Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia

Background

Preeclampsia is a new onset of hypertension and either proteinuria or end-organ failure after 20 weeks of gestation. It is a prevalent cause of perinatal mortality, morbidity, and neonatal complications in developing nations including Ethiopia. Thus, the aimed to assess the prevalence and determinants of adverse perinatal outcomes among women with preeclampsia with severity features (PEWSF) at two selected public hospitals in Addis Ababa, Ethiopia, 2023.

Method

A cross-sectional study was carried out among 348 mothers between January 1, 2023, and July 1, 2023. A structured, pre-tested questionnaire was used to gather data from in-person interviews and a review of the patient's medical record. The statistical program Epi-Data version 4.6 was used to enter the data, and SPSS version 26.0 was used for analysis. Binary logistic regression analysis was used to find factors that were associated with unfavorable perinatal outcomes. A p-value of less than 0.05 was used to declare the significance level.

Result

The overall prevalence of unfavorable perinatal outcomes was 59.2% (95% CI: 54.0-63.8). Among the complications, low birth weight, prematurity, NICU admission, and a low fifth-minute APGAR score, encompass 48.9%, 39.4%, 20.4%, and 14.7%, respectively. No formal education [OR = 5.14, 95% CI: (1.93-13.63)], unemployment [OR = 0.42, 95% CI: (0.24-0.73)], referral cases [OR = 2.03, 95% CI: (1.08-4.06), inadequate antenatal care (ANC) contact [OR = 3.63, 95% CI: (1.22-10.71)], and family history of hypertension [OR = 1.99, 95% CI: (1.03-3.85)] have shown a statistically significant association with unfavorable perinatal outcomes.

Conclusion

In this study, the prevalence of unfavorable perinatal outcomes was high compared to other studies in Ethiopia. Level of education, occupation, mode of admission, ANC contact, and family history of hypertension were significant predictors of unfavorable perinatal outcomes. Socio-economic development, improving referral systems, and adequate antenatal care contact are needed to improve unfavorable outcomes. Additionally, antenatal screening and specialized care for high-risk mothers, e.g., those with a family history of hypertension are recommended.

Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study

Background

Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions.

Methods and materials

A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR).

Results

In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53).

Conclusion and Recommendations

Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.

Utilization of non-pneumatic anti-shock garment for the management of obstetric hemorrhage among healthcare providers in north Shewa zone, Ethiopia

Background

Global maternal deaths have either increased or stagnated tragically. Obstetric hemorrhage (OH) remains the major cause of maternal deaths. Non-Pneumatic Anti-Shock Garment (NASG) has several positive results in the management of obstetric hemorrhage in resource-limited settings where getting definitive treatments are difficult and limited. Therefore, this study aimed to assess the proportion and factors associated with the utilization of NASG for the management of obstetric hemorrhage among healthcare providers in the North Shewa zone, Ethiopia.

Methods

A cross-sectional study was conducted at health facilities of the north Shewa zone, Ethiopia from June 10th-30th/2021. A simple random sampling (SRS) technique was employed among 360 healthcare providers. Data were collected using a pretested self-administered questionnaire. EpiData version 4.6 and SPSS 25 were used for data entry and analysis, respectively. Binary logistic regression analyses were undertaken to identify associated factors with the outcome variable. The level of significance was decided at a value of p of <0.05.

Results

The utilization of NASG for the management of obstetric hemorrhage among healthcare providers was 39% (95%CI: 34-45). Healthcare providers who received training on NASG (AOR = 3.3; 95%CI: 1.46-7.48), availability of NASG in the health facility (AOR = 9.17; 95%CI: 5.10-16.46), diploma (AOR = 2.63; 95%CI: 1.39-3.68), bachelor degree (AOR = 7.89; 95%CI: 3.1-16.29) and those healthcare providers who have a positive attitude toward utilization of NASG (AOR = 1.63; 95%CI: 1.14-2.82) were variables positively associated with the utilization of NASG.

Conclusion

In this study, almost two-fifths of healthcare providers used NASG for the management of obstetrics hemorrhage. Arranging educational opportunities and continuous professional development training for healthcare providers, providing in-service and refresher training, and making it available at health facilities may help healthcare providers to effectively use the device, thereby reducing maternal morbidity and mortality.

Women’s traditional birth attendant utilization at birth and its associated factors in Angolella Tara, Ethiopia

Background

In developing countries, home delivery without a skilled birth attendant is a common practice. It has been evidenced that unattended birth is linked with serious life-threatening complications for both the women and the newborn. Institutional delivery with a skilled birth assistance could reduce 20–30% of neonatal mortality. This study aimed to assess traditional birth attendants’ (TBAs) utilization and associated factors for women who gave birth in the last two years in Angolella Tara District, Ethiopia.

