Protective effect of pneumococcal conjugate vaccination on the short-term association between low temperatures and childhood pneumonia hospitalizations: Interrupted time-series and case-crossover analyses in Matlab, Bangladesh.

Studies have shown that ambient extreme temperatures (heat and cold) were associated with an increased risk of childhood pneumonia, but the evidence is very limited in low-middle-income countries. It also remains unknown whether pneumococcal conjugate vaccine (PCV) could prevent temperature-related childhood pneumonia. This study collected data on ambient temperature and hospitalizations for childhood pneumonia in Matlab, Bangladesh from 2012 to 2016. Interrupted time series (ITS) analysis was employed to assess the impact of PCV (10-valent) intervention on childhood pneumonia hospitalizations. A time-stratified case-crossover analysis with a conditional logistic regression was performed to examine the association of childhood pneumonia hospitalizations with extreme temperatures and heatwaves before and after PCV10 intervention. Subgroup analyses were conducted to explore the modification effects of seasons, age, gender, and socioeconomic levels on temperature-related childhood pneumonia hospitalizations. We found that after PCV10 intervention, there was a sharp decrease in hospitalizations for childhood pneumonia (relative risk (RR): 0.59, 95% confidence interval (CI): 0.43-0.83). During the study period, heat effects on childhood pneumonia appeared immediately on the current day (odds ratio (OR): 1.28; 95% CI: 1.02-1.60, lag 0), while cold effects appeared 4 weeks later (OR: 1.53, 95% CI: 1.06-2.22, lag 28). Importantly, cold effects decreased significantly after PCV10 (p-value＜0.05), but heat and heatwave effects increased after PCV10 (p-value＜0.05). Particularly, children from families with a middle or low socioeconomic level, boys, and infants were more susceptible to heat-related pneumonia. This study suggests that PCV10 intervention in Bangladesh may help decrease cold-related not heat-related childhood pneumonia.

Earning pocket money and girls' menstrual hygiene management in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Many adolescent girls in Ethiopia and elsewhere missed school during their monthly cycles due to a lack of affordable menstrual absorbent materials or money to buy sanitary pads. So far, few studies have looked into the relationship between earning pocket money and maintaining good menstrual hygiene. Hence, this systematic review and meta-analysis aimed to synthesize the best available evidence regarding the association between earning pocket money and menstrual hygiene management among adolescents in Ethiopia. METHODS: We systematically searched PubMed, Hinari, Science Direct, Cochrane Library, ProQuest, POPLINE, African Journal Online, Direct of Open Access Journals, and Google Scholar for studies examining the association between earning pocket money and menstrual hygiene management among adolescent girls in Ethiopia, without restriction in a publication year. The Joanna Briggs Institute quality assessment tool for the cross-sectional studies was used to assess the quality of included studies. A prefabricated checklist, including variables: first author, publication year, sample size, type of questionnaire, and the region was used to extract data from the selected articles. A random-effect meta-analysis model was used to estimate the pooled odds ratio (OR) of the association between earning pocket money and menstrual hygiene management. The heterogeneity and publication bias was assessed by using I2 test statistics and Egger's test, respectively. RESULTS: Data from nine studies involving 4783 adolescent girls were extracted. The meta-analysis revealed that adolescent girls who earned pocket money from their parents or relative had 1.64 times higher odds of having good menstrual hygiene management than their counterparts [pooled OR = 1.64, 95% CI: 1.16-2.34, I2:66.7%, n = 7 (number of studies)]. Similarly, the likelihood of having good menstrual hygiene management was lower by 49% among adolescent girls who did not receive any pocket money from their parents compared to their counterparts (pooled OR = 0.51, 95% CI: 0.35-0.74, I2:48.4%, n = 2). CONCLUSIONS: The findings revealed that adolescent girls who earned pocket money were more likely to practice good menstrual hygiene management. Progress toward better menstrual hygiene will necessitate consideration of this factor.

Knowledge of obstetric danger signs among child bearing age women in Goba district, Ethiopia: a cross-sectional study.

