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Background: Malnutrition in pregnancy remains unacceptably high across all regions of Africa though promising progresses have been made globally. Primary studies might not be sufficient to portrait a comprehensive picture of malnutrition during pregnancy and its main risk factors. Therefore, we intended to review the burden of malnutrition, for this specific review implies to protein energy malnutrition, during pregnancy in Africa to present its magnitude and determinant factors. Methods: We did a systematic review of observational studies published from January 1/2008 to January 31/2018. The (EBSCO), , Emcare, databases and Google scholar were searched. Articles quality was assessed using the Newcastle-Ottawa Scale and studies with fair to good quality were included. We pooled malnutrition prevalence and an odds ratio estimates for risk factors after checking for heterogeneity and publication bias. This review has been registered in Prospero with a protocol number CRD42018114949. Result: 23 studies involving 20,672 pregnant women were included. Using a random effect model, the overall pooled prevalence of malnutrition among pregnant women in Africa was 23.5% (95%CI: 17.72–29.32; I2 = 98.5%). Based on the current review pooled odds ratio finding; rural residency (POR = 2.6%; 95%CI: 1.48–4.65; I2 = 0%), low educational status of partners (POR = 1.7%; 95%CI: 1.19–2.53; I2 = 54.8%), multiple pregnancy (POR = 2.15%; 95%CI: 1.27–3.64; I2 = 0%) and poor nutritional indicators (POR = 2.03%; 95%CI: 1.72–2.4, I2 = 0%) were positively determine maternal malnutrition. On contrary, better household economic status (POR = 0.47%; 95%CI: 0.36–0.62; I2 = 24.2%) negatively determine maternal malnutrition. Conclusion: A significant number of the pregnant population in Africa are suffering of malnutrition, above 10% of the standard acceptable malnutrition rate. Thus, efforts should be renewed to ensure a proper and widespread implementation of programs that would address issues identified in the current review to reduce the burden of malnutrition. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia. Methods: A community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children’s vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations. Results: Age-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1–3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29–0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4–3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3–5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1–3.5), missing pregnant women’s conference (AOR: 2.7, 95% CI: 1.3–5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17–0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6–4.4). Conclusion: The proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence is a thoughtful public health concern and human rights violation towards pregnant women for it has a significant negative health effect on the life of both the mother and her fetus. However, there is a scanty of information about the extent of intimate partner violence during pregnancy in Ethiopia, particularly in the study area. Therefore, the current study was conducted to determine the prevalence of intimate partner violence among pregnant women attending antenatal care and identify associated factors that cause it. Methods: An institution based cross-sectional study was conducted on 409 pregnant women who were attending antenatal care service in Debre Markos town from March 17, 2018 –April 28, 2018. Systematic random sampling technique was used to select study participants. A pre-tested structured questionnaire was used to collect the data. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with intimate partner violence during pregnancy. Results: The prevalence of intimate partner violence during current pregnancy was found to be 41.1% (95% confidence interval (CI): 36.0–46.0). Of this, the prevalence of psychological, physical, and sexual violence was 29.1%, 21%, 19.8% respectively. Lower educational status of partners (AOR = 3.26, 95%CI: 1.45–7.36), rural residency (AOR = 4.04, 95%CI: 1.17–13.93), frequent alcohol abuse by partner (AOR = 4.79, 95% CI: 2.08–11.04), early initiation of antenatal care (AOR = 0.44, 95% CI: 0.24–0.81), the age of women between 17–26 years (Adjusted odds ratio (AOR) = 0.21, 95%CI: 0.09–0.49),choice of partner by the women only (AOR = 3.26,95% CI:1.24–8.57) were statistically significant factors associated with intimate partner violence towards pregnant women. Conclusions: In this study, the prevalence of intimate partner violence during pregnancy is found to be high. As a result, interventions that would address the above mentioned factors need to be implemented. [ABSTRACT FROM AUTHOR]

Background: Adolescents have physical, social and psychological characteristics that are different from adults. Adolescent pregnancy results in pregnancy and childbirth complications- an area neglected in developing countries like Ethiopia. This study, therefore, was conducted to assess the adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. Methods: Institutional-based study was conducted in East Gojjam zone, Northwest Ethiopia. A total of 374 adolescent (15–19 years) and 760 adult (20–34 years) women were included in this study. Data were collected among women who came to randomly selected health facilities in East Gojjam zone. Data were collected by trained research assistants using a structured data collection questionnaire. Descriptive statistics, chi-square test, and Student's t-tests were utilized. Bivariate and multivariable logistic regression analysis were employed to adjust for confounding factors of adverse neonatal outcomes. Statistical significance was declared when the p-value was less than 0.05. Results: Higher proportion of adolescent than adult women were from rural area (57.2% vs 44.7%), were not married (5.1% vs 1.7%), were pregnant for the first time (91.7% vs 34.1%), didn’t attend antenatal care (ANC) follow-up (12% vs 4.5%), and had late initiation of ANC follow-up. After adjusting for known confounding factors, the odds of low birth weight (LBW) was higher among adolescents than adult women (AOR 2.14; 95% CI, 1.36, 3.36, p-value = 0.001). Similarly, the odds of preterm birth was higher among adolescents than adult women (AOR 1.65; 95% CI, 1.09, 2.49, p-value = 0.017). There was no statistically significant difference in the rate of low Apgar score at first and five minutes after birth and neonatal Intensive Care Unit (ICU) admission between babies born from adolescent and adult women. Conclusions: Adolescent women were less likely to receive ANC service. Babies born from adolescent women are at higher odds of adverse neonatal outcomes like LBW and preterm birth than babies born from adult women. Use of community- and health facility-based intervention programs that can prevent adolescent pregnancy and reduce adverse neonatal outcomes among adolescent girls is recommended. [ABSTRACT FROM AUTHOR]

Background: Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth to impede closely spaced and unintended pregnancies. Globally, spacing pregnancies at least 2 years apart can prevent an estimated 10% of infant deaths and 21% of deaths in children 1–4 years of age. The main purpose of this study was to determine postpartum modern contraceptive use and associated factors in Hossana town, Hadiya zone, Southern nation nationalities peoples region, Ethiopia. Methods: Facility based cross-sectional study was conducted from June 03 to July 03, 2018, in Hossana town, Hadiya zone. Data was collected by structured questionnaires using face-to-face interview on 368 women. Systematic random sampling technique was employed to approach the study participants. SPSS version 20 software was used for data analysis. Both bivariate and multiple variable logistic regression analysis were computed. Odds ratio with their 95% confidence intervals were calculated and statistical significance was decided if p < 0.05. Result: Two hundred seventy one (72.9%) women used postpartum modern contraception. Educational status of mothers [AOR = 0.26; 95% Cl; 0.09–0.744], resumption of sex [AOR = 4.20; 95% Cl; 1.533–11.517], menses resumption [AOR = 8.48; 95% Cl; 3.072–23.228] and duration postpartum period [AOR = 0.26; 95% Cl; 0.107–0.644] had significant association with postpartum modern contraceptive use. Conclusions: The prevalence of postpartum modern contraception use is relatively high. Educational status of mothers, resumption of sex, menses resumption and duration of postpartum period were factors significantly associated with postpartum modern contraceptive use. Improving women education & delivering messages for couples on the risk of getting pregnant prior to menses is crucial. [ABSTRACT FROM AUTHOR]

