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1.
PLoS One ; 17(8): e0271967, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913995

RESUMO

BACKGROUND: Short inter-pregnancy interval is a public health concern because it results in adverse perinatal outcomes such as postpartum hemorrhage, anemia, premature birth, low birth weight, and perinatal deaths. Although it is critical to understand the factors that contribute to short inter-pregnancy interval to reduce the risk of these negative outcomes, adequate evidence about the factors in the urban context is lacking. Therefore, we aimed to assess the duration of the inter-pregnancy interval and its predictors among pregnant women in urban South Ethiopia. METHODS: A community-based retrospective follow-up study was conducted among 2171 pregnant women in five geographically diverse urban settings in South Ethiopia. For the analysis, a Cox gamma shared frailty (random-effect) model was used. Adjusted hazard ratio (AHR) with a 95% CI was used to assess significant predictors. The median hazard ratio (MHR) used to report clustering effect. RESULTS: The median duration of the inter-pregnancy interval was 22 months, 95% CI (21, 23), with an inter-quartile range of 14 months. Maternal age ≥30 years [AHR = 0.75, 95% CI: 0.58, 0.97], having no formal education [AHR = 0.60, 95% CI: 0.46, 0.78], contraceptive non-use [AHR = 2.27, 95% CI: 1.94, 2.66], breastfeeding for <24 months [AHR = 4.92, 95% CI: 3.95, 6.12], death of recent child [AHR = 2.90, 95% CI: 1.41, 5.97], plan pregnancy within 24 months [AHR = 1.72, 95% CI: 1.26, 2.35], lack of discussion with husband [AHR = 1.33, 95% CI: 1.10, 1.60] and lack of husband encouragement about pregnancy spacing [AHR = 1.25, 95% CI: 1.05, 1.48] were predictors of short inter-pregnancy interval. Adjusting for predictors, the median increase in the hazard of short inter-pregnancy interval in a cluster with higher short inter-pregnancy interval is 30% [MHR = 1.30, 95% CI: 1.11, 1.43] than lower cluster. CONCLUSIONS: In the study settings, the duration of the inter-pregnancy interval was shorter than the World Health Organization recommendation. There is a need to improve contraceptive use and breastfeeding duration to maximize the inter-pregnancy interval. Men's involvement in reproductive health services and advocacy for women's reproductive decision-making autonomy are fundamental. The contextual disparities in the inter-pregnancy interval suggests further study and interventions.


Assuntos
Intervalo entre Nascimentos , Gestantes , Adulto , Anticoncepcionais , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Parto , Gravidez , Estudos Retrospectivos
2.
PLoS One ; 17(7): e0271216, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35849596

RESUMO

BACKGROUND: Globally, postpartum hemorrhage is the leading preventable cause of maternal mortality. To decrease postpartum hemorrhage-related maternal mortalities, identifying its risk factors is crucial to suggest interventions. In this regard, little is known about the link between primary postpartum hemorrhage and inter-pregnancy interval in Ethiopia, where more than half of pregnancies occur shortly after the preceding childbirth. Therefore, we aimed to elucidate the association of primary postpartum hemorrhage with an inter-pregnancy interval in urban South Ethiopia. METHODS: A community-based matched nested case-control study was conducted among a cohort of 2548 pregnant women. All women with primary postpartum hemorrhage during the follow-up (n = 73) were taken as cases. Women who were randomly selected from those without primary postpartum hemorrhage (n = 292) were taken as controls. Cases were individually matched with controls (1:4 ratio) for age group and location. A conditional logistic regression analysis was done using R version 4.0.5 software. Statistically, a significant association was declared using 95% CI and p-value. Attributable fraction (AF) and population attributable fraction (PAF) were used to estimate the public health impacts of the inter-pregnancy interval. RESULTS: This study found out that more than half (66%) of primary postpartum hemorrhage was attributed to inter-pregnancy interval <24 months (AF = 66.3%, 95% CI: 37.5, 82.5%). This could be prevented if the inter-pregnancy interval was increased to 24-60 months. Likewise, nearly half (49%) of primary postpartum hemorrhage in the study population could be prevented if the inter-pregnancy interval <24 months was prevented. Additionally, primary postpartum hemorrhage was attributed to antepartum hemorrhage, prolonged labour and multiple pregnancies. CONCLUSIONS: Primary postpartum hemorrhage was associated with inter-pregnancy interval under 24 months, highlighting the need to improve postpartum modern contraceptive utilization in the community. Counseling couples about how long to wait until subsequent pregnancy and the risk when the inter-pregnancy interval is short need to be underlined.


