Search

Yohannes Ayanaw Habitu,1 Gashaw Andargie Biks,2 Abebaw Gebeyehu Worku,1 Kassahun Alemu Gelaye3 1Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Yohannes Ayanaw HabituUniversity of Gondar, P.O. Box: 196 Tel +251-901460706Fax +251-58 812 9011Email yohaneshabitu@gmail.comBackground: Youth-Friendly Services (YFS) is an evidence-based public health intervention aimed to reduce sexual and reproductive health problems among youth. To achieve the desired outcomes, YFS has to be implemented with a high level of fidelity. However, there is an evidence gap in its implementation with fidelity. Hence, the main objective of the study was to describe the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia. Therefore, this study investigated the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia.Methods: An institutional-based cross-sectional study was conducted from September to December in 2019. A total of 1029 youths, who came to 11 health centers where YFS has been implemented were randomly selected. A validated tool, comprised of 65 Likert scaled items, designed to measure the three dimensions of fidelity was used to collect data. Face to face clients exit interview approach was used to collect the data. Summary statistics were calculated for each fidelity dimension first, and then the overall fidelity of implementation score was computed.Results: Overall, only 48 (4.7%; 1.6– 11.3%) of youth received the YFS with a high level of implementation fidelity. Whereas 770 (74.8%; 57.6– 90.5%) and 211 (20.5%; 912.7– 31.0%) of youth received the YFS with a medium and low level of implementation fidelity, respectively. Considering each fidelity dimension, 241 (23.4%) youth received the YFS with a high level of adherence, 212 (20.6%) received the YFS with a high level of the structural quality of care, 323 (31.4%) received the YFS with a high level of process quality of care, 508 (49.3%) received the YFS with a high level of outcome quality of care, and 114 (11.1%), received the YFS with a high level of participant responsiveness.Conclusion: The identified low level of implementation fidelity of YFS indicates the urgent need to strengthen the YFS by the government and programmers. Further studies that can address barriers to the implementation fidelity of Youth-Friendly Services are recommended. In addition, further analysis to know the factors that may influence the fidelity of YFS are recommended.Keywords: fidelity, adherence, implementation, youth-friendly services, Ethiopia

Background Now a day, the consumption of alcohol among pregnant women is increasing from time to time, and it has become one of the increasingly serious public health and socio-economic problems. In addition, cause miscarriages, stillbirths, and a range of physical, behavioural, and intellectual disabilities for the baby that can last a lifetime. There is also limited evidence. Therefore, the objective of this study was to prevalence and associated factors of alcohol intake in the first trimester of pregnancy in Dabat district, northwest Ethiopia. Methods A community-based cross-sectional survey was conducted to determine the magnitude of alcohol intake within the first three months of pregnancy at the Dabat Demographic and Health Survey Site. A census of pregnant women in Dabat demographic and health survey sites was employed. A total of 579 pregnant women were found and participated in this study. The Data were entered and analyzed using EPI INFO and STATA version 14, respectively. Multivariable logistic regression analysis was used to determine factors related to alcohol intake during the first trimester of pregnancy. The adjusted odds ratio (AOR) with 95% confidence interval was used to show the strength of the association, and P value Results The prevalence of alcohol intake in the first trimester of pregnancy was 58% (95%CI (54.1, 61.8)). Rural residence (AOR = 6.83, 95% CI, 2.55, 18.32), being married (AOR = 2.37, 95% CI: 1.14, 4), being a housewife occupation (AOR = 2.24, 95% CI, 1.54, 3.26) and having a history of stillbirth ((AOR = 1.99, 95% CI: 1.2, 4.14) were significantly associated with alcohol intake in the first trimester. Conclusions The prevalence of alcohol consumption in the first trimester of pregnancy was high in the study area. Pregnant women’s’ sociodemogrphic characteristics and history of stillbirth are associated with alcohol consumption. Therefore, increasing maternal awareness of the negative effects of alcohol consumption among mothers living in rural areas is important to modify higher rates of alcohol intake in the first trimester. Mothers with a history of stillbirth should pay attention.

