Unravelling the complexity of research capacity strengthening for health professionals in low- and middle-income countries: A concept analysis.

AIMS: Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low- and middle-income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence-based decision-making. We seek to move beyond a surface-level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. DESIGN: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. CONCLUSION: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high-quality research and improve healthcare delivery in resource-constrained settings. IMPLICATIONS: RCS aims to empower health professionals to apply evidence-based practices, reduce disparities and enhance the well-being of populations in LMICs. IMPACT: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well-being of populations worldwide.

The practice of breast self-examination and associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda: a cross sectional study.

BACKGROUND: Breast self-examination (BSE) is considered one of the main screening methods in detecting earlier stages of breast cancer. It is a useful technique if practiced every month by women above 20 years considering that breast cancer among women globally contributed to 685,000 deaths in 2020. However, the practice of breast self-examination among healthcare professionals is low in many developing countries and it is not well known in Rwanda. Therefore, this research was intended to measure the level of breast self-examination practice and its associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda. METHODS: A cross-sectional study was conducted among 221 randomly selected female healthcare professionals in four district hospitals in Kigali, Rwanda. A self-administered structured questionnaire was used as data collection instrument. The predictor variables were socio-demographic and obstetrics variables, knowledge on breast cancer and breast self-examination as well as attitude towards breast cancer and breast self-examination. Sample statistics such as frequencies, proportions and mean were used to recapitulate the findings in univariate analysis. Multiple logistic regression analysis was employed to identify statistically significant variables that predict breast self-examination practice. Adjusted odds ratio with 95% confidence level were reported. P-value < 0.05 was used to declare statistical significance. RESULTS: Breast self-examination was practiced by 43.5% of female healthcare professionals. This prevalence is low compared to other studies. Attitude towards breast self-examination and breast cancer was the only predictor variable that was significantly associated with breast self-examination practice [AOR = 1.032; 95% CI (1.001, 1.065), p-value = 0.042]. However, number of pregnancy and number of children were not significantly associated with BSE practice in the multi-variate analysis. In addition, there was a positive linear link between knowledge and attitude, with a correlation coefficient (r) of 0.186 (p = 0.005). CONCLUSIONS: The breast self-examination practice among healthcare professionals was found to be low. Attitude towards breast cancer and breast self-examination was positively associated with BSE practice. Moreover, attitude and knowledge were positively correlated. This suggests the need for continuous medical education on breast self-examination and breast cancer to increase the knowledge & BSE practice level of female healthcare professionals.

Analysis of cesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: Cesarean section (CS) is an important indicator of access to, and quality of maternal health services. The World Health Organization recommends the Robson ten group classification system as a global standard for assessing, monitoring and comparing CS rates at all levels. This study aimed to assess the rate of CS and perform an analysis based on Robson classification system. METHODS: A facility-based cross-sectional study was conducted at a tertiary hospital in Addis Ababa, Ethiopia. Data were collected from medical charts of all women who delivered from January-June 2018. The overall CS rate was calculated then women were categorized into one of the ten Robson groups. Relative size of each group, contribution of each group to the overall CS rate, and CS rate within each group were calculated. RESULTS: A total of 4,200 deliveries were analyzed. Of these 1,459 (34.7%) were CS. The largest contributors to the overall CS rate were Group 10 (19.1%), Group 2 (18.3%), Group 5 (17.1%), and Group 4 (15.8%). There was also a high rate of pre-labor CS in Group 2, Group 4, and Group 10. CONCLUSION: Through implementation of the Robson ten group classification system, we identified the contribution of each group to the overall CS rate as well as the CS rate within each group. Group 10 was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low-risk groups. These target groups require more in-depth analysis to identify possible modifiable factors and to apply specific interventions to reduce the CS rate. Evaluation of existing management protocols and further studies into indications of CS and outcomes are needed to design tailored strategies and improve outcomes.

Neither n-3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia.

