Maternal sepsis and factors associated with poor maternal outcomes in a tertiary hospital in Tigray, Ethiopia: a retrospective chart review.

BACKGROUND: Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. METHODS: A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. RESULTS: Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. CONCLUSIONS: This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.

Unmet need for family planning among rural married women in Ethiopia: What is the role of the health extension program in reducing unmet need?

BACKGROUND: Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia. METHODS: This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP. RESULTS: The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37-0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67-0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67-2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01-1.48) were associated with a higher likelihood of an unmet need for FP. CONCLUSION: The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women.

Family planning is a method that couples can use to limit the number of child or space the gap. Unmet need for family planning is defined as the percentage of reproductive age women who wants to space or limit the number of children but not currently using any family planning method. There is a huge proportion of eligible women have an unmet need for family planning in Ethiopia. The health extension program is one of the strategies to reach rural women to improve the health of the community. Although, family planning service is one of the packages in a health extension program and this study aimed to estimate the role of health extension program in reducing unmet need for family planning. About 4991 married women were asked about the family planning use, need and the place where they get the services. During the assessment the role of health extension program was assessed by different question. Some of the major assessment areas were women exposer to service, service availability, awareness and mode of service delivery. One fourth of the women have unmet need for family planning. The family planning utilization is still low. The contribution of the health extension program in family planning service is significant. Women exposed to HEP through level 4 health extension worker and older age are significantly associated with low level of unmet need FP. The unmet need for family planning is high in rural Ethiopia. This will inform the improvement and sustainability of the program.

Prevalence and associated factors of intimate partner violence among pregnant women attending health care facilities, Northern Ethiopia: comparative cross-sectional study.

Intimate partner violence (IPV) is a major public health problem. While it is high among pregnant women in Ethiopia, the cases are under-reported, and the true extent of the issue is uncertain. The study is intended to determine the prevalence and determinants of IPV among pregnant women seeking antenatal care (ANC). A comparative cross-sectional survey was conducted in healthcare facilities, Northern Ethiopia, in 2019. A sample of 324 pregnant women visiting ANC service was selected by systematic sampling. Binary logistic regression was conducted to identify significant determinants. The prevalence of IPV during pregnancy was 36.3%. Lack of formal schooling, rural life, husband's additional sexual partners, lack of shared decisions, and partners' alcohol intake were identified as a predictor of IPV. It is important to consider raising awareness, enhancing women's decision-making abilities, and educating women. Furthermore, partner involvement should be addressed to minimize violence against women in the community.IMPACT STATEMENTWhat is already known on this subject? Intimate partner abuse (IPV) is a global public health problem as well as a significant violation of human rights, and Ethiopia has the world's highest rates of physical and sexual IPV. The immediate effect of IPV during pregnancy (sexually transmitted infections (STI), intrauterine growth retardations (IUGR), preterm labour, miscarriage, abortion, antepartum haemorrhage, perinatal death) was known.What do the results of this study add? Even though the outcome of IPV among pregnant women was recognised, the underlying factors of the violence were not well understood. As a result, this research will contribute to our understanding of the determinants of IPV among pregnant women.What are the implications of these findings for clinical practice and/or further research? In this research, we revealed that the majority of the determinants of IPV among pregnant women were linked to their husband's behaviour, and that women's decision-making capacity and educational level were also root causes of the violence. Therefore, Women empowerment and partner participation during antenatal care would offer outstanding feedback to reduce partner violence. Aside from that, more research in family health would provide in-depth knowledge about the root cause of the violence.

Use of community-based interventions to promote family planning use among pastoralist women in Ethiopia: cluster randomized controlled trial.

BACKGROUND: Afar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia. METHODS: The study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women's education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI). RESULTS: The proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women's education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women's education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women's education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm. CONCLUSION: The present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03450564, March, 2018.

Utilization and factors associated with antenatal, delivery and postnatal Care Services in Tigray Region, Ethiopia: a community-based cross-sectional study.

