Less known but greatly feared: Cervical cancer in Ethiopia community awareness.

To improve a community's awareness and attitude towards cervical cancer, strong evidence is needed to inform contextually appropriate policies. This study aims to explore community awareness about cervical cancer from the perspective of women, men and health extension workers (HEWs). The research was conducted from May to July 2021 in Jimma, Ethiopia. A total of 23 in-depth interviews were conducted. The study included married and unmarried women (15-19 and 25-29 years old), men of similar ages (married and unmarried), and HEWs. Furthermore, eight separate focus group discussions (FGDs) were conducted with both men and women. Thematic analysis was used to draw findings from the interviews and FGDs. Community awareness about cervical cancer was very limited. However, people who knew of it believed that cancer is fatal. A few participants were aware of cervical cancer through its symptoms, but most people did not know it by name and had never heard about HPV as the cause of cervical cancer. There was little understanding of HPV risk, transmission factors, prevention, vaccination, screening, or treatment. Participants considered their participation in this study as their first chance to learn about the disease. HEWs had limited knowledge about HPV and cervical cancer. Study participants demonstrated favorable attitudes towards HPV vaccination, cervical screening, and treatment after they received basic information about cervical cancer from the data collectors. Participants and HEWs strongly suggested awareness creation programs for the wider community members, including active involvement of men and HEWs in cervical cancer interventions. There is a critical information gap regarding cervical cancer, its cause and risk factors, HPV transmission, cervical screening, and treatment programs. Limited community awareness leads to poor uptake of cervical screening in the few settings where it is available. Therefore, community awareness programs about HPV, cervical cancer, and available services should improve the community's awareness of cervical cancer and HPV.

Effectiveness of Lactational Amenorrhea Method in Ethiopia: A Multi-Center Prospective Cohort Study.

Background: Although the lactational amenorrhea method (LAM) is one of the most commonly used contraception methods during the first six months of a woman's postpartum period, there has been little research on its effectiveness in general and particularly in Ethiopia. The purpose of this study was to evaluate the effectiveness of LAM and the experiences of Ethiopian women who used it. Methods: This was a multi-center prospective cohort study of postpartum women from five Ethiopian regions and one city administration. All pregnant women who gave birth in these randomly selected hospitals and five health centers directly referring to the hospitals were invited to the study if they selected LAM and were followed monthly at home. Each month, trained researchers visited the woman at her home and collected information about breast feeding, the return of menses, the resumption of sex, the use of another contraceptive, and a pregnancy test using urine human chorionic gonadotropin (hCG). Women who reported starting new contraceptive methods, resumption of menses, starting complementary feeding, neonatal death, getting pregnant, or refusing were excluded from the cohort. The data were collected using ODK Collect and exported to Stata 14 for analysis. Results: Among the 2162 women who selected LAM as a contraceptive, 2022 were enrolled in the cohort study, and 901 completed the follow-up. At the end of the sixth month, eight women got pregnant, corresponding to an effectiveness of 99.1%. More than half of the cohort were excluded from the follow-up for reasons of transitioning to other types of contraception, resumption of menses, or refusal to follow-up. Conclusion: The effectiveness of LAM is high and should be recommended for postpartum women, with proper counseling provided. A study should be conducted to examine the effectiveness of breast feeding as a contraceptive beyond the Bellagio consensus.

Why intrauterine device (IUD) utilization is low in southwestern Ethiopia. A mixed-method study.

