Birth, stillbirth and death registration data completeness, quality and utility in population-based surveys: EN-INDEPTH study.

BACKGROUND: Birth registration is a child's first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. METHODS: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. RESULTS: Almost all women, irrespective of their baby's survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4-5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27-1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37-5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. CONCLUSIONS: Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.

Psychological wellbeing of women after surgical correction of obstetric fistula in Northwest Ethiopia: a pre-post design.

The physical problems associated with fistula result in psychological alteration. This study was aimed to assess whether psychological wellbeing of women with fistula after surgical treatment differ from that of before treatment. Institution-based pre-post follow-up design was conducted. Self-reported incontinence and psychological wellbeing score were assessed. Data were analyzed using Stata 12. Paired t-test and multiple linear regressions were fitted to identify variables correlate with the score difference. In this study, 117 women were interviewed giving response rate of 98.3 percent. Their mean (±sd) age was 27.13 ± 5.37 years. On admission, all women had urinary or fecal incontinence and their mean psychological score was 31.1 (95 percent CI; 30.5-31.6). After treatment, however, 89.7 percent (n = 105) of women reported that they regained continence. Similarly, the mean psychological score has dropped to 18.05 (95 percent CI; 16.4-21.6, p < .001). Pre-treatment score, normal body weight, regaining continence, and getting counseling service were correlates of score difference. Psychological wellbeing of women with genital fistula was improved drastically after treatment. Establishing a system for early identification and treatment of cases could reduce prolonged psychological alteration.

Mothers' health care seeking behavior and associated factors for common childhood illnesses, Northwest Ethiopia: community based cross-sectional study.

BACKGROUND: Substantial progress has been made in reducing child mortality over the last decades, however the magnitude of the problem is yet high globally Appropriate health care-seeking behavior of mothers/guardians for common childhood illnesses could prevent a significant number of child deaths and complications due to childhood illnesses, currently, there is few of studies in Ethiopia. Therefore, this study aimed to assess mothers/caregivers health care seeking behavior for their children in Northwest Ethiopia. METHODS: Community based cross-sectional study of rural mothers living in Aneded district from February to March 2016. Data were collected using structured questionnaire by an interviewer. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with health care seeking behavior. Variables having P value ≤0.2 in the bivariate analysis were considered for multivariable analysis. P-value less than 0.05 was used to declare that there was statistically significant association. Odds Ratio (OR) with 95% confidence interval (CI) was used to determine the strength and direction of association. RESULT: A total of 410 mothers participated in this study. Among 48.8% (95% CI: 44, 53.6%) had sought health care, only 27% sought health care within a day. Having awareness of childhood illness (AOR = 3.8, 95% CI: 2.18-6.72), perceived importance of early treatment (AOR = 3.5, 95% CI: 2.00-6.07) and child age <  24 months (AOR = 1.7, 95% CI: 1.08-2.68) and illness not being perceived as severe (AOR:= 0.17, 95% CI: 0.09-0.30) were all factors associated with mothers healthcare seeking behavior during their child illness. CONCLUSION: Overall health care seeking behavior level was low. Awareness, perceived illness severity, perceived early treatment and having young children were predictors of mothers' health care seeking behavior. The Woreda health office administrators and health professionals should work to improve mothers' awareness and perception towards childhood problems and the importance of early seeking appropriate health care using the existed structures (one-to-five women networking and health developmental army).

Consequences of obstetric fistula in sub Sahara African countries, from patients' perspective: a systematic review of qualitative studies.

