Influence of perinatal distress on adverse birth outcomes: A prospective study in the Tigray region, northern Ethiopia.

BACKGROUND: In low-income countries, where socioeconomic adversities and perinatal distress are common, adverse birth outcomes are significant public health problems. In these settings, perinatal distress, i.e., high symptoms of anxiety, depression, and/or stress during pregnancy, may be linked with adverse birth outcomes. However, few prospective studies have investigated the impact of perinatal distress on adverse birth outcomes such as preterm birth (gestational age <37 weeks), low birth weight (<2.5 kg), and small for gestational age birth (birth weight below the 10th percentile for gestational age and sex). OBJECTIVES: Our main objective was to assess the influence of perinatal distress on adverse birth outcomes. Secondly, to investigate if perinatal distress is an independent risk factor or a mediator in the pathway between socioeconomic adversity and adverse birth outcomes. METHODS: In a prospective cohort study following 991 women from before 20 weeks of gestation until delivery in northern Ethiopia, we collected self-reported data on distress at a mean of 14.8 (standard deviation [SD] = 1.9) and 33.9 (SD = 1.1) weeks of gestation. Distress was measured using the Edinburgh Postnatal Depression Scale, the anxiety subscale of the Hospital Anxiety and Depression Scale, and the Perceived Stress Scale. To determine birth outcomes, gestational age was estimated from the last menstrual period, fundal palpation, and/or ultrasound, while birth weight was obtained from delivery records and measured within three days after birth for those delivered at home. Logistic regression and mediation analysis were employed to evaluate the impact of perinatal distress on adverse birth outcomes. RESULTS: Perinatal anxiety (OR [95% CI] 1.08 [1.02, 1.13]), depression (1.07 [1.03, 1.11]), stress (1.14 [1.07, 1.22]), and total distress (1.15 [1.07, 1.23]) were all associated with low birth weight, and small for gestational age birth but none did with preterm birth. Mediation analysis demonstrated that perinatal distress was a mediator in the pathway between socioeconomic adversity and adverse birth outcomes. CONCLUSION: Our study revealed that perinatal distress was linked with adverse birth outcomes and acted as a mediator between socioeconomic adversity and these outcomes. Our findings highlight the importance of screening women for distress and providing appropriate interventions, focusing on women experiencing socioeconomic adversity. Integrating mental health services into primary maternal care in low-income countries could be an effective approach to achieve this.

Pre-conception and prenatal factors influencing gestational weight gain: a prospective study in Tigray region, northern Ethiopia.

BACKGROUND: In low-income countries, the high prevalence of pre-pregnancy undernutrition remains a challenge for the future health of women and their offspring. On top of good nutrition, adequate gestational weight gain has been recognized as an essential prerequisite for optimal maternal and child health outcomes. However, good-quality data on factors influencing gestational weight gain is lacking. Therefore, this study was aimed to prospectively identify pre-conception and prenatal factors influencing gestational weight gain in Ethiopia. METHODS: A population based prospective study was undertaken between February 2018 and January 2019 in the Tigray region, northern Ethiopia. Firstly, the weight of non-pregnant women of reproductive age living in the study area was measured between August and October 2017. Subsequently, eligible pregnant women identified during the study period were included consecutively and followed until birth. Data were collected through an interviewer-administered questionnaire and anthropometric measurements complemented with secondary data. Gestational weight gain, i.e., the difference between 32 to 36 weeks of gestation and pre-pregnancy weights, was classified as per the Institute of Medicine (IOM) guideline. Linear, spline, and logistic regression models were used to estimate the influence of pre-conception and prenatal factors on gestational weight gain. RESULTS: The mean gestational weight gain (standard deviation[SD]) was 10.6 (2.3) kg. Overall, 64.0% (95% CI 60.9, 67.1) of the women did not achieve adequate weight gain. Factors associated with higher gestational weight gain were higher women empowerment (B 0.60, 95% CI 0.06, 1.14), dietary diversity (B 0.39, 95% CI 0.03, 0.76), pre-pregnancy body mass index (B 0.13, 95% CI 0.05, 0.22), and haemoglobin (B 0.54, 95% CI 0.45, 0.64). Additionally, adequate prenatal care (B 0.58, 95% CI 0.28, 0.88) was associated with higher gestational weight gain. CONCLUSIONS: Adequate gestational weight gain was not achieved by most women in the study area, primarily not by those who were underweight before pregnancy. Interventions that advance women's empowerment, dietary quality, pre-pregnancy nutritional status, and prenatal care utilization may improve gestational weight gain and contribute to optimizing maternal and child health outcomes.

