The effect of national antenatal care guidelines and provider training on obstetric danger sign counselling: a propensity score matching analysis of the 2014 Ethiopia service provision assessment plus survey.

BACKGROUND: Most pregnant women in low and lower-middle-income countries do not receive all components of antenatal care (ANC), including counselling on obstetric danger signs. Facility-level ANC guidelines and provider in-service training are major factors influencing ANC counselling. In Ethiopia, little is known about the extent to which guidelines and provider in-service training can increase the quality of ANC counselling. METHODS: We examined the effect of national ANC guidelines and ANC provider in-service training on obstetric danger sign counselling for pregnant women receiving ANC using the 2014 Ethiopian service provision assessment plus (ESPA +) survey data. We created two analysis samples by applying a propensity score matching method. The first sample consisted of women who received ANC at health facilities with guidelines matched with those who received ANC at health facilities without guidelines. The second sample consisted of women who received ANC from the providers who had undertaken in-service training in the last 24 months matched with women who received ANC from untrained providers. The outcome variable was the number of obstetric danger signs described during ANC counselling, ranging from zero to eight. The covariates included women's socio-demographic characteristics, obstetric history, health facility characteristics, and ANC provider characteristics. RESULTS: We found that counselling women about obstetric danger signs during their ANC session varied according to the availability of ANC guidelines (61% to 70%) and provider training (62% to 68%). After matching the study participants by the measured covariates, the availability of ANC guidelines at the facility level significantly increased the average number of obstetric danger signs women received during counselling by 24% (95% CI: 12-35%). Similarly, providing refresher training for ANC providers increased the average number of obstetric danger signs described during counselling by 37% (95% CI: 26-48%). CONCLUSION: The findings suggest that the quality of ANC counselling in Ethiopia needs strengthening by ensuring that ANC guidelines are available at every health facility and that the providers receive regular ANC related in-service training.

Maternal death from preventable pregnancy-related complications remains a global health challenge. In 2017, there were 295,000 maternal deaths worldwide, and about two-thirds of these deaths were from Sub-Saharan Africa. Ethiopia is a Sub-Saharan African country with 401 maternal deaths per 100,000 live births in 2017, and this rate is higher than the target indicated in sustainable development goals. Most maternal deaths are due to obstetric complications and could have been averted through early detection and treatment. Providing antenatal care counselling about obstetric danger signs enhances women's awareness of obstetric complications and encourages women to seek treatment from a skilled care provider. However, most women from low-income settings, including Ethiopia, do not receive counselling about obstetric danger signs. Facility-level antenatal care guidelines and provider in-service training improve antenatal care counselling. In Ethiopia, little is known to what extent antenatal care guidelines and provider training increase counselling on obstetric danger signs. The present study used the 2014 Ethiopian service provision assessment data and estimated the effect of antenatal care guidelines and provider training on counselling about obstetric danger signs. The analysis involved a propensity score matching method and included 1725 pregnant women. The study found that antenatal care guidelines at health facilities and antenatal care provider in-service training significantly increase counselling on obstetric danger signs by 24% and 37%, respectively. The finding suggests improving the quality of antenatal care counselling in Ethiopia needs antenatal care guidelines at each antenatal care clinic and refresher training for the providers.

Maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for this systematic review and meta-analysis. We systematically used PubMed, Cochrane Library, and African Journals online databases for searching. The Newcastle- Ottawa quality assessment scale was used for critical appraisal. Egger's test and I2 statistic used to assess the check for publication bias and heterogeneity. The random-effect model was used to estimate the pooled prevalence and odds ratios with 95% confidence interval (CI). RESULTS: The pooled maternal mortality and morbidity due to uterine rupture in Ethiopia was 7.75% (95% CI: 4.14, 11.36) and 37.1% (95% CI: 8.44, 65.8), respectively. The highest maternal mortality occurred in Southern region (8.91%) and shock was the commonest maternal morbidity (24.43%) due to uterine rupture. The pooled perinatal death associated with uterine rupture was 86.1% (95% CI: 83.4, 89.9). The highest prevalence of perinatal death was observed in Amhara region (91.36%) and the lowest occurred in Tigray region (78.25%). Prolonged duration of operation was a significant predictor of maternal morbidity (OR = 1.39; 95% CI: 1.06, 1.81). CONCLUSIONS: The percentage of maternal and perinatal deaths due to uterine rupture was high in Ethiopia. Uterine rupture was associated with maternal morbidity and prolonged duration of the operation was found to be associated with maternal morbidities. Therefore, birth preparedness and complication readiness plan, early referral and improving the duration of operation are recommended to improve maternal and perinatal outcomes of uterine rupture.

Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016.

BACKGROUND: Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016. METHODS: Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity. RESULTS: The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively. CONCLUSION: The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.

Social Anxiety Disorder Among Undergraduate Students of Hawassa University, College of Medicine and Health Sciences, Ethiopia.

INTRODUCTION: Social anxiety disorder (SAD), also called social phobia, is an uncontrollable fear of social situations, which involve fear of observation or making contact with strangers. So, helping individuals with social anxiety, which is among the factors affecting mental health, can significantly influence a students' mental health and prevent other problems. OBJECTIVE: The study aimed at assessing the magnitude of SAD and its determinants among undergraduate students of Hawassa University, College of Medicine and Health Sciences. METHODS: An institution based cross-sectional study was conducted from April 1 to May 30, 2018, in Hawassa University, College of Medicine and Health Sciences. We selected participants by a stratified random sampling method, and we collected data independently from each stratum (department) using a 17 item self-rating Social Phobia Inventory (SPIN) scale to assess SAD. We performed multiple logistic regression analysis to find factors associated with SAD. RESULTS: Out of 304 students, 293 completed the questionnaire, with a response rate of 96.3%. The mean age of the participants was 22.13 years with a standard deviation of ± 2.176, and 172 (58.7%) were males. The prevalence of SAD was 32.8%. Family history of mental illness (AOR=4.72, 95% CI (1.25, 17.74)), being a 3rd-year student (AOR=0.178, 95% CI (0.055, 0.57)) and being a 4th year student (AOR=0.15, 95% CI (0.049, 0.49)) were significantly associated with SAD. CONCLUSION: This study showed a high prevalence of SAD among medicine and health science students of Hawassa University. Therefore, the Ethiopian Ministry of Higher Education and university officials need to draw up a plan to reduce social phobia.

Predictors of mental distress among undergraduate health science students of Hawassa University, College of Medicine and Health Sciences, Hawassa, SNNPR, Ethiopia: a cross-sectional study.

INTRODUCTION: Mental distress is a mental health problem which includes anxiety, depression and somatic symptoms. Mental health problems affect society as a whole and no group is immune to mental disorders; however, students have significantly high level of mental distress than their community peers. OBJECTIVE: The aim of the study is to assess magnitude of mental distress and its predictors among undergraduate health science students of Hawassa University, College of Medicine and Health Sciences, SNNPR, Ethiopia. METHODS: Institution-based cross-sectional study was conducted among 311 students. Simple random sampling technique was used to select the study participants. Data were collected using pre-tested and structured self-administered questionnaire. Mental distress among students was assessed using SRQ-20, which is validated in Ethiopia. Bivariate and multivariate logistic regression model was fitted to identify predictors of mental distress among students. An adjusted odds ratio with 95% confidence interval was computed to determine the level of significance with P-value less than 0.05. RESULT: A total of 309 study participants were interviewed with a response rate of 99.34%. Among the total respondents 105 (34%) of them were found to have mental distress. In multiple logistic regression analysis, poor social support (AOR = 5.28; 95% CI (2.176-12.84) and current substances use (AOR = 12.83, 95% CI (7.13-23.13), were significant predictors of mental distress among respondents. CONCLUSION AND RECOMMENDATIONS: The overall magnitude of mental distress among students was found to be high. Therefore, it is recommended that mental distress needs due attention and remedial action from policy-makers, college officials, non-governmental organizations, parents, students and other concerned bodies.

Maternal dietary diversity and micronutrient adequacy during pregnancy and related factors in East Gojjam Zone, Northwest Ethiopia, 2016.

