Ayalew Astatkie

Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia

BackgroundGlobally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care.MethodsA cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers.ResultsKnowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) [Adjusted OR = 3.63(95%CI: 1.81, 7.28)].ConclusionsA significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.

Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia

BackgroundThe World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. The partograph consists of a graphic representation of labour and is an excellent visual resource to analyze cervix, uterine contraction and foetal presentation in relation to time. However, poor utilization of the partograph was found in the public health institutions which reflect poor monitoring of mothers in labour and/or poor pregnancy outcome.MethodsA retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study.ResultsAll facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed.ConclusionsThis study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour or simply inappropriate completion of the instrument and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.

The Prevalence of Precancerous Cervical Cancer Lesion among HIV-Infected Women in Southern Ethiopia: A Cross-Sectional Study

Introduction The magnitude of precancerous cervical cancer lesions as well as invasive cervical cancer is higher in HIV-infected women than non HIV-infected women. Thus, screening targeting HIV-infected women is being undertaken in developing countries, including Ethiopia. However, data on the prevalence and determinants of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia is lacking. Thus, this study aimed to assess the prevalence of and factors associated with precancerous cervical cancer lesion among HIV- infected women in southern Ethiopia. Methods A hospital-based cross-sectional study was conducted from October 2012 to February 2013 among HIV-infected women in Southern Ethiopia. Four hundred forty eight HIV-infected women who had been screened and treated for precancerous cervical cancer lesion were included in the study. Data were collected by using structured and pretested questionnaire. Visual inspection with acetic acid was applied for screening and treatment. SPSS version 16.0 was used for data entry and analysis. Logistic regression analysis was fitted and odds ratios with 95% Confidence intervals and p-values were computed to identify factors associated with precancerous cervical cancer lesion. Results Out of 448 study participants, 99 (22.1%) were found to be positive for precancerous cervical cancer. Being currently on highly active antiretroviral treatment (AOR=0.52, 95%CI: 0.35, 0.92), history of sexually transmitted disease (AOR=2.30, 95%CI: 1.23, 4.29) and having only one lifetime sexual partner (AOR=0.33, 95%CI: 0.20, 0.56) were factors associated with precancerous cervical cancer lesion. Conclusions The prevalence of precancerous cervical cancer lesion among HIV-infected women in southern Ethiopia was found to be high. Intervention to access all HIV-infected women like scaling up the limited services and awareness creation should be undertaken. Measures aimed at preventing the acquisition and transmission of sexually transmitted diseases and reducing the number of sexual partners are required. Besides, early initiation of highly active antiretroviral treatment is important.

Impact of HIV Status on Treatment Outcome of Tuberculosis Patients Registered at Arsi Negele Health Center, Southern Ethiopia: A Six Year Retrospective Study.

Background Despite implementation of different strategies, the burden and mortality of human immunodeficiency virus (HIV)-associated tuberculosis (TB) remains a challenge in Ethiopia. The aim of this study was to assess the impact of HIV status on treatment outcome of tuberculosis patients registered at Arsi Negele Health Center, Southern Ethiopia. Methods A six-year retrospective data (from September 2008 to August 2014) of tuberculosis patients (n = 1649) registered at the directly observed therapy short-course (DOTS) clinic of Arsi Negele Health Center was reviewed. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 20. Multinomial logistic regression analysis was used to examine the effect of HIV status separately on default/failure and death in relation to those who were successfully treated. Odds ratios with 95% confidence intervals were used to check the presence and strength of association between TB treatment outcome and HIV status and other independent variables. Results Out of the 1649 TB patients, 94.7% (1562) have been tested for HIV of whom 156(10%) were HIV co-infected. The mean (standard deviation) age of the patients was 28.5(15.5) years. The majority were new TB cases (96.7%), male (53.7%), urban (54.7%), and had smear negative pulmonary TB (44.1%). Overall, the treatment success rate of TB patients with or without HIV was 87.3%. Using cure/completion as reference, patients without known HIV status had significantly higher odds of default /failure [aOR, 4.26; 95%CI, 1.684–10.775] and transfer-out [aOR, 2.92; 95%CI, 1.545–5.521] whereas those who tested positive for HIV had a significantly higher odds of death [aOR, 6.72; 95%CI, 3.704–12.202] and transfer-out [aOR, 2.02; 95%CI, 1.111–3.680]. Conclusion Overall, treatment outcome and HIV testing coverage for TB patients is promising to reach the WHO target in the study area. However, default/failure among patients without known HIV status, and higher rate of mortality among HIV positive TB patients and transfer-out cases deserves concern. Therefore further prospective studies on quality of services, socioeconomics and psychology of this group should be conducted.