BACKGROUND: Awareness of the danger signs of obstetric complications is the essential first step in accepting appropriate and timely referral to obstetric and newborn care. Ethiopia is a country where maternal morbidity and mortality is high and little is known about knowledge level of reproductive age women on obstetric danger signs. The aim of the study was to assess knowledge of obstetric danger signs among mothers delivered in the last 12 months in Goba district, Ethiopia. METHODS: A community based cross-sectional study was conducted in Goba district. The study included 562 recently delivered women from 9 kebeles (the smallest administrative unit). A safe motherhood questionnaire developed by the Maternal and Neonatal Program of JHPIEGO, an affiliate of John Hopkins University was used to collect data. Binary and multiple logistic regressions were done to explore factors determining maternal knowledge on obstetric danger signs. Variables having P-value of less than or equal to 0.05 on binary logistic regression were the candidate for multiple logistic regressions. Statistical significance was declared at P < 0.05. RESULT: One hundred seventy nine (31.9%), 152 (27%) and 124 (22.1%) of study participants knew at least three key danger signs during pregnancy, delivery and postpartum period, respectively. As compared to women who did not attended Anti Natal Care service during their pregnancy, those who attend ANC were 2.56 times and 2.54 times more likely to know obstetric danger signs during pregnancy and child birth (AOR = 2.56 and 95% CI: 1.24-5.25) and (AOR = 2.54 and 95% CI: 1.14-5.66), respectively. CONCLUSION: This study showed low level of knowledge of obstetric danger signs during pregnancy, child birth and postpartum period among women in Goba district. This indicates the large proportions of pregnant women who do not have the knowledge are likely to delay in deciding to seek care. ANC follow up was a significant factor for knowledge about obstetric danger signs occurring during pregnancy and child birth. Every woman should be made aware of the likelihood of complications during pregnancy, childbirth/labour and the postpartum periods.

Documentation status of the modified World Health Organization partograph in public health institutions of Bale zone, Ethiopia.

BACKGROUND: Partograph is basically a graphic representation of the events of labour plotted against time in hours. It is designed for early detection of abnormal progress of labour and prevention of prolonged labour in order to reduce risk of Postpartum Haemorrhage (PPH), sepsis, obstructed labour and its sequels such as ruptured uterus and obstetric fistula. However, little is known about documentation status of partograph forms. Therefore, the aim of this study was to assess documentation status of partograph in public health institutions of Bale zone, Ethiopia. METHODOLOGY: Institution based, descriptive cross sectional study based on retrospective document review was conducted to assess partograph forms in public health institutions of Bale zone, from May 1(st) to June 30, 2014. A total of 508 sampled mothers' medical records that had been used to monitor labour three months prior to actual data collection period (from February to April 2014) were considered as study populations. The data were analyzed using statistical package for social science version 16.0 and descriptive statistics were computed. RESULTS: Out of the total 508 mothers' medical records reviewed, 342 (67.3%) medical records have partograph forms. Of which, 103 (30.1%) were not totally recorded and 239 (69.9%) partograph were recorded only in some manner. From partograph forms recorded in some manner, only 107 (44.8%) fetal heart rate, 3 (1.3%) moulding of fetal head, 76 (31.8%) cervical dilatation, and 17 (7.1%) descent of head, 57 (23.8%) uterine contraction, 23 (9.6%) blood pressure, and 14 (5.9%) temperature was documented to the standard level. CONCLUSION: There is poor documentation of the modified World Health Organization (WHO) partographs during labour in public health institutions of Bale zone, Ethiopia. It is recommended to provide continuous pre-service and on-job training for health care professionals about the standard protocol of partograph documentation and to set policy for each health facility that mandate documentation of the partograph for all laboring mother as per WHO recommendation.

Birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia.

