Quality of Midwife-provided Intrapartum Care in Amhara Regional State, Ethiopia.

BACKGROUND: Despite much progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal and newborn deaths and stillbirths. Ethiopia's plan to meet the sustainable development goals for maternal and child health includes unprecedented emphasis on improving quality of care. The purpose of this study was to assess the quality of midwifery care during labor, delivery and immediate postpartum period. METHODS: A cross-sectional study using multiple data collection methods and a 2-stage cluster sampling technique was conducted from January 25 to February 14, 2015 in government health facilities of the Amhara National Regional State of Ethiopia. Direct observation of performance was used to determine competence of midwives in providing care during labor, delivery, and the first 6 h after childbirth. Inventory of drugs, medical equipment, supplies, and infrastructure was conducted to identify availability of resources in health facilities. Structured interview was done to assess availability of resources and performance improvement opportunities. Data analysis involved calculating percentages, means and chi-square tests. RESULTS: A total of 150 midwives and 56 health facilities were included in the study. The performance assessment showed 16.5% of midwives were incompetent, 72.4% were competent, and 11.1% were outstanding in providing routine intrapartum care. Forty five midwives were observed while managing 54 obstetric and newborn complications and 41 (91%) of them were rated competent. Inventory of resources found that the proportion of facilities with more than 75% of the items in each category was 32.6% for drugs, 73.1% for equipment, 65.4% for supplies, 47.9% for infection prevention materials, and 43.6% for records and forms. Opportunities for performance improvement were inadequate, with 31.3% reporting emergency obstetric and newborn care training, and 44.7% quarterly or more frequent supportive supervision. Health centers fared worse in provider competence, physical resources, and quality improvement practices except for supportive supervision visits and in-service training. CONCLUSIONS: Although our findings indicate most midwives are competent in giving routine and emergency intrapartum care, the major gaps in the enabling environment and the significant proportion of midwives with unsatisfactory performance suggest that the conditions for providing quality intrapartum care are not optimal.

Obesity in young age is a risk factor for preeclampsia: a facility based case-control study, northwest Ethiopia.

BACKGROUND: Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy. For many years, obesity has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results. This study has aimed to estimate the effect of obesity and dietary habits on preeclampsia in Bahir Dar City, north-western Ethiopia. METHODS: A facility-based unmatched case-control study was conducted on 453 (151 cases and 302 controls) pregnant women, attending antenatal care or skilled delivery at Bahir Dar City. Data were collected through face to face interviews and measurements of mid-upper-arm circumference (MUAC) at the time of the interviews. Data were cleaned and entered into IBM SPSS version 20 and later analyzed using STATA version 12. Univariate and multivariate logistic regression analyses were employed to estimate the effect of independent variables on preeclampsia. Stratified analysis was conducted to check for presence of confounding and/or effect modification between covariates. RESULT: The odds of preeclampsia were higher among obese (MUAC ≥25 cm) women than their leaner counterparts (AOR = 3.33, 95 % CI: 1.87, 5.79). Obesity was also found to have a similar magnitude of risk for late onset preeclampsia (AOR = 3.63, 95 % CI: 1.89, 6.97). When stratified by age, the effect of obesity on overall and late onset preeclampsia was significant among young (age < 35 years) women (COR = 1.81, 95 % CI: 1.11, 2.99) and (COR = 2.09, 95 % CI: 1.16, 3.86), respectively. As the age groups became more homogenous through adjusted stratification, obesity showed a particularly significant effect in women age ≤24 and 25-29 years; (AOR = 2.31, 95 % CI: 1.06, 5.12) and (AOR = 3.66, 95 % CI: 1.37, 10.87) respectively. Similarly, the effect of obesity on late onset preeclampsia was evident among younger women age ≤24 and 25-29 years; (AOR = 3.16, 95 % CI: 1.21, 8.24) and (AOR = 1.98, 95 % CI: 1.16, 3.40) respectively. However, obesity has no significant effect on early onset of preeclampsia (AOR = 1.98, 95 % CI: 0.79, 4.94). On the other hand, compliance to folate supplementation during pregnancy and fruit consumption were associated with reduced risk of preeclampsia. CONCLUSION: Obesity in young age was found to be a risk factor for preeclampsia while compliance to folate supplement and adequate fruit consumption were found to be protective against preeclampsia. Promoting healthy life style, including body weight control, consumption of fruits and vegetables, and folate supplementation should be promoted to reduce the risk of preeclampsia.