Cervical cancer in Ethiopia: a review of the literature.

BACKGROUND: Cervical cancer is one of the most common malignancies affecting women worldwide with large geographic variations in prevalence and mortality rates. It is one of the leading causes of cancer-related deaths in Ethiopia, where vaccination and screening are less implemented. However, there is a scarcity of literature in the field. Therefore, the objective of this review was to describe current developments in cervical cancer in the Ethiopian context. The main topics presented were the burden of cervical cancer, knowledge of women about the disease, the genotype distribution of Human papillomavirus (HPV), vaccination, and screening practices in Ethiopia. METHODS: Published literature in the English language on the above topics until May 2021 were retrieved from PubMed/Medline, SCOPUS, Google Scholar, and the Google database using relevant searching terms. Combinations of the following terms were considered to retrieve literature; < Cervical cancer, uterine cervical neoplasms, papillomavirus infections, papillomavirus vaccines, knowledge about cervical cancer, genotype distribution of HPV and Ethiopia > . The main findings were described thematically. RESULTS: Cervical cancer is the second most common and the second most deadly cancer in Ethiopia, The incidence and prevalence of the disease is increasing from time to time because of the growth and aging of the population, as well as an increasing prevalence of well-established risk factors. Knowledge and awareness about cervical cancer is quite poor among Ethiopian women. According to a recent report (2021), the prevalence of previous screening practices among Ethiopian women was at 14%. Although HPV 16 is constantly reported as the common genotype identified from different grade cervical lesions in Ethiopia, studies reported different HPV genotype distributions across the country. According to a recent finding, the most common HPV types identified from cervical lesions in the country were HPV-16, HPV-52, HPV-35, HPV-18, and HPV-56. Ethiopia started vaccinating school girls using Gardasil-4™ in 2018 although the coverage is insignificant. Recently emerging reports are in favor of gender-neutral vaccination strategies with moderate coverage that was found superior and would rapidly eradicate high-risk HPVs than vaccinating only girls. CONCLUSIONS: Cervical cancer continues to be a major public health problem affecting thousands of women in Ethiopia. As the disease is purely preventable, classic cervical cancer prevention strategies that include HPV vaccination using a broad genotype coverage, screening using a high precision test, and treating cervical precancerous lesions in the earliest possible time could prevent most cervical cancer cases in Ethiopia. The provision of a focused health education supported by educational materials would increase the knowledge of women about cervical cancer in general and the uptake of cervical cancer prevention and screening services in particular.

High-level of anxiety and depressive symptoms among patients with general medical conditions and community residents: a comparative study.

BACKGROUND: The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia. METHODS: Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant. RESULTS: A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value < .0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms. CONCLUSIONS: Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center.

The effects of stillbirth and abortion on the next pregnancy: a longitudinal study.

BACKGROUND: Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The aim of the study was to assess the effect of stillbirth and abortion on the next pregnancy. METHODS: A prospective cohort study design was implemented. The study was conducted in Mecha demographic surveillance and field research center catchment areas. The data were collected from January 2015 to March 2019. Epi-info software was used to calculate the sample size. The systematic random sampling technique was used to select stillbirth and abortion women. Poison regression was used to identify the predictors of MCH service utilization; descriptive statistics were used to identify the prevalence of blood borne pathogens. The Kaplan Meier survival curve was used to estimate survival to pregnancy and pregnancy related medical disorders. RESULTS: 1091 stillbirth and 3,026 abortion women were followed. Hepatitis B was present in 6% of abortion and 3.2% of stillbirth women. Hepatitis C was diagnosed in 4.7% of abortion and 0.3% of stillbirth women. HIV was detected in 3% of abortion and 0.8% of stillbirth women. MCH service utilization was determined by knowledge of contraceptives [IRR 1.29, 95% CI 1.18-1.42], tertiary education [IRR 4.29, 95% CI 3.72-4.96], secondary education. [IRR 3.14, 95% CI 2.73-3.61], married women [IRR 2.08, 95% CI 1.84-2.34], family size [IRR 0.67, 95% CI 1.001-1.01], the median time of pregnancy after stillbirth and abortion were 12 months. Ante-partum hemorrhage was observed in 23.1% of pregnant mothers with a past history of abortion cases and post-partum hemorrhage was observed in 25.6% of pregnant mothers with a past history of abortion. PREGNANCY INDUCED DIABETES MELLITUS was observed 14.3% of pregnant mothers with a past history of stillbirth and pregnancy-induced hypertension were observed in 9.2% of mothers with a past history of stillbirth. CONCLUSION: Obstetric hemorrhage was the common complications of abortion women while Pregnancy-induced diabetic Mellitus and pregnancy-induced hypertension were the most common complications of stillbirth for the next pregnancy.

