Magnitude and Associated Factors of Maternal Near Miss in Public Hospitals of Tigrai, Northern Ethiopia: A Cross Sectional Study.

The purpose of this study was to determine magnitude and associated factors of maternal near miss among women seeking obstetric and gynecologic care. A hospital based cross-sectional study design was implemented in selected public hospitals of Tigrai. Systematic random sampling method was used to select study participants. Data were entered to epi data manager version 4.1 and exported to Statistical Package for social science version 20 for analysis. Bivariate and multivariate logistic regression was used to identify factors associated with maternal near miss. The magnitude of maternal near miss was found to be 7.3%. Regression analysis showed that, mothers who reside in rural area, had distance of greater than 10 km, referred from low level health institution, and mothers had no antenatal care follow up were significantly associated with maternal near miss. Therefore, promoting antenatal care and increasing awareness in rural areas related with maternal health care services is recommended.

Determinants of Uterine Rupture and Its Management Outcomes among Mothers Who Gave Birth at Public Hospitals of Tigrai, North Ethiopia: An Unmatched Case Control Study.

INTRODUCTION: Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai. OBJECTIVE: This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. METHOD: A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. RESULT: Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. CONCLUSION: Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.

Magnitude, trend, and causes of under-five mortality from Kilite-Awlaelo health demographic surveillance database, northern Ethiopia, 2009-2017.

BACKGROUND: Globally, neonatal and child mortality remains still high. Under-five mortality accounts for four-fifth of child and young adolescent deaths. In Ethiopia, though there has been a remarkable progress over the past years, under-five mortality is still high. Evidence from population-based longitudinal studies on under-five mortality is limited. Thus, this study aims to investigate the magnitude, trend, and causes of under-five mortality in the Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia. METHODS: Kilite-Awlaelo health and demographic surveillance system was established in 2009 in the northern part of Ethiopia. Population-based longitudinal study design was carried out through extracting data for nine consecutive years (2009-2017). After smoothing the data revealed a visually decreasing trend. Linear, quadratic, exponential, and autoregressive time-series models were checked. Accordingly, the exponential trend model provided the best fit with the lowest standard error of estimate, lowest sum square error and highest adjusted R2 value. Cause-specific mortality was determined by cross tabulating cause of death with specific age death. RESULTS: The overall under-five mortality rate was 35.62 per 1000 livebirths. The under-five mortality rate of rural and urban residents was 37.58 and 12.99 deaths per 1000 livebirths respectively. The exponential trend model showed the under-five mortality rate was declining exponentially. Bacterial sepsis 67(20.6%), prematurity 37(11.08%), intestinal infection disease 30(8.98%), acute lower respiratory infections 26(7.78%), and birth asphyxia 24(7.19%) were the major causes of under-five mortality. CONCLUSION: The overall under-five mortality rate for the surveillance period was comparatively lower. A statistically significant difference in under-five mortality rate was observed between urban and rural residents. A statistically significant declining trend in the under-five mortality rate was observed. Bacterial sepsis, prematurity, intestinal infection disease, acute lower respiratory infections, and birth asphyxia were the major causes of under-five mortality. We recommend the huge discrepancy in under-five mortality rate between urban and rural dwellers could be narrowed to some level by increasing healthcare access for rural residents.

Tetanus Toxoid Vaccination Uptake and Associated Factors among Mothers Who Gave Birth in the Last 12 Months in Errer District, Somali Regional State, Eastern Ethiopia.

