Utilization of preconception care and associated factors among pregnant women attending ANC in private MCH Hospitals in Addis Ababa, Ethiopia.

BACKGROUND: Despite its benefit in promoting maternal health and the health of her developing fetus, little is known about preconception care practice and its associated factors in Ethiopia. Moreover, preconception care utilization in private hospitals is not known. The purpose of this study, therefore, is to determine the utilization of preconception health care services and its associated factors among pregnant women following antenatal care in the private Maternal and Child Health hospitals in Addis Ababa. METHODS: A Hospital based cross-sectional study was conducted from April 1 to April 30,2022 among 385 women attending ANC in private MCH hospitals. Bestegah and Hemen MCH hospitals were selected by convenience method. Data were collected by a pretested self-administered semi-structured questionnaire. To identify the factors associated with the utilization of preconception care, bivariable and multivariable logistic regression analysis were performed. Adjusted odds ratios with 95% confidence interval were estimated to assess the strength of associations, and statistical significance was declared at a p-value < 0.05. RESULTS: The utilization of preconception care among the pregnant mothers according to our study was 40%. Professional/technical/managerial occupation (AOR = 4.3, 95%CI = 1.13, 16.33, P < 0.032), having good knowledge on preconception care (AOR = 3.5, 95%CI = 1.92, 6.53, P < 0.000), having unintended pregnancy (AOR = 0.1, 95%CI = 0.03, 0.42, P < 0.001), history of family planning use before conception (AOR = 3.9, 95%CI = 1.20, 12.60, P < 0.023), having pre-existing medical disease(s) (AOR = 8.4, 95%CI = 2.83, 24.74, P < 0.002), and having adverse pregnancy outcome(s) in previous pregnancies (AOR = 3.2, 95%CI = 1.55, 6.50, P < 0.000) were significantly associated with preconception care utilization. CONCLUSIONS: This study found out that the utilization of preconception care in the private MCH hospitals is still low i.e., only 40%. Occupation, level of knowledge, having unintended pregnancy, history of family planning use before conception, having adverse pregnancy outcome(s) in previous pregnancy and having pre-existing medical disease(s) were independently associated with preconception care utilization. Lack of awareness about the availability of the services and having an unintended pregnancy were the main reasons for not utilizing preconception care.

Use of magnesium sulfate in pre-eclampsia and eclampsia in teaching hospitals in Addis Ababa: a practice audit.

BACKGROUND: Magnesium sulphate is shown to be the drug of choice in the management of severe pre-eclampsia-eclampsia for over two decades. However, the drug was introduced in practice in teaching hospitals in Addis Ababa recently. Hence, it is important to audit its use at this stage. OBJECTIVES: To audit the experience of magnesium sulfate use for management of severe pre-eclampsia and eclampsia on its introduction in teaching hospitals in Addis Ababa. METHODOLOGY: A retrospective medical record review was conducted to audit use of magnesium sulfate, MgSO4, in two teaching hospitals in Addis Ababa between February and August 2006. RESULTS: One hundred three women received magnesium sulfate during the study period (February to August, 2006). It was possible to retrieve the charts of 95 women (92.2% chart retrieval rate). Seventy-four percent (54/73) of the eligible cases from Tikur Anbesa Hospital and 63.6% (49/77) from Gandhi Memorial Hospital received the drug. Patient selection for administration of magnesium sulfate was appropriate in 93.7% (89/95) of women with hypertension in pregnancy. Correct loading dose of MgSO4 was given for 90.4% (85/95) of the patients. No woman with severe pre-eclampsia convulsed after initiation of magnesium sulfate, while four of the eclamptic mothers had recurrence of seizures. The overall clinical monitoring of patients who were on treatment was inadequate with respect to the protocol of the hospitals. Only one (1.1%) woman was reported to have developed signs of a major side effect of magnesium sulfate and two mothers died. Both of these deaths were not attributed to magnesium sulfate toxicity. CONCLUSION AND RECOMMENDATIONS: This study showed that a good proportion (more than two-thirds) of the eligible cases has received magnesium sulfate. It is recommended that the respective hospitals should give due attention to the suboptimal patient monitoring.

Histopathological Changes of Placenta Associated with Maternal Anaemia in Northeast Ethiopia: A Comparative Study.

