Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020.

INTRODUCTION: Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. METHODS AND MATERIALS: The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. RESULTS: The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. CONCLUSION: The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.

Predictors of Uterine Rupture After One Previous Cesarean Section: An Unmatched Case-Control Study.

Background: Uterine rupture is a rare occurrence but has catastrophic complications during pregnancy. The incidence is relatively higher in scarred uteri because there is a promotion of labor after cesarean section. There is a scarcity of evidence from low-income countries regarding the predictors of uterine rupture after trial labor. Objective: To assess factors determining uterine rupture during labor after the previous cesarean section among mothers delivered at Hawassa University Comprehensive Specialized Hospital from September 2017 to September 2022. Methods: A facility-based unmatched case-control study was done by reviewing 105 patients, which included 35 cases and 70 controls in a 1:2 case-to-control ratio. The association between dependent and independent variables was sought with running binary and multivariate analyses by using the cut point of a p value < 0.05 and 95% CI. Results: The prevalence of uterine rupture is 1.6%. The factors significantly associated with uterine rupture after trial of labor are fetal weight >3.8 kg (AOR: 5.21), antenatal care 4 (AOR: 3.6), labor duration >15 hours (AOR: 10.7), and previous successful vaginal delivery (AOR: 3.4). Poor fetal-maternal outcomes like 91.4% fetal death, 29 hysterectomies, 22 blood transfusions, and 1 death. Conclusion: The prevalence is relatively higher than in developed countries. The number of antenatal care, labor duration, and lower fetal weight are not common findings associated with uterine rupture after trial of labor across the literature, so large-scale studies are needed to develop guidelines for the Ethiopian setup. Improving the quality of obstetrics care given in each level of health system.

Prevalence and Associated Factors of Poststroke Depression among Outpatient Stroke Patients Who Have a Follow-Up at the Outpatient Neurology Clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

Background: Poststroke depression is the most common and burdensome poststroke psychiatric complication. Studies showed discrepancies in reporting frequencies and risk factors for poststroke depression. Updated local data are relevant for efficient strategies of poststroke depression screening and prevention. Objectives: To determine the prevalence and associated factors of poststroke depression among outpatient stroke patients from the outpatient neurology clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Methods: An institution-based cross-sectional study was conducted on 249 stroke patients. Data was collected through structured questionnaire using interviews and a review of medical charts. PHQ-9 depression questionnaire was used to diagnose poststroke depression. Descriptive analysis was used to see the nature of the characteristics of interests. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using an odds ratio with 95% CI and p value < 0.05. Results: Point prevalence for poststroke depression was 27.5 percent. Female gender, unemployment, low social support level, diabetes mellitus, and poststroke period under 2 years were statistically significant and independent predictors for poststroke depression. Conclusions: The point prevalence estimate of poststroke depression was comparable with other studies. Low social support levels increased the odds for poststroke depression by more than eight folds. It appeared that external factors are more important in the pathogenesis of poststroke depression in the African population. Detection and prevention programs should consider disparities of poststroke depression incidence and risk factors.