BACKGROUND: Maternal tetanus is defined as tetanus acquired during pregnancy or within 6 weeks after the end of conception. As tetanus is a vaccine-preventable disease, immunization of pregnant mothers with a TT (tetanus toxoid) dose is one of the most effective ways to protect against the disease. Some studies showed that 94% of neonatal mortality reduction could be achieved through immunization of pregnant and childbearing-age mothers with at least two doses of TT vaccination. OBJECTIVE: To assess the uptake of tetanus toxoid vaccine and associated factors among mothers who gave birth in the last 12 months in Errer district, Somali Regional State, Eastern Ethiopia, 2017. METHODS AND MATERIALS: A community-based cross-sectional study design was implemented to study 440 mothers who gave birth in the last 12 months. Participants were selected using the strata and systematic sampling technique after conducting a preliminary survey. Data were collected through a face-to-face interviewer-administered questionnaire. The collected data was entered into EpiData version 3.02 and then exported to Statistical Package for the Social Sciences (SPSS) version 20. Bivariate and multivariate logistic regressions were carried out to see the association between variables at p < 0.05 and 95% confidence interval. Finally, the information was presented by using frequencies, summary measures, and tables. RESULT: The overall tetanus vaccination uptake (≥TT2) doses was found to be 51.8%, 95% CI (47.7%, 56.4%). The total number of mothers who complete the five TT doses was 31 (14.8%). Urban residence [AOR = 6.1, 95% CI: (2.33, 10.43)], multiparity [AOR = 2.3, 95% CI: (1.7, 6.4)], and traveling less than 30 minutes from the home to a health facility [AOR = 4.6, 95% CI: (1.34, 6.72)] were some the factors that were significantly associated with tetanus toxoid vaccination uptake. Conclusion and Recommendation. Although TT immunization is a scientifically proven mechanism to protect against maternal and neonatal tetanus, only half of the district mothers received ≥TT2 doses. Besides, our study revealed that the low vaccine uptake is attributed to long distance travel to reach a health facility, maternal illiteracy, and pastoralist lifestyle of mothers in the district. Thus, the regional stakeholders are required to scale up efforts on mother's awareness creation towards the importance of the vaccine through health education and to arrange outreach TT vaccination campaigns in distant pastoralist communities within the region.

Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia.

INTRODUCTION: Birth asphyxia is defined by the World Health Organization as not initiating and maintaining default breathing at birth. Approximately 24% of neonatal deaths occurred annually worldwide due to birth asphyxia. About 3% of the 120 million neonates born each year acquire asphyxia in third world countries. Long-term survivors may experience cerebral palsy, delay in growth, vision, hearing and intellectual deficiency, epilepsy, difficulties with communication and behavior. Thus, this study aims to determine the risk factors of birth asphyxia among neonates who were delivered at public hospitals of Tigray, Ethiopia. MATERIALS AND METHODS: Hospital-based unmatched case-control study design was implemented on 390 samples from January to February 2018. Data were collected by interviews using a structured questionnaire and checklist. The collected data were coded and entered using EpiData version 3.1 statistical software and transported to statistical package for social science (SPSS) version 20 software for analysis. Cross-tabulation and odds ratio with 95% confidence interval were computed. Bivariate logistic regression and multivariable logistic regression were done. Multicollinearity was checked. Goodness of fit was checked by the Hosmer-Lemeshow test. RESULTS: A total of 260 controls and 130 cases were enrolled in the study. Multivariable logistic regression showed that Primi-parity [AOR 5.5 (CI: 2.5, 12.3)], pre-eclamcia/pregnancy-induced hypertension [AOR12.4 (CI: 4.17, 37.15)], post-term pregnancy [AOR 2.73 (CI: 1.00, 7.55)] meconium-stained liquor [AOR 29.2 (CI: 12.0, 71.1)], cord entangled [AOR 5.67 (CI: 1.66,19.3)] and non-vertex presentation [AOR 5.49 (CI: 2.20,13.7)] were found to be risk factors for perinatal birth asphyxia. CONCLUSION AND RECOMMENDATIONS: Intrapartum factors and neonatal factors in the index pregnancy have an association with perinatal birth asphyxia. The research finding suggests effective antenatal care follow-up and follow-up of labor progress using partograph after labor initiation.

Correction to: Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study.

Following publication of the original article [1], we have been notified that the name of one author was spelled incorrectly as Kidanemariam Berhe, when the correct spelling is Kidanemaryam Berhe.

Knowledge of neonatal danger signs and associated factors among mothers who gave birth during the last 4 months while attending immunization services in Harar town public health facilities, Ethiopia, 2017.

