Khat chewing in pregnant women associated with prelabor rupture of membranes, evidence from eastern Ethiopia

Khat use and related determinants among pregnant women within Haramaya, Ethiopia: a mixed methods study

Introduction

Khat, a green leafy plant grown in East Africa and throughout the Arabian Peninsula, is chewed for its psychoactive and amphetamine-like effects, serving as a significant aspect of culture, economic livelihood, and global trade. Khat consumption during pregnancy has been associated with adverse effects, including anemia, premature rupture of membranes, and low birth weight, among others.

Methods

This cross-sectional, explanatory sequential mixed methods study was conducted in the Haramaya District of eastern Ethiopia using a questionnaire and focus group discussions. Questionnaires assessed socio-demographic information, pregnancy history, and diet, including khat use. Data were analyzed using SPSS v28 to include descriptive statistics, proportions, odds ratios, binary logistic regression, and chi-square analysis. FGDs expanded on the knowledge, attitudes, and practices of khat in the region, including pregnant or lactating women from two different kebeles. Two independent reviewers conducted a qualitative content analysis to examine the qualitative findings from the FGDs. Transcripts from the focus groups were entered into NVivo 14 to aid in capturing salient themes.

Results

A total of 444 pregnant women with a median age of 25 years completed the questionnaire. Two-thirds of the women, 66.9%, reported currently consuming khat while pregnant, and 72.7% of them reported daily consumption. The FGD analysis resulted in the discovery of five themes: Economic Livelihood, Maternal Significance, Medicinal Implications of Khat, Pesticide Use, and Social and Cultural Applications.

Discussion

This study revealed an alarming high prevalence of khat consumption among pregnant women in the Haramaya District, highlighting the pressing need for long-term studies to assess the health consequences. The role of khat as both an economic staple and an energy source for daily activities underscores the challenges in curbing its use. The documented health risks associated with the chemicals used in khat cultivation, including cancer, call for interventions to enhance safe agricultural practices in households involved in khat farming.

Khat chewing among parents and their children: A potential transgenerational effect

Background

Khat has a stimulating and addictive effect and can induce consequences on the health and socioeconomic status of khat chewers.

Objectives

This study aims to assess knowledge, attitude, and practice of khat chewing among parents in Jazan and its consequential effect on their children.

Methods

This cross-sectional investigation was conducted in the Jazan region of Saudi Arabia. Data was collected via a web-based, self-administered questionnaire measuring demographics, knowledge, attitudes, and practices concerning khat chewing. The Chi-square test or Fisher's exact test was used to assess factors associated with khat chewing among parents and its consequential effect on their children.

Results

A total of 724 parents were included. The sample had an overall good knowledge about the health hazards of khat chewing and an attitude against khat chewing. Nonetheless, the number of parents who reported that they had ever tried khat chewing was 200 (27.6%) and 106 parents (14.6%) confirmed that their children were khat chewers. Additionally, 98 (13.5%) parents declared that they practiced khat chewing in front of their children. Higher frequencies of parents who reported providing khat to their children were identified among parents with higher attitude levels that favor khat chewing (P value = 0.04).

Conclusions

Efforts should be made to develop targeted preventive and educational strategies to reduce khat chewing among parents who have favorable attitudes toward khat chewing.

Individual and community-level factors associated with khat (Catha edulis) use among women of reproductive age in Halaba zone, South Ethiopia: a multilevel mixed effect analysis

Introduction

There is a paucity of data on factors associated with khat chewing among women of reproductive age using multilevel analysis. Furthermore, the effects of some potential factors like stressful life events, knowledge about and attitude toward the effects of khat have been given little attention and are not well understood. Therefore, this study aimed to examine the prevalence and multilevel factors associated with khat use among women of reproductive age in Halaba zone, South Ethiopia.

Methods

A community-based cross sectional study was conducted in Halaba zone from February to July, 2023. Systematic random sampling technique was used to include 1573 study participants. The dependent variable was current khat use, which is operationalized as using khat within 30 days preceding the study. An interviewer administered questionnaire was used for the data collection.

