Neonatal outcomes of preterm neonates and its predictors in Ethiopian public hospitals: Multicenter prospective follow-up study.

Introduction: Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors. Objective: This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021. Methods: A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P-value less than 0.05. Result: The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (ß = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (ß = 0.85; 95% CI: 0.49, 1.22), body mass index (ß = -1.34; 95% CI: -1.87, -0.80), non-union marital status (ß = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (ß = -0.66; 95% CI: -0.99-0.32), multiparous (ß = 0.35; 95% CI: 0.01, 0.69), hypothermia (ß = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (ß = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (ß = -1.23; 95% CI: -1.99,-0.46) were significant predictors. Conclusion: In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births.

Person-centered Maternity Care Among Mothers Who Gave Birth in South Wollo Zone Public Hospitals, Northeastern Ethiopia: A Mixed-method Study.

Background: Globally, less attention has been given to the abuse and disrespect observed during maternity care. Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences and needs and that their values guide all clinical decisions during childbirth. In Ethiopia, person-centered health care is one of the factors that increase client satisfaction and health service utilization. Therefore, we aimed to determine the level of person-centered maternity care among mothers who gave birth in health facilities of South Wollo Zone public hospitals, Northeastern, Ethiopia, 2019 using a mixed-method study. Methods: An institution-based cross-sectional study was conducted using both qualitative and quantitative data collection methods. Three hundred sixty-nine study participants were selected for the quantitative study using simple random sampling. Twelve study participants were selected for the qualitative study using purposive sampling. The quantitative data was coded and entered into Epi data 4.4 version and the analysis was carried out using Statistical Package for Social Sciences version 23. Descriptive statics was presented using tables and figures. Thematic analysis was used for qualitative data and presented with the quantitative result through triangulation. Result: The Percentage mean score of the person-centered maternity care scale of the respondents was 64% of the total expected score. Whereas, the percentage means score sub-scales were 81.9%, for dignity and respect, 56.4% for communication and autonomy and 61.6% for supportive care. Most mothers who participated in an in-depth interview reported that there is not enough bed, delivery coach and bedpan in government hospitals. Conclusion and recommendations: Person-centered maternity care in health facilities of South Wollo Zone public hospitals is low. Therefore, responsible health sectors should work to improve the quality of care through effective communication between clients and providers and a supportive environment is crucial to succeeding in increasing the uptake of high-quality facility-based births.

Prevalence and determinants of overweight/obesity among under-five children in sub-Saharan Africa: a multilevel analysis.

INTRODUCTION: Childhood obesity has become a major public health problem for both developed and developing nations. It is uncommon to find under-nutrition in many low and middle-income countries; as well, obesity is a double burden in these settings. This study aimed to investigate the pooled prevalence of overweight /obesity among under-five (under-5) children in sub-Saharan Africa (SSA). METHODS: Data were accessed from the recent nationally representative demographic and health survey datasets from 33 SSA Countries. A total of 192,132 under-five children were recruited for this study. The pooled prevalence of overweight /obesity among under-5 was done using random-effects meta-analysis command. Multivariable multi-level mixed-effects logistic regression analysis was used to identify determinants for the prevalence of under-5 overweight and/or obesity. A P-value less than 0.05 was used to declare statistical significance. RESULTS: The pooled prevalence of overweight /obesity among under-5 was 5.10% (9% CI: 4.45 - 5.76) in SSA. South Africa region (8.80%, 95% CI: 4.18 - 13.42) had a higher prevalence of under-5 overweight and/or obesity followed by the East Africa region. Male under-5 children (adjusted odds ratio (AOR) = 1.09, 95 confidence interval (CI): 1.02 - 1.25), Larger birth weight under-5 children (AOR = 1.39, 95% CI: 1.26 - 1.54), under-5 children aged older two to three years (AOR = 0.85, 95% CI: 0.76 - 0.94), under-5 children born from educated mothers (secondary and above) (AOR = 1.12, 95% CI: 1.01 - 1.25), and under-5 children living in the West Africa (AOR = 0.67, 95% CI: 0.56 - 0.81) and South Africa (AOR = 1.87, 95% CI: 1.09 - 3.21) were significant determinants for under-5 overweight and/or obesity. CONCLUSION: Childhood obesity is becoming a great challenge and double burden in developing nations. In SSA Africa 1 in 20 under 5 children were overweight and/or obese. Male under-5 children, older aged, under-5 children born from educated mothers, and under-5 children living in the South Africa region were at higher risk for developing overweight and/or obesity. Thus, SSA countries should implement early to pause these consequences preventing the double burden of undernutrition.

