Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study.

Background: Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies. Objective: To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia. Methods and Materials: A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index. Results: The overall completion rate was 16.1% (CI, 13.8%-18.5%), with significant dropouts observed between the first and the fourth ANC.Factors associated with the completion of MHC included the women's residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women's occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC. Conclusion and Recommendations: The completion rate of CoC for MHC remains low. Factors influencing completion include women's residence, partners' educational status, women's occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence.

Introduction: Child marriage and teen pregnancy have negative health, social and development consequences. Highest rates of child marriage occur in sub-Saharan Africa (SSA) and 40% of women in Western and Central Africa got married before the age of 18. This systematic review was aimed to fill a gap in evidence of effectiveness to reduce teen pregnancy and child marriage in SSA. Methods: We considered studies conducted in sub-Saharan Africa that reported on the effect of interventions on child marriage and teen pregnancy among adolescent girls for inclusion. We searched major databses and grey literature sources. Results: We included 30 articles in this review. We categorized the interventions reported in the review into five general categories: (a) Interventions aimed to build educational assets, (b) Interventions aimed to build life skills and health assets, (c) Wealth building interventions, and (d) Community dialogue. Only few interventions were consistently effective across the studies included in the review. The provision of scholarship and systematically implemented community dialogues are consistently effective across settings. Conclusion: Program designers aiming to empower adolescent girls should address environmental factors, including financial barriers and community norms. Future researchers should consider designing rigorous effectiveness and cost effectiveness studies to ensure sustainability. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022327397.

Why do women walk away from maternal health services in Southwest Ethiopia? A qualitative study of caregivers' and clients' perspectives.

BACKGROUND: Continuum of care for Maternal Health Care is continuity of care through pregnancy, childbirth, and after birth as a key strategy in reaching mothers and babies at a crucial time. Despite the widespread drop out from the continuum of care, there is limited understanding of perspectives of providers and clients about factors leading to drop out from care among women in Ethiopia. OBJECTIVE: The aim of this study is to explore the underlying reasons for which women walk away from maternal health services in Ethiopia care providers' and clients' perspectives. METHODS: The population for the study were comprised of all purposefully selected district health department deputy heads, MCH coordinators, primary health center unit directors, midwives and nurses in charge of maternity department and who have been rendering maternal health services and chosen women among those attending the MCH clinic for maternal health services in order to identify reasons for dropout from the perspective of the service users based on the established criteria. The final sample size was determined based on the level of information saturation and a total of 20 in-depth interviewees were conducted. The unstructured key informant interview (KII) guide was used to collect data to gain an in-depth understanding of the context in which continuum of care for maternal health care takes place and existing barriers. RESULT: The main themes were identified and compared across all the transcripts to determine similarities and variations in the views of respondents. The major reasons for which women walk away from maternal health services were categorized under three main themes: healthcare system related reasons, community level barriers and individual level barriers. Interpretive analysis was conducted, and elucidations of the results follow the respective themes and verbatim that capture dominant views were considered wherever appropriate to substantiate the findings. CONCLUSION AND RECOMMENDATIONS: Women were walk away from maternal health services because of health system, community level and individual level factors. Hence, implementing initiatives to improve both providers and clients side barriers are essential. Furthermore, we recommend more large-scale studies to digging out more context specific barriers.

Exploration of barriers to postnatal care service utilization in Debre Libanos District, Ethiopia: A descriptive qualitative study.