OBJECTIVE: The purpose of this study was to assess knowledge about neonatal danger signs and associated factors among mothers who gave birth in the last 4 months attending immunization services. RESULT: The study recruited 432 mothers to participate. A knowledge score of neonatal danger signs was found [32.9% (95% CI 28.9%, 37%)]. Mothers educated to secondary level were 4.9 times more likely to know about neonatal danger signs [(AOR = 4.9, 95% CI (1.15, 21). Similarly, mothers whose husband educated to college and above [AOR = 4.95, 95% CI (1.15, 21)], and being multipara mother [(AOR = 2.59, 95% CI (1.05, 6.6)], were factors significantly associated with good knowledge of mothers about neonatal danger signs.

Maternal and fetal outcomes of cesarean delivery and factors associated with its unfavorable management outcomes; in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017.

OBJECTIVES: This study aimed to determine the unfavorable outcomes and to assess factors contribute to the unfavorable management outcomes after cesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. RESULTS: The unfavorable maternal management outcomes were Adhesion 28 (8.3%), excessive blood loss and blood transfusion 19 (5.6%), cesarean hysterectomy 10 (3%), relaparotomy 5 (1.5%), wound infection and wound dehiscence 23 (6.8%). Unfavorable fetal outcomes were were stillbirth 9 (2.6%), early neonatal death 8 (2.4%), low birth weight 58 (17.2%). women who did not book for Antenatal Care and having a history of previous cesarean delivery were found to be associated with unfavorable maternal outcomes and indications of cesarean delivery as obstructed labor was associated with unfavorable fetal outcomes.

Stunting and associated factors among under-five children in Wukro town, Tigray region, Ethiopia: a cross sectional study.

OBJECTIVE: The objective of the study was to assess the prevalence of stunting and associated factors among under-five children of Wukro town, Tigray, Ethiopia, 2017-2018. RESULT: Totally 394 under-five children were participated in this study with a response rate of 98.5%. A total of 222 (56.3%) of respondents were females and 106 (26.95%) were in the age group of 12-23 month. One hundred ninety-eight (50.3%) of the participants were between 2 and 3 in birth order and 194 (49.2%) had 4 to 5 house hold size. The overall prevalence of stunting was 194 (49.2%). Being female and presence of washing facilities nearby latrine were significantly associated with stunting. Under-five female children were 35.4% lower odds of stunting compared to male children (p = .041, OR = .644, and 95% CI (.422, .983)).

Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study.

BACKGROUND: The incidence of premature rupture of membranes ranges from about 5% to 10% of all deliveries. A woman with premature rupture of membranes is at risk of intra-amniotic infection, postpartum infection, endometritis, and death. A neonate born from premature rupture of membranes mother is at high risk of respiratory distress syndrome, sepsis, intraventricular hemorrhage and death. Little is known regarding the risk factors in Ethiopia. Therefore, this study was conducted to identify risk factors of premature rupture of membranes among pregnant women admitted to public hospitals in Mekelle city, Tigray, Ethiopia. METHODS: Hospital based unmatched case control study design was implemented on 240 samples (160 controls and 80 cases) from pregnant mothers admitted to public hospitals in Mekelle city from February - April/2016. Data was collected by interviewer administered Structured questionnaire and checklist. Binary logistic regression model was used to see the association between dependent and independent variables and multivariable logistic regression was used to identify the independent predictors of premature rupture of membranes. RESULTS: A total of 160 controls and 80 cases were enrolled in the study. Multivariable logistic regression showed that history of abortion [AOR 3.06 (CI: 1.39, 6.71)], history of PROM [AOR 4.45 (CI: 1.87, 10.6)], history of caesarean section [AOR 3.15(CI: 1.05, 9.46)] and abnormal vaginal discharge in the index pregnancy [AOR 3.31(CI: 1.67, 6.56)] were positively associated with premature rupture of membranes. CONCLUSIONS: Past obstetric history and risks in the index pregnancy have an association with premature rupture of membranes. The finding of the study suggests early identification and treatment of genitourinary infection.

Correction to: Risk factors of premature rupture of membranes in public hospitals at Mekele city, Tigray, a case control study.

Following publication of the original article [1], the author reported that his name was misspelled. The original article has been corrected.Incorrect name: Gidiom GebrehetCorrect name: Gdiom Gebreheat.