Introduction: Despite the government’s efforts to decentralize and expand health institutions to promote facility-based child delivery, home delivery and maternal mortality are still widespread problems in Ethiopia. Most mothers continue to give birth at home. This study aims at identifying the socio-cultural practices, perceived benefit or need, and accessibility factors influencing women’s choice of health facilities for delivery services in Gida Ayana Woreda, western Ethiopia. Methods: We conducted a cross-sectional survey to assess women’s use of delivery care services in Gida Ayana Woreda, from November 2016 to January 2017; 459 women who were selected randomly participated in the study. We evaluated the socio-cultural, perceived benefit or need, and economic and physical accessibility factors in women’s choice of delivery care and used adjusted logistic regression analysis to examine significant predictors of delivery site use decisions. Results: Over half (56.6%) of the women self-reported using institutional delivery care; 80.9% gave birth at a health center. A socio-cultural variable, maternal education, significantly influenced women’s choice of health facility for delivery care services (AOR 3.4; 95% CI 2.0–5.9). Mothers’ knowledge level of obstetric complications and experience of complications during the last birth were the two perceived benefits or need factors associated with higher odds of receiving delivery care from decentralized local facilities. Utilization of health centers for maternal delivery care was significantly higher than of health posts (AOR 5.0; 95% CI 2.4–10.2). Availability of motorized transportation during labor to nearby delivery site was a significant predictor of institutional delivery. Conclusion: This study demonstrates the under-utilization of decentralized health facilities for maternal delivery care services in Gida Ayana Woreda, which was significantly influenced by socio-cultural, perceived need, and accessibility factors of women during childbirth. This suggests the need for tailored intervention to improve childbirth services use for mothers in this kind of rural settings. [ABSTRACT FROM AUTHOR]

Introduction: Routine cervical screening has been shown to greatly reduce both the number of new cervical cancers diagnosed each year and the number of deaths resulting from the disease. Nevertheless, cervical screening knowledge and screening uptake is very low in developing countries. In Ethiopia, the coverage of cervical cancer screening is only 1%. In this study, we aimed to assess cervical cancer screening knowledge and barriers for screening uptake among women in Addis Ababa Ethiopia. Methods: A facility-based cross-sectional study was conducted from February to March 2015 in Addis Ababa, Ethiopia. A total of 520 women were selected by a multi-stage sampling procedure. Interview based questioner was used to collect the data. Descriptive statistics was used to describe the socio-demographic and clinical profiles of the women. Multivariate logistic regression using adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify independent predictors for cervical screening knowledge. A p-value of <0.05 was set to determine level of statistical significance. Results: Among all women, 42.7% had heard of cervical cancer screening and 144 (27.7%) women had adequate knowledge of cervical cancer screening. The mean (±SD) age of women was 27.7 (±5.49) years. In total, a quarter (25%) of eligible women had experience of cervical cancer screening. Not being married (adjusted odds ratio (AOR) = 1.8, 1.1–3.3), having an awareness of cervical cancer (AOR = 5.0, 2.7–9.1) and receiving information from health professionals (AOR = 1.9, 1.1–3.2) were the predictors for good cervical cancer screening knowledge. An absence of symptoms (57%), a lack of knowledge about screening (56.3%) and the lack of a screening service in their living area (42.2%) were the perceived barriers for screening uptake. Conclusions: Cervical screening knowledge was low among women and less than half had heard of screening. Women also had low experience of screening. The lack of a screening service, the absence of symptoms and not knowing about screening were the perceived reasons for the low uptake. Hence, awareness campaigns and education should be undertaken by health professionals. Access and availability of screening service is also essential to improve screening uptake. [ABSTRACT FROM AUTHOR]

Background: There is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias. Objective: This study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting. Methodology: A longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People’s Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators. Results: We find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency. Conclusion: As with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) against women is a major public health concern in low income countries. Violence against pregnant women has adverse effects on maternal and newborn outcomes. This study aimed to assess the prevalence and associated factors of intimate partner violence in Southeast Ethiopia pregnant women. Methods: Institutional based cross-sectional study was conducted on pregnant women who were attending antenatal care (ANC) in Bale Zone health institution during study period. Face to face interviews were conducted using a pre-tested structured questionnaire. Data related to socio-demographic characteristic, pregnancy and reproductive history, intimate partner behavior and IPV encountered during recent pregnancy was gathered for this study. Descriptive analysis and logistic regression were used for the data analysis. Odds ratio with 95% CI was computed to determine the presence and strength of associated factors with IPV. Results: A total of 612 pregnant women participated in the study. Of these, 361 (59.0%) pregnant women faced at least one type of IPV during the recent pregnancy. Physical violence (20.3%), sexual violence (36.3%), psychological/emotional violence (33.0), controlling behavior violence (30.4%) and economic violence (27.0) were the type of IPV encountered by participants. An intimate partners who were drank alcohol [AOR = 2.9; 95% CI: (1.5–5.4)], partners who were chewed Khat [AOR = 1.7; 95% CI: (1.1–2.6)], partners who were smoked cigarette [AOR = 2.6; 95% CI: (1.4–4.9)], partners who had aggressive behavior [AOR = 2.8; 95% CI: (1.7–4.6)], having partner age ≥30 year old [AOR = 1.8; 95% CI: (1.2–2.9)], unwanted pregnancy [AOR = 3.3; 95% CI: (1.9–5.5)] and history of adverse pregnancy outcome [AOR = 2.1; 95% CI: (1.2–3.6)] that were the factors that significantly associated with IPV of the pregnant women. Conclusion: The prevalence of IPV during pregnancy was high among the study participants. Intimate partners’ use of substance, intimate partners’ aggressive behavior, older intimate partners, unwanted pregnancy and history of adverse birth outcome were identified as associated factors for IPV. IPV needs to be considered during ANC service and integrated into the sexual and reproductive health education. Community-based interventions should be advocated as a way of health promotion. Counseling, awareness creation, service provision and program design on IPV is mandatory to minimize the victim. [ABSTRACT FROM AUTHOR]

