Audit of Clinical Care for Women with Preeclampsia or Eclampsia and Perinatal Outcome in Ethiopia: Second National EmONC Survey.

BACKGROUND: Preeclampsia and eclampsia contribute to maternal and perinatal morbidity and mortality, especially in developing countries. However, the evidence on clinical practice in the management of preeclampsia/eclampsia and perinatal outcomes is limited. Therefore, the aim of this study was to assess clinical care and perinatal outcomes for women with preeclampsia/eclampsia admitted to health facilities in Ethiopia. METHODS: This study used the 2016 Emergency Obstetric and Newborn Care survey, which included 3804 health facilities. The last two cases of women with preeclampsia/eclampsia who were admitted for birth in each participating health facility were selected and their medical records were reviewed. Descriptive analyses by health facility type, location and management authority were conducted. A chi-squared test was used to test for differences. RESULTS: Out of the 3804 health-care facilities across the country, we could review a total of 959 medical records of women with preeclampsia or eclampsia. Of all cases, 90% (863) were hospitalised in public health facilities, 542 (56.6%) were admitted at health centre/clinics and 638 (66.3%) were in urban health facilities. A substantial proportion of maternal and newborn information was missing from their medical records. Of the 553 records that recorded perinatal outcomes, the proportion of perinatal mortality prior to discharge was 16.3% (95% CI: 13.4%, 19.6%). A significant perinatal death was recorded among mothers admitted to hospitals (P < 0.01), maternal age 15-24 (P < 0.04), facilities in urban areas (P < 0.01), referred cases (P < 0.007), high systolic and diastolic blood pressure (P < 0.001), unconscious and experience seizure (P < 0.001), newborn with morbidity (P < 0.001), and women who spent more hours before giving birth (P < 0.002). CONCLUSIONS AND RECOMMENDATIONS: High perinatal mortality in health facilities was reported and care toward mothers with preeclampsia/eclampsia was limited. Strengthening the health facility readiness to respond for management with data registration and reporting system needs to be improved for evidence-based decision-making on perinatal and maternal health.

Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review.

OBJECTIVE: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. DESIGN: A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa. DATA SOURCES: Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv. ELIGIBILITY CRITERIA: Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020. DATA EXTRACTION AND SYNTHESIS: We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form. RESULTS: Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths. CONCLUSIONS: Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.

Geographic variation and determinants of help seeking behaviour among married women subjected to intimate partner violence: evidence from national population survey.

BACKGROUND: Help seeking behaviour amongst married women who experienced Intimate Partner Violence (IPV) has received limited attention in Africa. This study examines the geographic variation and investigates determinants of help seeking behaviour amongst married women in Ethiopia. METHODS: This study analysed data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Data was extracted for married women age 15-49 years old who experienced IPV. Factors associated with help seeking behaviour were identified using multiple logistic regression adjusted for clustering and weighing. The weighted proportion of factors associated with help seeking behaviour was exported to ArcGIS to conduct autocorrelation analysis. RESULTS: The prevalence of help seeking behaviour among married women who experienced IPV was 19.8% (95% CI: 15.9-24.3%). Only 9.2% of them sought help from a formal source (such as police, lawyer or doctor). Multiple logistic regression analyses showed physical violence (Adjusted odds ratio (AOR)=2.76), educational attainment (AOR=2.1), a partner's alcohol consumption (AOR=1.9), partner's controlling behaviour (AOR= 2.4), partner's employment status, (AOR= 1.9) and wealth index (AOR=2.8) were significantly associated factors with help seeking behaviour among married women who experienced IPV in Ethiopia (P< 0.05). Women in Benishangul-Gumuz, Gambella, Harari, Western and Eastern Amhara, and Afar had the lowest odds of help seeking behaviour (P< 0.001) after experiencing IPV. CONCLUSION: The findings of this study suggest that poor help seeking behaviour for married women experiencing IPV is a significant public health problem in Ethiopia. Multiple interrelated factors were associated with poor help seeking behaviour. These factors include women's level of educational attainment, women experiencing physical violence, partners exhibiting controlling behaviour, partner's alcohol consumption, the employment status of the partner, and wealth status of the household were important predictors of help seeking behaviour. Policies and interventions need to be tailored to address these factors to improve women's health outcomes and to prevent IPV.

Factors associated with hypertensive disorders of pregnancy in sub-Saharan Africa: A systematic and meta-analysis.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden of maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to systematically examine factors associated with HDP among women in SSA countries. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Articles conducted in SSA and published in English from January 2000 to May 2020 from electronic databases including MEDLINE, EMBASE, PubMed, and CINAHL were included. Articles, which focused on HDP and found to be relevant through the reference check, were included. Additional articles found through a hand search of reference lists were also included. The quality of papers was appraised using the Critical Appraisal Skills Programme (CASP) scale. Two reviewers independently screened, extracted, and assessed the quality of the articles. STATA 16 software was used to compute the pooled estimated odds ratios for each of the identified associated factor. Both random and fixed effect models were used for analysis. Heterogeneity of the studies and small study bias were checked by I2 and asymmetric test, respectively. RESULTS: Twenty-seven studies met the inclusion criteria and included in the systematic review and meta-analysis. Significant associations with HDP were identified through meta-analysis for the following variables: being primiparous (OR: 1.78; 95% CI: 1.11, 2.44), having previous HDP (OR: 3.75; 95% CI: 2.05, 5.45), family history of HDP (OR: 2.73; 95% CI: 1.85, 3.6), and lower maternal educational level (OR: 1.65; 95% CI: 1.17, 2.13). Due to the limited number of studies found specific to each variable, there was inconclusive evidence for a relationship with a number of factors, such as maternal nutrition, antenatal care visits, birth spacing, multiple birth, physical activity during pregnancy, use of contraceptives, place of residency, family size, and other related associated factors. CONCLUSIONS: The risk of developing HDP is worse among women who have a history of HDP (either themselves or their family), are primiparous, or have a lower maternal educational level. Therefore, investment in women's health needs considered to reduce the problem, and health service providers need to give due attention to women with at increased risk to HDP. Additionally, interventions need to focus on increasing women's access to education and their awareness of potential associated factors for HDP.

Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa.

BACKGROUND: Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries. METHODS: We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis. RESULTS: Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review. CONCLUSIONS: The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women's health needs to reduce the problem and health service providers need to give due attention to high-risk women.