Background: In Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related barriers to PNC service utilization, but limited evidence was available on the health facilities and health care provider-related barriers. Therefore, the study was aimed at exploring both community and health care provider-related barriers to PNC service utilization. Methods: A descriptive qualitative study was conducted at Debre Libanos District, Ethiopia, from 11 March to 7 April 2019. A purposive sampling technique was used to recruit study participants among recently delivered women (<2 months), health care providers, and community members. A total of five in-depth interviews, 12 key informant interviews, and four FGDs were conducted. Data were audio-recorded, transcribed verbatim, and translated, and inductive thematic analysis was used to analyze the data using the atlas ti.7.1 software. Results: A total of 51 participants were involved in the study. The findings were organized into two major themes: (1) Community/caregiver-related barriers to PNC service utilization: lack of awareness about PNC, its importance, and schedules; lack of awareness about postnatal danger signs, sociocultural and religious beliefs, topographical and transportation problems, non-functionality of the health developmental armies (HDA); (2) health facility and health care provider-related barriers to PNC service utilization: poor supportive supervision and monitoring, lack of health extension workers' (HEW) commitment, lack of an organized system to notify delivery to HEW, shortage of HEWs, the residence of the HEWs, closure of health posts (HP) on working hours, and non-functionality of HPs. Conclusions: The study findings underscore the need to develop different strategies and take actions. Therefore, the health centers and district health offices should have to assign the required number of HEWs at HPs, regularly supervise and monitor HEWs, and develop an organized system to facilitate early notification of delivery to HEWs. The HEWs should have to live near the HP, re-organize HDAs, create awareness of maternal and newborn danger signs, and conduct social and behavioral change communications to increase the health-seeking behavior of community members for utilizing PNC services.

Maternal Healthcare in Low- and Middle-Income Countries: A Scoping Review.

Background: Continuum of care [COC] for maternal health care [MHC] refers to continuity of care that has been considered as a core principle and framework to underpin strategies and programs to save the lives and promote wellbeing of mothers and newborns. However, the status of the continuum of care for maternal health care is not well studied. Thus, the objective of this analysis is to examine the status of the continuum of care for maternal health care and current recommendations in Low- and Middle-Income Countries. Methods: Our review followed the scoping review methods. We searched for relevant studies in the PubMed, and Cochrane Library databases. Additionally, lateral searching was carried out from google scholar, reference lists of the included studies and supplemented by a gray literature search. One reviewer screened the full list, which was randomly split into two halves and independently screened by other 2 reviewers. The 2 reviewers independently extracted the data and discrepancies were resolved through discussion. Results: A total of 1259 records were identified through the databases and others searching strategies. Of these, 13 studies were included in the review and the year of their publication was from 2015 to 2019, more than half (53.8 %) of the included studies were from African countries. As to the source of data 53.8% of them were from countries' Demographic Health Survey [DHS], and all of them were cross sectional study by design. The general picture shows a decline in use of the services as women move along the continuum of care from pregnancy to childbirth and postnatal, and the highest gap was noticed between institutional delivery and postnatal care. The completion status differs from country to country and 60% in Cambodia during the 2010 CDHS but, 5% in Ratanakiri, Cambodia in 2015. Conclusion and recommendations: The status of continuum of care for maternal health care is varies across the countries. Also, there is limited studies on the continuum of maternal health care and more than half of the studies on this area were from countries' Demographic Health Survey and all of them were cross sectional by design. Furthermore, none of the reviewed studies considered status of continuum of care and birth outcomes. Hence, it is decisive to estimate the status of completion of continuum of care, completion, and its effect on birth outcomes in countries like Ethiopia where the burden of maternal and newborn mortality is high. Plain English summary: Continuum of care for maternal health care means the continuity of care during prenatal, delivery and postnatal. It has been considered as core strategies to save the lives of mothers and newborns.We searched for relevant studies in the databases and gray literature. Two reviewers performed data extraction independently. A total of 1259 records were identified through searching. Thirteen studies were included in the review. More than half of the studies included were from African countries. Demographic Health Survey [DHS] reported from these countries formed the main source of data. All of them were cross sectional study by design.The general picture shows a decline in the use of the health services as women move along the continuum of care from ANC to PNC. The completion status varies across countries.

Diabetes mellitus self-management education at Jimma University Medical Center: evidence-based implementation project.

