Contraceptive use among people with disabilities in sub-Sahara Africa: A systematic review and meta-analysis

In sub-Saharan Africa, there are different studies on contraceptive use and associated factors among people with disabilities. However, the findings are inconsistent and inconclusive. This study aimed to estimate the pooled prevalence of contraceptive use and associated factors among women with disabilities in sub-Saharan Africa. Comprehensive search was performed from different databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to report the results. The data were analyzed by using STATA software. Heterogeneity and publication bias was checked. The pooled odds ratio (POR) with a 95% confidence interval (CI) was used to report the measures of associations. The pooled prevalence of contraceptive use was 25.61% (95% CI: 20.68, 30.54). Being married (POR = 2.96; 95% CI: 1.31, 4.62), high income (POR = 2.20; 95% CI: 1.42, 2.97), having media access (POR = 1.74; 95% CI: 1.24, 2.23), being in the age group of 25-34 (POR = 2.52; 95% CI: 1.01, 3.94), vision impairment (POR = 3.82; 95% CI: 2.05, 5.59), good contraceptive knowledge (POR = 2.09; 95% CI: 1.27, 2.91), primary education (POR = 1.82; 95% CI: 1.25, 2.39), secondary education (POR = 2.31; 95% CI: 1.03, 3.59) and tertiary educational status (POR = 3.37; 95% CI: 1.28, 5.46) were factors associated with contraceptive use. Contraceptive use among women with disabilities is considerably low in sub-Saharan Africa. The use of contraceptives is primarily dependent on socio-demographic and economic status.

Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study

BACKGROUND

Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia.

METHODS

A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach.

RESULTS

In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice.

CONCLUSION

Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.

The burden of disabilities in Sidama National Regional State, Ethiopia: A cross-sectional, descriptive study

BACKGROUND

Assessing the burden and describing the status of people with disabilities is very essential. The previous studies conducted about the prevalence, causes, and types of disability in Ethiopia were inconsistent and disagreeable.

OBJECTIVES

To determine the prevalence, causes, and types of disabilities in Sidama National Regional State, Ethiopia.

METHODS

A house-to-house census was carried out on a total of 39,842 households in 30 randomly selected kebeles of the Dale and Wonsho districts and Yirgalem city administration, Sidama National Regional State. The data were collected using structured and pretested questionnaires via the Kobo Collect application from May 01 to 30, 2022. The analysis was performed by STATA version 16 software. After cleaning and organizing, descriptive statistics were employed to characterize the study findings.

RESULTS

In this study, people with disabilities aged one to 80 years old were included. The mean Standard Deviation (SD) age of people with disabilities in years was 31.95 (15.33). Of 228,814 people, 1,694 were people with disabilities in Dale and Wonsho districts and Yirgalem city administration, with a prevalence of 0.74% (95% CI: 0.72, 0.76). Of the causes of disability, 61% of the disabilities were due to illness, injury, and accidents. Extremity paralysis (35.4%), vision disability (20.13%), hearing disability (19.7%), walking disability (14.7%), and cognitive disabilities (7.7%) were the identified types of disabilities.

CONCLUSION

This study revealed that the burden of disability is considerable in Dale and Wonsho districts and Yirgalem city administration. The vast majority of disability causes could have been avoidable. As a result, developing and implementing various strategies to raise community awareness about the causes and preventive measures is critical.

Unintended pregnancy and its associated factors among women with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

BACKGROUND

Unintended pregnancy is one of the most common reproductive health problems. The problem makes women with disabilities doubly burdened by their disabilities. The previous evidences are inconsistent and do not address all women with disabilities. The study aimed to assess the prevalence of unintended pregnancy and its associated risk factors among women with disabilities in Dale and Wonsho districts and Yirgalem city administration central Sidama National Regional State, Ethiopia.

METHODS

A community-based cross-sectional study design was conducted among 355 randomly selected women with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviews using a structured questionnaire. A multilevel logistic regression analysis model was employed to identify factors associated with an unintended pregnancy. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations.

RESULTS

In this study, the prevalence of unintended pregnancy among women with disabilities was 65.6% (95% CI: 60.4, 70.6). After adjusting for potential confounding variables, middle economic status (AOR = 2.07; 95% CI: 1.02, 4.20), giving birth (AOR = 2.20; 95% CI: 1.21, 3.99), extremity paralysis types of disability (AOR = 0.26; 95% CI: 0.12, 0.57), living in urban residences (AOR = 0.22; 95% CI: 0.12, 0.40) and alcohol using (AOR = 0.28; 95% CI: 0.11, 0.74) were risk factors with unintended pregnancy.