Methods

A community-based cross-sectional study was employed among 416 women who gave birth in the last two years at rural Angolella Tara District. Study participants were recruited by using a simple random sampling technique. Data were collected using a structured, pretested, and interviewer-administered questionnaire. Epi Data 4.6 and SPSS version 25 were used for data entry and analysis, respectively. A multivariable logistic regression model was fitted to identify factors associated with women’s utilization of traditional birth attendants. The level of significance in the last model was determined at a p-value of <0.05.

Result

Overall, 131 (31.5%) participants were used traditional birth attendants in their recent birth. Unmarried marital status (AOR 2.63; 95% CI: 1.16, 5.97), age at first marriage (AOR 2.31; 95%CI: 1.30, 4.09), time to reach health facility (AOR = 3.46; 95% CI: 1.94, 6.17), know danger sign of pregnancy and childbirth (AOR = 5.59, 95% CI; 2.89, 10.81), positive attitude towards traditional birth attendants (AOR = 2.56 95% CI; 1.21,5.52), had antenatal care follow-up (AOR: 0.11 95% CI 0.058, 0.21), and listening radio (AOR = 0.43; 95% CI: 0.18, 0.99) were significantly associated factors with the use of traditional birth attendants.

Conclusion

Nearly one-third of women used traditional birth attendant services for their recent birth. TBAs availability and accessibility in the community, and respect for culture and tradition, problems regarding infrastructure, delay or unavailability of ambulance upon call, and some participants knowing only TBAs for birth assistance were reasons for preference of TBAs. Therefore, effort should be made by care providers and policymakers to ensure that modern health care services are accessible for women in a friendly and culturally sensitive manner. In addition, advocacy through mass media about the importance of maternal health service utilization, particularly antenatal care would be important.

Determinants of neonatal mortality among neonates admitted to neonatal intensive care unit of Dessie comprehensive and specialized hospital, Northeast Ethiopia; An unmatched case-control study

Background

According to the World health organization, neonatal mortality is defined as the death of babies within the first 28 days of their lives. The newborn period is the most vulnerable period for a child's survival, with the bulk of neonatal deaths occurring on the first day and week. According to a recent study, about a third of all newborn deaths occur within the first day of life, and nearly three-quarters occur within the first week. This study aimed to assess the determinants of neonatal mortality among neonates admitted to the neonatal intensive care unit in Dessie comprehensive and specialized hospital, northeast Ethiopia.

Methodology

Health institution-based unmatched case-control study was conducted among neonates admitted to Dessie comprehensive and specialized hospital, Ethiopia from February 01 up to March 30, 2020. After keeping cases and controls in separate frames, study participants were chosen using a simple random sampling procedure until the sample size was met. Epi data version 7.0 and SPSS version 25 were used for data entry and analysis respectively. P ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

A total of 698 (233 cases and 465 controls) participated in the study. Pregnancy induced hypertension (AOR = 3.02; 95% CI; 1.47-6.17), public hospital delivery (AOR = 3.44; 95% CI; 1.84-6.42), prematurity (AOR = 2.06; 95% CI; 1.43-2.96), being referred (AOR = 4.71; 95% CI; 3.01-7.39), and hypothermia (AOR = 2.44; 95% CI; 1.56-3.82) were determinant factors of neonatal mortality.

Conclusion

Pregnancy-induced hypertension, public hospital delivery, prematurity, referral, and hypothermia were found to be the determinant factors of neonatal mortality. It would be important to give due attention to neonates delivered from mothers with a history of hypertensive disorder. Besides better to give due attention to neonates delivered in public health institutions, prematurely delivered, referred, and hypothermic neonates. Lastly, further research should be conducted to investigate the additional determinants of neonatal mortality.

A Systematic Review and Meta-Analysis on Post-Abortion Contraceptive Utilization and Associated Factors in Ethiopia

Background

Post-abortion contraceptive utilization is the initiation and use of family planning methods at the time of management of abortion or before fertility returns. A significant discrepancy was reported regarding the prevalence and its associated factors of post-abortion contraceptive utilization in Ethiopia. So, this systematic review and meta-analysis aimed to estimate the pooled prevalence of post-abortion contraceptive utilization and its associated factors in Ethiopia.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used. The databases such as PubMed, Google Scholar, Science Direct, Cochrane library, Scopus, CINAHL, Web of Science, and additional searches by using direct Google search, libraries, and preprint were searched. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal.

