Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey.

BACKGROUND: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. METHODS: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. RESULTS: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10-74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47-6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34-5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19-5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68-133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99-6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43-350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88-14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77-3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35-21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). CONCLUSION: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.

Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study.

Introduction: Global, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020-June 20/2020) in the rural Arsi zone of Ethiopia. Methods: A community-based Phenomenological study was conducted from January 10-25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020-June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. Results: Four major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. Conclusions: COVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Determinants of Unsuccessful TB Treatment Outcomes Among Patients on Directly Observed Treatment Short Course in Jimma Town Health Facilities, Southwest Ethiopia: A Case-Control Study.

Background: Even though Ethiopia's Federal Ministry of Health has been implementing several programs aimed at reducing the burden of tuberculosis (TB), It does not demonstrate adequate progress. As a result, identifying the determinants of unsuccessful outcomes of directly observed treatment, short-course (DOTS) is critical. Purpose: This study aimed to assess the determinants of unsuccessful TB treatment outcomes among patients with DOTS in Jimma town, southwest Ethiopia. Patients and Methods: An unmatched case-control study using secondary data was conducted among 118 cases and 472 controls from April 1 to June 1, 2021. Cases were TB cases with unsuccessful treatment courses whereas controls were those of successful treatment. Data were collected using a standardized tool. Statistical analysis was done using SPSS version 23 software. A binary logistic regression model was used to identify the determinants. Results: We found that the determinants including age > 35 years (AOR=1.9, 95% CI: 1.14-3.2), lack of contact person (AOR= 27, 95% CI: 15.8-46.3), being HIV positive (AOR=7.3, 95% CI: 3.7-14.2)), and being malnourished (AOR=4.5, 95% CI: 1.5-12.9) were significantly associated with unsuccessful tuberculosis treatment outcome. Conclusion: In this study, advanced age, being HIV positive, lack of contact person, and being malnourished were determinant factors for unsuccessful TB treatment outcomes. Hence, careful monitoring, screening, and management of risk factors are recommended.

Sexual Coercion is Associated with HIV Risk Behavior Among Female Waiters in Jimma Town, Southwest Ethiopia.

Background: Female waiters are at higher risk of workplace violence including sexual coercion. Even though there are numerous studies on the prevalence of sexual coercion among students, nurses, adolescents, and young pregnant women, studies on the prevalence of sexual coercion among female waiters are limited. Furthermore, there is no evidence existed that show a relationship between sexual coercion and HIV risk behavior in Ethiopia. Purpose: The purpose of this study was to examine the relationship between sexual coercion and HIV risk behavior among female waiters in Jimma, southwest Ethiopia. Patients and Methods: We conducted a cross-sectional survey from 1st April to 30, 2018, among 420 female waiters of reproductive age working in the licensed food and drinking establishments in Jimma town. A structured interviewer-administered questionnaire was used to collect data. Statistical analysis was conducted with SPSS version 21 statistical software. A binary logistic regression model was used to determine the association between independent variables and outcome variables. Results: The lifetime prevalence of sexual coercion among female waiters was 71.4% (95% confidence interval: 67.1-76.8). More than two-thirds (71.6%) of female waiters engaged in HIV-related risk behaviors. Working in the bar (AOR 4.64, 95% CI: 2.15-10.0), being a substance user (AOR 3.37, 95% CI: 1.7-6.7), experiencing sexual coercion (AOR 7.6, 95% CI: 3.8-15.3) were significantly associated with HIV risk behaviors. Conclusion: A significant number of female waiters experienced sexual coercion and engaged in HIV-risk behaviors. Workplace, substance use, and sexual coercion were significantly associated with HIV risk behavior. As a result, establishments, town health offices, and other stakeholders should work together to safeguard female waiters from the burdens of sexual coercion, HIV risk behavior, and sexually transmitted infections.