CONCLUSIONS

Unintended pregnancy among women with disabilities is remarkably high in central Sidama National Regional State, Ethiopia. Economic status, giving birth, types of disability, residence, and alcohol use were factors associated with an unintended pregnancy. As a result, economic empowerment, strengthening education and information about unintended pregnancy and its prevention strategies in rural settings are vital.

Sexual violence and associated factors among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

BACKGROUND

Sexual violence is one of the most common problems in reproductive health that causes different traumatic events that lead to mental, social, and physical problems. Females with disabilities are subjected to more traumatic events and consequences. In Ethiopia, there are limited evidences about the prevalence and associated factors of sexual violence among reproductive-aged females with disabilities. Therefore, this study aimed to assess the prevalence and associated factors of sexual violence among females with disabilities in reproductive-age in central Sidama National Regional State, Ethiopia.

METHODS

A multistage sampling technique was used to select 645 reproductive-age females with disabilities. Initially, three districts were purposefully selected, from which 30 kebeles and study participants were selected randomly from June 20 to July 15, 2022. A face-to-face interviewing technique was used to collect the data. The data were analyzed using a multilevel logistic regression analysis model. The measures of associations were reported using the adjusted odds ratio (AOR) and its 95% confidence interval (CI).

RESULTS

The prevalence of sexual violence among reproductive-age females with disabilities was 59.8% (95% CI: 56, 63.56). Residing in an urban setting (AOR = 0.51; 95% CI: 0.29, 0.88), being an adult (25 to 34 years old) (AOR = 5.9; CI: 3.01, 11.6), being an adult (35 to 49 years old) (AOR = 3.47; CI: 1.48, 8.14), having no sexuality information (AOR = 11.3; CI: 6.24, 20.5), and having hearing disabilities (AOR = 3.19; CI: 1.49, 6.83) were factors associated with sexual violence.

CONCLUSIONS

Sexual violence among reproductive-age females with disabilities is noticeably high. Place of residence, sexual orientation, age, and disability type were all factors associated with sexual violence. Therefore, providing sexuality education, giving high attention (information and education about sexuality) to rural residents, and considering females with hearing disabilities are important to minimize sexual violence among reproductive-age females with disabilities.

Effect of Balneotherapy on Skin Lesion at Hot Springs in Southern Ethiopia: A Single-Arm Prospective Cohort Study

Background

Balneotherapy is the use of mineral water for the treatment of a wide range of diseases including skin lesions. Even though Ethiopia has a large number of places with natural hot springs, their therapeutic value has not been thoroughly studied. The aim of this study was to determine the effect of balneotherapy among patients with skin lesions at hot springs in southern Ethiopia.

Methods

A single-arm prospective cohort study design was used to assess patient's progress from their skin lesion complaint after using the hot water for at least three consecutive days or more. An individual visiting the hot springs site and staying there for at least three days or more was included in the study. From four hot springs sites in Southern Ethiopia, 1320 study participants who were 18 years of age or older were enrolled. The data were gathered using a standardized questionnaire and a physical examination. A descriptive analysis was made.

Results

Of the total, 142 (10.8%) of them had various skin lesions. Flexural lesions accounted 87 (61.3%), non-specific skin conditions 51 (35.9%), co-lesions at the scalp, external ear canal, trunk, and various locations, and psoriatic lesions comprised 4.8%. There were 72 (82.8%) typical eczematous lesions among the total number of flexural lesions. After using balneotherapy for 3-7 days once daily, 69 (95.2%) cases of eczematous dermatitis and 30 (58.8%) cases of non-specific skin issues showed improvement from the lesion. Additionally, after 30 days of bathing once daily, the PASI score of more than 90% of the psoriatic cases dropped to a score of one.

Conclusion

Patients with skin lesions benefit significantly from balneotherapy when it lasts for three or more days. In order to improve skin lesions, proper application for at least a week or longer is highly beneficial.

Level of job satisfaction and associated factors among rural health extension workers in Hadiya Zone, Southern Ethiopia

BACKGROUND

The improvement of various health outcomes, including the reduction of maternal, neonatal, infant, and child mortality as well as the increased use of maternity and newborn health services, was significantly assisted by rural health extension workers. Implementing health extension programs and offering the community high-quality healthcare services requires job satisfaction. In the study area, there has been little research on job satisfaction and related variables. Therefore, the purpose of this study was to evaluate the degree of job satisfaction among rural health extension workers in the Hadiya zone, Southern Ethiopia, as well as associated factors.