BACKGROUND: Birth preparedness and complication readiness is the process of planning for normal birth and anticipating the actions needed in case of an emergency. It is also a strategy to promote the timely use of skilled maternal care, especially during childbirth, based on the theory that preparing for childbirth reduces delays in obtaining this care. Therefore, the aim of this study was to assess birth preparedness and complication readiness among women of child bearing age group in Goba woreda, Oromia region, Ethiopia. METHODS: A community based cross sectional study was conducted in Goba woreda, Oromia region, Ethiopia. Multistage sampling was employed. Descriptive, binary and multiple logistic regression analyses were conducted. Statistically significant tests were declared at a level of significance of P value < 0.05. RESULTS: Only 29.9% of the respondents were prepared for birth and its complications. And, only 82 (14.6%) study participants were knowledgeable about birth preparedness and complication readiness.Variables having statistically significant association with birth preparedness and complication readiness of women were attending up to primary education (AOR = 3.24, 95% CI = 1.75, 6.02), attending up to secondary and higher level of education (AOR = 2.88, 95% CI = 1.34, 6.15), the presence of antenatal care follow up (AOR = 8.07, 95% CI = 2.41,27.00), knowledge about key danger signs during pregnancy (AOR = 1.74, 95% CI = 1.06,2.88), and knowledge about key danger signs during the postpartum period (AOR = 2.08, 95% CI = 1.20,3.60). CONCLUSIONS: Only a small number of respondents were prepared for birth and its complications. Furthermore, the vast majority of women were not knowledgeable about birth preparedness and complication readiness. Residence, educational status, ANC follow up, knowledge of key danger signs during pregnancy and the postpartum period were independent predictors of birth preparedness and complication readiness.

Assessment of occupational injuries among Addis Ababa city municipal solid waste collectors: a cross-sectional study.

BACKGROUND: Collection of household waste is a job which requires repeated heavy physical activities such as lifting, carrying, pulling, and pushing. Like many developing countries, in Ethiopia municipal solid waste is collected manually. Therefore, this study is aimed to assess the extent of occupational injuries and associated factors among solid waste collectors in Addis Ababa City. METHODS: A cross-sectional study was conducted among 876 respondents sampled from 92 unions. A pre-tested structured questionnaire and observation check list were used to collect data. Crude odds ratio with 95% CI was computed to see the presence of association between selected independent variables and occupational injury. Multivariate logistic regression analysis was made to see the relative effect of independent variable on the dependent variable by controlling the effect of other variables. To maintain stability, only variables that have a p-value less than 0.30 in the binary logistic regression analysis were kept in the subsequent model. Enter method was used hierarchically. RESULTS: The response rate of this study was 97.9%. Female respondents accounted 71.2%. The median age of the study subjects was 33 year (with 52 inter quartile range). The overall occupational injury prevalence rate in the last 12 months was 383 (43.7%). Utilization of personal protective devices and family size in the household were statistically associated with injury. As compared to workers who used personal protective equipments while being on duty, odds of injury among workers not used personal protective equipments were 2.62 higher (AOR = 2.62, 95% CI: 1.48-4.63). As compared to those who had five and more children, odds of injuries among those who had 3-4 children was reduced by half (AOR = 0.52, 95% CI: 0.30-0.93). CONCLUSION: The extent of occupational injuries among Addis Ababa city solid waste collectors is present in a level that needs immediate public health action. Implementation of basic occupational health and safety services including training on occupational health and safety, ensuring the provision and use of personal protective devices are highly advisable.

Prevalence of female genital mutilation and its effect on women's health in Bale zone, Ethiopia: a cross-sectional study.

BACKGROUND: Females' genital mutilation (FGM) is one of the harmful traditional practices affecting the health of women and children. It has a long-term physiological, sexual and psychological effect on women. It remains still a serious problem for large proportion of women in most sub-Saharan Africa countries including Ethiopia. METHODS: A community based cross sectional study design which is supplemented by qualitative method was conducted in 2014. A total of 634 reproductive age women were involved in the quantitative part of the study. The respondents were drawn from five randomly selected districts of Bale zone. The total sample was allocated proportionally to each district based on the number of reproductive age women it has. Purposive sampling method was used for qualitative study. Then, data were collected using pre-tested and structured questionnaire. The collected data were analyzed by SPSS for windows version 16.0. Multiple logistic regressions were carried out to examine the existence of relationship between FGM and selected determinant factors. Variables significant in the bivariate analysis were then entered into a multiple logistic regression analysis. RESULTS: In this study, 486 (78.5%) of women had undergone some form of FGM with 75% lower and 82% upper confidence interval. To get married, to get social acceptance, to safeguard virginity, to suppress sexual desire and religious recommendations were the main reasons of FGM. The reported immediate complications were excessive bleeding at the time of the procedure, infection, urine retention and swelling of genital organ. Muslim women and women from rural areas were significantly more likely to have undergone the procedure. In addition to these, compared to women 15-20 years old older women were more likely to report themselves having undergone FGM. CONCLUSIONS: Although younger women, those from urban residence and some religions are less likely to have had FGM it is still extremely common in this zone. Deep cultural issues and strongly personally held beliefs which are not simple to predict or quantify are likely to be involved in the perpetuation of FGM. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.

