Perceived stress and its associated factors among people living in post-war Districts of Northern Ethiopia: A cross-sectional study.

BACKGROUND: War and conflict environments result in long-term physical and psychological consequences. Sexual violence, displacement, malnutrition, death, illness, injury, torture, and disability are some of the physical effects, whereas stress, depression, aggressive behaviors, and anxiety are some of the emotional complications of war. Hence, evidence-based interventions are required particularly to monitor mental health disorders. Thus, we aimed to investigate the prevalence of perceived stress and its associated factors among people living in post-war situations, Northern Ethiopia. METHOD: A community-based cross-sectional study design was employed among 812 samples from April 1 to May 15, 2022. The study participants were selected using a multistage sampling technique. The data was collected through face-to-face interviews using a structured and pre-tested tool. Data were cleaned and entered into Epi-Data version 4.6 and transferred to SPSS version 25 for analysis. Binary logistic regression analysis was performed to identify determinants of perceived stress. The Hosmer-Lemeshow goodness-of-fit was applied to test for model fitness and a p-value of <0.05 was considered statistically significant. RESULT: The prevalence of perceived stress was 76.1%, 95% CI (72.9-78.8). Age above 45 years (AOR (CI) = 2.45 (1.07-5.62), poor educational level (AOR (CI) = 5.92 (2.36-14.8), large family size (AOR (CI) = 0.48 (0.31-0.74), alcohol consumption (AOR (CI) = 0.63 (0.42-0.94), smoking (AOR (CI) = 0.17 (0.06-0.56), and exposure to multiple traumatic events (AOR (CI) = 2.38 (1.23-4.62) have shown a statistically significant association with perceived stress. CONCLUSION: This study revealed that more than three-fourths of participants living in post-war settings were found to have perceived stress. Older age, poor level of education, large family size, alcohol consumption, smoking, and the number of traumatic events were significant associates of perceived stress. Psychotherapy that can effectively address the medical, social, and psychological well-being of the community is important to reduce the burden of perceived stress.

Determinants of neonatal mortality among neonates admitted to neonatal intensive care unit of Dessie comprehensive and specialized hospital, Northeast Ethiopia; An unmatched case-control study.

Background: According to the World health organization, neonatal mortality is defined as the death of babies within the first 28 days of their lives. The newborn period is the most vulnerable period for a child's survival, with the bulk of neonatal deaths occurring on the first day and week. According to a recent study, about a third of all newborn deaths occur within the first day of life, and nearly three-quarters occur within the first week. This study aimed to assess the determinants of neonatal mortality among neonates admitted to the neonatal intensive care unit in Dessie comprehensive and specialized hospital, northeast Ethiopia. Methodology: Health institution-based unmatched case-control study was conducted among neonates admitted to Dessie comprehensive and specialized hospital, Ethiopia from February 01 up to March 30, 2020. After keeping cases and controls in separate frames, study participants were chosen using a simple random sampling procedure until the sample size was met. Epi data version 7.0 and SPSS version 25 were used for data entry and analysis respectively. P ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression. Results: A total of 698 (233 cases and 465 controls) participated in the study. Pregnancy induced hypertension (AOR = 3.02; 95% CI; 1.47-6.17), public hospital delivery (AOR = 3.44; 95% CI; 1.84-6.42), prematurity (AOR = 2.06; 95% CI; 1.43-2.96), being referred (AOR = 4.71; 95% CI; 3.01-7.39), and hypothermia (AOR = 2.44; 95% CI; 1.56-3.82) were determinant factors of neonatal mortality. Conclusion: Pregnancy-induced hypertension, public hospital delivery, prematurity, referral, and hypothermia were found to be the determinant factors of neonatal mortality. It would be important to give due attention to neonates delivered from mothers with a history of hypertensive disorder. Besides better to give due attention to neonates delivered in public health institutions, prematurely delivered, referred, and hypothermic neonates. Lastly, further research should be conducted to investigate the additional determinants of neonatal mortality.

Dropout from a maternal and newborn continuum of care after antenatal care booking and its associated factors in Debre Berhan town, northeast Ethiopia.

