Factors influencing antenatal care service utilization in hadiya zone

Background

In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women in Ethiopia. According to the 2005 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Therefore, the objective of this study was to explore factors influencing antenatal care services utilization in Southern Ethiopia.

Methods

A community-based cross sectional study was conducted in Hadiya Zone of Southern Ethiopia from January to February 2009. A multi stage sampling technique was used to select the study population in one urban and five rural kebeles. Analysis was done using SPSS for windows version 16.

Result

This study revealed that antenatal care service utilization in the study area was 86.3%. However, from those who attended antenatal care service 406 (68.2%) started antenatal care visit during the second trimester of pregnancy and significant proportion 250 (42%) had less than four visits. Maternal age, husband attitude, family size, maternal education, and perceived morbidity were major predictors of antenatal care service utilization.

Conclusion

Though the antenatal care service utilization is high in the study population, four in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promoting information, education and communication in the community is recommended to favorably affect the major predictors of antenatal care service utilization.     

Knowledge about Obstetric Danger Signs among Pregnant Women in Aleta Wondo District, Sidama Zone, Southern Ethiopia

Background

Raising awareness of women on danger signs of pregnancy, childbirth and the postpartum period is crucial for safe motherhood. In Ethiopia, a country where maternal morbidity and mortality is high little is known about knowledge level of pregnant women on obstetric danger signs. The objective of this study was to assess pregnant women''s knowledge about obstetric danger signs in Aleta Wondo district, Sidama Zone, South Ethiopia.

Methods

A community based cross-sectional study was conducted from January 18 – February 20, 2007, on a sample of 812 pregnant women selected from, 8 rural and 2 urban Kebeles. A structured pre-tested questionnaire was used to collect quantitative data on socio-demographic characteristics, obstetric history, and knowledge about danger signs of pregnancy, childbirth and post partum period. Qualitative data was collected through focus group discussion with pregnant women and in-depth interview with traditional birth attendants. The collected data were analyzed using SPSS for Windows version 12.0.1.

Results

Seven hundred forty three pregnant women participated in the study making a response rate of 92%. Out of the 743 pregnant women who participated in this study 226 (30.4%), 305(41.3%) and 279(37.7%) knew at least two danger signs during pregnancy, childbirth and postpartum period, respectively. Being urban resident was consistently found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4).

Conclusion

This study indicated that the knowledge level of pregnant women about obstetric danger signs (during pregnancy, childbirth and postpartum period) was low and affected by residential area. Therefore, the identified deficiencies in awareness should be addressed through maternal and child health services by designing an appropriate strategies including provision of targeted information, education and communication.     

Magnitude and pattern of injury in jimma university specialized hospital, South west ethiopia

Background

Injury statistics in Ethiopia provides little knowledge about its magnitude and related information needed for prevention. This study, therefore, aims to determine the magnitude and pattern of injury in Jimma University Specialized Hospital (JUSH).

Methods

A retrospective review of records of all injured patients seen at surgical outpatient department from April 09, 2010 to January 07, 2011; was conducted in January 2011. Data were collected using a structured checklist that was developed by adapting the World Health Organization instrument. Five degree holder nurses collected the data while investigators closely supervised. Socio demographic characteristics of the patients and injury related information were collected. Data were analyzed using SPSS for windows version 16.0.

Results

Of 13500 patients who visited surgical outpatient department of JUSH during the study period, 1102(8.2%) were injury cases. The commonest mechanism of injury was blunt assault, 341(30.9%), followed by road traffic accident, 334(30.3). Fracture was the leading outcome of injury, 454(41.2%), followed by bruise or skin laceration, 404(36.7%). Significantly more males had cut, (AOR=2.0; 95% CI=1.2, 3.3) and stab, (AOR=3.0; 95% CI=1.6, 5.7), injuries compared to females. Conversely, significantly fewer males had burn, (AOR=0.4, 95% CI=0.2, 0.8) and road traffic accident, (AOR=0.7, 95% CI=0.5, 0.9), than females. Most, 715(95.8%), patients were presented to the hospital within one week. The commonest functional limitations were; difficulty to use hands, 312(28.3%) and difficulty to use legs, 217(19.7%). Eighty three, (7.5%) of the patients died and road traffic accident alone accounted for almost half, 179 (49.7%), of the severe injuries.

