Determinants of perinatal mortality at tertiary hospitals in East Wollega, Western Ethiopia: a case-control study.

OBJECTIVE: This study was performed to determine predisposing factors of perinatal mortality among deliveries at tertiary hospitals in East Wollega, Western Ethiopia. METHODS: This institutional-based unmatched retrospective case-control study involved 810 samples (270 perinatal deaths and 540 controls) selected from the study hospitals. For each case, two controls were selected. Data were collected using a pretested structured questionnaire. Data were entered into EpiData Version 3.1 and exported to SPSS Version 25 for analysis. Descriptive analysis and logistic regression were performed. The adjusted odds ratio with 95% confidence interval was calculated, and statistical significance was declared at a P-value of <0.05. RESULTS: The statistical analysis revealed the following independent determinants of perinatal mortality: rural residence, lack of antenatal care, preterm delivery, induction of labor, presence of obstetric complications, breech presentation, shoulder presentation, low birth weight, congenital malformation, and not using a partograph. CONCLUSION: Given the determinant factors of perinatal mortality in the study area, health facilities are recommended to implement appropriate antenatal care, intrapartum care, and neonatal care to prevent perinatal mortality. They are also advised to use partographs and ensure better access to antenatal care facilities.

Determinants of Diarrhea in Under-Five Children Among Health Extension Model and Non-Model Families in Wama Hagelo District, West Ethiopia: Community-Based Comparative Cross-Sectional Study.

BACKGROUND: Diarrhea is a major leading cause of under-five morbidity and mortality in developing countries. Although the health extension program has been implemented for decades, diarrhea continues to be a major public health problem. OBJECTIVE: To determine determinants of diarrhea among under-five-year-old children in the health extension model and non-model families of Wama Hagelo District 2019. METHODS: A community-based comparative cross-sectional study was conducted among 512 under-five children among 257 model and 255 non-model health extension families. A multi-stage sampling technique was used. Households with at least one under-five child were selected using a simple random sampling method. Data were collected using an interviewer-administered questionnaire. Bivariate analysis was done to select candidate variables at p ≤ 0.2. Determinants of childhood diarrhea were determined by a multivariable logistic regression model at p-value less than 0.05. RESULTS: The two-week prevalence of diarrhea among under-five children in model and non-model families was 7.8% (95% CI=4.5-11.1%) and 27.8% (95% CI 22.3-33.3%), respectively. Unimproved water sources (AOR [95% CI] =5.5[2.2, 97.7]) and no vaccination against Rotavirus (AOR [95% CI] = 49.8 [4.2-94.8]) were associated with diarrhea among under-five children in model families. Family size > 5 (AOR [95% CI] = 5.2 [1.7-17.6]), using unimproved water sources (AOR [95% CI] = 7.2 [1.6-13.2]), not using latrine (AOR [95% CI] = 6 [1.8-20.6]), child not vaccinated against Rotavirus (AOR [95% CI] = 10.9 [2.9-41.1]), child not supplemented with vitamin A (AOR [95% CI] = 3.2 [1.4-7.2]), and not being health extension model families (AOR [95% CI] = 2.4 [1.15-4.99]) predict diarrhea among under-five children in non-model families. CONCLUSION: Diarrhea was more frequent among non-model than model families. Family size, type of water source, using a latrine, place of childbirth, child vaccination against Rotavirus, and vitamin A supplementation were independently associated with the occurrence of diarrhea in under-five children. Encouraging all non-model families to become models in implementing all health extension packages by strengthening community participation is important to decrease childhood diarrhea in under-five children.

Indications, Outcome and Risk Factors of Cesarean Delivery Among Pregnant Women Utilizing Delivery Services at Selected Public Health Institutions, Oromia Region, South West Ethiopia.

BACKGROUND: Approximately 10% of deliveries are considered as high risk, which may require cesarean section. Besides, a rise in cesarean section delivery is a real public health concern; cesareans are costly and carry 8-12 and 8 times higher feto-maternal morbidity and mortality, respectively, as compared to vaginal delivery. Like in other countries where unnecessary cesarean delivery is performed, it is also rising in our country, posing potential risk to the mothers and their newborns. OBJECTIVE: To assess the indications and outcome of cesarean section delivery among pregnant women utilizing delivery services in selected hospitals. METHODS: A case-control study design was used among 488 randomly selected pregnant women attending delivery services in Bedelle and Mettu-Kharl Hospitals. Data were collected by interviewer-administered questionnaire and entered into EPI-data version 3.1 and exported to SPSS version 20 for cleaning and analyses. Binary logistic regression analysis was used to control for possible confounders. Association was declared at 95% CI and P-value <0.05 to assess the association between dependent and independent variables. Variables with P-values <0.05 at bivariate analysis were entered to final logistic regression model. RESULTS: Nearly 30% and 24.6% of fetuses had been exposed to unfavorable outcome among those delivered following cesarean and vaginal delivery, respectively. The mean age of study participants was 25.79 (SD 6.76) for mothers who underwent cesarean delivery and 24.76 (SD 4.956) for their counterparts. Unfavorable maternal outcome was experienced by 20.5% and 14.7% of pregnant women who gave birth by cesarean and vaginal delivery, respectively. Those not having antenatal care follow-up were five times more likely to encounter unfavorable outcome than attendees (AOR 5.22, 95% CI 1.85-14.69), while mothers of newborns with low 5th minute Apgar score were 3 times (AOR 2.96, 95% CI 1.07, 8.16), multi-parity 7 times (AOR 7.22, 95% CI 1.45, 36.05) and rural residence were 1.29 times (AOR 1.29, 95% CI 5.09, 12.88) more likely to develop unfavorable feto-maternal outcome. CONCLUSION: Vaginal delivery results in more favorable feto-maternal outcomes than does cesarean delivery.