Determinants of postpartum depression among mothers in Debre Tabor town, North-central, Ethiopia: Community-based unmatched case-control study.

Background: Postpartum depression (PPD) is a non-psychotic depressive disorder of variable severity, and it can begin as early as 2 weeks after delivery and can persist indefinitely if left untreated. In Ethiopia, the prevalence of postpartum depression is high. There is a dearth of literature to determine factors associated with postpartum depression in Ethiopia, specifically in the study area. Objective: This study aimed to identify factors associated with postpartum depression among mothers in Debre Tabor Town, Northcentral Ethiopia. Method: A community-based unmatched case-control study was conducted among mothers who were living in Debre Tabor Town and fulfilled the inclusion criteria. Postpartum mothers were selected using a simple random sampling technique from the listed sampling frame at the health center. Then, the sample cases and controls were interviewed until the sample size was fulfilled by using a consecutive sampling method. The data were entered into the EPI data version 4.6 and then imported and analyzed using SPSS version 25. Descriptive statistics of different variables were done by cross-tabulation. Binary logistic regression was used to assess the determinant factors with the outcome variable. A P-value of < 0.05 was considered to declare statistical significance. Results: A total of 308 postnatal mothers living in Debre Tabor Town were included, with a 97.5% response rate. History of substance use in the previous 3 months (AOR: 6.47, 95% CI; 2.61, 15.74), current baby illness (AOR: 3.9, 95% CI; 1.5, 10.12), marital dissatisfaction (AOR: 2.41, 95% CI; 1.22, 4.75), unplanned current pregnancy (AOR: 3.46, 95% CI; 1.32, 9.12), and breastfeeding (AOR: 0.22, 95% CI; 0.09, 0.55) were independent factors that affected the occurrence of PPD. Conclusion: This study revealed that a recent history of substance use (in the past 3 months), current baby illness, marital satisfaction, unplanned current pregnancy, and breastfeeding were associated with postpartum depression. Healthcare providers working in maternal and child health clinics and health extension workers should give special attention to postpartum mothers who have had a history of substance use, current baby illness, unplanned pregnancy, non-breastfeeding mothers, and mothers with poor marital satisfaction.

Mother-Infant Bonding and Its Associated Factors Among Mothers in the Postpartum Period, Northwest Ethiopia, 2021.

Background: The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Ethiopia, there is a paucity of information about mother-infant bonding in the postpartum period. Objective: This study aimed to assess the level of mother-infant bonding and its associated factors among mothers in the postpartum period, Debre Tabor Town Northwest Ethiopia, 2021. Methods: A community-based cross-sectional study was conducted with 422 postpartum mothers. The postpartum Bonding Questionnaire was used to assess mother-infant bonding. The Edinburgh Postnatal Depression Scale was used to assess postnatal depression. The level of marital satisfaction was assessed by using Kansas marital satisfaction scale. Social support was assessed by Oslo social support scale. A simple random sampling technique was applied to select study participants. Simple and multiple linear regression were used to identify potential factors associated with the mother-infant bonding scale. A P-value of <0.05 was considered to declare statistical significance. Results: In this study, out of 420 postpartum mothers,53 (12.6%) had a risk for the quality of mother-infant bond difficulties between mother and an infant; 8.1% of mothers had a risk for rejection and pathological anger; 3.6% of mothers had a risk for infant-focused anxiety and 1.9% of mothers had risk for incipient abuse of an infant. Maternal depression status [adjusted ß coefficient (ß) = 2.31, 95% CI: (1.98, 2.64)], non-union marital status [ß = 15.58, 95% CI: (9.88, 21.27)], being government employee [ß = -5.68, 95% CI: (-9.71, -1.64)], having current pregnancy complication [ß = -7.28, 95% CI: (-12.27, -2.29)], being non-breastfeeding mother [ß = 7.66, 95% CI: (2.94, 12.38)], substance use history [ß = -6.55, 95% CI: (-12.80, -0.30)], and social support [ß = -2, 95% CI: (-2.49, -1.50)] were statistically significant factors for mother-infant bonding. Conclusion: Generally, a significant number of mothers had mother-infant bonding difficulties in the postpartum period. Preventing strategies for bonding difficulties focus on social support during pregnancy, screening postpartum mothers for postpartum depression, and special attention to substance users, non-union maternal status, and non-breastfeeding mothers.

