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Spatial distribution and determinants of solitary childbirth in Ethiopia: Evidence from the 2019 interim demographic and health survey

by Tadesse Tarik Tamir, Berhan Tekeba, Alebachew Ferede Zegeye, Deresse Abebe Gebrehana, Mulugeta Wassie, Gebreeyesus Abera Zeleke, Enyew Getaneh Mekonen

Introduction

Solitary childbirth—giving birth without any form of assistance—remains a serious global public health issue, especially in low-resource settings. It is associated with preventable maternal complications such as hemorrhage and sepsis, and poses significant risks to newborns, including birth asphyxia, infection, and early neonatal death. In Ethiopia, where many births occur outside health facilities, understanding the spatial and socio-demographic patterns of solitary childbirth is vital for informing targeted interventions to improve maternal and child health outcomes. This study aims to identify and map the spatial distribution of solitary childbirth across Ethiopia and to analyze its determinants using data from the 2019 national Interim Demographic and Health Survey.

Method

We analyzed data from the 2019 Interim Ethiopian Demographic and Health Survey to determine the spatial distribution and factors of solitary birth in Ethiopia. A total weighted sample of 3,884 women was included in the analysis. Spatial analysis was used to determine the regional distribution of solitary birth, and multilevel logistic regression was employed to identify its determinants. ArcGIS 10.8 was used for spatial analysis, and Stata 17 was used for multilevel analysis. The fixed effect was analyzed by determining the adjusted odds ratio with a 95% confidence interval.

Result

The prevalence of solitary childbirths in Ethiopia was 12.73%, with a 95% confidence interval spanning from 11.71% to 13.81%. The western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and the west of Amhara regions were hotspot areas for solitary birth. Having no formal education, not attending ANC visits, and residing in pastoral regions were significantly associated with higher odds of solitary birth in Ethiopia.

Cocnlusion

A notable proportion of women are experiencing childbirth alone, which highlights a significant aspect of maternal health in the country, reflecting both the challenges and improvements in childbirth practices. The distribution of solitary births exhibited spatial clustering with its hotspot areas located in western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and west of Amhara regions. Lack of education, not having an ANC visit, and being a resident of pastoral regions were significant determinants of solitary birth. The implementation of maternal and child health strategies in Ethiopia could benefit from considering the hotspot areas and determinants of solitary birth.

What do husbands know about neonatal danger signs? A cross-sectional study in Dessie City, Northeast Ethiopia

Por: Zeleke · A. · Mekonen · A. M. · Arefaynie · M. · Tsega · Y. · Gebeyehu · E. M.
Objective

This study assessed husbands’ knowledge of neonatal danger signs in Dessie City, Northeast Ethiopia, focusing on fathers of infants born within the preceding 6 months (2023).

Design

Community-based cross-sectional study.

Setting

Dessie City, Northeast Ethiopia.

Participants

We systematically selected 613 husbands of postpartum women (sampling period: December 15, 2022,–January 15, 2023).

Methods

Data were collected via structured questionnaires, entered into EpiData (v4.6) and analysed using SPSS (v26). Binary logistic regression identified factors associated with knowledge; statistical significance was set at p

Results

Among the 613 respondents, slightly over half (53%, n=325) demonstrated good knowledge of neonatal danger signs. Several factors were significantly associated with higher knowledge levels. Husbands residing in urban areas were nearly seven times more likely to have good knowledge compared with their rural counterparts (adjusted OR (AOR)=6.93; 95% CI, 3.23 to 14.90). Educational attainment also played a critical role: those with primary education or higher had 6.44 times higher odds of good knowledge than those with no formal schooling (95% CI, 1.83 to 22.61). Parity was another predictor, with fathers of 2–4 children showing markedly greater knowledge (AOR=10.39; 95% CI, 4.68 to 23.05) than those with only one child. Most notably, receiving information from health professionals had the strongest association—respondents who accessed such guidance were 11 times more likely to be knowledgeable (AOR=11.05; 95% CI, 5.46 to 22.36).