BACKGROUND: Low and middle-income countries are currently enduring the heaviest global burden of diabetes and diabetes-related mortalities. Diabetes self-management education (DSME) improves patient clinical outcomes, health status, and quality of life. Lack of awareness about best practice guidelines and recommendations may be associated with increased risk of diabetes morbidity and mortality. OBJECTIVES: The objective of this study was to improve knowledge and skill of healthcare providers and patients with diabetes by enhancing evidence-based practice through self-management education to increase compliance with best practice recommendations. METHODS: JBI's three-phase Practical Application of Clinical Evidence System and Getting Research into Practice audit criteria of diabetes of audit management criteria were used. To understand barriers, 12 audit criteria, patient's medical record handling and educational plan according to set standards were evaluated. To mitigate the barriers, strategies of training and supportive supervision on evidence-based DSME were implemented from 20 April 2018 to 7 June 2018. Sixteen health professionals and 80 patients with diabetes participated in the study conducted in Jimma University Medical Center. Both a baseline and follow-up audit was conducted using the JBI feedback tool. RESULT: The baseline audit results indicate that 3 of the 12 audit criteria recorded zero percent compliance, whereas other compliances were below 40%, representing poor compliance with the current evidence. The post implementation audit reported 100% compliance for criteria on availability of structured education plan, existence of appropriate training for staff, the presence of education regarding nutrition and medications, while for the remaining criteria on competency of staff members for delivering DSME, assessment of prior diabetes knowledge, status of documentation after each session, and the presence of appropriate referrals or booking the compliance rate was improved to 88%. Similarly, criteria on the presence of individualized education plan improved (0-75%), encountering knowledge regarding physical activity (6-75%), self-monitoring of blood glucose (4-60%), and prevention diabetes complications (10-90%). CONCLUSION: There were remarkable changes in both patients and care providers on comparison of pre-intervention and post-intervention, particularly in availability of materials, involvement of staff in self-management education, nutrition, and medication.

Compliance to antenatal psychosocial assessment practice among midwives: a best practice implementation project.

INTRODUCTION AND AIMS: As directed by the WHO, antenatal care providers have good opportunities to identify and refer mothers who are struggling with psychosocial problems. In Ethiopia, the pooled prevalence of perinatal depression is 25.8%, which is almost two-fold of the pooled global prevalence. Though this is an indication of the need for prompt interventions, there is no assessment targeted to this population. Therefore, the aim of this project was to promote an antenatal psychosocial assessment practice among midwives. METHODS: Using the Joanna Briggs Institute Practical Application of Evidence System, 66 first visit antenatal care assessment opportunities were observed in both baseline and follow-up audit using three audit criteria. Fourteen midwives were interviewed for the first criterion. On the basis of the results, the gaps and barriers were analyzed using Getting Research into Practice strategies. RESULT: The baseline audit result revealed a 0% compliance rate for all evidence-based antenatal psychosocial assessment audit criteria. This scenario disclosed that there had not been psychosocial problem assessment practice at antenatal clinic. However, the postimplementation result showed that an average 91.5% practice of evidence-based antenatal psychosocial assessment was applied as per standards. CONCLUSION: Carrying out discussions on evidence summary with providers, on-the-job training, using local leaders' opinions, and involving relevant stakeholders appeared to be the key methods in improving compliance to best available evidence in antenatal psychosocial assessment.

Compliance to kangaroo mother care best practice: an evidence-based implementation project.