Community-based health insurance, healthcare service utilization and associated factors in South Gondar Zone Northwest, Ethiopia, 2021: A comparative cross-sectional study.

INTRODUCTION: Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia has implemented community-based health insurance in piloted regions of the country. The scheme aims to improve the utilization of healthcare services by removing financial barriers. There is a dearth of literature regarding the effect of the insurance scheme on the utilization of healthcare services. METHODS: A community-based comparative cross-sectional study was conducted in the south Gondar Zone. Six hundred fifty-eight participants were selected using a systematic random sampling method. Data were entered into EPI data version 4.4.1 and exported to SPSS version 25 for analysis. Binary logistic regression was used to measure the association of factors with the outcome variable. The result of the final model was expressed in terms of Adjusted Odd Ratios (AOR) and 95% CI. RESULT: Two hundred twenty-three (67.8%) and 111 (33.7%) of the respondents reported that their family members went to health institutions within three months among CBHI users and non-users respectively. The presence of under-five children (AOR = 2, 95% CI = 1.6-2.4), CBHI scheme membership times (AOR = 3, 95% CI = 2.6-3.4), household wealth index rich (AOR = 4, 95% CI = 2.3-6.3), household wealth index medium (AOR = 3, 95% CI = 1.8-5.8) and presence of chronic illness (AOR = 0.5, 95% CI = 0.2-0.8) was associated with health care service utilization. Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled. CONCLUSION AND RECOMMENDATION: Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled. Therefore, health sector leaders and managers in the study area should strengthen their efforts for increasing the enrollment of the community into CBHI.

Development of a Nomogram for Clinical Risk Prediction of Preterm Neonate Death in Ethiopia.

Introduction: In 2020, over 6,500 newborn deaths occured every day, resulting in 2.4 million children dying in their 1st month of life. Ethiopia is one of the countries that will need to step up their efforts and expedite progress to meet the 2030 sustainable development goal. Developing prediction models to forecast the mortality of preterm neonates could be valuable in low-resource settings with limited amenities, such as Ethiopia. Therefore, the study aims to develop a nomogram for clinical risk prediction of preterm neonate death in Ethiopia in 2021. Methods: A prospective follow-up study design was employed. The data were used to analyze using R-programming version 4.0.3 software. The least absolute shrinkage and selection operator (LASSO) regression is used for variable selection to be retained in the multivariable model. The model discrimination probability was checked using the ROC (AUROC) curve area. The model's clinical and public health impact was assessed using decision curve analysis (DCA). A nomogram graphical presentation created an individualized prediction of preterm neonate risk of mortality. Results: The area under the receiver operating curve (AUROC) discerning power for five sets of prognostic determinants (gestational age, respiratory distress syndrome, multiple neonates, low birth weight, and kangaroo mother care) is 92.7% (95% CI: 89.9-95.4%). This prediction model was particular (specificity = 95%) in predicting preterm death, with a true positive rate (sensitivity) of 77%. The best cut point value for predicting a high or low risk of preterm death (Youden index) was 0.3 (30%). Positive and negative predictive values at the Youden index threshold value were 85.4 percent and 93.3 percent, respectively. Conclusion: This risk prediction model provides a straightforward nomogram tool for predicting the death of preterm newborns. Following the preterm neonates critically based on the model has the highest cost-benefit ratio.

