The utility of delivery ward register data for determining the causes of perinatal mortality in one specialized and one general hospital in south Ethiopia

Background Globally, the burden of perinatal mortality is high. Reliable measures of perinatal mortality are necessary for planning and assessing prenatal, obstetric, and newborn care services. However, accurate record-keeping is often a major challenge in low resource settings. In this study we aimed to assess the utility of delivery ward register data, captured at birth by healthcare providers, to determine causes of perinatal mortality in one specialized and one general hospital in south Ethiopia. Methods Three years (2014–2016) of delivery register for 13,236 births were reviewed from July 12 to September 29, 2018, in two selected hospitals in south Ethiopia. Data were collected using a structured pretested data extraction form. Descriptive statistics assessed early neonatal mortality rate, stillbirth rate, perinatal mortality rate and causes of neonatal deaths. Factors associated with early neonatal deaths and stillbirths were examined using logistic regression. The adjusted odds ratios with a 95% confidence interval were reported to show the strength of the association. Result The perinatal mortality ratio declined from 96.6 to 75.5 per 1000 births during the three-year study period. Early neonatal mortality and stillbirth rates were 29.3 per 1000 live births and 55.2 per 1000 total births, respectively. The leading causes of neonatal death were prematurity 47.5%, and asphyxia 20.7%. The cause of death for 15.6% of newborns was not recorded in the delivery registers. Similarly, the cause of neonatal morbidity was not recorded in 1.5% of the delivery registers. Treatment given for 94.5% of neonates were blank in the delivery registers, so it is unknown if the neonates received treatment or not. Factors associated with increased early neonatal deaths were maternal deaths and complications, vaginal births, APGAR scores less than 7 at five minutes and low birth weight (2500 g). Maternal deaths and complications and vaginal births were associated with increased stillbirths. Conclusion Our findings show that an opportunity exists to identify perinatal death and newborn outcomes from the delivery ward registers, but some important neonatal outcomes were not recorded/missing. Efforts towards improving the medical record systems are needed. Furthermore, there is a need to improve maternal health during pregnancy and birth, especially neonatal care for those neonates who experienced low APGAR scores and birth weight to reduce the prevalence of perinatal deaths.

Factors associated with stunting among children aged 6–59 months in Bensa District, Sidama Region, South Ethiopia: unmatched case-control study

Background Stunting remains one of the most common malnutrition problems among children in Ethiopia. Identifying the risk factors of stunting assists health planners to prioritize prevention strategies, and is a fundamental step for intervention. Therefore, this study aimed to assess factors associated with stunting among children aged 6–59 months in Bensa district, Sidama Region, South Ethiopia, 2018. Methods A facility-based unmatched case-control study was conducted from January 10 to March 10, 2018, on a sample of 237(79 cases and 158 controls) children aged 6–59 months with their respective mothers/caretakers. Data were collected using a structured, face-to-face interviewer-administered questionnaire and standard physical measurements. The data were entered into EP INFO version 7 and WHO Anthro software and analyzed using SPSS version 20. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with stunting. Adjusted odds ratio (AOR) with 95% confidence interval (95%CI) and p-value <0.05 was used to declare the significance. Results Sex distribution was almost equal (Males = 52.3%, Females = 47.7%).The mean (standard deviation) age of cases and controls was 27.35 (±12.71) and 28.70 (±13.27) months respectively. The risk factors for stunting were diarrhea in the past two weeks (AOR = 2.71, 95% CI: 1.42–5.16), being male (AOR = 2.37, 95% CI: 1.224–4.59), inappropriate exclusive breastfeeding (AOR =2.07, 95%CI: 1.07–4.01), having less than or equal to three under-five children in the household (AOR = 2.18, 95%CI: 1.03–4.64), and mothers who had no formal education (AOR =3.28, 95%CI :1.56–6.924). Conclusions Diarrhea in the past two weeks, sex of a child, inappropriate exclusive breastfeeding, number of under-five children in the household, and mothers who had no formal education were the risk factors of stunting. Thus organized efforts aimed at focus on prevention of diarrhea as part of an overall public health strategy for improving child health and nutrition. Educating mothers/caretakers on the importance of exclusive breastfeeding should be considered. Moreover, mothers need to be encouraged to space birth between children through the use of family planning services.