Abnormal ambient temperature change increases the risk of out-of-hospital cardiac arrest: A systematic review and meta-analysis of exposure types, risk, and vulnerable populations.

BACKGROUND: There is growing evidence in support of a short-term association between ambient temperature and cardiac arrest attacks that is a serious manifestation of cardiovascular disease and has a high incidence and low survival rate. However, it remains unrecognized about the hazardous temperature exposure types, exposure risk magnitude, and vulnerable populations. OBJECTIVES: We comprehensively summarize prior epidemiological studies looking at the short-term associations of out-of-hospital cardiac arrest (OHCA) with various temperature exposures among different populations. METHODS: We searched PubMed and Web of Science databases from inception to October 2021 for eligible English language. Temperature exposure was categorized into three types: heat (included high temperature, extreme heat, and heatwave), cold (included low temperature and extreme cold), and temperature variation (included diurnal temperature range and temperature change between two adjacent days). Meta-analysis weighted by inverse variance was used to pool effect estimates. RESULTS: This study included 15 studies from 8 countries, totaling around 1 million OHCA events. Extreme heat and extreme cold were significantly associated with an increased risk of OHCA, and the pooled relative risks (RRs) were 1.071 [95 % confidence interval (CI): 1.019-1.126] and 1.662 (95%CI: 1.138-2.427), respectively. The risk of OHCA was also elevated by heatwaves (RR = 1.248, 95%CI: 1.091-1.427) and more intensive heatwaves had a greater effect. Notably, the elderly and males seemed to be more vulnerable to the effects of heat and cold. However, we did not observe a significant association between temperature variation and the risk of OHCA (1.005, 95%CI: 0.999-1.012). CONCLUSION: Short-term exposure to heat and cold may be novel risk factors for OHCA. Considering available studies in limited regions, the temperature effect on OHCA should be urgently confirmed in different regions.

Ambient particulate matter (PM1, PM2.5, PM10) and childhood pneumonia: The smaller particle, the greater short-term impact?

BACKGROUND: Smaller sizes of ambient particulate matter (PM) can be more toxic and can be breathed into lower lobes of a lung. Children are particularly vulnerable to PM air pollution because of their adverse effects on both lung functions and lung development. However, it remains unknown whether a smaller PM has a greater short-term impact on childhood pneumonia. AIMS: We compared the short-term effects on childhood pneumonia from PM with aerodynamic diameters ≤1 µm (PM1), ≤2.5 µm (PM2.5), and ≤10 µm (PM10), respectively. METHODS: Daily time-series data (2016-2018) on pneumonia hospitalizations in children aged 0-17 years, records of air pollution (PM1, PM2.5, PM10, and gaseous pollutants), and weather conditions were obtained for Hefei, China. Effects of different PM were quantified using a quasi-Poisson generalized additive model after controlling for day of the week, holiday, seasonality and long-term time trend, and weather variables. Stratified analyses (gender, age, and season) were also performed. RESULTS: For each 10 µg/m3 increase in PM1, PM2.5, and PM10 concentrations over the past three days (lag 0-2), the risk of pneumonia hospitalizations increased by 10.28% (95%CI: 5.88%-14.87%), 1.21% (95%CI: 0.34%-2.09%), and 1.10% (95%CI: 0.44%-1.76%), respectively. Additionally, both boys and girls were at risk of PM1 effects, while PM2.5 and PM10 effects were only seen in boys. Children aged ≤12 months and 1-4 years were affected by PM1, but PM2.5 and PM10 were only associated with children aged 1-4 years. Furthermore, PM1 effects were greater in autumn and winter, while greater PM2.5 and PM10 effects were evident only in autumn. CONCLUSION: This study suggests a greater short-term impact on childhood pneumonia from PM1 in comparison to PM2.5 and PM10. Given the serious PM pollution in China and other rapid developing countries due to various combustions and emissions, more investigations are needed to determine the impact of different PM on childhood respiratory health.