Results

The prevalence of current khat use among women of reproductive age was 65.9% [95%CI (63.5-68.2%)]. Factors significantly associated with khat use were; ages of women 35 and above years [Adjusted Odds Ratio (AOR) = 6.35, 95% CI: (3.62, 11.13)], ever married [AOR = 2.41, 95% CI: (1.10, 5.31)], secondary and above education [AOR = 0.28, 95% CI: (0.15, 0.49)], belong to richer household [AOR = 1.75, 95% CI: (1.12, 2.75)], mass media use [AOR = 3.12, 95% CI: (1.85, 4.81)], low knowledge about khat effects [AOR = 3.12, 95% CI: (1.85, 5.24)], positive attitude towards khat use [AOR = 11.55, 95% CI: (6.76, 19.71)], and strong social support [AOR = 0.43, 95% CI: (0.28, 0.64)] and non-user friend [AOR = 0.31, 95% CI: (0.20, 0.48)]. From the community level variables: rural residence [AOR = 5.06, 95% CI: (1.82, 14.09)] was significantly associated with khat use.

Conclusion

Khat use among women of reproductive age was found to be very high. From individual-level factors: advanced ages of women, secondary and above education, live in the richer wealth quintile, mass media exposure, low knowledge on khat effects, positive attitude towards khat use, strong social support, and from community-level variables: residing in rural area were significantly associated with khat use. Khat use screening for all women of childbearing age, as well as referral to substance use disorder centers for those women identified as having khat use disorder, should become a standard of care in all health facilities.

In Vitro Filaricidal Properties of Aqueous Extracts of Combretum nigricans (Combretaceae) on Onchocerca ochengi (Onchocercidae)

Aim

Onchocerciasis is an endemic parasitic disease in sub-Saharan Africa that significantly impacts animal and human health. In Northern Cameroon, medicinal plants from the Combretum genus are used for onchocerciasis traditional treatment although there is no scientific evidence of their antifilarial potential. This study evaluates the in vitro macro- and microfilaricidal properties of water extracts from Combretum nigricans in Onchocerca ochengi. Material and Methods. O. ochengi microfilariae and adult male worms were recovered from cowhide fragments. Oxidative stress indicators and motility tests were used to assess the filaricidal impact. Female albino rats were used to test for acute toxicity. The contents of secondary metabolites were quantified.

Results

The bark aqueous extract was more active on macrofilariae at 1 mg/mL for 24 h (100%) than the leaf (63.9%) and root (75%) extracts at the same concentration. Likewise, a stronger microfilaricidal effect was found with this extract at 0.5 mg/mL for 1 h (100%) compared to root and leaf extracts. The dose-response effect with the bark extract gave an inhibitory concentration 50 (IC50) of 351 μg/mL vs. 113 μg/mL for flubendazole after 24 h incubation, while the microfilaricidal efficacy revealed an IC50 of 158.7 μg/mL vs. 54.09 μg/mL for ivermectin after one-hour incubation. Examining stress indicators on parasite homogenates showed that macrofilaricidal activity is associated with a significant increase in nitric oxide, glutathione, and malondialdehyde generation and a decrease in catalase activity. At 2000 mg/kg, rats showed no harm. The phytochemical investigation revealed that the barks contained more phenolic acids, condensed tannins, flavonoids, and saponins than the leaves (p < 0.001).

Conclusion

These findings support C. nigricans' antifilarial activity and identify oxidative stress indicators as prospective treatment targets in O. ochengi. It would be interesting to conduct in vivo studies to understand their antifilarial activity better.

Predictors and perinatal outcomes of pre-labor rupture of membrane among pregnant women admitted to Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: a retrospective study

Background

Pre-labor rupture of membrane (PROM) refers to a membrane rupture that occurs after the 28th week of pregnancy but before the start of labor. If not appropriately managed, it poses a significant risk to the health of the mother and fetus. However, information on the magnitude of PROM, contributing factors, and its perinatal outcomes was limited in Eastern Ethiopia. This study assessed the prevalence, predictors, and perinatal outcomes of PROM among pregnant women admitted to Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) in Eastern Ethiopia so as to guide specific preventive measures.