BACKGROUND: Monotonous and less diversified diets are associated with micronutrient deficiency. Evidence on maternal dietary intakes during pregnancy is essential to achieve the 2025 global nutrition target and reduce maternal and child mortalities. This study assessed pregnant women's dietary diversity and identified factors associated with inadequate dietary diversity in East Gojjam Zone. METHODS: We conducted a community-based cross-sectional study between April and June 2016. Eight hundred thirty-four pregnant women were randomly sampled. The Women Dietary Diversity Score tool developed by the Food and Agricultural Organization (FAO) and Food and Nutrition Technical Assistance (FANTA) was used. Data were entered into EpiData with double entry verification, and analysis was done using IBM SPSS version 20. Level of significance was set to P < 0.05 with 95% confidence interval (CI) to identify the independent factors associated with inadequate dietary diversity. RESULTS: The mean (±SD) dietary diversity score was 3.68 (±2.10). Inadequate dietary diversity was prevalent in 55% [95% CI (52.3-59.3%)] of pregnant women, or indirectly micronutrient was inadequate in more than half of the pregnant women. Commonly consumed dietary groups were legumes, nuts, and seeds (85.5%) followed by starchy staples (64.7%). Inadequate dietary diversity was higher among non-educated [Adjusted Odds Ratio (AOR) = 7.30, 95% CI (2.35-22.68)] compared to college and above completed women. Wealth index had significant association with dietary diversity, in which women in the poorest [AOR = 8.83, 95% CI, (1.60-48.61)], poorer [AOR = 6.34, 95% CI (1.16-34.65)], poor [AOR = 8.46, 95% CI (1.56-45.70)], and richer [AOR = 6.57, 95% CI (2.16-20.01)] had higher odds of inadequate dietary diversity. Those who had not received dietary counseling had three folds [AOR = 3.31, 95% CI (1.49-7.35)] of inadequate dietary diversity compared to their counterparts. Less likelihood of inadequate dietary diversity was among women with an increased meal frequency [AOR = 0.53, 95% CI (0.38-0.74)]. CONCLUSION: Consumption of less diversified food during pregnancy is common in the study area. Adequacy of micronutrients is insufficient for more than half of the studied pregnant women. We conclude that being non-educated affects pregnant women to depend on less diversified diet. Providing dietary counseling during pregnancy can improve nutritional practice for pregnant women.

A Systematic Review and Meta-Analysis of Epidemiology of Risky Sexual Behaviors in College and University Students in Ethiopia, 2018.

Background: Risk of sexual ill-health occurs with the onset of unsafe sexual activity, mostly among the adolescents, and continues as long as the risky activities are engaged in. Globally, and in Africa, adolescent AIDS-related mortality among adolescents has been increasing. Therefore, a systematic review and meta-analysis of epidemiology of risky sexual behaviors in college and university students in Ethiopia is mandatory. Methods: We conducted extensive search of articles as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). Databases such as PubMed, Global Health, Africa-wides, Google advance search, Scopus, and EMBASE were accessed for literature search. The pooled estimated effect of epidemiology of risky sexual behaviors and associated factors were analyzed by using the random effects model meta-analysis and 95% CI was also considered. PROSPERO registration number is CRD42018109277. Result: A total of 18 studies with 10,218 participants were encompassed in this meta-analysis. The estimated pooled prevalence of risky sexual behaviors among college and university students was 41.62%. Being male [OR: 2.35, with 95% (CI; 1.20, 4.59)], alcohol use [OR: 2.68, with 95% CI; (1.67, 4.33)] and watching pornography [OR: 4.74, with 95% CI; (3.21, 7.00)] were positively associated with risky sexual behaviors. Conclusion and recommendation: Risky sexual behavior among students was high. Educational institutions should give special attention for male sex, alcohol user, and students who watch pornography.

Factors associated with depression among prisoners in southern Ethiopia: a cross-sectional study.

OBJECTIVE: To assess the prevalence of depression and associated factors among prisoners in Hawassa Central Correctional Institution, Hawassa, SNNPR, Ethiopia. RESULT: 56.4% of study participants had significant depressive symptoms. During Multiple logistic regression, depression was significantly associated with not participating in income generating activities inside the prison [AOR = 0.531 95% CI (0.32, 0.87)], History of Chronic disease [AOR = 2.62 95% CI (1.29, 5.32)] and history of Khat chewing [AOR = 2.47, 95% CI (1.04-5.85)].

Prevalence and Associated Factors of Suicide Ideation and Attempt among Adolescent High School Students in Dangila Town, Northwest Ethiopia.