Prevalence of and factors associated with regular khat chewing among university students in Ethiopia

Purpose Khat (Catha edulis) is commonly chewed for its psychostimulant and euphorigenic effects in Africa and the Arabian Peninsula. Students use it to help them study for long hours especially during the period of examination. However, how regularly khat is chewed among university students and its associated factors are not well documented. In this article we report on the prevalence of and factors associated with regular khat chewing among university students in Ethiopia. Methods We did a cross-sectional study from May 20, 2014 to June 23, 2014 on a sample of 1,255 regular students recruited from all campuses of Hawassa University, southern Ethiopia. The data were collected using self-administered questionnaires. We analyzed the data to identify factors associated with current regular khat chewing using complex sample adjusted logistic regression analysis. Results The prevalence of current regular khat chewing was 10.5% (95% confidence interval [CI]: 6.1%–14.9%). After controlling for sex, religion, year of study, having a father who chews khat, cigarette smoking and alcohol drinking in the adjusted logistic regression model, living off-campus in rented houses as compared to living in the university dormitory (adjusted odds ratio [95% CI] =8.09 [1.56–42.01]), and having friends who chew khat (adjusted odds ratio [95% CI] =4.62 [1.98–10.74]) were found to significantly increase the odds of current regular khat use. Conclusion Students living outside the university campus in rented houses compared to those living in dormitory and those with khat chewing peers are more likely to use khat. A multipronged prevention approach involving students, the university officials, the surrounding community, and regulatory bodies is required.

Oral symptoms significantly higher among long-term khat (Catha edulis) users in Ethiopia

OBJECTIVES: Associations between khat (Catha edulis) chewing and different adverse oral-dental health conditions have been reported, yet evidence is still lacking. This study was designed to investigate the association between long-term regular khat chewing and self-reported oral symptoms. METHODS: A cross-sectional study was conducted on a sample of 1,255 university students in southern Ethiopia. Data on khat chewing status, a range of oral symptoms and other pertinent variables were collected using self-administered questionnaires. The association between long-term regular khat chewing and oral symptom count was investigated using negative binomial regression. RESULTS: The mean oral symptom count among long-term regular khat chewers was 1.75 (standard deviation [SD], 2.18; standard error [SE], 0.31), whereas that among those who were not long-term regular khat chewers was 1.18 (SD, 1.68; SE, 0.10). After adjustment for other variables, long-term regular khat chewers had approximately 50% more oral symptoms than those who were not long-term chewers did (adjusted count ratio, 1.53; 95% confidence interval, 1.12 to 2.10). CONCLUSIONS: Long-term khat chewing negatively affects the oral health of young university students.

Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis

BackgroundEmergence of antimicrobial resistance by Staphylococcus aureus has limited treatment options against its infections. The purpose of this study was to determine the pooled prevalence of resistance to different antimicrobial agents by S. aureus in Ethiopia.MethodsWeb-based search was conducted in the databases of PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals (DOAJ) to identify potentially eligible published studies. Required data were extracted and entered into Excel spread sheet. Statistical analyses were performed using Stata version 13.0. The metaprop Stata command was used to pool prevalence values. Twenty-one separate meta-analysis were done to estimate the pooled prevalence of the resistance of S. aureus to twenty-one different antimicrobial agents. Heterogeneity among the studies was assessed using the I2 statistic and chi-square test. Publication bias was assessed using Egger’s test. Because of significant heterogeneity amongst the studies, the random effects model was used to pool prevalence values.ResultsThe electronic database search yielded 1317 studies among which 45 studies met our inclusion criteria. Our analyses demonstrated very high level of resistance to amoxicillin (77% [95% confidence interval (CI): 68%, 0.85%]), penicillin (76% [95% CI: 67%, 84%]), ampicillin (75% [95% CI: 65%, 85%]), tetracycline (62% [95% CI: 55%, 68%]), methicillin (47% [95% CI: 33%, 61%]), cotrimoxaziole (47% [95% CI: 40%, 55%]), doxycycline (43% [95% CI: 26%, 60%]), and erythromycin (41% [95% CI: 29%, 54%]). Relatively low prevalence of resistance was observed with kanamycin (14% [95% CI: 5%, 25%]) and ciprofloxacin (19% [95% CI: 13%, 26%]). The resistance level to vancomycin is 11% 995% CI: (4%, 20%). High heterogeneity was observed for each of the meta-analysis performed (I2 ranging from 79.36% to 95.93%; all p-values ≤0.01). Eggers’ test did not show a significant publication bias for all antimicrobial agents except for erythromycin and ampicillin.ConclusionsS. aureus in Ethiopia has gotten notoriously resistant to almost to all of antimicrobial agents in use including, penicillin, cephalosporins, tetracyclines, chloramphenicol, methicillin, vancomycin and sulphonamides. The resistance level to vancomycin is bothersome and requires a due attention. Continued and multidimensional efforts of antimicrobial stewardship program promoting rational use of antibiotics, infection prevention and containment of AMR are urgently needed.

Home birth and its determinants among antenatal care-booked women in public hospitals in Wolayta Zone, southern Ethiopia

Introduction Antenatal care (ANC), health facility birth and postnatal care services are proved to reduce maternal and newborn morbidity and mortality. In Ethiopia, even though antenatal care coverage is good, still home birth is high. This study aimed to assess the prevalence and determinants of home birth among women who were booked for ANC in public hospitals in Wolaita zone, southern Ethiopia. Methods A cohort study was conducted from February to May 2017 among 554 third trimester pregnant mothers who visited public hospitals of Wolaita Zone, southern Ethiopia for ANC service. All women were interviewed twice: the first interview was done face-to-face in the health facility in which they were having ANC follow up to gather information about basic socio-demographic and obstetric characteristics; the second interview was done via telephone after they gave birth to get information about the place of birth. Epi-Data version 3.1 was used for data entry and the Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis. Results A total of 68 (13.5%; 95% Confidence Interval (CI): 10.5%-16.6%) women who were booked for ANC gave birth at home. Being uneducated (AOR = 2.46, 95% CI: [1.10–5.10]), starting ANC visit late (>16weeks) (AOR = 2.27, 95% CI: [1.14–4.50]), time taken to reach at health facility for ANC service (>30minutes) (AOR = 8.94, 95% CI: [4.50–17.72]), waiting time of greater than 30 minutes for ANC in health facilities (AOR = 1.18, 95% CI: [1.06–2.30]) and lack of knowledge about danger signs of pregnancy (AOR = 4.18, 95%CI: [1.80–9.70]) were significantly associated with home birth. Conclusions Home birth among ANC booked women is low compared to other studies. Yet, giving attention to women with no education and those coming from far areas while providing advice on birth preparedness and pregnancy danger signs may be useful to further reduce the rate of home birth. Advising mothers to start ANC early and trying to reduce ANC waiting time could also be of importance.

Seroepidemiology of Human Brucellosis among Blood Donors in Southern Ethiopia: Calling Attention to a Neglected Zoonotic Disease

Human brucellosis is neglected in southern Ethiopia. Although traditional food processing practices and animal husbandry which increase the risk of brucellosis are common, it has not been properly studied yet. This study was conducted to determine the seroepidemiology of brucellosis among apparently healthy individuals in southern Ethiopia. In the study, blood samples were collected to screen for serum agglutinins reactive to stained antigen of Brucella abortus Standard tube titration was performed for reactive serum to determine the titer of the agglutinin. A structured questionnaire was used to collect data on possible risk factors for brucellosis. The seroprevalence of human brucellosis in this study was found to be 10.6% (95% confidence interval = 7.0, 14.0). Possession of domestic ruminant animals, contact with ruminant animals, and husbandry practices at home were associated with seropositivity. The higher seroprevalence of human brucellosis in the study area needs attention and additional confirmatory investigation.