The effect of inter-pregnancy interval on stillbirth in urban South Ethiopia: a community-based prospective cohort study

Background Stillbirth is an invisible and poorly understood adverse pregnancy outcome that remains a challenge in clinical practice in low-resource settings. It is also a key concern in Ethiopia where more than half of pregnancies occur shortly after preceding childbirth. Whether the interval between pregnancies has an effect on stillbirth or not is unclear. Therefore, we aimed to assess the effect of inter-pregnancy interval on stillbirth in urban South Ethiopia. Methods A community-based prospective cohort study was conducted among 2578 pregnant women and followed until delivery. Baseline data were collected at the household level during registration and enrolment. End-line data were collected from hospitals during delivery. Exposed groups were pregnant women with inter-pregnancy intervals < 18 months and 18–23 months. Unexposed group contains women with inter-pregnancy intervals 24–60 months. A generalized linear model for binary outcome was applied, using R version 4.0.5 software. Relative risk (RR) was used to estimate the effect size with a 95% confidence level. Attributable fraction (AF) and population attributable fraction (PAF) were used to report the public health impact of exposure. Results The overall incidence of stillbirth was 15 per 1000 total births, (95% CI: 11, 20%). However, the incidence was varied across months of inter-pregnancy intervals; 30 (< 18 months), 8 (18–23 months) and 10 (24–60 months) per 1000 total births. The risk of stillbirth was nearly four times (ARR = 3.55, 95%CI: 1.64, 7.68) higher for women with inter-pregnancy interval < 18 months as compared to 24–60 months. This means, about 72% (AF = 72, 95%CI: 39, 87%) of stillbirth among the exposed group (inter-pregnancy interval < 18 months category) and 42% (PAF = 42, 95%CI: 23, 50%) of stillbirth in the study population were attributed to inter-pregnancy interval < 18 months. These could be prevented with an inter-pregnancy interval that is at least 18 months or longer. Conclusions Inter-pregnancy interval under 18 months increases the risk of stillbirth in this population in urban South Ethiopia. Interventions targeting factors contributing to short inter-pregnancy intervals could help in reducing the risk of stillbirth. Improving contraceptive utilization in the community could be one of these interventions.

Imprisonment for South Ethiopian people living with HIV presents a double health burden: exploring the barriers and facilitators of optimal HIV care

Background Optimal adherence to antiretroviral therapy (ART) is crucial for ensuring treatment benefits as well as prevention of further transmission. However, whilst the prevalence of ART non-adherence in prison populations is considered to be high in many countries, little information is available about its predisposing circumstances in resource limited countries. We explored the barriers to and facilitators of ART adherence amongst inmates living with HIV (ILWHA) in South Ethiopia with the aim of contextualising this significant public health problem and to make advances towards optimal HIV care. Methods We conducted qualitative in-depth interviewing with eleven ILWHA (eight male and three female ILWHA) and eleven service providers (seven male and four female service providers). Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging themes. A phenomenological approach was employed to abstract meaning attributed to the prisoners’ lived experiences in relation to ART adherence and service providers’ experiential account regarding HIV care provision. Findings: Several themes emerged in relation to barriers of ART adherence amongst ILWHA in South Ethiopia: limited access to standard HIV care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, depression related to imprisonment and food supply insufficiency appeared to negatively influence adherence. In addition to a unique opportunity offered by an imprisonment for some ILWHA to refrain from health damaging behaviours, the presence of social support in the prison system facilitated ART adherence. Conclusions This study identified important structural, social and behavioural factors that can both hinder and enhance ART adherence amongst ILWHA in South Ethiopia. Given the high prevalence of HIV infection in prisoners and the potential of transmission to others during and after incarceration, policy and practice development is required to address the barriers to ART adherence and to also strengthen the enablers with regard to an asset-based approach.

