Latrine Availability and Associated Factors among Religious Institutions in Northern Ethiopia, 2018.

Background: Religious institutions found in the community not only uphold belief and cultural values but can also act as a force for positive change and development. Improved sanitation and hygiene are crucial in these institutions to decrease preventable infections due to unsanitary conditions. However, there are no studies among religious institutions on availability of latrines. Therefore, this study was conducted to assess latrine availability and associated factors among religious institutions in the Tigray Region, Ethiopia. Method: An institution-based cross-sectional study design was conducted in the Tigray Region, Northern Ethiopia. Multistage sampling was used to sample 385 religious institutions. Data were collected using a pretested, structured questionnaire and observation checklist. Logistic regression was fitted, and an odds ratio with 95% confidence interval (CI) with p value less than 0.05 was used to determine the predictors of latrine availability. Analysis was carried out using the SPSS 20TM software package. Results: In this study, latrine availability was 32.8%. It was significantly affected by currently saved money towards having a latrine (adjusted odds ratio (AOR): 0.32, 95% confidence interval (CI) [0.25, 0.42]), any messages seen, heard, or received on sanitation and hygiene (AOR: 0.43, 95% CI [0.38, 0.51]), and the place where messages were seen, heard, or received (AOR: 2.95, 95% CI [1.11, 5.55]). Conclusion: Latrine availability was very low when compared to the national target of 100% among religious institutions and was affected by the currently saved money towards having a latrine, any messages seen, heard, or received on sanitation and hygiene, and the place where the messages were received. Information regarding latrine availability should be provided to the community visiting religious institutions through available channels and promotion of practical models.

Health care professionals' adherence to partograph use in Ethiopia: analysis of 2016 national emergency obstetric and newborn care survey.

BACKGROUND: The period around childbirth and the first 24 hours postpartum remains a perilous time for both mother and newborn. Health care providers' compliance to the World Health Organization modified partogram across the active first stage of labor is a graphic representation of a mother's condition that is used as a guide in providing quality obstetrics care. However, little evidence is documented on the health providers' adherence to the use of the partograph in Ethiopia, which limits health care providers' ability to improve quality care services. Therefore, this study assessed the adherence of partograph use and associated factors in Ethiopia. METHODS: Data from the Ethiopian 2016 National Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternity services were used. We extracted 2611 partograph charts over a 12 months period prior to the survey to review the proper recording of each component. Data analyses were performed using SPSS version 22.0 software. A logistic regression analyses was used to identify the association of explanatory variables with the outcome variable. A p-value of <0.05 was considered as cut off point to declare the significance association in the multivariable analysis. RESULTS: Of the total 2611 partographs reviewed, 561(21.5%) of them were fully recorded as per the WHO guideline. Particularly, molding in 50%, color of liquor in 70.5%, fetal heart beat in 93.3%, cervical dilation in 89.6%, descent in 63.2%, uterine contraction in 94.5%, blood pressure in 80.5%, pulse rate in 70.5%, and temperature in 53% were accurately recorded. The odds of adherence to partograph use were 1.4 in rural health facilities when compared to their counterparts (AOR=1.44; 95% CI: 1.15, 1.80, P- 0.002). CONCLUSION: This study revealed a poor level of adherence in partograph use in Ethiopia. Molding, maternal temperature and decent were the least recorded parameters of the partograph. The odds of completion of partograph were high in rural facilities. Strong supporting supervision and mentoring the health workers to better record and use of partograph are needed mainly in urban health facilities. Moreover in the future, interventional research should be conducted to improve the current rate of adherence.

Reducing Undernutrition through Counseling on Diversified Food Intake among Adult People Living with HIV on HAART, Northern Ethiopia.