Methods

A hospital-based retrospective cross-sectional study was carried out from May 15 to June 14, 2022, and data were gathered by reviewing the chart records of 424 pregnant women who were admitted to maternity and labor wards in the previous two years, from January 1, 2019 to December 31, 2020. Records were chosen using a simple random sampling method. Mother's socio-demographic traits, previous obstetric and gynecologic history, current pregnancy history, habit-related history (khat chewing), ultrasound findings, laboratory investigations, mode of delivery, maternal and perinatal outcomes were extracted from the maternal charts. Bi-variable and multivariable logistic regression analyses were performed to identify predictors of pre-labor membrane rupture. The association between the explanatory and outcome variables was expressed using an adjusted odds ratio with a 95% confidence interval.

Results

The prevalence of pre-labor membrane rupture was 16.27% with 95% CI: (13.05-20.11). Among 69 women who experienced pre-labor rupture of membrane, 50 (72.5%) of them had adverse perinatal outcomes. Of all 69 neonates 17 (24.64%) were delivered with low birth weight and 20 (29%) of them were born preterm. The overall perinatal mortality rate was 10.1% or 101 per 1,000 live births. History of abortion [AOR = 2.61; 95% CI (1.09, 6.24)], urinary tract infection [AOR = 2.59; 95% CI (1.23, 5.42)], antepartum hemorrhage [AOR = 3.35; 95% CI (1.38, 8.13)], and khat chewing (a leafy plant which contains psychoactive chemical) in the current pregnancy [AOR = 2.63; 95% CI (1.49, 4.63)] were all significantly associated with pre-labor rupture of membrane.

Conclusion

In this study, the magnitude of pre-labor membrane rupture was relatively high compared to the global rate. Prenatal risk identification and early detection of complications among mothers with a history of abortion, antepartum hemorrhage, urinary tract infection, and counseling on the effects of khat chewing during pregnancy are crucial to reduce the likelihood of pre-labor membrane rupture and its adverse perinatal outcome.

Development and Validation of a Risk Prediction Model to Estimate the Risk of Stroke Among Hypertensive Patients in University of Gondar Comprehensive Specialized Hospital, Gondar, 2012 to 2022

Background

A risk prediction model to predict the risk of stroke has been developed for hypertensive patients. However, the discriminating power is poor, and the predictors are not easily accessible in low-income countries. Therefore, developing a validated risk prediction model to estimate the risk of stroke could help physicians to choose optimal treatment and precisely estimate the risk of stroke.

Objective

This study aims to develop and validate a risk prediction model to estimate the risk of stroke among hypertensive patients at the University of Gondar Comprehensive Specialized Hospital.

Methods

A retrospective follow-up study was conducted among 743 hypertensive patients between September 01/2012 and January 31/2022. The participants were selected using a simple random sampling technique. Model performance was evaluated using discrimination, calibration, and Brier scores. Internal validity and clinical utility were evaluated using bootstrapping and a decision curve analysis.

Results

Incidence of stroke was 31.4 per 1000 person-years (95% CI: 26.0, 37.7). Combinations of six predictors were selected for model development (sex, residence, baseline diastolic blood pressure, comorbidity, diabetes, and uncontrolled hypertension). In multivariable logistic regression, the discriminatory power of the model was 0.973 (95% CI: 0.959, 0.987). Calibration plot illustrated an overlap between the probabilities of the predicted and actual observed risks after 10,000 times bootstrap re-sampling, with a sensitivity of 92.79%, specificity 93.51%, and accuracy of 93.41%. The decision curve analysis demonstrated that the net benefit of the model was better than other intervention strategies, starting from the initial point.

Conclusion

An internally validated, accurate prediction model was developed and visualized in a nomogram. The model is then changed to an offline mobile web-based application to facilitate clinical applicability. The authors recommend that other researchers eternally validate the model.