Decision-Making Power of Married Women on Family Planning Use and Associated Factors in Dinsho Woreda, South East Ethiopia.

BACKGROUND: Women's decisions on family planning use have multiple benefits to the family and community at large. In developing countries like Ethiopia, the choice of women to use a contraceptive is challenged by social and environmental factors that mitigate their ability to decide independently and freely. This study therefore determined the level of women's decision-making power on family planning use and associated factors among married women in the study area. METHODS: A community-based cross-sectional study was conducted in Dinsho woreda from March to April 2017. A simple random sampling technique was used to select 373 married women. A structured and pre-tested questionnaire was used to collect data by trained data collectors under continuous supervision. Multivariable logistic regression was performed to identify factors associated with women's decision-making power on family planning use. Crude and adjusted odds ratios with 95% confidence interval were used and p-value of <0.05 was considered as statistical significance. RESULTS: A total of 344 (92.2%) women participated in the study. Of the total respondents, 179 (52%) of women had good decision-making power on modern family planning use. Multivariable analysis showed that younger age (adjusted odds ratio [AOR] =8.59 [1.61, 45.80]), good participation in household decision-making (AOR =2.65 [1.46, 4.79]), positive attitude towards family planning (AOR =2.34 [1.31, 4.19]), and better knowledge towards family planning (AOR =3.04 [1.49, 6.22]) were factors statistically significantly associated with married women's decision-making power on family planning use. CONCLUSION AND RECOMMENDATION: Women's knowledge and attitudes toward family planning and their participation in household decision-making increased the likelihood of women's decision-making power for modern family planning use. There is a need to adopt a more comprehensive approach to reach men and women on modern family planning, to help women to decide freely without any restriction.

Maternal Health Service Uptake Is Associated with a Higher Skin-to-Skin Care Practice in Ethiopia: Result from a National Survey.

BACKGROUND: Though skin-to-skin care (SSC) is becoming an important newborn care package at both facility and community levels in Ethiopia, there is a lack of evidence to monitor the progress at each level. Therefore, this study is aimed at quantifying the proportion of SSC at both national and regional levels and identifying factors that affect SSC uptake in Ethiopia. METHOD: We used the 2016 Ethiopia Demographic and Health Survey data. The survey employed a multistage cluster sampling method. We included 7,488 live births in the analysis. The factors influencing SSC practice were identified using a multivariable logistic regression model. We reported adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: In Ethiopia, 24.3% of mothers practiced SSC for their newborns (95% CI = 23.3, 25.2). The highest proportion was in Addis Ababa (63%), and the lowest was in the Somali region (14.5%). Attending 1-4 antenatal care (AOR = 1.51, 95%CI = [1.08, 2.12], giving birth at health facility (AOR = 4.51, 95%CI = [2.16, 9.44], and having female births (AOR = 1.24, 95%CI = [1.01, 1.54]) were associated with more odds of practicing SSC. However, giving birth by the cesarean section had resulted in lower odds of practicing SSC (AOR = 0.37, 95%CI = [0.22, 0.63]). Regions with reduced odds of SSC practice include Amhara (AOR = 0.57, 95%CI = [0.40, 0.82]), Somali (AOR = 0.51, 95%CI = [0.31, 0.83]), and Southern Nations, Nationalities, and People (AOR = 0.64, 95%CI = [0.43, 0.94]). CONCLUSIONS: The SSC practice was low in Ethiopia with a high level of variation between regions. In Ethiopia, maternal health service uptake affects the SSC of the newborns. Well-tailored community-level interventions are needed to increase skin-to-skin care practice among home delivery mothers.

