Surgical management practice of pelvic organ prolapse among Ethiopian gynecologists, 2021: a descriptive study.

INTRODUCTION: Pelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina. Surgical intervention addresses both anatomical defect and associated symptoms. The landscape of prolapse surgery has been evolving constantly over years. Emerging evidences either support or challenge existing surgical treatment options, making urogynecology a dynamic field. In Ethiopia, the surgical management of pelvic organ prolapse has transitioned from abdominal to vaginal hysterectomy, supplemented later by McCall's culdoplasty. Disparities exist in the national uniformity of surgical approaches, linked to the establishment of Urogynecology centers in certain institutions. OBJECTIVES: This study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse. METHODS: A cross-sectional study encompassing all Gynecologists in Ethiopia took place between January to June 2021. Information was gathered through online Google forms crafted in English. Subsequently, the collected data underwent verification, coding, and entry into Epi info 7 before being exported to SPSS version 22 software for descriptive statistical analysis. RESULTS: We reached 280 gynecologists out of the 450 practicing in the Ethiopia making 62% response rate. Anterior colporrhaphy (98.6%), vaginal hysterectomy with McCall's cul-do-plasty (51.8%), and Posterior colporrhaphy (97.5%) were the most commonly performed surgical procedures for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Only 3.2% and 0.7% of the gynecologists conducted abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were carried out by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The main reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials. CONCLUSION AND RECOMMENDATION: Most gynecologists in Ethiopian continue to perform vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due primarily to lack of skill and appropriate materials to perform the alternative procedures. Implementing short term training on alternative surgical treatment options of pelvic organ prolapse with provision of suitable materials and increasing the number of urogynecologists in the country in the long run holds the potential to enhance the standard of care of women with the condition.

Reasons for modern contraceptives choice and long-acting reversible contraceptives early removal in Amhara Region, Northwest Ethiopia; qualitative approach.

BACKGROUND: Women use modern contraceptive methods, mainly either to limit or space pregnancy and both are not identical in their choices. One method may not best fit an individual's need irrespective of the time of spacing. Cognizant of this, the context with which women base in choice of contraceptives, their lived experiences in using, and factors for early removal/ discontinuation of long-acting reversible contraceptives (LARCs) are not much investigated in the study setting and our study aimed to bridge the gap through exploring the underlying reasons. METHOD: A phenomenological study design was used to explore sampled women's reasons and experiences. Reproductive-aged women (15-49 years) who removed long-acting methods in the past 6 months were included. A criterion sampling approach was employed to recruit study participants. Data was collected using an interview guide for in-depth (IDIs) and key informant interviews and were tape-recorded with interviewees' consent. Audio data were transcribed verbatim and translated into English. The data was first saved in plain text format and imported into Atlas.ti 7.0 software to facilitate coding and categorizing. The content analysis method was used to classify, organize data, and interpret the qualitative data according to key categories. RESULTS: Several misconceptions about contraceptives (e.g., implants are not appropriate for daily laborers, women who use contraceptives (such as injectables) can only bear girl-child, etc.) were reported by clients and health providers. These misconceptions might not have scientific merit but they are powerful enough to affect actual behaviors toward contraceptives, including early removal. The awareness, attitude, and use of contraceptives tend to be lower in rural areas. For premature removal of LARCs, side effects, and heavy menstrual bleeding, was the most commonly identified reason. The IUCD is the least preferred method and users said it is not comfortable during sex. CONCLUSION AND RECOMMENDATION: Our study found different reasons and misconceptions for modern contraceptive methods' non-use and discontinuation. Standardized counseling approaches like the REDI (Rapport Building, Exploration, Decision Making, and Implementation) framework should be implemented in the country consistently. Some of the concrete providers' conceptions should be well-studied considering contextual factors to bring scientific evidence.

Hematological parameters of reproductive-age women using hormonal contraceptives at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia: A comparative cross-sectional study.