BACKGROUND: This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. METHODS: A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May-June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. RESULTS: Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic media, and having 2-5 children were factors associated with an ANC 4+ visit. Whereas, partner involvement in ANC visit (AOR = 2.4, 95% of CI: 1.37, 4.35) and content of ANC discussed (AOR = 4.0, 95% of CI: 1.08, 14.93), having birth preparedness (AOR = 2.6, 95% of CI: 1.44, 4.97), residing within a distance of less than a 30-min walk to the nearest health facility (AOR = 2.0, 95% of CI: 1.16, 3.64), and having ANC 4+ visits (AOR = 2.4, 95% of CI: 1.39, 4.31) were the factors that were found to be associated with institutional delivery. As regards to PNC visits within 42 days of birth, age of 40-45 years, having 2-5 children, and ANC 4+ visits were found to be significant factors associated with it. CONCLUSION: The proportion of women who attended antenatal care and gave birth in a health facility was high. However, the proportion of women who attended antenatal and postnatal care was low. Residing in urban areas, having an electronic media, living near a health facility, having partner involvement in decision making, receiving appropriate ANC counseling, having birth preparedness, age of the woman, and number of children could potentially influence maternal health services utilization.

Validation of family planning tool in the pastoralist community.

BACKGROUND: Pastoralist community, Afar, women felt that they are embedded in strong cultural and religious perspectives which promotes a high number of children, and discourages family planning (FP) use. They are multifaced factors which hinder women not to use FP and it is time to develop a context-based tool to understand the situation at the ground. However, we have a dearth of evidence on a reliable and valid tool. Therefore, this study aims in developing a reliable and valid tool that considers the women's knowledge, male involvement, attitude, and belief about whether most people approve or disapprove of the behavior to use or not use of FP. METHODS: A total of 891 married women participated in the study. Reviewing the literature, piloting, pretesting, and collecting the actual data were the steps we used to develop a reliable and valid tool. We used the integrated behavioral model (IBM) as a conceptual framework for developing the tool. The developing tool consists of 1) knowledge 2) perceived male involvement and 3) constructs of integrated behavioral model (IBM); expressional and instrumental attitude, subjective norm, self-efficacy, perceived control and intention to use of FP. The IBM items composed of direct and indirect measurement. In the analysis of the data, exploratory and confirmatory factor analysis was done. Independent t. test with cohen's d was used to calculate the effect size. The correlation coefficient was carried between the direct and indirect measurements of the items of the integrated behavioral model (IBM). RESULTS: A total of 891 pastoralist married women were included in the analysis of the reliability and validity of the tool. The mean age of the participants was 26.74(±6.45). The KMO value for all items was greater than 0.83 with a Bartlett test of sphericity of (p < 0.00). Thirteen items were used to measure the knowledge of the respondent towards FP use. The tool had 64.92 variances explained and Cronbach alpha of 0.85. Acceptable values of the fitness indices were obtained in the confirmatory factor analysis (CFA) The items of knowledge towards FP had normed chi-square of 4.5, RMSEA with 90% CI of 0.064(0.056,.0.071), SRMR of 0.039, CFI of 0.969 and TLI of 0961. All the developed items had a Cohen's d ranges from 0.5 to 2. Moreover, the correlation test of the IBM ranges from 0.6 to 0.7 which shows a higher correlation between the measurement direct and indirect items. CONCLUSION: The pastoralist community version of the FP questionnaire is a valid and reliable tool and can be used to measure future family planning use. The indirect measurement of the IBM constructs was a good item to measure FP. However, as a limitation of the study respondents may face difficulty in realizing the difference one item to another especially when items on the scale look so similar to her.

Determinant factors of home delivery among women in Northern Ethiopia: a case control study.