Electronic maternal and child health application usability, feasibility and acceptability among healthcare providers in Amhara region, Ethiopia.

An innovative electronic Maternal and Child Health (eMCH) application was developed to support operational and clinical decision-making in maternal and child health services. End-user-based evaluation of eHealth application is a critical step to ascertain how successfully users can learn and use it, and improve the technology. Therefore, this study aimed to evaluate the eMCH tool usability, feasibility, and acceptability among healthcare providers (HCPs) in the Amhara region, Ethiopia. A cross-sectional study was conducted among HCPs working in six public healthcare facilities. The usability evaluation was done on 24 HCPs across three professional categories using the ISO 9241-11 usability guideline. One hundred nine HCPs were participated in the feasibility and acceptability study. Data were collected using a standard usability tool, think-aloud protocol, a self-administered approach, and Open Broadcaster Software Studio version 26.1.1 video recorder. Descriptive statistics were used to describe the data. A Kruskal-Wallis test was used to measure the association between mean scores and categories of HCPs. The recorded videos were used for the log file analysis method. None of the HCP categories were able to complete all the tasks without errors. The average number of errors and restarts were 7.5 and 2.8, respectively. The average number of restarts was directly proportional to the average number of errors. The participants successfully completed more than 70% of the tasks without requiring any assistance or guidance. Forty-seven comments or errors were identified from the think-aloud analysis and 22 comments from the usability metrics analysis. Overall, statistically significant performance differences were observed among the three HCP groups across the majority of the usability evaluation metrics. Fifty-seven percent of HCPs scored higher than the mean on the feasibility study. Slightly higher than half, 56 (51.4%), of the HCPs scored higher than the mean score on the acceptability study. The usability evaluation identified vital comments and usability flaws that were essential for the eMCH tool to be upgraded. The tool was feasible and acceptable as reported by end-users. Therefore, the errors and usability flaws of the tool should be fixed before deployment to other healthcare settings.

Acceptance of human papillomavirus vaccination and parents' willingness to vaccinate their adolescents in Ethiopia: a systematic review and meta-analysis.

INTRODUCTION: Despite the global vaccination campaign to prevent HPV-related morbidity, HPV vaccination uptake remains unacceptably low in the developing world, like Ethiopia. For strong interventional measures, compiled data in the field is required which is otherwise missed in the Ethiopian context. Therefore, this systematic review aimed to provide an estimate of the HPV vaccination uptake, mothers' willingness to vaccinate their adolescent girls, and associated factors in Ethiopia. METHODS: Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the vaccination uptake and mothers' willingness toward HPV vaccination in Ethiopia. RESULTS: We included 10 articles published between 2019 and 2022 covering reports of 3,388 adolescent girls and 2,741 parents. All the included articles had good methodological quality. The pooled estimate of the proportion of good knowledge about HPV vaccination and the agreement of girls to get the vaccine was 60% (95%CI: 59-62) and 65% (95%CI: 64-67), respectively. The pooled estimate of vaccination uptake of at least one dose of HPV vaccine among girls was 55% (95%CI: 53-57). Positive attitudes to the vaccine, higher maternal education, and having knowledge about HPV and its vaccine were reported as statistically significant predictors. On the contrary, not having adequate information about the vaccine and concerns about possible side effects were reported as reasons to reject the vaccine. Likewise, the pooled estimate of mothers who were knowledgeable about HPV vaccination, who had a positive attitude, and willing to vaccinate their children were 38% (95%CI: 36-40) 58% (95%CI: 56-60), and 74% (95%CI: 72-75), respectively. CONCLUSIONS: Knowledge about the HPV vaccine among girls and their vaccination uptake is suboptimal that falls short of the 2030 WHO targets. Therefore, stakeholders need major efforts in rolling out vaccination programs and monitoring their uptake. Social mobilization towards primary prevention of HPV infection should focus on adolescents. The existing strategies need to address the predictors of uptake by educating girls and parents.

