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Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia.
Journal of Public Health and Epidemiology. 2018 Dec; 10(12):429-442.There is growing evidence suggesting that young people in school are practicing risky sexual behaviors. Ethiopian people aged 10 to 24 years have emerged as the segments of the population most vulnerable to a broad spectrum of serious sexual health problems. Therefore, the main aim of this study was to assess risky sexual behaviors and associated factors among preparatory school students in Arba Minch, Southern Ethiopia. An institution based cross sectional study was conducted among 465 study participants from April 20 to June 2, 2018. A self-administered pre-tested questionnaire was used to collect the data. Bivariate and multivariate analysis was done using binary logistic regression. In this study, 22.4% (95%CI: 18.6%, 26.2%) of study participants had risky sexual behaviors. Marital status, education and occupational status of the father, occupation of the mother, watching pornographic movies, drinking alcohol, using hashish/shisha and knowledge about HIV/AIDS were significantly associated with odds (AOR=3.28, 95%CI: 1.24, 8.70), (AOR=5.96, 95%CI: 1.35, 26.25), (AOR=0.33, 95%CI: 0.12, 0.93), (AOR=0.22, 95%CI: 0.09, 0.51), (AOR=8.80, 95%CI: 4.04, 19.17), (AOR=2.71, 95%CI: 1.35, 5.46), (AOR=14.88, 95%CI: 4.52, 48.96) and (AOR=2.89, 95%CI: 1.42, 5.88), respectively. This finding noted that significant numbers of students were engaged in risky sexual behaviours. Those students had multiple sexual partners, used condoms inconsistently, had sex with risky individuals, and an early sexual start. Watching pornographic movies, substance abuse and a knowledge gap on HIV/AIDS were some of the significant factors. Awareness creation for youths to reduce substance abuses, HIV/AIDS and sexual and reproductive health in the school community is recommended.
Unmet need for modern contraception and associated factors among reproductive age group women in Eritrean refugee camps, Tigray, north Ethiopia: a cross-sectional study.
BMC Research Notes. 2018 Dec 4; 11(1):851.OBJECTIVE: Millions of women want to delay or avoid pregnancy, but they are not using contraception, especially in refugee settings. Due to lack of contraception, one fifth of reproductive age group women suffered from unwanted pregnancy and unsafe abortion, which accounted for 78% of maternal mortality in refugee camps. Therefore, the aim of this study was to assess the prevalence of unmet need for modern contraception and its associated factors among reproductive age group women in Eritrean refugee camps, Tigray, Northern Ethiopia, 2016. RESULTS: 400 women of reproductive age group interviewed. Prevalence of unmet need for modern contraception in this study was found to be 41.8% (95% CI 36.99%, 46.63%).Respondents' unfavorable attitude towards modern contraceptive methods [AOR = 0.372, 95% CI 0.170, 0.818] and the availability of modern contraceptive methods [AOR = 3.501, 95% CI 1.328, 9.231] were factors significantly associated with unmet need for modern contraception. Respondents' attitude towards modern contraceptive methods and availability of modern contraceptives were independent predictors of unmet need. Governmental and non-governmental organizations should design programs to create behavioral change in women's attitude towards contraceptive use and to secure the availability of contraceptive methods in refugee camp settings.
Utilization of long acting reversible contraceptive methods and associated factors among female college students in Gondar town, northwest Ethiopia, 2018: institutional based cross-sectional study.
BMC Research Notes. 2018 Dec 5; 11(1):862.OBJECTIVES: Family planning is achieved through use of different contraceptive methods among which the most effective methods are modern family planning methods like long acting reversible contraceptive which includes intra-uterine contraceptive device and Implants. The objective of this primary study was to assess utilization of long acting reversible contraceptive methods among female college students in Gondar town, northwest Ethiopia. RESULTS: The overall utilization of long acting reversible contraceptive methods among students was 20.4% (95% CI 18.1, 22.7) and the most commonly utilized long acting reversible contraceptive method was Implants 96.5% (95% CI 95.50, 97.50) followed by intra-uterine contraceptive device 3.5% (95% CI 2.97, 4.00). Marital status of the respondents [AOR = 3.97 (95% CI 2.05, 7.67)], discussion about long acting reversible contraceptive methods utilization with husbands or boyfriends [AOR = 2.20 (95% CI 1.19-4.06)] and attitude towards implants [AOR = 0.365 (95% CI 0.14, 0.93)] were found to be significantly associated with utilization of long acting reversible contraceptive among students.
Utilization and determinants of long term and permanent contraceptive methods among married reproductive age women at Janamora district, northwest Ethiopia.