Background: In the context of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. According to a 2016 national report, only 62% of pregnant women in Ethiopia made at least one antenatal care visit. The aim of this review was to systematically and quantitatively summarize the factors affecting utilization of antenatal care in Ethiopia. Methods: We searched PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care database for studies that had been conducted in Ethiopia between 2002 and 2016. We summarized the studies on the use of antenatal care services quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates. Results: A total of fifteen observational studies were included in this review. The pooled prevalence of utilization of antenatal care services in Ethiopia was 63.77% (95CI 53.84–75.54). The pooled odds ratio showed that a significant positive association was found between utilization of antenatal care and urban residence (OR = 1.92, 95%CI = 1.35–2.72), women’s education (OR = 1.90, 95%CI = 1.52–2.37), husband’s education (OR = 1.49, 95%CI = 1.32–1.69) and planned pregnancy (OR = 2.08, 95%CI = 1.45–2.98). Based on narrative synthesis exposure to mass media, family income and accessibility of the service were strongly associated with utilization of antenatal care. Conclusion: The findings of this review found several modifiable factors such as empowering women through education and increasing their decision-making power, promoting family planning to prevent unplanned pregnancy, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of antenatal care. Further research is needed on accessibility and availability of the service at the individual and community level to assess the predictors of antenatal care service utilization. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum intrauterine contraceptive devices (PP-IUCD) are one type of post-partum family planning method, which can be provided to a post-partum woman starting from the placental delivery time (within 10 minutes), or within the first 48 hours of postpartum period. In most developing countries, delivery time is the primary opportunity for women to access post-partum family planning methods, especially for those living in remote areas. Hence, this study assesses providers’ knowledge on postpartum intrauterine contraceptive device service provision. Methods: A facility-based cross-sectional study was conducted in Amhara region health center and hospitals. Health providers surveyed included obstetricians, gynecologists, general practitioners, emergency surgical officers, health officers, midwives and nurses from September 18, 2015 to December18, 2016. Simple random sampling was used to select 864 subjects. Data were collected by using a structured self-administered questionnaire and observing the facility. Multilevel analysis was done to see factors associated with outcome. Results: A total of 197 health facilities and 864 providers are included in the final analysis. Of the total providers 524 (60.6%) were from a health center. The mean age (±SD) of participants was 27.8 years (±5.4). The number of providers with good knowledge accounted for 253 of those surveyed (29.3%). The proportion of good knowledge among trained PP-IUCD providers was 35.7% (those who scored above average), and 27.9% was untrained about PP-IUCD. A considerable heterogeneity was observed between health facilities for each indicator of provider’s knowledge. Gender differences were observed as the mean knowledge score deference on PP-IUCD by 0.4 points (β = -0.41; -0.72, -0.10) when the participant was female. Having experience of regular counseling of pregnant women increases PP-IUCD knowledge score by 0.97. (β = 0.97; 95% CI: 0.48, 1.47). Where the health facility requested clients to purchase the IUCD themselves, the mean knowledge score decreased by 0.47 points compared with free of charge at the facility level (β = -0.47; 95%CI: -0.87, -0.07). Conclusion: Our findings showed that providers’ knowledge about postpartum IUCD was low in the Amhara region public health facility. The lowest knowledge score was noted among nurses, health Officers, midwives, and general practice professionals. Factors associated with providers’ knowledge on PP-IUCD are the status of health facility, female sex, training on PP-IUCD, regular counseling of pregnant women, and unavailability of IUCD service. [ABSTRACT FROM AUTHOR]

Poor nutritional status in pregnancy expressed as low mid-upper arm circumference (MUAC) is associated with low birth weight. The study aims were to assess the nutritional status of pregnant Ethiopian women using MUAC and examine association with nutrition-specific and nutrition-sensitive factors, using baseline data of a prospective longitudinal observational birth cohort study conducted in three rural districts in the Oromia region of Ethiopia. Recruitment into the cohort was rolling over a period of nine months, and the data used for this analysis were collected while the women were between 12–32 weeks of gestation. Detailed household socio-demographics, agricultural production, women’s health, morbidity and diets, with weights, heights and MUAC, and anemia prevalence (HemoCue) were collected. The prevalence of low MUAC (< 23 cm) was 41%. Controlling for location and clustering, wealth quintile (OR = 0.88, CI = 0.82 to 0.96, p<0.01) was associated with decreased risk of low MUAC, while trimester (OR = 1.31, CI = 1.16 to 1.48, p<0.001) was associated with increased risk of low MUAC. The only significant factor amenable to nutrition-specific interventions was altitude-adjusted anemia, which was associated with increased risk of low MUAC (OR = 1.28, CI = 1.09 to 1.49, p<0.01). Significant factors amenable to nutrition-sensitive factors and associated with higher odds of low MUAC were household food insecurity (OR = 1.04, CI = 1.02 to 1.06, p<0.001), distance to the clinic in minutes (OR = 1.01, CI = 1.0 to 1.01, p<0.0001) and season of recruitment (lean versus non lean) (OR = 1.30, CI = 1.10 to 1.54, p<0.01). Literacy (OR = 0.85, CI = 0.74 to 0.98, p<0.05) and numeracy (OR = 0.75, CI = 0.62 to 0.91, p<0.01) were also significantly associated with lower odds of low MUAC. Poor nutritional status in pregnancy expressed as percent with low MUAC was high in Ethiopian women. It was associated with several nutrition-specific and -sensitive factors indicating the importance of multisectoral actions in improving outcomes within the first 1000 days. [ABSTRACT FROM AUTHOR]

Background: Low birth weight at birth is an important underlying contributor for neonatal and infant mortality. It accounts for nearly half of all perinatal deaths. Identifying predictors of low birth weight is the first essential step in designing appropriate management strategies. Hence, this study aimed to identify risk factors for low birth weight in hospitals of northeastern Ethiopia. Methods: An institution based case-control study design was conducted from 10th April to 15th December 2016. Three hundred sixty mother-infant pairs (120 low birth weight babies as cases and 240 normal birth weights as controls) were included in the study. Data were collected by face-to-face interview. Univariable and multivariable logistic regression models were computed to examine the effect of independent variables on outcome variable using SPSS 20.0. Variables with p-value <0.05 were considered statistically significant. Results: The mean (±SD) gestational age and birth weight (±SD) were 39.2 (±1.38) weeks and 2800 (±612), grams respectively. Partner's education/being illiterate (AOR: 4.09; 95% CI 1.45, 11.50), antenatal care visit at private health institutions (AOR: 0.13; 95% CI 0.02, 0.66), having history of obstetric complications (AOR: 5.70; 95% CI 2.38, 13.63), maternal weight during pregnancy (AOR: 4.04; 95% CI 1.50, 10.84) and gravidity (AOR: 0.36; 95% CI 0.18, 0.73) were significantly associated with low birth weight. Additionally, a site for water storage and water treatment were significant environmental factors. Conclusion: Maternal weight during pregnancy, paternal education, previous obstetric complication and place of antenatal follow-up were associated with low birth weight. The risk factors identified in this study are preventable. Thus, nutritional counseling, health education on improvement of lifestyle and early recognition and treatment of complications are the recommended interventions. [ABSTRACT FROM AUTHOR]