Conclusion

The magnitude of injury in the hospital was considerably high. Age and sex were predictors of injury. Appropriate prevention strategies should be designed and implemented against assault, road traffic accident and cut by sharp tool.     

Pesticide Exposure and Hypertensive Disorders During Pregnancy

Background

Hypertensive disorders of pregnancy, including pregnancy-induced hypertension (PIH) and preeclampsia (PE), complicate 2–8% of pregnancies. Few studies have examined environmental risk factors in relation to these conditions.

Objectives

Our goal was to examine whether pesticide exposure during pregnancy was associated with hypertensive disorders of pregnancy.

Methods

We analyzed self-reported data from 11,274 wives of farmers enrolled in the Agricultural Health Study (AHS) between 1993 and 1997. Using logistic regression models, we estimated the adjusted odds ratios (AORs) for PIH and PE associated with pesticide-related activities during the first trimester of pregnancy.

Results

First-trimester residential and agricultural activities with potential exposure to pesticides were associated with both PIH [residential AOR = 1.27; 95% confidence interval (CI), 1.02–1.60; agricultural AOR = 1.60; 95% CI, 1.05–2.45] and PE (residential AOR = 1.32; 95% CI, 1.02–1.70; agricultural AOR = 2.07; 95% CI, 1.34–3.21).

Conclusions

Exposure to pesticides during pregnancy may increase the risk of hypertensive disorders of pregnancy. Laboratory research may provide insights into relationships between pesticide exposure and hypertensive diseases of pregnancy.     

Awareness of necessity to call 9-1-1 for stroke symptoms, upstate New York

Introduction

Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay.

Methods

A random-digit–dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke.

Results

The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%–74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%–36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58–1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53–0.91; facial droop: AOR, 0.85; 95% CI, 0.65–1.11; arm weakness: AOR, 0.80; 95% CI, 0.63–1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1.

Conclusion

Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.     

Anemia and Associated Factors Among Pregnant Women Attending Antenatal Care Clinic in Wolayita Sodo Town,Southern Ethiopia

Background

Anemia during pregnancy is a common problem which affects both the mother''s and her child''s health. The main aim of the study was to determine the prevalence and associated risk factors of anemia among pregnant women.

Methods

We conducted a facility based cross-sectional study on 363 pregnant women attending antenatal care clinic in Wolayita Soddo Otona Hospital from January to March 2014. Sociodemographic data were collected through questionnaire based interview. Four milliliter of venous blood and five grams of fecal samples were collected from each pregnant woman. Hematological parameters were determined using CELL DYN 1800^® (Abott, USA) Hematology analyzer. Stool samples were checked for intestinal parasites using both direct wet mount and formol-ether concentration techniques.Data were analyzed using SPSS version 20 software.

Results

Overall, the prevalence of anemia was 39.94% (95% CI: 34.7 – 45.2%), of which the majority (60%) had moderate anemia. The mean hemoglobin concentration was 11.55±2.97 g/dl. Age 15–24 years (AOR: 9.89, 95%CI:2.68–21.41), family size >5 (AOR:7.74, 95%CI:4.15–16.47), multigravida (AOR:2.66, 95%CI:1.1.31–4.53), having low income (AOR:5.81, 95%CI:2.93–14.11), current clinical illness (AOR: 6.38, 95%CI:3.13–13.00), intestinal parasitic infection (AOR:2.41, 95%CI:1.08–5.81), no history of contraceptive usage (AOR:5.02 95%CI:2.21–11.47), being in third trimesters (AOR:11.37, 95%CI:4.56–24.82), history of excess menstrual bleeding (AOR:9.82, 95%CI:3.27–21.35) and low body mass index (AOR:9.44, 95%CI:7.79–22.18) were identified as independent predictors of anemia among pregnant women.