BACKGROUND: Anaemia during pregnancy affects about half of all pregnant mothers in developing countries; it is the major causes of indirect maternal mortality. Anaemia can directly cause poor growth of fetus in utero due to inadequate oxygen flow to the placental tissue or it is indirect indicator of maternal nutritional deficiency. Mal-development of placenta is the leading cause of maternal and perinatal mortality and an important factor of fetal growth retardation. The aim of this study was to compare histopathological changes of placenta associated with maternal anaemia. METHODS: A comparative cross-sectional study was conducted from May-June, 2018 in Dessie Referral Hospital. A total of 66 placentas (33 anaemic and 33 non-anaemic) were collected after delivery. EPI data version 4.2.0 was used to enter the data while the data were analyzed by using SPSS version 22. Chi-square and one-way ANOVA were used to analyze the data. RESULTS: In pregnancies with maternal anaemia, 75.7% of anaemic placentas terminal villi vessels were increased in number, compared to 15.1% in non-anaemic (p=0.001). Placental calcification was 72.7% in anaemic groups compared to 54% in non-anaemic groups. However, it was insignificant (p=0.12). Intervillous space was wider in anaemic compared to non-anaemic groups (p<0.001). CONCLUSIONS: Chorionic villi capillaries were increased in number, and it was dilated in anaemic placenta, compared to non-anaemic. Intervillous space was significantly wider in anaemic placenta.

Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials.

BACKGROUND: UNICEF/WHO recommends that infants born to HIV-infected mothers who do not have access to acceptable, feasible, affordable, sustainable, and safe replacement feeding should be exclusively breastfed for at least 6 months. The aim of three trials in Ethiopia, India, and Uganda was to assess whether daily nevirapine given to breastfed infants through 6 weeks of age can decrease HIV transmission via breastfeeding. METHODS: HIV-infected women breastfeeding their infants were eligible for participation. Participants were randomly assigned to receive either single-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborns after birth) or 6 week extended-dose nevirapine (nevirapine 200 mg to women in labour and nevirapine 2 mg/kg to newborn babies after birth plus nevirapine 5 mg daily from days 8-42 for the infant). The randomisation sequences were generated by computer at a central data coordinating centre. The primary endpoint was HIV infection at 6 months of age in infants who were HIV PCR negative at birth. Analyses were by modified intention to treat, excluding infants with missing specimens and those with indeterminate or confirmed HIV infection at birth. These studies are registered with ClinicalTrials.gov, numbers NCT00074399, NCT00061321, and NCT00639938. FINDINGS: 2024 liveborn infants randomised in the study had at least one specimen tested before 6 months of age (1047 infants in the single-dose group and 977 infants in the extended-dose group). The modified intention-to-treat population included 986 infants in the single-dose group and 901 in the extended-dose group. At 6 months, 87 children in the single-dose group and 62 in the extended-dose group were infected with HIV (relative risk 0.80, 95% CI 0.58-1.10; p=0.16). At 6 weeks of age, 54 children in the single-dose group and 25 in the extended-dose group were HIV positive (0.54, 0.34-0.85; p=0.009). 393 infants in the single-dose group and 346 in the extended-dose group experienced grade 3 or 4 serious adverse events during the study (p=0.54). INTERPRETATION: Although a 6-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at 6 weeks of age, the lack of a significant reduction in the primary endpoint-risk of HIV transmission at 6 months-suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breast milk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high. FUNDING: US National Institutes of Health; US National Institute of Allergy and Infectious Diseases; Fogarty International Center.

Cesarean scar endometriosis--a case report.

Scar endometriosis is a rare event which usually develops after pelvic operations involving the uterus and fallopian tubes. Its diagnosis can sometimes be difficult and may be confused with various other surgical conditions. We present here a case of abdominal wall scar endometriosis in a woman who has undergone cesarean delivery four years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this condition will be discussed in brief. This is an interesting case of surgical scar endometriosis and to the best of our knowledge this is the first case report in Ethiopia.

Sexual violence and use of contraception among women with unwanted pregnancy in an Ngo Clinic, Addis Ababa.

