Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS: A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS: Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION: The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness.

Prevalence and Associated Factors of Antenatal Depression among Women Attending Antenatal Care Service at Gondar University Hospital, Northwest Ethiopia.

BACKGROUND: Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Depressive disorders are not only common and chronic among women throughout the world but also principal sources of disability. The scarce information and limited attention to the problem might aggravate the consequence of the problem and can limit the intervention to be taken. Therefore, the current study was conducted to determine the prevalence and identify associated factors for antenatal depression. METHODS: Institutional based cross-sectional study was conducted by taking a sample of 388 pregnant women coming for ANC service at Gondar University Hospital. Systematic random sampling technique was employed to recruit the study participants. Structured, pretested and interview administered questionnaire was used to collect related information while Beck Depression Inventory (BDI) was used to assess individuals`depression condition. A cut off point with high sensitivity and specificity was determined and internal consistency of the tool was checked (Cronbach alpha = 0.82). Ep Info V. 2002 and STATA 12 were used for data entry and analyses, respectively. Adjusted Odds Ratio with its 95% CI was used to declare the statistical significance of the factors. RESULTS: Depression among pregnant women was found to be 23% (95%CI: 18.48%, 26.86%). Factors significantly associated with depression were: woman`s age (20 to 29, AOR = 0.18,95% CI:0.07,0.49), occupation (housewife, AOR = 2.57,95%CI:1.21,5.46, merchant and daily laborers, AOR = 3.44 (1.38,8.58), previous pregnancy (No, AOR = 4.74,95% CI:1.58,14.17) and previous ANC follow up pattern (irregular, AOR = 11.43,95% CI:3.68,35.49), no follow up, AOR = 11.98, 95% CI:4.73,30.33). CONCLUSION: Depression symptoms are common in pregnant mothers in the study area and interventions that would address the aforementioned factors would benefit to tackle further complications.

Blood requisition and utilization practice in surgical patients at university of gondar hospital, northwest ethiopia.

Background. Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence based estimates. Overordering with minimal utilization squanders technical time, reagent and imposes extra expenses on patients. This study was conducted to assess blood utilization practices. Methods. Cross-sectional study was conducted in Gondar Hospital. Five-month data were collected from all discharged surgical patients and blood bank registries. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI) indices. Results. A total of 982 patients were requested to prepare 1,072 crossmatched units. Of these, 468 units were transfused for 286 patients. The overall ratios of C/T, %T, and TI index were 2.3, 47%, and 0.77, respectively. Blood transfusion from the units crossmatched was 43.6%. Moreover, the highest C/T ratio was observed in elective surgical patients. Conclusions. The overall blood utilization was encouraging, but excessive crossmatching with minimal transfusion practice was observed in elective surgical patients. Blood ordering pattern for elective procedures needs to be revised and overordering of blood should be minimized. Moreover, the hospital with blood transfusion committee should formulate maximum surgical blood ordering policies for elective surgical procedures and conduct regular auditing.