Disparities in menstrual hygiene management between urban and rural schoolgirls in Northeast, Ethiopia.

INTRODUCTION: Even though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia. METHODS: An institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance. RESULTS: Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls. CONCLUSIONS: Though the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls.

Surgical data strengthening in Ethiopia: results of a Kirkpatrick framework evaluation of a data quality intervention.

Background: One key challenge in improving surgical care in resource-limited settings is the lack of high-quality and informative data. In Ethiopia, the Safe Surgery 2020 (SS2020) project developed surgical key performance indicators (KPIs) to evaluate surgical care within the country. New data collection methods were developed and piloted in 10 SS2020 intervention hospitals in the Amhara and Tigray regions of Ethiopia. Objective: To assess the feasibility of collecting and reporting new surgical indicators and measure the impact of a surgical Data Quality Intervention (DQI) in rural Ethiopian hospitals. Methods: An 8-week DQI was implemented to roll-out new data collection tools in SS2020 hospitals. The Kirkpatrick Method, a widely used mixed-method evaluation framework for training programs, was used to assess the impact of the DQI. Feedback surveys and focus groups at various timepoints evaluated the impact of the intervention on surgical data quality, the feasibility of a new data collection system, and the potential for national scale-up. Results: Results of the evaluation are largely positive and promising. DQI participants reported knowledge gain, behavior change, and improved surgical data quality, as well as greater teamwork, communication, leadership, and accountability among surgical staff. Barriers remained in collection of high-quality data, such as lack of adequate human resources and electronic data reporting infrastructure. Conclusions: Study results are largely positive and make evident that surgical data capture is feasible in low-resource settings and warrants more investment in global surgery efforts. This type of training and mentorship model can be successful in changing individual behavior and institutional culture regarding surgical data collection and reporting. Use of the Kirkpatrick Framework for evaluation of a surgical DQI is an innovative contribution to literature and can be easily adapted and expanded for use within global surgery.

Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model.

OBJECTIVES: The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN: Cross sectional. SETTING: Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS: 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES: The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS: The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR1=aOR2; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR1 = aOR2; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR1= aOR2; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR1 = aOR2; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS: The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.

Determinants of antenatal care dropout among mothers who gave birth in the last six months in BAHIR Dar ZURIA WOREDA community; mixed designs.

BACKGROUND: Antenatal care is the care provides for a pregnant mother to improve the health of the mother and her baby. But in the World including Ethiopia still, mothers do not receive the required number of antenatal care visits. Therefore, the main aim of this study was to identify determinants of Antenatal care visit dropout in Bahir Dar Zuria Woreda North West Ethiopia. METHODS: The study was community-based unmatched case-control study that employed both quantitative and qualitative data. For the quantitative part, 134 cases and 266 controls (total 400) women who gave births in the last six months prior to the study in Bahir Dar Zuria Woreda were enrolled. Data were collected through face to face interviews from March 1 to 30, 2018 using a structured questionnaire. Bivariate and multivariate analysis was used. 95% confidence interval and P-value was used to measure the level of significance. For the qualitative part, six FGDs were conducted and open code software was used for the analysis of the data. The finding was narrated by triangulating with the quantitative findings. RESULT: Being far distance (AOR 7.26; 95% CI 4.23, 23.01), not having a companion (AOR 3.49; 95% CI; 2.39, 8.44), lack of knowledge (AOR 2.57; 95% CI; 1.25, 5.28), poor wealth index (AOR; 3.36, 95% CI 1.71, 6.62) and not developing a danger sign (AOR 2.18; 95% CI 2.28, 7.64) were predictors of ANC dropout. In addition to this, in the qualitative finding, the socio-culture of the community, attitudes, experience, and perception of the existing services and service provisions were also determinants of ANC drop out. CONCLUSION: Socio-cultural, economic, accessibility, and individual factors were determinants of ANC visit drop out. In addition, the behavior of the professional, the mother understands of the existing services, and their perception about ANC influenced ANC dropout.

Individual, Household, and Contextual Factors Influencing the Timing of the First Antenatal Care Attendance in Northwest Ethiopia: A Two-Level Binary Logistic Regression Analysis.