BACKGROUND: Sexual violence is one of the most prevalent but underreported incidents. One among many consequences of sexual violence is unwanted pregnancy. OBJECTIVES: To describe events related to and factors associated with sexual violence among women with unwanted pregnancy and describe knowledge and use of contraception among these women with unwanted pregnancy. METHODS: This cross-sectional study was done at one NGO clinic in Addis Ababa. Data was collected from women with unwanted pregnancy seeking termination of pregnancy using a structured questionnaire in March 2003. Sociodemographic variables were analyzed with selected variables related to sexual violence, knowledge and practice of contraception among these women seeking termination of pregnancy. RESULTS: Of the 394 women seeking termination of pregnancy, there was unwelcome kiss in 26.9%, attempted rape in 23.9% and completed rape in 18.3%. Most, 63/72 (87.5%), of the victims of completed rape were below 25 years of age. A linear trend was observed with increasing age (P < 0.05, X2 = 24.365). Unmarried and economically dependent groups were more vulnerable to rape related pregnancy, P < 0.05. Only 18/72 (25%) reported to the police. Psychological problems were common in women with completed rape. Suicidal thoughts was reported by 8/72 (11%). Only 84/394 (21.3%) used contraceptives of which 29/84 (34.5%) used emergency contraceptives. CONCLUSION: Unwanted pregnancy as a result of rape was observed more in younger, unmarried and economically dependent women. Use of contraception including emergency contraception, reporting to legal authorities and health professionals was low.

Admissions in second stage of labor in two teaching hospitals: obstetric outcomes and determining factors.

INTRODUCTION: Unmonitored labor and the second stage of labor are generally considered to be associated with increased maternal and neonatal complications. Study of admissions in the second stage of labor is important to understand the situation. OBJECTIVE: assess determinant factors and compare obstetric outcome of women admitted in second stage of labor with women admitted in the active phase of first stage of labor. METHODOLOGY: This is a case control study conducted between March and April 2002 in two teaching hospitals in Addis Ababa, Ethiopia. RESULTS: Of the total 755 deliveries 148 (20%) were admitted in the second stage of labor. Illiterates, housewives, students and house maids---are significantly likely to be admitted in second stage of labor, OR 3.0, 4.6, 5.7 and 9.3, respectively. Significant association was observed between admission in second stage of labor and unknown last menstrual period, OR 5.6, 2.02-2.67. Main reasons for coming late included problems related to referral, decision-making, transport, money and delay within hospitals in 64.2%, 29.2%, 25.5%, 19% and 11.7%, respectively. Significant association was observed in rates of uterine rupture/obstructed labor and prolonged rupture of membranes in cases, OR 10.7 and 2.2, respectively. Fifth minute apgar score of < or = 3 was significantly higher in newborns of mothers admitted in second stage, OR 2.46, 1.12, 5.42. Neonatal ICU admission and perinatal loss were higher in mothers admitted in second stage though not significant. CONCLUSION: Education, occupational status, economic problems, place of residence and institutional problems are determinants for admission in second stage. Maternal and perinatal complications are common in the cases. Timely referral, anticipation and management of complications related with admission in second stage is recommended.

The health system cost of postabortion care in Ethiopia.

To address the knowledge gap that exists in costing unsafe abortion in Ethiopia, estimates were derived of the cost to the health system of providing postabortion care (PAC), based on research conducted in 2008. Fourteen public and private health facilities were selected, representing 3 levels of health care. Cost information on drugs, supplies, material, personnel time, and out-of-pocket expenses was collected using an ingredients approach. Sensitivity analysis was used to determine the most likely range of costs. The average direct cost per client, across 5 types of abortion complications, was US $36.21. The annual direct cost nationally ranged from US $6.5 to US $8.9 million. Including indirect costs and satisfying all demand increased the annual national cost to US $47 million. PAC consumes a large portion of the total expenditure in reproductive health in Ethiopia. Investing more resources in family planning programs to prevent unwanted pregnancies would be cost-beneficial to the health system.

Slower clearance of nevirapine resistant virus in infants failing extended nevirapine prophylaxis for prevention of mother-to-child HIV transmission.