METHODS

A facility-based cross-sectional study was conducted among 262 rural health extension workers from May 30, 2021, to July 02, 2021. A simple random sampling method was used to select six rural districts. Data were gathered utilizing structured interviewer-administered questions and skilled data collectors. EpiData V4.4.1 was used to store the data, and SPSS Version 25 was used for analysis. To determine the relationship between the variables, bivariate and multivariate logistic regressions were used. The association was reported using the adjusted odds ratio (AOR) with a 95% confidence interval (95%CI), and the significance level was set at a p-value of 0.05.

RESULTS

This study showed that 52.7% of rural health extension workers were satisfied with their jobs. Support from Keble leaders [AOR = 5.3; 95% CI (2.6, 11.1)], on-job training [AOR = 5.7, 95% CI (2.2, 14.9)], supportive supervision [AOR = 4.3; 95% CI (1.7, 10.8)] and reward or recognition [AOR = 7.4, 95% CI (3.0, 18.1)] were factors that associated with job satisfaction of health extension workers.

CONCLUSION

According to this study, more than half of rural health extension workers were happy with their jobs. Health extension workers' job satisfaction was affected by support from keble leaders, supportive supervision, on-the-job training, and recognition and rewards. In order to increase the happiness of the health extension workers, supporting supervision must be strengthened and the best performers must be recognized.

Acceptance, utilization, and factors associated with immediate postpartum intrauterine contraceptive device among mothers delivered at public health facilities in Hawassa city, Ethiopia: Institution-based study

BACKGROUND

Immediate postpartum intra-uterine contraceptive device (IPPIUCD) placement within 10 min after the expulsion of the placenta following vaginal delivery is a safe and effective method when provided after comprehensive counseling. Studies on its acceptance and utilization are scarce in the study area. This study aims to assess the acceptance and utilization of IPPIUCD.

METHODS

A cross-sectional study was conducted from January 1st up to February 31st, 2020, among 392 mothers who delivered at public health facilities in Hawassa city. EPI-Data version 7.2 was used for data entry and STATA 14 for analysis. Data were collected using an interviewer administered structured questionnaire. A binary logistic regression and a multivariable logistic regression model were used to assess association. Statistical significance was determined at a p-value of less than 0.05 with a 95% confidence interval.

RESULTS

Of the 392 mothers enrolled, 16.3% (95% CI: 12.7-20.0) of them accepted immediate post-partum IUCD. However, only 10% (95%CI: 7.0, 12.9) utilized immediate post-partum IUCD. Counseling about IPPIUCD, Attitude, plan to have another child, and birth intervals were associated with acceptance of immediate PPIUCD while husband support for family planning use, delivery time, and the number of children had a significant association with utilization of immediate PPIUCD.

CONCLUSIONS

The study found a relatively low proportion of acceptors and utilizers of immediate post-partum IUCD in the study area. To improve the acceptance and utilization of immediate PPIUCD among mothers, all stakeholders concerned with family planning need to mitigate and promote the challenges and facilitating factors, respectively.

Contraceptive use among reproductive-age females with disabilities in central Sidama National Regional State, Ethiopia: a multilevel analysis

Background

Contraceptive use is an important and cost-effective intervention to prevent unwanted pregnancies. People with disabilities face discrimination when it comes to using contraception and are doubly burdened by unwanted pregnancies. However, the status of contraceptive use and associated factors among reproductive-aged females with disabilities was not adequately determined in Ethiopia.

Objective

This study aimed to assess contraceptive use and associated factors among reproductive-age females with disabilities in Dale and Wonsho districts and Yirgalem city administration of central Sidama National Regional State, Ethiopia.

Methods

A community-based cross-sectional study was conducted among randomly selected 620 reproductive-age females with disabilities living in the selected districts from June 20 to July 15, 2022. The data were collected through face-to-face interviewing techniques using a structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations.

Results

In this study, 27.3% (95% CI [23.8%-31.0%]) of the reproductive-age females with disabilities were current contraceptive users. Regarding the methods, 82 (48.5%) of the reproductive-age females with disabilities used implants. Having good contraceptive knowledge (AOR = 9.03; 95% CI [4.39-18.6]), transport accessibility to health facilities (AOR = 2.28; 95% CI [1.32-3.94]), being an adult (25 to 34 years old) (AOR = 3.04; 95% CI [1.53-6.04]), having a hearing disability (AOR = 0.38; 95% CI [0.18, 0.79]), having paralysis of the extremities (AOR = 0.06; 95% CI [0.03-0.12]), and wheel-chaired disability (AOR = 0.10; 95% CI [0.05-0.22]) were factors associated with contraceptive use.