BACKGROUND: Early antenatal visit is critical for the health and well-being of mothers and babies. However, various individual, family level, and contextual factors influence the timely initiation of antenatal care. OBJECTIVE: The aim of this study was to examine individual, household, and community-level factors associated with the timing of first ANC visit among mothers who gave birth in the last twelve months before the survey. METHODS: A community-based cross-sectional study was conducted in June 2018. A multistage cluster sampling technique was applied, and a sample of 898 women was considered. Data were collected using a questionnaire and checklist. The analysis was made using SPSS. A multilevel logistic regression with random effects at the kebele level was developed to assess the predictors of late initiation of antenatal care. Odds ratio with 95% confidence intervals was used to measure association while the intra-class correlation coefficient and the median odds ratio were used to measure variations. RESULTS: Overall, 78.4% (95% CI: 75.6, 80.9) of women started their first ANC in 4 months of gestation or later and significant heterogeneity was observed between clusters. At level 1, women with intended pregnancy (aOR=0.31; 95% CI: 0.12, 0.79), and being knowledgeable about the timing (aOR=0.43; 95% CI: 0.25, 0.75) and pregnancy-related complications (aOR=0.16; 95% CI: 0.10, 0.26) were less likely to delay their first ANC visit. Conversely, the odds of late ANC visit was higher among women with no formal education (aOR=4.08, 95% CI: 2.20, 7.55). Distance to the health facility (aOR=1.04; 95% CI, 1.01-1.08) was the only level-2 significant predictor. CONCLUSION: The study revealed that late ANC initiation was rampant. Several factors operating at different levels were associated with late ANC visits; yet, the role of individual-level factors was relatively stronger. Hence, awareness creation is essential to the underprivileged community using the available communication networks.

Women's retention on the continuum of maternal care pathway in west Gojjam zone, Ethiopia: multilevel analysis.

BACKGROUND: The continuum of maternal care has been one of the effective approaches for improving the health of mothers and newborns. Although large numbers of Ethiopian women do not use maternal health services, points of drop out along the continuum are not understood well. Understanding of a particular point of maternal care dropout on the continuum, however, helps governments make effective interventions. This study aimed to assess the extent of women's service utilization and the factors affecting retention on the continuum of care in West Gojjam Zone, Ethiopia. METHODS: A community-based study linked to health facility data was conducted in June 2018. Data were obtained from 1281 mothers who gave birth to their last baby within the preceding 12 months from a two-stage cluster sampling. Data were collected via face-to-face interviews using a pretested questionnaire. Multilevel logistic regression models were used to examine the effects of individual and cluster-level factors on key elements of the continuum of care. The measure of fixed effects was expressed as Odds Ratio with 95% confidence interval. RESULTS: The study revealed that only 12.1% of women completed the continuum of maternal care services (ANC4+, SBA, and PNC within 2 days after birth); while 25.1% of them did not receive any care during their recent births. There were commonalities and differences in the predictors of the three indicators of maternal health service utilization. Variables related to services received during antenatal care such as early initiation of ANC (AOR = 7.53, 95%CI, 2.94, 19.29) and receiving proper contents (AOR = 3.31, 95%CI, 1.08, 10.16) were among the predictors significantly associated with the completion of the continuum of care. CONCLUSIONS: The continuum of maternal care completion rate was extremely low, indicating that women were not getting the maximum possible health benefit from existing health services. The results also revealed that maternal health service utilization was influenced by factors operating at various levels-individual, household, community, and health facility. Since antenatal care is considered an entry point for the subsequent use of maternal services, strategies that aimed to improve maternal health service utilization should target early initiation and antenatal care quality.

The role of maternal health care services as predictors of time to modern contraceptive use after childbirth in Northwest Ethiopia: Application of the shared frailty survival analysis.