What factors are associated with pre-pregnancy nutritional status? Baseline analysis of the KITE cohort: a prospective study in northern Ethiopia.

OBJECTIVE: To assess a broad range of factors associated with pre-pregnancy nutritional status, a key step towards improving maternal and child health outcomes, in Ethiopia. DESIGN: A baseline data analysis of a population-based prospective study. SETTING: Kilite-Awlaelo Health and Demographic Surveillance Site, eastern zone of Tigray regional state, northern Ethiopia. PARTICIPANTS: We used weight measurements of all 17 500 women of reproductive age living in the surveillance site between August 2017 and October 2017 as a baseline. Subsequently, 991 women who became pregnant were included consecutively at an average of 14.8 weeks (SD: 1.9 weeks) of gestation between February 2018 and September 2018. Eligible women were married, aged 18 years or older, with a pre-pregnancy weight measurement performed, and a gestational age ≤20 weeks at inclusion. OUTCOME MEASURES: The outcome measure was pre-pregnancy nutritional status assessed by body mass index (BMI) and mid-upper arm circumference (MUAC). Undernutrition was defined as BMI of <18.5 kg/m2 and/or MUAC of <21.0 cm. BMI was calculated using weight measured before pregnancy, and MUAC was measured at inclusion. Linear and spline regressions were used to identify factors associated with pre-pregnancy nutritional status as a continuous and Poisson regression with pre-pregnancy undernutrition as a dichotomous variable. RESULTS: The mean pre-pregnancy BMI and MUAC were 19.7 kg/m2 (SD: 2.0 kg/m2) and 22.6 cm (SD: 1.9 cm), respectively. Overall, the prevalence of pre-pregnancy undernutrition was 36.2% based on BMI and/or MUAC. Lower age, not being from a model household, lower values of women empowerment score, food insecurity, lower dietary diversity, regular fasting and low agrobiodiversity showed significant associations with lower BMI and/or MUAC. CONCLUSION: The prevalence of pre-pregnancy undernutrition in our study population was very high. The pre-pregnancy nutritional status could be improved by advancing community awareness on dietary practice and gender equality, empowering females, raising agricultural productivity and strengthening health extension. Such changes require the coordinated efforts of concerned governmental bodies and religious leaders in the Ethiopian setting.

Postpartum Weight Change in Relation to Pre-Pregnancy Weight and Gestational Weight Gain in Women in Low-Income Setting: Data from the KITE Cohort in the Northern Part of Ethiopia.

(1) Background: Postpartum weight may increase compared to pre-pregnancy due to weight retention or decrease due to weight loss. Both changes could pose deleterious effects on maternal health and subsequent pregnancy outcomes. Therefore, this study aimed to assess postpartum weight change and its associated factors. (2) Methods: A total of 585 women from the KIlte-Awlaelo Tigray Ethiopia (KITE) cohort were included in the analysis. (3) Results: The mean pre-pregnancy body mass index and weight gain during pregnancy were 19.7 kg/m2 and 10.8 kg, respectively. At 18 to 24 months postpartum, the weight change ranged from -3.2 to 5.5 kg (mean = 0.42 kg [SD = 1.5]). In addition, 17.8% of women shifted to normal weight and 5.1% to underweight compared to the pre-pregnancy period. A unit increase in weight during pregnancy was associated with higher weight change (ß = 0.56 kg, 95% CI [0.52, 0.60]) and increased probability to achieve normal weight (AOR = 1.65, 95% CI [1.37, 2.00]). Food insecurity (AOR = 5.26, 95% CI [1.68, 16.50]), however, was associated with a shift to underweight postpartum. Interestingly, high symptoms of distress (AOR = 0.13, 95% CI [0.03, 0.48]) also negatively impacted a change in weight category. (4) Conclusions: In low-income settings such as northern Ethiopia, higher weight gain and better mental health during pregnancy may help women achieve a better nutritional status after pregnancy and before a possible subsequent pregnancy.