Health management information system (HMIS) data are important for guiding the attainment of health targets in low- and middle-income countries. However, the quality of HMIS data is often poor. High-quality information is especially important for populations experiencing high burdens of disease and mortality, such as pregnant women, newborns, and children. The purpose of this study was to assess the quality of maternal and child health (MCH) data collected through the Ethiopian Ministry of Health’s HMIS in three districts of Jimma Zone, Oromiya Region, Ethiopia over a 12-month period from July 2014 to June 2015. Considering data quality constructs from the World Health Organization’s data quality report card, we appraised the completeness, timeliness, and internal consistency of eight key MCH indicators collected for all the primary health care units (PHCUs) located within three districts of Jimma Zone (Gomma, Kersa and Seka Chekorsa). We further evaluated the agreement between MCH service coverage estimates from the HMIS and estimates obtained from a population-based cross-sectional survey conducted with 3,784 women who were pregnant in the year preceding the survey, using Pearson correlation coefficients, intraclass correlation coefficients (ICC), and Bland-Altman plots. We found that the completeness and timeliness of facility reporting were highest in Gomma (75% and 70%, respectively) and lowest in Kersa (34% and 32%, respectively), and observed very few zero/missing values and moderate/extreme outliers for each MCH indicator. We found that the reporting of MCH indicators improved over time for all PHCUs, however the internal consistency between MCH indicators was low for several PHCUs. We found poor agreement between MCH estimates obtained from the HMIS and the survey, indicating that the HMIS may over-report the coverage of key MCH services, namely, antenatal care, skilled birth attendance and postnatal care. The quality of MCH data within the HMIS at the zonal level in Jimma, Ethiopia, could be improved to inform MCH research and programmatic efforts. [ABSTRACT FROM AUTHOR]

Introduction: Weight gain during pregnancy is an important indicator of maternal and fetal nutrition during pregnancy. However, information regarding the effect of pregnancy weight gain on birth weight is lacking from developing countries. Objective: To determine the effect of pregnancy weight gain on the newborn’s birth weight in mothers attending antenatal care (ANC) services from private clinics. Methods: Health facility-based follow-up study was conducted among 332 pregnant mothers attending their antenatal care in Mekelle city, from October 2016 to June 2017. Before 28 weeks of gestation, pregnancy weight was collected retrospectively, then, mothers were followed-up until the time of infant delivery to record their birth weight. Data were also collected by a structured questionnaire and checklists and analyzed using SPSS version 21. The relationship between dependent and independent variables was assessed and presented using descriptive statistics, as well as t-test, ANOVA, and multivariable linear regression analysis. Variables:—pre-pregnancy BMI, maternal age, parity, decision making power on monetary resources, pregnancy interval, availability of housemaid, women dietary diversity score, maternal occupation, and pregnancy weight gain were included in the multivariable analysis. Results: Maternal weight increased monthly at a mean ± SD rate of 2 ± 0.7 kg in the second trimester, and 1.5 ± 0.7 kg in the third trimester. The mean ± SD of pre-pregnancy body mass index (BMI) and total pregnancy weight gain was 23.8 ± 4.6 kg/m2, and 12 ± 2.8 kg respectively. The mean ± SD of birth weight was 3440 ± 542 grams. Weight gain has a significant effect on infant birth weight, a 1 kg increase in the pregnancy weight was associated with 94 g increase in BW (β = 97, 95% CI: 73–120). After dividing the pre-pregnancy weight into four groups (< 18.5, 18.5–24.9, 25–29.9 and ≥30) kg/m2 based on the Institute of Medicine (IOM), we found a statistically significant birth weight difference between each group. Conclusion: Pregnancy weight gain has a significant effect on birth weight. Thus, ANC counseling services should focus on maternal weight gain to prevent sub-optimal birth weight. [ABSTRACT FROM AUTHOR]

Background: Maternal depression is the most prevalent psychiatric disorder during pregnancy, can alter fetal development and have a lasting impact on the offspring's neurological and behavioral development. However, no review has been conducted to report the consolidated magnitude of antenatal depression (AND) in Ethiopia. Therefore, this review aimed to systematically summarize the existing evidence on the epidemiology of AND in Ethiopia. Methods: Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of AND from three electronic databases (PubMed, EMBASE, and SCOPUS). We used predefined inclusion criteria to screen identified studies. A qualitative and quantitative analysis was employed. Heterogeneity across the studies was evaluated using Q and the I² test. Publication bias was assessed by funnel plot and Egger’s regression test. Results: In this review, a total of 193 studies were initially identified and evaluated. Of these, five eligible articles were included in the final analysis. In our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96–27.78). The prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. The prevalence of AND was 26.48% and 18.28% as measured by Beck depression inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Moreover, the prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.77% for the studies conducted in the institution-based setting. In our qualitative synthesis, we found that those pregnant women who had a history of stillbirth, complications during pregnancy, previous history of depression, no ANC follow-up, irregular ANC follow-up, not satisfied by ANC follow-up, and monthly income <1500 Ethiopian birr were linked with a greater risk of developing ANC. We also found that those women who experienced partner violence during pregnancy, food insecurity, medium and low social support, and those who were unmarried, age group 20–29, house wives and farmers were associated with a higher risk of developing ANC. Conclusion and recommendations: Our meta-analysis found that the pooled prevalence of AND in Ethiopia was 21.28%. The prevalence of AND was high in the third trimester of pregnancy as compared to the first and second trimesters of pregnancy. The prevalence of AND was high in studies conducted using BDI than EPDS. Studies on the magnitude of AND as well as the possible determinants in each trimester of pregnancy with representative sample size are recommended. Screening of depression in a pregnant woman in perinatal setting might be considered backed by integration of family planning and mental health services. The use of validated and a standard instrument to assess AND is warranted. Systematic review registration: The protocol for this systematic review and meta-analysis was registered at PROSPERO (record , ) [ABSTRACT FROM AUTHOR]

Background: There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. Methods: This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. Result: Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. Conclusion: The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction. [ABSTRACT FROM AUTHOR]

Introduction: Unintended pregnancy is a pregnancy which is not wanted and/or not planed at the time of conception. It has a major consequence on mothers’ and newborns’ health and its prevalence remains a major health problem in Ethiopia. This study was aimed to assess the prevalence and determinants of unintended pregnancy among pregnant women attending antenatal clinics of Addis Zemen hospital. Methods: An institutional-based cross-sectional study was employed in Addis Zemen hospital from April 01 to May 30, 2018. The sampled 398 pregnant mothers were selected by systematic random sampling. The data were collected using a-pretested structured questionnaire via face to face interview and the collected data were analyzed by using SPSS Version-20. The data were summarized with frequency and cross-tabulation. Both binary and multiple logistic regressions were used in order to identify predictor variables using odds ratio at 95% confidence interval. Results: All of 398 mothers answered the questionnaire making the response rate 100%. The prevalence of unintended pregnancy was 26.1% (CI;22.1, 30.4). Women who were multigravid (AOR; 4.7: CI; 2.3, 6.8), women who were multipara (AOR; 2.8: CI; 2.6, 9.7), and women who were from rural (AOR; 2.6: CI; 1.5, 4.6) were more likely experienced unintended pregnancy than their counterparts. Women who were Muslim (AOR; 0.79: CI; 0.6, 0.90) and women who attended secondary education (AOR; 0.58: CI; 0.42, 0.78) were less likely experienced unintended pregnancy. Conclusion and recommendation: The prevalence of unintended pregnancy is high in the study area. Educational status, parity, gravity, residence, and religion were the most important predictor variables of unintended pregnancy. Reducing the prevalence of unintended pregnancy especially in the rural area is recommended. [ABSTRACT FROM AUTHOR]

