Undernutrition and associated factors among pregnant women in Ethiopia. A systematic review and meta-analysis.

Background: Maternal undernutrition is a major public health concern due to its association with mortality and overall disease burden for mothers and their children. Maternal nutrition determines pregnancy outcomes since reduced intake of nutrients influences gestational age length, placental function, and fetal growth during pregnancy. The complexity of the intergenerational aspects of maternal nutrition may also confound the design of interventions. Therefore, this research aimed to assess the prevalence of undernutrition and associated factors among pregnant women in Ethiopia. Methods: We identified the literature from PubMed, EMBASE, Scopus, and CINAHL databases. Data were entered into Microsoft Excel and then exported to Stata version 17 statistical software for analysis. The I2 and Q-statistic values detect the level of heterogeneity, and meta regression was performed to investigate between-study heterogeneity using more than one moderator. JBI quality assessment tools were used to include relevant articles. Evidence of publication bias was indicated using the funnel plot and Egger's linear regression test. The effect size was expressed in the form of point estimates and an odds ratio of 95% CI in the fixed-effect model. Result: In total, 19 studies fulfill the inclusion criteria. The pooled prevalence of undernutrition among pregnant women was 32% (95% CI 31.3-33.2 I2 = 97.5%, P < 0.0). Illiteracy (AOR = 3.6 95% CI; 2.3-5.6), rural residence (AOR = 2.6 95% CI; 1.2-3.5), a lack of prenatal dietary advice (AOR = 2.6 95% CI; 1.8-3.7), household food insecurity (AOR = 2.5 95% CI; 1.9-3.2), and low dietary diversity score (AOR = 3.7 95% CI; 2.2-5.9) appear to be significantly associated with undernutrition among pregnant women. Conclusion: The review showed that the prevalence of undernutrition is still high among pregnant women. Illiteracy, rural residence, a lack of prenatal dietary advice, household food insecurity, and low dietary diversity score were significantly associated with undernutrition during pregnancy. Interventions should focus on educating the public and helping families access food or supplements they need through local markets, health systems, and community-based support, as undernutrition is caused by numerous interconnected causes. Systematic review registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42023417028.

Active management of the third stage of labour in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Post-partum haemorrhage occurs in over 10% of all births and is the leading cause of maternal mortality, accounting for 25% of all maternal deaths worldwide. Active management of the third stage of labor is the most important intervention for reducing maternal morbidity and mortality by preventing postpartum hemorrhage. Previously, documented primary studies had been great discrepancy, inconsistent results, and there is a lack of comprehensive study. Hence, this systematic review and meta-analysis were intended to assess the prevalence and associated factors of the practice of active management of the third stage of labour among obstetric care providers in Ethiopia. METHOD: Cross-sectional studies were systematically searched from January 01, 2010, to December 24, 2020, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of active management of the third stage of labour practice and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years and the sample sizes. RESULTS: Seven hundred fifty articles were extracted. The final ten studies were included in this systematic review, including 2438 participants. The pooled prevalence of practices of active management of the third stage of labour among obstetric care providers in Ethiopia was 39.65% (30.86, 48.45%). Educational status (OR = 6.11, 95%CI, 1.51-10.72), obstetric care training (OR = 3.56, 95% CI: 2.66, 4.45), work experience (OR = 2.17, 95%CI, 0.47, 3.87) and knowledge of active management of the third stage of labour (OR = 4.5, 95% CI: 2.71, 6.28) were significantly associated with active management of the third stage of labour practices. CONCLUSION: The practice of active management of the third stage of labour in Ethiopia was low. This study showed that educational status, taking obstetric care training, knowledge of AMTSL, and work experience of obstetric care providers were associated with of practices of active management of the third stage of labour. Therefore, obstetric care professionals should improve their academic level, knowledge, and skills in order to provide useful service to AMTSL and save mothers' lives. All obstetric care providers should get obstetric care training. Furthermore, the government should increase obstetric care professionals' educational level.

Delay in making decision to seek care on institutional delivery and associated factors among postpartum mothers in South Gondar zone hospitals, 2020: A cross-sectional study.

Background: Delay in seeking emergency obstetric care contributes to high maternal mortality and morbidity in developing countries. One of the major factors contributing to maternal death in developing countries is a delay in seeking emergency obstetric care. This study aimed to assess the proportion and associated factors of delay in deciding to seek emergency obstetric care on institutional delivery among postpartum mothers in the South Gondar zone hospitals, Ethiopia, 2020. Methods: An institution-based cross-sectional study design was conducted from September to October 2020. A total of 650 postpartum mothers were recruited using a systematic random sampling technique. We collected the data through personal interviews with pretested semi-structured questionnaires. We used a logistic regression model to identify statistically significant independent variables, and entered the independent variables into multivariable logistic regression. The Adjusted Odds Ratio was used to identify associated variables with delay in deciding to seek emergency obstetric care, with a 95% confidence interval at P-value < 0.05. Results: The proportion of delay in deciding to seek emergency obstetric care on institutional delivery was 36.3% (95% CI: 32.6-40.1). The mean age of the respondents was 27.23, with a standard deviation of 5.67. Mothers who reside in rural areas (AOR = 3.14,95%, CI:2.40-4.01), uneducated mothers (AOR = 3.62, 95%, CI:2.45-5.52), unplanned pregnancy (AOR: 2.01, 95% CI: 1.84-7.96), and no health facilities in Kebele (AOR: 1.62, 95% CI: 1.43-6.32) were significantly associated with delay in a decision to seek emergency obstetric care. Conclusion: The proportion of delay in deciding to seek emergency obstetric care was 36.3% among postpartum mothers in the South Gondar zone hospitals. One of the factors contributing to maternal death is a delay in seeking emergency obstetric care in South Gondar zone. Pregnant mothers living in the rural area, unplanned pregnancy, uneducated mothers, no health facilities in Kebele were associated factors in the study area. Therefore, stakeholders must address them to reduce the proportion of delay in deciding to receive on-time obstetric care as per the standards.