BACKGROUND: The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. OBJECTIVE: We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. METHODS: We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). RESULTS: The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (ß: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). CONCLUSIONS: n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.

Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial.

BACKGROUND: The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM. METHOD: Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital. The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations. RESULTS: The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes. CONCLUSION: Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available. TRIAL REGISTRATION: The trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) # NCT03036176 .

Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty: a randomized single-blind controlled trial.

BACKGROUND: Children living with foster families in a resource-limited setting such as Ethiopia are at risk of developmental problems. It is not yet clear whether intensive home-based developmental stimulation assisted by play can reduce these problems. The main objective of this study was to examine the effects of play-assisted intervention integrated into basic services on the developmental performance of children living with foster families in extreme poverty. METHODS: A randomized single-blind (investigator) controlled trial design was used. The study was conducted in Jimma, South West Ethiopia. Using computer-generated codes, eligible children of 3-59 months in age were randomly allocated to intervention (n = 39) and control (n = 39) groups at a 1:1 ratio. Children in the intervention group received home-based play-assisted stimulation in addition to the basic services provided to children in both groups. The intervention consisted of an hour of play stimulation conducted during a weekly home visit over the course of six months. Personal-social, language, fine and gross motor outcomes were assessed using Denver II-Jimma, and social-emotional outcome was obtained using an adapted Ages and Stages Questionnaire: Social-Emotional (ASQ: SE). Information about sociodemographic characteristics was collected using a structured questionnaire. Anthropometric methods were used to determine nutritional status. The effects of the intervention on the abovementioned outcomes over the study period and group differences in change over time were examined using Generalized Estimating Equations (GEE). RESULTS: Statistically significant intervention effects were found for language (P = 0.0014), personal-social (P = 0.0087) and social-emotional (P <  0.0001) performances. At the midline of the study, language (effect size = 0.34) and social-emotional (effect size = - 0.603) benefits from the play-assisted stimulation had already been observed for the children in the intervention group. For language, the intervention effect depended on the child's sex (P = 0.0100) and for personal-social performance, on family income (P = 0.0300). CONCLUSIONS: Intensive home-based play-assisted stimulation reduced the developmental problems of children in foster families in the context of extreme poverty. Longer follow-up may reveal further improvements in the developmental performance of the children. TRIAL REGISTRATION: The study was retrospectively registered on ClinicalTrials.gov on 17 November 2016, Study Identifier: NCT02988180 .

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

BACKGROUND: Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. METHODS: A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. RESULTS: Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. CONCLUSION: Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Factors associated with birth preparedness and complication readiness in Southern Ethiopia: a community based cross-sectional study.

BACKGROUND: Birth preparedness and complication readiness (BP/CR) is a strategy to promote use of skilled maternal and neonatal care so that they can get timely skilled care, particularly during child birth. There is minimal evidence on the factors associated with BP/CR among pregnant women in Ethiopia. Hence, this study aimed to assess the factors influencing BP/CR among pregnant women in Southern Ethiopia for the purpose of improving utilization of skilled attendant at birth. METHODS: A community based cross-sectional study was conducted among 707 pregnant women in Southern Ethiopia in March 2015. Both quantitative and qualitative methods of data collection were used. For the quantitative study, the study subjects were included in the study by employing multi-stage sampling. Data was entered into Epidata version 3.1 and analyzed using IBM SPSS statistics 20. Level of statistical significance was declared at a p- value of <0.05. For the qualitative study, six FGDs were conducted and analyzed based on the thematic areas. RESULT: The prevalence of BP /CR in Arba Minch Zuria Woreda was found to be 30%. The odds of being prepared for birth and its complications was higher among women from high economic class (AOR = 2.29, 95% CI = 1.16, 4.54), with frequency of antenatal care(ANC) > = 4 (AOR = 4.52, 95% CI = 2.26, 9.02), who received advice on BP &CR (AOR = 1.84, 95% CI = 1.13, 3.01),and who were knowledgeable on labor and delivery(LAD) danger signs (AOR = 1.85, 95% CI = 1.01, 3.44). However, it was lower among women with parity of 2 - 4(AOR = .0.51, 95% CI = 0.31, 0.84) and >4 (AOR = 0.51, 95% CI = 0.31, 0.84) than primiparous women. It was also lower among women from food insecure households (AOR = 0.26, 95% CI = 0.16, 0.42) than their counterparts. Lack of awareness on BP/CR, privacy and respect in health institutions were mentioned by the FGD discussants as barriers to women's preparation for birth. CONCLUSIONS: The study showed that BP/CR is inadequate among pregnant women in the study area. Improving socio-economic and food security status of women, strengthening community-based education on complete attendance of ANC, and conforming to professional ethical standards were recommended.