Assuntos
Intervalo entre Nascimentos , Hemorragia Pós-Parto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Período Pós-Parto , Gravidez
3.
Matern Health Neonatol Perinatol ; 8(1): 3, 2022 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-35545779

RESUMO

BACKGROUND: Preterm birth, low birth weight and perinatal deaths are common adverse perinatal outcomes that are linked with each other, and a public health problems contributing to neonatal mortality, especially in developing countries. Although more than half of women in Ethiopia become pregnant within a short interval after the preceding childbirth, whether the short intervals increase the risk of adverse perinatal outcomes or not is understudied. We, therefore, aimed to assess the effects of inter-pregnancy intervals (IPIs) on the adverse perinatal outcomes. METHODS: A community-based prospective cohort study was conducted among 2578 pregnant women in urban South Ethiopia. Pregnant women with IPIs < 24 months (IPIs < 18 and 18-23 months) were exposed groups, and those with IPI 24-60 months were the unexposed group. A multilevel analysis (mixed-effects) was done to estimate the effect of IPIs on preterm birth and low birth weight, and a generalized linear model for a binary outcome (fixed-effect) was done for perinatal deaths, using a 95% confidence level. RESULTS: In this study, IPI < 18 months found to increase the risk of preterm birth (Adjusted Relative Risk (ARR) = 1.35, 95% CI: 1.02, 1.78), term low birth weight (ARR = 2.20, 95% CI: 1.35, 3.58) and perinatal deaths (ARR = 3.83, 95% CI: 1.90, 7.71) than 24-60 months. The results suggest that, about 9% of preterm birth, 21% of term low birth weight and 41% of perinatal deaths in the study population were attributed to IPI < 18 months. These could be prevented with the removal of the IPI < 18 months in the study population. IPI 18-23 months has shown no effect on the three adverse perinatal outcomes. CONCLUSION: This study has shown that, IPI under 18 months has a higher risk of adverse perinatal outcomes than IPI 24-60 months. Due attention should still be given for spacing pregnancies.

4.
BMJ Open ; 12(4): e058055, 2022 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-35477882

RESUMO

OBJECTIVE: Pneumonia is the single-leading cause of infectious disease deaths in children under-5. Despite this challenge, the utilisation of preventive and curative child health services remains low in Ethiopia. We investigated the association between health post service readiness and caregivers' awareness of pneumonia services, care-seeking and utilisation of pneumonia-relevant immunisation in four Ethiopian regions. DESIGN AND SETTING: This cross-sectional study was conducted in 52 districts of four regions of Ethiopia from December 2018 to February 2019. The health posts preparedness for sick child care was assessed using the WHO Health Service Availability and Readiness Assessment tool. Multilevel analyses were employed to examine the associations between health post readiness and household-level awareness and utilisation of services. PARTICIPANTS: We included 165 health posts, 274 health extension workers (community health workers) and 4729 caregivers with 5787 children 2-59 months. OUTCOME MEASURES: Awareness of pneumonia treatment, care-seeking behaviour and coverage of pentavalent-3 immunisation. RESULTS: Only 62.8% of health posts were ready to provide sick child care services. One-quarter of caregivers were aware of pneumonia services, and 56.8% sought an appropriate care provider for suspected pneumonia. Nearly half (49.3%) of children (12-23 months) had received pentavalent-3 immunisation. General health post readiness was not associated with caregivers' awareness of pneumonia treatment (adjusted OR, AOR 0.9, 95% CI 0.7 to 1.1) and utilisation of pentavalent-3 immunisation (AOR=1.2, 95% CI 0.8 to 1.6), but negatively associated with care-seeking for childhood illnesses (AOR=0.6, 95% CI 0.4 to 0.8). CONCLUSION: We found no association between facility readiness and awareness or utilisation of child health services. There were significant deficiencies in health post preparedness for services. Caregivers had low awareness and utilisation of pneumonia-related services. The results underline the importance of enhancing facility preparedness, providing high-quality care and intensifying demand generation efforts to prevent and treat pneumonia.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia , Criança , Agentes Comunitários de Saúde , Estudos Transversais , Etiópia/epidemiologia , Humanos , Pneumonia/prevenção & controle
5.
Sci Rep ; 12(1): 5714, 2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35383259

RESUMO

Preterm premature rupture of membranes is one of the causes of premature birth and perinatal deaths, particularly in developing countries due to poor access and availability of medical resources to manage and sustain the pregnancy to term. Although, several risk factors for preterm premature rupture of membranes were identified, its association with inter-pregnancy interval was understudied. Therefore, we aimed to assess the incidence of preterm premature rupture of membranes and its association with inter-pregnancy interval in urban South Ethiopia. A community-based prospective cohort study was conducted among 2578 pregnant women, and followed until delivery. A generalized linear model for binary outcome was applied for the analysis, using a 95% confidence level and P-value. The incidence of preterm premature rupture of membranes was 2%, 95% CI: 2%, 3%. However, the incidence was varied across the months of inter-pregnancy intervals 4% (< 18 months), 2% (18-23 months) and 1% (24-60 months). The risk of preterm premature rupture of membranes was nearly three times (ARR = 2.59, 95%CI: 1.27, 5.29) higher for women with inter-pregnancy intervals < 18 months than 24-60 months. Inter-pregnancy interval under 18 months increases the risk of preterm premature rupture of membranes, highlighting the need to improve pregnancy spacing in the community.