BACKGROUND: More than one-third of reproductive aged women in Ethiopia use hormonal contraceptives to prevent conception. The present study aimed to compare the hematological parameters of reproductive-age women taking hormonal contraceptives at the University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia in 2021. METHODS: A comparative cross-sectional study was conducted from April to June 2021. A total of 240 study participants were recruited by using a consecutive sampling technique. Data on socio-demographic variables and clinical data were collected through face-to-face interviews using a structured questionnaire and medical record reviews, respectively. Three milliliter venous blood was collected for complete blood count analysis using Unicel DxH 800 coulter hematology analyzer. Data was entered into Epi-data 4.4.3.1 version then exported to IBM SPSS v25 for analysis. Kruskal-Wallis H, Dunn-Bonferroni pairwise comparison test, and Spearman's correlation analysis were used for inferential statistics. P<0.05 were considered statistically significant. RESULT: The median and interquartile range of platelet count among combined oral contraceptive users was 285(238-332) which is significantly higher than that of depot medroxyprogesterone acetate users 246(220-226) (p = 0.010), implant user 247(221-297) (p = 0.034), and controls 256(224-278) (p = 0.015). The result also showed long-term use of implant negatively correlated with red blood cell count (p = 0.033). CONCLUSION: This finding concludes that combined oral contraceptive users had a higher platelet counts than controls while long-term use of implants can result in low red blood cells count. Therefore, a baseline evaluation of complete blood count in women desiring contraceptive methods would also be recommended.

Prevalence and determinants of women's satisfaction on the quality of safe abortion service in Northwest Ethiopia.

BACKGROUND: The standard of treatment in developing countries is harmed by a complex political landscape, an uncertain economic climate, rapid population growth, and clients are constantly complaining about the poor health system. Patients' assessments of the benefits and shortcomings of the service provided to them are expressed as satisfied or dissatisfied. The objective of this study was to determine the magnitude of women's satisfaction on quality of safe abortion and factors associated with it in Northwest Ethiopia. METHODS: Institution-based cross-sectional study design was done to collect data from 618 women in the selected health facilities in Northwest Ethiopia. Women having the gestational trophoblastic disease (partial mole) and those who cannot hear or are seriously ill during the data collection period were excluded. The study subjects were chosen using a randomization process, and each participant was questioned after receiving all necessary abortion treatment and giving verbal consent. Both bivariable and multivariable logistic regression analysis was carried out to determine covariates significantly associated with women's satisfaction on quality of abortion. RESULTS: The highest proportion of women who were reasoned out to terminate the fetus in the current pregnancy was due to financial problems (29.36%) and partner coercion (23.85%). Client satisfaction with safe abortion services in the study region was 25.10% (95% CI; 21.81-28.70). Women were 53.2% satisfied with the art of treatment/interpersonal abilities, 59.2% satisfied with the professional quality of care professionals, 54.5% satisfied with the physical environment, and 49.8% satisfied with the structure of the health care system, respectively. In the multivariable logistic regression analysis, women's living solely 0.47(0.26-0.87) & living with 2 to 4 people 0.11(0.04-0.29), college and above level of education 1.78(1.01-3.15), wanted the status of pregnancy 0.44(0.23-0.85) and post-abortion contraceptive users 1.70(1.01-2.89) were factors significantly associated with women's satisfaction level. CONCLUSION: In this study, one-fourth of the women were satisfied with the quality of safe abortion services. Family size, women's educational status, maternity status, and post-abortion contraception use were predictors of women's satisfaction with the quality of abortion. Ethiopia's government should concentrate on addressing contraception needs in order to prevent women from having multiple abortions.

Correction: Adherence towards COVID-19 mitigation measures and its associated factors among Gondar City residents: A community-based cross-sectional study in Northwest Ethiopia.

[This corrects the article DOI: 10.1371/journal.pone.0244265.].

Knowledge and attitude of the communities towards COVID-19 and associated factors among Gondar City residents, northwest Ethiopia: A community based cross-sectional study.

BACKGROUND: COVID-19 is the novel coronavirus responsible for the ongoing global outbreak of acute respiratory disease and viral pneumonia. In order to tackle the devastating condition of the virus, countries need to attack the virus with aggressive and targeted tactics. Thus, to strengthen the COVID-19 mitigation measures and to give rapid response, there is an urgent need to understand the public's knowledge and attitude about of the pandemic at this critical moment. OBJECTIVE: This study was aimed to assess the knowledge and attitude of communities about COVID-19 and associated factors among Gondar City residents. METHODS: A community based cross-sectional study was done among 623 respondents in Gondar city from April 20-27/2020. Data were collected using a structured questionnaire adapted from different literatures. The data were entered using Epi data version 3.1 and then exported into STATA version 14 for analysis. Bi-variable and multivariable binary logistic regression were performed. Adjusted odds ratio with 95% CI was used to declare statistically significant variables on the basis of p value less than 0.05 in the multivariable binary logistic regression model. RESULTS: The overall knowledge and attitude of the community towards COVID19 was 51.85% [95% CI (47.91%-55.78%)] and 53.13% [95% CI (49.20, 57.06%)], respectively. In this study, being married [AOR = 0.60 at 95% CI: (0.42, 0.86)], educational level; primary [AOR = 3.14 at 95% CI: (1.78,5.54)], secondary [AOR = 2.81 at 95% CI: (1.70,4.63)], college and above [AOR = 4.49 at 95% CI: 7.92, 13.98)], and family size [AOR = 1.80, at 95% CI: (1.05, 3.08)] were emerged as statistically significant factors impacting the knowledge of the community about COVID-19. Besides, educational level; primary [AOR = 1.76 at 95% CI: (1.03, 3.01)], secondary [AOR = 1.69 at 95% CI: (1.07, 2.68)], and college & above [AOR = 2.38 at 95% CI: (1.50, 3.79)], and family size; four to six members [AOR = 1.84 at 95% CI (1.27, 2.67)], above seven members [AOR = 1.79 at 95% CI (1.08, 2.96)] were factors identified as significantly attribute for positive attitude of the communities towards COVID-19. CONCLUSION: More than half of the respondents had better knowledge and attitude regarding COVID-19. Higher educational level and larger family size were significant factors predominantly affecting the knowledge and attitude of the communities towards COVID-19.

