1
|
Tsadik M, Gebretnsae H, Ayalew A, Asgedom AA, Gebreyesus A, Hagos T, Abrha M, Weldegerima K, Abrha B, Gebre G, Hagos M, Esayas R, Gebregeorgis M, Gesesew HA, Mulugeta A. Child health services and armed conflict in Tigray, North Ethiopia: a community-based study. Confl Health 2023; 17:47. [PMID: 37798759 PMCID: PMC10557173 DOI: 10.1186/s13031-023-00545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Access to basic health services, notably child health services, is severely hampered by the armed conflict in Tigray, North Ethiopia. Little is known regarding the impacts of the armed conflict during the war in Tigray on access to child health services. The current study investigates the impact of the armed conflict on the utilization of child health services in Tigray. METHODS 4,381 caregivers from randomly recruited households (HHs) with at least one child younger than 1 year old participated in a community-based cross-sectional survey. We collected data on childhood immunizations and illness-related treatment seeking from August 4 to 20, 2021. We describe data using frequency and percentage and carry out an internal comparison among the study participants using chi-square tests. RESULTS 4,381 children under the age of one included in the study. In total, 39% of infants received no basic vaccines, 61.3% of the children under the age of one received at least one vaccine, and 20% received all the vaccinations recommended for their age. About 61% of children were affected by at least one childhood ailments where majority of them were from rural areas. Mothers who did not seek postnatal care (PNC) were responsible for more than 75% of reported childhood illnesses. CONCLUSIONS A sizable portion of children were unvaccinated and had at least one childhood sickness while the war was in progress. Particularly, people who live in rural areas reported a higher percentage of children's illnesses but a lower use of child health services. To lower childhood morbidity and mortality in the besieged area, such as Tigray, local to global actors need to get coordinated and warrying parties should stop weaponization of vaccination healthcare services.
Collapse
Affiliation(s)
- Mache Tsadik
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | | | - Asefa Ayalew
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Akeza Awealom Asgedom
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Aregawi Gebreyesus
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Tigist Hagos
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Marta Abrha
- School of Medicine, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Kiros Weldegerima
- School of Medicine, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Birikti Abrha
- School of Midwifery, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Gelawdiwos Gebre
- School of Midwifery, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Mulubrhan Hagos
- School of Midwifery, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| | - Rie Esayas
- Tigray Regional Health Bureau, Tigray, 07, Ethiopia
| | | | - Hailay Abrha Gesesew
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia.
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000, Australia.
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, 231, Ethiopia
| |
Collapse
|
2
|
Teka H, Yemane A, Abraha HE, Berhe E, Tadesse H, Gebru F, Yahya M, Tadesse Y, Gebre D, Abrha M, Tesfay B, Tekle A, Gebremariam T, Amare B, Ebrahim MM, Zelelow YB, Mulugeta A. Clinical presentation, maternal-fetal, and neonatal outcomes of early-onset versus late onset preeclampsia-eclampsia syndrome in a teaching hospital in a low-resource setting: A retrospective cohort study. PLoS One 2023; 18:e0281952. [PMID: 36848332 PMCID: PMC9970097 DOI: 10.1371/journal.pone.0281952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/04/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Pre-eclampsia-eclampsia syndrome remains the leading cause of maternal and neonatal mortality worldwide. Both from pathophysiologic and clinical stand points, early and late onset preeclampsia are thought to be two different disease entities. However, the magnitude of preeclampsia-eclampsia and maternal-fetal and neonatal outcomes of early and late onset preeclampsia are not adequately investigated in resource-limited settings. This study sought to examine the clinical presentation and maternal-fetal and neonatal outcome of these two entities of the disease in Ayder comprehensive specialized hospital, an academic setting in Tigray, Ethiopia, from January 1, 2015-December 31, 2021. METHODS A retrospective cohort design was employed. The patient charts were reviewed to see the baseline characteristics and their progress from the onset of the disease in the antepartum, intrapartum and postpartum periods. Women who developed pre-eclampsia before 34 weeks of gestation were defined as having early-onset pre-eclampsia, and those who developed at 34 weeks or later were identified as late-onset preeclampsia. We used chi-square, t-test and multivariable logistic regression analyses to determine differences between early- and late onset diseases in terms of clinical presentation, maternal-fetal, and neonatal outcomes. RESULTS Among the 27,350 mothers who gave birth at the Ayder comprehensive specialized hospital, 1095 mothers had preeclampsia-eclampsia syndrome, with a prevalence of 4.0% (95% CI: 3.8, 4.2)]. Of the 934 mothers analyzed early and late onset diseases accounted for 253 (27.1%) and 681 (72.9%) respectively. Overall, death of 25 mothers was recorded. Women with early onset disease had significant unfavorable maternal outcomes including having preeclampsia with severity features (AOR = 2.92, 95% CI: 1.92, 4.45), liver dysfunction (AOR = 1.75, 95% CI: 1.04, 2.95), uncontrolled diastolic blood pressure (AOR = 1.71, 95% CI: 1.03, 2.84), and prolonged hospitalization (AOR = 4.70, 95% CI: 2.15, 10.28). Similarly, they also had increased unfavorable perinatal outcomes, including the APGAR score at the 5th minute (AOR = 13.79, 95% CI: 1.16, 163.78), low birth weight (AOR = 10.14, 95% CI 4.29, 23.91), and neonatal death (AOR = 6.82, 95% CI: 1.89, 24.58). CONCLUSION The present study highlights the clinical differences between early versus late onset preeclampsia. Women with early-onset disease are at increased levels of unfavorable maternal outcomes. Perinatal morbidity and mortality were also increased significantly in women with early onset disease. Therefore, gestational age at the onset of the disease should be taken as an important indicator of the severity of the disease with unfavorable maternal, fetal, and neonatal outcomes.
Collapse
Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
- * E-mail:
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Hiluf Ebuy Abraha
- Ayder Comprehensive Specialized Hospital, Quality Assurance Office, Mekelle University, Mek’ele, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Fanos Gebru
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Mohammedtahir Yahya
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Ytbarek Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Daniel Gebre
- Department of Midwifery, Ayder Comprehensive Specialised Hospital, Mekelle University, Mek’ele, Ethiopia
| | - Marta Abrha
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Bisrat Tesfay
- Department of Internal Medicine, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Ashenafi Tekle
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Birhane Amare
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | | | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek’ele, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition, School of Public Health, Mekelle University, Mek’ele, Ethiopia
| |
Collapse
|