Assuntos
Ruptura Prematura de Membranas Fetais , Nascimento Prematuro , Intervalo entre Nascimentos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Incidência , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos
6.
Pan Afr Med J ; 41: 83, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432706

RESUMO

Introduction: even though there is a significant decline in neonatal mortality globally, it remained unacceptably high in Ethiopia. The estimated experience of neonatal danger signs affects the outcome more than the perceived knowledge. The main aim of this study was to estimate the experience of mothers on neonatal danger signs and its associated factors in Northwest Ethiopia. Methods: a community-based cross-sectional study was conducted from April 6-16, 2019. All the women who have delivered live birth in the past six months in three districts of Northwest Ethiopia were the source populations. A total of 2424 mothers were selected using two-stage stratified cluster random sampling technique. A pretested and semi-structured interviewer-administered questionnaire was used to collect data from eligible mothers. A multivariable logistic regression model was used to identify independent factors that affected mother´s experiences about neonatal danger signs at a p-value of 5%. Results: in this study, 2335 (96.3%) mothers completed the interview and 1509 (64.6%) of them have mentioned at least one danger sign. However, only 160 (11.0%) mothers have experienced danger signs in their babies. Of these, about 54 (49.1%) mothers have noticed within 24 hours of delivery and 37 (33.6%) have noticed after 48 hours of delivery. Fifty (45.5%) mothers have noticed the danger signs at home after birth, and 48 (43.6%) have noticed during birth. The frequently reported danger signs were; baby feels hot 106 (66.3%), fast breathing 67(41.9%), and difficulty of breathing 61(38.1%). Mothers who are living in urban, AOR=1.8(95%CI: 1.04,3.0), having multiple pregnancy, AOR=9.8 (95%CI: 2.3,42.0), absence of obstetric danger signs or complication, AOR=0.4 (95%CI: 0.2,0.6), post-term gestational age, AOR=6.5 (95%CI: 2.1,19.5), preterm gestational age, AOR=3.3 (95%CI: 0.8,13.4), assessment by hospital staff during delivery, AOR=2.1 (95% CI: 1.01,4.3), and poor mothers knowledge on neonatal danger signs, AOR=0.7 (95% CI: 0.5,0.9) were the predictors of mothers experience on neonatal danger signs. Conclusion: even though the knowledge of mothers on neonatal danger signs is high, the practice or experience in using their knowledge is very low. We recommend an implementation study to be conducted to bridge this "know-do" gap.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Mães , Estudos Transversais , Etiópia , Feminino , Humanos , Recém-Nascido , Parto , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários
7.
Inj Prev ; 28(4): 347-352, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35228314

RESUMO

BACKGROUND: Prehospital emergency care helps to reduce mortality and morbidity from time-sensitive conditions. In this study, we summarised the perspectives of various stakeholders on the establishment of a prehospital integrated emergency response system. METHODS: We conducted a qualitative study using a key informant interview. We used a purposive sampling technique to select participants from the sector offices based on their proximity to the problem under consideration. We took verbal informed consent from each participant before the interviews. We conducted a thematic content analysis. RESULTS: Twenty-three study participants, working at six sector offices (the zonal health office, University of Gondar, traffic office, fire extinguisher office, the Amhara regional health bureau and the Ethiopian red cross association), were included in this study. Five major themes have emerged. The themes that emerged include participants' views on the importance of prehospital service, barriers and opportunities for establishing the system, and how to start and sustain the system. CONCLUSION AND RECOMMENDATION: Lack of resources is not the main reason for the lack of prehospital emergency care in the study area rather; lack of commitment, ownership and high turnover of decision-makers were the main reasons for the absence of prehospital care, as viewed by respondents. On the other side, the availability of professionals, training institutions and the fact that emergency care is a shared agenda by different stakeholders were stated as an opportunity to establish the system. With the growing number of injuries and non-communicable diseases, emergency management should get due attention.


Assuntos
Serviços Médicos de Emergência , Etiópia , Humanos , Pesquisa Qualitativa
8.
Disaster Med Public Health Prep ; : 1-8, 2022 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-35331362

RESUMO

OBJECTIVE: Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals. METHODS: We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding. RESULTS: The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital. CONCLUSION AND RECOMMENDATION: Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.

9.
PLoS One ; 17(2): e0263733, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35143579

RESUMO

BACKGROUND: The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels. METHODS: This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI. RESULTS: Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants. CONCLUSIONS: The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/organização & administração , Adolescente , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Análise Multinível , Razão de Chances , Inquéritos e Questionários
10.
Patient Prefer Adherence ; 16: 333-342, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35173419

