Time to initiation of antenatal care and its predictors among pregnant women who delivered in Arba Minch town public health facilities, Gamo Zone, southern Ethiopia, 2023: a retrospective follow-up study.

BACKGROUND: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. METHODS: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. RESULTS: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. CONCLUSION: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed.

Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial.

INTRODUCTION: Maternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia. METHODS: We conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables. RESULTS: The study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar's Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4). CONCLUSION: The study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings. TRIAL REGISTRATION: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.

Many women in developing nations, including Ethiopia, are dying due to problems related to pregnancy and childbirth. One of the interventions to prevent maternal illness and deaths is promoting and ensuring the timely use of maternal health care services. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved institutional birth rate in rural Ethiopia. We conducted a trial at the Arba Minch HDSS site. The package provided information on safe motherhood via videos and audiocassettes for pregnant women, a birth preparedness card for women, community volunteers and extension workers training, and maternity waiting home services upgrading. In the control arm, women received routine services only. From the 10 Arba Minch HDSS kebele clusters, six kebele clusters were randomly assigned to the intervention and an additional four were assigned to the control. Different statistical techniques were used to evaluate the effectiveness of the intervention on the institutional birth rate. At the baseline, 727 pregnant women had enrolled across all 10 clusters, with a 617 (84.9%) successful follow-up rate. The intervention arm had a higher proportion of institutional birth (224/427 [52.5%]) at the endline than the baseline (174/478 [36.4%). Furthermore, the study showed a significant association between intervention status and institutional birth rate. Therefore, stimulating demand for existing services to ensure the timely use of care can improve maternal health service utilization, particularly the institutional birth rate.

Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis.

BACKGROUND: Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia. METHODS: The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance. RESULTS: Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service. CONCLUSIONS: Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.

Benefits, barriers and enablers of maternity waiting homes utilization in Ethiopia: an integrative review of national implementation experience to date.

BACKGROUND: Though Ethiopia has expanded Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, the utilization rate is low. To maximize the use of MWH, policymakers must be aware of the barriers and benefits of using MWH. This review aimed to describe the evidence on the barriers and benefits to access and use of MWHs in Ethiopia. METHODS: Data were sourced from PubMed, Google Scholars and Dimensions. Thirty-one studies were identified as the best evidence for inclusion in this review. We adopted an integrative review process based on the five-stage process proposed by Whittemore and Knafl. RESULTS: The key themes identified were the benefits, barriers and enablers of MWH utilization with 10 sub-themes. The themes about benefits of MWHs were lower incidence rate of perinatal death and complications, the low incidence rate of maternal complications and death, and good access to maternal health care. The themes associated with barriers to staying at MWH were distance, transportation, financial costs (higher out-of-pocket payments), the physical aspects of MWHs, cultural constraints and lack of awareness regarding MWHs, women's perceptions of the quality of care at MWHs, and poor provider interaction to women staying at MWH. Enablers to pregnant women to stay at MWHs were availability of MWHs which are attached with obstetric services with quality and compassionate care. CONCLUSION: This study synthesized research evidence on MWH implementation, aiming to identify benefits, barriers, and enablers for MWH implementation in Ethiopia. Despite the limited and variable evidence, the implementation of the MWH strategy is an appropriate strategy to improve access to skilled birth attendance in rural Ethiopia.

Factors associated with antenatal exercise in Arba Minch town, Southern Ethiopia: A community-based cross-sectional study.