Conclusions

Nearly half of the participants lacked adequate knowledge. Thus, integrating targeted health education into maternal and child health programmes could improve awareness and neonatal outcomes.

Gram-negative bacterial sepsis, antimicrobial susceptibility pattern and treatment outcomes at two neonatal intensive care units in Addis Ababa, Ethiopia: A retrospective observational study

by Biniyam Tedla Mamo, Zelalem Tazu Bonger, Feyissa Regassa Senbato, Tadesse Eguale, Kibrewossen Kiflu Akililu, Samuel Muluye Welelaw, Eden Dagnachew Zeleke, Asrat Demtse, Turegne Assefa, Ruth Woldeyohannes Yirgu, Zelalem Mekuria, Joan-Miquel Balada-Llasat, Shu-Hua Wang

Background

Neonatal sepsis is a leading cause of mortality and morbidity. To improve the clinical outcomes of neonates with sepsis, treatment should be based on bacteriological identification and antibiotic susceptibility. This study aims to assess the proportion of culture-positive gram-negative bacteria (GNB), the antibiotic susceptibility patterns, and treatment outcomes of neonatal sepsis at two neonatal intensive care units (NICUs) in Addis Ababa.

Methods

A retrospective observational study was conducted among gram-negative sepsis suspected neonates admitted at Zewditu Memorial Hospital and Tikur Anbessa Specialized Hospital NICUs from January to December 2023. All neonates who were suspected of having sepsis were included in this study. Standard microbiological culture and biochemical tests were used to identify bacterial species and the Kirby-Bauer disc diffusion assay using Mueller-Hinton agar was employed to test the antimicrobial susceptibility of bacterial isolates as per Clinical Laboratory Standard Institute guidelines. Descriptive statistics were used to describe the study variables. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with the treatment outcomes of neonatal sepsis. A p-value  Results

A total of 933 neonates were diagnosed with sepsis during the study period, of which 166 neonates were enrolled in the study for gram-negative sepsis: 84 (51%) were female and 97 (58%) had early onset sepsis. The median length of hospital stay was nine days with interquartile range of 16 days. The predominant GNB identified was Klebsiella spp. (n = 89; 49%), followed by Acinetobacter spp. (n = 38; 21%) and Escherichia coli (n = 19; 11%). In both hospitals, Klebsiella spp. was resistant to most of the routinely prescribed antibiotics: (n = 68; 89%) were resistant to ceftriaxone, (n = 56, 89%) cefepime and (n = 60; 75%) to gentamicin. Lower rates of resistance were recorded for other antibiotics such as ciprofloxacin (n = 12; 18%), ertapenem (n = 11; 16%), meropenem (n = 9; 13%), and amikacin (n = 3; 4%). A total of 92 (55%) neonates with the GNB isolated in the current study had multidrug-resistant (MDR) organisms. The study found that newborns with MDR infections were five times more likely to experience poor treatment outcomes compared to those with non-resistant strains (AOR, 5.23 95% CI [2.59, 11.11]). In addition, newborns who stayed less than seven days, compared to those who spent seven or more days in the hospital was four times (AOR: 4.16, 95% CI (2.0–9.01) more likely to experience poor health outcomes.

Conclusion

Klebsiella spp. was the most common GNB isolated from the NICUs. More than half neonatal sepsis was caused by MDR organisms and associated with significant poor treatment outcomes. high prevalence of MDR-gram-negative bacteremia is alarming and highlights the need for the implementation of routine surveillance and infection control measures to decrease morbidity and mortality and to combat the development of antimicrobial resistance.

A Life course approach to investigate breast cancer and migration in the greater Paris area: the SENOVIE study protocol

Por: Coulibaly · K. · Schantz · C. · Teixeira · L. · Desgrees du Lou · A. · Des Guetz · G. · Hocini · H. · Zelek · L. · Larmarange · J. · Gosselin · A. · the SENOVIE study group · Schantz · Aboubakar · Baron · Guetz · Gosselin · Petitet · Larmarange · Niangaly · Rath · Teixeira · Traore
Introduction

Breast cancer is a global public health challenge. It is the most commonly diagnosed cancer and the leading cause of cancer-related death in women. Several inequalities remain among women facing this disease, depending on their country of birth and their sociodemographic characteristics. The SENOVIE study (Therapeutic mobility and breast cancer) aims to understand the life trajectories of women born in France and in sub-Saharan Africa treated for breast cancer in four hospitals in the greater Paris area.

