Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study

BACKGROUND

Puerperal sepsis, is a significant factor in maternal morbidity and mortality, especially in regions with lower income levels where maternal mortality rates are highest. However, it can be largely avoided if detected in time. Recognizing and dealing with the root causes early is essential in addressing this problem. Therefore, this study aimed to identify the determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia.

METHODS

An institutional-based unmatched case-control study was conducted among 266 postpartum women (88 cases and 178 controls) from October 1, 2023 to November 30, 2023. For each case, two controls were chosen using a systematic random sampling approach. Data were collected using an interviewer-administered, structured questionnaire and medical record review. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 27. Binary logistic regression analysis was used to model the association between puerperal sepsis and independent variables. variables that had a crude association in the bivariable analysis (p < 0.25) were entered and analyzed by a multivariable binary logistic regression model to identify statistically significant factors. In the final model, Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. Statistical significance was declared at p < 0.05.

RESULT

Rural residence (AOR = 6.9; 95% CI:2.77-17.10), having no formal education (AOR = 3.8; 95% CI: 2.55, 10.76), cesarean section delivery (AOR: 5.1; 95% CI: 1.30, 11.00) and complication during pregnancy (AOR: 4.6, 95% CI: 1.96, 11.10) were independent determinants of puerperal sepsis.

CONCLUSION

Place of residence, maternal education level, mode of delivery, and complication during pregnancy were determinants of puerperal sepsis. It is crucial to implement education and awareness initiatives aimed at mothers, ensure universal access to healthcare services, advocate for evidence-based delivery protocols, and conduct comprehensive antenatal screenings.

Burden and risk profile of acute kidney injury in severe COVID-19 pneumonia admissions: a Finding from Jimma University medical center, Ethiopia

BACKGROUND

Acute kidney injury (AKI) is a serious complication of the Corona Virus Disease of 2019 (COVID-19). However, data on its magnitude and risk factors among hospitalized patients in Ethiopia is limited. This study aimed to determine the magnitude of AKI and associated factors among patients admitted for severe COVID-19 pneumonia.

METHODS

An institution-based retrospective cross-sectional study was conducted among 224 patients admitted to Jimma University Medical Center in Ethiopia for severe COVID-19 pneumonia from May 2020 to December 2021. Systematic random sampling was used to select study participants. Medical records were reviewed to extract sociodemographic, clinical, laboratory, therapeutic, and comorbidity data. Bivariable and multivariable logistic regressions were performed to examine factors associated with AKI. The magnitude of the association between the explanatory variables and AKI was estimated using an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and significance was declared at a p-value of 0.05.

RESULTS

The magnitude of AKI was 42% (95% CI: 35.3-48.2%) in the study area. Mechanical ventilation, vasopressors, and antibiotics were required in 32.6, 3.7, and 97.7% of the patients, respectively. After adjusting for possible confounders, male sex (AOR 2.79, 95% CI: 1.3-6.5), fever (AOR 6.5, 95% CI: 2.7-15.6), hypoxemia (AOR 5.1, 95% CI: 1.4-18.9), comorbidities (AOR 2.8, 95% CI: 1.1-7.0), and severe anemia (AOR 10, 95% CI: 1.7-65.7) remained significantly associated with higher odds of AKI.

CONCLUSION

The burden of AKI among patients with severe COVID-19 pneumonia is high in our setting. Male sex, abnormal vital signs, chronic conditions, and anemia can identify individuals at increased risk and require close monitoring and prevention efforts.

Diabetic peripheral neuropathy among adult type 2 diabetes patients in Adama, Ethiopia: health facility-based study

Diabetic peripheral neuropathy is the most prominent microvascular complication of diabetes mellitus and the leading cause of ulceration, amputation, and extended hospitalization. Evidence regarding the magnitude and factors associated with diabetic peripheral neuropathy is not well documented in Ethiopia, particularly in the study area. A facility-based cross-sectional study was conducted among 293 adult type 2 diabetic patients who were on treatment and follow-up from May to June 31, 2023. To select participants in the study, a systematic random sampling method was utilized. Data were collected using semi-structured questionnaires and medical record reviews. The Michigan Neuropathy Screening Instrument (MNSI) was employed to assess diabetic peripheral neuropathy. To model the association between diabetic peripheral neuropathy and independent variables, binary logistic regression model was used. An adjusted odds ratio with a 95% confidence interval was used to estimate the association and statistical significance was proclaimed at a p-value < 0.05. The magnitude of diabetic peripheral neuropathy was 14.3% (95% CI 10.4-18.0). It was 13.4% (95% CI 8.4-19.1) among males and 15.4% (95% CI 10.1-22.2) among females. Age above 60 years (AOR = 5.06, 95% CI 1.60-15.96), being rural resident (AOR = 2.41; 95% CI 1.15-5.06), duration of diabetes above 5 years (AOR = 2.48, 95% CI 1.16-5.27) and having comorbid hypertension (AOR = 2.56, 95% CI 1.24-5.28) were independently associated with diabetic peripheral neuropathy. One in seven adult type 2 diabetes patients in the study area had diabetic peripheral neuropathy. Factors such as age, place of residence, duration of diabetes, and comorbid hypertension showed positive associations with diabetic peripheral neuropathy. Thus, it is imperative to give special consideration to diabetic patients who are elderly, living in rural areas, experiencing a prolonged duration of diabetes, or dealing with comorbid hypertension.