Predictors of Survival Among Preterm Neonates Admitted to Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Background: Pre-maturity is the primary cause of neonatal mortality in the world. Although prematurity was the leading cause of neonatal mortality, the survival rate and its predictors may be varied from setting to setting and time to time due to different reasons. Therefore, this study aimed to assess the survival probability and predictors of mortality among preterm neonates at Felege Hiwot comprehensive specialized hospital. Methods: This is a retrospective follow-up study that included 542 randomly selected preterm neonates admitted at Felege Hiwot comprehensive specialized hospital from the period of 2016-2020. Semi-parametric and parametric survival models were fitted to identify the survival probability of preterm neonates and its association with different predictors. The best fit model was selected using Akaike's information criteria, Bayesian information criteria and likelihood ratio criteria. Results: The cumulative incidence and incidence rate of mortality among preterm neonates were 31 per 100 live births and 3.5 per 100 neonate days, respectively. From the adjusted cox-proportional-hazard model, predictors with higher preterm mortality risk include the presence of neonatal respiratory distress syndrome [AHR = 2.55, 95% CI: 1.23; 3.74], perinatal asphyxia [AHR = 4.26, 95% CI: 1.35; 6.79] and jaundice [AHR = 3.25, 95% CI: 2.14, 7.24]. However, admission weight of 1,500-2,499 g (AHR = 0.23, 95% CI: 0.11, 0.56) and ≥2,500 g (AHR = 0.12, 95% CI: 0.02; 0.32), early breastfeeding [AHR = 0.44, 95% CI: 0.36; 0.48] and kangaroo mother care [AHR = 0.11, 95% CI: 0.03; 0.15] were protective factors of preterm mortality. Conclusion: The cumulative incidence of mortality among preterm neonates was consistent with the national incidence of preterm mortality. Factors such as respiratory distress syndrome, perinatal asphyxia, breastfeeding, kangaroo mother care, admission weight, and jaundice are significant predictors of survival. Therefore, considerable attention such as intensive phototherapy, optimal calorie feeding, oxygenation, and good thermal care should be given for admitted preterm neonates.

Impact of respiratory distress syndrome and birth asphyxia exposure on the survival of preterm neonates in East Africa continent: systematic review and meta-analysis.

INTRODUCTION: Several kinds of researches are available on preterm mortality in the East Africa continent; however, it is inconsistent and inconclusive, which requires the pooled evidence to recognize the burden in general. PURPOSE: To collect and synthesis evidence on preterm mortality and identify factors in the East Africa continent. METHODS: PubMed, Google Scholar, Hinary, Cochrane library, research gate, and institutional repositories were retrieved to identity eligible articles through Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The articles were selected if the publication period is between 2010-2021 G.C. Data were extracted by a standardized JBI data extraction format for mortality rate and stratified the associated factors. Then exported to STATA 14 for further analysis. I2 and Egger's tests were employed to estimate the heterogeneity and publication bias respectively. Subgroup analysis based on country, study design, year of publication, and the sample size was also examined. RESULT: This meta-analysis included 32 articles with a total of 21,405 study participants. The pooled mortality rate among preterm in the East Africa continent was found to be 19.2% (95% CI (confidence interval (16.0-22.4)). Regarding the study design, the mortality rate was found to be 18.1%, 19.4%, and 19.7% concerning the prospective cohort, retrospective cohort, and cross-sectional studies. The pooled odds of mortality among preterm with respiratory distress syndrome decreased survival by nearly three folds [AOR (Adjusted odds ratio = 3.2; 95% CI: 22, 4.6)] as compared to their counterparts. Similarly, preterm neonates presented with birth asphyxia were nearly three times higher in death as compared with preterm without birth asphyxia [AOR = 2.6; 95% CI: 1.9, 3.4]. CONCLUSION: Preterm mortality was found to be unacceptably high in Eastern Africa continent.Fortunately, the main causes of death were found to be respiratory distress syndrome and birth asphyxia which are preventable and treatable hence early detection and timely management of this problem are highly recommended to improve preterm survival.

Priorities for intervention to prevent diarrhea among children aged 0-23 months in northeastern Ethiopia: a matched case-control study.