A systemic review and meta-analysis on the prevalence and associated factors of hypertension among adult clients in Ethiopia

Background

Hypertension is a major risk factor for premature mortality and excessive morbidity in the world. It is a growing public health problem in developing countries including Ethiopia. It is a silent killer. Information on the prevalence of hypertension and its associated factors is to be considered vital to focus on early diagnosis and improve prevention and control of cardiovascular diseases. However, on the prevalence and contributing factors of hypertension in Ethiopia, there is a dearth of information. Thus, this review aimed to estimate the pooled prevalence of hypertension and its contributing factors among Ethiopia's adult population.

Objective

The main objective of this study was to provide pooled evidence on the prevalence of hypertension among the adult population in Ethiopia.

Methods and material

This systematic review and meta-analysis were searched through MEDLINE/ Pub Med, Cochrane Library, and Google Scholar by using different search terms on the prevalence of hypertension and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. Egger's test was used to show the publication bias. The pooled prevalence of HDP and the odds ratio (OR) with 95% confidence interval were presented using forest plots.

Results

A total of 22 studies with 14,202 participants were included in this review and the overall estimated prevalence of hypertension among the adult population in Ethiopia was 28.02% (95% CI (23.89%, 32.15%). Age 4.37(2.71, 6.04), sex (AOR=2.54, 95% CI: 1.00-4.09), family history of hypertension (AOR=3.05, 95% CI, 1.89, 4.21), inactive physical exercise (AOR=2.67, 95% CI: 1.38, 3.97), being obese (AOR=3.94, 95CI:2.83, 5.06), khat chewing (AOR=3.73, 95% CI: 2.65, 4.80), salt consumption (AOR=4.20, 95% CI: 1.55, 6.86) were significantly associated factors. Subgroup meta-analysis done by region showed that a higher in Tigray region 52.19(46.54, 57.66), and the lower was observed in Harare region1 2.71 (9.54, 15.87).

Conclusion

The prevalence of hypertension among the adult population in Ethiopia is high. Healthcare professionals and other stakeholders should give attention to the early detection of hypertension in Ethiopia to reduce the burden of the disorder.

Khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia: a community-based study

Introduction

Despite its deleterious consequences, khat chewing is escalating worldwide. However, there is a lack of evidence about the extent of khat chewing among pregnant women in Ethiopia, particularly in the current study area. Therefore, this study aimed to assess the prevalence of current khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia.

Methods

This community-based cross-sectional study was conducted in Chiro district from November 1 to 30, 2022 G.C. Study participants were selected using the systematic random sampling technique. An interview-administered structured questionnaire was used to collect data through a house-to-house survey. The data were entered into EpiData version 3.1 and analyzed in STATA 14 software. Characteristics of study participants were summarized using descriptive analysis, and binary logistic regression was used to identify determinants of khat chewing.

Results

A total of 409 pregnant women participated in this study, with a response rate of 99%. The overall prevalence of khat chewing was 60.4% (95% CI: 55.5%, 65.2%). Religion (AOR: 2.08; 95% CI: 1.13, 3.82), khat cultivation (AOR: 0.43; 95% CI: 0.25, 0.77), partner khat use (AOR: 5.54; 95% CI: 3.11, 9.88), pre-pregnancy khat use (AOR: 9.95; 95% CI: 5.55, 17.81), antenatal care (ANC) visit (AOR: 2.71; 95% CI: 1.41, 5.21), and mental distress (AOR: 4.89; 95% CI: 2.38, 10.02) were significantly associated with current khat chewing.

Conclusion

The majority of pregnant women in the study area practice khat chewing. Thus, accessible and comprehensive pre-conception and pre-natal care incorporating the prevention and management of antenatal khat chewing is crucial to overcome this problem. Provision of mental healthcare involving partners of pregnant women is also important to reduce the extent and impacts of khat chewing during pregnancy. Further longitudinal studies triangulated with qualitative designs are recommended.