BACKGROUND: Suicide is a major public health problem and is common among adolescents worldwide. The true extent of the problem in Ethiopia is difficult to ascertain as suicides and suicidal behavior are significantly underreported and understudied. OBJECTIVE: We assessed the prevalence and factors associated with suicide ideation and suicide attempt among adolescent high school students in Dangila Town, Ethiopia. METHODS: This school-based cross-sectional study was conducted from April to May 2015 in Dangila Town. Data were collected from adolescent high school students using pretested, self-administered Amharic-language questionnaire. We conducted bivariable and multivariable logistic regression to identify the independent factors associated with suicide ideation and attempt. RESULTS: A total of 573 of 603 sampled students participated in the study (95% response rate). The mean (±SD) age of the respondents was 17.52 (±0.97) years. The minimum and maximum ages were 15 and 19 years, respectively. The prevalence of suicide ideation and attempt was 22.5% and 16.2%, respectively. School absenteeism [AOR 4.30, 95% CI (2.03, 9.10)] and poor social support [AOR 5.58, 95% CI (2.25, 13.84)] were positively associated with suicide ideation. Poor social support [AOR 4.55, 95% CI (1.40, 14.77)] and being physically hurt [AOR 4.25, 95% CI (1.77, 10.20)] were positively associated with suicide attempt. Unlike previous studies of adolescents in low-income countries, we find no association between gender or alcohol use and suicidal thoughts or attempts. CONCLUSION: This study revealed that at least one in five of the adolescents in our sample had experienced suicide ideation and one in six had attempted suicide. School absenteeism, poor social support, and experience of violence were identified as independent contributors to suicide ideation and attempt. These findings suggest a need for education policymakers to implement school-based behavioral therapy programs in collaboration with health institutions and programs to provide social support for vulnerable students.

Dietary diversity and associated factors among children aged 6-23 months in Sinan Woreda, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Child malnutrition accounted by poor dietary diversity is common in developing countries contributing for child morbidity and mortality. It also has an impact on child growth and development. Almost all nutritional related problems are preventable by implementing infant and child feeding strategies. The first two years of life are particularly important to reverse the nutritional problems by achieving dietary diversity feeding.The study aimed to assess dietary diversity and its associated factors among 6-23 months old children in Sinan Woreda, Northwest Ethiopia. METHODS: We conducted community based cross-sectional study among children aged 6-23 months in Sinan Woreda from February 16 to March 10, 2016. Random sampling technique was used to select 740 samples. Data on children's dietary diversity of the last 24 h were collected through interview of mothers. Data were entered into EpiData version 3.1 and analysis was performed using SPSS version 20. The bivariate and multivariable logistic regression analyses were done to identify the independent factors associated with sub-optimal dietary diversity among children aged 6-23 months. RESULTS: Seven hundred thirty six samples were included in the analysis with the response rate of 99%. Optimum dietary diversity was observed in 13% children. The dominant food groups consumed were grains. Availability of media sources at household [Adjusted Odds Ratio (AOR) = 2.77 (1.65-4.68)], availability of cow milk in the household [AOR = 2.39 (1.31-4.35)], women's involvement in decision-making at household level [AOR = 2.07 (1.02-4.20)], institutional delivery service utilization [AOR = 2.40 (1.24-4.67)], receiving assisted delivery service [AOR = 2.36 (1.12-4.98)], receiving postnatal care [AOR = 2.07 (1.18-3.63)], distance far from the health center [AOR = 3.11 (1.66-5.83)] and meal frequency being four and above [AOR = 3.31 (1.53-7.18)] were associated with dietary diversity. CONCLUSION: This study concluded that optimum dietary diversity among children aged 6-23 months in Sinan Woreda is low. Meal frequency is positively associated with dietary diversity. Women involvement at household decision making improves dietary diversity of children. Ensuring maternal health service utilization can contribute for better dietary diversity of children aged 6-23 months. Large scale an interventional based research has to be conducted.

Factors associated with depressive symptoms in people living with HIV attending antiretroviral clinic at Fitche Zonal Hospital, Central Ethiopia: cross-sectional study conducted in 2012.

BACKGROUND: Depression is one of the most common psychiatric disorders with the prevalence rate ranging from 5% to 10% in the general population and about 60% in people living with human immunodeficiency virus (PLHIV). It has been reported to be more common among women living with HIV. In HIV patients, depression can have negative impacts on their quality of life. OBJECTIVE: This study was aimed at identifying the prevalence of depressive symptoms and associated factors among PLHIV attending the antiretroviral therapy clinic at Fitche Zonal Hospital. METHODS: It was a cross-sectional study conducted among PLHIV in Fitche Zonal Hospital from February 15 to March 15, 2012. Center for Epidemiologic Studies Depression tool was used to collect data from 390 respondents. Both the bivariate and multivariable logistic regression analyses were carried out and variables with P<0.25 in the bivariate logistic regression analysis were entered into multivariable logistic regression analysis and statistical significance was declared at P<0.05. RESULTS: Of the total 390 respondents included in the analysis, the prevalence of depressive symptoms was 76.7%, ranging from mild to moderate (33.6%) to major (43.1%), and the highest proportion was observed among individuals with food insecurity accounting for 287 (79.3%). Food insecurity (adjusted odds ratio [AOR] =3.832 [1.575-9.322]), non-ownership of livestock (AOR =2.17 [1.157-4.104]), and opportunistic infections (AOR =5.20 [1.342-20.156]) were significantly associated with depressive symptoms. CONCLUSION AND RECOMMENDATIONS: Depressive symptoms were prevalent in PLHIV. Social disparities were important factors of depressive symptoms. Integration of mental health care services with HIV/acquired immune deficiency syndrome-related health care services at all health care levels was necessary. It was recommended that government and non-government organizations should provide assistance to the PLHIV to encourage their involvement in income-generating activities.

