The prevalence and associated factors of birth asphyxia among neonates delivered in Public Hospitals, Northern Ethiopia.

Introduction: A body of evidences showed that birth asphyxia is a serious public health problem in low income countries including Ethiopia. There are sparse data on the prevalence of birth asphyxia and its associated factors among neonates in low income countries like Ethiopia, as well as the research area. Objective: Therefore, this study determined the prevalence and associated factors of birth asphyxia among newborns administered in public hospitals in Northern Ethiopia, 2019. Methods and materials: A cross-sectional study of health institution was carried out in December 2019. Systematic sampling technique was used. Data was collected through interviews and chart review. Multivariate logistical regression analysis was done to control confounders and identify significantly associated variable. AOR with 95% confidence intervals were computed to identify the factors independently assoiated with birth asphyxia. Results: The finding showed that the prevalence of birth asphyxia was 20.0%. Induction of labor (AOR=3.59, 95% CI: 1.36-9.46), Prolonged labor (AOR=3.59, 95% CI: 1.36-9.46), meconium-stained amniotic fluid (AOR=3.49), referred mothers (AOR=3.68, 95 % CI: 1.46-9.28), instrumental delivery (AOR=2.87, 95% CI: 1.09-7.55)and primiparous mothers (AOR=2.048 95% CI: 1.10-3.80). were significantly associated with birth asphyxia. Conclusion: The Prevalence of birth asphyxia notable high. Therefore; intra-partum care services should be strengthened to prevent birth asphyxia.

Determinants of intrauterine contraceptive device utilization at primary health care facilities in Mekelle City, northern Ethiopia.

BACKGROUND: Each year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, approximately 222 million of them have an unmet need for modern contraception. In spite of several advantages and potential effectiveness of Intra Uterine Contraceptive Device, its utilization still too low in Sub Saharan African countries including Ethiopia. OBJECTIVES: To identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city. METHOD: Facility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by structured questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20.0 statistical software. During analysis the variables were defined, categorized and the difference in variables was determined. Odds ratio used to show degree of association between independent variables with Intra Uterine Contraceptive Device. RESULT: Marital status ([AOR (95%CI) =8.59(2.60-28.43)], number of pregnancies (AOR (95%) CI = 5.69(1.020-31.802), number of alive children [AOR (95%CI) =3.5 (1.03-11.9) are variables continued to have statistically significant association with use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about availability of health care provider able to insert Intra Uterine Contraceptive Device. CONCLUSION: This study has identified marital status, Gravidity, number of alive children and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, it is vital at addressing the aforementioned determinants will be vital to improve utilization of Intra Uterine Contraceptive Device. Among long acting reversible modern contraceptive methods, Intra Uterine Contraceptive Devices (IUCDs) are the most reliable and effective as well as with fewer side effects. Despite these advantages and cost effective potential of Intra Uterine Contraceptive Device its utilization is still too low in Sub Saharan countries like Ethiopia. Thus, this study intended to identify the factors that limit the utilization of Intra Uterine Contraceptive Device among women of Ethiopia in Mekele City. The study identify that the utilization of Intra Uterine Contraceptive Device was determined by the marital status of the women, the number of previous pregnancy and recent alive children and the level of awareness about Intra Uterine Contraceptive Device of the women. Therefore, providers training that focus on promoting Intra Uterine Contraceptive Device, centering on increasing awareness and practice about Intra Uterine Contraceptive Device is very important.

Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey.

INTRODUCTION: Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. METHODS: This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. RESULT: In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1-16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04-2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05-8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40-4.58) and rural residence (AOR = 0.56, 95%CI: 0.36-0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. CONCLUSION: Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.

Time to Relapse and Its Predictors among Children with Nephrotic Syndrome in Comprehensive Specialized Hospitals, Tigray, Ethiopia, 2019.