BACKGROUND: Women with fistula live in a state of distress and in fear of their future life. An obstetric fistula has a devastating impact on affected women and their families. The objective of this systematic review was to synthesize the evidence from published articles on the consequences of obstetric fistula on women who endure the condition. METHODS: The consequences were systematically reviewed from purely qualitative and mixed method primary studies. The literatures were searched through the search engines Google, Google scholar, Hinari using Pub Med data bases, and citation tracking. Relevant source of publications were searched for primary qualitative studies by formulating search protocol using related search terms. Time (articles published between January first of 2007 and 30th September 2016), participants (women who experienced obstetric fistula due to obstructed labor complications), types of study (purely qualitative and mixed method primary articles), findings (reporting consequences/impacts of obstetric fistula) were used as inclusion criteria. The quality appraisal tool for qualitative studies and the critical appraisal skills program were used to appraise the quality of the studies. The findings of sixteen studies were included in the review. The data were collected and then a thematic framework approach was applied for analysis. RESULTS: The thematic categories shared across most studies were related to the physical challenges of losing body control, women's social and family relationships, and the challenges of losing income. Obstetric fistula has far reaching consequences on women's physical well being, social and marital relationships, mental health and economic capacity. Fistula also challenged women coping abilities. CONCLUSION: The consequences of obstetric fistula are far more than the visible medical condition. Little evidence is available on mental health, child and fertility issues, and coping mechanisms. Therefore, further researches shall be aimed at addressing the understudied area and suitable interventions shall be offered to improve women's overall quality of life.

Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation.

Background: Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. Methods: A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. Results: The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. Conclusion: The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.

Determinants of time to first marriage and birth intervals among women of child bearing age in Dabat Health and demographic surveillance system site, Northwest Ethiopia.

BACKGROUND: Event histories such as marriage and birth have been used to study fertility behavior of women. Understanding the timing of these events provide insight to reproductive patterns of the population. Thus, the aim of this study was to assess the timing of marriage and durations of birth intervals and their associated factors, and and to examine their effects on the current fertility among women in Dabat health and demographic surveillance system site, Northwest Ethiopia. METHODS: A community based cross-sectional survey was carried out in the beginning of 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. The parametric survival analysis was employed to estimate the relationships among socioeconomic and demographic variables with outcome variables, the timing of age at first marriage and duration of birth intervals. RESULTS: This study confirmed that median age at first marriage was the lowest estimated at 15 years which was below the national and regional average. The result of the study also revealed that married women waited almost a median duration of three years for their first, second, third and fourth child which was increased to nearly four years for three years preceding the survey. The parametric survival analysis showed woman's education, occupation, and current age were the predictors of age at first marriage. divorce experience, women empowerment and marriage cohort were the determinant factors of first birth interval; women education, child death, and ideal number of children were the predictors of second and third birth intervals; and media exposure and child death experience of women were predictors of fourth birth interval. CONCLUSION: The study indicated that median age at first marriage was the lowest though the successive birth intervals were longer. The survival analysis identified women's education, occupation, child death and ideal number of children affected the timing of age at first marriage and duration of birth intervals. Hence, encouraging women for higher education and giving opportunity to women in employments may contribute for delaying age at first marriage and increasing the duration of birth intervals which in turn slowing down the fertility of women.

Increasing smear positive tuberculosis detection using a clinical score - A stepped wedge multicenter trial from Africa.

BACKGROUND: The Bandim TBscore is a clinical score that predicts treatment outcome in Tuberculosis (TB) patients and proved useful as an indicator of which healthcare-seeking adults to refer for sputum smear microcopy. We aimed to test in a randomized trial if the TBscore could be used to enhance the detection of smear positive (SP) TB. METHODS: We carried out a stepped wedge cluster-randomized trial at six health centers in Bissau, Guinea-Bissau, and Gondar, Ethiopia. The primary outcome was diagnostic yield for SP TB. Secondary outcomes were successful treatment and effect on overall 12 months mortality. The study was registered at the Pan African Clinical Trials Registry (PACTR201611001838365). RESULTS: We included 3571 adults. Overall, there was no effect of the intervention on SP PTB detected (OR 1.39 (95%CI 0.75 - 2.56). Analysis stratified by country, showed that the TBscore increased case detection in Gondar (OR 4.05 (95%CI 1.67 - 9.85)) but no effect was found in Bissau (OR 0.47 (95%CI 0.22 - 1.05)) where take-up was much lower. Overall mortality decreased during the intervention (HR 0.31 (95%CI 0.13-0.72)). CONCLUSION: Using the TBscore for triage before smear microscopy may improve case detection and decrease mortality if there is sufficient laboratory capacity to increase sputum smears.