BMC Research Notes. 2018 Nov 26; 11(1):836.OBJECTIVE: This study is aimed at determining the prevalence and factors associated with utilization of long acting and permanent methods among married reproductive age (15-49) females at Janamora district, in 2018. RESULT: Prevalence of long acting and permanent contraceptive method utilization was 12.9% (95% confidence interval (CI) 10%, 15%).Of those utilizers, 96.8% use implants, 2.1% use female sterilization and 1.1% use Intrauterine Contraceptive Device. Women's occupation, student as compared to housewife (Adjusted odds ratio (AOR) = 3.12, 95% CI 1.05-9.29), a women whose husband was government employed as compared to merchant (AOR = 2.51, 95% CI 1.1-5.75), and women who had high knowledge as compared to poor knowledge (AOR = 4.20, 95% CI 1.32-13.39) were positively associated with utilization of long acting and permanent contraceptive method.
Prevalence and factors associated with modern contraceptive discontinuation among reproductive age group women, a community based cross-sectional study in Humera town, northern Ethiopia.
BMC Women's Health. 2018 Nov 22; 18(1):190.BACKGROUND: Contraceptive prevalence rate (CPR) for married women aged 15-49 in Ethiopia is 36%, with 35% using modern methods and 1% using traditional methods. However, the discontinuation rate is fairly high. Women usually discontinue contraception use for fertility and method related reasons without adopting an alternate method which in turn leads to many health risks such as unwanted pregnancy, unplanned childbearing, miscarriage, abortion, leads to morbidity and mortality among mothers and newborns. The purpose of this study was to determine the prevalence of modern contraceptive discontinuation and to identify predicting factors. METHODS: A community- based cross- sectional study was conducted in Humera town among 321 married women of reproductive age (15-49 yrs.) who had a history of modern contraceptive use. Systematic sampling technique was employed to select study participants and data was collected by BSc health extension workers using interviewer -administered questionnaire. EPI-INFO (V-7) and SPSS (V-23) software were used for entry and analysis respectively. Descriptive statistics and logistic regression analysis were used to present results accordingly. P- Value < 0.05 was used as a cut point for statistical significance. RESULTS: The magnitude of modern contraceptive discontinuation was 27.1%. Number of desired children (AOR = 2.83 95% CI = 1.16, 6.89), experience of side effects (AOR = 3 95% CI = 1.2, 7.58), discussion with female friend (AOR = 3.26 95% CI = 1.27, 8.36), counseled on side effects (AOR = 6.55 95% CI = 2.21, 19.39), number of male children (AOR = 2.51 95% CI = 1.06, 5.96), absence of husband support (AOR = 12.99 95% CI = 4.59, 36.78) and presence of community prohibition (AOR = 6.88 95% CI = 3.05, 15.51) were identified as predicting factors for modern contraceptive discontinuation. CONCLUSION: Magnitude of modern contraceptive discontinuation among reproductive age group women in Humera was relatively high. Increasing community awareness, involving partners and pre dispensation counseling might help to reduce discontinuation and its consequences. Various targeted messages are also needed to dispel misconception at community level.
Intentions on contraception use and its associated factors among postpartum women in Aksum town, Tigray region, northern Ethiopia: a community-based cross- sectional study.
Reproductive Health. 2018 Nov 9; 15(1):188.BACKGROUND: Increased access to contraceptive methods has been established as a cost-effective strategy for developing countries to reduce maternal and child mortality. Intentions to contraceptive uptake appear to be best predictors of actual contraceptive practice than the unmet need. However, intention to contraceptive use in Ethiopia particularly among postpartum women is not well assessed. Therefore, the objective of this study was to assess intention to use modern contraceptive and to identify factors associated among postpartum women in Aksum town. METHODS: A community -based analytical cross-sectional study design was done to collect the data from 604 postpartum mothers using a structured questionnaire. The data was collected from March 25 to April 24, 2015. A multivariable logistic regression was conducted to assess factors associated with intentions to use contraceptive methods. Factors influencing intentions on contraceptive methods use were assessed by computing adjusted odds ratios (AOR) at 95% confidence interval (CI) with statistical significant p- value < 0.05. RESULTS: Intention to use modern contraceptive was 84.3%. Resumed sexual intercourse (AOR = 1.78; 95% CI: 1.34, 3.92) and women whose their husband approved family planning to use (AOR = 1.57; 95% CI: 2.02, 5.57) were more likely to have intention on contraceptive use. In addition, those women who knew at least one method of modern contraceptive (AOR = 5.17; 95% CI: 1.69, 15.82) were more likely to had intention to use modern contraceptive during extended postpartum period compared to their counterparts. CONCLUSION AND RECOMMENDATION: More than eight in ten study participants have intention to use contraceptive in the Aksum town. Resumed sexual intercourse, husband's approval of family planning and knew at least one method of contraceptive are the three major predictors to be an areas when considering interventions to increase of intention on contraceptive. Therefore, this study highlighted that; in order to increase intention and adoption of contraceptive, the family planning services providers and programmers should continue the promotion of partner involvement and increasing family planning knowledge through printed media and mass media.
Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey.