Background: Continuum of care (CoC) is the continuity of care from the beginning of pregnancy to the postnatal period to improve maternal, neonatal, and child health. Dropout from the maternal CoC remains a public health challenge in Ethiopia. There are limited studies on women who dropped out of the CoC. The available studies have focused on the time dimension of the CoC, and there is a paucity of data on the place dimension of the CoC. Thus, this study aimed to determine the prevalence of dropout from the maternal CoC and its associated factors in Debre Berhan town, northeast Ethiopia. Methods: A community-based cross-sectional study design was conducted among 842 mothers from September to October 2020. A cluster sampling technique was applied, and data were collected through face-to-face interviews using a structured and pre-tested questionnaire. Data were cleaned and entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics, and bivariable and multivariable logistic regression analyses were performed to summarize the findings, and a p-value of <0.05 was considered statistically significant. Result: The overall prevalence of dropout from the maternity continuum of care was 69.1% [95% CI (66.0-72.3)]. The prevalence of dropout from ANC, skilled birth attendant, and PNC visits was 45.4, 0.5, and 48.7%, respectively. Rural residents, partners' level of education, monthly income, the timing of the first ANC visit, antenatal counseling about a continuum of care, and the level of satisfaction with the service delivery were significantly associated with ANC dropout. Maternal age and occupation, partners' age, media exposure, parity, the timing of the first ANC visit, the place of ANC visit, and the time spent for an ANC visit were significantly associated with dropout from PNC visits. Husbands' occupation, monthly income, number of alive children, the timing of the first ANC visit, and the time spent for an ANC visit had a statistically significant association with dropout from the maternity CoC. Conclusion: Dropout from the CoC in the study area was high. Socioeconomic development, partner involvement, antenatal counseling, efficient service delivery, and media exposure are vital to improving the high dropout rate from the maternal continuum of care.

Menstrual irregularity and its associated factors among college students in Ethiopia, 2021.

Background: Menstrual irregularity can occur at any age, but it is most common among women under the age of 23 years. Menstrual irregularity is a foremost gynecological problem and a cause of anxiety to students and those close to them. These students experience monthly absenteeism, premenstrual symptoms, and a lack of concentration due to menstrual problems, all of which interfere with their education. Therefore, this study aimed to assess the magnitude of menstrual irregularity and associated factors among college students in Debre Berhan Town, North Shewa, Amhara Regional State, Ethiopia, in 2021. Methods: An institution-based cross-sectional study was conducted from June to July 2021 in Debre Berhan town. Data was collected using self-administered questionnaires in 420 eligible female college students by systematic random sampling technique. Weight and height were measured and Body Mass Index (BMI) was calculated after data collection. Each questionnaire was checked for completeness, cleaned, coded, entered into EPI-DATA, and then transported to SPSS software. Bi-variable and multivariable logistic regression analyses were employed to determine the association of each independent variable with the dependent variable. P ≤ 0.05 were used to declare association and select predictors. Results: In the current study, 395 students participated with a response rate of 93.6%. Of all the total respondents, the magnitude of menstrual cycle irregularity was 33.4% (95% CI 28.6-38.2). Age < 20 years old [AOR = 3.88, 95% CI (1.25-12.18)], age of menarche ≤ 12 years [AOR = 4, 95% CI (1.18-13.9), sleeping hours ≤ 5 h [AOR= 2.26, 95% CI (1.04-4.93)], perceived stress [AOR = 2, 95% CI (1.53-3.23)] and being overweight [AOR = 2, 95% CI (1.13-3.23) were the variables significantly associated with the magnitude of menstrual irregularity. Conclusion and recommendation: This study shows that more than one-third of the college students in Debre Berhan town have experienced menstrual irregularity. Being less than 20 years old, having a history of early menarche, being overweight, and perceived stress were a variable significantly associated with menstrual irregularity. To control menstrual irregularity, girls should control their weight and lead a healthy lifestyle, including getting adequate sleep which could be aided by training on time management.

A Systematic Review and Meta-Analysis on Post-Abortion Contraceptive Utilization and Associated Factors in Ethiopia.

Background: Post-abortion contraceptive utilization is the initiation and use of family planning methods at the time of management of abortion or before fertility returns. A significant discrepancy was reported regarding the prevalence and its associated factors of post-abortion contraceptive utilization in Ethiopia. So, this systematic review and meta-analysis aimed to estimate the pooled prevalence of post-abortion contraceptive utilization and its associated factors in Ethiopia. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used. The databases such as PubMed, Google Scholar, Science Direct, Cochrane library, Scopus, CINAHL, Web of Science, and additional searches by using direct Google search, libraries, and preprint were searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal. Results: A total of 17 studies with 13,075 individuals were included. Of these, 14 studies with 5,719 individuals were used to estimate the prevalence. The pooled prevalence of post-abortion contraceptive utilization in Ethiopia was 63.64% (95% CI: 57.75-69.53). The subgroup analysis reported the highest prevalence of post-abortion contraceptive utilization in a study conducted in Addis Ababa (77.40%), a study published in 2015-2021 (66.15%), and among studies with a sample size >400 (66.84%). The pooled odds ratio (OR) of post-abortion contraceptive utilization for the mothers who had post-abortion family planning counseling was 4.15 (95% CI = 1.30, 13.2), and history of family planning utilization was 4.28 (95% CI = 2.66, 6.89). Conclusions: The pooled prevalence of utilization of post-abortion contraceptives in this meta-analysis remains low. Post-abortion family planning counseling and the history of the utilization of modern family planning methods were significantly associated with the practice of post-abortion contraceptives. The Ministry of Health should encourage post-abortion family planning utilization, making more efforts on post-abortion contraceptive counseling. Health facilities should work hard to strengthen the family planning counseling service, especially focusing on those who had no previous family planning utilization.