Dietary diversity predicts dietary quality regardless of season in 6-12-month-old infants in south-west Ethiopia.

OBJECTIVE: Simple, cost-effective and convenient instruments like food group-based scores are proposed to assess micronutrient adequacy of children in developing countries. We assessed the predictive ability and seasonal stability of a dietary diversity score (DDS) to indicate dietary quality of infants. DESIGN: A 24 h dietary recall assessment was carried out on a sample of 320 and 312 breast-fed infants aged 6-12 months during harvest (HS) and pre-harvest (PHS) seasons, respectively, in Ethiopia. DDS was calculated based on seven food groups, while mean micronutrient density adequacy (MMDA) was calculated for eight micronutrients. Multiple linear regression models were used to assess the relationship between DDS and MMDA, and differences in nutrient intake between the two seasons. A receiver-operating characteristic curve analysis was performed to derive DDS cut-offs that maximized sensitivity and specificity of assessing dietary quality. SETTING: The study was conducted in the catchment of the Gilgel Gibe Field Research Centre of Jimma University, south-west Ethiopia. RESULTS: The mean (sd) DDS for HS and PHS was 2·1 (0·94) and 2·3 (1·1), respectively. The DDS was associated with MMDA (ß=0·045, P<0·0001 in HS; ß=0·044, P<0001 in PHS). A DDS of ≤2 food groups best predicted 'low' MMDA (<50 %) with 84 % and 92 % sensitivity, 36 % and 43 % specificity, and 47 % and 51 % correct classification for the HS and PHS, respectively. CONCLUSIONS: DDS is predictive of dietary quality of breast-fed infants. The study supports the use of DDS to indicate inadequate intakes of micronutrients by breast-fed infants in different seasons.

Introducing second-trimester anatomic scanning for improved detection and management of congenital anomalies: Experience from a novice center in East Africa.

OBJECTIVES: The aim of the current study was to describe the magnitude and pattern of congenital anomalies on routine second-trimester ultrasound and its practical implication in the management of pregnant women with fetal anomalies at a novice center in East Africa. METHODS: This cross-sectional study was conducted from September 2021 to May 2022 among women who had second-trimester anatomic scanning. Data were collected using a structured questionnaire and analyzed using SPSS version 23.1. Ethical clearance was obtained from the hospital's institutional review board and informed consent was obtained. RESULTS: The number of congenital anomalies was 45 of 1764 (2.55%). Most (41%) were in the age group 26-30 years and multigravida (62%). Average gestational age at anatomic scanning was 24 weeks. One or more risk factors for congenital anomalies were reported in 19 (31.0%) of the mothers. Most sonographic fetal abnormalities (51.7%) were reported in the central nervous system, followed by renal (18.0%) and skeletal (11.5%). Among the central nervous system anomalies, severe ventriculomegaly was the most common (38.7%), followed by Arnold-Chiari malformation (19.4%). Thirty-five (2%) of the mothers had a lethal fetal congenital anomaly and their pregnancy was terminated after counseling and informed consent. CONCLUSIONS: The rate of congenital anomalies in this study is comparable with most international data. The introduction of second-trimester anatomic scanning has led to timely termination of anomalous pregnancies, which contributes to reduction in direct and indirect costs of care and family's psychosocial distress and the stigma associated with the birth of and caring for a child with disability.

