Precancerous cervical lesions and associated factors among women on antiretroviral therapy at Dukem Health Center, Central Ethiopia: A cross-sectional study.

Background and Aims: Cervical cancer is a global public health problem and the second most common cancer which leads to morbidity and mortality among women in developing countries like Ethiopia. In Ethiopia, annually 6294 new cervical cancer cases and 4884 deaths are estimated in 2018 alone. This study aimed to assess the prevalence and associated factors of precancerous cervical lesions among women on antiretroviral therapy (ART) at Dukem Health Center, Central Ethiopia. Methods: An institution-based cross-sectional study was carried out among randomly selected 257 women receiving ART at Dukem Health Center. Data were collected using a pretested structured questionnaire, medical record review, and visual inspection with acetic acid. Collected data were entered into Epi-info 7.4 and exported to SPSS version 26 for analysis. The prevalence of precancerous cervical lesions and the characteristics of study participants were identified. Utilizing both binary and multivariable logistic regression models, the existence and degree of association with precancerous cervical lesions were determined with a p value < 0.05 and a 95% confidence interval. Results: The prevalence of precancerous cervical lesions was 16% (95% CI: 11.7-20.6). Significant association was found between precancerous cervical lesions and a history of STIs (AOR = 4.30, 95% CI: 1.48-12.49), oral contraceptive use (AOR = 6.56, 95% CI: 2.10-20.50), having multiple lifetime sexual partners (AOR = 2.53: 95% CI: 1.05-6.10), and a recent CD4 count of less than 200 cells/mm3 (AOR: 11.33, 95% CI: 2.88-24.58). Conclusion: In the study area, the prevalence of precancerous cervical lesions was relatively high. Therefore, concerned bodies are recommended to increase awareness of the prevention of sexually transmitted diseases and limit sexual partners.

Caregivers' knowledge, practice, and associated factors toward oral rehydration salt with zinc to treat diarrhea among under 5 children in Burayu town, Oromia, Ethiopia, 2022: Cross-sectional study: An implication for action.

Background: Diarrhea is the second leading cause of death in under 5 children of Ethiopia. Millions of young lives could be saved if mothers know and practice the three rules of diarrhea management: giving extra fluid (particularly oral rehydration salt [ORS]), zinc, and giving additional food during diarrhea illness. Aim: The objective of this study was to determine mothers'/caregivers' Knowledge, Practice, and associated factors toward ORS with zinc to treat diarrhea among under 5 children in Burayu town, Oromia Region, Ethiopia, 2022. Methods: A community-based cross-sectional study was conducted among 422 study participants from September 25 to October 10, 2022; in Burayu town, Ethiopia. Systematic random sampling technique was used to enroll study subjects from two randomly selected kebeles. Interviewer-administered structured questionnaire was used to collect data. Data were entered into Epi-info version 3.5.1 and exported to SPSS Version 21 for analysis. Binary and multivariable logistic regression was done to identify factors associated with knowledge and practice of ORS with zinc at p < 0.05% and 95% confidence interval (CI). Results: The findings showed that 59% and 52% of the respondents had good knowledge and practice toward ORS with zinc, respectively. Being housewives (adjusted odds ratio, AOR = 0.407, 95% CI: [0.195, 0.848]), primary education (AOR = 3.246, 95% CI: [1.614, 6.530]), income of >4000 (AOR = 5.132, 95% CI: [1.947, 13.524]), health seeking behavior (AOR = 0.369, 95% CI: [0.139, 0.979]), being divorced (AOR = 0.275, 95% CI: [0.09,0.842]) were found to be significantly associated with knowledge toward management of diarrhea with ORS and zinc. Housewives in occupation (AOR = 0.084, 95% CI: [0.029, 0.243]), secondary and above education (AOR = 6.26: 95% CI: [1.51, 25.86]), health seeking behavior (AOR = 6.885, 95% CI: [2.29, 20.67]), having good knowledge of ORS and zinc (AOR = 22.14, 95% CI: [8.44, 58.07]) were found to be significantly associated with practice of managing diarrhea with ORS and zinc. Conclusion: This study revealed low level of knowledge and practice of caregivers toward ORS with zinc. The more mothers/caregivers are knowledgeable, the more they are active to practice the use of ORS with zinc. Thus, health education and awareness creation for the mothers/caregivers on management of diarrhea is very crucial. Special attention should be given to enhancing income for mothers/caregivers.