INTRODUCTION: An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world. However, only a small proportion of women in developing countries, including Ethiopia, are currently using the method. Therefore, this study aimed to identify why IUD utilization is low in southwestern Ethiopia. MATERIAL AND METHODS: A mixed-method study involving health facilities and communities was conducted. The focus group discussions and key informant interviewees for the qualitative study were selected purposively, whereas 844 women family planning users were selected using systematic random sampling from November 1-30, 2020. Quantitative data was collected using Open Data Kit and analyzed using Stata version 16.0. Multivariable logistic regression analyses were done to identify significant factors influencing IUD use. The qualitative data were tape-recorded, transcribed, and finally, thematic analyses were done. RESULTS: A total of 784 participants were involved in the study yielding a response rate of 92.9%. Among all respondents, only 1.3%, 2.4%, and 30.0% had been using an IUD, preferred an IUD, and had the intention to use an IUD, respectively. The main reported barriers to use an IUD among qualitative participants were fear of side-effects, religious prohibitions of contraception use, husband disapproval, lack of training by health workers, misconceptions, and longer duration of use. IUD information (AOR = 2.19 [CI: 1.56-3.08]), and rich wealth status (AOR = 1.70 [CI: 1.13-2.56]) were associated with the intention to continue or start to use an IUD. CONCLUSIONS: IUD use and information on IUDs in the study area was very low. Information about IUDs, wealth status, and partner disapproval were determinant factors for intention to use an IUD. Thus, a regular awareness creation program using accessible media platforms by the government and stakeholders on IUD use is necessary to provide reliable information to the community and resolve misconceptions. In addition, women's empowerment to balance partner dominance on decision-making of contraception use and health care worker training on long-acting reversible contraceptives (LARCs) to increase access to LARC services are necessary to increase uptake of LARCs in general and of IUDs, in particular in the study regions.

No woman left behind: achieving cervical cancer elimination among women living with HIV.

Cervical cancer is the fourth most common malignancy in women of reproductive age globally. The burden of this disease is highest in low-income and middle-income countries, especially among women living with HIV. In 2018, WHO launched a global strategy to accelerate cervical cancer elimination through rapid scale-up of prophylactic vaccination, cervical screening, and treatment of precancers and cancers. This initiative was key in raising a call for action to address the stark global disparities in cervical cancer burden. However, achieving elimination of cervical cancer among women with HIV requires consideration of biological and social issues affecting this population. This Position Paper shows specific challenges and uncertainties on the way to cervical cancer elimination for women living with HIV and highlights the scarcity of evidence for the effect of interventions in this population. We argue that reaching equity of outcomes for women with HIV will require substantial advances in approaches to HPV vaccination and improved understanding of the long-term effectiveness of HPV vaccines in settings with high HIV burden cervical cancer, just as HIV, is affected by social and structural factors such as poverty, stigma, and gender discrimination, that place the elimination strategy at risk. Global efforts must, therefore, be galvanised to ensure women living with HIV have optimised interventions, given their substantial risk of this preventable malignancy.

Evaluating a clinical decision support point of care instrument in low resource setting.

BACKGROUND: Clinical pathways are one of the main tools to manage the health care's quality and concerned with the standardization of care processes. They have been used to help frontline healthcare workers by presenting summarized evidence and generating clinical workflows involving a series of tasks performed by various people within and between work environments to deliver care. Integrating clinical pathways into Clinical Decision Support Systems (CDSSs) is a common practice today. However, in a low-resource setting (LRS), this kind of decision support systems is often not readily accessible or even not available. To fill this gap, we developed a computer aided CDSS that swiftly identifies which cases require a referral and which ones may be managed locally. The computer aided CDSS is designed primarily for use in primary care settings for maternal and childcare services, namely for pregnant patients, antenatal and postnatal care. The purpose of this paper is to assess the user acceptance of the computer aided CDSS at the point of care in LRSs. METHODS: For evaluation, we used a total of 22 parameters structured in to six major categories, namely "ease of use, system quality, information quality, decision changes, process changes, and user acceptance." Based on these parameters, the caregivers from Jimma Health Center's Maternal and Child Health Service Unit evaluated the acceptability of a computer aided CDSS. The respondents were asked to express their level of agreement using 22 parameters in a think-aloud approach. The evaluation was conducted in the caregiver's spare-time after the clinical decision. It was based on eighteen cases over the course of two days. The respondents were then asked to score their level of agreement with some statements on a five-point scale: strongly disagree, disagree, neutral, agree, and strongly agree. RESULTS: The CDSS received a favorable agreement score in all six categories by obtaining primarily strongly agree and agree responses. In contrast, a follow-up interview revealed a variety of reasons for disagreement based on the neutral, disagree, and strongly disagree responses. CONCLUSIONS: Though the study had a positive outcome, it was limited to the Jimma Health Center Maternal and Childcare Unit, and hence a wider scale evaluation and longitudinal measurements, including computer aided CDSS usage frequency, speed of operation and impact on intervention time are needed.