Methods and analysis

The SENOVIE study is a mixed methods study, combining a quantitative and a qualitative approach. A quantitative retrospective life-event survey is conducted in four hospital centres in the greater Paris area, France, to (1) understand how breast cancer (diagnosis, treatment and possibly reconstruction) impacts the life trajectories of women in many spheres (migration, family life, professional life, financial situation, etc); (2) study the access to healthcare by women living with breast cancer and their determinants; and (3) examine how gender relations may shape breast cancer experience. Women born in France and women born in sub-Saharan Africa are recruited: 1000 women, including 500 per group. In the standardised, face-to-face questionnaire, each dimension of interest is collected year by year from birth until the time of the survey. Clinical and laboratory information is documented with a short medical questionnaire filled out by the medical teams. The qualitative survey is conducted specifically with women born in sub-Saharan Africa who came to France for treatment to better understand their trajectories and the specific obstacles they faced. To analyse the quantitative data collected, descriptive analyses will be used to visualise trajectories (sequence analysis), along with longitudinal analysis methods (survival models and duration models).

Ethics and dissemination

The study is conducted in accordance with the Declaration of Helsinki. The French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés, declaration number 2231238) and the Committee for Persons’ Protection East I (Comité de Protection des Personnes Est I, national number 2023-A01311-44) approved it. We will disseminate the findings through scientific publications, policy briefs, conferences and workshops.

Trial registration number

The SENOVIE France study is registered on Clinicaltrial.gov (NCT06503393; registration date: 7 September 2024; https://clinicaltrials.gov/study/NCT06503393).

Incidence and predictors of tuberculosis among HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

by Amare Kassaw, Worku Necho Asferie, Molla Azmeraw, Demewoz Kefale, Gashaw Kerebih, Gebrehiwot Berie Mekonnen, Fikadie Dagnew Baye, Shegaw Zeleke, Biruk Beletew, Solomon Demis Kebede, Tigabu Munye Aytenew, Lakachew Yismaw Bazezew, Muluken Chanie Agimas

Background

Globally, Tuberculosis (TB) is the main cause of morbidity and mortality among infectious disease. TB and Human Immune Virus (HIV) are the two deadly pandemics which interconnected each other tragically, and jeopardize the lives of children; particularly in Sub-Saharan Africa. Therefore, this review was aimed to determine the aggregated national pooled incidence of tuberculosis among HIV- infected children and its predictors in Ethiopia.

Methods

An electronic search engine (HINARI, PubMed, Scopus, web of science), Google scholar and free Google databases were searched to find eligible studies. Quality of the studies was checked using the Joanna Briggs Institute (JBI) quality assessment checklists for cohort studies. Heterogeneity between studies was evaluated using Cochrane Q-test and the I2 statistics.

Result

This review revealed that the pooled national incidence of tuberculosis among children with HIV after initiation of ART was 3.63% (95% CI: 2.726–4.532) per 100-person-years observations. Being Anemic, poor and fair ART adherence, advanced WHO clinical staging, missing of cotrimoxazole and isoniazid preventing therapy, low CD4 cell count, and undernutrition were significant predictors of tuberculosis incidence.

Conclusion

The study result indicated that the incidence of TB among HIV- infected children is still high. Therefore, parents/guardians should strictly follow and adjust nutritional status of their children to boost immunity, prevent undernutrition and opportunistic infections. Cotrimoxazole and isoniazid preventive therapy need to continually provide for HIV- infected children for the sake of enhancing CD4/immune cells, reduce viral load, and prevent from advanced disease stages. Furthermore, clinicians and parents strictly follow ART adherence.

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