Contextualizing a framework for improving postnatal care in Ethiopia.

Background: Postnatal care is among the major recommended interventions to reduce maternal deaths. To improve the low postnatal care utilization in Ethiopia, the framework developed for this purpose in Kenya was contextualized and adapted for implementation in the Ethiopian context. Objectives: The objectives of this article are to share the process followed to contextualize Chelagat's framework for improving postnatal care, for the implementation in Ethiopia as well as the finalized contextualized framework. Methods: A quantitative descriptive research design was adapted. A self-administered questionnaire was used to gather data during November 2018 from 422 postnatal care providers and coordinators, using stratified random sampling. The AGREE II was utilized to assess adaptability and applicability and an open-ended question allowed to assess the challenges and opportunities for utilizing the framework. The data were analyzed using SPSS computer software, Version 23. Results: The findings revealed that the framework from Chelagat was adaptable to use for the improvement of postnatal care in the Ethiopian context. The results from the analysis of the data using AGREE II indicated an average domain score of 92%, for contextualization possibility. Conclusion: The framework originally developed by Chelagat was contextualized and refined to be implemented in Ethiopia to improve postnatal care.

Safe menstrual hygiene management practice and associated factors among female adolescent students at high schools in central Ethiopia: A mixed-method study.

Background: Menstrual Hygiene Management (MHM) is a much-neglected issue in developing countries, including Ethiopia. Menstruating women and girls are forced into isolation, prevented from movement, dietary restrictions, and can be prevented from participating in daily routine activities. Furthermore, the way almost all previous studies conducted in Ethiopia measured the practice of MHM did not meet standard definition of safe MHM. This study aimed to assess safe management of menstrual hygiene practice and associated factors among female adolescent students in public high schools in central Ethiopia. Methods: A mixed-methods approach was employed in this study. Systematic random sampling technique was used to select 846 study participants. The collected data were entered through EPI INFO version 7 and exported to SPSS version 23 for cleaning and analysis. Bivariate and multivariate logistic regression analysis were performed to identify the association between MHM and independent variables. Finally, AOR, 95% CI, and p-value < 0.05 were considered statistically significant. The qualitative data was analyzed by ATLAS.ti in order to extract the main themes and categories. Direct quotations were presented with a thick description of the findings. Results: The safe management of menstrual hygiene was 28.20%. Living with parents (AOR = 2.51, 95% CI:1.11-5.68), living with relatives (AOR = 7.41, 95% CI:2.55-21.54), having a merchant mother (AOR = 1.81, 95% CI:1.14-2.9), having a mother who has private work (AOR = 4.56, 95% CI:1.31-5.90), having a farmer father (AOR = 1.53, 95% CI:1.1-2.31), rural resident (AOR = 1.61, 95% CI: 1.17-2.21) and realizing the absence of container for storing sanitary napkins in the toilet of the school latrine (AOR = 1.44, 95% CI: 1.1-0.94) were factors associated with MHM. Findings from a qualitative study were discussed under four themes to explore barriers to menstrual hygiene management, and three themes emerged as enablers to menstrual hygiene management. Conclusions: The safe management of menstrual hygiene was low among adolescent girls. People with whom adolescent girls live, the occupational status of mother and father, residence, the availability of a container to dispose of sanitary napkins in school toilets were factors associated with menstrual hygiene management. Behavioral change communications must be provided to female students about menstrual hygiene.

Challenges in postnatal care provision in Ethiopia.