Conclusion

Contraceptive use among reproductive-age females with disabilities is low. Transport accessibility, contraceptive knowledge, being in the age groups of 25 to 34 years, and the types of disability determine their contraceptive use. Therefore, designing appropriate strategies to provide contraceptive education and information and provide contraceptive services in their homes is important to enhance contraceptive use.

Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey

INTRODUCTION

Maternal mortality studies conducted at national level do not provide information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district level variations in Sidama National Regional State, southern Ethiopia.

METHODS

A cross sectional population-based survey was carried in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality.

RESULTS

We registered 10602 live births (LB) and 48 maternal deaths yielding the overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at health facility. Mothers who did not have formal education had higher risk of maternal death (AOR: 4.4; 95% CI: 1.7-11.0). The risk of maternal death was higher in districts with low midwife to population ratio (AOR: 2.9; 95% CI: 1.0-8.9).

CONCLUSION

The high maternal mortality with district level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the life of mothers.

Descriptive epidemiology of gynaecological cancers in southern Ethiopia: retrospective cross-sectional review

OBJECTIVE

To determine the epidemiology of gynaecological cancer among patients treated at Hawassa University Comprehensive and Specialized Hospital (HUCSH) from 2013 to 2019.

DESIGN

A retrospective cross-sectional review.

SETTING, PARTICIPANTS, AND OUTCOME MEASURE

A total of 3002 patients' cards with a diagnosis of cancer at a tertiary hospital named HUCSH were reviewed between February and May 2020. HUCSH is the only oncological care centre in the southern region of Ethiopia. Of this all-gynaecological cancer charts were extracted and descriptive and trend analyses were done. The review was conducted between February and May 2020.

RESULT

Out of all 3002 cancer cases, 522 (17.4%) cases of gynaecological cancers were identified in 7 years. Cervical cancer accounted for 385 (73.8%) of all gynaecological cancers in this study, the next most common gynaecological cancers were ovarian cancer 55(10.5%) and endometrial cancer 51(9.8%), respectively. The mean (SD) age was 44.84 (12.23). Trends of all identified gynaecological cancers showed continuous increments of caseload year to year. Since 2016 increment of cervical cancer is drastically vertical compared with others.

CONCLUSION

Despite the limited use of a registration and referral system in primary health institutions, the burden of gynaecological cancers has increased over time. Treatment steps should be taken as soon as possible after a cancer diagnosis to prevent the disease from progressing.

Incomplete immunization and associated factors among children 12-23 months in Aletawondo district, Sidama zone, South Ethiopia: Across-sectional study

Immunization is one of the most cost-effective and commonly used public health strategies for preventing child mortality. The goal of this study was to determine the prevalence of incomplete immunization and associated variables in children aged 12-23 months in the Aleta Wondo district of Southern Ethiopia. The researchers utilized a community-based cross-sectional study approach. A modified World Health Organization-Expanded Program on Immunization cluster sampling method was used to choose 634 mothers/caregivers of children aged 12-23 months. Data were collected by trained data collectors between March and April 2019. Descriptive statistics and logistic regression were done. In this study, 138 (21.8%) of children were not completed their immunization. Mothers who were literate [AOR = 2.1; (95% CI: 1.1, 4.2)]. Home birth [AOR = 2.9; (95% CI: 1.7, 5.3)], walking time from home to vaccination site [AOR = 1.95; (95% CI: 1.1,3.3)], inconvenience times for vaccination service [AOR = 2.4; (95% CI: 1.3,4.5)], postponing vaccination session schedule [AOR = 2.4; (95% CI:1.1,5.4)], households not visited by health extension workers [AOR = 4.1; (95% CI: 2.2,7.4)], poorer knowledge about child immunization [AOR = 4; (95% CI:2.2,7.5)] were factors associated with incomplete immunization. Incomplete immunization was higher compared to the national target. It is necessary to strengthen the program by enhancing the number of outreach sites considering the size of the target group.

Prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer in southern Ethiopia: a cross-sectional study

OBJECTIVE

The study was aimed to assess the prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer attending follow-up at Hawassa University Comprehensive Specialized Hospital cancer treatment centre, Ethiopia.

DESIGN

Institution-based cross-sectional study design was implemented.

SETTING

Patients with cancer at Hawassa University Comprehensive Specialized Hospital cancer treatment centre from October 2019 to December 2019.