Rockville, Maryland, ICF, DHS Program, 2018 Jun. 40 p. (DHS Working Papers No. 137)In Ethiopia, many mothers who attend the recommended number of antenatal care visits fail to use facility delivery and postnatal care services. This study identifies factors associated with facility delivery and use of postnatal care among mothers who had four or more antenatal care visits, using data from the 2016 Ethiopia Demographic and Health Survey (2016 EDHS). Methods: To identify factors associated with facility delivery, we studied background and service-related characteristics among 2,415 mothers who attended four or more antenatal care visits for the most recent birth. In analyzing factors associated with postnatal care within 42 days after delivery, the study included 1,055 mothers who attended four or more antenatal care visits and delivered at home. We focused on women who delivered at home because women who deliver at a health facility are more likely to receive postnatal care as well. A multivariable logistic regression model was fitted for each outcome to find significant associations between facility delivery and use of postnatal care. Results: Fifty-six percent of women had four or more antenatal care visits delivered at a health facility, while 44% delivered at home. Mothers with a secondary or higher level of education, urban residents, women in the richest wealth quintile, and women who were working at the time of interview had higher odds of delivering in a health facility. High birth order was associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Quality of antenatal care as measured by the content of care received during antenatal care visits stood out as an important factor that influences both facility delivery and postnatal care. Among mothers who attended four or more antenatal care visits and delivered at home, the content of care received during ANC visits was the only factor that showed a statistically significant association with receiving postnatal care. Conclusions: The more antenatal care components a mother receives, the higher her probability of delivering at a health facility and of receiving postnatal care. Thus, the health care system needs to increase the quality of antenatal care provided to mothers. Qualitative research is recommended to identify reasons why many women do not use facility delivery and postnatal care services even after attending four or more antenatal care visits.
Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed-methods study based on 45 years of experience.
Tropical Medicine and International Health. 2018 Dec; 23(12):1332-1341.Objective: To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. Methods: Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analy sis, descriptive statistics and data triangulation. Results: The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. Conclusions: Facilitators for MWH utilisation according to users and staff were perceived highquality EmONC, integrated health services, awareness of pregnancy-related complications and the husband’s support in overcoming barriers. If providing high-quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.
Maternal and perinatal outcomes of pregnancies complicated by eclampsia at Tikur Anbessa Hospital - A five year retrospective study.
Ethiopian Journal of Reproductive Health. 2014 Dec; 7(1):22-30.Introduction: Eclampsia is an important and mostly preventable cause of maternal and perinatal morbidity and mortality. Its incidence varies from 4-6 cases per 10,000 live births in developed countries to 6-100 cases per 10,000 live births in developing countries. Maternal complications occur in up to 70% of women with Eclampsia. Objective: To describe perinatal and maternal outcome of eclampsia in Tikur Anbessa Hospital and explore avoidable factors contributing to the adverse outcome. Methods: A hospital-based retrospective, cross sectional study of all eclamptic mothers admitted to Tikur Anbessa Hospital (TAH) in the time period of Meskerem 1, 1996 - Nehase 30, 2000 E.C. The main outcome measures were maternal and perinatal mortality & morbidities from Eclampsia. Results: During the study period, there were a total of 13,606 deliveries in TAH, of which 78 were eclamptic mothers making a prevalence of 5.7/1000 deliveries. Majority of convulsions (94.37%) occurred during the antepartum period. Aspiration pneumonia was the commonest maternal complication (34.3%), followed by HELLP syndrome (15.8%). The case fatality of Eclampsia in this study was 11.9% (8/67). And of total 71 babies, 20 (28.2%) of them were still births and four (5.6%) were ENND, making a perinatal mortality rate 338/1000 deliveries. Conclusions and recommendations: Eclampsia is still a common complication of pregnancy and one of the important causes of maternal and perinatal mortality in our set up. Further study on the subject preferably prospective with larger sample size is recommended to further assess the condition and improve its generalizability.
Ethiopian Journal of Reproductive Health. 2016 Feb; 8(1):8-18.INTRODUCTION: Globally eclampsia is an important cause of morbidity and mortality during pregnancy, child birth and puerperium. Early intervention and provision of critical care for those at risk of significant morbidity and mortality is important. OBJECTIVE: To identify important risk factors for maternal mortality among eclamptic women managed in Hawassa University Referral Hospital. METHODOLOGY: A five years retrospective case - control analysis of risk factors for maternal mortality among eclamptic women was done. Cases were those mothers who died and the controls were those who survived. Data was collected from patient charts and variables were assessed among cases and controls to identify risk factors for mortality. Odds ratio with 95% confidence interval and P- values were computed. RESULTS: The majority of eclamptics were below 26 years of age, 95 (65 %); primigravida, 76 (52 %) and from out of Hawassa, 95 (65 %). Five or more convulsions before admission (OR = 3.90, 95%CI, 1.64 -9.37), creatinine level above 0.9 mg/dl (0R = 7.73, 95%CI, 2.84 -21.63) and platelet count less than 100,000/mm3 (OR = 11.20, 95%CI, 3.70 -36.32) were significantly associated with the risk of mortality at admission. The case fatality rate of eclampsia was 24% and the most important causes of deaths were respiratory failure and acute renal failure. CONCLUSION: Closer follow up should be considered for those eclamptics with 5 or more convulsions before admission; and elevated creatinine level and thrombocytopenia at admission. The quality of care provided in the intensive care unit should be improved.