BACKGROUND: Worldwide about 13 million babies are born prematurely every year. Kangaroo mother care (KMC) is a proven, acceptable and feasible method to decrease the mortality rate of premature infants. Reviewing current KMC practices, implementing in the context and auditing the compliance would benefit the promotion evidence-based practice (EBP), which was not well known in the study area. OBJECTIVES: The main objective of the study was to increase awareness of EBP for KMC in the neonatal care unit of a public hospital through identifying local barriers and facilitators, and to measure compliance with best practice recommendations. METHODS: The current KMC best practice quality improvement project was conducted between March and May 2018. The project team was established for this implementation project. Six KMC best practice audit criteria were used to evaluate the compliance at baseline and endline using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. All (20) clinical staff who were working in the neonatal care unit were included in the study. Based on the baseline audit result, gaps and barriers were identified and discussed, and implementation strategies specific to the local setting were developed to mitigate the gaps. Baseline results were compared with the final follow-up audit result to measure change in compliance. Again, these data were compared with other studies to identify the sustainability of the project in a clinical setting. RESULTS: A total of 80 cases (baseline 20 and implementation 60) were observed demonstrating KMC procedures. Study found that follow-up compliance rates for all criteria improved compared with baseline audit; for example, criterion 5 (assessment of infant's condition) improved from 20% during baseline to 90% during follow-up and criterion 3 (parent/family received counselling) improved from 30 to 95%. CONCLUSION: The current study demonstrated that EBP training and frequent supportive supervision translated in improved compliance to best available evidence to KMC in a resource-limited setting.

Vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A scoping review.

INTRODUCTION: The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2. METHODS: We conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers. RESULTS: We identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia. CONCLUSION: Currently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.

Guidelines and best practice recommendations on reproductive health services provision amid COVID-19 pandemic: scoping review.

BACKGROUND: Policymakers and health professionals prefer to use summarized evidence of practice recommendations. The aim of this scoping review is therefore to identify available guidelines, consensus statements, the standard of practice, and practice recommendations on reproductive health service provision during the COVID-19 pandemics. METHODS: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for practice recommendations on sexual reproductive health services (SRH) during COVID-19 pandemics. Additionally, we searched: MEDLINE, EMBASE, and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that's relevant to the review question. The difference between the two authors on data extraction was resolved by discussion. RESULTS: A total of 21 records were included in the review. Identified recommendations were classified into thematic areas. The records addressed approaches to antenatal care, labour and delivery, postnatal care, safe abortion, contraception, gender-based violence, and artificial reproduction. CONCLUSIONS: There were consistent consensus statements and recommendations that there should be access to sexual and reproductive health services like antenatal care (ANC), postnatal care (PNC), contraception service, safe abortion care, and clinical management of rape survivors during the COVID-19 pandemics with the concerted effort of service re-organization. The practice recommendations focus on innovative ways of service provision to minimize patient and staff exposure to COVID-19 as well as alleviate the burden on the health care system. These include utilizing telemedicine and community/home-based care or self-care.

Perinatal outcome of meconium stained amniotic fluid among labouring mothers at teaching referral hospital in urban Ethiopia.

OBJECTIVE: To determine the perinatal outcome of labouring mothers with meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid at teaching referral hospital in urban Ethiopia. METHODS: A prospective cohort study was conducted among labouring mothers with meconium-stained amniotic fluid from July 1 to December 30, 2019. Data was collected with pretested structured questionnaires. A Chi-square test used to check statistical associations between variables. Those variables with a p-value of less than 0.05 were selected for cross-tabulation and binary logistic regression. P-value set at 0.05, and 95% CI was used to determine the significance of the association. Relative risk was used to determine the strength and direction of the association. RESULT: Among 438 participants, there where 75(52.1%) primigravida in a stained fluid group compared to112 (38.5%) of the non-stained fluid group. Labour was induced in 25 (17.4%) of the stained fluid group compared to 25(8.6%) of a non-stained fluid group and has a statistically significant association with meconium staining. The stained fluid group was twice more likely to undergo operative delivery compared with a non-stained fluid group. There were more low Apgar scores at birth (36.8% versus 13.2%), birth asphyxias (9% versus 2.4%), neonatal sepsis (1% versus 5.6%), neonatal death (1% versus 9%), and increased admissions to neonatal intensive care unit (6.2% versus 21.5%) among the meconium-stained group as compared to the non-stained group. Meconium aspiration syndrome was seen in 9(6.3%) of the stained fluid group. CONCLUSION: Meconium-stained amniotic fluid is associated with increased frequency of operative delivery, birth asphyxia, neonatal sepsis, and neonatal intensive care unit admissions compared to clear amniotic fluid.