RESUMO

BACKGROUND: The US Institute of Medicine's "quality chasm" report defined patient-centered care as care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Services that lack patient-centered care lead to unimproved health status, decreased patient and family satisfaction, and poor patient outcomes. Therefore, this study aimed to assess patient-centered care and associated factors among admitted patients in South Wollo public hospitals in northeast Ethiopia. METHODS: This was a facility-based quantitative cross-sectional study design supplemented with qualitative analysis conducted from February 10 to March 10, 2020 across South Wollo public hospitals. A total of 618 admitted patients were selected using multistage systematic random sampling and interviewed using a structured questionnaire. Five health professionals were selected for in-depth interviews. Binary logistic regression analysis was carried out to identify associated variables, and potential confounders were controlled using a multivariate logistic regression model, and P<0.05 was considered significant. RESULTS: Overall, 60.9% (95% CI 57.1%-64.5%) of patients received patient-centered care. Age 25-35 years (AOR 0.39, 95% CI 0.32-0.64) years, rural residence (AOR 2.61, 95% CI 1.62-4.02), social well-being (AOR 2.34, 95% CI 1.45-3.78), perceived high quality of care (AOR 3.69, 95% CI 2.07-6.04), length of stay (AOR 0.13, 95% CI 0.02-0.79), and routine checkups (AOR 1.92, 95% CI 1.15-3.13) were variables significantly associated with patient-centered care. CONCLUSION: This study revealed that among admitted patients, three in five received patient-centered care. Age, residence, social well-being, length of stay, perceived quality of care, and routine checkups were significantly associated with patient-centered care. Therefore, working on provider improvements in providing consultation and facilitation and decreasing length of stay to improve patient-centered care is needed.

11.
Traffic Inj Prev ; 23(1): 40-45, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34739307

RESUMO

OBJECTIVE: Measuring the level of disability following trauma is a key step for secondary and tertiary level trauma prevention. It can give important evidence for decision-makers and program implementers on the need for establishing rehabilitation centers. METHODS: This is a longitudinal follow-up study on 235 road traffic injury survivors. Patients were followed for 12 months, and the outcome was ascertained using the brief WHODAS-II 12-item instrument at 1, 3, 6, and 12-months post-injury. The level of disability was divided into five groups from no disability to very severe based on their disability scores. Work status was assessed at each survey using a single question "are you back to work?" We employed a linear mixed model to identify disability scores changes over time and risk factors associated with disability. Statistically, a significant association was declared at p < 0.05. RESULTS: The overall mean disability score was 24.9 ± 11.3 at one month and 8.3 ± 6.4 after 12 months of injury. Disability score has decreased by 1.3 units over time during 12 months post-injury. Functional limitation persisted on 25-88% of participants at specific dimensions of disability at the end of the study. After a year of injury, 44% of participants didn't return to work. Injury severity score (ß = 0.47, p < 0.001, length of hospital stays (ß = 0.88, p < 0.005) and discharge against medical advice (ß = 2.18, p < 0.001) were found to be predictors of disability following road traffic injuries. CONCLUSION: The current study demonstrated that, though there was a decrease in disability score over time, a significant number of participants were with some degree of limitation after one year of injury, and nearly half of them didn't return to work. Shortening of long waiting times and counseling services need to be considered by the hospital. Community-based Rehabilitation centers (CBR) should be expanded. Further study should be conducted to uncover the reasons for preferring traditional bone fixers over medical management.


Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Etiópia/epidemiologia , Seguimentos , Hospitais , Humanos , Estudos Prospectivos , Ferimentos e Lesões/epidemiologia
12.
BMC Pregnancy Childbirth ; 21(1): 847, 2021 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-34965870

RESUMO

BACKGROUND: Stillbirth is an invisible and poorly understood adverse pregnancy outcome that remains a challenge in clinical practice in low-resource settings. It is also a key concern in Ethiopia where more than half of pregnancies occur shortly after preceding childbirth. Whether the interval between pregnancies has an effect on stillbirth or not is unclear. Therefore, we aimed to assess the effect of inter-pregnancy interval on stillbirth in urban South Ethiopia. METHODS: A community-based prospective cohort study was conducted among 2578 pregnant women and followed until delivery. Baseline data were collected at the household level during registration and enrolment. End-line data were collected from hospitals during delivery. Exposed groups were pregnant women with inter-pregnancy intervals < 18 months and 18-23 months. Unexposed group contains women with inter-pregnancy intervals 24-60 months. A generalized linear model for binary outcome was applied, using R version 4.0.5 software. Relative risk (RR) was used to estimate the effect size with a 95% confidence level. Attributable fraction (AF) and population attributable fraction (PAF) were used to report the public health impact of exposure. RESULTS: The overall incidence of stillbirth was 15 per 1000 total births, (95% CI: 11, 20%). However, the incidence was varied across months of inter-pregnancy intervals; 30 (< 18 months), 8 (18-23 months) and 10 (24-60 months) per 1000 total births. The risk of stillbirth was nearly four times (ARR = 3.55, 95%CI: 1.64, 7.68) higher for women with inter-pregnancy interval < 18 months as compared to 24-60 months. This means, about 72% (AF = 72, 95%CI: 39, 87%) of stillbirth among the exposed group (inter-pregnancy interval < 18 months category) and 42% (PAF = 42, 95%CI: 23, 50%) of stillbirth in the study population were attributed to inter-pregnancy interval < 18 months. These could be prevented with an inter-pregnancy interval that is at least 18 months or longer. CONCLUSIONS: Inter-pregnancy interval under 18 months increases the risk of stillbirth in this population in urban South Ethiopia. Interventions targeting factors contributing to short inter-pregnancy intervals could help in reducing the risk of stillbirth. Improving contraceptive utilization in the community could be one of these interventions.