High-risk human papillomavirus genotype distribution among women with gynecology complaints in northwest Ethiopia.

BACKGROUND: Human papillomavirus (HPV) genotypes differ by geographic location. With the advent of HPV vaccination and HPV-based cervical screening tests in Ethiopia, a nationwide dataset on the genotype distribution of HPV among women has paramount importance in the fight against cervical cancer. However, there is limited data in this regard in the northwest part of the country. Therefore, this study aimed to identify the genotype distribution of high-risk HPVs among women presenting with cervical abnormalities. METHODS: A health facility-based cross-sectional study was conducted at Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Bahir Dar-Ethiopia. Women aged ≥ 30 years who visited the hospital gynecology unit from 01 March 2019 to 30 October 2021 were included. Following general and pelvic examinations, a senior gynecologist collected cervical punch biopsies for histopathological examinations and cervical swabs for HR-HPV detection using the Abbott Alinity m system (Abbott Molecular, Des Plaines, IL, USA). Extended genotyping was carried out with the INNO-LiPA HPV Genotyping Extra II assay (INNO-LiPA; Fujirebio Europe, Ghent, Belgium) as per the manufacturer protocols at the Institute of Virology, Leipzig University Hospital, Germany. RESULTS: We included 355 women with a mean age of 46.4 ± 11.4 years. The majority of the participants, 277 (79.4%) were sexually active before the age of 18 years and 180 (51.6%) had multiple sexual partners. Forty-eight (13.5%) of the participants were HIV positive. The proportion of HR-HPV was 53.0% (n = 188; 95%CI: 47.8-58.1%). From these samples, 13 different HR-HPV types with a total of 258 sequences were identified. The detection of HR-HPV increased significantly with an increase in the age of the participants. The predominant identified HR-HPV was HPV16, 50.4% followed by HPV31 (9.7%), HPV33 (8.5%), HPV39, and HPV68 each (5.8%) and HPV18 (4.7%). Of the total HR-HPV-positive women, 23.9% (45/188) were infected with multiple HR-HPV types. All HPV16, HPV18, HPV35, and HPV45 genotypes (as a single or in coinfections) were found to be associated with either high-grade lesions or cervical cancer. CONCLUSIONS: HR-HPV infection was reportedly higher among women in the present study area. Based on our findings, we strongly recommend the nonavalent HPV vaccine for immunization and any HPV-based screening method to take into consideration the predominant genotypes circulating in the country. The role of multiple HPV infections in high-grade cervical lesions entails further study in Ethiopia.

Histopathological profile of cervical punch biopsies and risk factors associated with high-grade cervical precancerous lesions and cancer in northwest Ethiopia.