Factors associated with diabetes concordant comorbidities among adult diabetic patients in Central Ethiopia: a cross-sectional study

Background

Diabetes comorbidities are a serious public health issue that raises the risk of adverse health effects and complicates diabetes management. It also harms emotional health, medication adherence, self-management, and general quality of life. However, evidence is scarce in Ethiopia, particularly in the study area. Thus, this study aimed to estimate the prevalence of diabetes concordant comorbidities and identify factors associated with the presence of concordant comorbidities among adult diabetic patients in central Ethiopia.

Methods

A health facility-based cross-sectional study was conducted among 398 adult diabetic patients. A computer-generated simple random sampling was used to select study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi info version 7.2 and exported to SPSS version 27 for analysis. A binary logistic regression model was used to analyze the association between dependent and independent variables. An adjusted odds ratio with the corresponding 95% confidence interval was used to measure the strength of the association and statistical significance was declared at a p-value < 0.05.

Result

The prevalence of diabetes-concordant comorbidities was 41% (95% CI: 36.2-46.0). The multivariable logistic regression model showed that age 41-60 (AOR = 2.86, 95% CI: 1.60-5.13), place of residence (AOR = 2.22, 95% CI: 1.33-3.70), having type two diabetes (AOR = 3.30, 95% CI: 1.21-8.99), and having positive proteinuria (AOR = 2.64, 95% CI: 1.47-4.76) were significantly associated with diabetes concordant comorbidities.

Conclusion

The prevalence of diabetes-concordant comorbidities was relatively high. Age, place of residence, type of diabetes, and positive proteinuria were factors associated with diabetes-concordant comorbidities. Prevention, early identification, and proper management of diabetes comorbidities are crucial.

Assessment of menstrual hygiene management knowledge, practice, and associated factors among girls in Boset District, Ethiopia: a school-based cross-sectional study

BACKGROUND

Adolescent girls, particularly in lower socioeconomic settings, lack adequate knowledge of menstrual hygiene management and have subpar hygiene habits. Likewise, the factors related to it have not been well addressed, and schoolgirls are facing a range of challenges. To develop effective intervention approaches, a context-specific assessment of menstrual hygiene practices is useful. Thus, this study aimed to assess menstrual hygiene management knowledge, practice, and associated factors among girls in the Boset district, Ethiopia.

METHODS

A school-based cross-sectional study was conducted at Boset district secondary schools among 629 randomly selected girls using the multi-stage sampling technique. Data were collected using a self-administered, structured questionnaire. The collected data were entered into Epi-info version 7 and analyzed by Statistical Package for Social Science (SPSS) version 26. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association, and a p-value < 0.05 was used to declare statistical significance.

RESULT

Of the total study participants, 51.2% (95% CI: 46.6-55.8%) had an appropriate practice of menstrual hygiene and 57.9% (95% CI: 53.3-62.5%) had good knowledge status on menstrual hygiene management. Being an urban resident (AOR = 1.84, 95% CI: 1.20-2.80), having a mother with a secondary and above educational level (AOR = 3.4, 95% CI: 2.07-5.57), earning regular pocket money (AOR = 2.19, 95% CI: 1.45-3.313), and discussing menstrual issues with parents and friends (AOR = 3.65, 95% CI: 2.327-5.727) were associated with good practice of menstrual hygiene.

CONCLUSION

In this study, nearly half of the school girls had good practice and knowledge of menstrual hygiene management. Educating mothers and promoting discussion about menstrual hygiene management issues, especially in rural areas, should be priority actions.

Uncontrolled blood pressure and associated factors in adult hypertensive patients undergoing follow-up at public health facility ambulatory clinics in Bishoftu town, Ethiopia: a multi-center study

BACKGROUND

Uncontrolled blood pressure is an important medical and public health problem in developing countries like Ethiopia. Improving the management of hypertension requires a better comprehension of the factors influencing blood pressure control and the application of interventions. But in clinical practice, blood pressure is still not adequately controlled. Thus, this study aimed to assess uncontrolled blood pressure and associated among adult hypertensive patients on follow-up at public health facility ambulatory clinics in Bishoftu, Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 398 adult hypertensive patients who were on treatment and follow-up from April to May 31, 2022. Systematic random sampling was used to select study participants. Data were collected using an interviewer-administered, semi-structured questionnaire and chart review. The Eighth Joint National Committee (JNC 8) criteria was applied to define blood pressure control status. Binary logistic regression analysis was used to model the association between dependent and independent variables. An adjusted odds ratio and 95% confidence interval were used to measure the strength of the association. Finally, at a p-value < 0.05, statistical significance was proclaimed.