Background: Most maternal deaths occur during the first 48 h after delivery; thus, a critical time for monitoring possible complications arising from the delivery. Quality postnatal care can contribute to a decrease in maternal mortality and morbidity rates. Despite the importance of postnatal care, it is generally a neglected aspect of maternal and child health services in most developing countries, including Ethiopia. Objectives: The objective of the study was to describe the challenges experienced by postnatal care providers and coordinators in providing postnatal care in the Ethiopian context. Methods: A quantitative cross-sectional descriptive study was conducted and data were gathered from 422 postnatal care providers and coordinators during November 2018. A simple random sampling technique was used to select the respondents and the data were gathered through a self-administered questionnaire. The data were cleaned, coded and entered into the Statistical Package for Social Sciences (SPSS) version 21 for analysis. Open-ended questions for qualitative enhancement were open-coded and thematically analyzed. Results: The findings revealed a lack of physical resources; infrastructure problems; cultural concerns; inadequate capacity building; inaccessibility of health services; unavailability of guidelines; a lack of communication with healthcare users and poor monitoring and evaluation as challenges. Conclusion: To improve postnatal care in Ethiopia and, ultimately, mother and child health, the challenges experienced by postnatal care providers and coordinators have to be dealt with. A strategic action plan with the active involvement of all stakeholders must be developed and implemented to deal with the challenges and improve postnatal care.

Magnitude and Factors Associated with Ambulance Service Utilization Among Women Who Gave Birth at Public Health Institutions in Central Ethiopia.

Background: Effective and well-organized ambulance services system forms the link between household and health facility for providing basic or comprehensive emergency obstetric care. Therefore, the establishment of a strong ambulance services network across the country based on evidences from local study is necessary for the improvement of ambulance service utilization among mothers who gave birth. This study aimed to assess magnitude and factors associated with ambulance service utilization among women who gave birth at public health institutions in central Ethiopia. Methods: A community-based cross-sectional study supplemented by a qualitative method was employed. Data were collected via face-to-face interview. A simple random sampling and purposive sampling techniques were used to select study participants. Bivariate and multivariable logistic regression analyses were done to identify factors associated with ambulance services utilization, and variables with a p-value <0.25 were entered in the multivariable logistic regression analysis. Adjusted odds ratio (AOR) with 95% CI and a P-value <0.05 were used to declare statistically significant associations. Results: Among study participants, only 214 (46%) utilized ambulance service. Mother who had no formal education (AOR=0.03, 95% CI [0.01, 0.07]), husband who completed primary school and above (AOR=7.03, 95% CI [1.83, 27.16]), rural residence (AOR=2.27, 95% CI [1.11, 4.65]), decision maker to get ambulance service (AOR=0.03, 95% CI [0.01, 0.07]), multigravida (AOR=4.8, 95% CI [2.48, 9.34]), having ambulance phone number (AOR=0.36, 95% CI [0.19, 0.68]), antenatal care attendance (AOR=0.07, 95% CI [0.04, 0.16]), and having discussion with health extension worker (AOR=0.14, 95% CI [0.084, 0.24]) were significantly associated with ambulance service utilization. Conclusion: The magnitude of ambulance service utilization was low. Hence, health sector should improve the awareness of pregnant mothers on benefit of ambulance utilization through provision of information. Health care providers should provide antenatal services for pregnant mothers as early as possible.

Knowledge, Attitude, and Practice Toward Cervical Cancer Screening Among Women Attending Health Facilities in Central Ethiopia.

BACKGROUND: In Ethiopia, cervical cancer ranked as the second leading cause of female cancer and also stands as the most common cancer among women aged from 15 to 44 years old. Hence, this study aimed to assess knowledge, attitude, and practice toward cervical cancer screening among women attending health facilities in central Ethiopia. METHODS: Institutional-based cross-sectional study was conducted among 420 study participants. Data were collected using an interviewer-administered questionnaire. The collected data were entered into EPI data 3.1 and exported to SPSS version 23 for analysis. Binary and multivariate logistic regressions were used to identify factors associated with knowledge, attitude, and practice of cervical cancer screening. Odds ratio (OR) with 95% CI and a P-value < .05 were used to declare statistical significance. RESULTS: Half, 50.7% of study participants had good knowledge. Less than half, 46.1% had a positive attitude toward cervical cancer screening. Only 6.3% of women have been screened for cervical cancer. Diploma and above education (AOR: 2.22, 95% CI: 1.32, 6.157), no idea about cervical cancer curable at an early stage (AOR: 6.23, 95% CI: 6.23 (2.77, 15.13) were significantly associated with knowledge of cervical cancer screening. Diploma and above education (AOR: 0.37, 95% CI: 0.19, 0.74) and multiple sexual partners (AOR: 0.18, 95% CI: 0.05, 0.62) were factors associated with a negative attitude toward cervical cancer screening. Positive attitude about cervical cancer screening (AOR: 2.37, 95% CI: 1.91, 6.20) was significantly associated with the practice of being screened. CONCLUSIONS: Cervical cancer screening knowledge and attitudes were moderate, but practice was low. Educational status, considering cervical cancer is not curable at an early stage and not having an idea about its curability at an early stage, was significantly associated with knowledge of cervical cancer screening. Sexual partner status and educational status showed significant association with an attitude toward cervical cancer screening and having a positive attitude toward cervical cancer screening were significantly associated with the practice of cervical cancer screening. Health professionals need to disseminate cervical cancer screening information and offer cervical cancer treatment during health-care appointments.