Conclusion

Anemia prevalence was found out to be moderate public health importance. Identified risk factors should be considered for prevention and control of anemia among pregnant women.     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

Risk Factors of Active Tuberculosis in People Living with HIV/AIDS in Southwest Ethiopia: A Case Control Study

Background

Determinants of active tuberculosis among People Living with HIV/AIDS (PLHA) are not well elucidated in countries with limited resources. The objective of this study was to assess distal and proximate determinants of active tuberculosis among people living with HIV/AIDS in southwest Ethiopia.

Methods

A case-control study was conducted from January to March, 2009 in South West Ethiopia. The study population consisted of 162 cases and 647 controls. Cases were adult people living with HIV/AIDS who developed active pulmonary tuberculosis and controls were people living with HIV/AIDS without active tuberculosis. An interviewer administered structured questionnaire was used to collect information on potential risk factors.

Results

After adjustment for potential confounders, male gender (OR=1.7; 95%CI: 1.1, 2.7), a low level of education (OR=2.8; 95% CI: 1.1, 7.1), a body mass index less than 18.5 kg/m2 (OR=4.1; 95% CI: 2.3, 7.4), hemoglobin level less than 10.0 g/dl (OR=2.8; 95%CI: 1.5, 5.2), a CD4 lymphocyte count less than 200 cells/µL (OR=9.8‘95% CI: 5.5, 17.5), a WHO clinical stage IV (OR=4.3; 95% CI: 2.6, 6.8), not taking antiretroviral treatment (OR=3.1; 95%CI: 1.9,4.9), an infection with helminthes (OR=2.2; 95% CI: 1.4, 3.4), a history of contact with a tuberculosis patient in the family (OR=2.0; 95% CI: 1.2, 3.3), and living in a house made of mud wall (OR=3.7; 95% CI: 1.5, 7.5) were independently associated with the development of active tuberculosis in people living with HIV/AIDS.

Conclusion

All people living with HIV/AIDS should be screened for tuberculosis but in the presence of the risk factors mentioned above, intensified screening is recommended.     

Delivery Site Preferences and Associated Factors among Married Women of Child Bearing Age in Bench Maji Zone,Ethiopia

Background

Efforts to reduce maternal mortality and morbidity must address societal and cultural factors that affect women''s health and their access to services. There was no research conducted previously on delivery site preferences and associated factors among married women of child bearing age in the study area. The aim of this study was to assess the delivery site preferences and associated factors among women of child bearing age in Bench Maji Zone, Southwest Ethiopia.

Methods

A community based cross sectional quantitative study design supplemented by qualitative data was conducted from April 20 to May 20, 2013. Simple random sampling to select kebeles and systematic random sampling to contact eligible woman were used. Data was collected using structured questionnaire. Data was analyzed by using SPSS version 16. Logistic regressions analysis was employed to identify potential predictor variables. Odds ratio with 95% confidence interval was used to assess the association of variables. P-value less than 5% was used to declare significant association.

Results

Three hundred five (61.9%) of the mothers gave birth at home. Three Hundred ninety six (78.7%) of them had Ante natal care. The preference of facility delivery was 412(88.3%). Age of women, mothers'' educational level, and place of delivery of the last baby, perception of mothers about pregnancy and health care workers significantly affected delivery site preference.

Conclusion

Most of the women attended Ante natal care. However, only some had actually delivered at health facilities to their last pregnancy. Community members should get health education to reduce misconceptions on delivering in health facility.     

The quality of care provided to patients with chronic non-communicable diseases: a retrospective multi-setup study in jimma zone, southwest ethiopia

Background

Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.

Methods

A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.

Results

Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.

Conclusion

The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.     

Using Residential History and Groundwater Modeling to Examine Drinking Water Exposure and Breast Cancer

Background

Spatial analyses of case–control data have suggested a possible link between breast cancer and groundwater plumes in upper Cape Cod, Massachusetts.

Objective

We integrated residential histories, public water distribution systems, and groundwater modeling within geographic information systems (GIS) to examine the association between exposure to drinking water that has been contaminated by wastewater effluent and breast cancer.