Managing Resident Workforce and Residency Training During COVID-19 Pandemic: Scoping Review of Adaptive Approaches.

OBJECTIVE: To review available adaptive residency training approaches and management of the resident workforce in different residency programs amid COVID-19 pandemic. MATERIALS AND METHODS: Websites of different professional associations and international or national specialty accreditation institutions were searched. We looked for English studies (any form), reviews or editorials, perspectives, short or special communications, and position papers on residency education during the COVID-19 pandemic. PubMed, EMBASE, and Google Scholar were also searched using keywords. Two independent reviewers extracted data using a customized tool that was developed to record the key information relevant to the review question. The two authors resolved their difference in data extraction by discussion. RESULTS: We identified 13 documents reporting on residency education during pandemics. Three were articles, 5 short or special communications, and the rest editorials and perspectives. We divided the data obtained into six thematic areas: resident staffing, clinical education, surgical education, didactic teaching, research activity, and accreditation process. CONCLUSION: Residency programs must reorganize the resident's staffing and provide appropriate training to ensure the safety of residents during the pandemic. There are feasible adaptive approaches to maintaining residency training in the domains of didactic teaching, clinical education, and some research activities. Although some innovative virtual surgical skills training methods are implemented in limited surgical residency disciplines, their effectiveness is not well examined. Guidance and flexibility of the accreditation bodies in ensuring the competency of residents is one component of the adaptive response.

Effectiveness of symptom-triggered regimen versus fixed-dosage regimen of benzodiazepine treatment for alcohol detoxification: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of a symptom-triggered regimen versus a fixed-dosage regimen of benzodiazepine treatment for alcohol detoxification. INTRODUCTION: Patients with alcohol use disorder who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal syndrome. Adequate treatment of detoxification can relieve the patient's distress, prevent the development of more serious symptoms and forestall collective effects that might worsen future withdrawals. INCLUSION CRITERIA: The review will consider studies that include people with alcohol withdrawal syndrome who are taking benzodiazepine treatment in an inpatient setting. Studies of people with alcohol withdrawal syndrome who are under the age of 18 will be excluded. This review will exclude studies of people with alcohol withdrawal syndrome who are non-verbal (e.g. stupor due to head injury) or have a history of seizure. Studies published in English will be included. METHODS: An initial limited search of MEDLINE and CINAHL was undertaken to identify articles. The text words contained in the titles and abstracts, and index terms were used to develop a full search strategy. The search strategy, including all identified keywords and index terms, will be adapted for each included information source. Studies will be pooled for statistical meta-analysis. Effect sizes will be expressed as odds ratios (for categorical data) or weighted mean differences (for continuous data), and their 95% confidence intervals will be calculated for analysis. The heterogeneity will be assessed using the I test and chi-squared test. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018115777.

How Prepared Is Africa for the COVID-19 Pandemic Response? The Case of Ethiopia.

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this research communication is to describe the general epidemic preparedness of Ethiopia using "Ready score" criterion that was developed by PreventEpidemics.org. The ReadyScore criteria is used to determine whether a country is prepared to find, stop, and prevent epidemics. This set of criteria advises countries to take tailored measures based on their actual circumstances. Ethiopia's preparedness as assessed using the ReadyScore criteria is 52%, which indicates that much work is expected from the country. Based on the current situation of Ethiopia's epidemic preparedness, the currently increasing trend in the number of COVID-19 cases and the current situation of Ethiopia in relation to its preparedness to mitigate the pandemic of Covid-19, we recommend (a) mass communication and community mobilization, (b) social distancing measures, (c) sanitary measures, (d) maximizing case tracing and detection, (e) developing detailed operational guidelines on preventive measures across different businesses, organizational and community settings, (f) measures for sustaining essential health services and (g) proactive measures to sustain life during the lockdown.

Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia.