BACKGROUND: Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Home delivery in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. This study identifies factors associated with home delivery in Tanqua-Abergele District, Tigray, northern Ethiopia. METHODS: Unmatched case-control study was conducted in April 2014 in Tanqua-Abergele, Tigray, northern Ethiopia. Simple random sampling was employed to select study participants. Data were analyzed using SPSS 20. Multi variable logistic regression analysis was used to identify independent predictors of home delivery. RESULTS: A total of 275 women (92 cases and 183 controls) participated in the study, giving a response rate of 96.5%. Not owning a radio or television (AOR: 7.2, 95% CI: 2.7-19.3), not pursuing ANC visits at all (AOR: 10.4, 95% CI: 2.9-37.1) orhaving1-3 ANC visits only (AOR: 4.75, 95% CI: 1.69-13.31),poor knowledge of obstetric complications (AOR: 8.7, 95% CI: 2.3-32.9) and walking time greater than two hours to the nearest health center (AOR: 5.1, 95% CI: 1.2-20.7) were strong predictors of home delivery. CONCLUSION: Unable to meet the minimum requirement WHO of ANC service had a potential to give birth at home. Investing in infrastructure will contribute to improving maternal health. Having a different source of media (radio or television) could have a role in increasing the institutional delivery. Policy makers and other concerned bodies should give due attention to the fulfillment of infrastructure and educate women on the importance of institutional delivery.

Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: a case-control study.

BACKGROUND: Every year, an estimated 19-20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia. METHODS: Unmatched case-control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions ("repeat abortion") were taken as cases and those who had a total of one abortion were taken as controls ("single abortion"). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI. RESULTS: Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1-3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion. CONCLUSION: This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

Prevalence and predictors of implanon utilization among women of reproductive age group in Tigray Region, Northern Ethiopia.

BACKGROUND: The Ethiopian Federal Ministry of Health introduced provision of the contraceptive Implanon at community level by trained health extension workers in 2009. However, little is known regarding the utilization and factors associated with Implanon use among rural women since the introduction of the community based intervention. Thus, this study assessed the utilization of Implanon and associated factors among reproductive aged women in rural areas of Saesie-Tsaeda Emba and Ofla districts in Tigray, Northern Ethiopia. METHODS: A cross sectional community based survey was conducted in May and June 2014. A multistage sampling technique was used to randomly select 524 reproductive aged women (15-49 years). Data was collected through interview using a pre-tested and structured questionnaire. Univariate analysis was done to determine the prevalence for Implanon use, to assess general characteristics of respondents, and to produce summaries. Bivariate analysis was conducted to examine the relationship between each independent variable with the dependent variable. Multivariate logistic regression was conducted to identify factors influencing Implanon use by controlling effect of confounding variables. RESULTS: Of all the women, 444 (84.7%) had heard of Implanon. Health extension workers were the primary source of information on Implanon as mentioned by 376 (71.8%) of the respondents. Little more than seven women in every ten, 319 (71.8%), had good knowledge of Implanon and 248 (55.5%) of the women had supportive attitudes towards Implanon use. Among our sample, 10.1% women were using Implanon, 33 (62.3%) reported having received their Implanon at a health post from health extension worker. Women's employment (AOR: 2.73, 95% CI: 1.20-6.21), the number of modern contraceptive methods known (AOR: 2.24, 95% CI: 1.09-4.62), and the number of contraceptive methods ever used (AOR: 11.0, 95% CI: 5.06-23.90) were positively associated with Implanon use. CONCLUSION: Trained health extension workers played a major role in information and service provision of Implanon. However, this study revealed that a significant number of women had incorrect information regarding Implanon. Hence, health extension workers and other health professionals should provide appropriate counseling and education regarding Implanon and other contraceptives.

Factors associated with contraceptive use in Tigray, North Ethiopia.

BACKGROUND: Family planning interventions are cost-effective and have several cross-cutting benefits. Despite these benefits of family planning, progress in ensuring universal access to family planning to women in developing countries has been slow. In light of this; this study investigated the prevalence and factors associated with contraceptive use in Tigray Region, Northern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 1966 women of reproductive age group (15-49) in 13 districts (3 urban and 10 rural) from May-June 2015. Multistage sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the effect of independent variables on utilization of contraceptive use. RESULTS: Out of total 1966 women, 1879 (95.6%) have ever heard about family planning. Depo-Provera (depot medroxyprogesterone acetate, or DMPA) was the most popular contractive method as mentioned by 1757 (93.5%) of the participants. The overall contraceptive prevalence rate among all women was 623 (35.6%) while the contraceptive prevalence rate among married women was 543 (41.0%). Seven-in-ten women had ever used short acting contraceptive. In fact Depo-Provera was the most common type of contraceptive used as mentioned by 402 (64.5%) of the women. The odds of using family planning by married women living in urban areas was two times more than their counterparts (AOR = 2.0, 95% of CI: 1.33, 3.06). Similarly, the odds of using family planning among mothers with primary education was 1.3 times more as compared with no education (AOR = 1.3, 95% of CI: 1.02,1.93). However, as regards to long acting contraceptive methods, the odds of using long acting contraceptive methods use among married women in urban areas was 50% less when compared to rural married women (AOR = 0.5, 95% of CI: 0.3, 0.88). CONCLUSION: Contraceptive prevalence rate in Tigray region increased almost four fold in just 15 years. However, the increase is not yet enough to meet national and global targets. Further interventions are needed to narrow disparities in contraceptive use among different population groups and increase long acting contraceptive users. Moreover, improving quality of family planning in terms of the content of information provided to clients is crucial.