BACKGROUND: The global public health problem of diarrhea is most prevalent in developing countries including Ethiopia, especially among children under two years of age. Limited information on the determinants of diarrhea among children aged 0-23 months hinders the design and prioritization of intervention strategies to address childhood diarrhea in Dessie City, northeastern Ethiopia. Therefore, this study was designed to assess the determinants of diarrhea in order to identify priority interventions for its control. METHODS: A community-based matched case-control study was conducted among children aged 0-23 months during January-February 2018. Cases defined as children with acute diarrhea, and controls defined as children without acute diarrhea, were matched by child's age (months) and place of residence (residing in the same kebele, the lowest local administrative unit, each of which has a population of approximately 5000) during the two weeks prior to data collection. Data were collected from mothers/caregivers of the 119 cases and 238 matched controls using a pre-tested structured questionnaire and an observational checklist. Data were analyzed using conditional logistic regression model with 95% confidence interval (CI); variables with p < 0.05 from multivariable analysis were considered as significantly associated with acute diarrhea among children aged 0-23 months. RESULTS: Age of mothers/caregivers (> 35 years of age) (adjusted matched odds ratio [adjusted mOR] = 2.00; 95% CI: 1.37-5.8); divorced/widowed marital status (adjusted mOR = 1.40; 95% CI: 1.26-3.3); lack of exclusive breastfeeding (adjusted mOR = 2.12; 95% CI: 1.15-3.70); presence of feces within/around latrines (adjusted mOR = 1.37; 95% CI: 1.21-3.50); lack of handwashing facility near latrine (adjusted mOR = 1.50; 95% CI: 1.30-5.30); presence of domestic sewage discharge within and/or outside the compound (adjusted mOR = 3.29; 95% CI: 1.85-7.50) and practice of handwashing at fewer than three of the five critical daily times (adjusted mOR = 4.50; 95% CI: 2.54-9.50) were significantly associated with acute diarrhea among children aged under two years. CONCLUSION: To reduce acute diarrheal disease among children under two, priority should be given to interventions that focus on improving exclusive breastfeeding practices, regular cleaning of latrines, advocating for availability of handwashing facility within/around latrines, use of proper domestic sewage discharge methods and improving handwashing practice at the five critical times each day. Strengthening communication that promotes hygiene and behavioural change may also raise awareness among mothers/caregivers and empower them to enhance handwashing practices at critical times.

Magnitude and associated factors of substance use among pregnant women attending antenatal care in public hospitals of eastern Ethiopia.

BACKGROUND: Use of substances like alcohol, tobacco and khat during pregnancy can bring miscarriage, prematurity, neurodevelopmental problems, sudden infant death syndrome and others. There are limited studies on the magnitude and associated factors of substance use among pregnant women in Eastern Ethiopia. Therefore, the aim of this study was to assess the magnitude and associated factors of substance use among pregnant women attending antenatal care in public hospitals of Easttern Ethiopia, 2019. METHOD: Hospital based cross-sectional study was employed on 510 pregnant women attending ANC at public hospitals of Eastern Ethiopia (Jigjiga, Dire Dawa and Harar towns). Data were collected from the study participants that were selected using systematic sampling method from each public hospital. The data were collected through interviewer administered structured questionnaire. Binary logistic regressions with 95% confidence interval were used to determine the degree of association between covariates and outcome variable. Multicollinearity between independent variables by using the standard error was checked. The goodness of fit was tested by Hosmer-Lemeshow statistic and Omnibus tests. RESULTS: Out of 526 participants, a total of 510 study participants were involved in this study thereby making a response rate of 96.9%. In this study, the magnitude of substance use among pregnant women attending ANC was 26.5% (95% CI: 22.7, 30.6%). Among the overall pregnant mothers, 100 (19.6%) chewed khat, 48 (9.4%) drank alcohol, 12 (2.4%) used tobacco products and 28(20.7%) were dual substance users. Pre pregnancy substance use (AOR = 27.25, CI: 14.107-52.66), partner substance use (AOR = 3.704 CI: 1.839-7.464), family substance use (AOR = 3.447 CI: 1.69-7.031) and the amount of monthly household income (AOR = 3.397, 95% CI: 1.316-8.766) were found to be statistically significant and positively associated with substance use during pregnancy. CONCLUSION: The magnitude of antenatal substance use in the study area was 26.5%. Pre- pregnancy substance use, partner substance use, monthly house hold income and family substance use were found to be positively associated with substance use during pregnancy. Therefore, health education which is inclusive of child bearing age women with their partner and family may be helpful to decrease antenatal substance use during pregnancy.