BACKGROUND: Intrauterine growth restriction is defined as a fetal weight below the 10th percentile for a given gestational age and can be identified using umbilical artery Doppler velocimetry which is a non-invasive technique. The objective of this study was to determine the perinatal outcome of growth-restricted fetuses with abnormal umbilical artery Doppler study compared to those with normal umbilical artery Doppler waveforms at a tertiary referral hospital in Ethiopia. METHODS: A prospective cohort study was conducted among pregnant mothers with fetal growth restriction admitted for labour and delivery from September 2018-February 2019. The data were entered and analyzed using SPSS version 23. After conducting descriptive analysis, exploring the entire data, and checking for, statistical associations between abnormal umbilical artery Doppler and outcome variables, multiple logistic regression was conducted to control for confounders. RESULTS: A total of 170 pregnant mothers complicated with growth-restricted fetuses were included in the study, among which 133 were with normal umbilical artery Doppler studies and 37 were with abnormal umbilical artery Doppler studies. Four (3%) of normal and 9(24.3%) of abnormal umbilical artery Doppler studies ended in perinatal death-value = 0.001. Twenty (15%) of normal and 24(64.9%) of abnormal umbilical artery Doppler study neonates required neonatal intensive care admission-value = 0.002. Growth restricted fetuses complicated with abnormal Doppler were two times more likely to require neonatal intensive care unit admissions compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.002, (OR = 2.059,95%CI 1.449-2.926). Growth restricted fetuses complicated with abnormal Doppler were four times more likely to end in early neonatal death compared to growth-restricted fetuses with normal umbilical artery Doppler flow, P-value 0.001, (OR = 4.136, 95%CI 3.423-4.998). However, the study is unmatched and there is a possibility of gestational age confounding the result and should be seen with the context of preterm morbidity and mortality. CONCLUSION: The abnormal umbilical artery Doppler waveform is associated with cesarean section delivery, neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and early neonatal death compared to normal umbilical artery Doppler flow.

Exploration of facilitators of and barriers to the community-based service utilization for newborn possible serious bacterial infection management in Debre Libanos District, Ethiopia: descriptive qualitative study.

BACKGROUND: Globally, possible serious bacterial infection [PSBI] is a cause for about 600,000 newborn deaths per year. To decrease the burden of this infection, a community-based management newborn PSBI when referral to hospital is not possible has been on implementation. Studies showed gaps in the service utilization and this study was aimed at exploring its barriers and facilitators. METHODS: A descriptive qualitative study was conducted from March 11- April 7, 2019, in Debre Libanos District, Ethiopia. Study participants were recruited purposively. Women who gave birth within 2 months before data collection, health extension workers [HEW], health workers, religious leader, kebele chairman, and other community members were involved in the study. Five in-depth interviews, seven key informant interviews, and four focused group discussions were conducted with a total of fifty-two participants. The data were audio-recorded, transcribed verbatim and translated, and inductive thematic analysis was done using Atlas ti.7.1 software. RESULT: The availability of health workers trained on community-based newborn care [CBNC], Integrated Management of Newborn and Childhood Illness guidelines, availability of medical supplies and job aids, and performance review meetings were identified as facilitators. Communities perception that the newborn illness has no medical treatment, newborn illness is not severe and is self-resolution; the belief in healing power of traditional medicines, socio-cultural and religious beliefs, lack of awareness about service availability at the health post, poor supportive supervision or monitoring, shortage of HEW, the residency of HEWs outside the health post, a poor commitment of health workers and HEWs, and non-functionality of health developmental army were explored as barriers. CONCLUSIONS: The findings provided insight into the facilitators of and barriers to community-based service utilization for newborn PSBI management. There is a need to develop strategies to address the barriers. Therefore, health care providers should have to develop strategies, and conduct a behavioral change communication to change the perception of community members towards newborn illnesses, promote the availability of the service at the health post, and the HEWs provide the service staying at the health post.

Effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices and maternal and perinatal outcome: A systematic review and meta-analysis.