INTRODUCTION: Cervical cancer is an important public health problem in Ethiopia. However, the disease is not well characterized and studied in various parts of the country. This study was designed to describe the histopathological profile of cervical biopsies and to identify risk factors associated with high-grade cervical lesions and cancer (CIN2+C). METHODS: A cross-sectional study was conducted at Felege Hiwot Compressive Specialized Hospital (FHCSH) between 1 March 2019 and 30 October 2021. A structured questionnaire was used to collect data on the participants' demographic, reproductive and gynecologic history. From women presented with different degrees of cervical lesions, a senior gynecologist collected cervical swabs using (Digene HC2 DNA collection device: Qiagen, Hilden, Germany) for detection of high-risk Human papillomaviruses (HR-HPV) and punch biopsy for histopathological examinations. HR-HPVs were detected using the Abbott Alinity m system following the manufacturer protocol at the Institute of Virology, Leipzig University Hospital, Germany. Collected data entered and analyzed using SPSS version 25. A logistic regression model was used for both bivariable & multivariable analysis in order to determine the association between independent variables and CIN2+C. Statistical significance was set at a p-value <0.05. RESULTS: In this study, 335 women were included; the mean age was at 46.5±11.4 years. Most were living in rural settings, 221(66%) and had no formal education, 259 (77.3%). More than half of the participants, 193(57.6%) were unaware of cervical cancer. The prevalence of HIV infection and previous history of cervical screening were 44(13.1%) and 93(27.8%), respectively. HR-HPVs were detected in 178(54.3%) of the participants. The majority of biopsies, 140(41.8%; 95%CI: 36.6-47.1%), were diagnosed as cervical carcinoma. Normal histology, cervicitis, cervical intraepithelial neoplasia (CIN)-1, CIN-2, and CIN-3 accounted for 74(22.1%), 30(9.0%), 40(11.9%), 12(3.6%), and 12(3.6%), respectively. High-grade lesions and cancer (CIN2+C) together accounted 164(49.0%; 95%CI: 43.6-54.2). Cervical cancer increased steadily with the age of the participants (p<0.001) in which women above the age of fifty were approximately four times more likely to develop CIN2+C than the younger ones (AOR: 3.73; 95%CI: 1.80-7.82; p<0.001). Likewise, no screening history in the last five years (AOR: 2.03; 95%CI: 1.05-3.92; p = 0.035) and being infected with HR-HPVs (AOR: 14.23; 95%CI: 7.9-25.64; p<0.001) were found significantly associated with CIN2+C. CONCLUSIONS: The findings of this study revealed that cervical cancer continues to be an important women's health challenge in northwest Ethiopia. Postmenopausal women, who had no screening history within a five-year period and those women who tested positive for HR-HPV need special attention. It is important to increase the awareness of women about cervical cancer and actions for early detection of precancerous lesions should be expanded.

Maternal and newborn effects of gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: Gestational diabetes mellitus (GDM) is a high glucose level detected during pregnancy and usually it disappears after 42 days of post partum. The aim of this research was to assess the maternal and newborn effects of GDM in resource limited settings. METHODS: A prospective cohort was implemented in the five referral hospitals of Amhara region. Data were collected using both primary data collection tool and reviewing the patients' charts. Descriptive statistics were used to describe the effects of GDM on the pregnancy outcomes, fractional regression was used to estimate the proportion of weight gain in the first 3 months, Poisson regression was used to identify the effects of GDM on the episodes of childhood infectious diseases, independent sample t-test was used to estimate the effects of GDM on the newborn serum zinc and vitamin D levels. RESULTS: A total of 3459 women were included with a response rate of 85.56%. Cesarean section rate among GDM mother was 40.3% and among GDM free mothers was 7.1%. In the first 3 months, the weight gains of infant born from GDM mothers were 53% higher than infant born from GDM free mothers. GDM increases the risk of infectious disease episodes by 4 folds. GDM decreases the neonatal serum zinc and vitamin D levels. CONCLUSION: GDM increases the maternal complications of pregnancy; GDM significantly depletes the newborn micronutrient levels and increase the episodes of infectious diseases during the infancy periods.

Prevalence and Associated Factors of Suicidal Behavior Among Patients and Residents in Northwest Ethiopia.

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p-value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5-6%). It was found to be 4.4% with 95% CI range 4-5% in residents and 7.9% with 95% CI range 6-9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries.

Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis.

INTRODUCTION: Cervical cancer is one of the leading causes of malignancies among women in Ethiopia. Knowing the disease could empower women to make an informed decision regarding participation with cervical cancer prevention strategies. There is scarcity of compiled data in the field. Therefore, this systematic review aimed to provide an overview of knowledge about cervical cancer among Ethiopian women. METHODS: We conducted a systematic review of peer-reviewed articles on the knowledge of cervical cancer. Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the overall knowledge of the women about cervical cancer. RESULTS: We included 26 articles published between 2013 and 2020 covering a total of 14,549 participants. All the included articles had good methodological quality. The proportion of participants who had heard of cervical cancer varied from 4.6 to 87.7% with the pooled estimate at 56% (95% CI: 47-66). Similarly, the proportion of participants who knew that HPV is the main cause of cervical cancer lied between 0 and 49.7% with the pooled result at 21% (95% CI: 13-30). Likewise, the pooled prevalence to identify at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was gauged at 52% (95% CI: 39-64), 43% (95% CI: 26-60), and 39% (95% CI: 24-55), respectively. The overall pooled prevalence of good knowledge about cervical cancer was at 43% (95% CI: 33-53). On top of this, the prevalence of previous screening practice among the participants was at 14% (95% CI: 9-20). CONCLUSIONS: Knowledge about cervical cancer among Ethiopian women is quite poor. Therefore, health education to provide sufficient and unbiased information about HPV and cervical cancer in general is required to the public.

