Prevalence, indications and fetal outcomes of operative vaginal delivery in Sub-Saharan Africa, systematic review, and meta-analysis.

PURPOSE: This systematic review and meta-analysis is intended to assess the prevalence, indications, and fetal outcome of operative vaginal delivery in sub-Saharan Africa. METHOD: In this study, 17 studies with a total population of 190,900 were included in both systematic review and meta-analysis. Search for relevant articles was done by using international online databases (like Google Scholar, PubMed, HINARI, EMBASE, Web of Science, and African journals) and online repositories of Universities in Africa. The JOANNA Briggs Institute standard data extraction format was used to extract and appraise high-quality articles before being included in this study. The Cochran Q and I2 statistical tests were used to test the heterogeneity of the studies. The publication bias was tested by a Funnel plot and Egger's test. The overall pooled prevalence, indications, and fetal outcome of operative vaginal delivery along a 95% CI using forest plots and tables. RESULT: The overall pooled prevalence of operative vaginal delivery in sub-Saharan Africa was 7.98% (95% CI; 5.03-10.65; I2 = 99.9%, P < 0.001). The indications of operative vaginal delivery in sub-Saharan African countries include the prolonged second stage of labor 32.81%, non-reassuring fetal heart rate 37.35%, maternal exhaustion 24.81%, big baby 22.37%, maternal cardiac problems 8.75%, and preeclampsia/eclampsia 2.4%. Regarding the fetal outcome, favourable fetal outcomes were 55% (95% CI: 26.04, 84.44), p = < 0.56, I2: 99.9%). From those births with unfavourable outcomes, the need for the resuscitation of new-born was highest 28.79% followed by poor 5th minute Apgar score, NICU admission, and fresh stillbirth, 19.92, 18.8, and 3.59% respectively. CONCLUSION: The overall prevalence of operative vaginal delivery (OVD) in sub-Saharan Africa was slightly higher compared to other countries. To reduce the increased applications and adverse fetal outcomes of OVD, capacity building for obstetrics care providers and drafting guidelines are required.

Acceptance of the Index Case HIV Testing and Associated Factors among Anti-Retroviral Therapy Patients in Public Health Facilities in Gedeo Zone, Southern Ethiopia. Cross-Sectional Study Design with Document Review.

Index case Human Immunodeficiency Virus (HIV) testing is a voluntary procedure wherein service providers request index clients to enumerate all sexual partners, including biological children, before proceeding with Human Immunodeficiency Virus (HIV) testing. This approach has demonstrated efficacy as a case-finding strategy aimed at curbing future transmission. Through index testing, we can pinpoint partners and children with undiagnosed infections, thereby facilitating early identification of Human Immunodeficiency Virus (HIV) -positive children who are currently healthy. The study aimed to assess the acceptance of index-case Human Immunodeficiency Virus (HIV) testing and its associated factors among anti-retroviral therapy (ART) patients in public health facilities within the Gedeo zone, southern Ethiopia. The study employed a cross-sectional design with a document review. It involved 396 anti-retroviral therapy (ART) patients and utilized a pretested checklist to extract data from clients' medical records. A simple random sampling technique was used to select anti-retroviral therapy (ART) facilities in the Gedeo zone. Data collection was done from anti-retroviral therapy (ART) patient documents by ODK-Kobo Collect form and data analysis was conducted using statistical package for social science (SPSS) version 25, with bivariate and multivariate analyses performed to identify associations between index case testing and associated factors. A significance level of P ≤ .05 was adopted. The findings were presented in textual format, tables, and graphs, providing a comprehensive overview of the results. The magnitude of the acceptance of the index case testing among anti-retroviral therapy (ART) patients was 240 (60.6% [95% CI: 56%-65%]). Concerning the adherence status of the index case, 156 (39.4%) and 54 (13.6%) had good and poor adherence, respectively. Duration on ART (AOR = 2.30 [95% CI: 1.86, 6.12]), HIV disclosure (AOR = 36.19 [95% CI: 7.26, 180.44]), and good ART adherence status (AOR = 14.52 [95% CI: 2.10, 100.2]) are found to be factors significantly associated with acceptance of index case testing. The study findings indicated that the overall acceptance rate of index case testing was 60%, which falls short of the national benchmark minimum acceptance rate of 95%. Factors significantly linked to the acceptance of index case testing included the duration of ART usage, disclosure of HIV status, and adherence to ART medication. To improve the magnitude of the index case testing, the government and other NGOs working in these areas should work on health education, awareness creation, and improvement of treatment adherence. Ensure the sustainability of ICT services in ART facilities and the provision of quality HIV index case testing services.