The epidemiology of khat (catha edulis) chewing and alcohol consumption among pregnant women in Ethiopia: A systematic review and meta-analysis

The use of khat (Catha edulis) and alcohol during pregnancy is a serious public health problem that has been associated with a number of harmful outcomes for both the fetus and the mother's health. There has been no systematic review with meta-analysis to determine risk factors associated with khat and alcohol use among pregnant women in Ethiopia. Therefore, we aimed to determine the pooled prevalence and risk factors of khat and alcohol use during pregnancy in Ethiopia. This review has been registered in PROSPERO with protocol ID: CRD42023395115. Studies identified from PubMed, Google Scholar, the WHO African Index Medicus, the Cochrane Library, African Journal Online, and Science Direct. Articles published from January 1, 2000 to February 10, 2023 were included. We searched for articles that included any combination of the following key terms: "khat", "qat", "alcohol", "ethanol", "prevalence", "factors", "pregnant" and "Ethiopia". Two reviewers worked independently to screen studies and extract data. A funnel plot and Egger's regression test were used to test publication bias. A forest plot was used to present the pooled prevalence and odds ratio with a 95% confidence interval (CI) using the random effect model. I2 metrics were used to assess heterogeneity. The meta-analysis was carried out with Stata 14.0 software. Nine hundred sixty-two records were retrieved from different sources, and 23 studies were included in the final analysis. The pooled prevalence of khat use and alcohol drinking during pregnancy was 26.6% (95% CI 17.8, 35.5) and 31.65% (95% CI: 21.8, 41.5), respectively. Partner khat use (OR 5.9 [95% CI (2.4, 14.5)]) was associated factor for khat use during pregnancy. Low educational level (OR 2.54 [95% CI (1.8, 3.5)]), pre-pregnancy alcohol use (OR 3.5 [95% CI (2.6, 4.7)]), unplanned pregnancy (OR 2.7 [95% CI (1.8, 4.0)]), history of abortion (OR 2.3 [95% CI (1.4, 3.7)]), poor social support (OR 3.3 [95% CI (2.0, 5.3)]), and mental distress (OR 2.6 [95% CI (2.0, 3.3)]) were associated factors for alcohol drinking during pregnancy. This review indicated that the magnitude of khat and alcohol use during pregnancy in Ethiopia was high. Targeted interventions for groups of pregnant women at high risk of khat and alcohol use are urgently needed. Community-based health education interventions and point-of-sale warnings are essential to reduce the burden. Future studies should consider the influence of community-level factors on khat and alcohol use during pregnancy.

Determinants of term premature rupture of membrane: case-control study in Saint Paul's Millennium Medical College Hospital, Addis Ababa, Ethiopia

BACKGROUND

The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications.

OBJECTIVES

This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia.

METHODS

This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul's hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05.

RESULTS

Factors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane.

CONCLUSION

Proper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.

The effects of khat use during pregnancy on perinatal and maternal outcomes: a meta-analysis

Chewing khat during pregnancy adversely affects maternal and fetal health, but available studies are scarce and inconsistent, and it is difficult to conclude the relationship between khat consumption and perinatal outcomes. We aimed to investigate the available studies on the effect of khat use during pregnancy on perinatal and maternal outcomes. For this meta-analysis, we conducted a thorough search of articles published in PubMed, Embase, Scopus, and Web of Science up to the date this search was undertaken (03.01.2022). We used random effect model with the Mantel-Haenszel method to calculate the pooled odds ratio and mean difference. We found that khat use during pregnancy was significantly associated with increased odds of low birth weight (OR:2.51; 95% CI: 1.60 to 3.94), congenital anomalies (OR:3.17; 95% CI: 1.30 to 7.73), premature rupture of membrane (OR: 1.99; 95% CI: 1.59 to 2.50), perinatal mortality (OR: 1.95; 95% CI: 1.26 to 3.03), and lower APGAR scores at the fifth minute (MD: -1.7; 95% CI: -2.32 to -1.07). Also, increased odds for developing maternal psychological stress and anemia were reported in women using khat during pregnancy. There were no statistically significant differences in stillbirth and preterm birth between women using khat during pregnancy and their counterparts. Since prenatal khat use is associated with adverse perinatal and maternal outcomes, we strongly recommend equitable and easily accessible health services through the implementation of integrated addiction treatment with maternity services to address khat use during pregnancy and encourage the practice of healthy behavior of women.

The impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers

Khat is a flowering plant whose leaves and stems are chewed for excitement purposes in most of east African and Arabian countries. Khat can cause mood changes, increased alertness, hyperactivity, anxiety, elevated blood pressure, and heart diseases. However, the effect of khat on the heart has not been studied exclusively. The purpose of this study was to investigate the impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers. ECG signals were recorded from 50 subjects (25 chewers and 25 controls) before and after chewing session to investigate the effect of khat on heart activity. In addition, ECG signals from 5 subjects were recorded on the first and eightieth day of rehabilitation therapy for investigating the effect of rehabilitation from khat addiction. All the collected signals were annotated, denoised and features were extracted and analysed. After chewing khat, the average heart rate of the chewers was increased by 5.85%, with 3 subjects out of 25 were prone to tachycardia. 1.66% QRS duration and 23.56% R-peak amplitude reduction were observed after chewing session. Moreover, heart rate variability was reduced by 19.74% indicating the effect of khat on suppressing sympathetic and parasympathetic nerve actions. After rehabilitation therapy, the average heart rate was reduced by 11.66%, while heart rate variability (HRV), QRS duration, and RR interval were increased by 25%, 3.49%, and 12.53%, respectively. Statistical analysis results also confirmed that there is a significance change (p < 0.05) in ECG feature among pre- and post-chewing session. Our findings demonstrate that, khat chewing raises heart rate, lowers heart rate variability, or puts the heart under stress by lowering R-peak amplitude and QRS duration, which in turn increases the risk of premature ventricular contraction and arrhythmia. The results also show that rehabilitation therapy from khat addiction has a major impact on restoring cardiac activity to normal levels.

Khat use and associated factors during pregnancy in eastern Ethiopia: A community-based cross-sectional study

INTRODUCTION

Women of reproductive age are increasingly using khat. The use of khat is associated with prelabor rupture of membranes, anemia among pregnant women, and other problems related to motherhood and infanthood. Most of the previous studies performed at the facility level revealed that different factors were associated with khat use among pregnant women. Lower educational status, low wealth index, and the age of the mother were the factors significantly associated with maternal khat use. Partner substance use also has a significant association with maternal khat use. However, there is limited information about khat use and its associated factors among pregnant women in the study area.

OBJECTIVE

This study aims at assessing the prevalence of khat use and associated factors among pregnant women in Kersa and Haramaya Health and Demographic Surveillance System Sites, eastern Ethiopia.

METHODS

A community-based cross-sectional study design was employed among randomly selected 1,015 pregnant women from an open cohort from Kersa and Haramaya Health and Demographic Surveillance System Sites in Ethiopia. Data were collected through face-to-face interviews from January 30 to April 30, 2021, using Open Data Kit (ODK) software and analyzed using SPSS v-26. Descriptive statistics were used to summarize the characteristics of pregnant women. Factors associated with khat use were identified by bivariate and multivariable logistic regression analyses; an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated. Statistical significance was declared at p < 0.05.

RESULTS

The prevalence of khat use among pregnant women was 15.5% (95% CI, 13.3-17.7). Age of the pregnant women; being in the age group between 25 and 35 years (AOR = 2.27, 95% CI, 1.33-4.89) and 35 years and greater (AOR = 2.33, 95% CI, 1.29-4.20); having a chronic medical illness (AOR = 3.28, 95% CI, 1.27-8.48); and having a history of abortion (AOR = 2.87 95% CI, 1.73-4.76) significantly increased the likelihood of khat use among pregnant women.

CONCLUSION

The current study revealed a relatively high magnitude of khat use in pregnant women as compared with previous studies. The age of the pregnant women, history of medical illness, and history of abortion were significantly associated with khat use during pregnancy.

