Determinants of repeated abortion among women of reproductive age attending health facilities in Northern Ethiopia: a case-control study

Background

Every year, an estimated 19–20 million unsafe abortions take place, almost all in developing countries, leading to 68,000 deaths and millions more injured many permanently. Many women throughout the world, experience more than one abortion in their lifetimes. Repeat abortion is an indicator of the larger problem of unintended pregnancy. This study aimed to identify determinants of repeat abortion in Tigray Region, Ethiopia.

Methods

Unmatched case–control study was conducted in hospitals in Tigray Region, northern Ethiopia, from November 2014 to June 2015. The sample included 105 cases and 204 controls, recruited from among women seeking abortion care at public hospitals. Clients having two or more abortions (“repeat abortion”) were taken as cases and those who had a total of one abortion were taken as controls (“single abortion”). Cases were selected consecutive based on proportional to size allocation while systematic sampling was employed for controls. Data were analyzed using SPSS version 20.0. Binary and multiple variable logistic regression analyses were calculated with 95% CI.

Results

Mean age of cases was 24 years (±6.85) and 22 years (±6.25) for controls. 79.0% of cases had their sexual debut in less than 18 years of age compared to 57% of controls. 42.2% of controls and 23.8% of cases cited rape as the reason for having an abortion. Study participants who did not understand their fertility cycle and when they were most likely to conceive after menstruation (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI]: 1.1–3.7), having a previous abortion using medication (AOR = 3.3, CI: 1.83, 6.11), having multiple sexual partners in the preceding 12 months (AOR = 4.4, CI: 2.39,8.45), perceiving that the abortion procedure is not painful (AOR = 2.3, CI: 1.31,4.26), initiating sexual intercourse before the age of 18 years (AOR = 2.7, CI: 1.49, 5.23) and disclosure to a third-party about terminating the pregnancy (AOR = 2.1, CI: 1.2,3.83) were independent predictors of repeat abortion.

Conclusion

This study identified several factors correlated with women having repeat abortions. It may be helpful for the Government of Ethiopia to encourage women to delay sexual debut and decrease their number of sexual partners, including by promoting discussion within families about sexuality, to decrease the occurrence of repeated abortion.

Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study

BACKGROUND

Isoniazid preventive therapy is a key public health intervention for the prevention of tuberculosis disease among people living with HIV. Despite the confirmed efficacy of isoniazid preventive therapy and global recommendations existing for decades, its implementation remains limited. In resource constrained settings, few have investigated why isoniazid preventive therapy is not implemented on full scale. This study was designed to investigate the level of isoniazid preventive therapy implementation and reasons for suboptimal implementation in Tigray region of Ethiopia.

METHODS

A review of patient records combined with a qualitative study using in-depth interviews and focus group discussions was conducted in 11 hospitals providing isoniazid preventive therapy in the Tigray Region. The study participants were health providers working in the HIV clinics of the 11 hospitals in the province. Health providers were interviewed about their experience of providing isoniazid preventive therapy and challenges faced during its implementation. All conversations were audio-recorded. Record review of 16,443 HIV patients registered for care in these hospitals between September 2011 and April 2014 was done to determine isoniazid preventive therapy utilization. Data were collected from April to August 2014.

RESULTS

Fifty health providers participated in the study. Overall isoniazid preventive therapy coverage of the region was estimated to be 20 %. Isoniazid stock out, fear of creating isoniazid resistance, problems in patient acceptance, and lack of commitment of health managers to scale up the program were indicated by health providers as the main barriers hindering implementation of isoniazid preventive therapy.

CONCLUSION

Implementation of isoniazid preventive therapy in Tigray region of Ethiopia had low coverage. Frequent interruption of isoniazid supplies raises the concern of interrupted therapy resulting in creation of isoniazid resistance. Health managers, drug suppliers and partners working in HIV and tuberculosis programs should be committed to ensure an uninterrupted supply of isoniazid and full scale implementation of isoniazid preventive therapy to eligible people living with HIV.