Background: It is estimated that sub-optimal feeding, especially non-exclusive breastfeeding in the first 6months of life, results in 1.4million deaths and 10% of disease burden in children younger than five years. Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6months of life, the majority receiving some other food or fluid in the early months. Besides, the Ethiopian demographic and health survey (2016) stated that the median duration of exclusive breastfeeding in Tigray region was 3.8 months which is shorter than the recommended duration. The main purpose of this study was to determine the magnitude of exclusive breastfeeding practice and associated factors among HIV positive mothers in public hospitals of Tigray region, Northern Ethiopia. Methods: A facility based cross-sectional study was conducted from July 9 to October 11, 2016, in public hospitals of Tigray region. Data was collected by using structured questionnaire using face-to-face interview among 304 eligible women through a systematic sampling technique. Data was analyzed using SPSS version 20.0. Binary and multiple variable logistic regressions (“odds ratio”) analyses were calculated with 95% CI and p value ≤ 0.05 as significance were used. Result: Two hundred seventy (88.8%) of mothers practiced exclusive breastfeeding for the first six months of life. Infant feeding counseling during antenatal care of last pregnancy [AOR = 6.9, 95% CI; 2.63, 17.99], knowledge on exclusive breastfeeding (AOR = 5.5, 95% CI; (2.12, 14.02] and attitude towards exclusive breastfeeding [AOR = 7.9; 95% CI; 2.96, 21.21] had significant association with exclusive breastfeeding practice. Conclusions: A high proportion of mothers practiced exclusive breastfeeding for the first six months of life. Infant feeding counseling, knowledge and attitude towards exclusive breastfeeding practice were the predictors of exclusive breastfeeding among HIV positive mothers. Strengthening infant feeding counseling during antenatal care and improving mothers’ knowledge and attitude on exclusive breastfeeding is essential. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia, the burden of malaria during pregnancy remains a public health problem. Having a good malaria knowledge leads to practicing the prevention of malaria and seeking a health care. Researches regarding pregnant women’s knowledge on malaria in Ethiopia is limited. So the aim of this study was to assess malaria knowledge and its associated factors among pregnant woman, 2018. Methods: An institutional-basedcross-sectional study was conducted in Adis Zemen Hospital. Data were collected using pre-tested, an interviewer-administered structured questionnaire among 236 mothers. Women’s knowledge on malaria was measured using six malaria-related questions (cause of malaria, mode of transmission, signs and symptoms, complication and prevention of malaria). The collected data were entered using Epidata version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariate logistic regressions were computed to identify predictor variables at 95% confidence interval. Variables having P value of <0.05 were considered as predictor variables of malaria knowledge. Result: A total of 235 pregnant women participated which makes the response rate 99.6%. One hundred seventy two pregnant women (73.2%) of mothers had good knowledge on malaria.Women who were from urban (AOR; 2.4: CI; 1.8, 5.7), had better family monthly income (AOR; 3.4: CI; 2.7, 3.8), attended education (AOR; 1.8: CI; 1.4, 3.5) were more knowledgeable. Conclusion and recommendation: Majority of participants had good knowledge on malaria. Educational status, household monthly income and residence werepredictors of malaria knowledge. Increasing women’s knowledge especially for those who are from rural, have no education, and have low monthly income is still needed. [ABSTRACT FROM AUTHOR]

Introduction: Nutritional anemia is a major public health problem throughout the world, particularly in developing countries. Iron with folic acid supplementation (IFAS) is recommended to mitigate anemia and its resulting complications during pregnancy. There has been limited study on IFAS adherence of pregnant women in the study area. The aim of this study was to assess adherence to IFAS and its associated factors among pregnant women attending antenatal care service in Debre Tabor General Hospital, Ethiopia. Methods: An institution-based cross-sectional study was conducted from January 9 to April 8, 2017, at Debre Tabor General Hospital. A total of 262 study participants were included and selected by systematic random sampling. The entire interviewed questionnaire was checked and entered into EpiData version 3.1 and then exported to SPSS version 20 for windows for analysis. IFAS adherence status was defined as, if pregnant mothers took 65% or more of the IFAS which is equivalent to taking IFAS at least 4 days a week during the 1-month period preceding the study. Regressions were fitted to identify independent predictors of IFAS adherence. A P-value of less than 0.05 was used to declare statistical significance. Results: A total of 241 pregnant women were included (92% response rate), of which 107 (44%) were adherent to IFAS. Only 39% received IFAS counseling, and 52% had some knowledge of IFAS. Gravidity (AOR = 2.92 95% CI (1.61, 5.30)), gestational age at first ANC visit (AOR = 3.67, 95% CI (1.94, 6.97)), pregnant women who got advice about IFAS (AOR = 2.04, 95%CI (1.12, 3.75)), current anemia (AOR = 2.22, 95%CI (1.45, 4.29)), and had knowledge about IFAS (AOR = 3.27, 95% CI (1.80, 5.95)) were statistically associated with adherence to IFAS among pregnant women. Conclusion: Overall, IFAS adherence among pregnant women was low. The associated factors with adherence of IFAS were counseling and knowledge, early ANC attendance, pregnancy history, and current anemia diagnosis. IFAS counseling by health workers was low but, when given, was associated with improved IFAS adherence. Health workers and health extension workers should consistently counsel on IFAS benefits during ANC visit, to improve IFAS adherence during the current and subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Maternal and child feeding behaviors are often rooted in family and sociocultural context, making these an important point of inquiry for improving nutrition and health over the life course. The present study explored the practice of fasting during religious periods in relation to eating patterns of pregnant and lactating women and young children in four regions of Ethiopia, a nation which has experienced rapid economic growth and marked improvement in health and nutrition outcomes over the last two decades. Qualitative data collection and analysis at community level illustrated conflicting areas of understanding and practice related to diets of children and pregnant and lactating women during fasting times, potentially leading to gaps in nutrition. Community participants described different understandings of fasting requirements for these vulnerable populations and associated social norms and doxa, not always in accordance with religious texts or published guidance. Useful behavior change strategies may be developed through these results to address the potential barriers to appropriate feeding patterns for pregnant and lactating women and young children in Ethiopia. This will include continuing to work with communities and religious leaders to clarify that religious doctrine promotes improved nutrition outcomes. [ABSTRACT FROM AUTHOR]