Premature luteinization and pregnancy outcomes in depot goserelin-downregulated assisted reproductive technology cycles: A cross-sectional study from Ethiopia.

OBJECTIVE: To compare the rate of premature luteinization in depot goserelin-downregulated in vitro fertilization (IVF) cycles with other IVF protocols at a teaching hospital in Ethiopia. METHODS: We conducted a cross-sectional study on the effects of premature luteinization on IVF outcomes at St. Paul's Hospital Millennium Medical College, a tertiary teaching hospital in Ethiopia. Patients who had IVF at this hospital between 2019 and 2020 were included in the study. Patient records were reviewed and collected on Open Data Kit. We used Stata release 15 to analyze the data. A simple descriptive analysis and bivariate analysis  were performed as appropriate. A P-value less than 0.05 was considered as statistically significant. RESULTS: A total of 305 patients (40 cases with premature luteinization and 265 without premature luteinization) were included. There was no difference in the rate of premature luteinization in the depot goserelin long protocol cycles (6.4%), compared to minimal stimulation (14.1%) and antagonist protocols (16.7%), P = 0.19. Embryo transfer was carried out in 27 (67.5%) patients in the premature luteinization group, which was lower than the 86.0% (228/265) in the non-premature luteinization group, P = 0.003. There was no difference in the median number of oocytes retrieved (8.5 [interquartile range 5.0, 13.0] per cycle in the premature luteinization group vs 5.0 [interquartile range 3.0, 10.0] in those without premature luteinization, P = 0.10). CONCLUSION: A depot goserelin-downregulated long protocol for IVF is a cost-effective and convenient option for controlled ovarian hyperstimulation without increased risk of having premature luteinization compared to antagonist and minimal stimulation protocols.

Utilization of third-trimester fetal transcerebellar diameter measurement for gestational age estimation: a comparative study using Bland-Altman analysis.

BACKGROUND: Several studies show that gestational age estimation during the third trimester of pregnancy using fetal transcerebellar diameter is superior to that measured using fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur diaphysis length). However, the conclusion of the studies stemmed from findings of correlation and regression statistical tests, which are not the recommended statistical analysis methods for comparing the values of 1 variable as measured by 2 different methods. OBJECTIVE: This study aimed to compare the accuracy of gestational age estimation using transcerebellar diameter to that using fetal biometry during the third trimester of pregnancy using Bland-Altman statistical analysis. STUDY DESIGN: This was a cross-sectional study on pregnant women who presented for routine antenatal care follow-up in the third trimester of pregnancy (28-41 weeks of gestation) at St. Paul's Hospital Millennium Medical College (Ethiopia) between November 1, 2020, and February 28, 2021. Data were collected prospectively using a structured questionnaire on the Open Data Kit. The primary outcome of our study was the mean bias of gestational age estimation (error in estimating gestational age) using transcerebellar diameter and composite fetal biometry (composite gestational age). Data were analyzed using Stata (version 15; StataCorp, College Station, TX). Simple descriptive analysis, Bland-Altman analysis, and the Kendall τa discordance measurement were performed as appropriate. The mean bias (error) and limits of agreement were used to present the significance of the finding. RESULTS: A total of 104 pregnant women in the third trimester were included in the study. The mean error (bias) when transcerebellar diameter was used to estimate the gestational age was 0.65 weeks vs a bias of 1.1 weeks using composite biometry, compared with the gold standard method from crown-lump length (in both cases). The calculated estimated limit of agreement was narrower in the case of transcerebellar diameter than in the case of composite fetal biometry (-3.56 to 2.25 vs -4.73 to 2.53). The Kendall τa discordance measurement revealed that gestational age estimations using composite biometry and crown-lump length were 51% to 70%, respectively, more likely to agree than disagree and that gestational age estimations using transcerebellar diameter and crown-lump length were 62% to 77%, respectively, more likely to agree than to disagree (P≤.001). CONCLUSION: Gestational age estimation using transcerebellar diameter is more accurate than gestational age estimation using composite gestational age (biparietal diameter, head circumference, femur diaphysis length, and abdominal circumference). Transcerebellar diameter should be used to date third-trimester pregnancies with unknown gestational age (unknown last normal menstrual period with no early ultrasound milestone).

