Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia.

OBJECTIVE: This study seeks to examine the prevalence of maternal morbidities and deaths in Ayder Comprehensive Specialized Hospital from 1 July 2018 to 30 June 2019. METHODS: This was a cross-sectional study. Total purposive sampling method was employed to collect data prospectively using modified World Health Organization criteria for baseline assessment of maternal near-miss and mortality. Pregnant women or those who are within 42 days postpartum/any form of pregnancy termination that satisfy the inclusion criteria were enrolled. RESULTS: A total of 691 mothers were recorded as having severe maternal complications. Out of these, 170 women developed severe maternal outcome, ending with 146 maternal near-miss cases and 24 maternal deaths. The maternal near-miss ratio and maternal mortality ratio were 28.5 per 1000 live births and 469.1 per 100,000 live births, respectively. The overall mortality index was 14%. The top underlying causes of severe maternal complications were the infamous triads of preeclampsia (n = 303, 43.8%), obstetric hemorrhage (n = 166, 24.0%) and sepsis (n = 130, 18.8%). About 62.5% of mothers who died were not admitted to intensive care unit. CONCLUSION: This study found that the infamous triads of preeclampsia, obstetric hemorrhage and sepsis persist as the commonest causes of severe maternal complications in the study area. A significant number of women with severe maternal outcome were not admitted to intensive care unit. It also highlights that the severe maternal complications, severe maternal outcome, maternal near-miss ratio and mortality index in the study area are disproportionately higher than the global average. These staggering numbers call for a system re-thinking at multiple junctures.

Community Perception Regarding Maternity Service Provision in Public Health Institutions in 2018 and 2019: A Qualitative Study.

BACKGROUND: In the perspective of health care, community perception is defined as a combination of experiences, expectations and perceived needs. The community and client's perception of health services seem to have been largely ignored by health-care providers in developing countries. There is a knowledge gap about communities' perception and perspective of maternal health. If the community's perception is known, the quality of maternity care may be improved, maternal morbidity and mortality could be decreased, and the overall health of the mother can be improved. The aim of this study was to explore community's perception of maternity service provision in public health institutions. METHODS: A qualitative study with the underpinning philosophy of phenomenology was conducted in five subcities of Mekelle city, Ethiopia. Focus group discussions (FGDs) and in-depth interviews (IDSs) with participants who are residing in Mekelle city and who experienced maternity service as a client or as attendants were conducted to collect the necessary information. Using a semi-structured tool that has been translated into the local language, collected data were analyzed thematically using computer-assisted qualitative data analysis software ATLAS version 7. Qualitative data were transcribed through replaying the tape recorded interview from IDIs and FGDs. The text was carefully read and similar ideas were organized together. The participant's inductive meanings were extracted verbatim and described in narratives. The researcher and research assistants independently transcribed participant's comments verbatim to confirm the reliability of the findings. RESULTS: Participants reported that maternal health services in public health institutions were negative. Participants described experiencing poor staff attitude, lack of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment made them develop a negative perception towards public health institutions. Despite these complaints, participants acknowledged public health facilities for affordable, accessible, qualified personnel and usually stocked with quality medications and equipment. CONCLUSION: This study revealed that the community has a negative perception of the maternal health services in the public health institutions. The main reasons for their negative perception were poor staff attitude, unavailability of prescribed drugs in the institutional pharmacies, long waiting time, family proximity by professionals, poor attention to women during labor, lack of privacy and mistreatment.

Midwifery as a Future Career: Determinants of Motivation Among Prep Students in Harar, Eastern Ethiopia.