PARTICIPANTS

Randomly selected 415 patients with cancer who had follow-up at cancer treatment centre.

MAIN OUTCOME MEASURES

Anxiety and depression symptoms were assessed using Hospital Anxiety and Depression Scale.

RESULT

The prevalence rates of depression and anxiety symptoms were found to be 244 (58.8%) and 249 (60.0%), respectively. Older age (>50 years) (AOR (adjusted OR)=2.24, 95% CI=1.14 to 4.40), being unemployed (AOR=1.96, 95% CI=1.08 to 3.56), advanced stage of cancer such as stage III (AOR=5.37, 95% CI=1.34 to 21.45) and stage IV (AOR=4.55, 95% CI=1.12 to 18.44), comorbid psychotic symptoms (AOR=1.67, 95% CI=1.07 to 2.61) and eating problem in the past 2 weeks (AOR=6.16, 95% CI=1.98 to 19.11) were independent factors significantly associated with depressive symptoms. In addition, cancer stage such as stage II (AOR=3.92, 95% CI=1.07 to 14.36) and stage IV (AOR=5.04, 95% CI=1.44 to 17.59) and comorbid psychotic symptoms (AOR=1.73, 95% CI=1.12 to 2.66) were significantly associated with anxiety symptoms.

CONCLUSION

Depression and anxiety symptoms among patients with cancer were considerably high. Age, occupation, cancer stage, comorbid psychotic symptoms and eating problem were determinant factors of depressive symptoms among patients with cancer. Moreover, cancer stage and comorbid psychosis were determinants of anxiety symptoms. Healthcare professionals working in the oncology unity need to conduct routine screening and treatment of depression and anxiety symptoms for patients with cancer.

Epidemiological Trends of Breast Cancer in Southern Ethiopia: A Seven-Year Retrospective Review

INTRODUCTION

African women are affected by cancer at an early age of their productivity. However, the exact prevalence and incidence of cancer, including breast cancer is not known in most sub-Saharan African countries, including Ethiopia because of lack of well-established cancer registry. This study aims to assess the epidemiology of breast cancer at Hawassa University Comprehensive Specialized Hospital (HUCSH), the biggest referral hospital with cancer treatment center serving the southern part of the country.

METHODS

Retrospective review of charts of all patients with a diagnosis of breast cancer between 2013 and 2019 at HUCSH was conducted. A standardized questionnaire was used to collect relevant data that include sociodemographic, symptoms, type of diagnosis, treatment, and outcomes. Data were entered using epidata version 3.1 and analyzed using MS Excel and SPSS version 20.

RESULTS

Five hundred fifty-nine (18.6%) breast cancer cases were retrieved in 7 years between 2013 and 2019. Of this, 548 (98%) were women. The median ages of the patents were 38 years. Invasive ductal carcinoma was the leading 309 (55.3%) histologic type followed by 185 (33.1%) lobular carcinoma. One hundred seventy-seven (31.7%) were moderately differentiated and 155 (27.7%) were poorly differentiated. Three hundred seventy-two (66.5%) were advanced breast cancer (Stages III and IV). Trends of breast cancer showed the case load is continuously increasing except with a slight reduction of cases in between 2015 and 2016. The majority were advanced breast cancer occurring at an early age by the time diagnosis made. Invasive ductal carcinomas were the predominant one. The trend also showed a continuous increment of cancer case load. Therefore, cancer registration center establishment, community awareness creation, and intensive early detection strategy are mandatory.

Balneotherapy for Musculoskeletal Pain Management of Hot Spring Water in Southern Ethiopia: Perceived Improvements

Background: Balneotherapy and hydrotherapy offer interesting treatment alternatives and are commonly used as additional interventions in the management of musculoskeletal disorders and pain management. Therefore, the aim of this study was to assess the effect of balneotherapy on musculoskeletal disorder pain and its perceived improvement among users of hot spring water in Southern Ethiopia. Methods: A single-arm cohort study and convenient sampling method were used to select 1337 study participants from four hot springs in Southern Ethiopia. A structured questionnaire, a physical examination, and laboratory blood tests were used to collect data. Data were entered using Epi data and transferred to SPSS 25 for cleaning and analysis. Descriptive analysis was made. Results: A total of 1279 participants were included in the study, giving a response rate of 96%. The majority of these patients have multiple health problems. Of all, 1137 (88.9%) of the patients were visiting the hot springs for joint pain followed by muscle pain 669 (52.2). Out of all cases of joint pain, 132 (11.6%) were clinically diagnosed with rheumatoid arthritis, and 5.3% were confirmed as having the disease based on a laboratory test. Of the total number of study participants, 1064 (83.2%) reported complete relief from the complaints they had at the start of the bath. Conclusions: Hot spring baths for three and more days have significant therapeutic effects on patients with musculoskeletal disorders, including rheumatoid arthritis. Physicians who are currently working in the area of diagnosis and treatment of patients in government and public facilities of the southern region should consider hot spring bath treatment for those patients with complaints of musculoskeletal pain, nonspecific arthritis, and rheumatoid arthritis. A hot spring bath is beneficial for everyone because it is a natural treatment with few side effects and a low cost.

