Effects of antenatal care service utilization on maternal near miss in Gamo Gofa zone, southern Ethiopia: retrospective cohort study

Background Antenatal care (ANC) provides an opportunity to prevent, identify and intervene maternal health problems. Maternal near miss (MNM), as an indicator of maternal health, is increasingly gaining global attention to measure these problems. However, little has been done to measure the effect of ANC on MNM in Ethiopia. Therefore, this study is aimed at determining the effect of ANC on MNM and its associated predictors at Gamo Gofa zone, southern Ethiopia. Methods Employing a retrospective cohort study design, 3 years data of 1440 pregnant mothers (480 ANC attendant and 960 non-attendant) were collected from all hospitals in the zone. Taking ANC visit as an exposure variable; we used a pretested checklist to extract relevant information from the study participants’ medical records. Characteristics of study participants, their ANC attendance status, MNM rates and associated predictors were determined. Results Twenty-five (5.2%) ANC attendant and seventy-one (7.4%) non-attendant mothers experienced MNM, (X2 = 2,46, df = 2, p = 0.12). The incidence rates were 59.6 (95% CI: 40.6–88.2) and 86.1 (95%CI: 67.3–107.2)/1000 person-years for the ANC attendant and non-attendant mothers, respectively. Mothers who were living in rural areas had higher hazard ratio of experiencing MNM than those who were living in urban areas, with an adjusted hazard ratio (AHR) of 1.68 (95% CI, 1.01, 2.78). Conclusion ANC attendance tended to reduce MNM. However, late initiation and loss to follow-up were higher in the current study. Therefore, on time initiation and consistent utilization of ANC are required.

Adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone public health hospitals

Introduction: Adherence to diabetes self-care management is a lifestyle modification for people with diabetes which includes; medication, dietary practice and regular physical activity. The objective of this study was to assess the adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone, Southern, Ethiopia, 2018. Methods: Institutional-based cross-sectional study design with a systematic random sampling technique was conducted. A total 635 diabetic participants were involved in this study. Data were collected using structured interviewer administered questionnaire. Data were analyzed using SPSS version 21. Descriptive statistics were employed to describe the study population in relation to the relevant variables. Binary and multivariable logistic regression was conducted to identify factors associated with the outcome variables. P-value < 0.05 with 95% confidence interval was used to declare statistical significance. Results: The prevalence of good adherence toward diabetes self-care management was 341 (53.7%), (95% confidence interval = 46.09, 61.31). Regarding diabetes self-care practices, poor adherence had been detected in blood sugar measurement practice, dietary feeding practice, physical exercise and eye examination practice. The multivariable analysis indicated that government workers [adjusted odds ratio = 2.74 (1.03, 7.30)], training on diabetes self-care practice [adjusted odds ratio = 3.13 (1.89, 5.16)], diabetes’ association membership [adjusted odds ratio = 1.59 (1.01, 2.50)], having personal glucometer at home [adjusted odds ratio = 2.70 (1.37, 5.33)], duration of diabetic illness >10 years [adjusted odds ratio = 9.59 (3.99, 23.05)] and people with diabetes who were not developing complication [adjusted odds ratio = 1.54 (1.01, 2.33)] were significantly associated with good adherence to diabetes self-care management practice. Conclusion: Significant number of diabetes patients had poor adherence to diabetes self-care practice. Special focus should be given to farmers with diabetes, those with diabetic complication and for those with duration of diabetes less than 10 years. Periodical training should be given for people with diabetes on dietary feeding, physical exercise and eye examination practice.

Soil-transmitted helminth infections among pre-school aged children in Gamo Gofa zone, Southern Ethiopia: Prevalence, intensity and intervention status

Background Soil-transmitted helminths (STH), i.e., Ascaris lumbricoides, Trichuris trichiura and hookworms are among the most prevalent Neglected Tropical Diseases (NTDs) in Ethiopia. Although pre-school aged children pay a high morbidity toll associated with STH infections, evidence on prevalence, intensity and intervention status is lacking in Ethiopia. This study, therefore, aimed to address these gaps to inform decision made on STH. Methods We did a community-based cross-sectional study in five districts of Gamo Gofa zone, Southern Ethiopia; in January 2019. Data were collected using pre-tested questionnaire, and the Kato-Katz technique was used to diagnose parasites eggs in stool. Then, collected data were edited and entered into EpiData 4.4.2, and exported to SPSS software (IBM, version 25) for analysis. Results A total of 2462 PSAC participated in this study. Overall, the prevalence of STH was 23.5% (578/2462) (95% confidence interval (CI) = 21.8%–25.2%). As caris lumbricoides was the most prevalent (18.6%), followed by Trichuris trichiura (9.2%), and hookworms (3.1%). Of the total, 7.4% PSAC were infected with two STH species. Most of the positive cases with STH showed low infection intensities, while 15.1% ascariasis cases showed moderate infection intensities. The study found that 68.7% of PSAC were treated with albendazole. Also, household’s level data showed that 39.4% used water from hand-dug well; 52.5% need to travel ≥30 minutes to collect water; 77.5% did not treat water, and 48.9% had no hand washing facility. In addition, almost 93% care givers achieved less than the mean knowledge and practice score (≤5) on STH prevention. Conclusions This study showed that significant proportions of pre-school aged children are suffering from STH infections despite preventive chemotherapy exist at the study area. Also, gaps in the interventions against STH were highlighted. Thus, a call for action is demanding to eliminate STH among PSAC in Ethiopia by 2030.