Factors Associated with Unmet Need for Family Planning among Married Reproductive Age Women in Toke Kutaye District, Oromia, Ethiopia.

BACKGROUND: It is estimated that more than 142 million married women in developing countries have an unmet need for family planning. This study is aimed at identifying factors associated with the unmet need of family planning among married women of reproductive age in Toke Kutaye district, Ethiopia in 2019. METHODS: A community-based cross-sectional study was conducted in Toke Kutaye district from March 1-30, 2019. A systematic random sampling technique was used to select 494 reproductive-age women who were married during data collection. Data were collected using a pretested structured questionnaire. Bivariate and multivariate logistic regression analyses were used to assess factors associated with the unmet need of family planning at 95% CI with a p value of ≤ 0.05. RESULT: The prevalence of unmet need for family planning in the Toke Kutaye district was 23.1% [95% CI (19.2-26.7)], with 15.2% for spacing and 7.9% for limiting. Women's education [AOR, 3.64, 95% CI: 1.43-9.25], number of living children [AOR, 2.63, 95% CI: 1.37-5.05], husband disapproval of family planning [AOR, 3.68, 95% CI: 2.20-6.16], and discussion with healthcare providers on family planning [AOR, 0.20, 95% CI: 0.13-0.37] were significantly associated with unmet need for family planning. CONCLUSION: The prevalence of unmet need for family planning was high. Therefore, program managers, partners, and health workers should work to address the gaps in maternal education, the number of living children, partner disapproval of family planning, and discussion on family planning issues through enhancing female education, awareness on family planning, and male involvement in family planning services.

Maternal Satisfaction and Factors Associated with Institutional Delivery Care in Central Ethiopia: a Mixed Study.

BACKGROUND: Women satisfaction recognized as an important outcome of the maternal health care delivery system. Despite the Ethiopian federal ministry of health implemented compassionate, respectful, and caring as one of the health sector transformation agendas to increase health service utilization, the level of maternal satisfaction of institutional delivery is still low. This study aimed to assess maternal satisfaction and factors associated with institutional delivery care in central Ethiopia. METHODS: Community-based cross-sectional study, which involved quantitative study supplemented with qualitative methods were employed. Mothers were proportionally allocated to each selected kebele according to the number of their size. Data were collected by a face-to-face interview using a standardized questionnaire to determine the level of maternal satisfaction with birth care. The result was presented using texts, percentages, and tables. Bivariate and multivariate logistic regressions were performed between dependent and independent variables at 95% confidence intervals and a P-value < 0.05 to show a significant association. In the qualitative part, data were transcribed carefully and analyzed thematically. RESULTS: The overall a total of 451 respondents participated in this study making a response rate of 98%. The level of maternal satisfaction was 36.6% in this study. Spontaneous vaginal deliveries (SVD) (AOR: 7.33, CI: 2, 26.79), being attended by female sex health workers (AOR: 1.54, CI: 1.04, 2.28), receiving ambulance service to arrive at health facilities (AOR: 7.84, CI: 2, 61.63), utilizing of maternal waiting areas AOR: 1.72, CI: 1.09, 2.66), and respectful care (AOR=1.55, CI: 1.03, 2.34) were factors associated with maternal satisfaction. From qualitative study, three themes and ten categories have emerged. CONCLUSION: Maternal satisfaction towards the delivery service was low. SVD, being attended by female sex health workers, ambulance service, cleaned delivery room, and respectful care were factors associated with maternal satisfaction. The health facilities in the study areas need to work on improving health facility cleanliness, health workers' compassionate and respectful care, and providing ambulance service as a main means of transportation for laboring mothers.