BACKGROUND: Many health risks in pregnant women and their foetuses can be reduced by practicing antenatal exercise. However, the adequate practice of antenatal exercise among pregnant women is low in Ethiopia. Therefore, this study aimed to assess the practice of antenatal exercise and its associated factors among pregnant women in Arba Minch town. METHODS: A community-based cross-sectional study design was conducted. Data were collected by using a structured questionnaire from 422 pregnant women selected by a simple random sampling technique. Descriptive statistics were computed and a binary logistic regression model was fitted. In multivariable logistic-regression adjusted odds ratio (AOR) with 95% confidence intervals were used to determine the strength of associations. The significance level was declared at a p-value < 0.05. RESULTS: Among 410 participants, 32.9% (95% CI 28%-37%) adequately practiced antenatal exercise. Factors negatively associated with an adequate antenatal exercise were husband's primary school level [Adjusted odds ratio (AOR) = 0.3, (95% CI: 0.1, 0.7)], history of miscarriage [AOR = 0.3, (95% CI: 0.1, 0.7)], inadequate knowledge [AOR = 0.2, (95% CI: 0.1, 0.3)], and unfavorable attitude [AOR = 0.3, (95% CI 0.2, 0.5)]. Whereas, factors positively associated with an adequate antenatal exercise were employment status of women [AOR = 4.8, (95% CI: 1.8, 13.1)], and a practice of regular exercise before current pregnancy [AOR = 1.9, (95% CI: 1.1, 3.2)]. CONCLUSIONS: The findings of this study indicated that adequate practice of antenatal exercise was found to be low. Appropriate measures should be taken to improve the husband's educational level, mother's occupation, knowledge, and attitudes towards antenatal exercise. Special consideration should be given to those with a history of miscarriage and women should be encouraged to practice regular exercise before pregnancy.

Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study.

BACKGROUND: Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. METHODS: We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. RESULTS: We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio (aHR = 1.96; 95% CI: 1.92-4.00)), rural residence (aHR = 1.98; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms (aHR = 2.19; 95% CI: 1.11-4.37), a fair level of adherence (aHR = 11.5; 95% CI: 2.10-61.10), and a poor level of adherence (aHR = 12.03; 95% CI: 5.4-26.7). CONCLUSIONS: In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.

Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia.

BACKGROUND: In rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia. METHODS: A community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas. RESULTS: MWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization. CONCLUSIONS: A low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended.

Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study.

BACKGROUND: Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS). METHODS: A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered. RESULTS: The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6-14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR = 0.49; 95% C.I: 0.29-0.85] and housewives [AOR = 0.63; 95% C.I: 0.45-0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41-0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46-0.93] compared with 1st quintiles), and climatic zone (midland [AOR = 1.80;95% CI: 1.11-2.93), highland [AOR = 1.95;95% CI: 1.19-3.18] compared with lowland). In addition, tobacco use [AOR = 4.28;95% CI: 3.38-5.43], and khat use [AOR = 4.75; 95% CI: 2.66-8.50) were also associated with heavy episodic drinking among the study participants. CONCLUSIONS: More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.

Fear of childbirth among pregnant women attending antenatal care in Arba Minch town, southern Ethiopia: a cross-sectional study.

BACKGROUND: Fear of childbirth is one of the life challenges the women encounter during pregnancy. It is an important source of distress for the women and their families and also increases the odds of obstetric complications during childbirth. The aim of this study was to assess the magnitude of fear of childbirth and associated factors among pregnant women attending antenatal care at public health facilities in Arba Minch town, southern Ethiopia. METHODS: Institution-based cross-sectional study was carried out among pregnant women who attended antenatal care at public health facilities in Arba Minch from November 1st - 30th 2019. A systematic random sampling technique was employed to include the participants. Data were collected through a face-to-face interview by using a structured and pretested questionnaire. Wijma Delivery Expectancy Questionnaire was used to score fear of childbirth. Epi Data version 3.1 and Statistical Package for the Social Sciences version 25.0 software were used for data management. Descriptive and analytic analyses were done and statistical significance was declared at a p-value < 0.05 and 95% confidence level in multivariable analysis. RESULTS: A total of 387 pregnant women have participated in this study. Forty (10.3%) of the pregnant women had a low degree fear, 154(39.8%) had a moderate degree fear, 98(25.3%) had a high degree fear, and 95(24.5%) had severe degree fear of childbirth. Unplanned pregnancy (AOR = 2.30, 95% CI: 1.12, 4.74), current pregnancy-related complications (AOR = 6.24, 95% CI: 2.72, 14.29), and poor social support (AOR = 1.93, 95%CI: 1.01, 3.68) were factors significantly associated with severe degree fear of childbirth. CONCLUSIONS: Almost three-fourth of the pregnant women in this study area had moderate to severe degree fear of childbirth. Tailoring counseling during antenatal care visits is needed to address those women who are at a high risk of considerable childbirth fear and its health consequences.

