Prevalence and risk factors of pelvic organ prolapse among women in Sidama region, Ethiopia: A community-based survey.

BACKGROUND: Pelvic organ prolapse is a descent of the vaginal compartments and the surrounding organ due to loss of support of the vaginal tissue. It has a significant psychological, physical, and social impact that affects women's quality of life. However, its true prevalence is unknown due to the variability in the methods used to diagnose the disorder. OBJECTIVES: This study aimed to determine the prevalence of pelvic organ prolapse and its associated risk factors among women in Sidama region, Ethiopia. STUDY DESIGN: A community-based cross-sectional survey was conducted in the Dale-Wonsho Health and Demographic Surveillance Site, Sidama region, from March to October 2023. METHODS: A multi-stage stratified cluster sampling was used to select a sample of 816 women. Anatomical prolapse was diagnosed based on the standardized pelvic organ prolapse quantification method, and symptomatic prolapse was assessed by patient-reported symptoms. A complex survey-based modified Poisson regression was used to assess the risk factors associated with prolapse. RESULTS: A total of 815 participated in the interview, and 779 (95.6%) underwent pelvic examination to assess for prolapse status. Anatomical prolapse (Stages II-IV) was observed in 241 (30.9%; 95% confidence interval = 24-38.7) of the participants. The prevalence of symptomatic pelvic organ prolapse was 78.5% (95% confidence interval = 69.1-85.7) among women with anatomical prolapse (189/241). This prevalence falls to 24.27% (95% confidence interval = 19.98-29.16) for the total sample population. Higher frequency of childbirth, prolonged heavy lifting activities, and prolonged labor increased the likelihood of developing anatomical prolapse. Childbirth at an early age and prolonged heavy lifting activities were significantly associated with symptomatic prolapse. CONCLUSION: Anatomical prolapse and symptomatic prolapse are high in the study area. Parity, prolonged heavy lifting, prolonged labor, and early age childbirth were associated with pelvic organ prolapse. Community-based education and interventions that focus on the modification of risk factors are needed.

A study on pelvic organ prolapse confirmed through physical examination and symptoms of prolapse assessed among women in Sidama region of EthiopiaWhy was the study done? Pelvic organ prolapse occurs when one or more vaginal compartments and their surrounding organs drop from their normal position. Imagine the pelvic floor as a supportive sling made of muscles, ligaments, and tissues. These structures usually hold organs, such as vagina, bladder, uterus, and rectum in place. However, when the pelvic floor weakens due to factors, such as pregnancy, childbirth, or menopause, these organs bulge. Symptoms may include feeling a tissue bulge near the vaginal opening, pelvic pressure, lower back pain, urinary changes, and even difficulty keeping in a tampon. However, evidence about how common the problem is in the Sidama region is limited. This may hinder the need for efforts to be taken in identifying and treating the disorder. What did the researchers do? The research team assessed the symptoms of prolapse by asking women through house-to-house visits invited them to the nearby health facility and conducted pelvic examination to confirm the presence of prolapse. Women's characteristics that can be related to prolapse were also assessed through interview. What did the researchers find? A total of 815 women participated in interviews on prolapse symptoms, and 779 underwent pelvic examination. Among those examined, one in three women (241/779) has a physically confirmed prolapse. Among the confirmed prolapses, 189 women reported symptom of prolapse. Women who have birth many times, who work on prolonged heavy lifting activities, and who have a history of labor that lasted more than 24 h have a high chance to develop prolapse. Similarly, those who gave birth before the age of 18 years and those engaged in prolonged heavy lifting activities have higher chance of developing prolapse symptoms. What do the findings mean? The findings showed that prolapse is common in the Sidama region of Ethiopia and that it needs attention of stakeholders.

Reliability and validity of the Sidaamu Afoo version of the pelvic organ prolapse symptom score questionnaire.