Dual Contraceptive Utilization and Associated Factors Among Reproductive-Age Women on Anti-Retroviral Therapy at Hospitals in Central Ethiopia.

BACKGROUND: Ethiopia is one of the Sub-Saharan African countries with an increasingly risky sexual practice and mostly affected by the Human Immunodeficiency Virus (HIV) epidemic. Dual protection is an important preventive approach which can prevent both unwanted pregnancy and sexually transmitted infections including HIV/AIDS. Therefore, this study aimed to assess the dual contraceptive utilization and associated factors among reproductive-age women on Anti-Retroviral Therapy (ART) in central Ethiopia. METHODS: An-institution based cross-sectional study was conducted among 311 women on ART at public hospitals of West Shewa Zone from June to September 2019. A systematic random sampling technique was used to select the study participants. A pretested structured interviewer-administered questionnaire was used for data collection. The data were entered into Epi data version 3.1 and exported to IBM SPSS statistical software version 25 for analysis. Bivariate and multivariable logistic regression analysis were computed. Odds ratio along with 95% confidence interval was computed to ascertain the association. RESULTS: The prevalence of dual contraceptive utilization among women on ART was 21.4% (95% CI: 16.8-25.9). Age of respondents between 15 and 24 years [AOR=8.35, (95% CI: 3.12-17.78)], living in urban [AOR=2.59, 95% CI: 1.15-4.22], separated women [AOR=2.28, 95% CI (1.26-5.04)], had post-diagnosis counselling on family planning [AOR=5.33, 95% CI: 1.52-18.68], disclosed HIV status [AOR=5.98, 95% CI: 1.63-21.93], freely discuss with their husband [AOR=4.22, 95% CI, 1.84-12.36], have no fertility desire [AOR=2.46, (95% CI: 1.34-6.44)] were significantly associated with dual contraceptive utilization. CONCLUSION AND RECOMMENDATION: The overall magnitude of dual contraceptive utilization among women on ART was found to be low. Factors like age, residence, marital status, post-diagnosis counselling, disclosure of HIV status, and free discussion with husband were significantly associated with dual contraceptive method utilization. Therefore, it is necessary to expand the range of strategies and tools available to married and single women's for protecting themselves from being infected with other strains and pregnancy. The concerned stakeholders also should emphatically consider those identified factors for intervention.

Prevalence of Cervical Cancer and Associated Factors Among Women Attended Cervical Cancer Screening Center at Gahandi Memorial Hospital, Ethiopia.

BACKGROUND: Despite the fact that cervical cancer is preventable disease, it is the fourth most frequently diagnosed cancer and leading cause of cancer death in women. An estimated 604 000 women were diagnosed with cervical cancer worldwide and 342 000 women died from the disease. Therefore, the purpose of this study was to determine the prevalence and factors associated with cervical cancer among women attended cervical cancer screening center in Gahandi memorial Hospital. METHODS: An institutional-based cross-sectional study was conducted at Gahandi Memorial Hospital in which simple random sampling technique was used to select 422 registration books of women who visited the hospital between May 2015 and May 2019. Texts, tables, and graph were used to present results. Binary logistic regression with a P-value of <.25 and multivariate logistic regression with a P-value of <.05 were used to determine the association between independent variables and outcome variable. RESULTS: In this study, from the total of 422 women screened with visual inspection with acetic acid (VIA) screening test, 23.5% of them were found to be positive for VIA test. From those who were diagnosed positive with VIA screening test, about 10.1 % were identified with high grade lesions. Having multiple sexual partners (AOR = 1.83, 95% CI: 1.21-3.29), being HIV-positive (AOR = 2.22, 95% CI:1.10-4.69), having a history of Sexual Transmitted Infection (STI) (AOR = 6.76, 95% CI: 1.14-3.90), and beginning sexual intercourse at early age (AOR = 1.38, 95% CI: 1.20-5.13) were factors associated with cervical cancer. CONCLUSION: The study concluded that the high prevalence of cervical cancer. Having multiple sexual partners, being Human Immune Deficiency Virus (HIV) positive, having STI history and early initiation of sexual intercourse were factors associated with cervical cancer. Therefore, avoiding multiple sexual partners, delaying of early sexual contact, and self-protection from STI infections might help to prevent cervical cancer.