Assuntos
Intervalo entre Nascimentos , Natimorto/epidemiologia , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Estudos Prospectivos , População Urbana
13.
BMJ Open ; 11(12): e051017, 2021 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930730

RESUMO

OBJECTIVE: The objective of this study was to identify timing distribution and predictors of deaths following road traffic injuries among all age groups at Gondar Comprehensive specialised hospital. DESIGN: A single-centre prospective cohort study. SETTING: The study hospital is a tertiary hospital in North West Ethiopia. PARTICIPANTS: We enrolled 454 participants who sustained road traffic injuries in to the current study. All age groups and injury severity were included except those who arrived dead, had no attendant and when the injury time was unknown. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was time to death measured in hours from injury time up to the 30th day of the injuries. Secondary outcomes were prehospital first aid, length of hospital stay and hospital arrival time. The article has been registered, with a unique identification number of research registry 6556. RESULTS: A total of 454 victims were followed for 275 534 person hours. There were 80 deaths with an overall incidence of 2.90 deaths per 10 000 person hours of observation (95% CI 2.77 to 3.03). The significant predictors of time to death were being a driver (AHR=2.26; 95% CI 1.09 to 4.65, AR=14.8), accident at interurban roads ((AHR (Adjusted HAzard Ratio=1.98; 95% CI 1.02 to 3.82, AR (Attributable Risk)=21%)), time from injury to hospital arrival (AHR=0.41; 95% CI 0.16 to 0.63; AR=3%), systolic blood pressure on admission of <90 mm Hg (AHR=3.66; 95% CI 2.14 to 6.26; AR=57%), Glasgow Coma Scale of <8 (AHR=7.39; 95% CI 3.0819 to 17.74464; AR=75.7%), head injury with polytrauma (AHR=2.32 (1.12774 4.79; AR=37%) and interaction of distance from hospital with prehospital care. CONCLUSION: Though the maturation of trauma centres in many developed countries has changed the temporal pattern of deaths following any trauma, our study demonstrated that trauma deaths follow the traditional trimodal pattern. That implies that potentially preventable causes of death continued in low-resource countries.


Assuntos
Traumatismo Múltiplo , Ferimentos e Lesões , Acidentes de Trânsito , Etiópia/epidemiologia , Hospitais , Humanos , Traumatismo Múltiplo/epidemiologia , Estudos Prospectivos
14.
Biomed Res Int ; 2021: 6632585, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493980

RESUMO

INTRODUCTION: Job satisfaction is a pleasurable or positive emotional state resulting from evaluating one's job or job experiences. However, knowledge of workplace factors that either satisfy employees to keep working or dissatisfy them making them leave their jobs or working places is essential for decision-making. Thus, this study is aimed at assessing job satisfaction and associated factors among healthcare professionals working at public and private hospitals in Bahir Dar city, northwest Ethiopia. METHODS: An institution-based comparative cross-sectional study design was conducted from 10 February 2020 to 29 May 2020. A total of 520 health professionals were selected from public and private health facilities using stratified systematic random sampling techniques. Data were collected using structured pretested self-administered questionnaires. A binary logistic regression model with Huber-White robust standard error was fitted to identify job satisfaction and associated factors among healthcare professionals working at public and private hospitals. A less than 0.05 p value and an Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were considered to have a statistically significant association with the outcome variable. RESULTS: The overall magnitude of job satisfaction was 55.2% (95% CI: 51.0, 59.4%). At public and private hospitals, the provider's satisfaction was 29.0% (95% CI: 23.2, 35.1%) and 81.23% (95% CI: 76.6, 85.8%), respectively. Working at private hospital (AOR: 8.89; 95% CI: 5.14, 15.35), pleasant nature of work (AOR: 1.82; 95% CI: 1.05, 3.15), autonomy (AOR: 2.37; 95% CI: 1.29, 4.33), adequate supportive supervision (AOR: 2.42; 95% CI: 1.33, 4.40), good reward and recognition (AOR: 3.04; 95% CI: 1.37, 6.75), and high normative commitment (AOR: 2.57; 95% CI: 1.48, 4.43) were factors affecting the overall job satisfaction of health professionals. CONCLUSIONS: The magnitude of job satisfaction was relatively low in private and public hospital health professionals and severe among health professionals working in public hospitals. Healthcare policy-makers and hospital managers need to develop and institutionalize evidence-based satisfaction strategies considering the predictors of health professional's job satisfaction.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Satisfação no Emprego , Local de Trabalho/estatística & dados numéricos , Adulto , Estudos Transversais , Etiópia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
15.
Reprod Health ; 18(1): 127, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120650