Factors affecting demand for modern contraceptives among currently married reproductive age women in rural Kebeles of Nunu Kumba district, Oromia, Ethiopia.

BACKGROUND: Family planning plays a key role in improving the health of the mother and the child. Yet there are still significant levels of demand for family planning that are unmet and these can lead to unintended pregnancy. So, women's demand for contraceptive utilization to limit, space, or delay the number of family size can be increased by integrating family planning service at each service delivery points. OBJECTIVE: The main aim of this study was to assess the demand for modern contraceptive and associated factors among currently married women of the reproductive age group in rural kebeles of Nunu Kumba District, 2015. METHODS: A community-based cross-sectional study design was conducted from January 15-30, 2015 among 584 systematically selected currently married women of reproductive age in six rural kebeles of Nunu Kumba District. A pre-tested and interviewer-administered questionnaire was used to collect the data. Data were analyzed using SPSS version 20. Descriptive statistics were done to summarize the data. A multivariate logistic regressions analysis method was employed and odds ratio with 95% confidence interval was used to control for possible confounders. P-value < 0.05 was used to declare a significant association. RESULTS: The total demand for modern methods of contraceptive was 450 (77.1%) of which 325 (55.7%) of them were current user and 125 (21.4%) of them were had unmet need for modern contraceptive methods. Being in the younger age group (15-24 and 25-34 years [AOR = 0.196; 95% CI: 0.055, 0.692] and [AOR = 0.179, 95% CI: 0.043, 0.745] respectively, husband having no intention for more children [AOR = 4.124, 95% CI: 1.891, 8.996], number of children alive [AOR = 2.617, 95% CI: 1.056, 6.486], and couples ever not discussed on family planning [AOR = 0.340, 95% CI: 0.187, 0.619] were factors associated with demand for modern methods of contraception. CONCLUSION: The total demand for modern methods of contraceptive was high in the study area except for long-acting and permanent methods with high unmet need for spacing than for limiting. Therefore, any program aimed at promoting family planning at the district level should look for ways and means of increasing demand for long-acting and permanent family planning methods and encouraging husband involvement to increase its utilization.

Factors determining late antenatal care booking and the content of care among pregnant mother attending antenatal care services in East Wollega administrative zone, West Ethiopia.

INTRODUCTION: Antenatal care (ANC) is important for both maternal and fetal health. However, the existing evidence from developing countries indicates that most pregnant women attending ANC in their late pregnancy. Little is known about the factors determining ANC booking and the content of care among pregnant women in West part of Ethiopia. Therefore, the present study was conducted to identify factors determining late ANC booking and the content of care among pregnant mother attending antenatal care services in East Wollega administrative zone, West Ethiopia. METHODS: Institutional based cross-sectional study was conducted from July to September, 2014 among 421 pregnant women's attending ANC services in purposively selected health facilities, East Wollega zone, Ethiopia. The pretested-structured questionnaires were used to collect socio-demographic data and predictor factors of late initiation of ANC services. Five trained nurse working at ANC clinic at each health institution administered the questionnaire. The collected data was analysed using SPSS version 20. RESULTS: The prevalence of late ANC booking was 81.5% (343/421) in the study area. Being from Oromo ethnic group (AOR 4.27, (95% CI, 1.48-12.33)), maternal age equal or more than 25 year old (AOR 3.09 (95% CI, 1.53-6.27)), second trimester (AOR 6.05(95% CI, 3.08-11.88)) and third trimester (AOR 7.97 (95% CI, 3.92-16.23)) were main factors identified as contributing (favoring factors) for the likely occurrence of late booking for ANC whereas; monthly income more than and/or equal to 15000 Ethiopian birrs (AOR 0.38 (95% CI, 0.18-084)) were factors compromising (decreasing) the chances for late attendance for the services among the pregnant women. CONCLUSION: Late ANC initiation is high in the study area despite the services is provided free of charge. Hence, it is important to provide health education on the timing of ANC among women with reproductive age. Community's awareness on importance of receiving early ANC also needs to be promoted.