Glycemic Control of Diabetes Mellitus Patients in Referral Hospitals of Amhara Region, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Glycemic control is the level of glucose in diabetes patient. Evidence regarding glycemic control is scarce in resource-limited settings, and this study was conducted to generate information regarding the prevalence and predictors of glycemic control among diabetes mellitus patients attending their care from the referral hospitals of the Amhara region, Ethiopia. METHODS: A cross-sectional study design was implemented. A simple random sampling technique was used. Data were collected from March 2018 to January 2020. The data were collected using interviews, chart review, and blood samples. Hemoglobin A1c was measured using high-performance liquid chromatography. Data were entered into Epi-info software and analyzed by SPSS software. Descriptive statistics were used to estimate the prevalence of glycemic control; linear regression was used to identify the predictors of HbA1c. RESULTS: A total of 2554 diabetes patients were included giving for the response rate of 95.83%. The mean age of the study participants was 54.08 years [SD (standard deviation) ± 8.38 years]. The mean HbA1c of the study participants was 7.31% [SD ± 0.94%]. Glycemic control was poor in 55.32% [95% CI: 53.4%-57.25%] of diabetes patients. The glycemic control of diabetes patients was determined by BMI (ß 0.1; [95% CI: 0.09-0.1]), type 2 diabetes (ß -0.14; [95% CI: -0.11-0.16]), age (ß 0.22; [95% CI: 0.02-0.024]), duration of the disease (ß 0.04; [95% CI: 0.037-0.042]), the presence of hypertension (ß 0.12; [95% CI:0.09-0.16]), regular physical exercise (ß -0.06; [95% CI: -0.03-0.09]), medication adherence (ß -0.16; [95% CI: -0.14-0.18]), and male (ß 0.34; [95% CI: 0.31-.037]). CONCLUSION: The glycemic control of diabetes patients was poor, and it needs the attention of decision-makers.

The Effect of Early Childhood Sexual Abuse on Mental Health Among Postpartum Women Visiting Public Health Facilities in Bahir Dar City, Ethiopia: Multicenter Study.

BACKGROUND: There is a scarcity of evidence regarding the effects of early childhood sexual abuse on mental health among women in Sub-Saharan Africa. The purpose of this study was to assess the proportion of postpartum depression and associated factors among postnatal women in care in public health facilities of Bahir Dar city, northwest Ethiopia. This study also aimed at evaluating the effect of early childhood sexual abuse on postpartum depression. METHODS: A multicenter cross-sectional study was conducted among 988 postpartum women in care at Bahir Dar city's public health facilities. A two-stage sampling technique and interviewer administered structured questionnaire were utilized. Edinburgh Postnatal Depression Scale (EPDS) with a cutoff point of ≥ 12 was employed to report postpartum depression. Binary logistic regression model was fitted and the level of significance was reported based on AOR with 95% CI at p-value of < 0.05. RESULTS: The prevalence of postpartum depression was 33.8% (95% CI: 31, 37) and 55.3% (95% CI: 46, 64) among all study participants and mothers having a history of childhood sexual abuse, respectively. Participants' age of < 25 years (AOR = 3.1; 95% CI: 1.9, 5.3) and 25-34 years (AOR= 2.0; 95% CI: 1.3, 3.2), family size of >5 (AOR = 2.5; 95% CI: 1.1, 5.7), alcohol use (AOR = 2.2; 95% CI: 1.6, 2.9), history of childhood sexual abuse (AOR = 2.8; 95% CI: 1.9, 4.3), joblessness (AOR = 1.4; 95% CI: 1.1, 1.9) and growing up with biological mothers (AOR = 0.5; 95% CI: 0.4, 0.8) have stastical significant association with postpartum depression as compared to the respective reference group. CONCLUSION: A significantly higher burden of postpartum depression was observed among mothers with a history of childhood sexual abuse. Thus, controlling childhood sexual abuse and other psychosocial determinants would improve maternal mental wellness.