Background Maternal continuum of care is identified to have a greatest impact on maternal and child survival. However, there is a wide variation in maternal health services utilization from place to place in Ethiopia. Therefore, knowing antenatal care, labor and delivery, and postnatal care uptake has paramount importance to take interventions. Methods A community-based cross-sectional survey was conducted among 1626 postpartum women. Descriptive statistics were done to characterize the study population and utilization of antenatal care, institutional delivery, and postnatal care services. Logistic regression analysis was employed to identify factors associated with institutional delivery. Results Nearly eighty percent, (79.7%, 95% CI: 77.7, 81.6), of women attended at least one antenatal care visit at any health facility. However, only less than one third (31.4%) used all the recommended antenatal care (ANC). About half, 820 (49.2%: 95% CI: 46.7, 51.8) women delivered their child in health institution. About half, 822 (50.6%, 95% CI: 48.2, 52.9) of postpartum women who participated in this study had at least one postnatal care (PNC) visit at health facilities. Being urban resident (AOR=8.18, 95%CI: 4.69, 14.26)), respondents of higher educational status (AOR= 4.99, 95%CI: 2.51, 9.90), being Orthodox Christian (AOR= 2.35, 95%CI: 1.15, 4.79), getting TT vaccination during pregnancy (AOR=1.54, 95%CI: 1.06, 2.23), and antenatal care utilization (AOR=2.97, 95%CI: 2.06, 4.27) were predictors for health facility/institutional delivery. Conclusions Though a significant proportion of the study participants initiated antenatal care, utilization of all the recommended antenatal care visits, facility delivery, and postnatal care services were low. Health professionals need to use the first antenatal care visit as a golden opportunity to attract and maintain pregnant women for the subsequent maternal health care services.

Studies in Ethiopia show an increasing trend in maternal health service use, such as having at least 4 visits of antenatal care (ANC4+) and skilled birth attendance (SBA). Improving the health information system (HIS) is an intervention that can improve service uptake and quality. We conducted a baseline study to measure current maternal service coverage, HIS performance status, and their relationship.We conducted a linked health facility-level and population-based survey from September 2020 to October 2020. The study covers all regions of Ethiopia. For the population-based survey, 3,016 mothers were included. Overall, 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. A two-stage sampling procedure was applied to select target households. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Multilevel logistic regression was employed to account for clustering and control for likely confounders.Maternal service indicators, ANC4+ visits (54.0%), SBA (75.8%), postnatal care (70.6%), and cesarean delivery (9%) showed good service uptake. All data quality and use indicators showed lower performance compared to the national target of 90%. Maternal education and higher levels of wealth index were significantly and positively associated with all selected maternal service indicators. Longer distance from health facilities was significantly and negatively associated with SBA and the maternal care composite indicator. Among HIS-related indicators, availability of electronic HIS tools was significantly associated with maternal care composite indicator and ANC4+.Maternal service indicators showed promising performance. However, current HIS performance is suboptimal. Both service user and HIS-related factors were associated with maternal service uptake. Conducting similar research outside of the project sites will be helpful to have a wider understanding and better coverage.

Background The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels. Methods This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI. Results Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants. Conclusions The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.

The physical problems associated with fistula result in psychological alteration. This study was aimed to assess whether psychological wellbeing of women with fistula after surgical treatment differ from that of before treatment. Institution-based pre-post follow-up design was conducted. Self-reported incontinence and psychological wellbeing score were assessed. Data were analyzed using Stata 12. Paired t-test and multiple linear regressions were fitted to identify variables correlate with the score difference. In this study, 117 women were interviewed giving response rate of 98.3 percent. Their mean (±sd) age was 27.13 ± 5.37 years. On admission, all women had urinary or fecal incontinence and their mean psychological score was 31.1 (95 percent CI; 30.5-31.6). After treatment, however, 89.7 percent (n = 105) of women reported that they regained continence. Similarly, the mean psychological score has dropped to 18.05 (95 percent CI; 16.4-21.6