Analysis of low resource setting referral pathways to improve coordination and evidence-based services for maternal and child health in Ethiopia.

BACKGROUND: In low-resource settings, patient referral to a hospital is an essential part of the primary health care system. However, there is a paucity of study to explore the challenges and quality of referral coordination and communication. OBJECTIVE: The purpose of this research was to analyze the existing paper-based referral registration logbook for maternal and child health in general and women of reproductive age in particular, to improve referral coordination and evidence-based services in Low-Resource Settings. METHODS: This study analyzed the existing paper-based referral registration logbook (RRL) and card-sheet to explore the documentation of the referral management process, and the mechanism and quality of referrals between the health center (Jimma Health Center-case, Ethiopia) and the Hospital. A sample of 459 paper-based records from the referral registration logbook were digitized as part of a retrospective observational study. For data preprocessing, visualization, and analysis, we developed a python-based interactive referral clinical pathway tool. The data collection was conducted from August to October 2019. Jimma Health Center's RRL was used to examine how the referral decision was made and what cases were referred to the next level of care. However, the RRL was incomplete and did not contain the expected referral feedback from the hospital. Hence, we defined a new protocol to investigate the quality of referral. We compared the information in the health center's RRL with the medical records in the hospital to which the patients were referred. A total of 201 medical records of referred patients were examined. RESULTS: A total of 459 and 201 RRL records from the health center and the referred hospital, respectively, were analyzed in the study. Out of 459, 86.5% referred cases were between the age of 20 to 30 years. We found that "better patient management", "further patient management", and "further investigation" were the main health-center referral reasons and decisions. It accounted for 40.08%, 39.22%, and 16.34% of all 459 referrals, respectively. The leading and most common referral cases in the health center were long labor, prolonged first and second stage labor, labor or delivery complicated by fetal heart rate anomaly, preterm newborn, maternal care with breech presentation, premature rupture of membranes, malposition of the uterus, and antepartum hemorrhage. In the hospital RRL and card-sheet, the main referral-in reasons were technical examination, expert advice, further management, and evaluation. We found it overall impossible to match records from the referral logbook in the health center with the patient files in the hospital. Out of 201, only 13.9% of records were perfect matching entries between health center and referred hospital RRL. We found 84%, 14.4%, and 1.6% were appropriate, unnecessary and unknown referrals respectively. CONCLUSION: The paper illustrates the bottlenecks encountered in the quality assessment of the referrals. We analyzed the current status of the referral pathway, existing communications, guidelines and data quality, as a first step towards an end-to-end effective referral coordination and evidence-based referral service. Accessing, monitoring, and tracking the history of referred patients and referral feedback is challenging with the present paper-based referral coordination and communication system. Overall, the referral services were inadequate, and referral feedback was not automatically delivered, causing unnecessary delays.

Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia.

OBJECTIVE: The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users. DESIGN: A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women. SETTING: The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study. PARTICIPANTS: The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period. INTERVENTIONS: A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation. RESULT: From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation. CONCLUSION: The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.

A Hybrid Approach for Designing Dynamic and Data-Driven Clinical Pathways Point of Care Instruments in Low Resource Settings.

Though a clinical pathway is one of the tools used to guide evidence-based healthcare, promoting the practice of evidence-based decisions on healthcare services is incredibly challenging in low resource settings (LRS). This paper proposed a novel approach for designing an automated and dynamic generation of clinical pathways (CPs) in LRS through a hybrid (knowledge-based and data-driven based) algorithm that works with limited clinical input and can be updated whenever new information is available. Our proposed approach dynamically maps and validate the knowledge-based clinical pathways with the local context and historical evidence to deliver a multi-criteria decision analysis (concordance table) for adjusting or readjusting the order of knowledge-based CPs decision priority. Our finding shows that the developed approach successfully delivered probabilistic-based CPs and found a promising result with Jimma Health Center "pregnancy, childbearing, and family planning" dataset.