Incidence and Predictors of Initial Antiretroviral Therapy Regimen Change Among HIV-Infected Adults Receiving Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia.

BACKGROUND: The effectiveness of the initial antiretroviral therapy regimen is the key to treatment success. However, regimen change affects this treatment success. Yet, evidence on the incidence and predictors of regimen change is scarce. Therefore, the aim of this study was to assess the incidence and predictors of initial antiretroviral therapy regimen change among HIV-infected adults receiving antiretroviral therapy. METHODS: An institutional-based retrospective cohort study was conducted. Data were collected from patients' charts selected by simple random sampling. Data entered into EpiData version 4.43 and analyzed by STATA version 13. The life table was used to estimate cumulative survival. Kaplan-Meir curve and Log-rank test were used to compare the survival experience of explanatory variables. Cox proportional hazard model was used to identify predictors. RESULTS: Five hundred and eight patients were followed for 871.87 person-years of observation with the median follow-up period of 16.12 months. The incidence rate of initial ART regimen change was 11.36 (95% CI: 9.32-13.83) per 100 person-year and the median survival time is 54 months. Not disclosing HIV status (adjusted hazard ratio (AHR) = 5.41, 95% CI = 2.38-12.27), co-medication with ART (AHR = 4.64, 95% CI = 1.43-15.10), occurrence of side effect on initial regimen (AHR = 7.32, 95% CI = 4.43-12.10), baseline CD4 count <200 cells/mm3 (AHR = 2.18, 95% CI = 1.37-3.47), ambulatory/bedridden baseline functional status (AHR = 3.55, 95% CI = 2.30-5.48) were significant predictors of initial regimen change. CONCLUSION: The incidence rate of initial ART regimen change was found to be low. HIV disclosure status, co-medication with ART, the occurrence of side effects on an initial regimen, low baseline CD4 count, ambulatory and bedridden baseline functional status were found to be predictors.

Disrespect and abuse of women during childbirth in public health facilities in Arba Minch town, south Ethiopia - a cross-sectional study.

INTRODUCTION: Disrespect and abuse of women during childbirth is one of the deterring factors to skilled childbirth utilization, especially in low and middle-income countries. OBJECTIVE: The objective of this study was to assess the prevalence of women's disrespect and abuse during childbirth in public health facilities in Arba Minch town, south Ethiopia. METHODS: Institution-based cross-sectional study design was employed at all public health institutions in Arba Minch town, south Ethiopia. A systematic random sampling method was used to include 281 women who had given birth at public health institutions between January 01 and February 28, 2017. Data were collected through face to face interview by four data collectors and they were supervised by the principal investigator during the entire period of data collection. A semi-structured pretested questionnaire was used to collect the data. Epi info version 7.1.2.0 and SPSS version 24 were used to enter and analyze the data, respectively. RESULTS: The overall prevalence of non-respectful care was 98.9%. The women's right to information and informed consent was the most frequently violated right with a prevalence of 92.5% (95% CI: 90.9, 94.1) followed by non-dignified care (36.7, 95% CI: 34.9, 38.5), physical abuse (29.5%, 95% CI: 24.2, 34.8), discrimination (18.1%, 95% CI: 13.6, 22.6), non-confidential care (17.1%, 95% CI: 12.7, 21.5) and abandonment of care (4.3%, 95% CI: 3.1, 5.5). Rural residence, giving birth in the hospital, having no or low educational status and giving birth by cesarean route were factors significantly associated with specific women's rights violations. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of women's disrespect and abuse during childbirth at the health care facilities in this study area is very high. Therefore, health managers need to work hard to tackle the problem.