Background: Anemia in pregnancy is a major public health concern worldwide, especially in developing countries. Thus, there is a need of having current information and local data on the prevalence of anemia and associated factors during pregnancy to help inform preventive programmes. The aim of this study was to assess the prevalence of anemia and associated factors among pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia. Methods: An institution based cross-sectional study was conducted at Debre Markos Referral Hospital in July and August 2016. A total of 234 randomly-selected pregnant women took part in the study. Data on sociodemographic factors, environmental and sanitation factors, reproductive factors, and nutrition related characteristics were collected using a structured questionnaire. Hemoglobin level was determined using hematological analyzer (Cell Dyn 1800) machine. The stool sample was collected to identify intestinal parasitic infections. Statistical analysis was done using logistic regression. The p value of less than 0.05 at 95% confidence interval was considered statistically significant. Results: The overall prevalence of anemia among pregnant women was 11.5% (95% CI: 8.2%– 14.9%). The result of multivariable analysis revealed that, coffee consumption [AOR = 2.91; 95% CI (1.63, 8.78)], and hookworm infection [AOR = 2.65; 95% CI (1.48, 4.72)] were factors significantly associated with anemia among pregnant women. Conclusion: Anemia is of public health concern among pregnant women in the study area. All pregnant women coming to antenatal clinics should be screened and treated routinely for intestinal parasitic infection. Pregnant women should limit coffee consumption, and avoid drinking coffee with meals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of copious information regarding contraceptive use benefits and the factors that influence the uptake of the services, there is little evidence revealing the lived experiences of rural women. Thus, this study was conducted with the purpose of exploring the lived experiences of women regarding contraceptive use and related benefits towards women’s empowerment. Methods: Interpretative phenomenological qualitative methodology was employed to explore the lived experiences of women. Data were collected through focus group discussions and in-depth individual interviews and analyzed using an interpretive phenomenological framework including phases of data immersion, transcribing, coding, theme development and phenomenological interpretation through hermeneutic circle. Result: The reported lived experiences of rural women revealed that their livelihoods greatly improved in different ways after they began to use contraceptives. The benefits included securing more time, energy and social engagements. Contraceptive use helped women postpone unwanted pregnancies and child births and engage in various income generation activities that not only boosted family incomes but also created opportunity to mobilize the resources for different expenses without waiting for the handouts from their husbands. The women’s experiences also indicated that contraceptive use improved the educational status of their daughters and they experienced improved self-image, better social standing and improved family relations. The experiences further illustrated that contraceptive use was not only emancipatory and transformative, but also created peace and stability in their lives. Conclusion: The study concludes that contraceptive use, which is part of a woman’s life experience, created remarkable opportunities and achievements. One of these was that women were able to control their bodies, reproduction and fertility which resulted in a higher degree of empowerment. The control of reproduction and fertility has liberated them from worries and entrapment of unplanned and unwanted pregnancies. Moreover, contraceptive use led to wider opportunities in the community, by improving their status and building a sense of empowerment. Creating awareness around the benefits of contraceptive use has the potential to improve community and national development. Based on the result, the study recommends that systems should be established to capitalize on the lessons learned about the lives of current users and expand the remarkable achievements and experiences to non-user counterparts. [ABSTRACT FROM AUTHOR]

Objective: To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia. Methods: A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV. Results: The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowledge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary education and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibility to HIV (AOR = 10.72; 95%CI: 3.90, 29.39). Conclusion: The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate mother’s knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother’s knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (> = 35years), rural residents, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV. [ABSTRACT FROM AUTHOR]

Anaemia is a condition in which the haemoglobin concentration falls below an established cut-off value due to a decrease in the number and size of red blood cells. The current study aimed (i) to assess the spatial pattern and (ii) to identify determinants related to anaemia using the third Ethiopian demographic health survey. To achieve these objectives, this study took into account the sampling weight and the clustered nature of the data. As a result, multilevel modeling has been used in the statistical analysis. The analysis included complete cases from 15,909 females, and 13,903 males. Among all subjects who agreed for hemeoglobin test, 5.22% males, and 16.60% females were anemic. In both binary and ordinal outcome modeling approaches, educational level, age, wealth index, BMI and HIV status were found to be significant predictors of anaemia prevalence. Furthermore, this study applied spatial methods to generate maps at regional level which could be useful for policy makers where great efforts should be concentrated to reduce the prevalence of anaemia. As revealed by Moran’s I test, significant spatial autocorrelation were noted across clusters. The risk of anaemia was found to vary across different regions, and higher prevalences were observed in Somali and Affar regions. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) during pregnancy increases adverse pregnancy outcomes. Knowledge of societal, community, family and individual related factors associated with IPV in pregnancy is limited in Ethiopia. Our study examined these factors in an Ethiopian context. Materials and methods: A cross sectional study was conducted among pregnant women attending antenatal care at governmental health institutions, using a consecutive probability sampling strategy. A total of 720 pregnant women were interviewed by five trained nurses or midwives, using a standardized and /pretested survey questionnaire. Bivariate and multivariate logistic regression analyses were applied to assess factors contributing to IPV. We used Akaike’s information criteria, to identify the model that best describes the factors influencing IPV in pregnancy. Results: Among the women interviewed, physical IPV was reported by 35.6%, and lifetime emotional or physical abuse by 81.0%. Perceiving violence as a means to settle interpersonal conflicts, presence of supportive attitudes of wife beating in the society, regarding violence as an expression of masculinity, and presence of strict gender role differences in the society, were all positively associated to IPV in pregnancy. The presence of groups legitimizing men’s violence in the community, feeling isolated, having no social support for victims, and presence of high unemployment, were the perceived community related factors positively associated with IPV in pregnancy. Conclusion: IPV in pregnancy is very prevalent in Ethiopia and is associated with multiple social ecologic factors. Reduction of IPV in pregnancy calls for cross sectorial efforts from stakeholders at different levels. [ABSTRACT FROM AUTHOR]

Background: In Ethiopia, 20,000 women die each year from complications related to pregnancy, childbirth and post-partum. For every woman that dies, 20 more experience injury, infection, disease, or disability. “Maternal near miss” (MNM), defined by the World Health Organization (WHO) as a woman who nearly dies, but survives a complication during pregnancy, childbirth or within 42 days of a termination, is a proxy indicator of maternal mortality and quality of obstetric care. In Ethiopia, few studies have examined MNM. This study aims to identify determinants of MNM among a small population of women in Tigray, Ethiopia. Methods: Unmatched case-control study was conducted in hospitals in Tigray Region, Northern Ethiopia, from January 30-March 30, 2016. The sample included 103 cases and 205 controls recruited from among women seeking obstetric care at six (6) public hospitals. Clients with life-threatening obstetric complications, including hemorrhage, hypertensive diseases of pregnancy, dystocia, infection, and anemia or clinical signs of severe anemia (in women without hemorrhage) were taken as cases and those with normal obstetric outcomes were controls. Cases were selected based on proportion to size allocation while systematic sampling was employed for controls. Binary and multiple variable logistic regression (“odds ratio”) analyses were calculated at 95% CI. Results: Roughly 90% of cases and controls were married and 25% experienced their first pregnancy before the age of 16 years. About two-thirds of controls and 45.6% of cases had gestational ages between 37–41 weeks. Among cases, severe obstetric hemorrhage (44.7%), hypertensive disorders (38.8%), dystocia (17.5%), sepsis (9.7%) and severe anemia (2.9%) were leading causes of MNM. Histories of chronic maternal medical problems like hypertension, diabetes were reported in 55.3% of cases and 33.2% of controls. Women with no formal education [AOR = 3.2;95%CI:1.24, 8.12], being less than 16 years of age at first pregnancy [AOR = 2.5;95%CI:1.12,5.63], induced labor[AOR = 3.0; 95%CI:1.44, 6.17], history of cesarean section[AOR = 4.6; 95% CI: 1.98, 7.61] or chronic medical disorder[AOR = 3.5;95%CI:1.78, 6.93], and women who traveled more than 60 minutes before reaching their final place of care[AOR = 2.8;95% CI: 1.19,6.35] had higher odds of experiencing MNM. Conclusions: Macro-developments like increasing road and health facility access as well as expanding education will all help reduce MNM. Work should be continued to educate women and providers about common predictors of MNM like history of C-section and chronic illness as well as teenage pregnancy. These efforts should be carried out at the facility, community, and individual levels. Targeted follow-up with women with history of chronic disease and C-section could also help reduce MNM. [ABSTRACT FROM AUTHOR]