Congenital ureterovaginal fistula: a rare case of single-system ectopic ureter with ipsilateral ectopic kidney managed by vaginal approach: a case report.

BACKGROUND: Diagnosing urinary incontinence from organic causes such as ectopic ureter is particularly important because of the potential for cure by surgical correction. The prevalence of ectopic ureter is uncertain because many are asymptomatic and the diagnosis is usually overlooked. Eighty percent of ectopic ureters in females are often associated with duplex kidney. However, an ectopic ureter draining a single-system ectopic dysplastic/atrophic but functioning kidney is rare, especially in females. The overall long-term continence rate after successful correction of ectopic ureter is satisfactory. CASE PRESENTATION: This case is reported to highlight a rare situation, where a 22-year-old nulligravid Ethiopian women presented with a complaint of continuous wetting of her underwear since childhood, but she had normal voiding pattern. Localized right pelvic kidney ultrasound and computed tomography scan with contrast revealed right ectopic ureter and atrophied ipsilateral pelvic kidney with good function. Surgical reimplantation through vaginal approach was performed, and the outcome was good. The patient's subsequent follow-ups were uneventful. CONCLUSION: An extramural vaginal ectopic ureter is better accessed through transvaginal approach than abdominal, especially when it is associated with pelvic ectopic kidney. This modified approach is less invasive and has lower morbidity and better success rate than a transabdominal approach.

Isolation and characterization of Listeria monocytogenes among women attending Jimma University medical center, Southwest Ethiopia.

BACKGROUND: Listeria monocytogenes (LM) has come to be a major public health issue of at-risk groups, causing high morbidity and mortality. Despite this data, studies are very limited in developing countries like Ethiopia. Thus, we aimed to isolate and characterize LM in terms of antibiogram and biofilm formation among pregnant women with fever, women with a history of spontaneous abortion, women with a history of fetal loss, and women with preterm delivery at Jimma University Medical Center (JUMC), southwest Ethiopia. METHODS: A cross-sectional study was done among 144 women from June to August 2019. Isolates were tested for antibiotic susceptibility and biofilm formation using disc diffusion and microtiter plate method, respectively. Data were collected using a structured questionnaire, entered into Epidata 3.1 and logistic regression was done by SPSS v25.0. RESULTS: LM was isolated in 8 (5.56%) of 144 screened women. The isolation rate of LM was relatively higher among women with a history of fetal loss (9.7%), followed by women with preterm delivery (6.25%). One of the six cord blood was positive for LM, indicating that the transplacental transmission rate at JUMC was 16.7%. More than 2% of women with an ongoing pregnancy were found to have LM septicemia, which could hurt their fetus. All of the isolates tested were susceptible to Ampicillin. However, all of the isolates were resistant to Penicillin and Meropenem and were biofilm producers. CONCLUSIONS: The high magnitude of pregnancy-related listeriosis in the current study setting appears that implementation of educational programs targeting risk reduction and more studies to identify sources of LM are warranted. The choice of antibiotics should be after susceptibility testing.

Risk factors associated with congenital anomalies among newborns in southwestern Ethiopia: A case-control study.

INTRODUCTION: Human embryo is well protected in the uterus by the embryonic membrane, although teratogens may cause developmental disruptions after maternal exposure to them during early pregnancy. Most of the risk factors contributing to the development of congenital anomalies are uncertain; however, genetic factors, environmental factors and multifactorial inheritance are found to be risk factors. Regardless of their clinical importance, there are little/no studies conducted directly related to predisposing risk factors in southwestern Ethiopia. OBJECTIVE: The study aimed to determine the associated risk factors with congenital anomalies among newborns in southwestern Ethiopia. METHODS: Case-control study was conducted on newborns and their mothers in six purposively selected hospitals in southwestern Ethiopia from May 2016 to May 2018. Data was collected after evaluation of the neonates for the presence of congenital anomalies using the standard pretested checklist. The data was analyzed using SPSS version 25.0. P <0.01 was set as statistically significant. RESULTS: Risk factors such as unidentified medicinal usage in the first three months of pregnancy (AOR = 3.435; 99% CI: 2.012-5.863), exposure to pesticide (AOR = 3.926; 99% CI: 1.266-12.176), passive smoking (AOR = 4.104; 99% CI: 1.892-8.901), surface water as sources of drinking (AOR = 2.073; 99% CI: 1.221-3.519), folic acid supplementation during the early pregnancy (AOR = 0.428; 99% CI: 0.247-0.740) were significantly associated with the congenital anomalies. CONCLUSIONS: In this study, risk factors such as passive smoking, exposure to pesticides, chemicals and use of surface water as a source of drinking during early pregnancy had a significant association with congenital anomalies. There is a need to continuously provide health information for the community on how to prevent and control predisposing risk factors.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