Magnitude and Determinant Factors of Postpartum Depression Among Mothers Attending Their Postnatal and Vaccination Services at Public Health Institutions of Addis Ababa, Ethiopia.

Background: The postpartum period is known as a high-risk period for the onset of different maternal mental health problems. Globally, 10-20% of postnatal mothers suffer from depressive symptoms. This study aimed to assess the magnitude and determinant factors of postpartum depression among mothers attending their postnatal and vaccination services at public health institutions in Addis Ababa, Ethiopia. Methodology: Health institution-based cross-sectional study was conducted among 461 postnatal mothers attending public health institutions in Addis Ababa from 15 May 2021 to 15 July 2021. A multistage sampling technique was employed to select the public health institutions and a systematic random sampling method was used to get selected, postnatal mothers. Epidata version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression. Results: From total postnatal mothers 91(19.7%) of them had postpartum depression. Occupational status [AOR = 3.39, 95% CI: 1.04, 8.15], marital status [AOR = 2.69, 95% CI =1.33, 5.45], income management [AOR = 3.76, 95% CI: 1.53, 8.21], sex of baby [AOR = 5.07, 95% CI: 1.24, 20.69], history of child death [AOR = 6.93, 95% CI: 2.67, 15.79], unplanned pregnancy [AOR = 3.08, 95% CI: 1.65, 7.93], negative life event [AOR = 2.39, 95% CI: 1.03, 5.39], substance use during pregnancy [AOR = 6.23, 95% CI: 2.72, 20.05], history of depression [AOR = 5.08, 95% CI: 1.79, 14.39], and marriage satisfaction [AOR = 6.37, 95% CI: 2.63, 14.29] were determinant factors of postpartum depression. Conclusion: The prevalence of postpartum depression in this study is high compared to national findings. Occupational status, marital status, income management, sex of baby, history of child death, unplanned pregnancy, negative life event, substance use during pregnancy, history of depression, and marital satisfaction were determinant factors of postpartum depression. The ministry of health should integrate mental health services with existing maternal health care services. It would be better if all healthcare professionals working in the maternal and child health unit will routinely screen postpartum depressive symptoms and link them to mental health services.

Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia.

Background: World health organization defined herbal medicines as the practice of herbs, herbal materials, herbal preparations, and finished herbal products. Globally women are the primary utilizer of herbal medicine and even they consume it during their pregnancy period. The World health organization reported that the majority of the global population used traditional medicine. This study aimed to assess the magnitude and determinant factors of herbal medicine utilization among pregnant mothers attending their antenatal care at public health institutions in Debre Berhan town, Ethiopia. Methodology: Institution-based cross-sectional study was conducted among pregnant mothers who attended their antenatal care at public health institutions in Debre Berhan town, Ethiopia from 12 February 2021 to 12 April 2021. A systematic random sampling method was used to get selected pregnant mothers. Epi data version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤0.05 was used as a cut point of statistical significance in multivariable binary logistic regression. Results: A total of 422 pregnant mothers were included with a 100% response rate and 277 (65.6%) of them used an herbal medicine during their current pregnancy. Educational level up to primary school [AOR 2.21, 95% CI: 1.17 - 4.18], monthly family income of <2,800 ETB [AOR 1.72, 95% CI: 1.01-2.92], and lack of awareness of the complication of herbal medicine utilization [AOR 10.3, 95% CI: 6.27-16.92] were determinant factors of herbal medicine utilization. Conclusion: The utilization of herbal medicine among pregnant mothers in this study is high and almost all of them did not disclose their utilization of herbal medicine to their healthcare providers. The ministry of health should integrate traditional medicine with conventional medicines. Midwives and obstetricians should openly discuss regarding benefits and complications of herbal medicine utilization for those pregnant mothers during their antenatal care counseling sessions as routine care.