Validation of a Vaginal Birth after Cesarean Delivery Prediction Model in Teaching Hospitals of Addis Ababa University: A Cross-Sectional Study.

BACKGROUND: External validation of a vaginal birth after cesarean delivery (VBAC) prediction model is important before implementation in other settings. The primary aim of this study is to validate the Grobman prenatal VBAC calculator in the Ethiopian setting. Secondarily, the study was aimed at developing and comparing a new VBAC model that includes both the prenatal and intrapartum variables. METHODS: A cross-sectional survey was conducted, complemented by a medical chart review of 268 women admitted at three teaching hospitals of Addis Ababa University and who underwent a trial of labor after one prior cesarean birth. Maternal age, prepregnancy BMI, prior vaginal delivery, prior VBAC, and prior cesarean delivery indication type were included in the Grobman model. Observed delivery outcomes were recorded and then compared with the outcomes predicted by the calculator. We assessed the predictive abilities of the Grobman model and the new model using a receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was conducted to identify variables associated with successful VBAC. RESULTS: Out of the 268 participants, 186 (69.4%) (95% CI 57.5-81.3) had successful VBAC. The area under the ROC curve (AUC) of the Grobman model was 0.75 (95% CI 0.69-0.81). Notably, the novel model including both the prenatal and intrapartum variables had a better predictive value than the original model, with an AUC of 0.87 (95% CI 0.81-0.93). Prior VBAC, prepregnancy BMI, fetal membrane status, and fetal station at admission were predictors of VBAC in the newly developed logistic regression model. CONCLUSIONS: The success rate of VBAC was similar to other sub-Saharan African countries. The Grobman model performed adequately in the study setting; however, the model including both the prenatal and intrapartum variables was more predictive. Thus, intrapartum predictors used in the new model should be considered during intrapartum counseling.

Determinants of Insomnia among Mothers during Postpartum Period in Northwest Ethiopia.

OBJECTIVE: Postpartum period is a state of instability that may be accompanied by mood liability, anxiety, insomnia, and neuropsychiatric disturbance in women. This neuropsychiatric disturbance has a negative influence on the child's psychological and physical development. Our aim was to see the level of sleep difficulties among postpartum mothers in three obstetric care settings in Ethiopia. METHOD: Institutional based cross-sectional study was conducted at one referral hospital and two health centers. A total of 988 postpartum mothers had been interviewed for sleep difficulties by using Athens Insomnia Scale (AIS). Adjusted Odd Ratio (AOR) and 95% Confidence Interval (CI) were used and P-value <0.05 was used for indicating significant variables. RESULT: The prevalence of sleep difficulty between four to six weeks of postpartum period was 21.8% (215/988). Marital status of divorced/widowed/separated [AOR= 2.29, 95% CI (1.40, 6.08)], no educational opportunity [AOR= 2.35, 95% CI (1.57, 3.51)], having poor social support [AOR=2.82, 95% CI (1.63, 4.88)], alcohol use [AOR=1.58, 95% CI (1.13, 2.22)], history of depression [AOR=1.93, 95% CI (1.13, 3.31)], and who has poor support from husband [AOR=1.94, 95% CI (1.18, 3.18)] had association with sleep difficulty. CONCLUSION: There is a high magnitude of sleep difficulties during four to six weeks of postpartum period in postpartum mothers and they are associated with many preventable risk factors.

Suicidal behaviour in postnatal mothers in northwestern Ethiopia: a cross-sectional study.

AIM: To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers. METHOD: An institutional cross-sectional study was employed from March to April 2017. SETTING: Two primary health centres and one referral hospital in northwestern Ethiopia. PARTICIPANTS: A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included. OUTCOME MEASURE: Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance. RESULTS: The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours. CONCLUSION: Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care.