BACKGROUND: Both for clinical and research purposes, it is critical that clinicians and researchers use a tool that is trans-culturally adapted and tested for its psychometric properties. The English version of the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire was developed in 2000. Since then it has been translated into other languages and verified. However, the tool has not been adapted for use in Sidaamu Afoo language in the Sidama Region of Ethiopia. OBJECTIVE: This study aimed to translate and adapt the Pelvic Organ Prolapse Symptom Score questionnaire into Sidaamu Afoo and evaluate its psychometric properties. METHODS: A total of 100 women with symptomatic prolapse completed version-2 of the POP-SS questionnaire during the first round of interviews, and 61 of them completed the questionnaire during the second round of interviews (to establish the test-retest reliability). We adapted the scale translation process recommended by Beaton and his colleagues. The content validity was assessed using the content validity index and the construct validity was done based on exploratory factor analysis using the principal component analysis model. The criterion validity was evaluated by using the Kruskal-Wallis test based on stages of the prolapse established via pelvic examination. The internal consistency reliability of the scale was assessed using Cronbach's alpha value, and test-retest reliability was evaluated using the intraclass correlation coefficient. RESULTS: The questionnaire was successfully translated to Sidaamu Afoo, and achieved a good content validity index (0.88), high internal consistency (Cronbach's alpha of 0.79), and test-retest reliability (an intraclass correlation coefficient of 0.83). The exploratory factor analysis revealed two factors based on an eigenvalue of 1. The two factors explained 70.6% of the common variance, and each item loaded well (0.61 to 0.92) to its corresponding factor. There is a significant difference in the median score of prolapse symptoms across different stages of prolapse (Kruskal-Wallis χ2, 17.5, p < 0.001). CONCLUSION: The Sidaamu Afoo version of the POP-SS tool is valid and reliable. Further studies that involve a balanced number of women in each stage of prolapse are needed to avoid the ceiling and floor effects.

Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: a systematic review and narrative synthesis.

INTRODUCTION: Pelvic organ prolapse (POP) affects women's quality of life in various aspects. However, evidence on the healthcare-seeking behavior of women with POP is limited. Therefore, this review aimed to identify and synthesize the existing evidence on the healthcare-seeking behavior among women with POP. METHODS: This systematic review and narrative synthesis of the literature on healthcare-seeking behavior among women with POP was conducted from 20 June to 07 July 2022. The electronic databases PubMed, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus and Directory of Open Access Journal, and Google Scholar were searched for relevant literature published from 1996 to April 2022. The retrieved evidence was synthesized using a narrative synthesis approach. The characteristics of included studies and the level of healthcare-seeking behavior were summarized in a table and texts. Error bar was used to show the variability across different studies. RESULTS: A total of 966 articles were retrieved of which only eight studies with 23,501 women (2,683 women with pelvic organ prolapse) were included in the synthesis. The level of healthcare-seeking behavior ranges from 21.3% in Pakistan to 73.4% in California, USA. The studies were conducted in four different populations, used both secondary and primary data, and were conducted in six different countries. The error bar shows variation in healthcare-seeking behavior. CONCLUSIONS: The level of health-care seeking behavior among women with POP is low in low-income countries. There is substantial variability in the characteristics of the reviewed studies. We recommend a large-scale and robust study which will help to better understand the healthcare-seeking behavior among women with POP.

Maternal Depression and Associated Factors Among Pregnant Women Attending Ante Natal Care, Southern Ethiopia: Cross-Sectional Study.

Background: Patients with depressed mental disorders may experience a lack of interest or pleasure, a poor mood, feelings of guilt or unworthiness, sleep and appetite disturbances, and easy fatigability. Based on the degree of the condition, depression is classed as mild, moderate, or severe. Maternal depression is the most common psychiatric condition during pregnancy, and its harmful effects have serious ramifications for both the mother and the fetus. Almost one in every four women will experience depression at some point in her life, the majority of which will occur during her childbearing years. Studies reports showed that antenatal depression is a common maternal problem in Ethiopia and as reported antenatal depression ranges in Ethiopia from 19.04 to 29.92%. Objective: To assess the prevalence of maternal depression and associated factors among antenatal care attendants at Wolayta Sodo Teaching and Referral hospital, Southern Ethiopia. Methods: Health facility based cross-sectional study was conducted at Wolayta Sodo Teaching and Referral Hospital from May 01 to 30, 2018. Data were collected from through face to face interview at exit from antenatal care unit using structured questionnaire and checklist adopted from patient Health Questionnaire (PHQ-9). Data were collected from 309 antenatal attendant mothers using systematic random sampling from each either mother. Binary and multivariable logistic regression model was employed to identify factors associated with maternal depression at P-value <0.05 level of significant. Result: Depression among pregnant mother was found to be 27.2% (95% Cl: 22, 32%). Women's level of education; being elementary school (AOR = 6.35 95%CL (2.32, 17.38), completing high school and above (AOR = 3.35, 95%CL 1.33, 8.47) were associated with maternal depression whereas having good husband support was protective for maternal depression (AOR = 0.4, 95%CL: 0.19, 0.83) and also not using substance during pregnancy period was protective for maternal depression (AOR = 0.39, 95%CI, 0.19, 0.77). Conclusion: The frequency of mother depression in this community was greater than in previous Ethiopian studies reported. Maternal depression was linked to a woman's level of education, husband support, and substance usage. This suggested that health care providers regarding pregnant women should emphasize the importance of husband support, substance usage and women level of education.