New Dates for Megalithic Stele Monuments of Gedeo, South Ethiopia

This paper reports the results of an archaeological survey and test excavation conducted in one of the ancient megalithic stele sites in south Ethiopia, Sakaro Sodo. The Sakaro Sodo stele site is situated in Gedeo zone, which is known to have the largest number and highest concentration of megalithic stele monuments in Africa, with an estimate of more than 10,000 stelae in sixty or more sites. Prior to our work, only one absolute date was available (850 ± 40 BP) (Joussaume 2012) from a stele site in the Gedeo zone, suggesting stele sites began to be constructed in the region approximately a millennium ago. We report here new AMS dates suggesting that stelae were being emplaced about 2000 BP, pushing the creation of these monuments back at least a millennium. Additionally, we report preliminary findings from characterizing the geochemical properties of obsidian artifacts recovered from stele sites, and stone used to make stelae. While compositional analysis of obsidian suggests long-distance movement of material from sources located in northern Kenya, petrographic microscopy and electron microprobe analyses show a strong connection of stelae to local geological tuff exposures/sources.

Magnitude and factors associated with Availability of Adequately Iodized Salt at Households of Pregnant Mothers in Wonago district, south Ethiopia

Background Salt iodization is the most cost-effective, safe and sustainable strategy to eliminate iodine deficiency disorders. It is especially damaging during pregnancy and in early child hood. Adding iodine to salt provides protection from brain damage due to iodine deficiency for whole populations. However, little was known about the availability of adequately iodized salt in South Ethiopia. The aim of this study was to assess prevalence and factors associated with availability of adequately iodized salt at the households of pregnant mothers in Wonago District, South Ethiopia, 2018. Methods Community-based cross-sectional study was conducted from May 14-29, 2018 in Wonago district. Using a stratified two stage random sampling technique, a total of 604 pregnant mothers were included in the study. The level of salt iodine content was determined using the rapid field test kit, considering a value of <15 parts per million (PPM) and ≥15 PPM with the corresponding color chart on the rapid test kit for classification. Multivariable logistic regression model was fitted to identify factors associated with the availability of adequately iodized salt. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association. Result Availability of adequately iodized salt at households of pregnant mothers was 19.9%. House hold head, husband education, average monthly household income and time of salt addition during cooking were independently associated with adequately iodized salt availability. Accordingly, participatory male headed households [AOR=2.1(95%CI 1.08, 3.96)], women with an average monthly household income of ≥ 817 ETB [AOR=7.3(95%CI 3.03, 17.70)] and those who added salt late or after cooking during food preparation [AOR=2.17(1.08, 4.38)] were more likely to utilize adequately iodized salt. Conversely, women whose husband had no formal education were less likely [AOR=0.33(95%CI 0.11, 0.88)] to utilize iodized salt. Conclusion Compared to the recommended standard, use of adequately iodized salt among pregnant women is very low. Paternal conditions and household income level are key predictors of use of adequately iodized salt.

Evaluation of Seven Gap-Filling Techniques for Daily Station-Based Rainfall Datasets in South Ethiopia

Meteorological stations, mainly located in developing countries, have gigantic missing values in the climate dataset (rainfall and temperature). Ignoring the missing values from analyses has been used as a technique to manage it. However, it leads to partial and biased results in data analyses. Instead, filling the data gaps using the reference datasets is a better and widely used approach. Thus, this study was initiated to evaluate the seven gap-filling techniques in daily rainfall datasets in five meteorological stations of Wolaita Zone and the surroundings in South Ethiopia. The considered gap-filling techniques in this study were simple arithmetic means (SAM), normal ratio method (NRM), correlation coefficient weighing (CCW), inverse distance weighting (IDW), multiple linear regression (MLR), empirical quantile mapping (EQM), and empirical quantile mapping plus (EQM+). The techniques were preferred because of their computational simplicity and appreciable accuracies. Their performance was evaluated against mean absolute error (MAE), root mean square error (RMSE), skill scores (SS), and Pearson’s correlation coefficients (R). The results indicated that MLR outperformed other techniques in all of the five meteorological stations. It showed the lowest RMSE and the highest SS and R in all stations. Four techniques (SAM, NRM, CCW, and IDW) showed similar performance and were second-ranked in all of the stations with little exceptions in time series. EQM+ improved (not substantial) the performance levels of gap-filling techniques in some stations. In general, MLR is suggested to fill in the missing values of the daily rainfall time series. However, the second-ranked techniques could also be used depending on the required time series (period) of each station. The techniques have better performance in stations located in higher altitudes. The authors expect a substantial contribution of this paper to the achievement of sustainable development goal thirteen (climate action) through the provision of gap-filling techniques with better accuracy.