BACKGROUND: Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. STUDY DESIGN: We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. RESULTS: Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. CONCLUSIONS: Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs.

Development of a Surgical Infection Surveillance Program at a Tertiary Hospital in Ethiopia: Lessons Learned from Two Surveillance Strategies.

BACKGROUND: Surgical site infections (SSIs) are a leading cause of post-operative morbidity and mortality. We developed Clean Cut, a surgical infection prevention program, with two goals: (1) Increase adherence to evidence-based peri-operative infection prevention standards and (2) establish sustainable surgical infection surveillance. Here we describe our infection surveillance strategy. PATIENTS AND METHODS: Clean Cut was piloted and evaluated at a 523 bed tertiary hospital in Ethiopia. Infection prevention standards included: (1) Hand and surgical site decontamination; (2) integrity of gowns, drapes, and gloves; (3) instrument sterility; (4) prophylactic antibiotic administration; (5) surgical gauze tracking; and (6) checklist compliance. Primary outcome measure was SSI, with secondary outcomes including other infection, re-operation, and length of stay. We prospectively observed all post-surgical wounds in obstetrics over a 12 day period and separately recorded post-operative complications using chart review. Simultaneously, we reviewed the written hospital charts after patient discharge for all patients whose peri-operative adherence to infection prevention standards was captured. RESULTS: Fifty obstetric patients were followed prospectively with recorded rates of SSI 14%, re-operation 6%, and death 2%. Compared with direct observation, chart review alone had a high loss to follow-up (28%) and decreased capture of infectious complications (SSI [n = 2], endometritis [n = 3], re-operations [n = 2], death [n = 1]); further, documentation inconsistencies failed to capture two complications (SSI [n = 1], mastitis [n = 1]). Concurrently, 137 patients were observed for peri-operative infection prevention standard adherence. Of these, we were able to successfully review 95 (69%) patient charts with recorded rates of SSI 5%, re-operation 1%, and death 1%. CONCLUSION: Patient loss to follow-up and poor documentation of infections underestimated overall infectious complications. Direct, prospective follow-up is possible but requires increased time, clinical skill, and training. For accurate surgical infection surveillance, direct follow-up of patients during hospitalization is essential, because chart review does not accurately reflect post-operative complications.

Uterine Rupture in Pregnancy following Fall from a Motorcycle: A Horrid Accident in Pregnancy-A Case Report and Review of the Literature.

Uterine rupture is one of the most catastrophic complications during pregnancy. It is a rare complication in developed countries but a frequent cause of maternal and perinatal morbidity and mortality in Africa. Uterine rupture occurs in 1.6% of patients suffering blunt abdominal trauma. Here we report a unique case of complete fundal rupture of the unscarred uterus following fall from motorcycle in 39-week-pregnant mother who was managed with total abdominal hysterectomy and left salpingo-oophorectomy and survived, though fetus died before intervention. We also reviewed similar cases reported from different parts of Africa. This is a preventable complication had the woman been properly instructed on transportation safety during her antenatal care visits.

Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia.

