Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

BACKGROUND

Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia.

OBJECTIVES

The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia.

METHODS

A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome.

RESULTS

In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable.

CONCLUSIONS

Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.

Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study

BACKGROUND

Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area.

OBJECTIVE

To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022.

METHODS AND MATERIALS

An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05.

RESULTS

The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety.

CONCLUSION

Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.

Maternal complications and associated factors among mothers who underwent a cesarean section at Gebretsadik Shewa general hospital: an institution based cross-sectional study

Introduction

Cesarean sections have played a major role in lowering maternal morbidity and mortality rates, but are a major concern in developing countries. This study aims to assess the magnitude of maternal complication and its associated factors among women who underwent a cesarean section at Gebretsadik Shewa general hospital, Southwest Ethiopia.

Method

A hospital-based cross-sectional study was conducted in Gebretsadik Shewa general hospital. Data were extracted from 382 mothers' medical charts, retrieved from the labor and operations theatre log book registry using systematic random sampling technique. The extracted data was coded and entered into Epi Data version 3.0, and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. Logistic regression analysis was conducted and significance and strength association was determined considering AOR with a 95% confidence level.

Result

A total of 382 mothers' charts were reviewed; however, 368 charts were eligible for data entry. The age of the participants ranges between 16 and 42 years with mean and standard deviation of 26.1 ± 4.8 years. Maternal complication rate was 30.4% [95% CI: 25.8- 35.1]. Surgical site infection (10.3%), anemia (6.5%) and intraoperative bleeding (4.6%) were the most common. Multivariable logistic regression analysis showed that no antenatal care follow up, medical illness during pregnancy, emergency cesarean section and not receiving a prophylactic antibiotic were statistically associated with maternal complications.

Conclusion

The incidence of maternal complication following cesarean delivery was unduly high. Community based education about antenatal care follow up and its importance should be further strengthened for favorable maternal and fetal outcomes.

Antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama Region, Ethiopia

BACKGROUND

Antenatal physical exercise has roles in health maintenance, prevention, and treatment of disease for pregnant women and fetuses. Different organizations and medical institutions prescribe regular physical exercise during the antenatal period. Despite this, the pregnant populations are less active and decrease their exercise levels during pregnancy than in their non-pregnant state. Therefore, this study aimed to assess antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama regional state, Ethiopia.

METHODS

Institutional based cross-sectional study design was employed, and 600 study participants were interviewed using a systematic sampling technique from 25th September/2021 to 25th November/2021. Data entry was made using Epi-Data software version 3.1 and exported to SPSS version 25 for analysis. A bivariate logistic regression assessed the association between each independent variable and the outcome variable. Explanatory variables with a p-value of less than 0.25 were a candidate for the multivariable logistic regression. Finally, variables with a p-value of less than 0.05 were declared as statistically significant and reported with their AOR and 95% CI.

RESULT

In this study, 25.5% of pregnant women had an adequate practice of antenatal physical exercise while 43.7% of pregnant women had an adequate level of knowledge on antenatal physical exercise An adequate practice of women's antenatal exercise is more likely to occur in women who are exposed to mass media (AOR: 2.43, 95% CI: 1.57, 3.78), Husband college and above educational level (AOR 1.57, 95% CI: 1.05, 6.12), having an adequate level of knowledge (AOR 2.12, 95% CI: 1.13, 3.37), and have of supporting facility (AOR: 2.29, 95% CI: 1.49, 3.51).

CONCLUSION

In this study, three fourth of the study participants had an inadequate level of practice in antenatal physical exercise than the global standard. It shall be beneficial if the city health administration works towards improving pregnant women's knowledge and practice level on physical exercise by providing information using different media outlets. Healthcare providers should broadcast antenatal physical exercise prescriptions in integration with health-related programs.

Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey

Background

Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia.

Methods

A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05.

Results

In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care.

Conclusion

Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.