Adherence towards COVID-19 mitigation measures and its associated factors among Gondar City residents: A community-based cross-sectional study in Northwest Ethiopia.

BACKGROUND: Considering its pandemicity and absence of effective treatment, authorities across the globe have designed various mitigation strategies to combat the spread of COVID-19. Although adherence towards preventive measures is the only means to tackle the virus, reluctance to do so has been reported to be a major problem everywhere. Thus, this study aimed to assess the community's adherence towards COVID-19 mitigation strategies and its associated factors among Gondar City residents, Northwest Ethiopia. METHODS: A community-based cross-sectional study was employed among 635 respondents from April 20-27, 2020. Cluster sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. Epi-Data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Binary logistic regressions (Bivariable and multivariable) were performed to identify statistically significant variables. Adjusted odds ratio with 95% CI was used to declare statistically significant variables on the basis of p < 0.05 in the multivariable logistic regression model. RESULTS: The overall prevalence of good adherence towards COVID-19 mitigation measures was 51.04% (95%CI: 47.11, 54.96). Female respondents [AOR: 2.39; 95%CI (1.66, 3.45)], receiving adequate information about COVID-19 [AOR: 1.58; 95%CI (1.03, 2.43)], and favorable attitude towards COVID-19 preventive measures were significantly associated with good adherence towards COVID-19 mitigation measures. Whereas, those respondents who had high risk perception of COVID-19 were less likely to adhere towards COVID-19 mitigation measures [AOR: 0.61; 95% CI (0.41, 0.92)]. CONCLUSIONS: The findings have indicated that nearly half of the study participants had poor adherence towards COVID-19 mitigation measures. Sex, level of information exposure, attitude towards COVID-19 preventive measures, and risk perception of COVID-19 were factors which significantly influenced the adherence of the community towards COVID-19 mitigation measures. Therefore, it is crucial to track adherence responses towards the COVID-19 preventive measures, scale up the community's awareness of COVID-19 prevention and mitigation strategies through appropriate information outlets, mainstream media, and rely on updating information from TV, radio, and health care workers about COVID-19.

Community Level of COVID-19 Information Exposure and Influencing Factors in Northwest Ethiopia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging respiratory infection, and the crisis has become a worldwide issue, and society has become concerned in various aspects. Good information exposure related to transmission, prevention, and risk factors of COVID-19 can be the best means to reduce the risk of disease exposure and mitigate further spread. The countries that have well practiced this strategy (society information exposure) were controlling disease progression, but there is a low practice in sub-Saharan countries, including Ethiopia. Therefore, this study aimed to evaluate the information exposure level about COVID-19 and influencing factors among northwest community of Ethiopia. METHODS AND MATERIALS: Community-based cross-sectional study design was employed among the community of Gondar city from April 20 to 27, 2020. A total of 623 study participants were involved in this interview, and a systematic sampling technique was applied to select the households. Data were entered into EpiData version 4.6 and then exported to STATA version 14 for analysis. A multivariable binary logistic regression was employed to identify factors associated with good information exposure about COVID-19. The adjusted odds ratio (AOR) with 95% confidence interval (CI) was estimated to show the strength of association. A p-value <0.05 was a cut-off point to declare statistical significance. RESULTS: The overall rate of information exposure about COVID-19 was 44.9%. Age 18-26 years [AOR=0.53; 95% CI (0.28-0.99)] and 34-45 years [AOR=0.44; 95% CI (0.24-0.80)], elementary school [AOR=2.48; 95% CI (1.20-5.15)], secondary school [AOR=3.98; 95% CI (1.99-7.99)], college and above [AOR=8.38; 95% CI (4.10-17.26)], browsed or follow social media [AOR=2.21; 95% CI (1.44-3.38)] and those having a discussion with their family members [AOR=2.37; 95% CI (1.44-3.90)] and friends [AOR=2.15; 95% CI (1.38-3.34)] were the factors significantly associated with good information exposure towards COVID-19. CONCLUSION: Communities total level of good information exposure from different information platforms about COVID-19 in this study area remains low. Age, high level of education, browsing social media, and those having interpersonal (family and friends) discussion were the factors that significantly influence communities who have good information exposure related to COVID-19. Therefore, efforts on community mobilization through regional/national mass media and other information conveying platforms are recommended.