BACKGROUND: More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. OBJECTIVE: To determine the effectiveness of highly active antiretroviral and short course antiretroviral regimens in prevention of mother-to-child transmission of HIV and associated factors Jimma University Specialized Hospital (JUSH). METHOD: A hospital based retrospective cohort study was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART) clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. RESULTS: A total of 180 mother infant pairs were considered for the final analysis, 90(50%) mothers received single dose nevirapine (sdNVP) designated as regimen-3, 67 (37.2%) mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1), while the rest 23 (12.8%) mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2). Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67), 8.6% (2/23), and 15.5% (14/90) respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180). Postnatal transmission at 6 months was 28.5% (8/28) of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy (OR=4.3, 95%CI =1.38-13.46), base line CD4 less than 350 cells/cubic mm (OR=6.98, 95%CI=0.91-53.76), early infant infection (OR=5.4, 95%CI=2.04-14.4), infants delivered home (OR=13.1, 95%CI=2.69-63.7), infant with birth weight less than 2500 g (OR=6.41, 95%CI=2.21-18.61), and mixed infant feeding (OR=6.7, 95%CI=2.2-20.4). Antiretroviral regimen duration less than 2 months, maternal base line CD4 less than 350 cells/cubic mm and mixed infant feeding were also important risk factors for late infant infection or death. CONCLUSION: The effectiveness of multiple antiretroviral drugs in prevention of early mother-to-child transmission of HIV was found to be more effective than that of single dose nevirapine, although, the difference was not statistically significant. But in late transmission, a significant difference was observed in which infants born to mother who received multiple antiretroviral drugs were less likely to progress to infection or death than infants born to mothers who received single dose nevirapine.

Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia / Comparación de estrategias de tratamiento antirretroviral en prevención de transmisión madre a hijo en un hospital universitario de Etiopia

Background: More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. Method: A hospital based retrospective cohort study was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART) clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. Results: A total of 180 mother infant pairs were considered for the final analysis, 90(50%) mothers received single dose nevirapine (sdNVP) designated as regimen-3, 67 (37.2%) mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1), while the rest 23 (12.8%) mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2). Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67), 8.6% (2/23), and 15.5% (14/90) respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180). Postnatal transmission at 6 months was 28.5% (8/28) of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy (OR=4.3, 95%CI =1.38-13.46), base line CD4 less than 350 cells/cubic mm (OR=6.98, 95%CI=0.91-53.76), early infant infection (OR=5.4, 95%CI=2.04-14.4), infants delivered home (OR=13.1, 95%CI=2.69-63.7), infant with birth weight less than 2500 g (OR=6.41, 95%CI=2.21-18.61), and mixed infant feeding (OR=6.7, 95%CI=2.2-20.4). Antiretroviral regimen duration less than 2 months, maternal base line CD4 less than 350 cells/cubic mm and mixed infant feeding were also important risk factors for late infant infection or death. Conclusion: The effectiveness of multiple antiretroviral drugs in prevention of early mother-to-child transmission of HIV was found to be more effective than that of single dose nevirapine, although, the difference was not statistically significant. But in late transmission, a significant difference was observed in which infants born to mother who received multiple antiretroviral drugs were less likely to progress to infection or death than infants born to mothers who received single dose nevirapine (AU)