Nevirapine resistance mutations arise commonly following single or extended-dose nevirapine (ED-NVP) prophylaxis to prevent mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), but decay within 6-12 months of single-dose exposure. Use of ED-NVP prophylaxis in infants is expected to rise, but data on decay of nevirapine resistance mutations in infants in whom ED-NVP failed remain limited. We assessed, in Ethiopian infants participating in the Six-Week Extended Nevirapine (SWEN) Trial, the prevalence and persistence of nevirapine resistance mutations at 6 and 12 months following single-dose or up to 6 weeks of ED-NVP, and correlated their presence with the timing of infection and the type of resistance mutations. Standard population genotyping followed by high-throughput cloning were done on dried blood spot samples collected during the trial. More infants who received ED-NVP had nevirapine resistance detected by standard population genotyping (high frequencies) at age 6 months compared with those who received single-dose nevirapine (SD-NVP) (58% of 24 vs. 26% of 19, respectively; p = 0.06). Moreover, 56% of ED-NVP-exposed infants with nevirapine resistance at age 6 months still had nevirapine resistance mutations present at high frequencies at age 1 year. Infants infected before 6 weeks of age who received either SD- or ED-NVP were more likely to have Y181C or K103N; these mutations were also more likely to persist at high frequencies through 1 year of age. HIV-infected infants in whom ED-NVP prophylaxis fails are likely to experience delayed clearance of nevirapine-resistant virus in the first year of life, which in turn places them at risk for early selection of multidrug-resistant HIV after initial therapy with nonnucleoside reverse transcriptase inhibitor-based regimens.

Caring for women with abortion complications in Ethiopia: national estimates and future implications.

CONTEXT: Ethiopia liberalized its abortion law in 2005, primarily to reduce the incidence of unsafe abortion. However, little is known about the current extent and consequences of unsafe abortion. METHODS: Data were collected in 2007-2008 on 1,932 women seeking postabortion care at a nationally representative sample of 344 public and private health facilities. In addition, staff respondents at 337 facilities provided information on their facility's services and caseload. These data were used to examine patterns of abortion-related morbidity and treatment and to generate national estimates. RESULTS: Almost 58,000 women sought care for complications of induced or spontaneous abortion in 2008. Three-quarters of the women received care in government facilities. Forty-one percent had moderate or severe morbidity, such as signs of infection, that were likely related to an unsafe abortion. Seven percent of all women had signs of a mechanical injury or a vaginally inserted foreign body. More than 13,000 women seeking postabortion care required a hospital stay of at least 24 hours. The case fatality rate among women seeking postabortion care in public hospitals, where the most serious complications were seen, was 628 per 100,000. CONCLUSIONS: Postabortion care and safe abortion services should be further expanded and strengthened to make these services more accessible and affordable, which in turn may ease the financial burden on hospitals and allow the resources currently required for postabortion care to be used for other health needs. Ensuring that all women know that safe abortion is available and legal for many indications will further reduce morbidity from unsafe abortions.

The estimated incidence of induced abortion in Ethiopia, 2008.

CONTEXT: Unsafe abortion is an important health problem in Ethiopia; however, no national quantitative study of abortion incidence exists. In 2005, the penal code was revised to broaden the indications under which induced abortion is legal. It is important to measure the incidence of legal and illegal induced abortion after the change in the law. METHODS: A nationally representative survey of a sample of 347 health facilities that provide postabortion or safe abortion services and a survey of 80 professionals knowledgeable about abortion service provision were conducted in Ethiopia in 2007-2008. Indirect estimation techniques were applied to calculate the incidence of induced abortion. Abortion rates, abortion ratios and unintended pregnancy rates were calculated for the nation and for major regions. RESULTS: In 2008, an estimated 382,000 induced abortions were performed in Ethiopia, and 52,600 women were treated for complications of such abortions. There were an estimated 103,000 legal procedures in health facilities nationwide--27% of all abortions. Nationally, the annual abortion rate was 23 per 1,000 women aged 15-44, and the abortion ratio was 13 per 100 live births. The abortion rate in Addis Ababa (49 per 1,000 women) was twice the national level. Overall, about 42% of pregnancies were unintended, and the unintended pregnancy rate was 101 per 1,000 women. CONCLUSIONS: Unsafe abortion is still common and exacts a heavy toll on women in Ethiopia. To reduce rates of unplanned pregnancy and unsafe abortion, increased access to high-quality contraceptive care and safe abortion services is needed.