BACKGROUND: HIV/AIDS and malnutrition are interrelated and exacerbate one another in a vicious cycle. As HIV infection progresses it causes catabolic state and increases susceptibility to other infections, leading to progressive aggravation of undernutrition. However, data are lacking in Ethiopia on determinants of undernutrition among people living with HIV on antiretroviral therapy. Therefore, this study aimed to assess determinants of undernutrition among adult HIV/AIDS patients in Northern Ethiopia. METHOD: Facility-based unmatched case-control study was conducted among 324 randomly selected people living with HIV on antiretroviral therapy (ART). A structured and pretested interviewer questionnaire was used to collect data, while digital Seca weight and Seca measuring rod were used to measure weight and height, respectively. Logistic regression was used to identify independent factors of undernutrition, and p value <0.05 was declared for statistical significance. All statistical analyses were performed using SPSS 21™. RESULT: This study revealed that people of younger age and those on ART (AOR = 0.29 (95% CI: 0.10, 0.84)) had low risk of being undernourished. However, average individual monthly income (AOR = 2.61 (95% CI: 1.48, 4.61)), not receiving nutritional counseling during visits (AOR = 2.5 (95% CI: 1.52-3.89)), and low diet diversity (AOR = 10.55 (95% CI: 4.17, 26.73)) had higher odds of undernutrition among people living with HIV/AIDS. CONCLUSION: Age of patients, average monthly income, nutritional counseling during visits, and diet diversity were the independent factors of undernutrition. Counseling on well-timed and sufficient consumption of nutritious foods, economic strengthening, and livelihood activities is important. Future longitudinal study is necessary to elucidate the problem of undernutrition among people living with HIV/AIDS.

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates.

BACKGROUND: Birth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia. METHOD: We used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge. RESULTS: The finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09-3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate. CONCLUSION: Only half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment's. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

Overweight and obesity among children under five in Ethiopia: further analysis of 2016 national demographic health survey: a case control study.

OBJECTIVE: The objective of this study was to assess the determinants of overweight and obesity among children under 5 years in Ethiopia. RESULTS: Data from a total of 672 (224 cases and 448 controls) under 5 years of age children were included in the study. Urban residence (AOR = 2.63, 95% CI 1.29, 5.34), boys (AOR = 1.56, 95% CI 1.10, 2.22) and age of the child less than 6 months (AOR = 3.40, 95% CI 2.05, 5.64) were the determinants for being childhood overweight and obesity.

Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice.

BACKGROUND: Providing high-quality kangaroo mother care (KMC) is a strategy proven to improve outcomes in premature babies. However, whether KMC is consistently and appropriately provided in Ethiopia is unclear. This study assesses the quality of KMC services in Ethiopia and the factors associated with its appropriate initiation among low birth weight neonates. METHODS: We used data from the 2016 national Emergency Obstetric and Newborn Care (EmONC) assessment which contains data on all health facilities providing delivery care services in Ethiopia (N = 3,804). We described the quality of KMC services provided to low-birth weight (LBW) babies in terms of infrastructure, processes and outcomes (survival status at discharge). We also explored the factors associated with appropriate KMC initiation using multivariable logistic regression models. RESULTS: The quality of KMC services in Ethiopia was poor. The facilities included scored only 59.0% on average on a basic index of service readiness. KMC was initiated for only 46.4% of all LBW babies included in the sample. Among those who received KMC, 66.7% survived, 13.3% died and 20.4% had no data on survival status at discharge. LBW babies born in health centers were twice more likely to receive KMC compared to those born in hospitals (AOR = 2.0, 95% CI: 1.3-3.0). Public facilities, those with a staff rotation policy in place for newborn care, and those with separate newborn corners were also more likely to initiate KMC for LBW babies. CONCLUSIONS: We found low levels of appropriate KMC initiation, inadequate infrastructure and staffing, and poor survival among LBW babies in Ethiopia. Efforts must be made to improve the adoption of this life saving technique, particularly in hospitals and in the private sector where KMC remains underutilized. Facilities should also dedicate specific spaces for newborn care that enables mothers to provide KMC. In addition, improving record keeping and data quality for routine health data is a priority.

Mothers' utilization and associated factors in preconception care in northern Ethiopia: a community based cross sectional study.

BACKGROUND: Adverse pregnancy outcomes remain a prevalent health problem in Ethiopia. Mothers' use of preconception care service has the potential to avert many of the adverse outcomes. However, the use of this service and its determinants is not well investigated. Therefore, this study was conducted to assess the utilization and determinants of preconception care among recently delivered mothers. METHODS: A community based cross-sectional design was conducted among 564 recently delivered mothers in Mekelle City, Northern Ethiopia. A multi stage cluster sampling technique was employed. Data was collected using a pre-tested, structured interviewer questionnaire and was entered in to Epi-Info™ Version 7 and analyzed using SPSS™ Version 20.0. Descriptive, bivariable and multivariable logistic regression was used to identify the association. RESULTS: This study revealed that, 102(18.2%) of the mothers had utilized preconception care. Mothers' knowledge on preconception care (AOR: 2.21; 95% CI: 1.03, 4.73), prior experience of adverse birth outcomes (AOR: 5.10; 95% CI: 2.31, 11.24), history of chronic health problems (AOR: 5.69; 95% CI: 2.06, 15.72), husband's support (AOR: 13.84; 95% CI: 6.02, 31.79), and challenges in accessing a health facility (AOR: 0.24; 95% CI: 0.16, 0.48) were significantly associated with preconception care service utilization. CONCLUSION: Mothers' utilization of preconception care is low. Mothers knowledge on preconception care, experience of adverse birth outcome, having chronic health problems and husband support increases utilization of preconception care. However, mothers who experienced challenges in visiting a health facility showed decrease preconception care utilization. Therefore, increased efforts are need in terms of advocating for involvement of husband's and awareness creation respecting preconception care services for all women.