Late presentation for diagnosis of HIV infection among HIV positive patients in South Tigray Zone, Ethiopia

BACKGROUND

In spite of the availability and accessibility of HIV testing opportunities and efforts, people are being late to test in the course of HIV infection. Late diagnosis leads to late anti-retroviral therapy initiation which in turn results in poor treatment outcome and prognosis of the disease. The aim of this study was to determine the prevalence and predictors of late HIV diagnosis among HIV-infected patients in South Tigray Zone, Ethiopia.

METHODS

A facility based cross sectional study was conducted among HIV positive patients from February 1-30, 2014 in Southern Tigray, Ethiopia. Multistage sampling technique was employed to select the study participants. Data were collected by reviewing patient medical card and interviewing using structured questionnaire. Data were entered using Epi-Data version 3.1 and analyzed using SPSS version 20.0. Both bivariate and multivariate logistic regressions were modeled to evaluate the association of predictors with late diagnosis of HIV infection.

RESULTS

Out of 789 study participants, 68.8 % of them were late for HIV diagnosis. Feeling healthy (65.7 %), fear of stigma and discrimination (32.4 %) and using traditional treatment (1.5 %) were reported as the main reasons for late HIV diagnosis. Use of Khat [AOR = 3.27, 95 % CI (1.75, 6.13)], bed ridden functional status [AOR = 2.66, 95 % CI (1.60, 4.42)], ambulatory functional status [AOR = 1.56, 95 % CI (1.03, 2.35)] and Muslim religion [AOR = 2.26, 95 % CI (1.13, 4.49)] were significantly associated with late presentation for HIV diagnosis.

CONCLUSIONS

High prevalence of late HIV diagnosis was recorded in Southern Tigray Zone, Ethiopia. Public health educations and campaigns targeted at improving early diagnosis and prognosis of people living with HIV/AIDS in Southern Tigray, Northern Ethiopia should be underway.

Undernutrition status and associated factors in under-5 children, in Tigray, Northern Ethiopia

OBJECTIVE

The aim of this study was to assess the nutritional status and associated factors in children <5 y in the Medebay Zana District, northern Ethiopia.

METHODS

A community-based cross-sectional study was conducted in the Medebay Zana District from September 8 to 29, 2013. A two-stage cluster-sampling technique was used to select 605 children age <5 y. Descriptive, binary, and multiple logistic regression analyses were performed.

RESULTS

The results of this study demonstrated that the level of stunting was 56.6%, underweight 45.3%, and wasting 34.6%. Stunting was predicted by having mothers who attended high school (adjusted odds ratio [AOR], 0.75; 95% confidence interval [CI], 0.09-0.85), living in a household where providing priority food was given to the father (AOR, 4.32; 95% CI, 2.10-9.05), and water was taken from unprotected sources (AOR, 2.13; 95% CI, 1.09-4.14). In all children, initiation of breast-feeding within 1 to 3 h after birth (AOR, 4.06; 95% CI, 1.77-9.33), having mothers who could make financial decisions (AOR, 0.09; 95% CI, 0.02-0.51), and being breast-fed for 12 to 23 mo (AOR, 0.07; 95% CI, 0.01-0.40) were predictors of wasting. Moreover, in girls (AOR, 1.84; 95% CI, 1.25, 2.69), initiation of breast-feeding 6 h after birth (AOR, 12.94; 95% CI, 4.04-41.49) and having mothers who could make financial decisions (AOR, 0.33; 95% CI, 0.15-0.74) were predictors of being underweight.

CONCLUSION

The undernutrition status among children <5 y was high. Children's age group, time initiation of breast-feeding, child's sex, source of water, parents' educational status, type of food used for starting of complementary feeding, and mothers' financial decision-making ability could have an influence in undernutrition of children in this age group.

Prevalence and determinant factors of exclusive breastfeeding practices among mothers in Enderta woreda, Tigray, North Ethiopia: a cross-sectional study

BACKGROUND

In Ethiopia national breastfeeding practice is poor because of traditional and cultural beliefs, low educational levels, heavy workload of mothers, poor sanitary conditions, type of assistance at delivery, duration of stay at home, ethnicity, poor maternal knowledge, age, parity, antenatal service utilization and place of delivery. This study is aimed to assess the prevalence and determinants of exclusive breastfeeding practice in mothers in Enderta woreda (district), Ethiopia.