Acceptability and factors associated with post-partum IUCD use among women who gave birth at bale zone health facilities, Southeast-Ethiopia.

BACKGROUND: The postpartum intrauterine contraceptive devices (PPIUCD) is the only family planning method for couples requesting highly effective, reliable, inexpensive, non-hormonal, immediately reversible, and long-acting contraceptive that can be initiated during the immediate postpartum period and it has no a negative effect on lactation. Despite these benefit, the acceptance and utilization of immediate PPIUCD were very low and the reasons for rejecting immediate PPIUCD usage have not been characterized in Southeast Ethiopia. Therefore, this study determined the level of acceptability and factors associated with immediate PPIUCD use among women who gave birth at Bale zone health facilities, Southeast Ethiopia. METHODS: A facility based cross-sectional study was conducted from March to July 2017 in Bale zone health facilities. Four hundred twenty-nine women were successfully interviewed using structured and pre-tested questionnaire. Health facilities were selected by lottery method. Study participants were selected systematically. Data were entered into Epi data version 3.1 and exported into SPSS version 21 for analysis. Logistic regression analyses were done. A significant association was declared at a p-value less than 0.05. RESULTS: The acceptance of immediate PPIUCD usage was 12.4%. Non-acceptors reported their reasons for rejecting PPIUCD use; concern and fears of complications (24.8%), religious beliefs (19.8%), and husband refusal (17.7%). Respondents who had completed secondary education were more likely to accept PPIUCD usage than those who had no formal education (AOR = 3, CI = 11.81, 53.91). In addition, the odds of accepting PPIUCD insertion was higher among women who attended 3 antenatal care visits than those who did not attend antenatal care visits for the current birth (AOR = 1.81, CI = 0.34, 0.85). CONCLUSIONS: The acceptance of immediate PPIUCD usage was still low. This might be attributed to the low achievement of education, perceived concern and fears of complications towards IUCD insertion. The male partner's refusal and religious beliefs also have a role in the usage of postpartum IUCD. Due attention should be given to enhancing educational level of women and effective IUCDs counseling should be given during antenatal care visits to correct misconceptions and fears of complication about PPIUCD insertion.

Intention toward the continuation of female genital mutilation in Bale Zone, Ethiopia.

BACKGROUND: Female genital mutilation (FGM) is a harmful traditional practice that is deeply rooted in Africa. It is associated with health complications and human rights violations. Research on intention for the continuation of FGM and the social determinants underpinning this practice are scarce. Therefore, this study intended to assess the intention of women toward the continuation of FGM among Bale Zone reproductive-age women. METHODS: A community-based cross-sectional study design supplemented by qualitative methods was conducted in 2014. A total of 634 reproductive-age women were involved in the quantitative part of the study. The respondents were drawn from five randomly selected districts of Bale Zone. The total sample was allocated proportionally to each district based on the number of reproductive-age women it has. Purposive sampling method was used for qualitative study. Then, data were collected using a pretested and structured questionnaire. The collected data were analyzed by Statistical Package for Social Sciences for Windows version 16.0. Multiple logistic regressions were carried out to examine the existence of a relationship between intentions for the continuation of FGM and selected determinant factors. RESULTS: This study revealed that 26.7% of the respondents had intention for the continuation of FGM. Religion, safeguarding virginity, tradition, and social values were the major reasons for the perpetuation of this practice. Circumcised respondents and those who were not able to read and write were ~3 (adjusted odds ratio = 2.89, 95% confidence interval = [1.33, 6.20]) and 7.58 (adjusted odds ratio = 7.58, 95% confidence interval = [3.47, 16.54]) times more likely intending the continuation of FGM than uncircumcised and those who attended secondary-level education and above, respectively. CONCLUSION: The study shows that the intention toward the persistence of the practice is high in Bale Zone. Rural residents, those who were not able to read and write, and circumcised respondents were more likely to continue the practice.