Descriptive epidemiology of external structural birth defects in Enugu State, Nigeria

Objectives

To determine the birth prevalence, trend, and characteristics of external structural birth defects occurrence in Enugu Metropolis, Nigeria.

Design

Cross-sectional study involving review of delivery records.

Setting

The study was conducted at three tertiary hospitals, one public and two missionary, in Enugu Metropolis.

Participants

Mothers and their babies delivered between 1 January 2009 and 31 December 2016 in the study facilities.

Main outcome measures

Birth prevalence of defects presented as frequency/10,000 births. Other descriptive variables are presented as frequencies and percentages.

Results

There were 21530 births with 133 birth defects (birth prevalence: 61.8/10,000 births) and 1176 stillbirths (stillbirth rate: 54.6/1000 births). The frequencies and birth prevalence (/10,000 births) of recorded defects were: Limb deformities 60(27.9), Neural tube defects (NTDs): 36(16.7), Urogenital system defects: 12(5.6), Gastrointestinal system defects 10(4.6) and Orofacial clefts 4(1.9). Birth defects occurrence showed a rising trend from 2009 to 2016. The mean (SD) age of mothers whose babies had Birth defects was 29.1(4.7) years. Only 62(46.6%) of 133 antenatal clinic folders of these women were traceable for further review. Eighteen (29.0%) had febrile illness in early pregnancy, 9(14.5%) had Malaria, 17(27.4%) had <4 antenatal clinic attendance, 7(11.3%) did not take folic acid and 6(9.7%) took herbal medications during pregnancy.

Conclusions

Birth defects occurrence showed a rising trend with limb deformities and NTDs having the highest prevalence. Record keeping was poor at the facilities. Birth defects preventive interventions like folic acid supplementation for women-of-childbearing age should be promoted in Enugu Metropolis.

Funding

This work was supported by the non-communicable disease Minigrant from the Task Force for Global Health, Decatur, Georgia, USA (TPN-FE-NCD-C2-IFO-9).

High infection rates for onchocerciasis and soil-transmitted helminthiasis in children under five not receiving preventive chemotherapy: a bottleneck to elimination

BACKGROUND

The current mainstay for control/elimination of onchocerciasis and soil-transmitted helminthiasis (STH) relies on ivermectin- and mebendazole/albendazole-based preventive chemotherapies. However, children under five years of age have been excluded in both research activities and control programs, because they were believed to have insignificant infection rates. There is therefore a need for up-to-date knowledge on the prevalence and intensity of STH and onchocerciasis infections in this age group. This study aimed at assessing the rates and intensities of onchocerciasis and STH infections in children under five years of age who are excluded from ivermectin- or mebendazole/albendazole-based preventive chemotherapies.

METHODS

A series of cross-sectional surveys was conducted in four Health Districts in the Centre and Littoral Regions of Cameroon between 2018 and 2019. All subjects aged 2 to 4 years, were screened for prevalence (or infection rate) and intensity [number of eggs per gram of stool (epg) or number of microfilariae per skin snip (mf/ss)] of STH and onchocerciasis infections respectively using the Kato-Katz and skin snip methodologies. Chi-square and the non-parametric tests (Mann Whitney and Kruskal Wallis) were used to compare infection rates and intensities of infections between Health Districts and genders, respectively.

RESULTS

A total of 421 children were enrolled in this study. The overall prevalence of onchocerciasis was 6.6% [95% confidence interval (CI): 4.3‒9.9], ranging from 3.6% (in the Ntui Health District) to 12.2% (in the Bafia Health District). The intensity of infection ranged from 0.5 to 46 microfilariae per skin snip [median: 5; interquartile range (IQR): 2.25‒8.5]. The overall prevalence of STH was 9.6% (95% CI: 6.5‒13.9), with a high infection rate (29.6%) in the Akonolinga Health District. Two STH species (Ascaris lumbricoides and Trichuris trichiura) were found among infected individuals. The median intensities of STH infections were 1,992 epg (IQR: 210‒28,704) and 96 epg (IQR: 48‒168) for A. lumbricoides and T. trichiura, respectively.