Community Attitude and Associated Factors towards People with Mental Illness among Residents of Worabe Town, Silte Zone, Southern Nation's Nationalities and People's Region, Ethiopia.

BACKGROUND: Mental illnesses worldwide are accompanied by another pandemic, that of stigma and discrimination. Public understanding about mental illnesses and attitudes towards people with mental illness play a paramount role in the prevention and treatment of mental illness and the rehabilitation of people with mental illness. OBJECTIVE: To assess community attitude and associated factors towards people with mental illness. METHODS: Community based cross-sectional study was conducted from April 28 to May 28, 2014. Quantitative data were collected through interview from 435 adults selected using simple random sampling. Data were collected using community attitude towards mentally ill (CAMI) tool to assess community attitude towards people with mental illness and associated factors. Multiple linear regression analysis was performed to identify predictors of community attitude towards people with mental illness and the level of significance association was determined by beta with 95% confidence interval and P less than 0.05. RESULTS: The highest mean score was on social restrictiveness subscale (31.55±5.62). Farmers had more socially restrictive view (ß = 0.291, CI [0.09, 0.49]) and have less humanistic view towards mentally ill (ß = 0.193, CI [-0.36, -0.03]). Having mental health information had significantly less socially restrictive (ß = -0.59, CI [-1.13, -0.05]) and less authoritarian (ß = -0.10, CI [-1.11, -0.06]) view towards mentally ill but respondents who are at university or college level reported to be more socially restrictive (ß = 0.298, CI [0.059, 0.54]). Respondents whose age is above 48 years old had significantly less view of community mental health ideology (ß = -0.59, CI [-1.09, -0.08]). CONCLUSION AND RECOMMENDATION: Residents of Worabe town were highly socially restrictive but less authoritarian. There was high level of negative attitude towards people with mental illness along all the subscales with relative variation indicating a need to develop strategies to change negative attitude attached to mental illness in Worabe town at community level.

Determinants of cessation of exclusive breastfeeding in Ankesha Guagusa Woreda, Awi Zone, Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Exclusive breast-feeding (EBF) is the practice of feeding only breast milk (including expressed breast milk) during the first six months and no other liquids and solid foods except medications. The time to cessation of exclusive breast-feeding, however, is different in different countries depending on different factors. Studies showed the risk of diarrhea morbidity and mortality is higher among none exclusive breast-feeding infants, common during starting other foods. However, there is no study that evaluated the time to cessation of exclusive breast-feeding in the study area. The aim of this study was to show time to cessation of EBF and its predictors among mothers of index infants less than twelve months old. METHODS: We conducted a community-based cross-sectional study from February 13 to March 3, 2012 using both quantitative and qualitative methods. This study included a total of 592 mothers of index infant using multi-stage sampling method. Data were collected by using interviewer administered structured questionnaire. Bivariate and multivariate Cox regression analyses were performed. RESULTS: Cessation of exclusive breast-feeding occurred in 392 (69.63%) cases. Among these, 224 (57.1%) happened before six months, while 145 (37.0%) and 23 (5.9%) occurred at six months and after six months of age of the index infant respectively. The median time for infants to stay on exclusive breast-feeding was 6.36 months in rural and 5.13 months in urban, and this difference was statistically significant on a Log rank (Cox-mantel) test. Maternal and paternal occupation, place of residence, postnatal counseling on exclusive breast-feeding, mode of delivery, and birth order of the index infant were significant predictors of cessation of exclusive breast-feeding. CONCLUSION: Providing postnatal care counseling on EBF, routine follow-up and support of those mothers having infants stressing for working mothers can bring about implementation of national strategy on infant and young child feeding.