Knowledge, attitude and practice on birth preparedness and complication readiness among pregnant women attending antenatal care at Chiro Zonal Hospital Eastern Ethiopia.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):55-64.BACKGROUND: Birth preparedness and complication readiness is a comprehensive strategy to improve the use of skilled providers at birth, and the key intervention to decrease maternal mortality. It is also a key component of globally accepted safe motherhood programs. OBJECTIVE: To assess the knowledge, attitude and practices about birth preparedness and complication readiness among pregnant women attending antenatal care at Chiro Zonal Hospital, East Ethiopia. METHODS: Hospital based cross sectional study was conducted on a sample of 418 pregnant women. Exit interview using a pretested structured questionnaire was used to collect data from pregnant women attending antenatal care at Chiro Zonal Hospital. The collected data was cleaned, coded and analyzed using SPSS version 20 statistical package. RESULT: Twenty percent had knowledge of one key danger signs during pregnancy, child birth and postpartum and 61.2% had favorable attitudes towards birth preparedness and complication readiness. Knowledge of at least one key danger signs during pregnancy, child birth and postpartum, attitudes towards birth preparedness and practice of birth preparedness were associated with birth preparedness and complication readiness. CONCLUSION AND RECOMMENDATION: Both knowledge of obstetric danger signs and birth preparedness and complication readiness were low. Enhancing women’s awareness and improving the quality of labour wards would improve delivery service utilization.
Determinants of high fertility among married women in Angacha District, Kambeta Tembero Zone, Southern Ethiopia.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):46-54.BACKGROUND: Fertility is the major component of population dynamics, which is used to show a major role in the size, and structure of a particular population. In Ethiopia, total fertility rate is 4.6 children per woman. This high fertility brings a significant problem on the health of mothers and children. OBJECTIVE: To identify the determinants of high fertility in Angacha District, Southern Ethiopia. METHOD: A community-based case-control study design was conducted from September 20 to October 10, 2017 in Angacha district, Southern Ethiopia. A total of 388 married women in Angacha district were selected using simple random sampling technique. Bi-variable and multi-variable logistic regression analyses were performed. RESULT: A total of 388 eligible women (129 cases and 259 controls) requested to interview, of which 126 cases and 255 controls participated. Educational status of women (AOR[95% CI] = 0.36 [0.160.83]), desire to have more children before marriage (AOR[95% CI] = 0.51[0.28, 0.93]), age at first marriage (AOR[95% CI] = 4.77[2.59, 8.78]), history of under-five mortality (AOR[95% CI] = 4.22[2.43, 7.31]) and not ever use of contraceptive methods (AOR[95% CI] = 4.55[2.21, 9.39]) were identified as determinants of high fertility. CONCLUSION: In this study educational status of women, age at first marriage, desire to have children before marriage, not ever use of contraceptive methods and experiencing under-five mortality were identified as determinants of high fertility. Therefore, all concerned bodies should intervene in improving the education level of women, increase age at first marriage, reduce child mortality and improve the access to contraceptive methods.