CONCLUSIONS

This study reveals that children < 5 years of age are highly infected with STH and onchocerciasis, and could contribute to the spread of these diseases, perpetuating a vicious circle of transmission and hampering elimination efforts. These findings reveal the urgent need to provide (or scale) treatments (likely pediatric formulations) to these preschool-aged children, especially in areas of high transmission, to accelerate efforts to reach WHO 2030 target.

Plasmid-mediated quinolone resistance determinants in clinical bacterial pathogens isolated from the Western Region of Ghana: a cross-sectional study

Introduction

quinolones are critically important antibiotics that are reserved for treating very severe infections caused by multidrug-resistant bacterial pathogens. However, their indiscriminate uses have resulted in an increased number of resistant strains in many parts of the world including Ghana. We determined the quinolone resistance profile of Gram-negative bacterial pathogens and characterized the underlying molecular determinants of resistance.

Methods

Gram-negative pathogens obtained from clinical specimens at three hospital laboratories were tested for resistance to quinolones and other commonly used antibiotics. ESBL production among the Enterobacterial isolates was confirmed using the combined disc diffusion method. We then used PCR to determine seven types of plasmid-mediated quinolone resistance genes present in the isolates resistant to nalidixic acid and ciprofloxacin.

Results

in this study, 29.5% of the isolates were resistant to ciprofloxacin, with the highest of 50% among E. coli resistance to the other quinolones was levofloxacin (24.4%), norfloxacin (24.9%), and nalidixic acid (38.9%). Significant proportions of the quinolone-resistant isolates were ESBL producers (P-values < 0.001). The aac(6´)-Ib-cr, qnrS, oqxA, and qepA genes were present in 43 (89.6%), 27 (56.3%), 23 (47.9%), and one (2.1%) of the isolates, respectively. None of the isolates tested positive to qnrA, qnrB, and oqxB genes. The presence of the aac(6´)-Ib-cr gene positively correlated with resistance to ceftriaxone, cefotaxime, and gentamicin (P-values < 0.05).

Conclusion

high proportions of Gram-negative bacterial isolates were resistant to quinolones and most of these isolates possessed multiple PMQR genes. There is a need to implement measures to limit the spread of these organisms.

Prevalence of premature rupture of membrane and its associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis

Background

Premature rupture of the membrane is a serious public health problem, especially in low- and middle-income countries with significant maternal and perinatal morbidity and mortality. Despite its substantial contributions to feto-maternal complications, the burden of premature rupture of the membrane was not systematically analyzed in Ethiopia. Hence, this review aimed to identify the burden of premature rupture of the membrane and associated factors among pregnant women in Ethiopia.

Methods

PubMed/Medline, Scopus, and African journal online databases and Google Scholar were searched for articles published in the English language. Independent review authors selected and screened studies. Appraisal for methodological quality of studies was conducted using the Joanna Briggs Institute assessment checklist. RevMan 5.3 software was used for meta-analysis. The I ² statistical significance and Egger's test were used to assess heterogeneity and publication bias, respectively.

Results

The pooled prevalence of premature rupture of the membrane among pregnant women in Ethiopia was 9.2% (95% confidence interval = 5.0, 16.4). Factors significantly associated with premature rupture of the membrane were no antenatal care visit (odds ratio = 2.87, confidence interval = 1.34, 6.14), history of premature rupture of the membrane (odds ratio = 4.09, 95% confidence interval = 2.82, 5.91), history of abortion (odds ratio = 3.13, confidence interval = 1.63, 6.01), abnormal vaginal discharge (odds ratio = 6.78, confidence interval = 4.11, 11.16), and urinary tract infection (odds ratio = 3.04, confidence interval = 1.21, 7.63).

Conclusion

Nearly one in ten pregnancies in Ethiopia encounters premature rupture of the membrane complications. The finding highlights improving antenatal care utilization, thus preventing or treating urinary and reproductive tract infections, and tailored interventions for pregnant women with a history of premature rupture of the membrane or abortion contribute to reduced premature rupture of the membrane.