BACKGROUND: Relapse in children with nephrotic syndrome leads to a variety of complications due to prolonged treatment and potential dependency on steroids. However, there is no study conducted to determine the incidence and predictive factors of relapse for nephrotic syndrome in Ethiopia, especially in children. Thus, this study aimed to assess the incidence of relapse and its predictors among children with nephrotic syndrome in Ethiopia. METHODS: A retrospective study was conducted by reviewing all charts of children with an initial diagnosis of the nephrotic syndrome in tertiary hospitals from 2011 to 2018. Charts of children with a diagnosis of steroid-resistant cases were excluded. The extraction tool was used for data collection, Epi-data manager V-4.4.2 for data entry, and Stata V-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, life table, and crude hazard ratios were used to describe the data and adjusted hazard ratios with 95% CI and P value for analysis. Median relapse time, incidence rate of relapse, and cumulative relapse probabilities at a certain time interval were computed. Bivariable and multivariate analyses were performed using the Cox proportional hazard regression to identify the factors associated with relapse. Any variable at P < 0.25 in the bivariable analysis was transferred to multivariate analysis. Then, the adjusted hazard ratio with 95% CI and P ≤ 0.05 was used to report the association and to test the statistical significance, respectively. Finally, texts, tables, and graphs were used to present the results. Results and Conclusion. Majority, 64.5% (40/66), of relapses were recorded in the first 12 months of follow-up. The incidence rate of relapse was 42.6 per 1000 child-month-observations with an overall 1454 child-month-observations and the median relapse time of 16 months. Having undernutrition [AHR = 3.44; 95% CI 1.78-6.65], elevated triglyceride [AHR = 3.37; 95% CI 1.04-10.90], decreased serum albumin level [AHR = 3.51; 95% CI 1.81-6.80], and rural residence [AHR = 4.00; 95% CI 1.49-10.76] increased the hazard of relapse. Conclusion and Recommendation. Relapse was higher in the first year of the follow-up period. Undernutrition, hypoalbuminemia, hypertriglyceridemia, and being from rural areas were independent predictors of relapse. A focused evaluation of those predictors during the initial diagnosis of the disease is compulsory.

Magnitude and factors associated with upper respiratory tract infection among under-five children in public health institutions of Aksum town, Tigray, Northern Ethiopia: an institutional based cross-sectional study.

INTRODUCTION: upper respiratory tract infection is a leading cause of morbidity among under-five, particularly in the developing countries. Delays in the identification and treatment of under-fives are among the main contributors to the complication. The aim of this study was to assess the magnitude and to identify factors associated with upper respiratory tract infection among under-five children, in public health institutions of Aksum City, Tigray Region, North Ethiopia, 2016. METHODS: institutional based cross-sectional study was done. Cases were under-five children who had get service. The study participants were selected using Systematic random sampling technique. Data were entered, using Epi-info version 7 and analyzed using SPSS version 22.0. Clinical data from the chart were used to diagnose upper respiratory tract infection types. The binary logistic regression model was used to test the association between dependent and independent variables and multivariable logistic regression was used to identify the associated factors to upper respiratory tract infections. RESULTS: out of 213 study participants 52.6% identified as having at least one type of upper respiratory tract infection, i.e. sinusitis 22 (10.3%), 37 (17.4%) otitis media, 39 (18.3%) tonsillitis and common cold 83 (39.0%). Multivariable logistic regression analysis shows that rural residence 7.6 [AOR (95%CI) (2.49, 23.58)], civil servant father's children 4.49 [AOR (95%CI) (1.57, 12.83)], non-immunization 6.0 [AOR(95%CI) (1.38, 26.8)], mud house wall 4.58 [AOR (95%CI) (1.74, 12.0)], rental house 5.1 [AOC (95% CI) (1.82, 14.6] and large family size 5.3 [AOC (95%CI) (2.3, 12.1 )], were found to be statistically associated. CONCLUSION: socioeconomic, maternal and environmental factors had contributed to the upper respiratory tract infection. Strengthening of the existing disease prevention policy as well as improvement of institutional health service behavior is crucial.

Parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, Northern Ethiopia: a cross-sectional study.

INTRODUCTION: worldwide, antibiotics are the most commonly prescribed and abused drugs for upper respiratory tract infections. Acute upper respiratory infections are common in children who attend childcare and preventing transmission of disease in health setting depends on actions by parents and staff. Therefore the objective of this study is to assess the parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, northern Ethiopia, 2018. METHODS: a facility-based cross-sectional study design was adopted involving 384 parents of children visited governmental health facilities in Aksum town from February to March, 2018. Respondents were selected based on the proportion of nurses in the health facilities. SPSS version 22 was applied for data entry and analysis. RESULTS: the total number of questionnaires was 384 resulting in a 100% response rate. Almost half of the parents had poor knowledge of the use of antibiotics in children for URTIs 183(47.7%), followed by 156(40.6%) moderate knowledge and 45(11.7%) good knowledge. Practices regarding antibiotic use in children with URTI varied. Only 12.8% of the parents did not always follow the doctors´ advice regarding antibiotic use. In this study has reported many areas in which parental awareness on antibiotic use for acute URTI is considered inadequate, consequently inappropriate knowledge and practices. CONCLUSION: nearly half of the parents attending the physicians for their children with URTI expected to get antibiotics.