This study was conducted to explore the experiences of community members, particularly mothers, concerning their beliefs about the causes, treatment practices, and preferences for World Health Organization-defined neonatal danger signs in northwest Ethiopia. A phenomenological qualitative study was conducted in three districts of north Gondar Zone, Amhara region, Ethiopia, from March 10 to 28, 2016. Twelve focus group discussions were conducted involving 98 individuals. In-depth interviews were conducted with six health extension workers and 30 women who were either pregnant or who delivered in the past 6 months. Six subthemes emerged explaining the causes of neonatal danger signs. The causes varied from danger sign to danger sign and from person to person. Most of the perceived causes of danger signs in neonates do not align with the current biomedical science. Causal assumptions and perceived seriousness of danger signs influenced treatment practices and preferences. Four subthemes also emerged for treatment practices and preferences. In some cases, respondents indicated that non-biomedical sources of treatment were superior in outcome compared with biomedical treatment options. Unsatisfactory outcomes were mentioned as major reasons to opt for treatments from non-biomedical sources. Religious and cultural reasons were reported to be major impediments for treatment seeking for newborn danger signs. There is an urgent need to introduce or expand locally modified program interventions, such as community-based newborn care, to educate the community on the causes of neonatal danger signs and the need for prompt care seeking from qualified providers.

Back ground: Following a fistula repair, there is a need to rehabilitate and reintegrate women into society. Existing interventions are not well documented or not sufficient to maintain victims’ life and in most cases the issue of reintegration depends up on treatment success. Data on how reintegration has fulfilled women’s needs is sparse. Therefore, the aim of this study was to explore the needs and challenges of women on post obstetric fistula repair. Method: A qualitative, phenomenological approach was used through in-depth interviews to explore women`s perspectives on reintegration service. Respondents were selected by purposive and snow ball sampling until data saturation was reached. Women were interviewed at least one year after they obtained surgical correction. Open code version 4.03 and thematic analysis was used to analyze the data. Result: Twelve women after fistula repair were interviewed at different settings; their median age at interview was 27(range 24- 45). Five were fully continent and six claimed to have either stress or urge incontinence. Repair sessions ranged between 1-5surgeries with an average period of 6.25 years after treatment. The meaning attached to reintegration slightly differed between those women who regained continence and those with unsuccessful repair. Surgical correction, resource support and restoration of social health were found to be the most important aspects of the service. Financial difficulty, lack of counseling on fertility needs, lack of individual centered services and residual leaks were commonly reported challenges. Conclusion: Effective reintegration services should meet women’s needs to the level of their anticipation. Challenges inherent in post repair reintegration require appropriate measures to mitigate dependency, loneliness and the recurrence of fistula.

BackgroundPeriodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. ObjectiveThis study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. MethodsA randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit–based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. ResultsFrom the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. ConclusionsEDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site.

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.

BackgroundNeonatal mortality contributes to nearly half of under-five mortality in Ethiopia. Treatment seeking for newborn danger signs remains low despite correlations with neonatal mortality. This study tests a theoretical model of factors affecting mothers' treatment seeking intention for neonatal danger signs in northwest Ethiopia.MethodA cross sectional study was conducted from March 3-18, 2016 in northwest Ethiopia. A total of 2,158 pregnant women and women who had delivered in the past 6 months were interviewed. Latent variables; knowledge of neonatal danger signs (KDS), household level women empowerment (HLWE) and positive perception toward the behavior of health care providers (PPBHCP) were measured using a Five Point Likert Scale. Socioeconomic status (SES), number of antenatal care attendance, perceived cost of treatment (PCT), average distance to health facilities (ADHF) and treatment seeking intention (TSI) were observed variables in the study. A structural equation modeling was applied to test and estimate the hypothesized model of relationships among latent and observed variables and their direct and indirect effects on TSI.ResultKDS, PPBHCP, HLWE, and PCT showed direct, positive and significant association with TSI (β = 0.41, pConclusionPPBHCP, HLWE, PCT and KDS were associated with mothers' TSI for newborn danger signs.

No abstract available for this resource

No abstract available for this resource

BACKGROUND Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. OBJECTIVE This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. METHODS A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit–based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. RESULTS From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. CONCLUSIONS EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site.