Methods

Exposure was assessed from 1947 to 1993 for 638 breast cancer cases who were diagnosed from 1983 to 1993 and 842 controls; we took into account residential mobility and drinking water source. To estimate the historical impact of effluent on drinking water wells, we modified a modular three-dimensional finite-difference groundwater model (MODFLOW) from the U.S. Geological Survey. The analyses included latency and exposure duration.

Results

Wastewater effluent impacted the drinking water wells of study participants as early as 1966. For > 0–5 years of exposure (versus no exposure), associations were generally null. Adjusted odds ratios (AORs) for > 10 years of exposure were slightly increased, assuming latency periods of 0 or 10 years [AOR = 1.3; 95% confidence interval (CI), 0.9–1.9 and AOR = 1.6; 95% CI, 0.8–3.2, respectively]. Statistically significant associations were estimated for ever-exposed versus never-exposed women when a 20-year latency period was assumed (AOR = 1.9; 95% CI, 1.0–3.4). A sensitivity analysis that classified exposures assuming lower well-pumping rates showed similar results.

Conclusion

We investigated the hypothesis generated by earlier spatial analyses that exposure to drinking water contaminated by wastewater effluent may be associated with breast cancer. Using a detailed exposure assessment, we found an association with breast cancer that increased with longer latency and greater exposure duration.     

Iron and folic acid supplements and reduced early neonatal deaths in Indonesia

Objective

To examine the relationship between antenatal care, iron and folic acid supplementation and tetanus toxoid vaccination during pregnancy in Indonesia and the risk of early neonatal death (death in days 0–6 of life).

Methods

We analysed pooled data on neonatal survival in singleton infants born in the 5 years before each of the Indonesian demographic and health surveys of 1994, 1997 and 2002–2003. Only the most recently born infant of each mother was included. Multivariate Cox proportional hazards models were used to identify factors linked to early neonatal death.

Findings

Of the 40 576 infants included, 442 experienced early neonatal death. After adjustment, the risk of early neonatal death was significantly reduced for infants of mothers who received either any form of antenatal care (hazard ratio, HR: 0.48; 95% confidence interval, CI: 0.31–0.73), any quantity of iron and folic acid (HR: 0.53; 95% CI: 0.36–0.77) or ≥ 2 tetanus toxoid injections (HR: 0.66; 95% CI: 0.48–0.92). When we analysed different combinations of these measures, iron and folic acid supplementation provided the main protective effect: early neonatal deaths were still significantly reduced among infants whose mothers received iron and folic acid supplements but no other form of antenatal care (HR: 0.10; 95% CI: 0.01–0.67), or the supplements but < 2 tetanus toxoid injections (HR: 0.46; 95% CI: 0.29–0.73). Subsequent analysis showed that 20% of early neonatal deaths in Indonesia could be attributed to a lack of iron and folic acid supplementation during pregnancy.

Conclusion

Iron and folic acid supplementation during pregnancy in Indonesia significantly reduced the risk of early neonatal death and could also do so in other low- and middle-income countries.     

Prevalence and determinants of obesity among primary school children in Dar es Salaam,Tanzania

Background

Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam.

Methods

A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam.

Results

A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m², 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity.

Conclusions

The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity.     

Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa,Ethiopia: A cross-sectional study

Background

Tuberculosis is the leading causes of mortality among infectious diseases worldwide. The risk of transmission from patients to health workers is doubles that of the general population. The close contact to the infectious case before diagnosis is the major risk for tuberculosis infection. The aim of the study was to assess knowledge and practice of health professionals towards tuberculosis infection control and its associated factors in health facilities of Addis Ababa, Ethiopia.

Methods

A cross-sectional study was conducted from February 29 to April 15/2014 in selected health facilities in Addis Ababa. Five hundred ninety health workers were included in the study. The sample size was assigned to each health facility proportional to their number of health workers. Study subjects were selected from each stratum by simple random sampling technique. Interviewer administered structured questionnaire was used to collect information. Logistic regression was used to identify factors associated with knowledge and practice of health workers towards tuberculosis infection control.