RESUMO

BACKGROUND: Quality of essential newborn care is defined as the extent of health care services to improve the health of newborns. However, studies are scarce regarding the quality of newborn care implementation. Therefore, this study aimed to measure the magnitude and factors associated with essential newborn care implementation perceived quality among health facility deliveries in Northwest Ethiopia. METHODS: A facility-based cross-sectional study design was employed to collect data from 370 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. Essential newborn care implementation perceived quality was assessed in two domains (delivery and process) from clients' perspectives. A pre-tested interviewer-administered structured questionnaire was adopted from different kinds of literature and guidelines. The research data were collected by trained midwives and nurses. A binary logistic regression model was used to identify associated factors with newborn care implementation perceived quality. Odds ratio with 95% CI was computed to assess the strength and significant level of the association at p-value < 0.05. RESULTS: About 338 mothers completed the interview with a response rate of 97.1%. The mean age of the study participants was 26.4 (SD = 5.7) with a range of 12 and 45 years. Most mothers, 84.3%, have attended antenatal care. The overall implementation perceived quality of essential newborn care was found to be 66.3%. The implementation perceived quality of cord care, breast-feeding and thermal care was 75.4, 72.2 and 66.3% respectively. Newborn immunization and vitamin K administration had the lowest implementation perceived quality i.e. 22.4 and 24.3% respectively. Friendly care during delivery (AOR = 5.1, 95% CI: 2.4, 11.0), partograph use (AOR = 3.0, 95% CI: 1.1, 8.6), child immunization service readiness (AOR = 2.9, 95% CI: 1.5, 5.7), BEmEONC service readiness (AOR = 2.1, 95% CI: 1.2, 3.9) and facing no neonatal illness at all (AOR = 4.2, 95% CI: 1.6, 10.9) were significantly associated with good essential newborn care implementation qualities. CONCLUSIONS: The perceived quality of essential newborn care implementation was low in the study area. This is associated with poor readiness on BEmEONC and child immunization services, unfriendly care and not using partograph during delivery. Hence, availing the BEmEONC and the child immunization service inputs, continuous training and motivation of healthcare workers for friendly care are vital for improving essential newborn care implementation perceived quality.


Essential newborn care is a set of practices provided by healthcare workers and mothers to every newborn during delivery. Studies are scarce regarding the quality of newborn care implementation. Therefore, this study aimed to measure the magnitude and factors associated with essential newborn care implementation perceived quality among health facility deliveries in Northwest Ethiopia.A facility-based cross-sectional study design was employed to collect data from 370 randomly selected deliveries in 11 health facilities. A pre-tested interviewer-administered structured questionnaire was adopted from different kinds of literature and guidelines. A binary logistic regression model was fitted to assess the strength and significant level of the association at p-value < 0.05.The overall implementation perceived quality of essential newborn care was found to be 66.3%. The implementation perceived quality of cord care, breast-feeding and thermal care was 75.4, 72.2 and 66.3% respectively. Newborn immunization and vitamin K administration had the lowest implementation perceived quality i.e. 22.4 and 24.3% respectively. Friendly care during delivery (AOR = 5.1, 95% CI: 2.4, 11.0), partograph uses (AOR = 3.0, 95% CI: 1.1, 8.6), child immunization service readiness (AOR = 2.9, 95% CI: 1.5, 5.7), BEmEONC service readiness (AOR = 2.1, 95% CI: 1.2, 3.9) and facing no neonatal illness at all (AOR = 4.2, 95% CI: 1.6, 10.9) were significantly associated with good essential newborn care implementation qualities.The perceived quality of essential newborn care implementation was low in the study area. This is associated with poor readiness on BEmEONC and child immunization services, unfriendly care and not using partograph during delivery. Hence, availing the BEmEONC and child immunization service inputs, continuous training and motivation of healthcare workers for friendly care are vital for improving essential newborn care implementation perceived quality.


Assuntos
Aleitamento Materno , Atenção à Saúde , Cuidado do Lactente/normas , Recém-Nascido , Mães/psicologia , Cuidado Pré-Natal , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Criança , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Qualidade da Assistência à Saúde , Adulto Jovem
16.
J Multidiscip Healthc ; 14: 713-725, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33790570

RESUMO

BACKGROUND: Despite the efforts put forth in improving neonatal survival, there is still a high rate of neonatal morbidity and mortality in northwest Ethiopia. Therefore, this study aimed to determine the essential newborn care service readiness scores and explore the health facility-related barriers in North Gondar Zone, Northwest Ethiopia. METHODS: A cross-sectional survey of 16 health facilities (14 health centers and two hospitals) and twelve in-depth interviews were included in the study in three randomly selected districts of North Gondar Zone. A pretested health facility inventory questionnaire customized from the World Health Organization (WHO) service readiness assessment tool was used for a facility audit. Basic emergency and essential obstetric and newborn care (BEmONC), and child immunization service readiness scores were determined using unweighted averages according to the WHO guideline. Descriptive statistics were done for the quantitative data, and thematic content analysis was employed using NVivo 12 software for the qualitative data. RESULTS: All the surveyed health facilities had no specialist medical doctors, and 50% (8/16) of them had no inpatient beds. The overall BEmONC service readiness score was 62.7% (10/16) (95% CI: 34.8, 83.8) and only one facility had all the tracer items. Trained staff and guidelines had a 27.5% (4/16) readiness score, followed by 71.9% (12/16) readiness score for equipment, and 88.6% (14/16) readiness score for medicine and commodities. The overall child immunization service readiness score was 90.3% (15/16) (95% CI: 51.4, 94.7) and eleven facilities (68.8%) had all the tracer items. The immunization service readiness score was higher; 84.4% (14/16) for trained staff and guidelines, 92.8% (15/16) for equipment, and 93.8% (15/16) for medicines and commodities. Unavailability of equipment, shortage of supplies, and lack of respectful and compassionate healthcare practices were the key facility-related barriers compromising essential newborn care service readiness. CONCLUSIONS FOR PRACTICE: The survey revealed that the essential newborn care service readiness score of the health facilities was low, and it calls for improving BEmONC service readiness in particular. Provision of timely training for newly recruited staff, fulfilling essential equipment, and steady supply is imperative.