Healthcare Professionals' Knowledge of Neonatal Resuscitation in Ethiopia: Analysis from 2016 National Emergency Obstetric and Newborn Care Survey.

BACKGROUND: Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the principal causes of neonatal mortality in Ethiopia. Adequate knowledge of newborn resuscitative procedures plays an important role in early diagnoses and suitable management. However, there are limited data on healthcare professionals' knowledge about neonatal resuscitation. Thus, this study aimed to determine the knowledge of healthcare professionals about neonatal resuscitation and factors affecting it. METHODS: Data from the Ethiopian 2016 national Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternal and newborn health services were analyzed. We have included 3804 healthcare providers, who attended the largest number of deliveries in the last month prior to the survey, and assessed their knowledge of neonatal resuscitation. It was also determined whether certain factors were associated with healthcare providers' knowledge through linear regression method. RESULT: The overall knowledge score of the healthcare providers about neonatal resuscitation ranged from 12 to 24 out of 37 items (with mean score of 18.4 (±5.47) and mean score percentage of 49%). The findings showed that providers trained on neonatal resuscitation (ß=2.65, 95% CI: 0.65, 4.62; p <0.00), facilities that had guideline of neonatal resuscitation (ß=2.50, 95% CI: 0.60, 3.52; p =0.01), and availability of essential equipment (ß=0.95, 95% CI: 0.44, 1.45; p =0.02) were significantly associated with sufficient knowledge of neonatal resuscitation in Ethiopia. CONCLUSION: Overall knowledge of neonatal resuscitation was insufficient. Trained healthcare providers, having guideline on neonatal resuscitation, and availability of essential equipment were significantly associated with knowledge of neonatal resuscitation. Competency and simulation-based in-service training and refresher training complemented by supportive supervision and mentorship are helpful ways to put up providers capability to perform neonatal resuscitation.

Does short inter-pregnancy interval predicts the risk of preterm birth in Northern Ethiopia?

OBJECTIVE: The study aimed to assess the effect of inter pregnancy interval on preterm birth in Northern Ethiopia: prospective cohort study. RESULT: This study showed that, total incidence of premature birth was 10.4%. Among mothers with short inter pregnancy interval the incidence of preterm birth was 39 (25.9%).Whereas, among mothers who had recommended inter pregnancy interval was 9 (2.9%). Short inter-pregnancy interval [adjusted hazard ratio (AHR): 6.85, 95% confidence interval (CI) 3.07-15.31], antenatal care (ANC) visit 1-3 times (AHR: 2.24, 95% CI 1.04-4.85), complication during pregnancy (AHR: 3.16, 95% CI 1.58-6.33) and birth defect (AHR: 8.01, 95% CI 2.56-25.07) were predictors of premature birth.

Nutritional status significantly affects hospital length of stay among surgical patients in public hospitals of Northern Ethiopia: single cohort study.

OBJECTIVE: This study aimed to assess the effect of nutritional status on length of hospital stay in Northern Ethiopia. RESULT: Institutional based prospective cohort study was conducted among 324 admitted surgical patients. Length of hospital stay were significantly associated with duration of disease (Adjusted Hazard Ratio (AHR) = 3.7,95% Confidence interval (CI):2.35-5.82), history of surgery (AHR = 1.4, 95% CI 1.40, 95% CI 1.17-1.86), nutritional status (Body Mass Index (AHR = 1.38, 95% CI 1.28-1.51), Mid Upper Arm Circumference (AHR = 1.29, 95% CI 1.04-1.62)) and individual diet diversity score (AHR = 2.64, 95% CI 1.14-6.14). Screening of patients for malnutrition at admission and provision of dietary supplements based on their nutritional status is recommended.