A 3 years review of maternal death and associated factors at Ayder Comprehensive Specialized Hospital, Northern Ethiopia.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):38-45.BACKGROUND: Maternal mortality ratio in Ethiopia is one of the highest in the world. Despite measures to alleviate it and showing a promising declining trend, it still remains one of the highest at 412 maternal deaths per 100,000 live births. To our knowledge there is no accessible published study on maternal mortality at Ayder Comprehensive Specialized Hospital (ACSH). OBJECTIVE: The aim of this study is to systematically analyze causes of maternal deaths and contributing factors at (ACSH). METHODS: This was a descriptive, retrospective chart review of institutional maternal deaths using a 3-years record from July 1, 2014 -June 30, 2017 at ACSH. RESULTS There were 52 maternal deaths from July 1, 2014 -June 30, 2017 at ACSH. The main causes of these deaths were related to obstetric hemorrhage (n=11, 21.2 %), hypertensive disorders of pregnancy (n=10, 19.2%) and sepsis (n=7, 13.5%). About 86.5% (n=45) of the mothers were referral cases of whom 24 (53.33%) of them travelled more than 100 kilometers to reach ACSH. The furthest referral site was 498 kilometers from ACSH. Most common reasons for referral include for admission to intensive care unit, for further workup and management, for blood transfusion and for high risk admission. Most of the maternal deaths occurred in the postpartum period. CONCLUSION: There is an urgent need for expansion of intensive care unit (ICU) and availing blood transfusion services in all the general and regional hospitals with close monitoring of mothers in the postpartum period. The referral system needs coordination from the lower level to the teritirary care centers.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):25-37.BACKGROUND: Maternal death is a major public health problem in Ethiopia. Antenatal care (ANC) utilization is believed to promote the uptake of obstetric care services and hence improve maternal health. But ANC coverage is low and reviews on determinants of utilization are lacking in Ethiopia. OBJECTIVE: Synthesize evidence on factors influencing ANC utilization in Ethiopia. METHODOLOGY: Relevant articles were searched electronically, filtered and quality assessed. Factors were categorized using a conceptual framework adapted from Anderson’s model and bio-behavioural modelling in health care utilization. RESULTS: Twenty-five studies were reviewed. Maternal education, place of residence, family income, husband’s approval, media exposure, pregnancy intention and previous bad obstetric history were the major individual factors affecting ANC utilization. The only health service factor was distance of a health facility. Most of the studies lack standardized outcome measures which could differentiate between non-use verses inadequate use of ANC. Only a single study used conceptual framework. Other important individual factors such as women’s autonomy, cultural beliefs, social networks and health facility factors such as quality, waiting time, and service fee were not examined. No study identified consumer satisfaction as a factor affecting ANC use. CONCLUSIONS AND RECOMMENDATIONS: Comprehensive data on factors influencing ANC utilization is lacking in Ethiopia. The measurement of ANC utilization should be standardized and factors should be segregated into those influencing initiation verses adequate use of ANC. Programs intended to improve ANC utilization should focus on women’s education; promote planned pregnancy; target the underprivileged and expand their scope to involve partners in ANC provision.
Barriers to utilization of long acting reversible and permanent contraceptive methods in Ethiopia: Systematic review.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):1-24.BACKGROUND: Globally the use of Long-Acting Reversible and Permanent Methods (LARPMs) has been recommended as the first-line, highly effective options for pregnancy prevention. They have greater efficacy than short acting contraceptive methods and are associated with lower rates of unwanted pregnancy. Ethiopia has made significant progress in family planning (FP); however, one fourth of married women still have unmet need for FP and nearly three-fourth of family planning users depend on short acting injectable contraceptives. The aim of this study was to review existing researches to identify barriers to long acting reversible and permanent contraceptive use in emerging regions of Ethiopia. METHOD: Published and unpublished literatures were searched using major search engines and different search terms related to the topic. Literature search was carried out from March to May 2016. Six selection criteria were prepared to summarize the findings using PRISMA protocol. A checklist of eight-item quality assessment criteria was used to rate the quality of studies independently by two investigators, and the third investigator cross checked and decided on agreements. The studies were critically appraised, and thematic analysis was used to synthesize the data. RESULTS: Using the screening criteria, 69 eligible full-text articles and reports were reviewed; of which 34 articles and 8 policy/strategy documents were considered for data synthesis. The review has included policy related, individual, socio-cultural and health facility related barriers/factors affecting LARPMs use in emerging regions. Lack of strategies to reach the mobile population of emerging regions, facility readiness to provide LARPMs and quality of care were major policy and health care factors contributing for the low utilization of LARPMs. Low knowledge of LARPMs, health concerns, fear of side effects, and lower education were among individual level barriers identified through the review. Moreover, the review showed that men’s (partner’s) objection, desire for more children (especially by the male partner), absence of male involvement, lack of women’s decision-making power and lack of discussion with partners were gender related barriers. CONCLUSION: The regional disparity in LARPM use, particularly in emerging regions, requires targeted policy and strategic direction to address the prevailing inequality in family planning use and method mix. To improve the utilization of LARPMs, efforts should be made to address the key demand and supply side barriers. More context specific research evidences should be generated to understand barriers that are specific to these regions.
Maternal behavioural determinants and livestock ownership are associated with animal source food consumption among young children during fasting in rural Ethiopia.
Maternal and Child Nutrition. 2018 Sep 19; 9 p.Religious fasting often involves abstention from animal source foods (ASFs). Although children are exempt, their diets are influenced by the widespread fasting practices. This study investigated the factors influencing ASF consumption among young children during the Lent fasting period in western Amhara, Ethiopia. We used baseline survey data from households with children 6-23 months of age (n = 2,646). We conducted regression analysis to examine the maternal and household factors associated with ASF consumption and path analysis to examine the direct and indirect effects of maternal knowledge, beliefs, social norms, and livestock ownership on ASF consumption. Only 24% of children consumed any ASF in the previous day-18% dairy products, 5% eggs, and 2% flesh foods. Mothers with high knowledge, beliefs, and social norms about feeding children ASFs during fasting had higher odds (odds ratio: 1.3-1.4) of children who consumed them. Compared with households with no ASFs, those with ASFs available were 4.8 times more likely to have children who consumed them. Most of the association between knowledge, beliefs and social norms, and ASF consumption was explained by pathways operating through ASF availability (approximately 9, 12, and 8 pp higher availability, respectively), which in turn were associated with higher consumption. Cow ownership was directly and indirectly associated with ASF consumption, whereas having chickens was indirectly associated with consumption via the availability pathway. Our findings corroborate the importance of maternal behavioural determinants related to feeding ASFs to children during fasting on ASF consumption via household availability and the positive influence of livestock ownership.