Family planning use and associated factors among pastoralist community of afar region, eastern Ethiopia.

BACKGROUND: Ethiopia is the second most populous country in Africa with a total fertility rate (TFR) of 4.8 children per a woman and contraceptive prevalence rate (CPR) of 29 %. The overall prevalence of modern family planning in a pastoralist community, like Afar region, is low (9.1 %). This study aimed to assess family planning utilization and associated factors among married women of Afar region, Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted from January 10-28, 2013 among 602 women. Multistage sampling technique was used to select the study participants. Descriptive and multiple variable logistic regression analyses were done to isolate independent predictors on utilization of family planning using SPSS 20. RESULTS: The overall prevalence of family planning utilization in Afar region was 8.5 % (6.2-10.7). Majority of the women (92.2 %) had used injectable. The most common reasons mentioned in the non-use of family planning methods were religion-related (85.3 %), desire to have more children (75.3 %), and husband's objection (70.1 %). Women who had a positive attitude towards family planning utilization (AOR = 4.7, 95 % CI: 2.1, 10.3), owning radio (AOR = 1.8, 95 % CI: 1.02, 4.18), and literate (AOR = 4.4, 95 % CI: 1.80, 11.08) were more likely to use family planning methods as compared to their counterparts. The increase of monthly income was also associated with the likelihood of family planning methods utilization. The odds of using family planning methods were higher among those with monthly income of $27-$55.5 (AOR = 2. 0, 95 % CI: 1.9, 4.7) and > $55 (AOR = 4. 6, 95 % CI: 1.23-17.19) as compared to women with the lowest category of monthly income ($27 and less). CONCLUSION: The low coverage of family planning in the region could be due to the influence of husband, religious and clan leader. Attitude of women towards family planning methods, possession of radio, monthly income, and educational status could influence family planning utilization.

Rural women are more likely to use long acting contraceptive in Tigray region, Northern Ethiopia: a comparative community-based cross sectional study.

BACKGROUND: In the latest report of Ethiopian Demographic and Health Survey (EDHS) 2011, the maternal mortality ratio (MMR) was estimated at 676/100,000 live births, with total fertility rate at 4.8 and contraceptive prevalence rate at 29 %. Knowledge and utilization of long acting contraceptive in the Tigray region are low. This study aims at comparing and identifying factors related to the utilization of long acting contraceptive in urban versus rural settings of Ethiopia. METHODS: A comparative community-based cross-sectional study, comprised of quantitative and qualitative methods, was conducted among 1035 married women in Wukro (urban area) and Kilteawlaelo district (rural area) in March, 2013. Stratified sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple logistic regression analysis was used to identify the respective effect of independent predictors on utilization of long acting contraceptive. RESULTS: The proportion of long acting contraceptive use among the respondents was 19.9 % in the town of Wukro and 37.8 % in the district of Kilteawlaelo. Implanon was the most common type of contraceptive used in both districts, urban (75 %) and rural (94 %). The odds of using the long acting contraceptive method were three times higher among married women in the rural areas as compared with the urban women [AOR = 3. 30; 95 %, CI:2.17, 5.04]. No or limited support from male partners was an obstacle to using long acting contraceptive method [AOR = 0. 24, 95 of CI: 0.13, 0.44]. Moreover, married women whose partner did not permit them to use long acting contraceptive [AOR = 0. 47, 95 % of CI: 0.24, 0.92] and women who attended primary education [AOR = 0.24, 95 %, CI: 0.13, 0.44] were significantly associated with long acting contraceptive use. CONCLUSION: Overall, the proportion of long acting contraceptive use has found to be low. Rural women were more likely to use long acting contraceptives as compared to urban women. Moreover, educational status and the partner's permission to use contraception could influence the utilization of long acting contraceptives.