Determinants of adverse birth outcome in Tigrai region, North Ethiopia: Hospital-based case-control study.

BACKGROUND: Adverse birth outcome which attributes to most perinatal deaths is an important indicator of child health and survival. Hence, this study aims to identify determinants of adverse birth outcome among mothers who gave birth in public hospitals of Tigrai region, North Ethiopia. METHODS: Hospital based case-control study was conducted in Tigrai region, Ethiopia between December 2015 and January 2016 among 405 (135 cases and 270 controls) consecutively selected mothers who gave birth in four randomly selected public Hospitals. Mothers with adverse birth outcome (preterm birth; < 37 gestational weeks at birth, low birth weight; < 2.5 kg at birth, or still birth) were the cases while mothers without adverse birth outcome (live birth, birth weight ≥ 2.5 kg and of ≥37 gestational weeks at birth) were the controls. Data were collected by interview and reviewing medical records using structured questionnaire. The collected data were entered into database using EPI info version 3.5.1 then exported to SPSS version 21 for analysis. Finally, multivariate logistic regression was used to identify determinants of adverse birth outcomes at P value < 0.05. RESULT: The mean age of cases and controls was 27.3 (SD = 6.6) and 26.14 (SD = 4.9) years, respectively. In a multivariate analysis; less than four antenatal care visits [AOR = 4.35, 95% CI: 1.15-13.50], not receiving dietary counseling [AOR = 11.24, 95% CI: 3.92-36.60], not using family planning methods [AOR = 4.06, 95% CI:1.35-17.34], less than 24 months inter pregnancy interval [AOR = 5.21, 95% CI: 1.89-13.86], and less than 11 g/dl hemoglobin level [AOR = 4.86, 95% CI: 1.83-14.01] were significantly associated with adverse birth outcomes. CONCLUSION AND RECOMMENDATION: The number of antenatal care visits, ever use of family planning methods, not receiving dietary counseling during antenatal care follow up visits, short inter-pregnancy interval, and low hemoglobin level were identified as independent determinants of adverse birth outcome. A concerted effort should be taken improve family planning use, and antenatal care follow-up with special emphasis to maternal nutrition to prevent adverse birth outcomes.

Predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy at Suhul Hospital, Tigrai, Northern Ethiopia: a retrospective follow-up study.

BACKGROUND: Ethiopia is striving to achieve a goal of "zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths." However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS: A retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality. RESULTS: The median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality. CONCLUSION: The overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.

Health care seeking delay among pulmonary tuberculosis patients in North West zone of Tigrai region, North Ethiopia.

BACKGROUND: Tuberculosis (TB) is a major public health problem and it is among the top 10 causes of death worldwide. One of the challenges against attaining an effective TB control program is delay in seeking health care to diagnosis and treatment of TB patients. The aim of this study was to assess health care-seeking delay among pulmonary TB patients. METHODS: An institutional based cross-sectional study was conducted among new pulmonary tuberculosis (PTB) patients > 15 years of age who were enrolled in the intensive phase TB treatment from November 1, 2015 - January 30, 2016. Data were collected by an interviewer administered technique using a structured questionnaire. Health care seeking delay was categorized by using a median cutoff point of > 30 days as a prolonged health care seeking delay. Logistic regression analyses were employed to determine factors independently associated with the delays in health care seeking. RESULTS: A total of 422 PTB patients were included in this study. The median age of respondents was 37 years (interquartile range (IQR) =35-44). The median time of health care seeking delay was 30 days (IQR) = 21-60). Respondents occupation, knowledge about pulmonary tuberculosis, health facility visited first, seeking treatment from traditional or religious healers before visiting health facilities, reason for not seeking treatment early from health facilities, and reason for first consultation were found to be significantly associated with health care seeking delay. CONCLUSION: The study showed the magnitude of health care seeking delay among pulmonary tuberculosis patient was very long and the factors associated with health care seeking delay were: occupation, knowledge status, health facility visited first and seeking treatment from religious or traditional healer before health facilities. To overcome delay of health care seeking among tuberculosis patients, efforts should required availing tuberculosis diagnostic and treatment services at the primary health care level.

Determinants of childhood diarrhea in Medebay Zana District, Northwest Tigray, Ethiopia: a community based unmatched case-control study.