Gender and household structure factors associated with maternal and child undernutrition in rural communities in Ethiopia.
PloS One. 2018; 13(10):e0203914.Addressing maternal and child undernutrition is a priority for the National Nutrition Program of Ethiopia. In a cross-sectional design, we selected mother-child pairs (n = 630) from Halaba, south Ethiopia (n = 413, two communities) and Zeway, Oromiya region (n = 217, one community). These communities were previously included in a project to improve agricultural practices. We aimed to estimate the level of maternal and child undernutrition in the two study sites and compare findings to regional/national reports. We also examined associations with gender, household-structure and nutrition/health related variables. Households were selected using simple random sampling based on list of households obtained from local health posts. Mothers were interviewed via questionnaire. Anthropometric measurements were taken from mothers-child pairs. Maternal undernutrition (% BMI<18.5) ranged from moderate (14% Zeway) to high (22% Halaba). In the children, stunting and underweight were very high (54% and 42% stunting, 36% and 21% underweight, in Halaba and Zeway, respectively). Up to 95% of Halaba and 85% of Zeway mothers reported "same as usual" or "less than usual" consumption patterns during their most recent pregnancy compared to periods of non-pregnancy. Mothers reported (61% in Halaba, 18% in Zeway) abstaining from consumption of certain nutritious foods for cultural reasons. Gender and socio-economic-demographic structure of the households, including imbalance of power, control of farm produce, physiological density, household size and dietary habits during pregnancy showed significant associations with maternal and child undernutrition (p<0.05). The levels of child and maternal undernutrition, particularly in children, were unexpected and of concern, given that a national nutrition program has been in place since 2008. The study provides insights for policy makers to improve women's education, reproductive health services for better family planning, and strengthen nutrition/health programs designed to target vulnerable segments of the population in these and other rural communities and districts with similar structure and demographics in Ethiopia.
Resistance pattern and maternal knowledge, attitude and practices of suspected Diarrheagenic Escherichia coli among children under 5 years of age in Addis Ababa, Ethiopia: Cross sectional study.
Antimicrobial Resistance and Infection Control. 2018; 7(1)Background: Diarrheal illness remains one of the leading causes of morbidity and mortality among children under 5 years of age worldwide, especially in developing countries. Diarrheagenic Escherichia coli (DEC) is the major cause of gastroenteritis in children in the developing world and is associated with high resistance levels to antibiotics. The aims of this study were to isolate and determine susceptibility patterns of DEC among children under 5 years of age with acute diarrhea and to assess maternal knowledge, attitude and practice towards childhood diarrhea. Methods: A cross sectional study was conducted from August-December 2015 at 3 selected health institutions. Stool samples were cultured and isolated E. coli species were run for antimicrobial susceptibility testing using disk diffusion method. In addition, children's caretakers were interviewed using structured questionnaires including a Knowledge, Attitude and Practice (KAPs) survey. Bivariate and multivariate logistic regression analysis was used to quantify the effect of different risk factors on bacterial related diarrhea. Results: A total of 253 children, 115 males and 138 females with acute diarrhea were enrolled. E. coli was identified in a total of sixty-one children (24.1%), followed by Shigella (9.1%) and Salmonella (3.95%). Additionally, eighty-six children (34.0%) had parasites identified in stool samples. E. coli isolates showed 83.6% resistance to ampicillin and augmentin followed by, trimethoprim-sulfamethoxazole (62.3%). Multiple resistances were observed in 72.1% of isolates; however, more than 90% of the strains were sensitive to ciprofloxacin and ceftriaxone. Caretakers identified the following as causes of infection: contaminated food and water (83.4%), microorganisms (55.3%), inadequate breast milk (54.1%), teething (45.1%), house flies (43.1%) and evil eye (15.8%). No hand washing before meals and low levels of knowledge had a significant association with E. coli infection (p < 0.05). Conclusion: In children with suspected diarrheagenic E. coli, we observed a high frequency of multidrug resistant E. coli. Furthermore, study subjects with low awareness about source, cause and symptoms of the disease were more likely to acquire suspected diarrheagenic E. coli infections. Thus, there is a need for more education in addition to continuous surveillance of the prevalence and antibiotic susceptibility pattern of diarrheal bacterial isolates in hospitals and in the community. © 2018 The Author(s).