Background Birth asphyxia, which accounts for 31.6% of all neonatal deaths, is one of the leading causes of such mortality in Ethiopia. Early recognition and management of its contributing factors would modify the problem. Thus, this study aimed to identify the determinants of birth asphyxia among live births at the University of Gondar Referral Hospital, northwest Ethiopia. Methods A hospital-based unmatched case-control study was conducted from April to July 2017.Cases were newborn babies with an APGAR score of < 7at 5 minutes of birth; controls were newborn babies with an APGAR score of ≥7 at 5 minutes of birth. Every other asphyxiated baby was selected as a case and every 6th non-asphyxiated baby as a control. A pretested structured questionnaire was used to collect data on maternal sociodemographic characteristics. A pretested structured checklist was used to retrieve data on ante-partum, intra-partum, and neonatal factors of both cases and controls. Data were entered using Epi Info 7 and analyzed using SPSS 20. The bivariate logistic regression analysis was used to identify the relation of each independent variable to the outcome variable. Variables with p values of up to 0.2 in the bivariate analysis were considered for the multiple logistic regression analysis. An adjusted odds ratio (AOR) with a 95% CI and p-value of

Background Without improving the survival of newborns, meaningful reduction in under-five mortality is difficult. Most neonatal deaths are preventable when appropriate and timely care is sought. In Ethiopia, there is lack of evidence on the type and contribution of delays in treatment seeking to neonatal deaths. Methods A community based social autopsy (SA) of 39 neonatal deaths was conducted from March 16 to 24, 2016 in Dabat Health and Demographic Surveillance System (HDSS) in northwest Ethiopia. The result was linked with verbal autopsy (VA) information completed for each of the deaths as part of the ongoing HDSS. The SA tool was adapted from INDEPTH Network. Three delay model approach was used to classify the delay types that contributed for the deaths investigated. Descriptive statistics was used to analyze the data. Results SA was completed for 37 (94.9%) of the 39 neonatal deaths. Of all the deaths, 51.3% (19/37) of them occurred within the first 24 h, 75.6% (28/37) within the first 6 days and the remaining in 7–28 days. Birth asphyxia was the leading cause of death (34%) followed by bacterial sepsis (31%) and prematurity (16%). The median time from recognition of illness to initiation of modern treatment was 1 day (IQR 1–2.5 days). Delay in treatment seeking outside home (delay one) was associated with 81% of the deaths. Delay in receiving care at a health facility (delay three) and delay in transport (delay two) were associated with 16 and 3% of the deaths, respectively. The major contributors of death for delay one were bacterial sepsis (33.3%), birth asphyxia (30%), unspecified illness (20%) and acute lower respiratory tract illnesses (6.7%). For delay three, the major causes of death included birth asphyxia (50%), prematurity (33.3%) and bacterial sepsis (16.7%). Conclusions Delays created at home and at health facility were the major delays contributing to the death of newborns. More focus has to be given in improving delays at home and at health facility.

No abstract available for this resource

Mother-to-child transmission (MTCT) is the major source of HIV infection among children under the age of 15 years. There were limited studies on the MTCT rate in Amhara Region, Ethiopia. Therefore, this study aimed to measure mother-to-child transmission and to identify factors associated with MTCT. An institutional-based retrospective cohort study was conducted among HIV-exposed infants (HEIs). The HEIs who booked in mother–baby pair cohort register between January 2014 and December 2016 were abstracted and included in the study. A structured pretested questionnaire was used for data abstraction. The collected data were coded and double entered into EPI Info version 3.5.4 and exported to STATA version 14 for analysis. A penalized logistic regression model was used. p-value 350 CD4 count at the first antenatal care visit. Overall, MTCT of HIV was 1.5%, and 59.2% of HEIs were discharged from the PMTCT care at the age of 12-18 months. The vertical transmission of HIV was significantly associated with the duration of ART (AOR 0.16; 95% CI: 0.02, 0.96). The MTCT was 84.0% less likely in mothers who did receive Antiretrovirals (ARVs) >12 months compared with mothers who did receive ARVs

