Fistula in War-Torn Tigray: A Call to Action.

Fistula is roaring in the ongoing war on Tigray. The potential risk factors for fistula in the conflict zone include obstructed labour due to limited or absent maternal care services, a correlation between malnutrition-stunted growth and birth difficulties and trauma, and sexually transmitted infections (STIs) due to conflict-related sexual violence. As a call to action to mitigate the unimaginable suffering that women and girls are facing in the region, concerted international effort is needed to provide treatment, rehabilitation, and re-integration; secure peace and stability; rebuild the health-care system; and ensure perpetrators are held accountable.

Coverage of completion of four ANC visits based on recommended time schedule in Northern Ethiopia: A community-based cross-sectional study design.

BACKGROUND: Despite decades of implementation of maternal health care programs, the uptake of antenatal care services based on the recommended gestational age continues to be below the national and regional targets. Thus, this study aimed to assess the prevalence and factors related to the completion of four antenatal care visits among mothers who gave birth 6 months preceding the study. METHOD: We conducted a community-based cross-sectional study using both quantitative and qualitative approaches. The quantitative component included administering a pre-tested structured questionnaire to 466 mothers who gave birth 6 months preceding the study using a simple random sampling technique from respective Tabias. The quantitative result was analyzed using SPSS version 22. Bivariate and multivariate analysis was done to determine the association between independent and dependent variables. Variables were declared as statistically significant at P ≤ 0.05 in multivariable logistic regression model. The qualitative interview data were collected from eight mothers and four key informants recruited through purposive sampling method. RESULTS: The overall prevalence of completion of four ANC visits based on the recommended time schedule was 9.9% (95% CI, 7.1-12.4). However, 63.9% of the participants attended four visits or more regardless of the recommended time schedule. Being member of community health insurance (AOR 2.140, 95% CI, 1.032-4.436), walking on foot less than or equal one hour to reach the health facility (AOR 3.921, 95% CI, 1.915-8.031), having workload at home (AOR 0.369, 95% CI, 0.182-0.751), and husband supported during antenatal care (AOR 2.561, 95% CI, 1.252-5.240) were independently associated with the completion of four ANC visits based on the recommended time schedule in multivariable analysis. CONCLUSION: The completion of four ANC contacts based on the recommended time schedule remains low in rural areas of Northern Ethiopia. Being a member of community health insurance, distance to the health facility, workload, and male involvement were associated with the completion of four ANC visits based on the recommended time schedule. The existing health system should consider improving the recommended ANC visits by integrating Community based interventions.

Older siblings' influence on sexual behavior of high school adolescents in Mekelle, northern Ethiopia.

Background: Older siblings are one of the key sources of beliefs about sexual activity, including safe sexual practices, and can even exert pressure to engage in sexual activities. This effect persists beyond parental supervision and peer pressure. Despite this, although a considerable body of research has examined parental and peer influence, comparable data on older sibling influence on younger adolescent sexual behaviors are scant, and this area needs in-depth analysis. Objective: The objective of this study was to assess older siblings' influence on sexual behavior of high school adolescents in Mekelle, northern Ethiopia in 2017-2018. Methods: A cross-sectional study design was used, and a total of 285 adolescents who had ever had sex were sampled randomly from selected schools. Data were entered into Epi-info version 07 and exported to and analyzed with SPSS version 22. Means ± SD, frequency, percentage, and cross-tabulation were used to describe the result. Bivariate and multivariate logistic regression was fitted to compute older sibling influence. Results: Perceiving older sibling sexual behavior as risky increased adolescents' likelihood of engaging in risky sexual behavior. (AOR 4.52, 95% CI 2.59-7.89) whereas high intimacy with an older sibling (AOR 0.32, 95% CI 0.17-0.59) decreased the odds of risky sexual behavior (AOR 0.59, 95% CI 0.30-0.92). Conclusion: Older siblings had an influence on the sexual behavior of youngr adolescents. Perceiving older sibling sexual behavior as healthy and high sibling intimacy may serve as protective factors; however, risky sexual behavior of an older sibling can increase high school adolescents' likelihood for same. As such, families should realize that elders can affect their younger siblings' behavior, included the former in family strategies, and give them responsibility to protect their younger siblings.

Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia.

BACKGROUND: Missed nursing care is considered an error of omission and is defined as any aspect of required patient care that is omitted (either in part or whole) or significantly delayed. Nursing care missed in the perinatal setting can cause negative outcomes and repercussions for the quality and safety of care. This has been reported in multiple settings and countries and is tied to negative maternal outcomes. Preventing missed nursing care requires in-depth research considering the clinical setting. OBJECTIVE: The main aim of the study was to assess commonly missed nursing care elements, reasons, and factors for the omission in the obstetric and gynecologic units of general hospitals in Tigray 2017/18. METHODS AND MATERIALS: A cross-sectional study was conducted in eight randomly selected general hospitals in Tigray, Ethiopia. A total of 422 nurses and midwives were selected through simple random sampling using the staff list as a sampling frame. To identify the commonly missed nursing care and related factors, the MISSCARE survey tool was used. Descriptive, bivariate, and multivariate logistic regression analysis was performed to assess potential risk factors of nursing cares omission. RESULT: The study results showed that 299 (74.6%) participants commonly missed at least one nursing care in the perinatal setting. Labor resources 386(96.3%), teamwork 365(91%), material resources 361 (90%) and communication 342 (85.3%) were the reasons identified for commonly missing care. In the multivariate analyses, sex (p-value <0.001), educational level (p-value 0.034), working shift (p-value <0.001) and having an intention to leave the institution (p-value <0.001) showed a significant association with commonly missing care. CONCLUSION: The proportion of commonly missed nursing care was high. After adjusting for demographic variables, labor resources, material resources, and communication were reasons for commonly missed nursing care. Increasing male professional proportion, investing in nurses/midwives training, and harmonizing nursing service administration through appropriate working shift arrangement and timely assessment of professionals' stability and satisfaction could minimize frequent omission of nursing care.

Early Implanon discontinuation rate and its associated factors in health institutions of Mekelle City, Tigray, Ethiopia 2016/17.

OBJECTIVE: Contraceptive discontinuation rate is very common in most developing countries, especially removal in the first year of use is common (18-63%), and the majority of these discontinuations are among women who are still in need of contraception. So the objective of this study was assessing early Implanon discontinuation rate and its associated factors in the study area. Institutional based cross sectional study was conducted and systematic random sampling technique was employed to interview the study participants. A binary logistic regression model was used to test association. RESULT: In this study early Implanon discontinuation rate was 38%, 95% CI (32%, 44%). women who attend secondary [AOR: 95% CI 0.35 (0.14, 0.82)] and more than secondary school [AOR: 95% CI 0.23 (0.09, 0.59)] were less likely to remove Implanon early as compared to those illiterate. Mothers who were not counseled [AOR: 95% CI 2.45 (1.05, 5.69)] and those mothers who had a side effect of the method [AOR: 95% CI 2.66 (1.23, 5.72)] discontinue the method early. The study revealed that early Implanon discontinuation rate was high. Women's educational level, presence of side effect and effective counseling were independent predictors of early Implanon removal.