Correction to: Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis.

An amendment to this paper has been published and can be accessed via the original article.

Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis' as given in the submission system.

BACKGROUND: Alcohol consumption during pregnancy represents a significant public health concern. It has several adverse health effects for both the mother and the developing fetus. This study aimed to estimate the pooled prevalence and the effect size of associated factors of alcohol consumption during pregnancy in Sub-Saharan Africa countries. METHODS: The results of the review were reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline and, it was registered in the Prospero database, number CRD42019127103. The available primary studies were collated from different databases: PubMed, CINAHL, Cochrane Library, PsycINFO, Google Scholar, African Journals Online and Centre for Addiction and Mental Health Library. The main search terms were [((alcohol consumption) OR (alcohol drinking) OR (alcohol use) OR (ethanol use) OR (alcohol exposure)) AND ((pregnant women) OR (pregnant mother) OR (during pregnancy)) AND (Sub-Saharan Africa)]. We used the Joanna Briggs Institute (JBI) for critical appraisal of studies. The random-effects model was computed to estimate the pooled prevalence. Heterogeneity between studies was checked using the I2 statistic and the Cochrane Q test. RESULTS: The review resulted in 963 original studies after searching various databases, and finally 37 studies in qualitative synthesis and 30 articles in the systematic review and meta-analysis were included. The overall summary estimate of the prevalence of alcohol consumption during pregnancy was found to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that depression (OR: 1.572; 95% CI: 1.34, 1.845), partners' alcohol use (OR: 1.32, 95% CI: 1.11, 1.57), knowledge on harmful effect of alcohol consumption (OR: 0.36, 95% CI: 0.29, 0.45) and, unplanned pregnancy (OR: 2.33, 95% CI: 1.17, 4.63) were statistically significant factors with alcohol consumption during pregnancy. CONCLUSIONS: The result showed that there was high alcohol consumption during pregnancy in Sub- Saharan Africa. Alcohol consumption during pregnancy was associated with depression, partners' alcohol use, unplanned pregnancy and knowledge of the harmful effects of alcohol consumption. Therefore, this will be a basis for public policy and resource allocation for prevention initiatives.

Health professionals' willingness to pay and associated factors for cervical cancer screening program at College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.

INTRODUCTION: Cervical cancer is a major public health problem in developing countries like Ethiopia. Cervical cancer screening service has been offered to high-risk groups in Ethiopia since 2013. However, there is no evidence on the willingness to pay for the screening. Therefore, we conducted this study to assess the female health professionals' willingness to pay for cervical cancer screening at the College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia. METHODS: Institutional based cross-sectional study design was used to assess the health professionals' willingness to pay for the cervical screening from March to April, 2018. Simple random sampling technique was used to select study participants from a list of female health professionals who has been working for the College of Medicine and Health Sciences, University of Gondar. The data were entered into EpiData version 3.1 and exported to STATA version 14 for analysis. Tobit models were used to identify factors which had statistical significant association with willingness to pay for cervical cancer screening service. RESULTS: A total of 392 respondents participated in the study with a response rate of 92.7%. The majority (83.4%) of participants were willing to pay for cervical cancer screening. The average amount of money they were willing to pay was ETB 194.7 (US$7.16) per service. Age ≥ 30 years, educational status, perceived seriousness of cervical cancer, perceived quality of cervical cancer screening service and monthly income were significantly associated with willingness to pay for cervical cancer screening. CONCLUSION: High proportion of study participants were willing to pay for cervical cancer screening. Therefore, the policy makers can scale-up cervical cancer screening by setting appropriate fee for service charge. They can also raise awareness of cervical cancer and offer quality service in order to increase the benefits of the program.