Community's perceived high risk of coronavirus infections during early phase of epidemics are significantly influenced by socio-demographic background, in Gondar City, Northwest Ethiopia: A cross-sectional -study.

BACKGROUND: Epidemiological studies during the early phase of the coronavirus (COVID-19) pandemics reported different level of people's risk perception in different countries. There is a paucity of data on perceived high risk of COVID-19 and associated factors in Ethiopia. We sought to assess the prevalence of community's perceived high risk about COVID-19 infections and associated factors among Gondar town community. METHODS: A cross-sectional study was carried out from April 20 to 27, 2020 in Gondar town community, Northwest Ethiopia. Multistage cluster sampling technique was used to recruit 635 participants. Structured and pre-tested questionnaire was used to collect the data. Descriptive statistics, bivariate and multivariable binary logistic regression were used to summarize the results. RESULTS: A total of 623 participants were considered in the analysis with a response rate of 98.1%. The prevalence of coronavirus high risk perceptions of the respondents was found to be 23.11% (95% CI; 19.80%-26.43%). Age above 45 years (AOR = 1.41, 95%CI; 1.19-2.66), college and above educational level (AOR = 0.28, 95%CI; 0.21-0.98), and poor knowledge towards COVID-19 virus (AOR = 1.57, 95%CI; 1.09-2.23) were significantly associated with perceived high risk about COVID-19. CONCLUSIONS: The prevalence of perceived high risk of COVID-19 was found to be low. Factors such as age, educational status, and knowledge about COVID-19 virus were found to be independent predictors of perceived high risk towards COVID-19. Government and non-government organizations should use formal and informal means of educating the community.

Determinants of long acting reversible contraception utilization in Northwest Ethiopia: An institution-based case control study.

BACKGROUND: Though long-acting reversible contraceptives (LARCs) are highly effective, have minimal side effects, require minimal follow-up, and are low cost, only 10% of contraceptives used in Ethiopia are LARCs. The reason for this low uptake is not understood at the country or regional level. Therefore, this study identified determinants of LARC utilization in Northwest Ethiopia. METHODS: A facility-based unmatched case control study, using LARC users as cases and short- acting reversible contraception (SARC) users as controls, had been conducted at fourteen public health institutions in Northwest Ethiopia. A systematic random sampling technique was used to select participants with a 1:2 case to control ratio (n = 1167). Binary logistic regression analysis was used to identify determinants of LARC utilization among family planning service users. RESULTS: Wealth status [AOR:1.87, 95%CI (1.08, 3.24)], history of abortion [AOR:2.69, 95%CI (1.41, 5.12)], limiting family size [AOR: 2.38, 95%CI (1.01, 5.62)], good knowledge about LARCs [AOR: 2.52, 95%CI (1.17, 5.41)], method convenience [AOR: 0.23, 95%CI (0.16, 0.34)], good availability of method [AOR:0.10 (0.05, 0.19)], less frequent visits to health facility [AOR:2.95, 95% CI(1.89, 4.62)], health care providers advice [AOR:10.69, 95%CI (3.27, 34.87)], partner approval [AOR:0.66, 95%CI (0.45, 0.97)], and favorable attitude towards LARCs [AOR:13.0, 95%CI (8.60, 19.72)] were significantly associated with LARC utilization. CONCLUSION: Professional support, favorable attitude towards LARC use, high economic status, history of abortion, advantage of less frequent visits, having good knowledge towards LARC and interest of limiting births were significantly associated with LARC Utilization. On the other hand, perceived method convenience, and contraception availability were inversely associated with it. Family planning education about the benefits of LARC should be done by health providers and media. Male involvement in the counselling and decision making about the advantage of using LARC may improve the negative influence of partners on LARC utilization. It is also recommended that, future qualitative research further explore perceptions of LARC use.