The effect of maternal undernutrition on adverse obstetric outcomes among women who attend antenatal care in Gedeo zone public hospitals, cohort study design.

BACKGROUND: Undernutrition refers to an overall deficiency of nutrients due to an inadequate intake of a well-balanced diet. Undernourishment during pregnancy is an important contributor to maternal morbidity and mortality. It remains a persistent problem in developing countries, where women usually fall behind men in having access to food, health care, and education. Despite the high prevalence of maternal undernourishment, its direct impact on obstetric outcomes has not been studied in developing countries, including Ethiopia. OBJECTIVE: This study aimed to assess the effect of maternal undernutrition on adverse obstetric outcomes in Gedeo zone public hospitals. METHOD: A cohort study design was employed in Gedeo zone public hospitals from June 30, 2022, to February 28, 2023. This study included 721 pregnant women, 237 were exposed group whereas 484 were non-exposed. A systematic random sampling technique was used to select a non-exposed group and the exposed group was selected consecutively. Both groups were followed for 7 months, from 16 weeks of gestation to 24 h of delivery. The pretested interviewer-administered questionnaire and checklist were used. EpiData 4.4.1.2.version was used for data entry and analyzed using Stata version 16 software. A modified Poisson regression model with robust standard errors was used to determine relative risk, and the statistical association was declared at a p-value ≤ 0.05. Finally, the findings were reported in figures, tables, and words. RESULT: The incidence of adverse obstetrics outcomes among undernourished and normally nourished mothers was hypertensive disorder during pregnancy (HDDP) (7.49% vs. 3.19%), antepartum haemorrhage (7.49% vs. 3.19%), obstructed labor (1.53% vs. 3.49%), premature rupture of the membrane (2.5% vs. 3.33%), preterm labor (6.52% vs. 6.93%), instrumental vaginal delivery (1.8% vs. 4.3%), postpartum haemorrhage (5.95% vs. 3.88%), and sepsis (3.74% vs. 1.94%). The risk of adverse obstetric outcomes among undernourished women was hypertensive disorder during pregnancy (HDDP) (aRR) = 4.07, 95%CI: 2.53-6.55), antepartum haemorrhage (APH) (aRR = 5.0, 95% CI: 2.08-12.72), preterm labor (aRR = 1.8, 95%CI: 1.23-2.62), operative delivery (aRR = 1.24, 95%C: 0.87-1.78), postpartum haemorrhage (aRR = 3.02, 95%CI: 1.91-4.79), and sepsis/chrioaminitis (aRR = 3.55, 95%CI: 1.83-6.89) times higher than normally nourished women. CONCLUSION: The incidence rates of hypertensive disorder during pregnancy (HDDP), antepartum haemorrhage, postpartum haemorrhage, and sepsis were higher among undernourished women than normally nourished women. Undernourished women during pregnancy have an increased risk of adverse obstetrics outcomes including hypertensive disorder during pregnancy, antepartum, preterm labor, operative delivery, postpartum haemorrhage, and sepsis/chorioamnionitis.

Evidence-based intrapartum care practice and associated factors among obstetrics workers in Ethiopia, systematic review and meta-analysis.

Background: Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. Objective: The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Method: Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. Result: A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. Conclusion: The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.

Determinants of neural tube defect among newborns admitted to neonatal intensive care units of teaching hospitals in Gedeo Zone and Sidama Region, Southern Ethiopia: a case-control study.

BACKGROUND: Neural tube defects are a significant cause of morbidity and mortality that can occur in the early pregnancy periods. Though the burden is high, it gains only limited attention. In Ethiopia, the estimated number of neural tube defect cases was significantly higher. So, identifying factors contributing to it would be significant for planning risk reduction and preventive strategies. Therefore, identifying the possible determinants was aimed at this study. METHODS: A hospital-based, unmatched case-control study was conducted on 104 cases and 208 controls selected from neonatal intensive care units of teaching hospitals in Gedeo Zone and Sidama Region, southern Ethiopia from December 2021 to November 2022. All neural tube defect cases were included consecutively and controls were selected by using a simple random sampling method. Data were collected using interviewer-administered semistructured questionnaires. Data analysis was done by using SPSS V.25. Binary logistic regression was used, and variables with a p value less than 0.25 in bivariate analysis were entered into the multivariable logistic regression model. An adjusted OR with a 95% CI was estimated, and finally, variables that show a level of p value less than 0.05 in multivariable analysis were declared statistically significant. RESULT: After controlling confounders, factors such as unplanned pregnancy 2.20 (95% CI 1.20 to 4.041), history of abortions 2.09 (95% CI 1.19 to 3.67), khat chewing 6.67 (95% CI 2.95 to 15.06), antipyretic and analgesic medications 2.87 (95% CI 1.47 to 5.56) and, being a female neonate 2.11 (95% CI 1.21 to 3.67) were significantly associated with a neural tube defect. CONCLUSION: This study has identified some determinants of neural tube defects. Hence, the behavioural, medical and obstetrical conditions of mothers need serious evaluation in the prepregnancy period. So, improving preconception counselling and prenatal care practices would have a significant role in reducing the risk of neural tube defects.