Unintended pregnancy among female sex workers in Mekelle city, northern Ethiopia: a cross-sectional study.

BACKGROUND: Unintended pregnancy is a significant public health concern in the world. Particularly, female sex workers are exposed to the risk of unintended pregnancy, abortion and their consequences. The aim of this study was, therefore, to assess unintended pregnancy and associated factors among female sex workers in Mekelle city, northern Ethiopia. METHODS: A community based cross-sectional study was conducted among 346 female sex workers from five Kebelles (smallest administrative units in Ethiopia) of Mekelle city from March-April, 2014. Sex workers were selected with simple random sampling technique using sampling frame obtained from urban health extension program. Epi-data version 3.1 was used to enter data and analysis was done using SPSS version 20. Bivariate and multivariate logistic regressions were performed to identify factors associated with unintended pregnancy using odds ratio and 95% confidence interval with P-value of 0.05. RESULTS: The magnitude of unintended pregnancy among female sex workers in the past two years was 28.6%. During this period, 59 women had abortion which represents three-fifths, (59.6%), of those who had unintended pregnancies, and 17.1% of all female sex workers. Female sex workers who gave birth and had history of abortion formerly had 3.1 (AOR = 3.07, 95% CI: [1.54, 6.09]) and 15.6 (AOR = 15.64 95% CI: [8.03, 30.47]) times higher odds of unintended pregnancy compared to their counterparts, respectively. Sex workers who had steady partners had 2.9 (AOR = 2.87, 95% CI: [1.47, 5.61]) times higher odds of have unintended pregnancy than those who hadn't. Drug users had 2.7 (AOR = 2.68, 95% CI: [1.30, 5.52]) times higher odds of unintended pregnancy than those who hadn't use. Sex workers who had 60-96 months of duration in sex work were 67% less likely to have unintended pregnancy than those with <12 months (AOR = 0.33, 95% CI: [0.11, 0.95]). CONCLUSIONS: High level of unintended pregnancy and a range of associated factors were identified among sex workers. Improving utilization of effective pregnancy prevention methods in a consistent manner can avert the existing high level of unintended pregnancy among female sex workers.

Prevalence and predictors of sexual violence among commercial sex workers in Northern Ethiopia.

BACKGROUND: Gender-based violence is a natural outgrowth of the stigma and discrimination experienced by commercial sex workers (CSWs) across the globe. In light of this, the current study aimed to describe the prevalence and character of sexual violence, as well as any risk factors for violence, experienced by CSWs in Mekelle City, Northern Ethiopia. METHODS: A cross-sectional study was conducted in Mekelle City in April 2013. 250 CSWs were selected for participation using simple random sampling. Data were collected via a questionnaire instrument. Descriptive statistics and multiple logistic regression analyses were performed using SPSS 20 for Windows. RESULTS: The overall prevalence of sexual violence among CSWs was 75.6 %. Basic literacy [(AOR = 5.3, 95 % of CI (1.15-25.20)], completion of only elementary school [AOR = 6.9, 95 % of CI (1.55-31.25)], completion of only high school [AOR = 7.9, 95 % of CI (1.65-38.16)], being married [(AOR = 3.8, 95 % CI (1.34-11.09)], engaging in sex work for 1-4 years [(AOR = 5.3, 95 % CI(1.7-16.2)] and drug use [AOR = 5.3, 95 % of CI (1.78-16.21)] were all significant risk factors for sexual violence. CSWs with lower monthly income were also more likely to experience sexual violence; monthly income of 51.2-101.9 USD yielded AOR = 2.4 (95 % CI 1.12-5.37) and monthly income of 102.2-153.1 USD yielded AOR = 7.9 (95 % CI 2.46-25.58), compared to CSWs earning 153.2 USD or more. CONCLUSION: The prevalence of sexual violence among CSWs is high. Lower educational attainment, being married, lower monthly income, drug use, and shorter duration of sex work are all risk factors for sexual violence.