Correlates of the Women's Development Army strategy implementation strength with household reproductive, maternal, newborn and child healthcare practices: a cross-sectional study in four regions of Ethiopia.
BMC Pregnancy and Childbirth. 2018 Sep 24; 18(Suppl 1):373.BACKGROUND: To address the shortfall in human resources for health, Ethiopia launched the Health Extension Program (HEP) in 2004, establishing a health post with two female health extension workers (HEWs) in every kebele (community). In 2011, the Women's Development Army (WDA) strategy was added, using networks of neighboring women to increase the efficiency of HEWs in reaching every household, with one WDA team leader for every 30 households. Through the strategy, women in the community, in partnership with HEWs, share and learn about health practices and empower one another. This study assessed the association between the WDA strategy implementation strength and household reproductive, maternal, newborn and child health care behaviors and practices. METHODS: Using cross-sectional household surveys and community-level contextual data from 423 kebeles representing 145 rural districts, an internal comparison group design was applied to assess whether HEP outreach activity and household-level care practices were better in kebeles with a higher WDA density. The density of active WDA leaders was considered as WDA strategy implementation strength; higher WDA density in a kebele indicating relatively high implementation strength. Based on this, kebeles were classified as higher, moderate, or lower. Multilevel logit models, adjusted for respondents' individual, household and contextual characteristics, were used to assess the associations of WDA strategy implementation strength with outcome indicators of interest. RESULTS: Average numbers of households per active WDA team leader in the 25th, 50th and 75th percentiles of the kebeles studied were respectively 41, 50 and 73. WDA density was associated with better service for six of 13 indicators considered (p < 0.05). For example, kebeles with one active WDA team leader for up to 40 households (higher category) had respectively 7 (95% CI, 2, 13), 11 (5, 17) and 9 (1, 17) percentage-points higher contraceptive prevalence rate, coverage of four or more antenatal care visits, and coverage of institutional deliveries respectively, compared with kebeles with one active WDA team leader for 60 or more households (lower category). CONCLUSION: Higher WDA strategy implementation strength was associated with better health care behaviors and practices, suggesting that the WDA strategy supported HEWs in improving health care services delivery.
Ethiopian Journal of Health Sciences. 2017 Jul; 27(4):314.Add to my documents.
Prevalence of premarital sexual practices and its associated factors among high school students in Addis Zemen Town, South Gondar, Ethiopia, 2017.
Journal of Public Health and Epidemiology. 2018 Oct; 10(10):356-362.Pre-marital sex is a penetrative vaginal or anal sexual intercourse performed before formal marriage in younger population. Moreover, these population groups are less likely than adults to have the information, skills and support to protect themselves against HIV/AIDS and other consequences of premarital sex. The aim of this study was to assess the prevalence of pre-marital sexual practice and its associated factors among high school students in Addis Zemen town. A cross sectional study design was conducted in purposefully selected site from April to June 2017. Single population proportion formula was used to select 284 study subjects. Study participants were selected randomly from grade 9 and 10 students. Structured pre-tested questionnaire was used to collect the data and data were checked and entered to EpiInfo v.3.5. Statistical Packages for Social Sciences v.20 used to analyze the data. Bivariant analysis results with p-value <0.2 was included in multivariate logistic regression. The study showed a prevalence of 32.6% premarital sex. Being lower age groups (13-18) were 2.48 times at higher risk than those who are at high age groups (19-25), (AOR=2.48, CI= 1.24-4.95). Having girl/boyfriends were 20.66 times at higher risk than those who have no girl/boyfriend, (AOR=20.66, CI= 9.39-45.46). Premarital sexual practice among the study participants was strongly associated with being lower age groups and having boy/girlfriends. The most mentioned reason for students to start their first sexual practice was love affair and interest. Health education should be encouraged and the clinic at school level should be strengthened as well as establishing a club to teach about premarital sexual practices are suggested.
Occurrence of diarrhea and utilization of zinc bundled with ORS among caregivers of children less than five years in Addis Ababa, Ethiopia.