Early discontinuation of the IMPLANON® and associated factors in Ethiopia, systematic review and meta-analysis.

Background: Implanon® is a commonly used effective long-acting reversible contraceptive method. It provides contraception for up to three years. Its early discontinuation was associated with an unwanted pregnancy, abortion, and socioeconomic burden. Thus, the main aim of this systematic review and meta-analysis is to determine the rate of early discontinuation of Implanon® and associated factors in Ethiopia. Method: This Systematic review and meta-analysis was performed by using online databases including PubMed, Google Scholar, Cochrane, HINARI, Web of Science, and other gray and online repositories of Ethiopian Universities. The JOANNA Briggs Institute standard data extraction and appraising sheet format was used for the extraction of all included studies. To test the heterogeneity of the studies the Cochran Q test and I2 statistics test were used. The Funnel plot and Egger's tests were used to detect possible publication biases of the included studies. The forest plots were used to present the finding of the overall prevalence of the early Implanon® discontinuation and the odds ratio (OR) along with a 95% CI. Result: In this systematic review and meta-analysis seven studies with a total population of 3161 women using Implanon® were included. The overall pooled early Implanon® discontinuation rate was 31.34% (95%CI: 19.20, 43.47). Early discontinuation of Implanon® was associated with lack of counseling during service delivery 2.55times (OR: 2.55, 95%CI: 1.99, 3.25), the experienced side effect 3.25 times (OR: 3.25, 95%CI: 2.48, 4.24), absence of appointment after insertion 6.06 times (OR: 6.06, 95%CI: 2.15, 17.05), others decision on the women's choice 3.30 times (OR = 3.30, 95%CI: 2.52, 4.32), and lack the satisfaction of provided service 2.68 times (OR: 2.68, 96%CI: 1.61, 4.45). Conclusion: About one-third of the women in Ethiopia discontinue the use of Implanon® within one year of the insertion. This is high compared to findings from other countries. Lack of counseling about the service, women's experience of the side effect, absence of the appointment following the service provision, other decisions on the method chosen, and lack of satisfaction were factors associated with the discontinuation of Implanon®. Hence, efforts should be made to reduce the rate of early discontinuation of Implanon® through drafting national guidelines and strategies accompanied by appropriate implementation, follow-up to foster adequate counseling, arrangement of appointments, helping women to decide on the choice, and increase the quality of care provision to enhance the satisfaction of the service.

Determinants of premature rupture of membrane among pregnant women in Harar town, Eastern Ethiopia: A case-control study.

Introduction: Premature rupture of membrane is a disruption of fetal membrane followed by passage of watery fluid gush before the onset of labor any time beyond 28 weeks of gestation. It is a significant cause of perinatal morbidity and mortality. Many studies were conducted on the pre-labor rupture of membrane, yet limited evidence is available on its determinants. This study aimed to identify determinants of premature rupture of membrane among pregnant women in Harar Town, Eastern Ethiopia. Method: ology; Hospital-based unmatched case control study was conducted on 115 cases and 230 controls from 15th May to 15th July 2021. The study was conducted on two public hospitals in Harar town. All cases admitted at the time of data collection were included until the required sample size was obtained and controls were selected by using simple random sampling among all non -cases. Data were collected using interviewer-guided semi-structured questionnaires. The data were entered into Epi-data version 3.1 and exported to SPSS version 22.0 for analysis. Binary logistic regression was used to identify determinants of the outcome and statistical significance declared at a p-value less than 0.05. Multicollinearity was checked and model fitness was assessed by Hosmer Lemeshow test. Results: Abnormal vaginal discharge [AOR 2.15 (2.53, 22.46), history of cesarean delivery [AOR 2.06 (1.11, 6.78)], history of premature rupture of membrane [AOR 4.62 (2.06, 11.52)] and history of abortion [AOR 2.81 (1.04, 6.23)] increase the odds of the outcome. Conclusion: Bad obstetric histories in the current and previous pregnancies are related to premature rupture of membrane. Therefore, it is recommended that health care providers should take attention to women with past and current pregnancy complications.