Nutritional-Related Predictors of Anemia among Pregnant Women Attending Antenatal Care in Central Ethiopia: An Unmatched Case-Control Study.

BACKGROUND: Anemia is a major public health problem in both developed and developing countries especially among pregnant women. Nearly half of pregnant women in Ethiopia have anemia which has both health and economic impacts. Therefore, this study is aimed at identifying nutritional-related predictors of anemia among pregnant women attending antenatal care in Central Ethiopia, 2019. METHODS: An unmatched case-control study was conducted at public hospitals in Central Ethiopia from February to April 2019. The consecutive sampling technique was used to select study participants. Data were collected by a structured questionnaire, and the collected data were entered into Epi Info version 7 and SPSS version 23 for analysis. Binary and multiple logistic regression analyses were computed to identify predictors of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 was used to determine the presence of an association. RESULT: A total of 426 pregnant women (142 cases and 284 controls) had participated in this study. Taking tea/coffee immediately after food (AOR = 2.35, 95% CI: 1.39-3.99), mid-upper arm circumference (MUAC) of mothers of <23 centimeters (AOR = 3.83, 95% CI: 2.26-6.49), the presence of forbidden food during pregnancy (AOR = 2.21, 95% CI: 1.24-3.88), not taking additional food (AOR = 1.99, 95% CI: 1.17-3.40), unable to take fruit (AOR = 4.05, 95% CI: 1.3-15.47), loss of appetite (AOR = 2.28, 95% CI: 1.28-4.09), low dietary diversity score (DDS) (AOR = 3.29, 95% CI: 1.83-5.90), and medium DDS (AOR = 2.88, 95% CI: 1.46-5.70) were found to be determinants of anemia. CONCLUSIONS: Taking tea or coffee immediately after food, MUAC of mothers, the presence of forbidden food, not taking additional food, frequency of taking fruit, and dietary diversity were predictors of anemia among pregnant women. Therefore, interventions targeted at prevention of anemia among pregnant mothers should emphatically consider those identified determinants. This finding also highlights the need for strong nutritional counseling to prevent anemia among pregnant mothers during antenatal care follow-ups along with other interventions.

Determinants of Skilled Birth Attendant Utilization at Chelia District, West Ethiopia.

BACKGROUND: An estimated 303,000 maternal deaths occurred globally in 2015 from which sub-Saharan Africa alone accounted for 201,000 (66%) of the maternal deaths, and most of these are attributed to complications of pregnancy and childbirth due to the absence of institutional delivery by skilled attendants. OBJECTIVE: The aim of this study was to assess institutional delivery utilization and associated factors among mothers who gave birth in the last one year in Chelia District. Methodology. A community-based cross-sectional study design supplemented by a qualitative method was employed from March 15 to 30, 2018. A multistage sampling technique was used to select 475 study participants. Quantitative data were collected using structured questionnaires, and focus group discussions were employed to get qualitative data. The data were entered to EpiData version 3.1 and exported to the statistical package version 21 for analysis. Descriptive statistics and bivariate and multivariate logistic regression analysis were computed to measure the strength of association between dependent and independent variables at a p value of <0.05. RESULTS: Among the respondents, 216 (46.2%) utilized institutional delivery service. Monthly income (AOR = 4.465, 95%CI = 1.729, 11.527), antenatal care attendance (AOR = 0.077, 95%CI = 0.008, 0.73), knowledge of mothers about their expected date of delivery (AOR = 0.297, 95%CI = 0.179, 4.93), intended pregnancy (AOR = 0.326, 95%CI = 0.162, 0.654), discussion with health extension workers about the place of delivery at home visit (AOR = 0.11, 95%CI = 0.023, 0.523), knowledge of mothers about the existence of the waiting area in health facilities (AOR = 0.14, 95%CI = 0.023, 0.84), and number of children (AOR = 0.119, 95%CI = 0.029, 0.485) had a significant association with institutional delivery utilization. CONCLUSION: Utilization of institutional delivery was low and far away from the expected country target in the district. The health sector should strive to increase proportion of institutional delivery by reaching pregnant mothers with timely antenatal care service provision and enhancing family planning provision.