Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia.

BACKGROUND: Knowledge and practice gaps among providers have been cited as factors behind the underuse of aspirin for preeclampsia prevention globally. OBJECTIVE: This study aimed to determine the knowledge and practice levels of prenatal care providers at a national tertiary referral hospital in Ethiopia and its catchment health institutions. STUDY DESIGN: This was a cross-sectional survey on the knowledge and practice of preeclampsia prevention through aspirin prophylaxis among prenatal care providers at St. Paul's Hospital Millennium Medical College (Ethiopia) and its catchment health institutions. Data were collected prospectively using a structured questionnaire on ODK (Get ODK Inc, San Diego, CA). The primary objective of our study was to determine the knowledge and practice levels among prenatal care providers. Data were analyzed using SPSS software (version 23; IBM, Chicago, IL). Simple descriptive analyses were performed to analyze the data. Proportions and percentages were used to present the results. RESULTS: A total of 92 prenatal care providers working at 17 health institutions were approached, and 80 of them agreed to participate in the study, constituting a response rate of 87%. The mean scores of knowledge and practice of preeclampsia prevention using aspirin were 42.90 (±0.13) and 45.8 (±0.07), respectively. Most of the providers had poor knowledge (score of <50%) and poor practice (score of <50%). Among the 80 prenatal care providers, only 19 (23.8%) had good knowledge, and only 29 (36.3%) had good practice. More than half of the respondents (49/80 [61.3%]) mentioned "lack of national guidelines for use of aspirin in pregnancy" as the main factor that affected their practice of aspirin prophylaxis for preeclampsia prevention in pregnant women. Among the resources used as a reference for the practice of aspirin prophylaxis for preeclampsia prevention, International Federation of Gynecology and Obstetrics or World Health Organization guidelines (45/80 [56.3%]) were the most frequently used resources, followed by American College of Obstetricians and Gynecologists guidelines (36/80 [45.0%]) and clinical judgment (36/80 [45.0%]). CONCLUSION: Our results support previous reports of significant knowledge-to-practice gaps in the use of aspirin prophylaxis for preeclampsia prevention among prenatal care providers. Moreover, the results underscore the need for immediate action in narrowing this gap among providers by availing practical national guidelines for preeclampsia prevention and in-service trainings.

Can mid-level providers manage medical abortion after 12 weeks' gestation as safely and effectively as physicians? A non-inferiority, randomized controlled trial in Addis Ababa, Ethiopia.

OBJECTIVE: To determine whether clinical outcomes among clients undergoing medical abortion after 12 weeks' gestation differ by provider cadre. METHODS: Randomized controlled trial conducted among eligible clients seeking abortion between 13 and 20 weeks' gestation. Participants seeking in-facility abortion were randomized to receive care from a mid-level provider (nurse/midwife) or physician. The primary outcome was median time to expulsion with non-inferiority margin of -1.5 h between provider groups. Quantile median regression models assessed non-inferiority. Secondary outcomes included retained placenta, complications, and patient acceptability. RESULTS: After randomization and eligibility assessment by the provider, 171 women participated in the study: 81 in the physician group and 90 in the mid-level provider group. Their average age was 24 years, the mean gestational age was 16 weeks, and 65% were nulliparous in both groups. The median time to expulsion did not differ significantly, being 8.1 h for the mid-level group and 6.6 h for the physician group. The adjusted median difference was 0.8 h (95% confidence interval [CI] -1.15 to 2.66), within the non-inferiority margin. Retained placenta occurred similarly: 30.0% (n = 24) of the physician group and 20.5% (n = 18) of the mid-level provider group (adjusted risk difference [ARD] 7.6%, 95% CI -2.81 to 18.06). Complications occurred in 7% of cases, including 5.0% (n = 4) of patients in the physician group and 8.9% (n = 8) in the mid-level provider group (ARD -4.7%, 95% CI -12.43 to 3.12). Patient acceptability did not differ by group. CONCLUSIONS: Training mid-level providers to provide abortion services after 12 weeks' gestation independently of physicians is feasible and may result in comparable clinical outcomes.

Missed opportunity for aspirin prophylaxis for preeclampsia prevention: a cross-sectional study from Sub-Saharan Africa.