Incidence, indications, and maternal outcomes of emergency peripartum hysterectomy at a tertiary hospital in Ethiopia: A retrospective review.

OBJECTIVE: To determine the incidence, indications, and maternal outcomes of emergency peripartum hysterectomy (EPH) at a tertiary setting in Ethiopia. MATERIALS AND METHODS: A 4-year retrospective review of EPH cases was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from January 2016 to December 2019. Data were collected by reviewing maternal charts of EPH cases using a structured data extraction format. Stata Statistical Software, release 14, was used for data analysis. Frequency and percentages are used to present the significance of results. RESULTS: Among 39 629 deliveries during the study period, there were 105 EPH, making the incidence rate 2.6 per 1000 deliveries. The common indications for EPH were uterine rupture (63/105; 60%), intractable uterine atony (23/105; 21.9%), and placenta accreta spectrum (14/105; 14.7%). The most common complications were anemia (85/105; 80.9%), puerperal fever (13/105; 12.4%), acute kidney injury (10/105; 9.5%), and relaparotomy (7/105; 6.7%). CONCLUSION: The incidence of EPH observed in our institution is high. Appropriate patient selection for vaginal delivery and strict labor follow up with early intervention for labor abnormalities should be the guiding principles of optimal obstetrical care to alleviate the burden of uterine rupture.

Cesarean delivery surgical techniques in Africa: A survey study from Ethiopia.

OBJECTIVE: To describe the surgical techniques of Caesarean delivery (CD) practiced by Ethiopian Obstetricians and Gynecologists. METHODS: A descriptive survey study was conducted in Ethiopia from March 1, 2021 to April 30, 2021. Members of the Ethiopian Society of Obstetrician and Gynecologists were randomly selected and their Cesarean delivery surgical techniques were explored. Data were analyzed using IBM SPSS statistics 22. Simple descriptive analysis were employed and frequencies and percentage were calculated to present the data. RESULTS: A total of 258 obstetricians and Gynecologists practicing in Ethiopia were approached with a response rate of 97.3% (251/258). Double layer closure of uterine incision (98.4%) and subcuticular closure of skin wound (96.4%) are practiced by most of the participants. There was a large difference in practice of blunt versus sharp fascia extension (43.3 vs 55.8%), cephalo-caudad versus lateral uterine incision extension (58 vs.39%), and closure versus non-closure of pelvic and parietal peritoneum (57.4 vs 42.6, and 39.8 versus 60.2%). CONCLUSIONS: Blunt and sharp fascia extension, cephalo-caudad and lateral uterine incision extension, closure and non-closure of the pelvic and parietal peritoneum are practiced by similar numbers of Ethiopian Obstetricians and Gynecologists. This demonstrates a wide variation exists in the techniques of Cesarean Delivery across Ethiopia.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia.

BACKGROUND: This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC). METHODS: A cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared. RESULTS: A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC. CONCLUSION: CTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.

Feeding styles of caregivers of children 6-23 months of age in Derashe special district, Southern Ethiopia.