Health Professionals Job Satisfaction and Associated Factors in Ethiopia: A Systematic Review and Meta-analysis.

BACKGROUND: Health professionals' job satisfaction is crucial for health professionals' life which determines health care service quality. This study aimed to estimate pooled prevalence of job satisfaction of health professionals and associated factors in Ethiopia. METHODS: Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was followed to prepare this study. Studies were searched from PubMed (EBSCOhost), Directory of open access journals (DOAJ), Global health, African Index Medicus, IRIS (WHO digital publication), African Journals Online (AJOL), Google Scholar, and Google. Random-effect model was used to estimate the pooled prevalence of job satisfaction and associated factors. Heterogeneity was assessed using I 2 test statistics. Publication bias was checked using funnel plot, Egger's regression test, and sensitivity analysis. RESULT: The pooled prevalence of health professionals' job satisfaction was computed from 35 studies, and it was 46.68% (95%, confidence interval (CI): 41.82, 51.54, I 2 = 95.8%). Specifically, job satisfaction was 57.56%, 48.80%, 48.57%, 48.48%, 44.56%, 39.20%, and 16.5% among pharmacy professionals, health officers, midwives, nurses, anesthetists, physicians, and health extension workers, respectively. Secured working environment (pooled odds ratio [POR] = 6.50, 95% CI: 3.41-9.58), coworkers relationship (POR = 5.14, 95% CI: 1.27, 9.02), good relationship with supervisors (POR = 5.86, 95% CI: 2.56-9.16) and having bachelor's degree (POR = 2.52, 95% CI: 1.31, 3.72) were significantly associated with job satisfaction. CONCLUSION: Job satisfaction among Ethiopian health professionals is considerably low. Secured working environment, positive relationships among staff, and having a bachelor's enhanced the job satisfaction. Designing strategies to improve safety in the work environment and improved communication among workers could improve job satisfaction.

Respectful family planning service provision in Sidama zone, Southern Ethiopia.

INTRODUCTION: Disrespect and abusive care is a violation of women's basic human rights and it is serious global problem that needs urgent intervention. Poor quality client-provider interaction is commonly reported from family planning programmes. In Ethiopia, disrespect and abusive care is very common (21-78%) across health facilities. OBJECTIVE: To assess the status of respectful family planning service (client-provider interaction) in Sidama zone, south Ethiopia. METHODOLOGY: Health facility-based cross-sectional study was conducted from June to August 2018. Data were collected from 920 family planning clients recruited from 40 randomly selected health facilities. The Mother on Respect index (MORi) questionnaire was used to collect the data through client exit interview. Partial proportional odds ordinal regression was employed to identify determinants of respectful family planning service. RESULT: Among family planning clients, the level of respectful family planning service was found to be zero (0%) in the very low respect category, 75(18.5%) in the low respect category, 382(41.52%) in moderate respect category and 463(50.33%) in high respect category. Being a short acting method client (AOR = 0.30, 95%CI [0.12, 0.72]), being an uneducated client (AOR = 0.39, 95%CI [0.25, 0.61]) or a client with elementary education (AOR = 0.41, 95%CI [0.23, 0.73]), client's poverty (AOR = 0.75, 95%CI [0.56, 0.99]), and long waiting time (AOR = 0.46, 95%CI [0.30, 0.69])significantly reduced the odds of moderate and high respect compared to low respect. Conversely, preference of male service providers, service providers' work satisfaction and health workers' prior training on respectful care significantly increased the odds of moderate and high respect. CONCLUSION: Considering the current strategy of zero tolerance for disrespect and abuse in Ethiopia, the level of respectful care in this study is sub-optimal. Short term training for service providers on respectful care seems valuable to enhance the level of respectful care for family planning clients irrespective of their socioeconomic background.