BACKGROUND: Globally, childhood diarrhea is amongst the most prevalent health problems and accounts for 9% of all deaths in children under-five. In Ethiopia, childhood diarrhea is a major public health problem in which the prevalence ranges from 13.5 to 30.5% and experienced by multiple factors. Although health extension program has been implementing for couples of years; diarrheal disease remains the second cause of morbidity and continues an important public health problem in the study district. Thus, this study assessed determinants of diarrheal disease among under-five children in the Medebay Zana district, northwest Tigray, Ethiopia, 2015. METHOD: A community based case-control study was used. A multistage sampling procedure was employed to enroll the study participants. Data were collected using face to face administered questionnaire. The collected data were entered into Epi Info version 3.5.4 and exported to SPSS Version 21 for analysis. Frequencies with percentages were computed using univariate analysis. Finally, logistic regression model was fitted to identify factors associated with childhood diarrhea where P-values of less than 0.05 were considered statistically significant. RESULTS: Socio-demographic factors such as low maternal educational level [AOR = 2.88, 95% CI (1.70, 4.88)], being index child of older age, households with ≥3 number of children under-five [AOR = 4.05, 95% CI (1.91, 8.60)] and maternal history of diarrhea [AOR = 2.10, 95% CI (1.09, 4.05)] were statistically associated with childhood diarrhea. This study also revealed that child feeding practice; not exclusively breastfed [AOR = 4.84, 95% CI (2.21, 10.60)] and initiation of complementary feeding above 6 months [AOR = 1.78, 95% CI (1.09, 2.92)] were statistically associated with outcome variable. Environmental and behavioral practices such as unavailability toilet facility [AOR = 2.10, 95% CI (1.34, 3.30)], improper solid waste disposal [AOR = 2.29, 95% CI (1.53, 3.44)] and unprotected drinking water [AOR = 1.83, 95% CI (1.12, 2.98)] were also found significant factors of childhood diarrhea. CONCLUSION: Maternal educational status, age of index child, number of < 5 children, child feeding practices, maternal history of diarrhea, toilet facility, solid waste disposal and household drinking water were found determinants of childhood diarrhea. These findings have policy implications and insight the strengthening for health intervention programs.

Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study.

BACKGROUND: Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. METHODS: A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. RESULTS: From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1-3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively). CONCLUSION: The magnitude of non-prescribed antimicrobial use was high. Familiarizing with health care utilization and delayed waiting time in health care facilities were the very important factors independently associated with non-prescribed antimicrobial use. Emphasis should be given to community education through involvement of the private health sector and health care providers. Regulation and policy enforcement are also necessary to promote the rational use of antimicrobial.

Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia.

BACKGROUND: Malnutrition hastens progression to Acquired Human Immunodeficiency Syndromes (AIDS) related illnesses; undermines adherence and response to antiretroviral therapy (ART) in resource-poor settings. However, nutritional status of people living with HIV (PLHIV) can be affected by various psychosocial factors which have not been well explored in Ethiopia. Therefore, the objective of this study was to determine psychosocial correlates of nutritional status among people living with HIV (PLHIV) on ART in Central zone of Tigray, Northern Ethiopia. METHODS: A matched case-control study design was conducted to assess psychosocial correlates of nutritional status among PLHIV on ART. Data were collected by an interviewer-administered technique using structured pre-tested questionnaire, record review using a checklist and anthropometric measurements. Cases were selected by simple random sampling and controls purposively to match the selected cases. Conditional logistic regression was used to compute relevant associations by STATA version 12. RESULTS: The psychosocial factors independently associated with malnutrition were ever consuming alcohol after starting ART [AOR = 4.7, 95% CI: 1.8-12.3], ever smoking cigarette after starting ART [AOR = 7.6, 95% CI: 2.3-25.5], depression [AOR = 2.8, 95% CI: 1.3, 6.1], not adhering to ART [AOR = 6.8,95% CI: 2.0-23.0] and being in the second lowest wealth quintile [AOR = 4.3,95% CI: 1.1-17.7]. CONCLUSION: Ever consuming alcohol and ever smoking cigarette after starting ART, depression, not adhering to ART and being in the second lowest wealth quintile were significantly associated with malnutrition. Therefore; policies, strategies, and programs targeting people living with HIV should consider psychosocial factors that can impact nutritional status of people living with HIV enrolled on ART.