DETERMINANT FACTORS OF VISUAL INSPECTION WITH ACETIC ACID (VIA) POSITIVE LESIONS AMONG HIV POSITIVE WOMEN IN MEKELLE HOSPITAL, NORTHERN ETHIOPIA: A CASE CONTROL STUDY.

BACKGROUND: Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women living with HIV/AIDS are at greater risk of developing cervical cancer. The study aimed to identify the determinant factors forsuspected precancerous cervical lesions among HIV- positive women in Mekelle hospital, Ethiopia. METHODS: Anunmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. In Mekelle Hospital, routine screening for lesions of the cervix uteri by visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses. Suspicious findings are treated by cryotherapy or referred to the Gynaecologist. A number of 116 cases, who had suspicious findings on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study The determinant factors for precancerous cervical lesion were analyzed using multiple logistic regression and described as adjusted odds ratio (AOR). RESULTS: HIV positive women who had CD4 cells less than 350/mm3 were two times more likely to have precancerous cervical lesion compared to those with CD4 cells above 350/mm3. Women with two (AOR = 3.6; 95% CI: 1.7, 7.7) and three (AOR = 2.5; 95% CI: 1.2, 5.4) sexual partners were four and three times more likely to have precancerous cervical lesion, respectively, as compared to those who had one sexual partner. Age, History of STI and duration of ART had no influence on presence of VIA positive lesions in HIV positive women. CONCLUSION: CD4 count cells and number of sexual partners were predictors of VIA positive cervical lesion among HIV positive women.

HIV disclosure to sexual partner and associated factors among women attending ART clinic at Mekelle hospital, Northern Ethiopia.

BACKGROUND: Disclosure of HIV positive status has two sets of contrary effects. It may motivate partner for Voluntary Counseling and Testing; on the other hand, it may cause blame, discrimination, depression and loss of economic support. Consequently, HIV positive status disclosure among women has become one of the major concerns that should be addressed in HIV prevention and control activities. This study aimed at assessing the magnitude and factors related to HIV positive status disclosure to sexual partners among HIV positive women. METHODS: A cross sectional study was conducted in Mekelle hospital from July 10-26, 2013 to collect data from 315 HIV positive women using a systematic random sampling. Descriptive and multiple logistic regression analyses were performed using SPSS 20 for windows to estimate indicators and effect sizes of the predictors on HIV disclosure status to partners. RESULTS: The proportion of HIV disclosure status to their partner was 63.8%. Women who knew the HIV status of their sexual partner and those who got pretest counseling had a positive association with HIV disclosure with AOR of 16.9 (95% CI: 8.11, 35.21) and AOR of 2.8 (95% CI: 1.83, 4.28). Mothers with two years or beyond, since they knew their HIV status had more odds (AOR = 3. 2, 95% CI: 1.7, 6.29) to disclose their HIV status to their partner. Mothers who had seen people with HIV positive who disclose their HIV status to the community (AOR = 2.1, 95% CI: 1.08, 4.01) and those who had a discussion prior to HIV testing (AOR = 4.87, 95% CI: 2.45, 9.71) were more likely to disclose their HIV status than their counterparts. CONCLUSIONS: The rate of HIV disclosure to their partner was low. Knowledge of HIV status of partner, receiving pretest counseling, longer time since the HIV testing, know people who disclose their status to the community and having discussion prior to HIV testing could influence disclosure of HIV status of mothers to their partners.

Individual and community level factors associated with modern contraceptive utilization among women in Ethiopia: Multilevel modeling analysis.

