Testing the Safe Abortion Care model in Ethiopia to monitor service availability, use, and quality

Objective

To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time.

Methods

The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model.

Results

Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500 000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P < 0.01), and the proportion performed with recommended technology increased from 30% to 85% (P < 0.01). The proportion of abortion patients who received modern contraception also increased from 31% to 78% (P < 0.01).

Discussion

While widespread service delivery improvements were recorded using the SAC monitoring approach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was no comparison group of facilities, timing did not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support.

Conclusion

Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life‐saving care to reduce preventable abortion mortality in the region.     

The hazard of pregnancy loss and stillbirth among women in Kersa,East Ethiopia: A follow up study

BackgroundAlthough pregnancy loss causes considerable challenge to women’s health, population-based studies in rural areas are not widely available in low-income countries. This study aims to determine the hazard of pregnancy loss and related factors in the rural communities of Ethiopia.MethodologyA prospective community-based study was conducted over a period of 1 year. Pregnancy was identified as early as possible by a pregnancy urine test. All pregnant women identified during the screening were followed up at their home until termination of pregnancy or delivery of the neonate. The total follow-up time was 7802 ‘pregnant person months’. A Cox regression analysis was done to estimate the hazard of pregnancy loss.ResultOut of a total of 1438 terminated pregnancies, 143 (9.9%) did not end in live birth, 116 ended due to bleeding and 27 were stillbirths. Whilst the hazard of pregnancy loss was low among women with pregnancy interval of two or more years [AHR 0.3 (95% CI: 0.15, 0.43)], it was high among women having unplanned pregnancy [AHR 2.2 (95% CI: 1.56, 3.11)], among those who complained STI like symptoms during the index pregnancy [AHR 4.5 (95% CI: 2.79, 7.38)] and among those never received antenatal care [AHR 1.8 (95% CI: 1.13, 2.73)].ConclusionPregnancy loss was higher amongst women experienced unplanned pregnancy, complained STI like symptoms and women who had not attended antenatal care services.RecommendationTo reduce pregnancy loss in rural Ethiopia expanding and promoting the use of family planning, antenatal services and other reproductive health care is necessary.     

Relationship between trachoma and chronic and acute malnutrition in children in rural Ethiopia

Trachoma is the leading infectious cause of blindness in the world. Areas where it is most prevalent also have some of the highest rates of childhood malnutrition. We examined the relationship between both acute and chronic malnutrition and clinical trachoma. We also explored whether malnutrition alters the clinical manifestations of the disease. Children with chronic malnutrition, but not acute malnutrition, were more likely to have clinical trachoma. Stunted children are 1.96 times more likely to have clinical trachoma than nonstunted children (95% CI: 1.12-3.43), even after controlling for age, gender and infection status of other household members. Host factors including malnutrition may play a role in determining disease manifestations.     

Azithromycin prevents recurrence of severe trichiasis following trichiasis surgery: STAR trial

PURPOSE: Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threatening recurrence is unknown. This randomized, clinical trial determined if treating trichiasis surgical patients with oral azithromycin compared to usual care (topical tetracycline) resulted in a reduction in severe recurrence of trichiasis to one year. METHODS: In a rural, trachoma hyperendemic district in Ethiopia, 1452 trichiasis patients age 18 or older presenting for surgery were randomly allocated to azithromycin, single 1 gram dose, versus topical tetracycline twice per day for six weeks. The outcome was recurrent severe trichiasis, defined as lashes touching the cornea, or more than 5 lashes touching the globe, to one year. RESULTS: Patients randomized to receive azithromycin had significantly fewer severe recurrences, 4.2/100 person years overall, compared to those randomized to topical tetracycline, 7.9/100 person years (p < 0.01). CONCLUSIONS: A single dose of azithromycin has been shown to reduce severe post-surgical trichiasis recurrence rates to one year and should become standard post surgical treatment.     

Virological outcomes of antiretroviral therapy in Zomba central prison,Malawi; a cross‐sectional study

Introduction : Antiretroviral therapy (ART) outcomes that include viral suppression rates are rarely reported among African prison populations. Prisoners deal with specific challenges concerning adherence to ART. We aimed to describe virological outcomes of ART in a large prison in Malawi. Methods : A cross‐sectional study of ART outcomes was conducted at the Zomba Central Prison HIV clinic, Malawi, following the introduction of routine viral load monitoring. All prisoners on ART for at least 6 months were eligible for a viral load test. Patients with ≥1,000 copies/ml received adherence support for 3 months, after which a second VL sample was taken. Patients with ≥5,000 copies/ml on the second sample had virological failure and started 2nd line ART. We describe demographics and patient characteristics and report prevalence of potential‐ and documented virological failure. In the potential virological failure rate, those who could not be sampled after 3 months adherence support are included as virological failures. Logistic regression analysis was used to determine factors associated with potential ART failure. Results and discussion : Viral load testing was started at the end of 2014, when 1054 patients had ever registered on ART. Of those, 501 (47.5%) had transferred out to another clinic, 96 (9.1%) had died, 11 defaulted (1.0%) and 3 (0.3%) stopped ART. Of 443 (42.0%) remaining alive in care, an estimated 322 prisoners were on ART >6 months, of whom 262 (81.4%) were sampled. Their median age was 35 years (IQR 31–40) and 257 (98.1%) were male. Self‐reported adherence was good in 258 (98.5%). The rate of potential ART failure was 8.0%, documented ART failure was 4.6% and documented HIV suppression 95.0%. No patient characteristics were independently associated with potential ART failure, possibly due to low numbers with this outcome. Conclusions : Good virological suppression rates can be achieved among Malawian prisoners on ART, under challenging circumstances.