Determinants of Sub-Optimal Birth Spacing in Gedeo Zone, South Ethiopia: A Case-Control Study.

BACKGROUND: Birth spacing is key in ensuring the health of mothers and their children as well as determining population growth. Most of the mothers in developing nations including Ethiopia have been practicing short inter-birth intervals. There is a paucity of studies concerned with suboptimal birth spacing among women in reproductive age in the study area. PURPOSE: This study aims to identify the determinants of sub-optimal birth spacing among reproductive-age women in Gedeo zone, South Ethiopia. MATERIALS AND METHODS: A community-based unmatched case-control study was undertaken among 814 reproductive-age women in Gedeo zone, South Ethiopia from October 1 to November 30, 2018. Cases were women practiced suboptimal/short birth intervals (<33 months), whereas controls were women practiced inter-birth intervals of 33 months and more. A structured interviewer-administered questionnaire was used. A stratified, two-stage cluster sampling technique was used. EpiData version 3.1 and SPSS version 22 were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression analyses were computed. P-value <0.05 was considered as statistically significant. All ethical procedures were considered. RESULTS: Women's educational status, AOR (95% CI) =0.6 (0.43, 0.96), age at first marriage, AOR (95% CI) = 0.9 (0.85, 0.99), distance from the nearest health facility, AOR (95% CI) = 1.4 (1.04, 1.94), wealth index, AOR (95% CI) = 4.1 (2.66, 6.19), and postnatal care utilization after the previous birth, AOR (95% CI) = 0.4 (0.25, 0.53) were statistically significant with suboptimal birth spacing. CONCLUSION: Women's educational status age at first marriage, distance from the nearest health facility, wealth index and postnatal care utilization after the previous birth were the determinants of suboptimal birth spacing.

Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia.

OBJECTIVE: To assess labor pain control and associated factors among women who give birth at Leku primary hospital, southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS). RESULTS: In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24 year AOR = 5.85 (95% CI 2.14, 15.98), being farmer AOR = 2.5 (1.14, 5.57), primi-para AOR = 0.13 (0.06, 0.3), good family support AOR = 2.8 (1.49, 5.3), short duration of labor (< 12 h) AOR = 3.2 (1.65, 6.23) and history of pregnancy loss AOR = 0.06 (0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.

Mobile Phone Based Strategies for Preconception Education in Rural Africa.

BACKGROUND: Prepregnancy health care is vital to alleviate and prevent maternal and neonatal disability and death. OBJECTIVE: The purpose of the study was to measure the levels of knowledge and attitude on preconception care and their determinants among women who delivered at government hospitals in a rural setting in southern Ethiopia. METHOD: A facility-based cross sectional study was done from January 01 to February 30, 2017 on a sample of 370 women who delivered at government hospitals in Wolayita zone. The mothers were selected using systematic random sampling technique. The data were collected using structured and pretested interviewer administered questionnaires at the postnatal ward of each hospital. Data were analyzed using bivariate and multivariable techniques. RESULTS: The result showed that 53% (95% confidence interval [CI]: 47.8%, 58.1%) of mothers who delivered at public hospitals had adequate level of knowledge on preconception care, whereas 54.3% (95% CI: 49.2%, 59.5%) possessed positive attitude to preconception care. Mothers who have radio, planned pregnancy and have participated in community meetings related to preconception care had a meaningfully higher odds of good level of knowledge to preconception care. Ordinal regression showed that women who own mobile phone had at least three times significantly higher odds of positive attitude to preconception care, whereas women who have participated community meetings had lower odds of positive attitude on preconception care. CONCLUSION: The results revealed that the levels of mothers' knowledge and positive attitude on preconception care are low relative to other studies. Using transistor radio and mobile phone have significant effect in improving the knowledge and attitude of reproductive age women on preconception care. Hence, providing community health education based on radio and/or mobile phone messaging could be useful in positively influencing the knowledge and attitude of women on preconception care.