Background Because of the unacceptably high maternal and perinatal morbidity and mortality, the government of Ethiopia has established health extension program with a community-based network involving health extension workers (HEWs) and a community level women organization which is known as “Women’s Health Development Army” (WHDA). Currently, the HEWs and WHDA network is the approach preferred by the government to register pregnant women and encourage them to link in the healthcare system. However, its association with skilled delivery service utilization is not well known. Methods A community-based cross-sectional study was conducted from January to February 2015. Within 380 clusters of WHDA, a total of 748 reproductive-age women who gave birth in 1 year preceding the study, were included using multistage sampling technique. The data were entered into EPI info version 7 statistical software and exported to STATA version 11 for analysis. Multilevel analysis technique was applied to check for an association of selected variables with a utilization of skilled delivery service. Results About 45% of women have received skilled delivery care. A significant heterogeneity was observed between “Women’s Health Development Teams (clusters)” for skilled delivery care service utilization which explains about 62% of the total variation. Individual-level predictors including urban residence [AOR (95% CI) 35.10 (4.62, 266.52)], previous exposure of complications [AOR (95% CI) 3.81 (1.60, 9.08)], at least four ANC visits [AOR (95% CI) 7.44 (1.48, 37.42)] and preference of skilled personnel [AOR (95% CI) 8.11 (2.61, 25.15)] were significantly associated with skilled delivery service use. Among cluster level variables, the distance of clusters within 2 km radius from the nearest health facility was significantly associated [AOR (95% CI) 6.03 (1.92, 18.93)] with skilled delivery service utilization. Conclusions In this study, significant variation among clusters of WHDA was observed. Both individual and cluster level variables were identified to predict skilled delivery service utilization. Encouraging women to have frequent ANC visits (− 4 and above), enhancing awareness creation towards the delivery care attendance, constructing more health facilities and roads in hard to reach areas and establishing telemedicine services are recommended.

Fantu Abebe Eyowas,1 Ashebir Kidane Negasi,1 Gizachew Eyassu Aynalem,1 Abebaw Gebeyehu Worku2 1International NGO, Strengthening Human Resource for Health, Bahir Dar, 2Institute of Public Health, University of Gondar, Gondar, Ethiopia Introduction: Some studies favor elective cesarean delivery, and other surveys benefit vaginal delivery, while others emphasize that the quality of care during labor, birth, and immediate postpartum period plays a great role than the route of delivery. However, little information is locally available regarding the incidences of adverse birth outcome with respect to the route of delivery. Methods: This study was a retrospective analysis of eligible patient records that included 3,003 pregnant women who had undergone either cesarean or vaginal delivery from July 1, 2012, to June 31, 2013. Pretested questionnaire was used to collect the data. The completeness and consistency of the data were checked, cleaned, and double entered to EPI-INFO 3.5.2 and analyzed with SPSS V20. Independent sample t-test and chi-square test were conducted to compare the outcome of vaginal delivery and cesarean section (CS) using index variables. Significance was taken at P

Background The extended postpartum period is a one year period after delivery which is critical for women to prevent unintended pregnancy and to reduce the risk of maternal and child mortality by ensuring safe birth intervals. Studies indicate that birth intervals of three to five years reduce maternal mortality and provide health benefits to newborn babies, infants, and children. As a result, assessing postpartum contraceptive use and its determinants are an increasingly important component of global health. The objectives of the study were to determine postpartum contraceptive use and identify the variables which affect postpartum contraceptive use among women of Dabat district. Methods All women aged 15 to 49 years who delivered a child between January 1, 2012 and December 31, 2012 in the Debat district were interviewed by house-to- house survey. Results A total of 10.3 % of the mothers reported adopting contraception in the extended postpartum period. Women who delivered with the assistance of a skilled attendant [AOR = 1.88, 95 % CI (1.01-3.51)] and attended postnatal care services [AOR = 2.19, 95 % CI (1.06-4.52)] were more likely to use contraceptives. Secondary and above level of the husband’s education was also a variable that significantly affected postpartum contraceptive use [AOR = 2.98, 95 % CI (1.49-5.97)]. Conclusions Contraceptive use in the extended postpartum period was found to be low placing women at risk for a pregnancy in the extended postpartum period. Advice about contraceptives during postnatal clinic visits was limited. Improving utilization of institutional delivery by a skilled attendant and enhancing postnatal care services are important to increase contraceptive use in the extended postpartum period.