Maternal and partner's level of satisfaction on the delivery room service in University of Gondar Referral Hospital, northwest, Ethiopia: a comparative cross-sectional study.

BACKGROUND: Asking patients/clients what they perceive about the care and treatment they have received is one of the important steps towards improving the quality of health care. In the scientific world, a number of efforts have been tried to understand about what laboring mothers perceive about the care provided. However, little is known about the birth experiences of partners in Ethiopia. Therefore, this study was aimed to assess the maternal and partner's level of satisfaction on the delivery room service in the study area. METHODS: A comparative cross-sectional study was conducted from December 2018 to January 2019 in University of Gondar referral hospital. The birth satisfaction scale is used for the mother, and it was adapted to the partners' perspective. Paired-samples t tests were used for comparing mothers and partners for the birth satisfaction scales global and thematic scores. A binary logistic regression model was fitted to identify predicting factors for mothers' and partners satisfaction. RESULTS: The overall satisfaction of mothers in this study was 47.6%. Whereas, 41.2% of partners were satisfied by delivery room services. There were mean difference between mothers and partners' birth satisfaction scale (p = 0.02). Maternal satisfaction scale was affected by age [OR = 0.36, 95%CI (0.18, 0.73)], perception [OR = 0.02, 95%CI (0.001,0.09)], waiting time [OR = 0.11, 95%CI (0.001, 0.09)],visiting mode [OR = 0.01, 95%CI (0.001,0.08)], pregnancy status [OR = 0.04, 95%CI (0.01,0.33)] and fatal outcome [OR = 0.001, 95%CI (0.001,0.018)] .whereas, partners satisfaction was associated with age [OR = 0.16,95%CI (0.05 0.49)], occupational status [OR = 0.02, 95%CI (0.001, 0.24), amount of money to pay for service [OR = 2.87, 95%CI (1.07, 7.71), visiting mode of his wife [OR = 0.08, 95%CI (0.01, 0.35)], waiting time [OR = 0.12, 95%CI (0.04, 0.33)], privacy [OR = 10.61, 95%CI (3.00, 37.52)], mode of delivery of his wife [OR = 7.69, 95%CI (3.00, 19.69)]. CONCLUSION: This finding would alert the health care system to design a client-friendly approach. It will provide insight to hospital administrators and providers in formulating a policy that would enhance the support of partners during labour and delivery process.

Community's misconception about COVID-19 and its associated factors among Gondar town residents, Northwest Ethiopia.

Background: Despite the implementation of various strategies such as the declaration of COVID-19 emergency state, staying at home, lockdown, and massive protective equipment distribution, still COVID-19 is increasing alarmingly. Therefore, the study aimed to assess the community's perception of COVID-19 and its associated factors in Gondar town, Northwest Ethiopia. Methods: A community-based cross-sectional study was employed among 635 Gondar administrative town residents, from April 20 to April 27, 2020. Study participants were selected using a cluster sampling technique. Data were collected using an interviewer-administered structured questionnaire. Epi-Data version 4.6 and STATA 14 were used for data entry and analysis, respectively. Logistic regressions (bivariable and multivariable) were performed to identify statistically significant variables at p < 0.05. Results: Of the 635 study participants, 623 have completed the study with a 98.1% response rate. The mean age of participants was 36.32 years (SD ± 13.24). The overall magnitude of the community's misconception about COVID-19 stood at 56.9% (349). Age and religion showed a negative association with misconceptions. To be specific, being in the age group of 27-33 (AOR = 0.52, 95% CI 0.32, 0.86) and being a Muslim (AOR 0.51, 95% CI 0.34, 0.78) were negatively associated with the misconception of COVID-19, whereas occupation and awareness showed positive associations with the misconception. To be specific, having an unemployed occupational status (AOR = 1.79, 95% CI 1.14, 2.82) and being unaware of the number of cases of COVID-19 (AOR 1.66, 95% CI 1.05, 2.62) were positively associated with the community's misconception on COVID-19. Conclusion: The magnitude of the community's misconception about COVID-19 among Gondar town residents was high. Age, religion, unemployment, and unawareness about the number of COVID-19 cases were significant factors of misconception about COVID-19. Thus, stakeholders ought to build community perceptions about COVID 19. To resolve misinformation about COVID-19, accurate and relevant information should be provided to the community using appropriate communication media.

Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study.

BACKGROUND: There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. METHODS: This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. RESULT: Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. CONCLUSION: The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.