BACKGROUND: Apart from basic determinants, appropriate child care practices are important in prevention of growth faltering and undernutrition. Providing safe and appropriate quality complementary foods is crucial to child growth and development. However, some children in low-income communities grow normally mainly due to proper caregiver feeding behaviors. Hence, the objective of this study was to determine caregivers' feeding styles as well as to indentify predictors in Derashe special district, Southern Ethiopia. METHODS: A community based cross-sectional study design was employed in the seven randomly selected Kebeles (smallest administrative unit) of Derashe special district. A total of 826 caregivers provided data pertaining to socio-demographic variables. However, 764 caregivers had complete data for the outcome variable (caregiver feeding style). A multistage stratified sampling technique was used to identify study subjects. An adapted Caregiver's Feeding Styles Questionnaire (CFSQ) was used to gather information about caregivers' feeding styles. Multivariate multinomial logistic regression was employed to identify predictors of caregivers' feeding style. RESULTS: The majority (80.6%) of caregivers were biological mothers. Nearly seventy-six percent of the caregivers practiced a responsive feeding style. Caregivers other than the biological mother favoured a laissez-faire feeding style, while caregivers residing in rural Kebeles were more responsive. Caregivers with a breastfeeding frequency of more than eight times predicted both laissez-faire (RRR = 1.88; 95% CI = 1.03-3.41) and controlling (RRR = 1.7; 95% CI = 1.02-2.85) feeding styles as compared to responsive feeding. CONCLUSION: Responsive feeding was the commonest style practiced by the caregivers. Many of the caregivers who were rural residents and birth parents have been responsive in child feeding. The instruments needed to be validated in the Ethiopian context and an additional prospective study based on direct observation of caregiver-child interactions is recommended.

Time to early cessation of exclusive breast feeding and associated factors among 6-12 months old children: Survival analysis.

BACKGROUND: WHO and UNICEF (1990) have recommended EBF for six months, followed by an introduction of complementary foods at the age of six months with continued breastfeeding for the first 24 months or more. Exclusive breastfeeding (EBF) during the first 6 months of life reduces infant morbidity and mortality. According to Ethiopia Demographic Health Survey (DHS), only 58% of children were exclusively breastfed during the first 6 months of age. OBJECTIVE: The study aimed to identify time to early cessation of EBF and associated factors among 6-12 months old children in Lanfuro Woreda, Silte Zone. METHODS: A community-based cross-sectional study was conducted in Lanfuro Woreda, Silte Zone, from March to April 2017. A total of 636 mothers with 6-12 months old infants from ten randomly selected kebeles were included. Both quantitative and subjective information assortment techniques were utilized. The Kaplan-Meier curve with log-rank test was used to compare the survival difference by the selected covariates. Both bivariate (P < 0.25) and multivariable (P < 0.05) Cox Proportional Hazards model were fitted to identify factors predicting time to early cessation of EBF. RESULTS: The median duration of exclusive breastfeeding was 6.22 months. The highest proportion of cessation of exclusive breastfeeding occurred during the first four to five months. Early cessation of exclusive breastfeeding was observed in 295 (48%). Place of residence (AHR: 1.6; 95% CI = 1.14-2.20), knowledge on EBF (AHR = 1.31; 95% CI = 1.02-1.68), type of delivery (AHR: 2.41; 95% CI = 2.24-3.68), pre-lacteal feeding (AHR = 1.8; 95% CI = 1.32-2.36) and household food insecurity (AHR = 5.02; 95% CI = 3.89-6.50) were significant independent factors which were associated with time to early cessation of exclusive breastfeeding. CONCLUSION AND RECOMMENDATION: There are still sizable proportions of children not enjoying exclusive breastfeeding for the first full six months. Being an urban resident and coming from food-insecure households, giving birth by CS, having low knowledge on EBF, and giving pre-lacteal feeding were factors associated with time to early cessation of EBF. Multi-sectoral action should be taken for respective predictors of time to early cessation of EBF.

Late request for safe abortion care at a tertiary hospital in Ethiopia; the role of emotional factors: A cross-sectional study.