Assessment of knowledge and attitude towards palliative care and associated factors among nurses working in selected Tigray hospitals, northern Ethiopia: a cross-sectional study.

INTRODUCTION: Palliative care is a multidisciplinary approach which is focused on both the patient and their family. Therefore the objectives of the study is to assess the knowledge and attitude towards palliative care and its associated factors among nurses in Tigray, Northern Ethiopia, 2018. METHODS: An institutional based cross-sectional quantitative study design was carried out using 355 nurses working in selected hospitals in Tigray region from February to March, 2018. Systematic random sampling was used to select six governmental hospitals. We used triangulation in the study method, making use of both Frommelt's Attitude Toward Care of the Dying (FATCOD) scale, and Palliative Care Quiz for Nursing (PCQN) knowledge. SPSS were applied for data entry and analysis. Statistical significance was declared at P<0.05. The goodness of fit the final logistic model was tested by using the Hosmer and Lemeshow test at a value of > 0.05. RESULTS: All the participants were able to respond. Out of the total study participants, 223 (62.8%) had good knowledge and 200 (56.3%) had a favorable attitude towards Palliative care. A medical ward had (AOR = 3.413, CI = 1.388-8.392, P = 0.019), trained Nurses [AOR = 3.488; CI = 1.735-7.015; P = 0.00) significant associated with nurses knowledge towards palliative care. Nurses working in the lemlem Karl (AOR=2.541; 95% CI; 0.013(1.106-5.835), nurses who had a 20-30 years ago had unfavorable attitude (AOR = 2.660; 95% CI; 0.002(1.386-5.106) were significant. CONCLUSION: The nurses had poor knowledge. However, their attitude towards palliative care (PC) was favorable.

Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019.

BACKGROUND: Despite many efforts undertaken to control the human immunodeficiency virus epidemic, it remains to be the major global public health challenge. With expanding access to pediatric antiretroviral therapy, children are more likely to experience treatment failure. All previous studies conducted in Ethiopia estimated treatment failure using only clinical and CD4 criteria. Thus, the ART failure rate is expected to be underestimated in our country. OBJECTIVES OF THE STUDY: To assess the incidence and predictors of treatment failure among children receiving first-line ART in general hospitals of Mekelle and Southern Zones of Tigray region, Ethiopia, 2019. METHODS: Retrospective follow up study was employed. The sample size was estimated based on a Log rank test using Stata V-13 and all 404 charts were taken for review. Data were collected by extraction tool; entered using Epi-data manager; cleaned and analyzed by Stata V-14. Data were described using the Kaplan-Meier curve, Log rank test, life table, and crude hazard ratios and analyzed using adjusted hazard ratios and p-value by Cox proportional hazard regression. Any variable at P <0.05 in the bi-variable analysis was taken to multi-variate analysis and significance was declared at P≤ 0.05. Data were presented using tables, charts, and texts. RESULTS: The incidence rate of ART failure was 8.68 (95% CI 7.1 to 10.6) per 1000 person-month observations with a total of 11,061.5 person-month observations. Children who had tuberculosis at baseline [AHR=2.27; 95% CI 1.12-4.57], advanced recent WHO stage [AHR=5.21; 95% CI 2.75-9.88] and sub-optimal ART adherence [AHR=2.84, 95% CI 1.71-4.72] were at higher hazard for first-line treatment failure. Besides this having a long duration of ART follow up [AHR=0.85; 95% CI 0.82-0.87] was found to be protective against treatment failure. CONCLUSION AND RECOMMENDATION: The incidence of first-line ART failure was grown as a major public health concern. Treatment failure was predicted by the duration of follow up, advanced recent WHO stage, sub-optimal adherence, as well as the presence of tuberculosis at baseline. Hence, it is better to give priority for strengthening the focused evaluation of the WHO clinical stage and tuberculosis co-infection at baseline with continuous adherence monitoring.

Magnitude and determinants for place of postnatal care utilization among mothers who delivered at home in Ethiopia: a multinomial analysis from the 2016 Ethiopian demographic health survey.