Introduction: Anemia affects around 38.2% and 22% of pregnant women at a global and national level respectively. In developing countries, women start pregnancy with already depleted body stores of iron and other vitamins with significant variation of anemia within and between regions. Objective: To identify the determinants of anemia among pregnant mothers attending antenatal care in Dessie town health facilities, northern central Ethiopia. Methods: A health facility based unmatched case control study was conducted among 112 cases and 336 controls from January to March 2016 G.C. The sample size was determined by using Epi Info version 7.1.5.2. Study subjects were selected using consecutive sampling technique. Data were collected using a structured questionnaire, entered using Epi Data version 3.1 and analyzed using SPSS version 20. Bivariable and multivariable logistic regression model was used to see the determinants of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value<0.05 were used to see the significant association. Results: Failure to take dark green leafy vegetables per two weeks (AOR = 5.02, 95% CI: 2.16, 11.71), didn’t take chicken per two weeks (AOR = 2.68, 95% CI: 1.22, 5.86), 1st trimester (AOR = 2.07, 95% CI: 1.12, 3.84), 3rd trimester (AOR = 2.96, 95% CI: 1.53, 5.72), HIV infection (AOR = 6.78, 95% CI: 2.28, 20.18) and medication (AOR = 3.57 95% CI: 1.60, 7.98) were positively associated with anemia. Conclusions: Inadequate intake of dark green leafy vegetables, inadequate consumption of chicken, trimester of the current pregnancy, HIV infection and medication were the determinants of anemia among pregnant women. Therefore, anemia prevention strategy should include promotion of adequate intake of dark green leafy vegetables and chicken, increase meal pattern during the entire pregnancy and strengthen the prevention of mother to child HIV transmission/antenatal care programs. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. Methods: Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. Result: More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%—64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. Conclusion: Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement. [ABSTRACT FROM AUTHOR]

Background: In a large population in Southwest Ethiopia (population 700,000), we carried out a complex set of interventions with the aim of reducing maternal mortality. This study evaluated the effects of several coordinated interventions to help improve effective coverage and reduce maternal deaths. Together with the Ministry of Health in Ethiopia, we designed a project to strengthen the health-care system. A particular emphasis was given to upgrade existing institutions so that they could carry out Basic (BEmOC) and Comprehensive Emergency Obstetric Care (CEmOC). Health institutions were upgraded by training non-clinical physicians and midwives by providing the institutions with essential and basic equipment, and by regular monitoring and supervision by staff competent in emergency obstetric work. Results: In this implementation study, the maternal mortality ratio (MMR) was the primary outcome. The study was carried out from 2010 to 2013 in three districts, and we registered 38,312 births. The MMR declined by 64% during the intervention period from 477 to 219 deaths per 100,000 live births (OR 0.46; 95% CI 0.24–0.88). The decline in MMR was higher for the districts with CEmOC, while the mean number of antenatal visits for each woman was 2.6 (Inter Quartile Range 2–4). The percentage of pregnant women who attended four or more antenatal controls increased by 20%, with the number of women who delivered at home declining by 10.5% (P<0.001). Similarly, the number of deliveries at health posts, health centres and hospitals increased, and we observed a decline in the use of traditional birth attendants. Households living near to all-weather roads had lower maternal mortality rates (MMR 220) compared with households without roads (MMR 598; OR 2.72 (95% CI 1.61–4.61)). Conclusions: Our results show that it is possible to achieve substantial reductions in maternal mortality rates over a short period of time if the effective coverage of well-known interventions is implemented. [ABSTRACT FROM AUTHOR]

Background: Depression during pregnancy is a major health problem because it is prevalent and chronic, and its impact on birth outcome and child health is serious. Several psychosocial and obstetric factors have been identified as predictors. Evidence on the prevalence and predictors of antenatal depression is very limited in Ethiopia. This study aims to determine prevalence and associated factors with antenatal depression. Methods: Community based cross-sectional study was conducted among 527 pregnant women recruited in a cluster sampling method. Data were collected by face-to-face interviews on socio-demographic, obstetric, and psychosocial characteristics. Depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). The List of Threatening Experiences questionnaire (LTE-Q) and the Oslo Social Support Scale (OSS-3) were used to assess stressful events and social support, respectively. Data were entered into Epi-info and analyzed using SPSS-20. Descriptive and logistic regression analyses were carried out. Results: The prevalence of antenatal depression was found to be 11.8%. Having debt (OR = 2.79, 95% CI = 1.33, 5.85), unplanned pregnancy (OR = 2.39, 95% CI = (1.20, 4.76), history of stillbirth (OR = 3.97, 95% CI = (1.67,9.41), history of abortion (OR = 2.57, 95% CI = 1.005, 6.61), being in the third trimester of pregnancy (OR = 1.70, 95% CI = 1.07,2.72), presence of a complication in the current pregnancy (OR = 3.29, 95% CI = 1.66,6.53), and previous history of depression (OR = 3.48, 95% CI = 1.71,7.06) were factors significantly associated with antenatal depression. Conclusion: The prevalence of antenatal depression was high, especially in the third trimester. Poverty, unmet reproductive health needs, and obstetric complications are the main determinants of antenatal depression. For early detection and appropriate intervention, screening for depression during the routine antenatal care should be promoted. [ABSTRACT FROM AUTHOR]