17.
Int J Gen Med ; 14: 993-1001, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33790628

RESUMO

BACKGROUND: Although Ethiopia has developed many strategies to promote health facility delivery, more than half of the women gave birth at home contributing to high maternal and neonatal mortality. Therefore, this study aimed to identify the determinants of health facility delivery in Northwest Ethiopia. METHODS: A community-based unmatched case-control study was conducted in selected districts in Northwest Ethiopia. The sample included 885 infant mothers (295 cases and 590 controls) from April 6-16, 2019. Data were collected using a pretested interviewer-administered structured questionnaire. A multivariable logistic regression model was used to identify predictors, and STATA 14 statistical software was used to analyze the data. RESULTS: The mean maternal age was 26.4 years (SD±6.7) for cases and 28.1 years (SD±6.8) for controls. The overall good newborn care qualities were 95.8% (206) for cases and 40.8% (262) for controls. Attending a formal education (AOR=2.1 (95% CI: 1.5, 2.9)), having first pregnancy from 18 to 25 (AOR=1.5 (95% CI: 1.1, 2.1)), living within 1 km distance from the nearest health center (AOR=2.5 (95% CI: 1.5, 4.0)), having ANC visits (AOR=3.9 (95% CI: 2.4, 6.5)), having a mobile (AOR=1.7 (95% CI: 1.3, 2.4)) were the determinants of health facility delivery. CONCLUSION: Maternal education, not having pregnancy at early age, accessing health facilities to the nearby residents, attending antenatal care, and having a mobile were the determinants of health facility delivery. Therefore, strengthening education and health-seeking behavior of the mothers using a locally contextualized strategy is essential. Reaching mothers who are still far from health facility also deserves needs due attention.

18.
Risk Manag Healthc Policy ; 14: 1097-1108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33758562

RESUMO

BACKGROUND: Youth-Friendly Services (YFS) is an evidence-based public health intervention aimed to reduce sexual and reproductive health problems among youth. To achieve the desired outcomes, YFS has to be implemented with a high level of fidelity. However, there is an evidence gap in its implementation with fidelity. Hence, the main objective of the study was to describe the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia. Therefore, this study investigated the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from September to December in 2019. A total of 1029 youths, who came to 11 health centers where YFS has been implemented were randomly selected. A validated tool, comprised of 65 Likert scaled items, designed to measure the three dimensions of fidelity was used to collect data. Face to face clients exit interview approach was used to collect the data. Summary statistics were calculated for each fidelity dimension first, and then the overall fidelity of implementation score was computed. RESULTS: Overall, only 48 (4.7%; 1.6-11.3%) of youth received the YFS with a high level of implementation fidelity. Whereas 770 (74.8%; 57.6-90.5%) and 211 (20.5%; 912.7-31.0%) of youth received the YFS with a medium and low level of implementation fidelity, respectively. Considering each fidelity dimension, 241 (23.4%) youth received the YFS with a high level of adherence, 212 (20.6%) received the YFS with a high level of the structural quality of care, 323 (31.4%) received the YFS with a high level of process quality of care, 508 (49.3%) received the YFS with a high level of outcome quality of care, and 114 (11.1%), received the YFS with a high level of participant responsiveness. CONCLUSION: The identified low level of implementation fidelity of YFS indicates the urgent need to strengthen the YFS by the government and programmers. Further studies that can address barriers to the implementation fidelity of Youth-Friendly Services are recommended. In addition, further analysis to know the factors that may influence the fidelity of YFS are recommended.