Introduction: Ethiopia remains one of the highest tuberculosis burden countries in the world and tuberculosis is one of the most pressing health problems. Weight gain in the course of Anti tuberculosis treatment is indicator of improved nutritional status and treatment success. Objectives: To assess weight gain and associated factors among adult tuberculosis patients on directly observed treatment short-course in Northwest Ethiopia. Methods: Institution based longitudinal study was conducted from March 1 to August 28, 2013 at tuberculosis units in Gondar town and surrounding community. Simple random sampling technique was used to select 407 patients. Data were collected using structured questionnaire and anthropometric measurement was performed. Data were entered in to EPI-INFO version 3.5.1 and analysed using SPSS version 20 software. Multiple linear regression models were used to see effect of factors on weight gain among adult tuberculosis patients. Results: A total of 384 patients were participated in the study. The mean ( ± SD) body weights (in kg) for the patients were 45.9 ± 7.4, 48.9 ± 7.4 and 51.1 ± 7.4 at diagnosis, after two months and end of six months treatments respectively. The mean ( ± SD) weight gain was 5.2 kgs (95% CI: 4.83, 5.54), ± 3.55, at the end of 6th-month’s treatments. Meal frequency four and above (s 1.886) and being literate (s 1.286) have shown positive association with weight gain, whereas previous tuberculosis treatment (s -1.652) showed negative association with weight gain of study patients. Conclusion: Two-third of tuberculosis patients was underweight at the time of diagnosis. However, after initiation of anti- tuberculosis drug there were significant increments in weight gain. The weight gain of patients was affected by educational status, history of previous tuberculosis treatment and meal frequency per day. Education of tuberculosis patients about drug adherence and adequate food intake during therapy is mandatory.

This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21 %) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6 %) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits

Background People have the right to make choices regarding their own sexuality, as far as they respect the rights of others. The knowledge of those rights is critical to youth’s ability to protect themselves from unwanted reproductive outcomes. Reproductive health targeted Millennium Development Goals will not be achieved without improving access to reproductive health. This study was aimed to assess knowledge of reproductive and sexual rights as well as associated factors among Wolaita Sodo University students. Methods An institution-based cross-sectional survey was conducted among 642 regular undergraduate Wolaita Sodo University students selected by simple random sampling. A pretested and structured self-administered questionnaire was used for data collection. Data were entered using EPI info version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. Descriptive statistics was used to describe the study population in relation to relevant variables. Bivariate and multivariate logistic regression was also carried out to see the effect of each independent variable on the dependent variable. Results More than half (54.5%) of the respondents were found to be knowledgeable about reproductive and sexual rights. Attending elementary and high school in private schools [AOR: 2.08, 95% CI: 1.08, 3.99], coming from urban areas [AOR: 1.46, 95% CI: 1.00, 2.12], being student of faculty of health sciences [AOR: 2.98, 95% CI: 1.22, 7.30], participation in reproductive health clubs [AOR: 3.11, 95% CI: 2.08, 4.65], utilization of reproductive health services [AOR: 2.34, 95% CI: 1.49, 3.69] and discussing sexual issues with someone else [AOR: 2.31, 95% CI: 1.48, 3.62], were positively associated with knowledge of reproductive and sexual rights. Conclusion The level of knowledge of students about reproductive and sexual rights was found to be low. The Ministry of Education has to incorporate reproductive and sexual rights in the curricula of high schools and institutions of higher learning.