INTRODUCTION: Above half of mothers in Ethiopia give birth at home. Home based care within the first week after birth as a complementary strategy to facility-based postnatal care service is critical to increase the survival of both mothers and newborns. However, evidence on utilization of postnatal care and location of service among mothers who delivered at home in Ethiopia is insufficiently documented. Therefore, this study assessed the magnitude and determinants for place of postnatal care service utilization among mothers who delivered at home in Ethiopia. METHODS: We used the 2016 Ethiopian Demographic and Health Survey, and extracted data from 4491 mothers who delivered at home during 5 years preceding the survey. A multinomial logistic regression model was applied to examine the determinants of both facility and home -based postnatal care service utilization. Likelihood ratio test was used to see the model fitness and p-value of < 0.05 was used to determine statistical significance at 95% confidence interval. RESULTS: From the total 4491 mothers who delivered at home, only 130(2.9%) and 236(5.3%) of them utilized postnatal service at home and at a health facility respectively. Being from an urban region (AOR = 0.378, 95%CI: 0.193-0.740), ever using the calendar method to delay pregnancy (AOR = 0.528, 95%CI: 0.337-0.826), receiving four and above antenatal care visits (AOR = 0.245, 95%CI: 0.145-0.413) and having a bank account (AOR = 0.479, 95%CI: 0.243-0.943) were the factors associated with utilizing home- based postnatal care. Similarly being a follower of the orthodox religion (AOR = 1.698, 95%CI: 1.137-2.536), being in the rich wealth index (AOR = 0.608, 95%CI: 0.424-0.873), ever using the calendar method to delay pregnancy (AOR = 0.694, 95%CI: 0.499-0.966), wantedness of the pregnancy (AOR = 0.264, 95%CI: 0.352-0.953), receiving four and above antenatal care visits (AOR = 0.264, 95%CI: 0.184-0.380) and listening to radio at least once a week (AOR = 0.652, 95%CI: 0.432-0.984) were the determinants of facility-based postnatal care utilization. CONCLUSION: The coverage of postnatal care service utilization among mothers who delivered at home was very low. Living in urban region, following the Orthodox religion, having higher wealth index, having a bank account, ever using calendar method to delay pregnancy, wantedness of the pregnancy, receiving four and above antenatal care visit and listening to radio at least weakly were associated with postnatal care service utilization. Therefore, targeted measures to improve socio-economic status, strengthen the continuum of care, and increase health literacy communication are critically important to increase postnatal care service utilization among women who deliver at home in Ethiopia.

Quality of basic emergency obstetric and newborn care (BEmONC) services from patients' perspective in Adigrat town, Eastern zone of Tigray, Ethiopia. 2017: a cross sectional study.

BACKGROUND: Most of the maternal and newborn deaths occur at birth or within 24 h of birth. Provision of quality Basic Emergency Obstetric and Neonatal Care (BEmONC) is very crucial and the current recommended intervention to prevent maternal and newborn morbidity and mortality. METHODS: An institution based cross-sectional study was conducted among mothers receiving at least one of the signal functions of BEmONC services. A total of 398 women were included in the study. The study participants were selected using a systematic random sampling method. Data was collected using structured interviewer-administered Tigrigna version questionnaire. Data were analyzed using SPSS version 20. Multi-variable logistic regression was used to control the effect of confounders. RESULTS: The perceived quality of BEmONC was 66.7%, which is poor. Clients scored lower quality rates on aspects such as the availability of necessary equipment, lack of clean and functional shower and toilet and administration of anti-pain during delivery and manual vacuum aspiration (MVA). Quality of BEmONC was lower among rural residents (AOR = 0.273, 95% CI: (0.151-0.830). Whereas, Presence of companion (AOR = 2.259; 95% CI: (3.563-13.452) were found with a higher score of quality of BEmONC compared to their counterparts. CONCLUSION: The overall perception of quality of BEmONC services received was poor. Residence, ANC follow-up, and presence of companion during labor or delivery were found to have a significant association with the perceived quality of BEmONC services.

Late antenatal care initiation: the case of public health centers in Ethiopia.

OBJECTIVE: The aim of this study was to determine the magnitude of late initiation of antenatal care visit and associated factors among antenatal care follow up women in Tselemte district health facilities. The data were obtained at health facilities level in a single survey within 1 month and there is no continuation part of this study or previously published part elsewhere. RESULTS: 60.5% of women were late to initiate the first antenatal care visit. Time constraint with household activity (24.4%), distance to health center (17.2%) and fear of long waiting time in health facility (19.5%) were among the reasons mentioned for late initiation of antenatal care visit. Monthly income ≤ $21(400 ETB) (AOR = 4.54, 95% CI 1.07, 19.33), women who accompanied by their husband during antenatal care visit (AOR = 6.99, 95% CI 2.82, 17.31), who had information access on antenatal care (AOR = 4.85, 95% CI 1.88, 12.50) and distance from home to health center (AOR = 5.44, 95% CI 1.54, 19.25) were significantly associated factors with late initiation of antenatal care visit. This study illustrated that large number of pregnant women still late for first antenatal care visit. Husband involvement and health education about the timing of antenatal care initiation should be encouraged in all aspects of maternal care.