortality is high in Addis Ababa public Hospitals. Preterm birth, low five-minute Apgar score, hypothermia and crying at birth were found to be independent predictors of early neonatal death. Good care and attention to neonate with low Apgar scores, premature, and hypothermic neonates.

Practice of breast self-examination and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia, 2022: a convergent mixed-methods study.

OBJECTIVE: To assess practice of breast self-examination (BSE) and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia. DESIGN: Community-based cross-sectional study with a convergent mixed-methods approach. SETTING: The study was conducted in the North Shoa Zone of Oromia, Central Ethiopia, between 1 May 2022 and 30 June 2022. PARTICIPANTS: 1076 women of reproductive age were selected using simple random sampling technique for the quantitative study. For the qualitative part, a total of 46 women were approached purposively to elicit rich ideas and insight into the issue. The quantitative data were collected using an interviewer-administered questionnaire, and focus group discussions were used for the qualitative part. Quantitative data were analysed using SPSS V.26. An adjusted OR with a 95% CI was employed. Thematic analysis approach was applied for the qualitative data analysis. OUTCOME MEASURES: Participants were interviewed to respond whether they practised BSE. RESULTS: Overall, 192 (18.2%; 15.7%-20.5%) of the participants had ever performed BSE. Having a family history of breast cancer (BC) (adjusted OR (AOR)=6.9, 95% CI 4.6 to 10.3), being knowledgeable on BSE (AOR=3, 95% CI 1.9 to 4.3), having high perceived susceptibility (AOR=1.7, 95% CI 1.2 to 2.5), having high self-efficacy (AOR=1.5, 95% CI 1.1 to 2.3) and having a high perceived benefit to BSE (AOR=1.5, 95% CI 1.1 to 2.3) were significantly associated with increased odds of BSE practice.Four main themes emerged from the qualitative analysis: BC and BSE-related knowledge, perceived benefits of treatment, barriers to BSE practice and enablers of BSE practice. CONCLUSION: The practice of BSE in this area was considerably low. The North Shoa Zonal Health Office and other stakeholders should disseminate instructional materials that cover the techniques and benefits of regularly performing BSE. Healthcare professionals should engage in the community to address the obstacles women face in practising BSE.

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model.

OBJECTIVE: To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia. DESIGN: Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey. SETTING AND PARTICIPANTS: 2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study. OUTCOME MEASURES: Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC. RESULTS: In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation. CONCLUSION: Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.

Knowledge on gestational diabetes mellitus and associated factors among pregnant women attending antenatal care clinics of North Shewa zone public hospitals, Oromia region, Central Ethiopia: a cross-sectional study.

BACKGROUND: Globally, the prevalence of gestational diabetes mellitus (GDM) is currently rising. Assessing GDM knowledge and taking various public health actions will help pregnant women know more about the condition, resulting in its prevention. OBJECTIVE: To assess pregnant women's knowledge of GDM and associated factors at antenatal care clinics of public hospitals in the North Shewa zone, Oromia region, Central Ethiopia. DESIGN: Cross-sectional study. SETTING: Five public hospitals of North Shewa zone, Oromia regional state, Central Ethiopia. PARTICIPANTS: A total of 417 pregnant women. METHODS: A face-to-face interview was conducted. A 13-items tool was used to measure GDM knowledge. Multivariable binary logistic regression was fitted to identify factors associated with the knowledge of GDM. The adjusted OR (AOR) with 95% CI and a p<0.05 was used to determine statistical significance. RESULTS: Overall, 48% (95% CI 43.4% to 52.8%) of pregnant women had sufficient knowledge about GDM. The level of sufficient knowledge for GDM risk factors, screening/treatment and its consequences were 48%, 54.4% and 99%, respectively. Age group 15-24 years (AOR 3.49, 95% CI 1.05 to 11.59), attending secondary and above education (AOR 4.27, 95% CI 1.29 to 14.070, women whose partners attended primary school (AOR 3.83, 95% CI 1.36 to 10.78), history of GDM (AOR 3.36, 95% CI 1.68 to 6.71), history of hypertension (AOR 2.42, 95% CI 1.21 to 4.84), receiving preconception care (AOR 3.02, 95% CI 1.74 to 5.22) and being multigravida (AOR 3.19, 95% CI 1.52 to 6.67) were factors significantly associated with sufficient knowledge about GDM. CONCLUSION: Overall, more than half of pregnant women have insufficient knowledge about GDM. Significant association between GDM knowledge and women's age, women's and partners' educational status, preconception care, history of GDM and hypertension, and the number of pregnancies were detected. Therefore, to increase pregnant women's GDM knowledge, health education programmes in the community and healthcare facilities should target the identified factors.