INTRODUCTION: The first year after birth is an ideal time to offer contraception services, as many women have many opportunities to be in contact with the health care system. Nevertheless, a large number of postpartum women in developing countries do not use the service owing to the interplay of factors operating at various stages. Therefore, this study aimed to assess predictors of modern contraceptive use in the extended postpartum period. METHODS: A community based retrospective cross-sectional study was done among 1281 women who gave birth within 12 months preceding the survey. Kaplan-Meier plots and log rank tests were used to explore the rate of modern contraceptive use. The Weibull regression survival model with multivariate frailty was employed to identify the predictors of time to contraception. RESULTS: Of the respondents, 59.1% (95% CI: 56.8%-62.2%) had started using modern contraceptive methods within 12 months after birth. By the second month after birth, only 11.1 percent of the women surveyed started to use a contraceptive method, which increased steadily to 25.9%, 37.7%, and 59.5% at 6, 9, and 12 months, respectively. The most preferred contraceptive method was injectable (71.5%), followed by implants (21.5%). Women's education (aHR = 1.29; 95%CI: 1.02, 1.66), four or more antenatal care (aHR = 1.59; 95% CI: 1.22, 2.06), early initiation of antenatal care (aHR = 2.03; 95% CI: 1.28, 3.21), and early postnatal checkup (aHR = 1.39; 95% CI: 1.12, 1.73) were statistically significant predictors of earlier initiation of modern contraceptive methods. CONCLUSIONS: A substantial proportion of women did not use modern contraceptive methods in the first year after birth. Maternal services were found to be the sole predictors in postpartum contraceptive use. Findings suggest the importance of linking postpartum family planning along the continuum of care. The observed heterogeneity at cluster level also urges the need of disaggregating data for decision-making.

Factors associated with knowledge on obstetric danger signs among women who gave birth within 1 year in Bahir Dar city administration, North West, Ethiopia.

OBJECTIVE: This study aimed to assess factors associated with knowledge on obstetric danger signs among women who gave birth within 1 year in North West, Ethiopia. RESULTS: Overall, 37.9% of the respondents were knowledgeable. Women mention three and more key danger signs during pregnancy and after delivery were 15% and 18.5% respectively. Decision making power of women [AOR = 1.59, 95% CI 1.10, 2.29], starting antenatal visit lately [AOR = 3.1, 95% CI 1.63, 6.33], housewife [AOR = 2.15, 95% CI 1.25, 3.68], merchant [AOR = 2.01, 95% CI 1.05, 3.88], and government employees [AOR = 2.75, 95% CI 1.38, 5.49] were among the predictors of knowledge on obstetric danger signs.

Dietary practice and associated factors among type 2 diabetic patients in Felege Hiwot Regional Referral Hospital, Bahir Dar, Ethiopia.

OBJECTIVE: Even if patient's dietary practice is a gold standard measure to manage type 2 diabetes, there is a limited study in the area. Therefore, the objective of this study was to assess dietary practice and associated factors among type 2 diabetic patients. RESULT: The study revealed that only 35.9% of the patients had good dietary practice. Attending above primary education [AOR = 1.9, 95% CI (1.1, 3.2)], having family support [AOR = 2.6, 95% CI (1.6, 4.2)], and receiving nutrition education [AOR = 2.5, 95% CI (1.5, 4.2)] were independent predictors for good dietary practice. Thus, the findings indicate the need to improve a method of nutrition education both for the patients and their families. Moreover, the government needs to improve literacy rate of citizens.

Under nutrition and associated factors among school adolescents in Dangila Town, Northwest Ethiopia: a cross sectional study.

BACKGROUND: Under nutrition in adolescents is an important determinant of health outcomes. Yet, adolescents are not usually part of health and nutrition surveys. Therefore, this research was conducted to assess factors associated with under nutrition among school adolescents. METHOD: A cross-sectional study was conducted among 424 school adolescents from November 1-15, 2015. Simple random sampling was used to select the study participants. Data were collected using structured questionnaire and analyzed by SPSS version 20 software. Both bivariate and multivariable logistic regression analyses were carried out to identify predictors of under nutrition. Furthermore, anthropometric data were calculated using Anthro-plus software. RESULT: The prevalence of stunting and thinness were 24.8 % and 7.1 %, respectively. Male gender [AOR=3.2, 95 % CI: (1.7, 5.8)], infrequent food intake [AOR=4.6, 95% CI: (2.6, 8.0)], unavailability of latrine [AOR=2.7, 95 % CI: (1.2, 6.0)], and poor hand washing practice [AOR=3.9, 95 % CI: (1.9, 8.1)] were independent predictors of stunting. Factors associated with thinness were being male [AOR=11.5, 95% CI: (3.3, 39.5)], illness in the last two weeks [AOR=2.9, 95 % CI: (1.2, 7.0)], and having more than five family members [AOR=3.6, 95% CI: (1.3, 9.4)]. CONCLUSION: The prevalence of under nutrition was high in this study. Infrequent food intake, unavailability of a latrine, poor hand washing practice, and large family members were the factors associated with under nutrition. There is need to implement nutrition education to school adolescents by giving emphasis on environmental and personal hygiene.