Incidence and predictors of women's place of delivery among pregnant women who received antenatal care in Southern Ethiopia: a prospective cohort study.

BACKGROUND: Home delivery is responsible for a high number of maternal and newborn deaths due to the occurrence of obstetric complications during labour and delivery. Little is known about the incidence and predictors of women's place of delivery after utilizing antenatal care services in Ethiopia and the study area. Therefore, the purpose of this study is to fill those gaps in the studies mentioned above by determining the incidence and predictors of women's place of delivery. METHODS: An institutional-based prospective cohort study was conducted among pregnant women in public hospitals of Gedeo zone, Southern Ethiopia between May 1 and October 30, 2021. A total of 390 pregnant women receiving antenatal care at Gedeo zone public hospitals were enrolled using a systematic random sampling technique and followed up to delivery. Data were entered into Epidata version 3.1 and exported to SPSS version 25 for analysis. For both bivariate and multivariable analyses, a poison regression model was used to identify the association between the dependent and independent variables. A statistical significance level was declared at a p-value less than 0.05. RESULTS: In this study, the overall incidence of home delivery and institutional delivery among pregnant women was 37.4% (95% CI: (32.5, 41.9)) and 62.6% (95% CI: 58.1, 67.5)) respectively. Distance from home to nearest health facility(ARR = 1.17:95%:CI (1.01,1.36), poor quality of antenatal care service(ARR = 1.40;95%:CI (1.10,1.79), no formal maternal education(ARR = 1.49;95%:CI (1.21,1.83), previous home delivery history(ARR = 1.38;95%:CI(1.22,1.56), unplanned pregnancy(ARR = 1.23;95%:CI (1.10,1.37) and history of pregnancy-related complication at health facility(ARR = 1.16;95%:CI(1.02,1.33) were predictors of home delivery. CONCLUSIONS: The study indicated a high incidence of home birth after utilizing antenatal care services. As a result, interventions targeting those identified factors during antenatal care services are critical to reducing home births.

Acceptance of COVID-19 vaccine among healthcare workers in Africa, systematic review and meta-analysis.

Objectives: This study is intended to assess healthcare workers' acceptance of the COVID-19 vaccine in Africa. Study design: Systematic review and meta-analysis. Method: The search was done using: PubMed, HINARI and Web of Science, African OnLine, and other gray and online repositories of Universities in Africa. All included articles were extracted and appraised using the standard data extraction sheet format of JOANNA Briggs Institute. Cochran Q test and I2 statistics test were used to test the heterogeneity of the studies. A Funnel plot and Egger's test were used to detect the publication bias of included studies. A Forest plot was used to present the pooled prevalence acceptance of the COVID-19 vaccine. Result: In this systematic review and meta-analysis thirteen cross-sectional studies and one nationwide survey with a total population of 23,739 were included. The pooled estimated prevalence of healthcare workers' acceptance of the COVID-19 vaccine in Africa was 56.59 (95%CI; 46.26-66.92; I2 = 99.6%, p = 0.000). Subgroup analysis was done using the regions in Africa, willingness to accept the COVID-19 vaccine was highest in the South African region accounting for 74.64 (95%CI; 44.16-105.11) followed by the North African region at 66.68 (95% CI; 50.74-82.62). Conclusion: The overall acceptance of the COVID-19 vaccine among healthcare workers in Africa was low. Thus, further duties should be unwavering to improve the COVID-19 vaccine acceptance by healthcare workers, through consistent and committed efforts in improving political commitment, amending strategies, improving awareness, and disclosing information about the safety, side effects, and effectiveness of the COVID-19 vaccine.

Post-operative pain and associated factors after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia: A cross-sectional study.