RESULT

Of the total study participants, 249(62.6%) were male. The mean age was 62.26 ± 11.55 years. The overall proportion of uncontrolled blood pressure was 58.8% (95% CI: 54-64). Salt intake (AOR = 2.51; 95% CI: 1.49-4.24), lack of physical activity (AOR = 1.40; 95% CI: 1.10-2.62), habitual coffee consumption (AOR = 4.52; 95% CI: 2.67-7.64), higher BMI (AOR = 2.08; 95% CI: 1.24-3.49), and non-adherence to antihypertensive medications (AOR = 2.31; 95% CI: 1.3-3.89) were independent predictors of uncontrolled blood pressure.

CONCLUSION

More than half of the hypertensive patients in this study had uncontrolled blood pressure. Healthcare providers and other accountable stakeholders should urge patients to follow salt restriction, physical activity, and antihypertensive medication regimes. Reduced coffee consumption and weight maintenance are other crucial blood pressure control measures.

Magnitude, Indications, and Factors Associated With Operative Vaginal Delivery Among Mothers Who Gave Birth at Adama Hospital Medical College, Ethiopia, 2022

Introduction

Operative vaginal deliveries are a method of dealing with issues that arise during the second stage of labor with the use of vacuum device or forceps. The decision to use an instrument to deliver the fetus weighs the maternal, fetal, and neonatal consequences of the procedure against the alternative option of cesarean birth. However, evidence on operative vaginal delivery is limited in Ethiopia in general and in the study area in particular.

Objectives

This study aimed to assess the magnitude, indications, and factors associated with operative vaginal delivery among mothers who gave birth at Adama Hospital Medical College, Ethiopia.

Methods

A facility-based cross-sectional study was conducted among a sample of 440 mothers who gave birth from 1 to 30 June 2022. A systematic random sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. The data were entered into EPI INFO version 7 and exported to SPSS version 25 for analysis. Bivariate logistic regression analysis was used to identify candidate variables at p < .25 and multivariable logistic regression analysis was used to identify the independent predictors of operative vaginal delivery at p < .05 with 95% confidence intervals (CIs).

Results

The magnitude of operative vaginal delivery was 14.8% (95% CI: 10.8, 18.8). Rural residence (adjusted odds ratio (AOR), 2.09; 95% CI: 2.01, 7.41), maternal age 25-34 (AOR, 4.95; 95% CI: 1.62, 9.2), being primigravida (AOR: 3.5, 95% CI: 1.26, 9.98), gestational age ≥42 weeks (3.09; 95% CI: 1.38, 6.9), and antenatal care (ANC) follow-ups <4 times (AOR:3.9; 95% CI: 1.09, 9.45) were significantly associated with operative vaginal delivery.

Conclusion

The magnitude of operative vaginal delivery in the study area was relatively low. Rural residence, maternal age 25 to 34, primigravida, gestational age ≥42 weeks, and ANC follow-ups <4 times were independent determinants of operative vaginal delivery. Thus, health education programs and other multidisciplinary strategies are required to encourage mothers to have regular ANC follow-ups.

A Community-Based Cross-Sectional Study on Latrine Utilization and Associated Factors Among Rural Community of East Meskan District, Gurage Zone, Southern Ethiopia

Background

Using sanitary facilities is proven to enhance health and halt the spread of fecal-to-oral disease. Despite efforts to improve the availability of latrine facilities in developing countries like Ethiopia, finding a village that is entirely free of open defecation remains difficult. To determine the need for intervention programs and promote regular latrine usage, local data is essential.

Objectives

This study aimed to assess latrine utilization and associated factors among households in East Meskan District, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 630 households from April 15 to May 30, 2022. A simple random sampling technique was used to select the study households. Data were collected using an interviewer-administered structured questionnaire and an observational checklist. The collected data were then entered into Epi-Info version 7.1 and analyzed using SPSS version 21. In binary logistic regression analysis, independent variables with a P-value < .25 were considered candidates for multiple logistic regression analysis. The association was expressed in odds ratio with a 95% confidence interval (CI), and significance was declared at P-value < .05 in the final model.

Results

The magnitude of latrine utilization was 73.3% (95% CI: 69.7, 76.8) in the study district. Husband being family head (adjusted odds ratio [AOR] = 12.9; 95% CI: 5.78 ,28.90), being female (AOR = 16.4; 95% CI: 6.52, 41.27), family size less than 5 (AOR = 24.2; 95% CI: 11.49, 51.09), absence of school children (AOR = 0.3; 95% CI: 0.13, 0.51), and greater than 2 years since latrine was constructed (AOR = 14; 95% CI: 7.18, 27.41) had a significant association with latrine utilization.

Conclusion

In this study, utilization of latrines was low compared to the national target plan. Family head, sex, family size, presence of school children, and length of years in which the latrine was constructed were factors associated with latrine utilization. Thus, regular supervision of early latrine construction and utilization in communities is essential.