Prevalence of exclusive breastfeeding practice and its association with maternal employment in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Exclusive breastfeeding is defined as the practice of providing only breast milk for an infant for the first 6 months of life without the addition of any other food or water, except for vitamins, mineral supplements, and medicines. Findings are inconsistent regarding the prevalence of exclusive breastfeeding in Ethiopia. Full-time maternal employment is an important factor contributing to the low rates of practice of exclusive breastfeeding. Empowering women to exclusively breastfeed, by enacting 6 months' mandatory paid maternity leave can increase the rate of exclusive breastfeeding in the first 6 months of life up to 50%. The purpose of this review was to estimate the pooled prevalence of exclusive breastfeeding and its association with full-time maternal employment in the first 6 months of life for infants in the context of Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in this systematic review and meta-analysis. All observational studies reporting the prevalence of exclusive breastfeeding and its association with maternal employment in Ethiopia were considered. The search was conducted from 6 November 2020 to 31 December 2020 and all papers published in the English language from 1 January 2015 to 31 December 2020 were included in this review. RESULTS: Forty-five studies were included in the final analysis after reviewing 751 studies in this meta-analysis yielding the pooled prevalence of EBF 60.42% (95% CI 55.81, 65.02) at 6 months in Ethiopia. Those full-time employed mothers in the first 6 months were 57% less likely to practice exclusive breastfeeding in comparison to mothers not in paid employment in Ethiopia (OR 0.43; 95% CI 0.31, 0.61). CONCLUSIONS: Full-time maternal employment was negatively associated with the practice of exclusive breastfeeding in comparison to unemployed mothers. The prevalence of exclusive breastfeeding in Ethiopia is low in comparison to the global recommendation. The Ethiopian government should implement policies that empower women. The governmental and non-governmental organizations should create a conducive environment for mothers to practice exclusive breastfeeding in the workplace.

Assessment of Midwife Knowledge, Practice, and Associated Factors towards Active Management of the Third Stage of Labor at Governmental Health Institutions in Tigray Region, Northern Ethiopia, 2018.

INTRODUCTION: Globally, postpartum hemorrhage is the most common cause of maternal mortality and morbidity, and it accounts for more than 25% of all maternal deaths. The majority of death due to postpartum hemorrhage is caused by uterine atony. Routine and correct usage of active management of the third stage of labor decreases the occurrence of postpartum hemorrhage by 60% when compared to expectant management of the third stage of labor. The purpose of this study was to assess midwife knowledge, practice, and associated factors towards active management of the third stage of labor at governmental health institutions in the Tigray region, 2018. RESULTS: These study results showed that from the total study participants (N = 278), 170 (61.2%) were good in knowledge and 121 (43.5%) were good in practice towards active management of the third stage of labor. Training related to active management of the third stage of labor (AOR = 2.119, 95%CI = 1.141, 3.3937) and practice level of midwives (AOR = 8.089, 95%CI = 4.103, 15.950) became significantly associated with the knowledge level. The educational level of midwives (AOR = 3.811, 95%CI = 2.015, 7.210), training related to active management of the third stage of labor (AOR = 2.591, 95%CI = 1.424, 4.714), and knowledge level of midwives towards active management of the third stage of labor (AOR = 7.324, 95%CI = 3.739, 14.393) were significantly associated with the practice level. This study showed that training related to active management of the third stage of labor was significantly associated with the knowledge and practice level of midwives. The educational level and knowledge level of midwives were significantly associated with the practice level of midwives towards active management of the third stage of labor. Therefore, midwives should update their academic level and knowledge. Health institutions in collaboration with the Tigray Regional Health Bureau should arrange training for all midwives to bring change.

Teenage Pregnancy and Its Adverse Obstetric and Perinatal Outcomes at Lemlem Karl Hospital, Tigray, Ethiopia, 2018.

INTRODUCTION: One of the major public health issues across the whole world these days is teenage pregnancy which is defined as being pregnant in the age ranging from 13-19 years. About 11% of all births which occurred worldwide accounted for girls aged 15 to 19 years. From these, 95% teenage deliveries occur in low- and middle-income countries. World health 2014 statistics show that complications during pregnancy and childbirth are the second cause of death for 15-19-year-old girls globally. The aim of this study was to determine adverse obstetrical and perinatal outcomes of teenage pregnancy among deliveries at Lemlem Karl General Hospital, Tigray, Ethiopia, 2018. RESULT: This study result showed that 17.5% of the teenagers and 6.8% of the adults deliver low birth weight neonates. From the total teenage mothers, about thirty-five (11.3%) of them had developed pregnancy-induced hypertension, whereas about thirteen (4.2%) of adults develop pregnancy-induced hypertension. Regarding cesarean delivery, forty (12.9%) of those teenage mothers deliver by a cesarean section while 58 (18%) of the adult mothers deliver by cesarean delivery. Teenage pregnancy was significantly associated with adverse obstetric and perinatal outcomes, a cesarean delivery (AOR: 0.57; 95% CI, 0.36-0.90), episiotomy (AOR: 2.01; 95% CI, 1.25-3.39), and low birth weight (AOR: 2.22; 95% CI, 1.13-4.36), and premature delivery were 2.87 (1.49-5.52). This study shows that adverse obstetric and perinatal outcomes were significantly associated with teenagers than adult mothers. Therefore, giving health education on focused ANC is very important to bring change to the teenager at this study area.