Effect of Balneotherapy on Chronic Low Back Pain at Hot Springs in Southern Ethiopia: Perceived Improvements from Pain

Background

Low back pain (LBP) is an important musculoskeletal condition results in clinical, social and public health problems globally. Hydrotherapy, using water and heat together can be utilized to treat conditions, relieve pain and increase muscular power and a range of joint movement in patients with chronic lower back pain. Most patients with acute LBP improve spontaneously within four weeks; however, chronic LBP is extremely common and usually mechanical in nature.

Objective

The objective of the current study was to assess effect of balneotherapy in decreasing the lower back pain and its improvements among adults using a spa in southern Ethiopia.

Methods

We employed a single arm cohort study and convenient sampling method to select 442 study participants from four hot springs located in Sidama Region and Gedeo Zone, Southern Ethiopia. Structured and pretested questionnaire was used and administered face-to-face by trained data collectors. Data were entered using EpiData and transferred to SPSS for cleaning and analysis. Descriptive and bivariate analyses were made.

Results

A total of 427 participants were included in the study giving response rate of 96.6%. The mean (standard deviation) age of respondents was 42.55 (±14.92) years. Perceived improvement from back pain was 332 (77.8%) with 95% confidence interval (CI) of 74–82%. Factors showing association with perceived improvement from back pain after spa therapy were, study site being near Hawassa (Burkitu) with crude odds ratio (COR) of 3.3 and 95%CI: 1.83–5.98 and p-value <0.001; and sex of respondents that the odds of perceived improvements among males were about twofold compared with females, (COR: 1.7, 95%CI: 1.07–2.74, p-value 0.025.

Conclusion

Our study shows significant perceived improvement from back pain after utilization of spa water. This is associated with type of hot spring used, male sex, and having neurological symptoms. Therefore, hot spring spa water had better therapeutic effect for back pain and emphasis should be given to integrate it with modern medicine and further experimental study to be conducted to recommend it for medical purposes.

Economic Burden of Cancer on Cancer Patients Treated at Hawassa University Comprehensive Specialized Hospital

Cancer causes the highest economic loss of all of the leading 15 causes of death worldwide. The economic loss includes the loss of income and the expenses associated with health care costs. The Low awareness of the community toward cancer, the inadequacy of professionals and service providers, and the high budget consuming nature of the treatments are creating a great burden on the cancer patients. The objective of this study was to calculate patient side cancer treatment cost and to assess the contributing factors, among the cancer patients who were treated at Hawassa University Comprehensive Specialized Hospital. The health facility based cross-sectional study design was employed using a consecutive sampling technique. Questionnaires was used to collect primary data; while chart was used to collect the secondary data. Indirect costs incurred on these patients due to off job days were checked. Descriptive and inferential statistics were applied to illustrate the data. On average, $209.99 was spent on treatment by each cancer patients. Of these, medication cost is the highest ($20.77, IQR = 0.53-112.56) from the direct medical costs, and transportation cost is the highest ($58.33, IQR = 22.0-131.67) from the indirect medical costs. Inpatients paid $245.16 (IQR = 147.64-439.20); while outpatients paid $147.37 (IQR = 81.42-240.50). The patients lose about 55.99% of their average annual income. Outpatients pay $0, 92 less than in patients (P = 0.00, CI -0.72-0.34), and the cost increases by $0.2 for the patients who came from Oromia. The cost of transportation and medication were the one which were significantly affecting the burden; but the total cost of treatment was lesser when compared to similar studies done in different areas. The cost balances toward the patients who came from the Oromiya region. Treatment service has to be extended to West Arsi Zone to minimize the cost of transportation and awareness about cancer is needed in the first place and due attention has to be given to thyroid cancer. Furthermore, facility side study should be done to see the complete picture of the burden.

