Inequalities in adherence to the continuum of maternal and child health service utilization in Ethiopia: multilevel analysis.

BACKGROUND: Despite progress made to improve access to child health services, mothers' consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use. METHOD: The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services. RESULTS: The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization. CONCLUSION: The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services.

Alterations in conjunctival bacteria and antimicrobial susceptibility during topical administration of ofloxacin after cataract surgery in dogs.

OBJECTIVE To evaluate changes in conjunctival bacteria and antimicrobial susceptibility of bacteria after cataract surgery in dogs. ANIMALS 16 client-owned dogs. PROCEDURES Samples for aerobic and anaerobic culture were obtained from the conjunctival fornices of both eyes of dogs 24 hours before (week 0) and 1, 3, and 6 weeks after cataract surgery. Topical administration of ofloxacin (every 6 hours) was initiated 12 hours before surgery and continued for 3 weeks. In vitro antimicrobial susceptibility was determined by Kirby-Bauer disk diffusion and a commercially available test for ofloxacin. RESULTS Frequency of positive culture results was significantly higher at week 6 than at weeks 0 and 1. Bacterial load was more likely to be moderate or high at weeks 3 and 6 than at weeks 0 and 1. The most frequently cultured organism was Staphylococcus pseudintermedius (21/78 [26.9%]), followed by coagulase-negative Staphylococcus spp (19/78 [24.4%]). Staphylococcus pseudintermedius was the organism most frequently cultured at weeks 0 (5/12), 1 (4/12), and 6 (8/19), whereas frequency of this organism was lowest at week 3 (1/20). In contrast, coagulase-negative Staphylococcus spp were the most frequently cultured organisms at week 3 (10/20). There was a significant increase in the proportion of organisms resistant to ofloxacin at week 3, compared with the proportion at week 0. CONCLUSIONS AND CLINICAL RELEVANCE The number of bacterial organisms increased and the population of conjunctival bacteria was altered and had a higher proportion resistant to ofloxacin during the 6 weeks after cataract surgery for dogs treated by use of this protocol.