OBJECTIVE: To determine the prevalence of second-trimester safe abortion care and to examine its association with emotional factors. METHODS: We conducted a cross-sectional study on second-trimester safe abortion care clients from June 1, 2020 to December 31, 2020 at St. Paul's Hospital Millennium Medical College. Data were collected using an interviewer-administered questionnaire on Open Data Kit and analyzed using STATA release 15. Variables with P value <0.2 on bivariate analysis were entered for multivariable regression analysis. Odds ratio with 95%CI and P value below 0.05 were used to present the significance of study findings. RESULTS: The prevalence of induced second-trimester abortion among safe abortion clients was 64%. Women who had no emotional factors, who had no interpersonal problems, who were married, and who had middle or high incomes were less likely to make a late request for safe abortion care (aOR 0.31, 95% CI 0.15-0.67; aOR 0.55, 95% CI 0.32-0.97; aOR 0.37, 95% CI 0.17-0.77; and aOR 0.51, 95% CI 0.27-0.96, respectively). CONCLUSION: Sixty-four percent of safe abortion-care clients made a late request (second trimester presentation) for safe abortion care. Women who had no emotional factors had a low risk of making such a late request. Likewise, married women who had no interpersonal factors and had middle or high income were at low risk of seeking safe abortion care in the second trimester.

Duration and determinants of birth interval among women of child bearing age in Southern Ethiopia.

BACKGROUND: Longer intervals between consecutive births decrease the number of children a woman can have. This results in beneficial effects on population size and on the health status of mothers and children. Therefore, understanding the practice of birth interval and its determinants is helpful to design evidence based strategies for interventions. The objective of this study was to determine duration and determinants of birth interval among women of child bearing age in Lemo district, southern Ethiopia in March 2010. METHODS: A community based cross sectional study design with stratified multistage sampling technique was employed. A sample of 844 women of child bearing age were selected by using simple random sampling technique after complete census was conducted in selected kebeles prior to data collection. Structured interviewer administered questionnaire was used for data collection. Actual birth interval was measured with the respondents' memory since majority of the women or their children in the area had no birth certificate. RESULTS: Majority (57%) of women were practicing short birth interval length with the median birth interval length of 33 months. Actual birth interval length is significantly shorter than preferred birth interval length. Birth interval showed significant variation by contraceptive use, residence, wealth index, breast feeding and occupation of husbands. CONCLUSION: low proportion of optimal birth spacing practices with short actual birth interval length and longer preferred birth interval lengths were evident among the study subjects. Hence interventions to enhance contraceptive utilization behaviors among women in Lemo district would be helpful to narrow the gap between optimal and actual birth spacing.

Married women's decision making power on modern contraceptive use in urban and rural southern Ethiopia.

BACKGROUND: Women in developing countries are either under collective decision making with their partners or completely rely on the male partner's decision on issues that affect their reproductive live. Identifying the major barriers of married women's decision making power on contraceptive use has significant relevance for planning contextually appropriate family planning interventions. The objective of this study was to determine current modern contraceptive practices and decision making power among married women in Tercha Town and surrounding rural areas of Dawro zone, Southern Ethiopia. METHODS: Community based comparative cross-sectional design with both quantitative and Qualitative study has been employed in March and April 2010. The respondents were 699 married women of child bearing age from urban and rural parts of Dawro zone. After conducting census, we took the sample using simple random sampling technique. RESULTS: Current modern contraceptive use among married women in the urban was 293 (87.5%) and 243 (72.8%) in rural. Married women who reside in urban area were more likely to decide on the use of modern contraceptive method than rural women. Having better knowledge about modern contraceptive methods, gender equitable attitude, better involvement in decisions related to children, socio-cultural and family relations were statistically significant factors for decision making power of women on the use of modern contraceptive methods in the urban setting. Better knowledge, fear of partner's opposition or negligence, involvement in decisions about child and economic affairs were statistically significant factors for better decision making power of women on the use of modern contraceptive methods in the rural part. CONCLUSIONS: High level of current modern contraceptive practice with reduced urban-rural difference was found as compared to regional and national figures. Urban women had better power to make decisions on modern contraceptive than rural women. Modern family planning interventions in the area should be promoted by considering empowering of women on modern contraceptive use decision making.