Perceived Quality of Nursing Care Among Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center; Hawassa Southern Ethiopia: Cross-Sectional Study

Background

Cancer has become one of the most common and the second leading cause of death. According to grounded theory, quality care is meeting all the needs of the patients. Low-quality nursing care relates omission of nursing care required to meet patients' need. Quality of nursing care in oncologic setting was nursing practice area where studies are limited.

Objective

The aim of the study was to assess the perceived quality of nursing care among patients with cancer attending Hawassa University comprehensive specialized Hospital.

Methods

A quantitative Cross-sectional study was conducted. Among the proposed 422 patients with cancer, using a simple random sampling technique 415 patients were included in this study. Seven data were discarded due to incompleteness and inconsistency between collected data and patient medical record. Data were collected using structured questionnaires and Quality of Oncology Nursing Care Scale. We carried out statistical analysis using SPSS V-20. We used descriptive analysis to examine the quality of oncology nursing care.

Results

The mean age of patients was 42.51 (±14.24) years, among patients diagnosed with cancer more than one-third 148 (35.70%) had breast cancer. The majority of patients with cancer 173 (41.70%) were in stage-III. Nearly two-third 266 (64.10%) of patients were on chemotherapy. Among study participants on treatment, 249 (60.00%) perceived they received good quality of nursing care. The mean score related to the domain of support and confirmation is 62.73 ± 7.26. In terms of spiritual care, the mean score is 21.03 ± 5.37.

Conclusion

The perceived quality of nursing care was high however not all domains of oncology care were achieved. We recommend Detail and focused study to explore important predictors’ quality nursing care.

Determinants of gonorrhea and syphilis infections among pregnant women attending antenatal clinic at Dilla University Referral Hospital, Ethiopia: Unmatched case-control study

Objective:

This study was designed to determine the risk factors associated with gonorrhea and syphilis infections among pregnant women attending antenatal care clinic at Dilla University Referral Hospital.

Method:

A hospital-based unmatched case-control study (64 cases and 128 controls) with 1:2 ratios was conducted from 29 January 2018 to 20 June 2018, at the antenatal care clinic of the Dilla University Referral Hospital. Venous blood and vaginal swab were collected to screen for gonorrhea and syphilis. A pretested interviewer-administered questionnaire was used to gather data on sociodemographic and predisposing factors. Logistic regression analysis used to identify risk factors for sexually transmitted infections among pregnant women at 95% confidence interval and p-value < 0.05.

Result:

A total of 64 cases of syphilis or gonorrhea were identified with a mean age of 26 years (±4.1 years.). Of those cases, 40 were syphilis seropositive and the remaining were gonorrhea cases. Lower educational status (adjusted odds ratio = 2.4, 95% confidence interval: 1.1–4.9), age of first sex <18 years (adjusted odds ratio = 2.8, 95% confidence interval: 1.3–5.9), history of abortion (adjusted odds ratio = 3.1, 95% confidence interval: 1.4–6.6), and having two or more sexual partners in the past year (adjusted odds ratio = 2.5, 95% confidence interval: 1.1–5.7) were significantly associated with gonorrhea and syphilis infection.

Conclusion:

Demographic, behavioral, and obstetric factors are associated with the occurrence of syphilis or gonorrhea among pregnant women. Strengthening the existing antenatal care services, providing health education on risk factors, and prioritizing women with the risk characteristics and initiation of gonorrhea and syphilis screening during antennal care are mandatory.

<p>Determinants of Sub-Optimal Birth Spacing in Gedeo Zone, South Ethiopia: A Case–Control Study</p>

Background

Birth spacing is key in ensuring the health of mothers and their children as well as determining population growth. Most of the mothers in developing nations including Ethiopia have been practicing short inter-birth intervals. There is a paucity of studies concerned with suboptimal birth spacing among women in reproductive age in the study area.

Purpose

This study aims to identify the determinants of sub-optimal birth spacing among reproductive-age women in Gedeo zone, South Ethiopia.

Materials and Methods

A community-based unmatched case–control study was undertaken among 814 reproductive-age women in Gedeo zone, South Ethiopia from October 1 to November 30, 2018. Cases were women practiced suboptimal/short birth intervals (<33 months), whereas controls were women practiced inter-birth intervals of 33 months and more. A structured interviewer-administered questionnaire was used. A stratified, two-stage cluster sampling technique was used. EpiData version 3.1 and SPSS version 22 were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression analyses were computed. P-value <0.05 was considered as statistically significant. All ethical procedures were considered.

