Prevalence and determinants of post--abortion family planning utilization in a tertiary Hospital of Northwest Ethiopia: a cross sectional study.

BACKGROUND: Provision of post abortion contraception following an abortion is an excellent opportunity to address unmet family planning needs of women. In Ethiopia, post abortion family planning is minimal and underutilized. The objective of this study is to assess determinant factors for utilization of contraception following any abortion process (induced and/or spontaneous) among reproductive age women (15-49 years) in a tertiary hospital of North West Ethiopia. METHODS: A cross-sectional study was conducted on 423 clients who presented for either spontaneous or induced abortion care from September 2016 to August 2017 in Felege Hiwot referral hospital, North West Ethiopia. Respondents were identified using a consecutive sampling method. Data was collected in clinic using an interviewer administered pre-tested questionnaire administered after services were completed. Factors associated with use of post-abortion family planning were explored using multivariable logistic regression analysis. RESULTS: 64.8% of clients who presented for abortion care received family planning services before discharge from the hospital. Family planning counseling during service provision [AOR: 25.47, 95% CI: (9.11, 71.58)], having previous information about family planning [AOR: 2.16, 95% CI: (1.09, 4.23)], gestational age of index pregnancy less than 3 months [AOR: 1.78, 95% CI:(1.13, 3.05)], being a housewife [AOR: 0.32, 95% CI: (0.16, 0.65)] and monthly income > 5000 ETB [AOR: 0.38, 95% CI:(0.16,0.98)] are significantly associated with post abortion family planning utilization. CONCLUSIONS: The proportion of post abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion services strongly influenced the usage of family planning services. The government and regional health bureau at large as well as health care providers at each health system level have an opportunity to provide information and counsel women on family planning methods to increase utilization of post abortion contraception.

Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study.

Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.

Craniopagus parasiticus - a parasitic head protruding from temporal area of cranium: a case report.

BACKGROUND: Craniopagus parasiticus is rare with an incidence of approximately four to six cases in 10,000,000 births. In our case, the head of the parasitic twin protruded from the temporal area of the normal twin's cranium. The parasitic twin had two deformed lower limbs, of which one was rudimentary, and long bones of the bilateral lower limbs and some pelvic bone. Dissection of the mass of the parasitic twin's body revealed the intestine but no chest organs or abdominal organs. There was a rudimentary labium but no vaginal opening. In resource-limited countries, maternal age or nutritional factors may play a role in craniopagus parasiticus. CASE PRESENTATION: A 38-year-old multigravida (gravida V para IV) woman of Amhara ethnicity was referred from a rural health center to our hospital due to prolonged second stage of labor at 42+1 weeks. On her arrival at our hospital, an obstetrician decided to do a caesarean section because she was unable to deliver vaginally. A live baby girl weighing 4200 g was delivered. The placenta was single and normal. Her Appearance, Pulse, Grimace, Activity, and Respiration scores were 7 and 9 at 1 and 5 minutes, respectively. She appeared to be grossly normal except for the parasitic co-twin attached to her cranium. After a week of extensive counselling and investigation, a successful separation operation was done. Postoperation, she comfortably suckled on the breast and had no neurological deficit. Two weeks after separation she was discharged in a good healthy condition with an arrangement for postnatal follow up. CONCLUSIONS: The causes of craniopagus parasiticus are still unknown due to a rarity of cases and a limited number of studies on it. There have been only nine to ten cases of craniopagus parasiticus, of which only three survived past birth and were documented in the literature. Genetic scientists and researchers continue to investigate this case because they might find explanations for the birth defect, and provide answers to improve the prognosis and the life chances of twins with craniopagus parasiticus.

Prevalence and associated factors of clinical manifestations of vitamin a deficiency among preschool children in asgede-tsimbla rural district, north Ethiopia, a community based cross sectional study.