Introduction: Option B+, an approach that involves provision of antiretroviral therapy (ART) to all HIV-infected pregnant women for life, is the preferred strategy for prevention of mother to child transmission of HIV. Lifelong retention in care is essential to its success. We conducted a discrete choice experiment in Ethiopia and Mozambique to identify health system characteristics preferred by HIV-infected women to promote continuity of care. Methods: Women living with HIV and receiving care at hospitals in Oromia Region, Ethiopia and Zambézia Province, Mozambique were shown nine choice cards and asked to select one of two hypothetical health facilities, each with six varying characteristics related to the delivery of HIV services for long term treatment. Mixed logit models were used to estimate the influence of six health service attributes on choice of clinics. Results: 2,033 women participated in the study (response rate 97.8% in Ethiopia and 94.7% in Mozambique). Among the various attributes of structure and content of lifelong ART services, the most important attributes identified in both countries were respectful provider attitude and ability to obtain non-HIV health services during HIV-related visits. Availability of counseling support services was also a driver of choice. Facility type, i.e., hospital versus health center, was substantially less important. Conclusions: Efforts to enhance retention in HIV care and treatment for pregnant women should focus on promoting respectful care by providers and integrating access to non-HIV health services in the same visit, as well as continuing to strengthen counseling. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia, even if a significant reduction in child mortality is recorded recently, perinatal mortality rate is still very high. This study assessed the magnitude, determinants and causes of perinatal death in West Gojam zone, Ethiopia. Methods and materials: A nested case control study was conducted on 102 cases (mothers who lost their newborns for perinatal death) and 204 controls (mothers who had live infants in the same year) among a cohort of 4097 pregnant mothers in three districts of the West Gojam zone, from Feb 2011 to Mar 2012. Logistic regression models were used to identify the independent determinant factors for perinatal mortality. The World Health Organization verbal autopsy instrument for neonatal death was used to collect mortality data and cause of death was assigned by a pediatrician and a neonatologist. Result: Perinatal mortality rate was 25.1(95% CI 20.3, 29.9) per 1000 live and stillbirths. Primiparous mothers had a higher risk of losing their newborn babies for perinatal death than mothers who gave birth to five or more children (AOR = 3.15, 95% CI 1.03–9.60). Babies who were born to women who had a previous history of losing their baby to perinatal death during their last pregnancy showed higher odds of perinatal death than their counterparts (AOR = 9.55, 95% CI 4.67–19.54). Preterm newborns were more at risk for perinatal death (AOR = 9.44, 95%CI 1.81–49.22) than term babies. Newborns who were born among a household of more than two had a lesser risk of dying during the perinatal period as compared to those who were born among a member of only two. Paradoxically, home delivery was found to protect against perinatal death (AOR = 0.07 95% CI, 0.02–0.24) in comparison to institutional delivery. Bacterial sepsis, birth asphyxia and obstructed labour were among the leading causes of perinatal death. Conclusion: Perinatal mortality rate remains considerably high, but proper maternal and child health care services can significantly decrease the burden. [ABSTRACT FROM AUTHOR]

Background: Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. Methods: A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. Findings: Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53–2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12–3.61)). Conclusions: Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their clients. [ABSTRACT FROM AUTHOR]

Background: Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Depressive disorders are not only common and chronic among women throughout the world but also principal sources of disability. The scarce information and limited attention to the problem might aggravate the consequence of the problem and can limit the intervention to be taken. Therefore, the current study was conducted to determine the prevalence and identify associated factors for antenatal depression. Methods: Institutional based cross-sectional study was conducted by taking a sample of 388 pregnant women coming for ANC service at Gondar University Hospital. Systematic random sampling technique was employed to recruit the study participants. Structured, pretested and interview administered questionnaire was used to collect related information while Beck Depression Inventory (BDI) was used to assess individuals`depression condition. A cut off point with high sensitivity and specificity was determined and internal consistency of the tool was checked (Cronbach alpha = 0.82). Ep Info V. 2002 and STATA 12 were used for data entry and analyses, respectively. Adjusted Odds Ratio with its 95% CI was used to declare the statistical significance of the factors. Results: Depression among pregnant women was found to be 23% (95%CI: 18.48%, 26.86%). Factors significantly associated with depression were: woman`s age (20 to 29, AOR = 0.18,95% CI:0.07,0.49), occupation (housewife, AOR = 2.57,95%CI:1.21,5.46, merchant and daily laborers, AOR = 3.44 (1.38,8.58), previous pregnancy (No, AOR = 4.74,95% CI:1.58,14.17) and previous ANC follow up pattern (irregular, AOR = 11.43,95% CI:3.68,35.49), no follow up, AOR = 11.98, 95% CI:4.73,30.33). Conclusion: Depression symptoms are common in pregnant mothers in the study area and interventions that would address the aforementioned factors would benefit to tackle further complications. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) is the principal risk factor for neonatal and infant mortality in developing countries. This study examines the effects of unwanted pregnancy, prenatal depression and social support on the risk of low birth weight in rural southwestern Ethiopia. We hypothesized that unwanted pregnancy and prenatal depression increase the risk of low birth weight, while social support mediates this association. Methods: Data for the study comes from a prospective study in which women were followed from pregnancy through to delivery. Six hundred twenty two women were followed and 537 birth weights were measured within 72 hours. Multivariable log binomial regression was used to model the risk of low birth weight. Results: The mean birth weight was 2989 grams (SD±504 grams), and the incidence of LBW was 17.88%. The mean birth weight of babies after unwanted pregnancy was 114 g lower compared to births from intended pregnancy. Similarly, mean birth weight for babies among women with symptoms of antenatal depression was 116 grams lower. Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with LBW. The relationship between antenatal depressive symptoms and LBW was mediated by the presence of social support, while the association between LBW and unwanted pregnancy remained after multivariable adjustment. Conclusion: The incidence of low birth weight is high in the study area. Poverty, nonuse of antenatal care, low social support and unwanted pregnancy contribute to this high incidence of low birth weight. Hence, identifying women’s pregnancy intention during antenatal care visits, and providing appropriate counseling and social support will help improve birth outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Ethiopia has achieved the fourth Millennium Development Goal by reducing under 5 mortality. Nevertheless, there are challenges in reducing maternal and neonatal mortality. The aim of this study was to estimate maternal and neonatal mortality and the socio-economic inequalities of these mortalities in rural south-west Ethiopia. Methods: We visited and enumerated all households but collected data from those that reported pregnancy and birth outcomes in the last five years in 15 of the 30 rural kebeles in Bonke woreda, Gamo Gofa, south-west Ethiopia. The primary outcomes were maternal and neonatal mortality and a secondary outcome was the rate of institutional delivery. Results: We found 11,762 births in 6572 households; 11,536 live and 226 stillbirths. There were 49 maternal deaths; yielding a maternal mortality ratio of 425 per 100,000 live births (95% CI:318–556). The poorest households had greater MMR compared to richest (550 vs 239 per 100,000 live births). However, the socio-economic factors examined did not have statistically significant association with maternal mortality. There were 308 neonatal deaths; resulting in a neonatal mortality ratio of 27 per 1000 live births (95% CI: 24–30). Neonatal mortality was greater in households in the poorest quartile compared to the richest; adjusted OR (AOR): 2.62 (95% CI: 1.65–4.15), headed by illiterates compared to better educated; AOR: 3.54 (95% CI: 1.11–11.30), far from road (≥6 km) compared to within 5 km; AOR: 2.40 (95% CI: 1.56–3.69), that had three or more births in five years compared to two or less; AOR: 3.22 (95% CI: 2.45–4.22). Households with maternal mortality had an increased risk of stillbirths; OR: 11.6 (95% CI: 6.00–22.7), and neonatal deaths; OR: 7.2 (95% CI: 3.6–14.3). Institutional delivery was only 3.7%. Conclusion: High mortality with socio-economic inequality and low institutional delivery highlight the importance of strengthening obstetric interventions in rural south-west Ethiopia. [ABSTRACT FROM AUTHOR]