Maternal and newborn effects of gestational diabetes mellitus: A prospective cohort study.

BACKGROUND: Gestational diabetes mellitus (GDM) is a high glucose level detected during pregnancy and usually it disappears after 42 days of post partum. The aim of this research was to assess the maternal and newborn effects of GDM in resource limited settings. METHODS: A prospective cohort was implemented in the five referral hospitals of Amhara region. Data were collected using both primary data collection tool and reviewing the patients' charts. Descriptive statistics were used to describe the effects of GDM on the pregnancy outcomes, fractional regression was used to estimate the proportion of weight gain in the first 3 months, Poisson regression was used to identify the effects of GDM on the episodes of childhood infectious diseases, independent sample t-test was used to estimate the effects of GDM on the newborn serum zinc and vitamin D levels. RESULTS: A total of 3459 women were included with a response rate of 85.56%. Cesarean section rate among GDM mother was 40.3% and among GDM free mothers was 7.1%. In the first 3 months, the weight gains of infant born from GDM mothers were 53% higher than infant born from GDM free mothers. GDM increases the risk of infectious disease episodes by 4 folds. GDM decreases the neonatal serum zinc and vitamin D levels. CONCLUSION: GDM increases the maternal complications of pregnancy; GDM significantly depletes the newborn micronutrient levels and increase the episodes of infectious diseases during the infancy periods.

Glycemic Control of Diabetes Mellitus Patients in Referral Hospitals of Amhara Region, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Glycemic control is the level of glucose in diabetes patient. Evidence regarding glycemic control is scarce in resource-limited settings, and this study was conducted to generate information regarding the prevalence and predictors of glycemic control among diabetes mellitus patients attending their care from the referral hospitals of the Amhara region, Ethiopia. METHODS: A cross-sectional study design was implemented. A simple random sampling technique was used. Data were collected from March 2018 to January 2020. The data were collected using interviews, chart review, and blood samples. Hemoglobin A1c was measured using high-performance liquid chromatography. Data were entered into Epi-info software and analyzed by SPSS software. Descriptive statistics were used to estimate the prevalence of glycemic control; linear regression was used to identify the predictors of HbA1c. RESULTS: A total of 2554 diabetes patients were included giving for the response rate of 95.83%. The mean age of the study participants was 54.08 years [SD (standard deviation) ± 8.38 years]. The mean HbA1c of the study participants was 7.31% [SD ± 0.94%]. Glycemic control was poor in 55.32% [95% CI: 53.4%-57.25%] of diabetes patients. The glycemic control of diabetes patients was determined by BMI (ß 0.1; [95% CI: 0.09-0.1]), type 2 diabetes (ß -0.14; [95% CI: -0.11-0.16]), age (ß 0.22; [95% CI: 0.02-0.024]), duration of the disease (ß 0.04; [95% CI: 0.037-0.042]), the presence of hypertension (ß 0.12; [95% CI:0.09-0.16]), regular physical exercise (ß -0.06; [95% CI: -0.03-0.09]), medication adherence (ß -0.16; [95% CI: -0.14-0.18]), and male (ß 0.34; [95% CI: 0.31-.037]). CONCLUSION: The glycemic control of diabetes patients was poor, and it needs the attention of decision-makers.

Progression of pregnancy induced diabetes mellitus to type two diabetes mellitus, an ambidirectional cohort study.

INTRODUCTION: Diabetes mellitus (DM) is a metabolic disorder characterized by elevated level of blood glucose. It affects more than 422 million people globally. In resource limited settings, the progression of gestational diabetes (GDM) to DM was not well investigated and this research work was conducted to estimate the incidence of DM after GDM and their predictors in resource limited settings. METHODS: A retrospective and prospective cohort studies were used from January 2010 until December 2019. The data were collected using patients chart review, interview and collecting blood sample. Initially, baseline data were collected from GDM and GDM free women and update data were collected every 3 month. Clinical nurses were used to extract the necessary data from medical charts and to collect the data using patient interview. Laboratory technologists were used to measure the blood glucose level of the study participants. The study was conducted in pregnant women presenting themselves in the referral hospitals of Amhara regional state. The sample size was calculated using Epi-info software. Descriptive statistics were used to describe the profile of study participants. Kaplan Meier survival curve and life-table were used to estimate the survivals of study participants. Incidence density was used to estimate the incidence of DM. Cox regression was used to identify the predictors DM. RESULTS: A total of 4892 women were followed giving for the response rate of 88.62%. The mean age of study participants at the start of the study was 28.34 years with standard deviation [SD] ±7.48 years. DM was associated with gestational diabetes mellitus [AHR (adjusted hazard ratio); 2.53, 95% CI: 2.14-2.99], frequency of breastfeeding [AHR; 0.72, 95% CI: 0.69-0.74], age [AHR; 1.04, 95% CI: 1.03-1.05], parity [AHR; 1.14, 95% CI: 1.07-1.21], regular physical exercise [AHR; 0.45, 95% CI: 0.37-0.55], family history of DM [AHR; 2.04, 95% CI: 1.76-2.37], stillbirth [AHR; 1.67: 95% CI: 1.34-2.07], abortion [AHR; 2.64, 95% CI: 2.25-3.09]. CONCLUSION: The progression of GDM to DM was very high and special follow up should be implemented for women with a history of abortion, stillbirth, and family history of DM.

Level of immunization coverage and associated factors among children aged 12-23 months in Lay Armachiho District, North Gondar Zone, Northwest Ethiopia: a community based cross sectional study.

BACKGROUND: Immunization against childhood disease is one of the most important public health interventions with cost effective means to preventing childhood morbidity, mortality and disability. However, complete immunization coverage remains low particularly in rural areas of Ethiopia. This study aimed to assess the level of immunization coverage and associated factors in Lay Armachiho District, North Gondar zone, Northwest Ethiopia. A community based cross-sectional study was conducted in March, 2014 among 751 pairs of mothers to children aged 12-23 months in Lay Armachiho District. A two stage sampling technique was employed. Logistic regression analysis was carried out to compute association between factors and immunization status of children. Backwards stepwise regression method was used and those variables significant at p value 0.05 were considered statistically significant. RESULTS: Seventy-six percent of the children were fully immunized during the study period. Dropout rate was 6.5% for BCG to measles, 2.7% for Penta1 to Penta3 and 4.5% for Pnemonia1 to Pnemonia3. The likelihood of children to be fully immunized among mothers who identified the number of sessions needed for vaccination were higher than those who did not [AOR = 2.8 (95% C1 = 1.89, 4.2)]. Full immunization status of children was higher among mothers who know the age at which the child become fully immunized than who did not know [AOR = 2.93 (95% CI = 2.02, 4.3)]. Taking tetanus toxoid immunization during pregnancy showed statistically significant association with full immunization of children [AOR 1.6 (95% CI = 1.06, 2.62)]. Urban children were more likely to be fully immunized than rural [AOR = 1.82 (95% CI = 1.15, 2.80)] and being male were more likely to be fully immunized than female [AOR = 1.80 (95% CI = 1.26, 2.6)]. CONCLUSION AND RECOMMENDATION: Vaccination coverage was low compared to the Millennium Development Goals target. It is important to increase and maintain the immunization level to the intended target. Efforts should be made to promote women's' awareness on tetanus toxoid immunization, when the child should start vaccination, number of sessions needed to complete immunization, and when a child become complete vaccination to improve immunization coverage through health development army and health professionals working at antenatal care, postnatal care and immunization units.