Evidence-based guideline on chronic postsurgical pain management in adult patients in resource-restricted setting, 2023: systematic review and guideline.

Background: Chronic postsurgical pain (CPSP) after tissue trauma is frequent and may have a long-lasting impact on the functioning and quality of life. The development of CPSP increases the burden on both the patient and the community. This review aims to systematically review articles and, lastly, pull an evidence-based guideline for CPSP management in adult patients in resource-limited areas. Methodology: The review was reported based on preferred reporting items for the systemic review and meta-analysis (PRISMA) protocol. A literature search was conducted from the Cochrane, PubMed/Medline, and Google Scholar databases, and other gray literature from 2010 to 2022. The conclusion was made based on the level of evidence. Results: A total of 3521 articles were identified through the database by searching strategies. Finally, by filtering duplicates unrelated to the topics, 22 articles (9 meta-analyses and systematic reviews, 12 systematic reviews, and one cohort study) were selected on the management of CPSP in adult patients. Filtering was made based on the intervention, outcome data of the population, and methodological quality. Conclusion: Given the complexity and multidimensional nature of chronic postsurgical pain, effective assessment, and management require a comprehensive, multiaxial approach. Adequate preoperative preparation and counseling, potential risk identification and optimization, and use of a multimodal approach, and noninvasive surgical techniques are crucial in reducing the development of chronic postsurgical pain.

Proportion of births protected against neonatal tetanus and its associated factors among mothers who gave birth within the past 6 months in Gozamn district, Northwest Ethiopia, 2022.

Today, neonatal tetanus accounts for a significant portion of newborn and under-5 mortality - 40% and 57%, respectively - and is the most prevalent cause of neonatal mortality and morbidity, particularly in developing nations. As a result, more study on birth protection against neonatal tetanus is required because it is such a terrible condition with such a high death rate and there is a need for more recent evidence on it. From April 1 to 30, 2022, a community-based cross-sectional survey was carried out in the Gozamn district of Northwest Ethiopia. A two-stage stratified sampling procedure was applied, with an overall sample size of 831. The data were gathered using a pre-tested, structured questionnaire. It was then checked, cleaned, and entered into Epidata software version 4.6 before being exported to Stata version 14 for analysis. The proportions of birth protected against neonatal tetanus were 58.57% (95% CI (55.15-61.89%) in the study. Mother who had radio (AOR = 3.09,95%CI: 2.09, 4.56), mother who travel less than one hour to reach nearest health facility (AOR = 1.96,95%CI: 1.23,3.10), mother who gave birth of their last child in the health institution (AOR = 4.17,95%CI:2.39,7.28), mothers who had information from health professional (AOR = 2.56,95%CI:1.56,4.19) and > 4 ANC visit (AOR = 2.57,95%CI:1.55,4.26) were positive predictors of birth protected against neonatal tetanus. Low levels of maternal protection against neonatal tetanus were seen in this study location. To enhance the percentage of births protected against neonatal tetanus, professional-based guidance regarding the TT vaccine are essential.

Incidence and predictors of women's place of delivery among pregnant women who received antenatal care in Southern Ethiopia: a prospective cohort study.

BACKGROUND: Home delivery is responsible for a high number of maternal and newborn deaths due to the occurrence of obstetric complications during labour and delivery. Little is known about the incidence and predictors of women's place of delivery after utilizing antenatal care services in Ethiopia and the study area. Therefore, the purpose of this study is to fill those gaps in the studies mentioned above by determining the incidence and predictors of women's place of delivery. METHODS: An institutional-based prospective cohort study was conducted among pregnant women in public hospitals of Gedeo zone, Southern Ethiopia between May 1 and October 30, 2021. A total of 390 pregnant women receiving antenatal care at Gedeo zone public hospitals were enrolled using a systematic random sampling technique and followed up to delivery. Data were entered into Epidata version 3.1 and exported to SPSS version 25 for analysis. For both bivariate and multivariable analyses, a poison regression model was used to identify the association between the dependent and independent variables. A statistical significance level was declared at a p-value less than 0.05. RESULTS: In this study, the overall incidence of home delivery and institutional delivery among pregnant women was 37.4% (95% CI: (32.5, 41.9)) and 62.6% (95% CI: 58.1, 67.5)) respectively. Distance from home to nearest health facility(ARR = 1.17:95%:CI (1.01,1.36), poor quality of antenatal care service(ARR = 1.40;95%:CI (1.10,1.79), no formal maternal education(ARR = 1.49;95%:CI (1.21,1.83), previous home delivery history(ARR = 1.38;95%:CI(1.22,1.56), unplanned pregnancy(ARR = 1.23;95%:CI (1.10,1.37) and history of pregnancy-related complication at health facility(ARR = 1.16;95%:CI(1.02,1.33) were predictors of home delivery. CONCLUSIONS: The study indicated a high incidence of home birth after utilizing antenatal care services. As a result, interventions targeting those identified factors during antenatal care services are critical to reducing home births.