INTRODUCTION: The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is a 29-item checklist based on essential childbirth practices to help health-care workers to deliver consistently high quality maternal and perinatal care. The Checklist was intended to reduce maternal and perinatal mortality and address the primary cause of maternal death, intrapartum stillbirth, and early neonatal death. The objective of this review was to locate international literature reporting on the effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices, early neonatal death, stillbirth, maternal mortality, and morbidity. METHODS: We searched MEDLINE, google scholar, Cochrane Central Register of Controlled Trials (CENTRAL), met-Register of Controlled Trials (m-RCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/stop/search/en) to retrieve all available comparative studieshttp://www.opengrey.eu/ published in English after 2008. Two reviewers did study selection, critical appraisal, and data extraction independently. We did a random or fixed-effect meta-analysis to pool studies together and effect estimates were expressed as an odds ratio. Quality of evidence for major outcomes was assessed using the Grading of Recommendations, Assessment, development, and evaluation(GRADE). RESULTS: We retained three cluster randomized trials and six pre-and-post intervention studies reporting on WHO SCC's. The WHO SCC utilization improved quality of preeclampsia management(moderate quality of evidence) (OR = 7.05 [95% CI 2.34-21.29]), maternal infection management(moderate quality of evidence) (OR = 7.29[95%CI 2.29-23.27]), Partograph utilization(moderate quality of evidence) (OR = 3.81 [95% 1.72-8.43]), postpartum counselling(low quality of evidence) (RR = 132.51[95% 49.27-356.36]) and still birth(moderate quality of evidence) (OR = 0.92[95% CI 0.87-0.96]). However, the utilization of the checklist had no impact on early neonatal death (very low quality of evidence) (OR = 1.07[95%CI [1.01-1.13]) and maternal death (low quality of evidence) (OR = 1.06[95% CI 0.77-1.45]). CONCLUSIONS: Moderate quality of evidence indicates that WHO SCC utilization is effective in reducing stillbirth and Improving preeclampsia management, maternal infection management and partograph utilization Low quality of evidence indicates that WHO SCC is effective in enhancing postpartum danger sign counseling. Low and very low quality of evidence suggests that WHO SCC has no impact on maternal and early neonatal death, respectively.

Exploration of barriers and facilitators to household contact tracing of index tuberculosis cases in Anlemo district, Hadiya zone, Southern Ethiopia: Qualitative study.

BACKGROUND: Tuberculosis [TB] is the second leading cause of death from an infectious disease in the world. Intensifying tuberculosis screening and contact investigation strategy is recommended to ensure early diagnosis among household contacts of TB patients. Studies showed that there is low TB contact tracing. There was limited evidence on barriers and facilitators of household contact tracing. Therefore, this study was aimed at exploring barriers and facilitators for household contact tracing of index TB cases. METHODS: A descriptive qualitative study was conducted at Anlemo district, Hadiya zone, Ethiopia from March 12-April 9, 2019. Purposive sampling technique was used to recruit study participants. A total of 16 participants were involved in the study which included health extension workers [HEWs], index TB patients, household contacts of TB patients, health center TB focal and district TB coordinator. Data were collected through in-depth interviews using a semi-structured guide, transcribed verbatim and translated into English. Inductive thematic analysis was employed using ATLAS.ti7.1 software and the findings were presented on major themes, categories, and quotations. RESULTS: This study found low TB contact tracing and investigation, and explored barriers and facilitators such as monitoring and supervision, training of health workers, logistics and infrastructure, waiting time and institutional readiness, referral, feedback and linkage, human resource, charge for some laboratory, transportation, budget, knowledge, commitment and motivation, workload, distance, social support, economic constrain, and stigma and discrimination for household contact tracing of index TB cases under four themes. CONCLUSIONS: From this study, it was understood that there was a gap in addressing all household contacts. Also, the study explored a wide range of possible barriers and facilitators for it. Explored barriers outweigh the facilitators which might have an implication facilitating the dissemination of TB silently within the community. This underscores the importance of taking action to avert those barriers by developing different strategies to increase TB contact tracing. Therefore, health care providers should have to improve the implementation of contact tracing by designing and developing appropriate strategies that should fit the local context.