The two faces of preeclampsia / A praeeclampsia két arca

During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence and also the extreme extent regarding the volume expansion are likely accompanied with serious conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and proteinuria during the second half of pregnancy, is not a homogenous disease. The early onset which begins prior to the 34th week, is characteristically a hypovolemia-associated form and depicts the placental origination, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and microthrombosis. Fetal blood supply progressively worsens due to placental insufficiency. The outcome of this condition often leads to fetal death, eclampsia, or placental abruption. Management is confined to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function. The late onset form, associated with high cardiac output, is a maternal disease, in which obesity is a risk factor since it predisposes individuals to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, low extremity edema often times progresses to a generalized form and frequently results in hypertension. In several cases proteinuria appears. This condition entirely meets the preedampsia criteria. Fetal weight is normal or frequently over the average. It is very likely, the increasing parenchymal stasis will lead to ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preedampsia, the administration of diuretic furosemide treatment seemingly offers promise.

Characteristics of Homebirth in Hungary: A Retrospective Cohort Study.

Homebirth is legal and has been regulated by law in Hungary since 2012. Despite the obvious advantages of homebirth, it has not yet been broadly accepted, due to various opinions related to safety and risks associated with giving birth outside of a hospital. Our study aimed at exploring both real maternal and feto-neonatal characteristics associated with Hungarian homebirths. A total of 2997 cases were considered in support of our retrospective cohort study. In the examined period, there was a significant, continual rise in the number of homebirths by a rate of 0.22% on average per year. Aggregated maternal complications (primary uterine inertia, prolonged second stage labour, and third stage haemorrhage) were prevalent among homebirth cases (1.29% vs. 0.72%, p < 0.05) and were associated with an average of 11.77% rate of transfer to a health care institution. On the other hand, the rate of operative (vaginal or caesarean) delivery was 26.31% among institutionalized births. A slightly better Apgar score and relatively high rate (20%) of caesarean deliveries were correlated with institutionalized births (p < 0.05). However, the overall intervention rate was lower among homebirths (0.11% vs. 42.57%) than institutional birth cases (p < 0.001). Overall, homebirth is a reliable option for childbirth for healthy and low-risk mothers with uncomplicated pregnancies, which is reflected in the increasing number of deliveries at home in Hungary. Furthermore, utilizing the experiences of countries where homebirth is a long-established method may further improve the outcome of homebirths in Hungary.

Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration.

During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence coupled with the extreme extent regarding the volume expansion, are likely accompanied with pathological conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and organ deficiency, such as proteinuria during the second half of pregnancy, is not a homogenous disease. Clinically speaking, two main types of preeclampsia can be distinguished, in which a marked difference between them is vascular condition, and consequently, the blood volume. The "classic" preeclampsia, as a two-phase disease, described in the first, latent phase, in which, placenta development is diminished. Agents from this malperfused placenta generate a maternal disease, the second phase, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and thrombotic microangiopathy. In this hypovolemia-associated condition, decreasing platelet count, signs of hemolysis, renal and liver involvement are characteristic findings; proteinuria is marked and increasing. In the terminal phase, visible edema develops due to increasing capillary transparency, augmenting end-organ damages. "Classic" preeclampsia is a severe and quickly progressing condition with placental insufficiency and consequent fetal growth restriction and oligohydramnios. The outcome of this condition often leads to fetal hypoxia, eclampsia or placental abruption. The management is limited to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function, careful diminishing high blood pressure, and delivery induction in due time. The other subtype, associated with relaxed vasculature and high cardiac output, is a maternal disease, in which obesity is an important risk factor since predisposes to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, enhanced water retention leads to lowered extremity edema, which oftentimes progresses to a generalized form and hypertension. In several cases, proteinuria appears most likely due to tissue edema. This condition already fully meets preeclampsia criteria. Laboratory alterations, including proteinuria, are modest and platelet count remains within the normal range. Fetal weight is also normal or frequently over average due to enhanced placental blood supply. It is very likely, further water retention leads to venous congestion, a parenchyma stasis, responsible for ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preeclampsia, the administration of diuretic furosemide treatment seemingly offers promise.