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Association between preconception care and family planning and previous adverse birth outcomes in Ethiopia: systematic review and meta-analysis

Por: Mekonnen · B. D. · Tsega · S. S.
Objectives

Inconsistent findings on the associations of preconception care with the utilisation of family planning and previous adverse birth outcomes have not been systematically reviewed in Ethiopia. Thus, this review aims to estimate the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes in Ethiopia.

Design

Systematic review and meta-analysis of observational studies.

Data sources

MEDLINE Complete, CINAHL Complete, Scopus and Global Health were searched from inception to 28 July 2023.

Eligibility criteria

Observational studies that reported preconception care as an outcome variable and the use of family planning before pregnancy or previous adverse birth outcomes as exposure variables were included.

Data extraction and synthesis

Two reviewers independently conducted study screening, data extraction and quality assessment. A fixed-effects model was used to determine the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes.

Results

Eight studies involving a total of 3829 participants were included in the review. The pooled meta-analysis found that women with a history of family planning use had a higher likelihood of using preconception care (OR 2.09, 95% CI 1.74 to 2.52) than those women who did not use family planning before their current pregnancy. Likewise, the pooled meta-analysis found that women with prior adverse birth outcomes had a higher chance of using preconception care (OR 3.38, 95% CI 1.06 to 10.74) than women with no history of prior adverse birth outcomes.

Conclusion

This review indicated that utilisation of preconception care had a positive association with previous use of family planning and prior adverse birth outcomes. Thus, policymakers and other relevant stakeholders should strengthen the integration of preconception care with family planning and other maternal healthcare services.

PROSPERO registration number

CRD42023443855.

Active close contact investigation of tuberculosis through computer-aided detection and stool Xpert MTB/RIF among people living in Oromia Region, Ethiopia (CADOOL Study): protocol for a prospective, cross-sectional study

Por: Segala · F. V. · Nigussa · W. · Guido · G. · Kenate · B. · Facci · E. · Tsegaye · A. · Gulo · B. · Manenti · F. · Bobosha · K. · Cotugno · S. · Asmare · A. B. · Cavallin · F. · Tilahun · M. · Miccio · M. · Abdissa · A. · Putoto · G. · Saracino · A. · Di Gennaro · F.
Introduction

Pulmonary tuberculosis (TB) is an infectious disease with high incidence in low-income countries (LICs); it remains one of the infectious diseases with the highest mortality in the world, especially in LICs. It is crucial to recognise and diagnose TB as soon as possible, but microbiological tests on sputum are not always sensitive enough. New methods for an early diagnosis of TB are needed. In this study, we will investigate the role of two different tests to detect TB in Ethiopia (where the prevalence of TB is high): molecular search for TB in stool samples with Xpert assay and detection of pulmonary TB signs on chest X-rays with CAD4TB technology.

Methods and analysis

A prospective diagnostic test accuracy study during TB active contact investigation will be conducted. In the referral hospital in Southwest Shoa Zone, Oromia Region, Ethiopia, patients with pulmonary TB and a sputum sample positive for Mycobacterium tuberculosis and household contacts of at least 4 years of age will be enrolled, with a target sample size of 231 patients. Trained staff will label household contacts as ‘possible TB’ cases or not according to their symptoms; when TB is possible, a stool Xpert and computer-aided detection on chest X-ray will be performed, alongside standard diagnostic methods, assessing the diagnostic accuracy of CAD4TB compared with Xpert MTB/RIF during TB contact investigation and the accuracy of stool Xpert compared with sputum Xpert.

Ethics and dissemination

This study has been approved by the Oromia Health Bureau Research Ethics Committee (ref no BFO/MBTFH/1-16/100023). All information obtained will be kept confidential. Selected investigators will have access to data, while international partners will sign a dedicated data protection agreement. Eligible participants will receive brief information about the study before being asked to participate and they will provide written informed consent. Results will be disseminated through peer-reviewed journals.

Trial registration number

NCT05818059.

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study

Por: Lesego · A. · Tsegaye · T. · Were · L. P. O. · Sakvarelidze · G. · Garg · S. · Morrison · L. · Nigussie · S. · Githendu · P. · Achoki · T.
Objective

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018–2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt.

Design

Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data.

Setting

The study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021.

Participants

Twenty-five Ethiopian healthcare decision-makers and health workers.

Intervention

Global Fund training programme for health workers and infrastructural improvements

Outcomes

Operational and financial measures for healthcare PSCM.

Results

The availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems.

Conclusion

The Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.

Knowledge and practice of nurses with respect to perioperative hypothermia prevention in the Northwest Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study

Por: Woretaw · A. W. · Yimer Mekonnen · B. · Tsegaye · N. · Dellie · E.
Objectives

It has been reported that maintaining a normal body temperature among surgical patients can reduce the length of hospitalisation by up to 40%, decrease the risk of surgical site infection by 64% and reduce mortality by fourfold. Nurses are primarily responsible for preventing the occurrence of hypothermia among surgical patients. This study assessed nurses’ knowledge and practices with respect to perioperative hypothermia prevention in Northwest Ethiopia, and investigated the factors associated with good knowledge and practice.

Design

Cross-sectional study.

Setting

Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia, 25 March–20 May 2021.

Participants

413 nurses working in the perioperative units of five referral hospitals.

Outcome measures

Perioperative hypothermia prevention knowledge and practice among nurses.