METHODS

A community based cross-sectional study with multistage sampling method was used to select 541 mothers with children less than 24 months of age in Enderta woreda. Data was collected by administered structured questionnaire. Bivariate and Multivariable logistic regression was used to check the associations and controlling confounding variables.

RESULT

A total of 530 mothers were included with a response rate 98%. The mean (± SD) age of the mothers was 26.9 (± 5.98) years. Majority of the mothers (70.2%) were practiced exclusive breastfeeding. Age of the mother (AOR 0.12; 95% CI: 0.02, 0.97), age of the child (AOR 0.52 95% CI: 0.27, 0.99) and postnatal care (AOR; 2.68; 95% CI: 1.44, 4.98) were found statistically significant with exclusive breastfeeding.

CONCLUSION

The prevalence rate of exclusive breastfeeding was high in Enderta woreda. The age of the mother, age of the child and receiving postnatal care were the determinant factors for exclusive breastfeeding in the study area.

Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia

OBJECTIVE

The aim of this study was to determine the level of adherence to Option B+ PMTCT drugs and factors associated with adherence among HIV-positive pregnant women in public hospitals of Tigray, northern Ethiopia.

METHODS

A cross-sectional study was conducted among 277 HIV-positive pregnant women in 2014. A two-stage cluster sampling technique was used to select the study participants. Individual consent was obtained from each participant. Multivariate logistic regression was used to estimate the net effect sizes of factors associated with adherence to Option B+ PMTCT drugs.

RESULTS

The level of adherence of respondents to Option B+ PMTCT drugs was 87.1% (95% confidence interval (CI) 82.6-90.7%). Controlling for the effect of other factors, the odds of adhering to Option B+ PMTCT were 4.7 times higher among women who received counselling on medication as compared to those who did not (adjusted odds ratio (aOR) 4.7, 95% CI 1.98-11.35). Similarly, disclosing HIV status was positively associated with good adherence (aOR 4.2, 95% CI 1.07-16.33).

CONCLUSIONS

The adherence level was found to be reasonably good. Counselling on medication and HIV status disclosure were positive predictors of adherence to Option B+ PMTCT drugs.

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia

Background

Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus.

Objectives

To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia.

Methodology

Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome.

Results

Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR = 3.2, CI = 1.58–6.82, p-value = 0.001), age greater than 45 years (AOR = 6.08, CI = 2.28–16.23) and baseline CD4 count less than 200 cells/μL (AOR = 6.19, CI = 2.28–16.89, p-value = 0.001).

Conclusion

The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases.

Knowledge, attitudes and practice about malaria in rural Tigray, Ethiopia

OBJECTIVE

To assess the knowledge, attitude and practice (KAP) regarding malaria and their determinants in a rural population of northern Ethiopia.

METHODS

The study was conducted in the district of Samre Saharti, Tigray, northern Ethiopia. A structured questionnaire collecting socio-demographic and malaria-related KAP information was administered to the mothers from a representative sample of households.

RESULTS

A total of 1652 questionnaires were available for analysis. Most of the respondents (92.7%) were able to mention at least one symptom of malaria. Mosquito as a cause of malaria was recognized by nearly half of the respondents (48.8%). Most of the households had a bed net (85.9%). To have a literate person at home, to belong to the lowland stratum, to have received some type of health education and to own a radio were associated with the knowledge of malaria. A strong association remained between living in the lowland stratum, to own a radio and to live close to the health post and the use of ITN. Being a housewife, lack of health education and to live further than 60 minutes walking distance to the health post were related to a delay on treatment finding.

CONCLUSION

This study has identified some aspects which the MCP might need to improve. The knowledge about malaria transmission should be strengthened. Promotion of literacy and participation in health education are vital components in terms of malaria knowledge and practice. Issues related to geographical location and accessibility to health post should be also carefully examined.