BACKGROUND: Modern contraceptive utilization is the most effective intervention to tackle unintended pregnancy and thereby reduce abortion and improve maternal, child, and newborn health. However, multilevel factors related to low modern contraceptive utilization and the robust analysis required for decision-making were scarce in Ethiopia. OBJECTIVE: To investigate the individual and community-level predictors of modern contraceptive utilization among reproductive-age women in Ethiopia. METHODS: We utilized data from a cross-sectional 2019 Performance Monitoring for Action Ethiopia survey. The survey employed a stratified two-stage cluster sampling method to select households for inclusion. In Stata version 16.0, the data underwent cleaning, aggregation, and survey weighting, following which a descriptive analysis was performed utilizing the "svy" command. Subsequently, the primary analysis was executed using R software version 4.1.3. We fitted a two-level mixed effects logistic regression model on 6,117 reproductive-age women nested within 265 enumeration areas (clusters). The fixed effect models were fitted. The measures of variation were explained by intra-cluster correlation, median odds ratio, and proportional change in variance. The shrinkage factor was calculated to estimate the effects of cluster variables using the Interval odds ratio and proportion opposed odds ratio. Finally, the independent variables with a significance level of (P<0.05) and their corresponding Adjusted Odds ratios and 95% confidence intervals were described for the explanatory factors in the final model. RESULTS: In Ethiopia, the prevalence of modern contraceptive utilization was only 37.% (34.3 to 39.8). Women who attained primary, secondary, and above secondary levels of education were more likely to report modern contraceptive utilization with AOR of 1.47, 1.73, and 1.58, respectively. Divorced/widowed women were less likely to report modern contraceptive utilization (AOR:0.18, 95% CI 0.13,0.23) compared to never-married women. Discussions between women and healthcare providers at the health facility about family planning were positively associated with modern contraceptive utilization (AOR:1.84, 95% CI: 1.52, 2.23). Community-level factors have a significant influence on modern contraceptive utilization, which is attributed to 21.9% of the total variance in the odds of using modern contraceptives (ICC = 0.219). Clusters with a higher proportion of agrarian (AOR: 2.27, 95% CI 1.5, 3.44), clusters with higher literacy (AOR: 1.46, 95% CI 1.09, 1.94), clusters with empowered women and girls about FP (AOR: 1.47, 95% CI 1.11, 1.93) and clusters with high supportive attitudes and norms toward FP (AOR: 1.37, 95% CI 1.04, 1.81) had better modern contraceptive utilization than their counterparts. CONCLUSION: In Ethiopia, understanding the factors related to modern contraceptive use among women of reproductive age requires consideration of both individual and community characteristics. Hence, to enhance family planning intervention programs, it is essential to focus on the empowerment of women and girls, foster supportive attitudes towards family planning within communities, collaborate with education authorities to enhance overall community literacy, pay special attention to pastoralist communities, and ensure that reproductive-age women as a whole are targeted rather than solely focusing on married women.

Determinants of unmet need for modern contraceptives in Ethiopia.

OBJECTIVE: To identify the determinants of the unmet need for modern contraceptives in Ethiopia. DESIGN: Community-based cross-sectional study. SETTING: Ethiopia. PARTICIPANTS: A group of 6636 women of reproductive age (15-49 years) who were sexually active were included in the study. OUTCOME: Unmet need for modern contraceptives METHOD: The study used data from the 2019 Performance Monitoring for Action-Ethiopia survey, which was community-based and cross-sectional. The sample consisted of women aged 15-49 from households randomly selected to be nationally representative. Multinomial logistic regression and spatial analysis were performed to determine the factors influencing unmet needs for modern contraceptives. The descriptive analysis incorporated svy commands to account for clustering. RESULTS: The proportion of unmet need for modern contraceptives was 19.7% (95% CI: 18% to 21.5%). Women with supportive norms towards family planning had a lower risk of unmet need for spacing (relative risk ratio (RRR)=0.92, 95% CI: 0.86 to 0.99). Older age lowered the risk of unmet need for spacing 40-44 (RRR=0.28, 95% CI: 0.13 to 0.59) and 45-49 (RRR=0.11, 95% CI: 0.04 to 0.31). Being married increased the unmet need for spacing (RRR=1.9, 95% CI: 1.36 to 2.7) and limiting (RRR=3.7, 95% CI: 1.86 to 7.4). Increasing parity increases the risk of unmet need for spacing (RRR=1.27, 95% CI: 1.16 to 1.38) and limiting (RRR=1.26, 95% CI: 1.15 to 1.4). Contrarily, older age increased the risk of unmet need for limiting 40-44 (RRR=10.2, 95% CI: 1.29 to 79.5), 45-49 (RRR=8.4, 95% CI: 1.03 to 67.4). A clustered spatial unmet need for modern contraceptives was observed (Global Moran's I=0.715: Z-Score=3.8496, p<0.000118). The SaTScan identified 102 significant hotspot clusters located in Harari (relative risk (RR)=2.82, log-likelihood ratio (LLR)=28.2, p value<0.001), South Nations Nationalities and People, Oromia, Gambella and Addis Ababa (RR=1.33, LLR=15.6, p value<0.001). CONCLUSIONS: High levels of unmet need for modern contraceptives were observed in Ethiopia, showing geographical variations. It is essential to address the key factors affecting women and work towards reducing disparities in modern contraceptive unmet needs among different regions.