BACKGROUND: Recent studies showed that aspirin for preeclampsia prevention is underused despite its effectiveness in preventing preeclampsia among patients with moderate and high risk factors. Little is known about this issue in the Sub-Saharan setting, including Ethiopia. OBJECTIVE: This study aimed to determine the missed opportunity for aspirin prophylaxis among candidates for this preeclampsia preventive intervention at a national tertiary referral hospital in Ethiopia. STUDY DESIGN: This was a cross-sectional study on pregnant women who had preeclampsia and who were managed at the St. Paul's Hospital Millennium Medical College (Ethiopia) over a 6-month period (April 1-September 30, 2023). Data were collected prospectively using a structured questionnaire. The primary outcome was the proportion of women who had an indication for aspirin prophylaxis for preeclampsia prevention but were not given the opportunity (missed opportunity for aspirin) among all pregnant preeclampsia patients presenting to our hospital. Secondary outcomes were adverse maternal and perinatal outcomes. Data were analyzed using SPSS version 23. Descriptive statistics were employed to analyze the data. Proportions and percentages were used to present the results. RESULTS: A total of 427 pregnant women with preeclampsia were screened for inclusion and 32 of them were excluded based on the study criteria. Among the 395 pregnant women with preeclampsia who were included in the final analysis, 195 (50.6%) had an indication for aspirin prophylaxis for the prevention of preeclampsia. The mean systolic and diastolic blood pressure measurements at presentation were 153.8±12.8 and 100.6±8.5 mm Hg, respectively. Most patients had proteinuria (51.7% of the participants had a urine test-strip protein level of +2, whereas 18.5% [74/395] had a urine test-strip protein level of +1 and 10.9% had 24-hour urine protein levels in the preeclampsia range). Among the women who had an indication for aspirin prophylaxis, only 1.1% received aspirin (the missed opportunity for aspirin prophylaxis for preeclampsia prevention was 98.9%). The perinatal morality rate was 11.9%, whereas the neonatal intensive care unit admission rate was 20.5%. The rate of a low Apgar score at 5 minutes was 8.9%. Eight mothers (2.1%) developed hemolysis, elevated liver enzymes, and low platelet count syndrome, whereas another 3 (0.8%) mothers developed a pulmonary edema. CONCLUSION: In this study, the missed opportunity for administration of aspirin prophylaxis for the prevention of preeclampsia was high although more than half of the study subjects were candidates for this preventive intervention. Preeclampsia was also associated with higher rates of adverse perinatal outcomes and serious maternal morbidity.

Recurrent ovarian cancer in Africa: Rate and associated factors at a gynecologic oncology treatment center in Ethiopia-A cross-sectional study.

OBJECTIVE: To determine the recurrence rate of epithelial ovarian cancer (EOC) and associated factors in an Ethiopian tertiary setting. METHODS: A cross-sectional study was conducted on recurrent ovarian cancer at St. Paul's College Millennium Medical College (Ethiopia). Data were collected through chart review using a structured questionnaire. SPSS version 26 was used to analyze the data. Descriptive analysis, bivariate, and multivariate regression analysis were performed as appropriate. Percentages, frequencies, odds ratio with 95% confidence interval (CI) were used to present the results' significance. RESULTS: A total of 202 patients with EOC were reviewed. The recurrence rate of ovarian cancer (OC) among these patients was 86.1% (a total of 173 patients developed recurrent disease). The commonest site of recurrence was the pelvis (89.1%, 180/202) and the majority of patients with recurrence were platinum sensitive, accounting for 63.8% (129/202) of cases. Age ≥40 years (adjusted odds ratio [AOR], 23.3, CI: 4.3-31.5), macroscopic residual disease (AOR, 5.2, CI: 1.96-17.68), and FIGO Stage III/IV (AOR, 22.11, CI: 8.3-39.13) were associated with recurrence. CONCLUSION: The recurrence rate of OC in this study was higher than previous reports. Advanced age at first presentation, extent of residual disease after surgery, and FIGO Stage III and IV disease were associated with disease recurrence.

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.

Women's satisfaction with intrapartum care in St Paul's Hospital Millennium Medical College Addis Ababa Ethiopia: a cross sectional study.