Result

Five hundred eighty two participants with 98.6% response rate were involved in the study. Of these, 36.1% had poor knowledge and 51.7% unsatisfactory practice score towards tuberculosis infection control. Having more than six years working experience in health facility (AOR = 2.51; 95% CI: 1.5-4.1) and tuberculosis related training (AOR = 2.51 95% CI; 1.5, 4.1) were significantly associated with knowledge on tuberculosis infection control. Having experience in tuberculosis clinic (AOR =1.93; 95% CI: 1.12, 3.34) and tuberculosis related training (AOR = 1.48; 95% CI: 1.87, 2.51) were significantly associated with practice on tuberculosis infection control.

Conclusion

One third of health workers had relatively poor knowledge and nearly half of them had unsatisfactory practice on tuberculosis infection control. Tuberculosis training and work experiences in health facility are determinant factor to knowledge. Whereas tuberculosis related training and experience in tuberculosis clinic are predictor to practice. So, training of the health professionals, on job orientations of junior health workers, and farther study including private health workers are recommended.     

Determinants of prenatal anemia in Ethiopia

Background

Anemia is responsible for 20% of maternal mortality worldwide, and it is associated with premature birth, low birth weight, and infant mortality. In Ethiopia, about 22% of pregnant women are anemic. However, literatures are limited, therefore, this study aimed to investigate the prevalence and associated factors of anemia among pregnant women attending antenatal care (ANC) in Asossa Zone Public Health Institutions, northwest Ethiopia.

Methods

A facility based cross-sectional study was conducted from February to March 2016. Data were collected by interviewer administered, pretested and structured questionnaires. A multi-stage sampling technique was used to select 762 pregnant women. The hemoglobin level was determined by taking 5 ml of venous blood using Sahli’s method. A multivariate binary logistic regression model was fitted to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was computed to show the strength of association and statistical significance was determined at a P-value of <0.05.

Results

The prevalence of anemia was 31.8% [95% CI: 28.9, 35.5]. In the adjusted analysis, maternal age of 30–34 years [AOR = 0.34, 95% CI: 0.14, 0.86], household size of ≥6 [AOR = 4.27, 95% CI: 1.58, 11.45], dietary diversity [AOR = 0.58, 95% CI: 0.38, 0.93], no meat consumption [AOR = 1.80, 95% CI: 1.11, 2.91], not drinking soft beverages [AOR =1.96, 95% CI: 1.19, 3.23], undernutrition [AOR = 7.38, 95% CI: 4.22, 12.91], not consuming fruits [AOR = 3.29, 95% CI: 1.59, 6.82], inter-pregnancy interval of ≥2 years [AOR = 0.59, 95% CI: 0.34, 0.99], and third trimester of pregnancy [AOR = 0.33, 95% CI: 0.20, 0.57] were significantly associated with anemia.

Conclusions

The prevalence of prenatal anemia is high in the Asossa Zone; suggesting a moderate public health concern. Socio-demographic and dietary intake characteristics were significantly associated with anemia. Therefore, improving dietary diversity and animal food consumption are the key to reduce the high burden of anemia. It is also important to strengthen interventions aiming to reduce closed birth interval and teenage pregnancy.

     

Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality

Objectives

To compare risks of hypernatraemia on admission to hospital in persons who were with those who were not identified as care home residents and evaluate the association of hypernatraemia with in-hospital mortality.

Design

Retrospective observational study.

Setting

A National Health Service Trust in London.

Participants

A total of 21,610 patients aged over 65 years whose first admission to the Trust was between 1 January 2011 and 31 December 2013.

Main outcome measures

Hypernatraemia on admission (plasma Na > 145 mmol/L) and in-hospital death.

Results

Patients admitted from care homes had 10-fold higher prevalence of hypernatraemia than those from their own homes (12.0% versus 1.3%, respectively; odds ratio [OR]: 10.5, 95% confidence interval [CI]: 8.43–13.0). Of those with hypernatraemia, nine in 10 cases were associated with nursing home ECOHOST residency (attributable fraction exposure: 90.5%), and the population attributable fraction of hypernatraemia on admission associated with care homes was 36.0%. After correcting for age, gender, mode of admission and dementia, care home residents were significantly more likely to be admitted with hypernatraemia than were own-home residents (adjusted odds ratio [AOR]: 5.32, 95% CI: 3.85–7.37). Compared with own-home residents, care home residents were also at about a two-fold higher risk of in-hospital mortality compared with non-care home residents (AOR: 1.97, 95% CI: 1.59–2.45). Consistent with evidence that hypernatraemia is implicated in higher mortality, the association of nursing homes with in-hospital mortality was attenuated after adjustment for it (AOR: 1.61, 95% CI: 1.26–2.06).