Results

Nearly three-fifths (59.1%; 95% CI: 54.7% to 63.7%) of respondents had good knowledge and about half (50.4%; 95% CI: 45.5% to 55.0%) had good practice with respect to perioperative hypothermia prevention. Factors associated with nurses’ knowledge of prevention of perioperative hypothermia included male sex (adjusted OR (AOR): 1.61, 95% CI: 1.02 to 2.53), having a bachelor’s degree (AOR: 2.50, 95% CI: 1.25 to 5.00), having a master’s degree (AOR: 4.39, 95% CI: 1.45 to 13.20) and training participation (AOR: 3.68, 95% CI: 2.14 to 6.33). Factors associated with nurses’ practice of prevention of perioperative hypothermia included working in recovery (AOR: 2.87, 95% CI: 1.08 to 7.58) and intensive care units (AOR: 2.39, 95% CI: 1.09 to 5.22), training participation (AOR: 2.64, 95% CI: 1.53 to 4.57), being satisfied with their job (AOR: 2.15, 95% CI: 1.34 to 3.43) and having good knowledge (AOR: 2.64, 95% CI: 1.63 to 4.27).

Conclusion

Nurses’ knowledge and practice of the prevention of perioperative hypothermia were inadequate. Hospital managers need to design and strengthen training programmes and work to enhance job satisfaction.

Determinants of cervical cancer screening utilization among HIV-positive women, in public general hospitals of Central Zone, Tigray, Ethiopia, 2020: Case-control study

by Tsega Gebremichael Gebremeskel, Merkeb Zeray Gebretatios

Introduction

Cervical cancer is the second leading cause of cancer-related morbidity and mortality in Ethiopia. Evidence showes that, despite the magnitude and severity of cervical cancer, utilization of cervical cancer screening in the study area among HIV-positive women is low.

Objective

This study aimed to assess the determinants of cervical cancer screening utilizationamong HIV-positive women in general public hospitals in the central zone of Tigray, Ethiopia.

Method

This study was a facility-based unmatched case-control study conductedamong HIV-infected womenin public general hospitals in the central zone of Tigray. Cases were HIV infected women not screened for cervical cancer, and controls were HIV infected women screened for cervical cancer. A total of 800participants (400 cases and 400 controls) wereselected using systematic random sampling with a 1:1 case-to-control ratio.Data collection was done using a pre-tested interviewer-administered questionnaire and a medical record review.The determinants of cervical cancer screeningutilization were identified through binary logistic regression.

Result

Significant determinants of cervical cancer screening utilization among HIV-infected women in the central zone of Tigray werebeing in the age group of 18–30 [AOR = 0.46, 95% CI = 0.22, 0.98], living in rural areas [AOR = 0.47, 95% CI = 0.26, 0.87], no formal education [AOR = 0.25, 95% CI = 0.14, 0.45] and primary education [AOR = 0.28, 95% CI = 0.16,0.49], not working outside the home [AOR = 0.21, 95% CI = 0.10, 0.44], poor knowledge about cervical cancer [AOR = 0.29, 95% CI = 0.19, 0.44], and about cervical cancer screening [AOR = 0.44, 95% CI = 0.28, 0.70], and unfavorable attitudes toward cervical cancer screening [AOR = 0.52, 95% CI = 0.34, 0.79].

Conclusion

Being in the age group of 18–30, living in rural areas, lacking formal education or havingonly primary level education, not working outside of the home, having poor knowledge of cervical cancer and screening,and having unfavourable attitudestowards cervical cancer screeningare significant determinat factors in cervical cancer screening utilization among HIV-infected women in the central zone of Tigray, Ethiopia. Considering such factors during the design of policies and programs could enhance the utilization of cervical cancer screening in the region.

Work-related stress and associated factors among health professionals working in Ambo town public health facilities, West Shoa Zone, Ethiopia, 2021: a cross-sectional study

Por: Bakare · M. · Darega · J. · Nugus · G. G. · Tsegaw · M.
Objectives

To assess work-related stress (WRS) and associated factors among health professionals working in Ambo town governmental health facilities, in 2021.

Design

Institution-based analytical cross-sectional study.

Setting

Institution-based analytical cross-sectional study was conducted in Ambo town from 15 July 2021 to 15 August 2021. A simple random sampling technique was used to select 420 participants. Data were collected by using structured self-administered questionnaire. Descriptive statistics was used to show the magnitude of WRS. Multivariate logistic regression was employed to identify variables that are significantly associated with WRS at 95% CI and p value

Participants

A total of 407 participants were involved in the study making the response rate 96.9%. The age of the respondents ranged from 20 to 52 with the mean age of 29 years (SD=4.8). Among all participants, 261 (64.1%) were male health professionals.

Results

This study found that the overall prevalence of WRS was 52.33% (47.5, 57.2). Being female (adjusted OR (AOR)=1.73, 95% CI 1.06, 2.81), home-work interface (AOR=1.93, 95% CI 1.19, 3.14), job insecurity (tendency not knowing continue current job (AOR=3.22, 95% CI 1.87, 5.56) and major life events (serious injury to close relatives (AOR=3.13, 95% CI 1.68, 5.84), death of close relative (AOR=2.09, 95% CI 1.16, 3.77), being violated by other (AOR=3.10, 95% CI 1.65, 5.83) and anything else seriously upset (AOR=2.63, 95% CI 1.60, 4.32) were factors significantly associated with WRS.

Conclusion

The prevalence of WRS among health professionals working in Ambo town public health facilities was high as compared with other studies. Sex, job insecurity, home-work interface and occurrence of major life events were factors that positively related to WRS and make the work of health professionals stressful. Health facilities, programme managers and policy makers should consider those identified factors while designing public health interventions to reduce WRS among health professionals.

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