BACKGROUND: Satisfaction during intrapartum care is the most influential attribute on maternal health service return behaviors and utilization. Measuring satisfaction of women with intrapartum care helps to address the problems and improves the quality of delivery services. The aim of this study is to assess women's level of satisfaction during intrapartum care. METHOD: A hospital based, analytic, cross sectional study was conducted at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa Ethiopia, from May to June 2015. Data collectors administered a structured and pretested questionnaire to collect data and then analyzed it using SPSS version 20.0 software. Binary logistic regression was used to identify factors associated with women's intrapartum care satisfaction. RESULT: A total of 394 women of mean age 25.98 years with a standard deviation of ±4.72were included in the study. Only 19% of the women were satisfied with the intrapartum care they received. The variables which were significantly associated with satisfaction of intrapartum care were; opportunity to talk Adjusted Odds Ratio (AOR) (95% CI) 2.44 (1.12, 5.29); Pain Management AOR (95% CI) 3.37 (1.83, 6.21); Short Length of Time Taken for Admission After Seen by Health Professionals AOR (95% CI)0 .97 (0.93, 0.99), and Short Length of Stay in the Hospital AOR (95% CI) 0.91 (0.87, 0.96). CONCLUSIONS: The women's overall satisfaction with intrapartum care was low. Multiple factors influence their satisfaction. Health professionals, policy makers and health administrators should give emphasis to factors that contribute to low satisfaction of women with intrapartum care. They should also strengthen their efforts to deliver quality and easily accessible maternal health service to improve women's overall satisfaction with the maternal health service.

Quality of family planning counseling among women attending prenatal care at a hospital in Addis Ababa, Ethiopia.

OBJECTIVE: To assess the quality of family planning counseling among women attending a prenatal clinic in Addis Ababa, Ethiopia. METHODS: In a descriptive cross-sectional study conducted between February and April, 2015, at the prenatal care clinic of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, pregnant women in their third trimester were interviewed about their experience of family planning counseling. Data were collected via a questionnaire. Logistic regression was used to assess predictors of satisfaction with the counseling service. RESULTS: During the study period, 400 women were interviewed. Only 139 women (34.8%) were counseled about family planning. Among those counseled, 126 (90.6%) decided to use a contraceptive method after delivery and 46 (36.7%) decided to use an injectable contraceptive. Women were more likely to report high satisfaction when their provider asked about their partner's attitude toward contraceptive methods (adjusted odds ratio 6.6; P<0.001), and when asked about their concerns and worries regarding family planning methods (adjusted odds ratio 5.1; P<0.001). CONCLUSION: Very few women were counseled about contraception during prenatal care. Asking about a partner's attitude toward contraceptives and discussing women's fears or worries about contraceptives should be considered during family planning counseling to improve satisfaction and quality of care.

Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study.

BACKGROUND: Vaginal delivery after previous one cesarean section for a non recurring indication has been described by several authors as safe and having a success rate of 60-80%. Hence many centers are offering VBAC for candidates leaving the century old dictum of once cesarean always cesarean. But predicting success of VBAC after trial of labor (TOL) is still a difficult task due to the lack of a validated prediction tool. Studies on predictors of success are few and most of them conducted in developed countries and difficult to generalize. Therefore assessing factors associated with successful VBAC is very important to for counseling mothers while offering VBAC. The aim of this study was to assess factors associated with successful VBAC in three teaching Hospitals in Addis Ababa Ethiopia. METHODS: A case control study was conducted to compare the factors associated with successful VBAC in teaching hospitals in Addis Ababa in one year period. The cases were those successfully delivered vaginally and the controls were those with failed VBAC and delivered by caesarean section. The sample size of the cases was 101vaginal deliveries and the controls were 103 failed VBAC patients which made the case to control ratio of 1:1. RESULT: In this study independent factors determining successful VBAC were, history of successful VBAC in the past, rupture of membrane at admission, and cervical dilatation of more than 3cm at admission. Presence of meconium, malposition and history of stillbirth were associated with failed VBAC. Factors like maternal age, past caesarean indications, inter delivery interval, and birth weight were not found to be significant determinants of success. The most common reason for repeat cesarean section for after trial of labor was labour dysfunction because of absence of a policy for augmentation on a scarred uterus in these hospitals. CONCLUSION: It is possible to prepare a decision tool on the success of VBAC by taking important past and present obstetric and reproductive performance history as predictor.