Conclusions

Patients admitted to hospital from care homes are commonly dehydrated on admission and, as a result, appear to experience significantly greater risks of in-hospital mortality.     

Peer Reviewed: Attempted Breastfeeding Before Hospital Discharge on Both Sides of the US-Mexico Border, 2005: The Brownsville-Matamoros Sister City Project for Women’s Health

Introduction

The US-Mexico border region has a growing population and limited health care infrastructure. Preventive health behaviors such as breastfeeding ease the burden on this region''s health care system by reducing morbidity and health care costs. We examined correlates of attempted breastfeeding before hospital discharge on each side of the US-Mexico border and within the border region.

Methods

The cross-sectional study included women who delivered a live infant in Matamoros, Tamaulipas, Mexico (n = 489), and Cameron County, Texas (n = 457), which includes Brownsville, Texas. We interviewed women before hospital discharge from August 21 through November 9, 2005. We used multivariate logistic regression to estimate the odds of attempted breastfeeding before hospital discharge in Cameron County, Texas, the municipality of Matamoros, Mexico, and the 2 communities combined.

Results

Prevalence of attempted breastfeeding before hospital discharge was 81.9% in Matamoros compared with 63.7% in Cameron County. After adjusting for potential confounders, the odds of attempted breastfeeding before hospital discharge were 90% higher in Matamoros than in Cameron County (adjusted odds ratio [AOR], 1.93; 95% confidence interval [CI], 1.31-2.84 for the combined model). In the 2 communities combined, odds of attempted breastfeeding before hospital discharge were higher among women who had a vaginal delivery than among women who had a cesarean delivery (AOR, 1.98; 95% CI, 1.43-2.75) and were lower among women who delivered infants with a low birth weight than among women who delivered infants with a normal birth weight (AOR, 0.26; 95% CI, 0.15-0.44).

Conclusion

The rate of attempted breastfeeding in Matamoros was significantly higher than in Cameron County. Additional breastfeeding support and messages on the US side of the US-Mexico border are needed.     

Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

Objective

To investigate the scale-up of antenatal combination antiretroviral therapy (cART) in Ukraine since this became part of the national policy for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV).

Methods

Data on 3535 HIV-positive pregnant women who were enrolled into the Ukraine European Collaborative Study in 2008–2010 were analysed. Factors associated with receipt of zidovudine monotherapy (AZTm) – rather than cART – and rates of mother-to-child transmission (MTCT) of HIV were investigated.

Findings

cART coverage increased significantly, from 22% of deliveries in 2008 to 61% of those in 2010. After adjusting for possible confounders, initiation of antenatal AZTm – rather than cART – was associated with cohabiting (versus being married; adjusted prevalence ratio, aPR: 1.09; 95% confidence interval, CI: 1.02–1.16), at least two previous live births (versus none; aPR: 1.22; 95% CI: 1.11–1.35) and a diagnosis of HIV infection during the first or second trimester (versus before pregnancy; aPR: 1.11; 95% CI: 1.03–1.20). The overall MTCT rate was 4.1% (95% CI: 3.4–4.9); 42% (49/116) of the transmissions were from the 8% (n = 238) of women without antenatal ART. Compared with AZTm, cART was associated with a 70% greater reduction in the risk of MTCT (adjusted odds ratio: 0.30; 95% CI: 0.16–0.56).

Conclusion

Between 2008 and 2010, access to antenatal cART improved substantially in Ukraine, but implementation of the World Health Organization’s Option-B policy was slow. For MTCT to be eliminated in Ukraine, improvements in the retention of women in HIV care and further roll-out of Option B are urgently needed.