Journal of Public Health and Epidemiology. 2018 Sep; 10(9):348-355.In response to the high occurrence of diarrhea in Ethiopia, the Federal Ministry of Health employed an effective strategy that included administration of zinc together with oral rehydration salt to treat children suffered diarrhea since 2013. Nonetheless, information on zinc bundled with ORS uptake is limited and thus this study has examined zinc utilization among beneficiaries. A community based cross-sectional study was conducted among 422 households whose under-five- children (U5C) had diarrhea in Akaki sub city from February to March, 2016. Prior to selection of households, participants were identified through health facilities and were traced using their household number. Relevant sociodemographic and other important health information were collected from respective caretakers using a pre-tested structured questionnaire through interview. Data were then entered using Epi Info Version 3.5.4, exported and analyzed using SPSS version 20 software. Both bivariate and multivariate regression analyses were used to identify the factors related to zinc utilization and a p-value below 0.05 was considered as statistically significant. All recruited subjects participated in the study with 100% response rate. Of the 422 participants, 283 (67.1%) caretakers used zinc bundles with ORS when the under-five-child had diarrhea. The majority (82.2%) sought treatment from health centers though their major (80.90%) source for zinc was private pharmacies. Following zinc intake, diarrhea subsided within 1-3 days in most (76.3%) of them. About the same proportion of caretakers recommended the zinc for watery diarrhea and the vast majority (90.5%) were satisfied with zinc supplement. Caregivers' whose child diarrhea stopped were more likely (AOR=10.29; 95% CI=2.52-42.05) to use zinc while those whose child diarrhea stopped after six days (AOR=0.09; 95% CI=0.02-0.45) and had mucoid diarrhea (AOR=0.32; 95% CI=0.10-0.97) were less likely to give their children the zinc than their counterparts. The study thus revealed that slightly over two in three children were given diluted zinc and the major augmenting factors for the zinc bundled with ORS uptake were withholding to administer the full dose, stopping the drug when diarrhea improved and recommending zinc therapy. It is thus essential to consider the above determinants, avail the zinc in the government facilities, improve zinc bundled with ORS intake and ultimately reduce deaths emanating from diarrhea.
Factors associated with birth preparedness and complication readiness among antenatal clinic attendants in selected public hospitals in Addis Ababa, Ethiopia: institution based cross sectional study.
Journal of Public Health and Epidemiology. 2018 Aug; 10(8):287-294.Birth preparedness and complication readiness is a comprehensive strategy aimed in promoting timely access to skilled maternal and neonatal services. It also facilitates active preparation and decision making for delivery by pregnant women. The aim of this study was to assess birth preparedness and complication readiness plans of antenatal clinic attendees in selected public Hospitals of Addis Ababa. Institution based cross-sectional design was used. Single population proportion formula was used to calculate sample size for the study. Bivariate and multivariate logistic regression analysis used to identify the association between the dependent and independent variables. This study revealed, among the study participants 72.60% stated that they were prepared for birth and its complication. Birth preparedness and complication readiness was found to have a statistically significant association with family income (AOR= 4.167, 95% CI, (1.092, 15.89) and knowledge about preparation for birth and its complications. In conclusion, majority of the study participants had planned birth preparedness and complication readiness but their preparation was not all rounded. Birth preparedness and complication readiness has statistically significant association with family about preparation for birth and its complication. Community education about birth preparation and its complication readiness; and improvement of the community economic status are recommended.
Determinants of modern contraceptive use among fertile women in Debark districts, North West Ethiopia.
Journal of Public Health and Epidemiology. 2018 Aug; 10(8):270-280.This study examined and identified the determinants of modern contraceptive use among fertile women in Debark district. In order to meet the objective descriptive, multiple logistic regression and multilevel logistic regression statistical techniques were used for data analysis. The results of multiple logistic regressions showed that health center, place of residence, marital status, access to media, environmental condition, frequency of modern contraceptive use, type of modern contraceptive and HIV test are significant determinant factors of modern contraceptive use in Debark districts. The results of multilevel logistic regression analysis showed that the random intercept and the fixed coefficient model provided the best fit for the data under consideration. The variance of the random component related to the intercept term was found to be statistically significant, implying differences in the distribution of modern contraceptive use in the health center. It also found that place of residence, marital status, environmental conditions, access of media, frequency of modern contraceptive use, type of modern contraceptive and HIV test were significant determinant factors of distribution of modern contraceptive among health center.
Factors affecting implementation of integrated community case management of childhood illnesses in South West Shoa Zone, Central Ethiopia.
Journal of Public Health and Epidemiology. 2018 May; 10(5):132-138.Ethiopia, this proven strategy is being implemented in selected districts of the regions but there are no sufficient evidences to decision-makers for improvement interventions. Cross-sectional study was conducted by including all functional health posts and HEWs from four randomly selected districts. Pre-tested structured questionnaires and observation checklist were used to collect data. Data was entered into Epi data version.3.1 and transported to SPSS v.21.0 for analysis. Bivariate and multiple binary logistic regression analysis were used to identify the determinants. 60 (60.6%) of the Health post were in good implementation category. 24 (15.3%) had only one HEW each, 26.8% had recommended three HEWs and 16 (16.2%) had no. HEWs mentored quarterly had three times better implementation (AOR) 3.14, 95% CI [1.65-6.52]). The services were less likely implemented in kebelles lacking any CHAs (AOR 0.47, 95% CI [0.19-0.83]). Health posts which were serving community for greater than eight hours per day had five times better implementation (AOR 5.33, 95% CI [2.58-9.33]). The study revealed that there is still a long way to go for better implementation of the program. Improving the program implementation needs a coordinated effort of all stakeholders at different levels. Nationally, preparing a system-wide approach towards resolving multifaceted challenges facing the programs will help attain the sectorial mission of reducing child mortality.