BACKGROUND: Vitamin A Deficiency is a common form of micronutrient deficiency, globally affecting 33.3 % of preschool-age children. An estimated of 44.4 % of preschool children in Africa were at risk for vitamin A deficiency. In Ethiopia, vitamin A deficiency leads to 80,000 deaths a year and affects 61 % of preschool children. The aim of this study was to investigate the prevalence and associated factors with the night blindness, Bitot's spot and vitamin A intake among preschool children in rural area, Asgede-Tsimbla district, North Ethiopia. METHODS: Community based cross sectional study was conducted from January 27 to March 7, 2014. A total 1230 preschool children were selected by systematic random sampling from 8 randomly selected kebelles (smallest administrative unit). Structured and pretested questionnaires adapted from relevant studies and WHO/FAO was for data collection. In addition, sex, age, and height were taken and filled to Emergency Nutrition Assessment (ENA) for Standardized Monitoring and Assessment of Relief and Transition (SMART) 2007 software to convert the nutritional data into Z-scores of the indices. The data was then transported to SPSS version 20. Bivariate and Multivariable binary logistic regressions were carried out to investigate the effect of each independent variable on the dependent variable. Statistical significance was set at p-value < 0.05. RESULT: The odds of Bitot's spots (1.46 %) and night blindness (1.22 %) were higher than the WHO Cut-off levels used to define a public health problem. The odds of night blindness was 4 times higher among children belonging to family size greater or equal to four [Adjusted Odds Ratio (AOR) = 4.18, 95 % CI = 1.15,15.3] and 6 times higher among children of illiterate mothers [AOR = 5.96 , 95 % CI = 1.33,26.69]. The odds of Bitot's spots was 5.35 times higher among children belonging to family size greater or more four [AOR =5.35; 95 % CI = 1.49, 19.2], 4.75 times higher among children of illiterate mothers [AOR = 4.75, 95 % CI =1.32, 17.18] and 6 times higher in males than females [AOR = 5.8, 95 % CI = 1.65, 20.46]. CONCLUSIONS: The study revealed that night blindness and Bitot's spots are major nutritional problems in the study area. The independent predictors of night blindness were mother illiteracy status and large family size and also for Bitot's spots were mother illiteracy status, male sex of child and large family size. Therefore, the need to increase educational level of mother, use of family planning of women and emphasis on male children and children from large family size by involving the Education sector, Health sector, (Federal Ministry of Health) FMOH and (Tigray Regional Health Bureau) TRHB is crucial.

Desire for birth spacing or limiting and non-use of long acting and permanent contraceptive methods among married women of reproductive age in Aksum Town, North Ethiopia.

BACKGROUND: Long acting and permanent contraceptive methods are the most effective family planning (FP) methods to prevent pregnancy and thereby averting adverse consequences of too many and ill-timed pregnancies. However, long acting and permanent contraceptive methods (LAPMs) are underutilized in Ethiopia for little documented reasons. Therefore, this study is aimed to assess magnitude and factors associated with desire for birth spacing for at least 2 years or limiting child bearing and non-use of LAPMs among married women of reproductive age in Aksum town, Northern Ethiopia. METHODS: A community-based cross-sectional study was conducted in Aksum town, North Ethiopia from May to June, 2015 among 779 randomly selected married women of reproductive age. Data were collected using interviewer administered pre-tested questionnaire. Data were entered using Epi-Info version 6.04 and exported to SPSS version 16 for analysis. Multivariate logistic regression models were fitted to identify factors associated with desire for birth spacing or limiting and not using LAPMs. RESULTS: The total desire for birth spacing or limiting was 69 % and amongst those women 85.2 % were not using LAPM. Education, occupation, husband's attitude towards LAPMs, age, number of pregnancy, regular media exposure and decider on the number of children to bear were significantly associated with desire for birth spacing or limiting. Moreover; education, occupation, husband's attitude towards LAPMs, discussion on family planning with husband, knowledge, attitude and intention to use LAPMs were significantly associated with not using LAPMs. CONCLUSION: Desire for birth spacing or limiting and not using LAPMs is very high in the study area. Therefore, increasing access to family planning information and services with special emphasis on LAPMs and male involvement in the program are very important.