Antecedentes: Más del 90% de la infección por virus de inmunodeficiencia humana (VIH) en niños es adquirida debido a una transmisión madre-hijo que se establece durante el embarazo, parto o lactación. Objetivo: Determinar la efectividad de antiretrovirales altamente activos en la prevención de la transmisión madre-hijo del VIH y sus factores asociados en el Hospital Universitario de JIMMA (JUSH). Método: Se realizó un estudio de cohorte retrospectiva sobre madres que dieron a luz infectadas de VIH y tuvieron seguimiento en la Clinica de tratamiento antirretroviral (ART) por al menos un periodo de 6 meses emparejado con sus hijos. Los resultados primarios y secundarios fueron la tasa de infección por VIH en niños a las 6 semanas y 6 meses, respectivamente. Se utilizó el chi-cuadrado para comparación de los datos categóricos y un modelo de regresión logística multivariado para identificar los determinantes de transmisión temprana madre-hijo a las 6 semanas. Se usó el modelo de riesgo proporcional de Cox para analizar los factores que afectaron la supervivencia libre de VIH a 6 meses de niños nacidos de madres con VIH. Resultados: Se consideraron un total de 180 pares madre/hijo para el análisis final, 90 (50%) madres recibieron una dosis única de nevirapina (sdNVP) denominado régimen-3, 67 (37,2%) madres recibieron diferentes tipos de regímenes ARV, normalmente AZT+3TC+NVP (régimen-1), mientras que las restantes 23 (12,8%) estuvieron a tratamiento con un régimen corto de AZT + 3TC + sdNVP (régimen-2). La tasa temprana de transmisión madre-hijo a 6 semanas para los regímenes 1, 2 y 3 fue 5,9% (4/67), 8,6% (2/23), y 15,5% (14/90), respectivamente. La tasa tardía acumulativa de transmisión madre-hijo a los 6 meses, independientemente del régimen, fue del 15,5% (28/180). La transmisión postnatal a 6 meses fue del 28,5% (8/28) de los niños infectados. Los factores que se encontraron asociados a alto riesgo de transmisión de VIH madre-hijo incluían la duración del régimen ARV menor de 2 meses durante el embarazo (OR=4,3; 95%CI =1,38-13,46), CD4 al inicio de menos de 350 células/mm cubico (OR=6,98; 95%CI=0,91-53,76) , infección temprana del niño (OR=5,4, 95%CI=2,04-14,4), niños nacidos en casa (OR=13,1; 95%CI=2,69-63,7), niños nacidos con peso menor de 2500 g (OR=6,41; 95%CI=2,21-18,61), y alimentación infantil mixta (OR=6,7; 95%CI=2,2-20,4). La duración del régimen menor de 2 meses, las CD4 iniciales en menos de 350 celulas7mm cubico y la alimentación infantil mixta fueron también factores de riesgo importantes para infección infantil tardía y muerte. Conclusión: se encontró que la efectividad de los tratamientos antirretrovirales múltiples para la prevención de transmisión temprana madre-hijo de VIH era más efectiva que la dosis única de nevirapina, aunque la diferencia no era estadísticamente significativa. Pero en transmisión tardía, se observó una diferencia significativa en la que los niños nacidos de madres que recibieron tratamientos antirretrovirales múltiples tenían menos probabilidad de progresar hacia la infección que los niños de madres tratadas con una dosis única de nevirapina (AU)

Sexual assault: pattern and related complications among cases managed in Jimma University Specialized Hospital.

BACKGROUND: Sexual assault affects one out of every five women, and it is a substantial public health and human rights problem in developing countries including Ethiopia. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to assess the pattern of sexual assault and related complications in cases which were treated at Jimma University Specialized Hospital from November 1, 2011 - October 31, 2012. METHODS: A hospital based cross-sectional descriptive study was conducted with the aim of assessing sexual assault patterns and related complications on 99 sexual assault cases which were managed at the Gynecology Out-patient Department of the Hospital. Data on circumstances of sexual assault, survivor specific demographic characteristics and information on complications and interventions provided were collected by trained third year residents in obstetrics and gynecology using pretested questionnaire after respondent consent was taken. The collected data was cleaned, edited, fed into computer and analyzed using SPSS for windows version 16.0. RESULTS: The mean (±SD) of the survivors' age was 14 (±5) years; 57.5% of the survivors were children and 68.7% were from rural areas. Three percent of the clients visited the Gynecology Outpatient Department for sexual assault where rape accounted for 78.8%. The majority (76.8%) of the assailants was known to the survivors, 91% were assaulted by one assailant and 5.1% of the rape cases were gang rape. The mean time of presentation after sexual assault to the hospital was 15 days. Survivors had pregnancy test, HIV test and screening for sexually transmitted infections in 76.8%, 99%, 93% respectively of which 17.1%, 5.1%, 14.1% tested positive for pregnancy, HIV, and some STIs respectively. All HIV positive survivors were children under fifteen years of age. Forty percent of the survivors were provided with emergency contraception. In addition, 60.5%, 63%, and 91.9% of them were provided with post-exposure prophylaxis for HIV, STIs prophylaxis and were given counseling respectively. CONCLUSION: It has been revealed that sexual assault is a major problem of women and children of less than fifteen years. There were gaps in providing and receiving packages of care and justice system to protect survivors indicating the needs for community intervention and providing quality of care by health care staff.

Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia.

BACKGROUND: Surgical Site infections are the second most frequently reported infections of all nosocomial infections among hospital patients. Among surgical patients in obstetrics, Surgical Site Infections were the most common nosocomial infections and the rate is higher in sub-Saharan Africa. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to determine the surgical site infection rate among women having surgery for delivery in obstetrics of Jimma University Specialized Hospital (JUSH) from April 1, 2009 to March 31, 2010. METHODS: A prospective descriptive study design was conducted with the aim of determining the surgical site infection rate on all 770 women who had surgery for delivery from April 1, 2009 to March 31, 2010 in obstetric ward of the Hospital. Data on history of the patient, patient specific demographic information on potential risk factors and the occurrence of Surgical Site infections in the first 30 days following surgery were collected using pretested data collection form. In addition, relevant data were also abstracted from the operation logbook of the cases. Then data were cleaned, edited and fed to computer and analyzed using SPSS for window version 16.0. Finally Statistical test for significance was employed using chi-squared (X (2)) where appropriate at 5% level of significance. RESULTS: The mean (±SD) of the subjects' age was 26(±7) years and the majority of the women were from the rural areas (72.7%). The overall surgical site infection rate was 11.4%. Of those who had surgical site infections, 64.8% had clean-contaminated wound and 35.2% had contaminated /dirty wounds. Wound class at time of surgery has a statistically significant association with Surgical Site infections (p <0.001).The Surgical Site infections rate was similar for cesarean section and abdominal hysterectomy but higher for destructive delivery under direct vision. Majority of the operations were made for emergency Obstetric conditions (96.6%) and the Surgical Site Infections rate was two times higher compared to that of elective surgery. Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections. CONCLUSION: It has been revealed that Surgical Site Infections rates are higher than acceptable standards indicating the need for improving Antenatal care, increasing the number of skilled birth attendants at the local clinics, increasing basic and comprehensive emergency obstetric care services, applying improved surgical techniques and improving infection prevention practices to decrease infection rate to acceptable standard.

Surgical site infection rate and risk factors among obstetric cases of Jimma University Specialized Hospital, Southwest Ethiopia

BACKGROUND: Surgical Site infections are the second most frequently reported infections of all nosocomial infections among hospital patients. Among surgical patients in obstetrics, Surgical Site Infections were the most common nosocomial infections and the rate is higher in sub-Saharan Africa. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to determine the surgical site infection rate among women having surgery for delivery in obstetrics of Jimma University Specialized Hospital (JUSH) from April 1, 2009 to March 31, 2010. METHODS: A prospective descriptive study design was conducted with the aim of determining the surgical site infection rate on all 770 women who had surgery for delivery from April 1, 2009 to March 31, 2010 in obstetric ward of the Hospital. Data on history of the patient, patient specific demographic information on potential risk factors and the occurrence of Surgical Site infections in the first 30 days following surgery were collected using pretested data collection form. In addition, relevant data were also abstracted from the operation logbook of the cases. Then data were cleaned, edited and fed to computer and analyzed using SPSS for window version 16.0. Finally Statistical test for significance was employed using chi-squared (X 2) where appropriate at 5% level of significance. RESULTS: The mean (±SD) of the subjects' age was 26(±7) years and the majority of the women were from the rural areas (72.7%). The overall surgical site infection rate was 11.4%. Of those who had surgical site infections, 64.8% had clean-contaminated wound and 35.2% had contaminated /dirty wounds. Wound class at time of surgery has a statistically significant association with Surgical Site infections (p <0.001).The Surgical Site infections rate was similar for cesarean section and abdominal hysterectomy but higher for destructive delivery under direct vision. Majority of the operations were made for emergency Obstetric conditions (96.6%) and the Surgical Site Infections rate was two times higher compared to that of elective surgery. Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections. CONCLUSION: it has been revealed that Surgical Site Infections rates are higher than acceptable standards indicating the need for improving Antenatal care, increasing the number of skilled birth attendants at the local clinics, increasing basic and comprehensive emergency obstetric care services, applying improved surgical techniques and improving infection prevention practices to decrease infection rate to acceptable standard