Results

A total of 17 studies with 13,075 individuals were included. Of these, 14 studies with 5,719 individuals were used to estimate the prevalence. The pooled prevalence of post-abortion contraceptive utilization in Ethiopia was 63.64% (95% CI: 57.75–69.53). The subgroup analysis reported the highest prevalence of post-abortion contraceptive utilization in a study conducted in Addis Ababa (77.40%), a study published in 2015–2021 (66.15%), and among studies with a sample size >400 (66.84%). The pooled odds ratio (OR) of post-abortion contraceptive utilization for the mothers who had post-abortion family planning counseling was 4.15 (95% CI = 1.30, 13.2), and history of family planning utilization was 4.28 (95% CI = 2.66, 6.89).

Conclusions

The pooled prevalence of utilization of post-abortion contraceptives in this meta-analysis remains low. Post-abortion family planning counseling and the history of the utilization of modern family planning methods were significantly associated with the practice of post-abortion contraceptives. The Ministry of Health should encourage post-abortion family planning utilization, making more efforts on post-abortion contraceptive counseling. Health facilities should work hard to strengthen the family planning counseling service, especially focusing on those who had no previous family planning utilization.

Magnitude and Determinant Factors of Postpartum Depression Among Mothers Attending Their Postnatal and Vaccination Services at Public Health Institutions of Addis Ababa, Ethiopia

Background

The postpartum period is known as a high-risk period for the onset of different maternal mental health problems. Globally, 10–20% of postnatal mothers suffer from depressive symptoms. This study aimed to assess the magnitude and determinant factors of postpartum depression among mothers attending their postnatal and vaccination services at public health institutions in Addis Ababa, Ethiopia.

Methodology

Health institution-based cross-sectional study was conducted among 461 postnatal mothers attending public health institutions in Addis Ababa from 15 May 2021 to 15 July 2021. A multistage sampling technique was employed to select the public health institutions and a systematic random sampling method was used to get selected, postnatal mothers. Epidata version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

From total postnatal mothers 91(19.7%) of them had postpartum depression. Occupational status [AOR = 3.39, 95% CI: 1.04, 8.15], marital status [AOR = 2.69, 95% CI =1.33, 5.45], income management [AOR = 3.76, 95% CI: 1.53, 8.21], sex of baby [AOR = 5.07, 95% CI: 1.24, 20.69], history of child death [AOR = 6.93, 95% CI: 2.67, 15.79], unplanned pregnancy [AOR = 3.08, 95% CI: 1.65, 7.93], negative life event [AOR = 2.39, 95% CI: 1.03, 5.39], substance use during pregnancy [AOR = 6.23, 95% CI: 2.72, 20.05], history of depression [AOR = 5.08, 95% CI: 1.79, 14.39], and marriage satisfaction [AOR = 6.37, 95% CI: 2.63, 14.29] were determinant factors of postpartum depression.

Conclusion

The prevalence of postpartum depression in this study is high compared to national findings. Occupational status, marital status, income management, sex of baby, history of child death, unplanned pregnancy, negative life event, substance use during pregnancy, history of depression, and marital satisfaction were determinant factors of postpartum depression. The ministry of health should integrate mental health services with existing maternal health care services. It would be better if all healthcare professionals working in the maternal and child health unit will routinely screen postpartum depressive symptoms and link them to mental health services.

Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia

Background

World health organization defined herbal medicines as the practice of herbs, herbal materials, herbal preparations, and finished herbal products. Globally women are the primary utilizer of herbal medicine and even they consume it during their pregnancy period. The World health organization reported that the majority of the global population used traditional medicine. This study aimed to assess the magnitude and determinant factors of herbal medicine utilization among pregnant mothers attending their antenatal care at public health institutions in Debre Berhan town, Ethiopia.

Methodology

Institution-based cross-sectional study was conducted among pregnant mothers who attended their antenatal care at public health institutions in Debre Berhan town, Ethiopia from 12 February 2021 to 12 April 2021. A systematic random sampling method was used to get selected pregnant mothers. Epi data version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

A total of 422 pregnant mothers were included with a 100% response rate and 277 (65.6%) of them used an herbal medicine during their current pregnancy. Educational level up to primary school [AOR 2.21, 95% CI: 1.17 – 4.18], monthly family income of &lt;2,800 ETB [AOR 1.72, 95% CI: 1.01–2.92], and lack of awareness of the complication of herbal medicine utilization [AOR 10.3, 95% CI: 6.27–16.92] were determinant factors of herbal medicine utilization.

Conclusion

The utilization of herbal medicine among pregnant mothers in this study is high and almost all of them did not disclose their utilization of herbal medicine to their healthcare providers. The ministry of health should integrate traditional medicine with conventional medicines. Midwives and obstetricians should openly discuss regarding benefits and complications of herbal medicine utilization for those pregnant mothers during their antenatal care counseling sessions as routine care.