Determinants of soil-transmitted helminth infections among pre-school-aged children in Gamo Gofa zone, Southern Ethiopia: A case-control study

Background Pre-school aged children (PSAC) are highly affected by soil-transmitted helminths (STH), particularly in areas where water, sanitation, and hygiene (WASH) are inadequate. Context-specific evidence on determinants of STH infections in PSAC has not been well established in the study area. This study, therefore, aimed to fill these gaps in Gamo Gofa zone, Southern Ethiopia. Methods A community-based unmatched case-control study, nested in a cross-sectional survey, was conducted in January 2019. Cases and controls were identified based on any STH infection status using the Kato-Katz technique in stool sample examination. Data on social, demographic, economic, behavioral, and WASH related variables were collected from primary caregivers of children using pre-tested questionnaire. Determinants of STH infections were identified using multivariable logistic regression model using SPSS version 25. Results A total of 1206 PSAC (402 cases and 804 controls) participated in this study. Our study showed that the odds of STH infection were lowest among PSAC living in urban areas (AOR = 0.55, 95% CI: 0.39–0.79), among those from households with safe water source (AOR = 0.67, 95% CI: 0.47–0.0.93), and in those PSAC from households with shorter distance from water source (<30 minutes) (AOR = 0.51, 95% CI: 0.39–0.67). On the other hand, the odds of STH infection were highest among PSAC from households that had no functional hand washing facility (AOR = 1.36, 95% CI: 1.04–1.77), in those PSAC from households that had unclean latrine (AOR: 1.82, 95% CI: 1.19–2.78), and among those PSAC under caregivers who had lower score (≤5) on knowledge related to STH transmission (AOR = 1.85, 95% CI: 1.13–3.01). Conclusions Given efforts required eliminating STH by 2030; the existing preventive chemotherapy intervention should be substantially strengthened with WASH and behavioral interventions. Thus, an urgent call for action is required to integrate context-specific interventions, particularly in rural areas.

Level of and associated factors for non-adherence to anti-tuberculosis treatment among tuberculosis patients in Gamo Gofa zone, southern Ethiopia: cross-sectional study

Background Non-adherence to anti-TB treatment is one of the crucial challenges in improving tuberculosis (TB) treatment outcomes and reducing healthcare costs. The poor adherence to anti-TB treatment among patients with TB is a major problem in Ethiopia. This study aimed to assess the level of and associated factors for non-adherence to anti-TB therapy among patients with tuberculosis in the Gamo Gofa Zone. Methods A cross-sectional study was conducted at Gamo Gofa Zone from July 20 – August 30, 2017. A multi-stage sampling technique was used. The study included 289 patients who were on anti-TB treatment. Data were collected by trained data collectors using a structured and pre-tested questionnaire through interviews. A multiple logistic regression model was fitted using SPSS 23 to identify factors associated with non-adherence to anti-TB treatment at a 5% significance level. Results We found that 16.5% of the participants were non-adherent for anti-TB treatment. Failure to disclose one’s TB status to his or her family (AOR = 31.7; 95% CI: 9.1–111.1), having no information on the expected adverse events (AOR = 31.1; 95% CI: 7.5–128.3), past anti-TB treatment history (AOR = 5.3; 95% CI: 1.5–18.8) and a smoking cigarette (AOR = 11.7; 95% CI: 3.2–43.03) were found to be associated with a higher odds of being non-adherent to anti-TB treatment. Conclusions The level of non-adherence to anti-TB treatment among TB patients was high. Health care providers should counsel TB patients on the expected adverse events and measures to be taken when patients face the expected adverse events. They should also counsel their patients to disclose their TB status to his or her family and for ceasing cigarette smoking.

Prevalence and factors associated with early discontinuation rate of Implanon utilization among women who ever used Implanon in Kucha District Gamo Gofa Zone, Southern Ethiopia

Background The promotion of contraception in countries with high birth rates has the potential to reduce poverty, hunger, maternal, and childhood deaths. Every year in sub-Saharan Africa approximately 14 million unintended pregnancies occurred and a sizeable proportion was due to poor use of short-term hormonal methods. Contraceptive hormonal implants are highly effective and suitable for almost all women at any stage of their reproductive lives. On the other hand, early discontinuation of the Implanon contraceptive method utilization is one of the foremost problems amid the family planning program. Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation lingers the most significant anxiety for family planning programs. In unindustrialized countries, contraceptive discontinuation due to health concerns is generally higher; these complaints are often related to service quality. Hence, this study aimed to assess the prevalence and factors associated with early discontinuation of Implanon among women who ever used Implanon in Kucha district, Gamo Gofa Zone, Southern Ethiopia. Methods Implanon contraceptive device users were selected from the Kucha district using a cross-sectional community-based survey from January to March 2018. A total of 430 women were selected and data were collected through face-to-face interviews by using a pre-tested structured questionnaire. Data were cleaned, coded, and entered into Epi-Info version 7statistical software. Factors that showed association in a bivariate analysis that has a p value of less than 0.25 were entered into multiple logistic regression models for controlling confounding factors. The strength of statistical association was measured by adjusted odds ratio, at 95% confidence intervals, and p value < 0.05 were considered as statistically significant variables. Result The result of this study revealed that the overall discontinuation rate of Implanon in the study was 34%. Variables having statistically significant association with Implanon discontinuation were women who never use a contraceptive method other than Implanon (AOR = 2.96, 95% CI 1.53–5.74), women who didn’t make discussion with a partner (AOR = 3.32, 95% CI 1.57–7.04), poor counseling and follow up (AOR = 9.23, 95% CI 4.7–18.13), fear of side effects (AOR = 0.12, 95% CI 0.058- 0.24) and poor satisfaction of service (AOR = 5.2, 95% CI 2.77- 9.76) Conclusion The overall early discontinuation rate of Implanon in the study area was high. The main factors associated with early discontinuation of Implanon were contraceptive ever use, discussion with partner, poor follow-up of counseling, fear of side effects, and un-satisfaction by the services given during the insertion rate of Implanon.