BACKGROUND: Midwifery is a profession that deals with care and advice during pregnancy, labor, childbirth and postpartum period including support for the newborn. Like other professions, the sustainability of midwives depends on recruiting new professionals who are inspired to train as their future career. In this regard, the inspiration of preparatory students to embracing the profession and secure the future midwife workforce is critical. In Ethiopia, there is no literature on the assessment of students' intention toward the midwifery profession. Hence, this study is crucial to fill data scarcity. OBJECTIVE: To assess the intention and related factors to choose midwifery as a future profession among preparatory students at Harar. METHODOLOGY: An institutional cross-sectional study was conducted on preparatory students from March 20 to April 12/2019. Self-administered questionnaires were randomly given to 423 students. Multivariate logistic regression analysis was done for variables with p-value <0.2 in binary logistic regression. The odds ratio was used to measure the degree of association. RESULTS: Only 18.1% intended to choose midwifery as a future profession. The odds of considering to choose midwifery is 5 times higher in those who have a health professional mother [AOR= 5.518 p-value 0.009]. Students who have good perceptions are 7 times more likely to choose the profession [AOR= 7.072 p-value 0.00]. Students who perceived low regard toward the profession [AOR= 0.231 p-value 0.001] and blood contact as a barrier to be a midwife [AOR= 0.174 p-value 0.001] are less likely to choose it. CONCLUSION: Preparatory students in Harar have minimal intention to choose midwifery. This is due to a lack of information about the profession, poor perception, low regard to the profession, and fear of blood contact. This finding contributes to the midwifery association and ministry of health to enhance positive perception toward the profession.

Pregnant women adherence level to antenatal care visit and its effect on perinatal outcome among mothers in Tigray Public Health institutions, 2017: cohort study.

OBJECTIVE: To assess pregnant women adherence level to antenatal care visit and its effect on perinatal outcome among mothers in Tigray Public Health institutions, 2017. RESULTS: The overall adherence level of the women towards to antenatal care visit was 49.9% and incidence of PPH, still birth, early neonatal death, late neonatal death and low birth weight complication was 4.3%, 2.3%, 2.7%, 1.9% and 7.5% respectively. PPH, preterm labor, early neonatal death and LBW complication was reduced by 81.2%, 52%, 61% and 46% respectively among women's with complete adherence to ANC visit.

Prevalence and factors associated with modern contraceptive discontinuation among reproductive age group women, a community based cross-sectional study in Humera town, northern Ethiopia.

BACKGROUND: Contraceptive prevalence rate (CPR) for married women aged 15-49 in Ethiopia is 36%, with 35% using modern methods and 1% using traditional methods. However, the discontinuation rate is fairly high. Women usually discontinue contraception use for fertility and method related reasons without adopting an alternate method which in turn leads to many health risks such as unwanted pregnancy, unplanned childbearing, miscarriage, abortion, leads to morbidity and mortality among mothers and newborns. The purpose of this study was to determine the prevalence of modern contraceptive discontinuation and to identify predicting factors. METHODS: A community- based cross- sectional study was conducted in Humera town among 321 married women of reproductive age (15-49 yrs.) who had a history of modern contraceptive use. Systematic sampling technique was employed to select study participants and data was collected by BSc health extension workers using interviewer -administered questionnaire. EPI-INFO (V-7) and SPSS (V-23) software were used for entry and analysis respectively. Descriptive statistics and logistic regression analysis were used to present results accordingly. P- Value < 0.05 was used as a cut point for statistical significance. RESULTS: The magnitude of modern contraceptive discontinuation was 27.1%. Number of desired children (AOR = 2.83 95% CI = 1.16, 6.89), experience of side effects (AOR = 3 95% CI = 1.2, 7.58), discussion with female friend (AOR = 3.26 95% CI = 1.27, 8.36), counseled on side effects (AOR = 6.55 95% CI = 2.21, 19.39), number of male children (AOR = 2.51 95% CI = 1.06, 5.96), absence of husband support (AOR = 12.99 95% CI = 4.59, 36.78) and presence of community prohibition (AOR = 6.88 95% CI = 3.05, 15.51) were identified as predicting factors for modern contraceptive discontinuation. CONCLUSION: Magnitude of modern contraceptive discontinuation among reproductive age group women in Humera was relatively high. Increasing community awareness, involving partners and pre dispensation counseling might help to reduce discontinuation and its consequences. Various targeted messages are also needed to dispel misconception at community level.

Health care providers' adherence to immediate postpartum care guideline and associated factors among women who gave birth in Mekele public teaching hospitals, Tigray 2018.

OBJECTIVE: To assess health care providers adherence to immediate postpartum care and associated factors among women's who gave birth in Mekele teaching public hospitals, 2018. RESULTS: The Health care providers' complete adherence to immediate postpartum care guideline was 22.8%. Health care providers who have complete adherence to prenatal care guideline were 93.3% less likely to have incomplete adherence to immediate postpartum care guideline (AOR 95% CI 0.067 (0.036-0.125)).

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.