Women's decision-making power regarding family planning use and associated factors in Ethiopia: A systematic review and meta-analysis.

Objective: Although emphasis is placed on women's decision-making power regarding family planning use in Ethiopia, the utilization of contraceptives is low. There are studies conducted in different parts of the country on women's decision-making power regarding family planning use; however, there are inconsistent findings. Thus, this study aimed to determine the pooled prevalence of women's decision-making power regarding family planning use and associated factors in Ethiopia. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to develop the systematic review and meta-analysis. All observational studies were retrieved from online databases, including PubMed, CINAHL, Google Scholar, African Journal Online and gray literature. The data search was performed from 1 December to 16 May 2022. The quality of the studies was critically assessed using the Joanna Briggs Institute checklist. Heterogeneity among studies was examined using the I 2 statistic. RevMan version 5.3 and STATA version 14 software were used for analysis. Results: A total of 852 studies were retrieved, and 8 studies were included in the final meta-analysis. The pooled prevalence of women's decision-making power regarding family planning use was 57 (95% confidence interval: 37, 77). Good knowledge of family planning methods (odds ratio: 2.46, 95% confidence interval: 1.65, 3.67), a positive attitude toward family planning methods (odds ratio: 2.04, 95% confidence interval: 1.3, 3.2), and having primary or higher education (odds ratio: 9.76, 95% confidence interval: 4.36, 21.99) were associated with increased odds of women's decision-making power regarding family planning use. Conclusion: Nearly three in five married women made decisions regarding family planning use in Ethiopia. Women with good knowledge of family planning methods, a positive attitude toward family planning methods, and women having primary or higher education were associated with increased odds of women's decision-making power regarding family planning use.

A systematic review and meta-analysis of sexually transmitted infection prevention practices among Ethiopian young people.

Objective: Approximately 178.5 million new cases of treatable sexually transmitted infections are thought to be diagnosed each year among young people worldwide who are between the ages of 15 and 24 years. The results regarding sexually transmitted infection prevention studies in Ethiopia are not consistent. Therefore, the objective of this systematic review and meta-analysis was to determine the pooled prevalence of sexually transmitted infection prevention methods among young people in Ethiopia. Methods: The systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Between 5 January and 18 May 2022, published studies were searched using online databases such as PubMed, CINAHL, African Online Journal, and Google Scholar. The quality of the study was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. A random-effects model was used for the statistical analysis using STATA version 14 software. Results: A total of 3331 studies were searched, and five studies with a total of 1925 participants were included in the final meta-analysis. The pooled prevalence of preventive practice toward sexually transmitted infections was 54% (95% confidence interval: 44, 64). According to a subgroup analysis based on regional state, the prevalence was highest in the southern region, at 66% (95% CI: 59, 73), and lowest in the Amhara region, at 42% (95% confidence interval: 38, 45). Institution-based studies had high heterogeneity, according to a subgroup analysis based on study setting (I 2 = 95.39%, p value 0.001). Conclusion: Almost one in every two young people is engaged in preventive practices. This is lower than the World Health Organization global health sector strategy target (70%) for sexually transmitted infections. A subgroup analysis based on regional state and study setting showed a variation in the prevalence of preventive practices and significant heterogeneity among the regions.