Factors associated with low birth weight among babies born at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

BACKGROUND: Low birth weight is defined as infant born with weight of less than 2500 g. It is one of the major public health problems worldwide. In Ethiopia, there are limited evidences on factors contributing to low birthweight. OBJECTIVE: To assess factors associated with low birth weight babies in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia from March to April, 2018. METHODS AND MATERIALS: An unmatched case control study was conducted at Hawassa University Comprehensive Specialized Hospital. All low birth weight newborns and two unmatched controls for each case were included in the study from March to April, 2018. Data were collected through face to face interview using a structured and pre-tested questionnaire. The collected data were managed with Epi-data version 3.1 software and exported to the Statistical Package for Social Science (SPSS) version 22. Bivariate and multivariate binary logistic regression were used to identify factors associated with low birth weight at p-value < 0.05 with their respective odds ratios and 95% confidence interval. Hosmer-Lemeshow test was used to assess goodness-of-fit. RESULTS: In this study 330 mother-newborn pairs (110 cases and 220 controls) were participated making 100% response rate. Among the participants 325(98.48%) were married, 164 (49.7%) were Protestant, 296 (89.7%) had ANC follow up and 212 (64.24%) were multipara. Mothers' mid-upper arm circumference less than 220 mm [(AOR) =2.89, 95% CI: 1.58, 5.29)], lack of nutritional counseling [AOR = 2.37, 95%CI: 1.3, 4.34], presence of complications during pregnancy [AOR = 2.96, 95%CI: 1.55, 5.64)] and lack of iron supplementations during pregnancy [AOR = 2.89, 95%CI: 1.58, 5.29)] were significantly associated with Low birth weight. CONCLUSIONS: Mothers' mid-upper arm circumference less than 220 mm, lack of nutritional counseling, presence of complications and lack of iron supplementations during current pregnancy were significantly associated with low birth weight. Counseling on nutrition during prenatal care needs attention of service providers.

Home birth and its determinants among antenatal care-booked women in public hospitals in Wolayta Zone, southern Ethiopia.

INTRODUCTION: Antenatal care (ANC), health facility birth and postnatal care services are proved to reduce maternal and newborn morbidity and mortality. In Ethiopia, even though antenatal care coverage is good, still home birth is high. This study aimed to assess the prevalence and determinants of home birth among women who were booked for ANC in public hospitals in Wolaita zone, southern Ethiopia. METHODS: A cohort study was conducted from February to May 2017 among 554 third trimester pregnant mothers who visited public hospitals of Wolaita Zone, southern Ethiopia for ANC service. All women were interviewed twice: the first interview was done face-to-face in the health facility in which they were having ANC follow up to gather information about basic socio-demographic and obstetric characteristics; the second interview was done via telephone after they gave birth to get information about the place of birth. Epi-Data version 3.1 was used for data entry and the Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis. RESULTS: A total of 68 (13.5%; 95% Confidence Interval (CI): 10.5%-16.6%) women who were booked for ANC gave birth at home. Being uneducated (AOR = 2.46, 95% CI: [1.10-5.10]), starting ANC visit late (>16weeks) (AOR = 2.27, 95% CI: [1.14-4.50]), time taken to reach at health facility for ANC service (>30minutes) (AOR = 8.94, 95% CI: [4.50-17.72]), waiting time of greater than 30 minutes for ANC in health facilities (AOR = 1.18, 95% CI: [1.06-2.30]) and lack of knowledge about danger signs of pregnancy (AOR = 4.18, 95%CI: [1.80-9.70]) were significantly associated with home birth. CONCLUSIONS: Home birth among ANC booked women is low compared to other studies. Yet, giving attention to women with no education and those coming from far areas while providing advice on birth preparedness and pregnancy danger signs may be useful to further reduce the rate of home birth. Advising mothers to start ANC early and trying to reduce ANC waiting time could also be of importance.