Measurement of reproductive health indicators in Ethiopia: A mixed method study

Aim

Various reproductive health (RH) indicators have been formulated and used to measure RH services and status. Despite their widespread use, the measurement of these indicators has never been explored in a systematic manner. This study aimed to examine methods and methodologies in the measurement of common RH indicators in the Ethiopian context.

Subjects and Methods

A mixed-method design, comprising in-depth expert interviews, the abstraction of information from relevant public documents and an analysis of peer-reviewed literature, was used. Information from these three sources was then organised and synthesised using a thematic approach.

Results

Until now, routine health information system and demographic and health survey have been the primary sources for RH indicators in Ethiopia. A number of improvements have recently been made in data collection and aggregation methods; however, the focus has been more on the coverage of services than the quality of data. We noted that variations were observed in indicator definition between the two data sources and, as a consequence, in their estimates. It was found that many of the inherent limitations in the measurement of RH indicators could be addressed by making small modifications to the data sources and the reporting formats. Data quality concerns mainly occur at the point of data collection although there are also issues with data aggregation, dissemination and use.

Conclusion

There is a gap in the measurement of the quality and continuity of RH services. Many of the limitations and data quality concerns in the measurement of RH indicators could be resolved with minimal improvements to the current health information system.

     

Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics

Background: Previous studies have demonstrated an association between malnutrition and poor outcomes. The primary objective of this study was to explore the difference in the composite end point of readmission rate or mortality rate between hospitalized veterans with and without malnutrition. Materials and Methods: This was a retrospective chart review comparing veterans with malnutrition based on a modified version of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus characteristics that used 5 of the 6 clinical characteristics to a matched control group of nonmalnourished veterans based on age, admitting service, and date of admission who were admitted between August 1, 2012, and December 1, 2014. Data were extracted from the medical record. Multivariate analysis was used to identify predictors of outcomes. Results: In total, 404 patients were included in the final analysis. All end points were found to be statistically significant. The malnourished group was more likely to meet the composite end point (odds ratio [OR], 5.3), more likely to be readmitted within 30 days (OR, 3.4), more likely to die within 90 days of discharge (OR, 5.5), and more likely to have a length of stay >7 days (OR, 4.3) compared with the nonmalnourished group. Length of stay was significantly longer in the malnourished group, 9.80 (11.5) vs 4.38 (4.5) days. Conclusion: Malnutrition was an independent risk factor for readmission within 30 days or death within 90 days of discharge. Malnourished patients had higher rates of readmission, higher mortality rates, and longer lengths of stay and were more likely to be discharged to nursing homes.     

Benzyl alcohol toxicity: impact on neurologic handicaps among surviving very low birth weight infants

Benzyl alcohol preservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II). Survivors were enrolled in a follow-up program. Results of the study demonstrated that infants from period II had fewer neurologic handicaps. The incidence of cerebral palsy decreased from 50% to 2.4% (P less than .001), and the presence of cerebral palsy and developmental delay combined decreased from 53.9% to 11.9% (P less than .001). Several factors other than benzyl alcohol exposure were examined for their importance on outcome but were found not to be related to it. It is concluded that the dramatic improvement in outcome could be the result of discontinuation of benzyl alcohol.     

Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis.

Rutter, N., Milner, A. D., and Hiller, E. J. (1975). Archives of Disease in Childhood, 50, 719. Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis. Respiratory resistance was measured using a forced oscillation technique in 16 infants and young children with bronchiolitis and wheezy bronchitis. Measurements were made before and after administration of nebulized salbutamol or isoprenaline. No significant change in resistance was found.     

Nebulized sodium cromoglycate in young asthmatic children. Double-blind trial.

Seventeen asthmatic children under 5 years of age took part in a double-blind controlled trial of nebulized sodium cromoglycate solution. Daily symptom scores kept by the parents showed improvement in 11 children during active treatment, and a significant improvement in scores for cough by day and night was obtained for the group as a whole.     

Use of salbutamol powder in childhood asthma.

In this study on 31 asthmatic children, salbutamol powder was as effective as salbutamol aerosol in the older asthmatic child studied daily during a 6-week period. The rotahaler can be used successfully from 3 years and, as measured by the peak expiratory flow rate, salbutamol powder is effective in this young age group.     

C-reactive protein measured in dried blood spots from patients with cystic fibrosis

There was no significant difference in C-reactive protein concentration determined in paired serum and eluates from dried blood spots collected on Guthrie cards; mean difference 0.6 microgram/ml (95% CI -3.3-2.2 micrograms/ml; n = 101). Dried blood spot samples were stable for up to 21 days and were unaffected by posting to the laboratory. In eight patients with cystic fibrosis undergoing specific antibiotic treatment for Pseudomonas aeruginosa pulmonary infection the fall in C-reactive protein concentration was not significantly different between serum and dried whole blood spot specimens. This method could be used to monitor infection and the response to antibiotic treatment.     

High intraocular pressure and survival: the Framingham Studies

PURPOSE: To examine whether high intraocular pressure (greater than or equal to 25 mm Hg) or a history of treatment for glaucoma is associated with decreased survival and, if so, how such ocular markers might be explained. METHODS: Eye examinations, including applanation tonometry, were conducted on members of the Framingham Eye Study cohort from February 1, 1973, to February 1, 1975. Participants who reported a history of treatment for glaucoma were identified. Survival data, including information on the date of death, were available from the time of the Eye Study through March 31, 1990. RESULTS: Of the 1,764 persons under the age of 70 years at the baseline eye examination, 1,421 persons had low intraocular pressure (< or =20 mm Hg), 264 persons had medium intraocular pressure levels (20 to 24 mm Hg), and 79 persons had high intraocular pressure (> or =25 mm Hg) or history of glaucoma treatment. During the follow-up period, 29%, 30%, and 47% died in the groups with low, medium, and high intraocular pressure (or history of glaucoma treatment), respectively. In an age-and-sex adjusted Cox proportional hazards analysis, the death rate ratio for the group with medium intraocular pressure relative to the group with low intraocular pressure was 1.04. The corresponding death rate ratio for the group with high intraocular pressure was 1.56 with a 95% confidence interval of 1.11 to 2.19 (P < .001). After adjustment for age, sex, hypertension, diabetes, cigarette smoking, and body mass index, a positive relationship remained, but at a borderline level of significance (P = .075). CONCLUSIONS: High intraocular pressure or the presence of glaucoma is a marker for decreased life expectancy in the Framingham Eye Study cohort. The relationship is present even after adjustment for risk factors known to be associated with higher mortality such as age, sex, hypertension, diabetes, cigarette smoking, and body mass index. Special attention to the general health status of patients with high intraocular pressure or glaucoma seems warranted.