Cesarean delivery rates, hospital readiness and quality of clinical management in Ethiopia: national results from two cross-sectional emergency obstetric and newborn care assessments.

BACKGROUND: Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in Ethiopian CD rates, readiness of hospitals to provide CD and quality of clinical care, while highlighting the role of hospital management authority. METHODS: This secondary data analysis draws from two national cross-sectional studies to assess emergency obstetric and newborn care. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 women whose CD chart was reviewed in 2008 and 568 in 2016. Descriptive statistics are used to describe our primary outcome measures: population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management, including the relative size of Robson classification groups. RESULTS: The national population CD rate increased from 2008 to 2016 (< 1 to 2.7%) as did all regional rates. Rates in 2016 ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in private for-profit hospitals in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and private for-profit hospitals. Only half of the women whose charts were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9 to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, 40% of chart reviews from public hospitals were among low-risk nulliparous women (Robson groups 1&2). CONCLUSIONS: Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.

Breast and complementary feeding in Ethiopia: new national evidence from systematic review and meta-analyses of studies in the past 10 years.

PURPOSE: The aim of this systematic review and meta-analysis was to provide a national estimate of breast and complementary feeding practices and its predictors in Ethiopia. METHODS: PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases were searched for all available literature published until April 2018. Observational studies including cross-sectional, case-control and cohort studies were included. Newcastle-Ottawa Scale was used to assess the quality of studies. Heterogeneity of studies was quantified using Cochran's Q χ2 statistic and Higgins's method (I2). A meta-analysis using a weighted inverse variance method was performed. Subgroup analysis was carried out based on region and study area. RESULTS: In total, 70 studies that involved > 55,000 women from nine regions and two chartered cities in Ethiopia were included. The pooled national prevalence for timely initiation of breastfeeding (TIBF), exclusive breastfeeding (EBF) and timely initiation of complementary feeding was 66.5%, 60.1% and 62.5%, respectively. Guidance and counselling on breastfeeding, vaginal delivery and health institution delivery significantly increased the odds of TIBF and EBF. In addition, TIBF significantly associated with high EBF practice. Maternal occupational status significantly associated with low EBF practice, but not TIBF. CONCLUSIONS: Based on the WHO standard, the current breast and complementary feeding practice in Ethiopia is good and improving. Integrated intervention is still required for further improvement and minimizing the effect of occupational status.

Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: Evidences from the National NCDs STEPS Survey, 2015.

The prevalence of diabetes, dyslipidemias, and high blood pressure is increasing worldwide especially in low and middle income countries. World Health Organization has emphasized the importance of the assessment of the magnitude of the specific disease in each country. We determined the prevalence and determinant factors of high blood pressure, hyperglycemia, dyslipidemias and metabolic syndrome in Ethiopia. A community based survey was conducted from -April to June 2015 using WHO NCD STEPS instrument version 3.1. 2008. Multistage stratified systemic random sampling was used to select representative samples from 9 regions of the country. A total of 10,260 people aged 15-69 years participated in the study. Blood pressure (BP) was measured for 9788 individuals. A total of 9141 people underwent metabolic screening. The prevalence of raised blood pressure (SBP ≥140 and/or DBP ≥ 90 mmHg) was 15.8% (16.3% in females and 15.5% in males). The prevalence of diabetes mellitus (FBS ≥ 126 mg /dl) including those on medication was 3.2% (3.5% males and 3.0% females). The prevalence of impaired fasting glucose was 9.1% with ADA criteria and 3.8% with WHO criteria. Hypercholesterolemia was found in 5.2%, hypertriglyceridemia in 21.0%, high LDL cholesterol occurred in 14.1% and low HDL cholesterol occurred in 68.7%. The prevalence of metabolic syndrome using IDF definition was 4.8% (8.6% in females and vs. 1.8% in males). Advanced age, urban residence, lack of physical exercise, raised waist circumference, raised waist hip ratio, overweight or obesity, and total blood cholesterol were significantly associated with raised blood pressure (BP) and diabetes mellitus. Increased waist- hip ratio was an independent predictor of raised blood pressure, hyperglycemia and raised total cholesterol. Our study showed significantly high prevalence of raised blood pressure, hyperglycemia and dyslipidemia in Ethiopia. Community based interventions are recommended to control these risk factors.

Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia.

BACKGROUND: The early initiation of breastfeeding (EIBF), or timely initiation of breastfeeding, is the proportion of children put to the breast within one hour of birth. It is an important strategy for reducing perinatal and infant morbidity and mortality, but it remains under practiced in Ethiopia. The aim of the study was to assess the prevalence and the predicting factors associated with EIBF. METHODS: A community based cross-sectional study was conducted in 634 mothers in Dale Woreda, South Ethiopia. Multistage cluster sampling was used to select participating mothers. EIBF was outcome variable whereas sociodemographic characteristics and knowledge and practice of maternal health service were explanatory variables. A face-to-face interview using a pretested semi-structured questionnaire was done from September 2012 to March 2013. To investigate predicting factors, bivariate and multivariate logistic regression analysis was done. RESULTS: A total of 634 mothers of children under 24 months were interviewed. During the time of data collection, 94.3% of the mothers had breastfed. The prevalence of EIBF was 83.7%. Ownership of the house was a significant predicting factor for EIBF. Mothers who lived in rented houses were significantly less likely (60%) to initiate breastfeeding within one hour of birth compared to mothers who owned their own house: Adjusted odds ratio 0.40 (95% Confidence Interval 0.16, 0.97). CONCLUSION: More than three-fourths of mothers initiated breastfeeding within an hour. Findings from our study suggest that improving the mother's socioeconomic status as reflected by house ownership, being a significant predictor of EIBF, would have a central role in improving EIBF.