Background: The most frequent obstetric surgery both in Ethiopia and around the world is the cesarean section (CS). Postoperative pain that is not well managed can have a major negative impact on surgical patient morbidity, delaying healing and the return to normal daily activities. Even though the cesarean section is one of the most commonly performed operations, postoperative pain after cesarean section and associated factors has not been studied. Objective: To assess the magnitude and factors associated with postoperative pain after cesarean section at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Methods: From February 1 to September 30 in 2021, a hospital-based cross-sectional study was undertaken among women who underwent cesarean deliveries at Hawassa University Comprehensive Specialized Hospital. The patient's medical file was read, and information was gathered from them using a structured questionnaire and checklist. The information was prepared for analysis by being cleaned, coded, and put into EPI Data version 3.1 before being exported to SPSS version 20. The prevalence rate and socio-demographic details were displayed using descriptive statistics. Bivariate and multivariable logistic regression analysis was done to identify the associated factors. Variables with a p-value of <0.05 were considered statistically significant. Results: The magnitude of moderate to severe post-operative pain after a cesarean section was 89.8% (95% CI 84.7, 93.5). Duration of procedure (AOR: 3.62, 95% CI: 1.33, 15.85), type of anesthesia (AOR: 2.38, 95% CI: 1.31, 8.71), and type of analgesics administered (AOR: 2.3, 95% CI: 1.28, 19.21) were significantly associated with moderate to severe post-operative pain. Conclusion: In this study a significant number of parturient in this study reported moderate to severe post-cesarean pain within 24 h. The duration of the procedure, the type of anesthesia used, and the type of analgesics administered were all found to be significantly associated with postoperative pain after cesarean section.

Community-based new born care practice and its associated factors among women who give birth at home in Ethiopia: cross-sectional study.

BACKGROUND: In Ethiopia, perinatal mortality rate was 33 per 1000 pregnancies and 64.4% of this death was occurred within the first 7 days of neonatal life. Moreover, more than 2.1% of new born babies were died within their first seven days of life in Ethiopia. Majority of neonatal deaths are preventable by applying an effective and lifesaving interventions. However, little is known about newborn care practice at the community level. METHODS: A community-based cross-sectional study design was used. Multi-stage sampling techniques were used to get a total of 540 mothers who gave birth at home within the past six months from their kebeles in Ethiopia. Data was collected by using face-to-face interview with structured questionnaires. Then the data was coded, cleaned, and entered into Epidemiological data version 3.1 and exported to statistical package for social science version 23.0 for analyses. Bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio at 95% confidence interval with P-Value 0.05% was computed. RESULTS: A total of 540 women were participated with a response rate of 98.3%. Only 208 (44%) of the women had good practice towards essential newborn care. Head of households [AOR (95%CI) 2.7417 (1.80-4.25)], type of birth attendant [AOR (95%CI) 3.962 (3.329-7.171)] and bad obstetrical history [AOR (95%CI) 3.151 (2.209-4.969)] were significantly associated with maternal newborn care practice. CONCLUSION: Less than half of the mothers had good newborn care practice. In this study, head of household, type of birth attendant, and bad obstetrical history were significantly associated with maternal newborn care practice. Therefore, Ministry of Women and Woreda women and Child offices needs to promote the socioeconomic empowerment of women to increase the practice of essential newborn care practices.

Failed induction of labor and associated factors among women delivered in Jigjiga University Sheik Hassan Yabare Referral Hospital: a cross-sectional study.

OBJECTIVE: This study was aimed to assess the magnitude of failed induction of labor and associated factors among mothers delivered in Eastern Ethiopia. METHODS: An institutional-based cross-sectional study was carried out among 364 women who had induction of labor at Jigjiga University, Sheik Hassan Yabare Referral Hospital from 2018 to 2021. A checklist was used to collect the data from the women's chart. To isolate independent predictors related to failed induction of labor, multivariate logistic regression analyses were performed. RESULT: The magnitude of failed induction of labor was 36.8% (95% CI: 31.8, 42.0). Age (AOR = 3.2; CI: 1.78, 5.75), rural residency (AOR = 2.28; CI:1.29, 4.01), para (AOR = 2.76; CI: 1.55, 4.91), gestational age (AOR = 2.65; CI: 1.44, 4.89), multiple pregnancy (AOR = 2.36; CI: 1.01, 5.55), premature rapture of membrane (AOR = 4.88; CI: 2.33, 10.21), pregnancy-induced hypertension (AOR = 5.11; CI: 2.67, 9.79), and bishop score (AOR = 1.95; CI: 1.15, 3.32) were significantly associated with failed induction of labor. CONCLUSION: The magnitude of failed induction of labor was relatively high in the study setting. Failed induction of labor was significantly associated with age, rural residency, primipara, gestational age, multiple pregnancy, premature rapture of membrane, PIH, and bishop score less than six. Prior to initiating the induction of labor, proper pelvis assessment and cervical ripening for bishop score might be considered. Beside to this, adherence to locally available induction protocols and guidelines might also be needed.