Background The evaluation of all potential sources of low skilled maternal care utilization is crucial for Ethiopia. Previous studies have largely disregarded the contribution of different levels. This study was planned to assess the effect of individual, communal, and health facility characteristics in the utilization of antenatal, delivery, and postnatal care by a skilled provider. Methods A linked facility and population-based survey was conducted over three months (January - March 2012) in twelve “kebeles” of North Gondar Zone, Amhara Region. A total of 1668 women who had births in the year preceding the survey were selected for analysis. Using a multilevel modelling, we examined the effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization. Result About 32.3%, 13.8% and 6.3% of the women had the chance to get skilled providers for their antenatal, delivery and postnatal care, respectively. A significant heterogeneity was observed among clusters for each indicator of skilled maternal care utilization. At the individual level, variables related to awareness and perceptions were found to be much more relevant for skilled maternal service utilization. Preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal health care utilizations. Birth order, maternal education, and awareness about health facilities to get skilled professionals were consistently strong predictors of skilled antenatal and delivery care use. Communal factors were relevant for both delivery and postnatal care, whereas the characteristics of a health facility were more relevant for use of skilled delivery care than other maternity services. Conclusion Factors operating at individual and “kebele” levels play a significant role in determining utilization of skilled maternal health services. Interventions to create better community awareness and perception about skilled providers and their care, and ensuring the seamless performance of health care facilities have been considered crucial to improve skilled maternal services in the study area. Such interventions should target underprivileged women.

Background Inappropriate feeding practice increases risk of under nutrition, illness, and mortality amongst children less than 2 years of age. The objective of this study is to assess minimum dietary diversity, meal frequency and its associated factors among infant and young children aged 6–23 months in Dangila Town, Northwest Ethiopia. Methods A community based cross sectional study was conducted. Simple random sampling technique was used to select study participants. Interviewer administered questionnaire were used. Bivariate and multivariable logistic regression analyses was employed to identify factors associated with minimum dietary diversity and meal frequency. Results A total of 920 children 6–23 months were included. Proportion of children who met the minimum dietary diversity and meal frequency was 12.6 and 50.4 %, respectively. Mothers education [AOR =2.52], age of a child [AOR = 2.05], birth order of index child [AOR = 2.08], living in urban area [AOR = 2.09], having home gardening [AOR = 2.03], and media exposure [AOR = 2.74] were positively associated with dietary diversity. Moreover, age of the child [AOR = 3.03], birth order of index child [AOR = 1.58], mothers involvement in decision making [AOR = 1.51], media exposure [AOR = 2.62], and having postnatal visit [AOR = 2.30] were positively associated with meal frequency. Conclusion The proportion of children who received minimum dietary diversity and meal frequency was low. Being at younger age, first birth order, and lack of media exposure affect both dietary diversity and meal frequency. Increasing mother’s education, home gardening, mass media promotion and empowering women in decision making are highly recommended to increase dietary diversity and meal frequency.

Background Neonatal danger has become a substantial problem in many developing countries like Ethiopia. More specifically, neonatal rates in Ethiopia are among the highest in the world. In this regard, health-seeking behavior of mothers for neonatal care highly relies on their knowledge about neonatal danger sign, and it has been hardly investigated. Therefore, this study was intended to determine the level of mother’s knowledge about neonatal danger signs and to identify factors associated with good mother’s knowledge. Methods Community-based cross-sectional study was conducted from February to May 2014. A multi-stage sampling technique was used to select 603 mothers. A structured, pre-tested, and interview-administered questionnaire comprehending 13 neonatal danger signs was employed to collect the data. Data were entered into EPI-Info 3.5.2 and analyzed by SPSS version 16. Binary logistic regression model was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength and significant level of the association. Results All mothers expected to participate in the study were interviewed. The results of the study showed that mothers who had knowledge of three or more neonatal danger signs (good knowledge) were found to be 18.2% (95% CI 15.1, 21.3%). The odds of having good knowledge was positively associated with mother’s (AOR = 3.41, 95% CI 1.37, 8.52) and father’s (AOR = 3.91, 95% CI 1.23, 12.36) higher educational achievement. Similarly, the odds of having good knowledge about neonatal danger signs was higher among Antenatal care (AOR = 2.28, 95% CI 1.05, 4.95) and Postnatal care attendant mothers (AOR = 2.08, 95% CI 1.22, 3.54). Furthermore, access to television was also associated with mothers’ good knowledge about neonatal danger signs (AOR = 3.49, 95% CI 1.30, 9.39). Conclusion Maternal knowledge about neonatal danger signs was low. Therefore, intervention modalities that focus on increasing level of parental education, access to antenatal and postnatal care and PNC service, and advocating the use of television was pinpointed.