19.
PLoS One ; 16(3): e0248678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33784322

RESUMO

BACKGROUND: The neonatal period is the most vulnerable stage of life. In Ethiopia, neonatal illness is common and the reduction in neonatal mortality is not as significant as for under-five mortality. OBJECTIVES: To determine the prevalence and factors associated with neonatal illness symptoms reported by mothers delivering in health facilities in Northwest Ethiopia. METHODS: A repeated measure cross-sectional study design was employed to collect data from 358 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. A pretested and interviewer-administered structured questionnaire adapted from the literature was employed to record neonatal outcomes (illnesses and/or deaths) at birth, 24 hours, 7th, 14th and 28th day from birth. Cleaned data was exported to STATA version 14 software for analysis. Multilevel analysis was used to identify individual and facility-level characteristics associated with neonatal illness symptoms. RESULTS: The prevalence of neonatal illness symptoms was 27.8% (95% CI; 23.2, 32.8) of the 338 babies born alive and the neonatal mortality rate was 41/1000 live births (14/338). The most common symptoms or conditions of neonatal illness reported by mothers' in the study area were possible serious bacterial infections (95.8%, 90/94), localized bacterial infections (43.6%, 41/94), low birth weight (23.4%, 22/94), diarrhea (18.1%, 17/94), prematurity (14.9%, 14/94), and jaundice (7.5%, 7/94). Among the babies who died, neonates who had possible serious bacterial infections, low birth weight, localized bacterial infections, and prematurity took the highest proportions with 100% (14/14), 64.3% (9/14), 50% (7/14), and 42.9% (6/14), respectively. Having a maximum of 3 children (AOR = 1.96; 95% CI = 1.1-3.6), having twins or triplets during pregnancy (AOR = 2.43; 95% CI = 1.1-6.1), and lack of antenatal counseling (AOR = 1.83; 95% CI = 1.1-3.3) were among the maternal factors associated with neonatal illness. Having low birth length (AOR = 7.93; 95% CI = 3.6-17.3), and having a poor breastfeeding quality (AOR = 2.37; 95% CI = 1.4-4.0) were found to be the neonatal factors associated with neonatal illness. CONCLUSIONS: This study indicated a high prevalence of neonatal illness symptoms in Northwest Ethiopia. Therefore, early detection, referral and better management of symptoms or conditions with a high mortality, like sepsis and low birth weight are compulsory to save the lives of many neonates. Strengthening the health extension programme to improve antenatal care service utilization and breastfeeding quality of neonates among postpartum women is crucial.


Assuntos
Infecções Bacterianas/epidemiologia , Diarreia/epidemiologia , Instalações de Saúde , Mortalidade Infantil , Doenças do Recém-Nascido/epidemiologia , Icterícia/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Infecções Bacterianas/mortalidade , Aleitamento Materno , Estudos Transversais , Parto Obstétrico , Diarreia/mortalidade , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Icterícia/mortalidade , Nascido Vivo , Masculino , Parto , Gravidez , Nascimento Prematuro/mortalidade , Cuidado Pré-Natal , Prevalência , Adulto Jovem
20.
Popul Health Metr ; 19(Suppl 1): 17, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557859

RESUMO

BACKGROUND: Low birthweight (< 2500 g) is an important marker of maternal health and is associated with neonatal mortality, long-term development and chronic diseases. Household surveys remain an important source of population-based birthweight information, notably Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Surveys (MICS); however, data quality concerns remain. Few studies have addressed how to close these gaps in surveys. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken in five Health and Demographic Surveillance System sites (Matlab-Bangladesh, Dabat-Ethiopia, Kintampo-Ghana, Bandim-Guinea-Bissau, IgangaMayuge-Uganda). Responses to existing DHS/MICS birthweight questions on 14,411 livebirths were analysed and estimated adjusted odds ratios (aORs) associated with reporting weighing, birthweight and heaping reported. Twenty-eight focus group discussions with women and interviewers explored barriers and enablers to reporting birthweight. RESULTS: Almost all women provided responses to birthweight survey questions, taking on average 0.2 min to answer. Of all babies, 62.4% were weighed at birth, 53.8% reported birthweight and 21.1% provided health cards with recorded birthweight. High levels of heterogeneity were observed between sites. Home births and neonatal deaths were less likely to be weighed at birth (home births aOR 0.03(95%CI 0.02-0.03), neonatal deaths (aOR 0.19(95%CI 0.16-0.24)), and when weighed, actual birthweight was less likely to be known (aOR 0.44(95%CI 0.33-0.58), aOR 0.30(95%CI 0.22-0.41)) compared to facility births and post-neonatal survivors. Increased levels of maternal education were associated with increases in reporting weighing and knowing birthweight. Half of recorded birthweights were heaped on multiples of 500 g. Heaping was more common in IgangaMayuge (aOR 14.91(95%CI 11.37-19.55) and Dabat (aOR 14.25(95%CI 10.13-20.3) compared to Bandim. Recalled birthweights were more heaped than those recorded by card (aOR 2.59(95%CI 2.11-3.19)). A gap analysis showed large missed opportunity between facility birth and known birthweight, especially for neonatal deaths. Qualitative data suggested that knowing their baby's weight was perceived as valuable by women in all sites, but lack of measurement and poor communication, alongside social perceptions and spiritual beliefs surrounding birthweight, impacted women's ability to report birthweight. CONCLUSIONS: Substantial data gaps remain for birthweight data in household surveys, even amongst facility births. Improving the accuracy and recording of birthweights, and better communication with women, for example using health cards, could improve survey birthweight data availability and quality.


Assuntos
Mortalidade Infantil , Recém-Nascido de Baixo Peso , Peso ao Nascer , Confiabilidade dos Dados , Feminino , Humanos , Lactente , Recém-Nascido , Inquéritos e Questionários
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