Results

Women’s educational status, AOR (95% CI) =0.6 (0.43, 0.96), age at first marriage, AOR (95% CI) = 0.9 (0.85, 0.99), distance from the nearest health facility, AOR (95% CI) = 1.4 (1.04, 1.94), wealth index, AOR (95% CI) = 4.1 (2.66, 6.19), and postnatal care utilization after the previous birth, AOR (95% CI) = 0.4 (0.25, 0.53) were statistically significant with suboptimal birth spacing.

Conclusion

Women’s educational status age at first marriage, distance from the nearest health facility, wealth index and postnatal care utilization after the previous birth were the determinants of suboptimal birth spacing.

Community Acceptance and Utilization of Maternal and Community-Based Neonatal Care Services Provided by Health Extension Workers in Rural Sidama Zone: Barriers and Enablers: A Qualitative Study

Purpose

This study assessed the community acceptance and utilization of maternal and community-based neonatal care services, its barriers, and enablers in southern Ethiopia, 2019.

Methods

An exploratory qualitative study was conducted among mothers, health extension workers, their supervisors and coordinators in four districts of Sidama Zone, Hawassa University Demographic Surveillance Site. An in-depth interview has been carried out with eight health extension workers and eight program coordinators and supervisors, while four focus group discussions were held with eligible mothers. Digital recording was applied to record the interview and discussion followed by transcription and thematic analysis through open code.

Results

Study findings reveal that services provided by health extension workers at community level for mothers and their children are highly appreciated and recognized by the community. Most of the communities are free from wrong perception regarding the practices. Their performance was better in focused antenatal care, but postnatal care and community-based neonatal care were reported to be insignificant. Knowledge and skills of HEWs was based on their extended experiences. The challenges and opportunities include workload, road inaccessibility, poor supervision, inadequate drugs and equipment supply, shortage of man power and budget at health posts, distance and topography factors of homes from health posts making the visits more difficult, etc. To improve uptake of the services, increasing the number of health extension workers in the heath post, supportive supervision, continuous essential drugsm and medical supplies were suggested by participants.

Conclusion

This study shows that services provided by health extension workers for mothers and their neonates are highly appreciated by the community, and there is better change in focused antenatal care services, but postnatal care and sick newborn care are still low. Therefore, maternal and neonatal programs should focus on the postnatal home visits and sick newborn care through solving identified barriers.

Quality of Life Among Breast Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center

BACKGROUND

Breast cancer affects the overall quality of life (QOL) among its survivors. Limited evidence is available about the QOL among cases. Therefore, this study was intended to assess the quality of life of breast cancer patients attending the cancer treatment center at Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among breast cancer patients attending cancer treatment at the Hawassa University Comprehensive Specialized Hospital between April and June, 2019. All breast cancer patients attending treatment the center were included in the study by universal sampling. Data were collected using a structured questionnaire containing demographic data, patient clinical factors and Quality of Life Instrument (WHOQOL)-BREF version 3.0. The collected data were entered into EpiData software version 3.1 and analyzed using SPSS Version 20.0. Descriptive statistics were presented in tables.

RESULTS

A total of 259 respondents with a mean age of (SD) 44.89 (12.56) participated in study. The mean score of overall global health scale was 75.3 (SD±17.1) with the mean health satisfaction was 12.43 (SD±3.98). The highest mean score was observed in environmental domain, 93.31 (SD±19.76), despite social domain being very low, 36.69 (SD±7.62). Most of the participants were highly satisfied with the health care service that was provided, with a mean score of 16.1 (SD±3.1). In contrast, the majority of study participants were disappointed with the need for any medical treatment, body appearance, luxurious activities, and sexual life, with mean scores of 8.93 (SD±3.68), 8.74 (SD±4.26), 9.1 (SD±4.22), and 8.1 (SD±4.14), respectively.

CONCLUSION

Breast cancer patients in southern Ethiopia suffered from poor social and psychological support that, in turn, highly affected their life value. Therefore, due attention should be given to enhance social and psychological support for breast cancer patients as a whole.

Outcome of uterine rupture and associated factors in Yirgalem general and teaching hospital, southern Ethiopia: a cross-sectional study

Background

The occurrence of uterine rupture has dropped significantly in high income countries. It continues, however, to be a major public and clinical health problem in low income countries including Ethiopia. Aim of this study was to assess management outcomes of uterine rupture and associated factors in Yirgalem General and Teaching Hospital in South Ethiopia.

Methods

Institution-based cross-sectional study was conducted to examine medical records of women with uterine rupture between January 1, 2012, and Decem”ber 31, 2017. Data were collected based on a checklist. Descriptive statistics and logistic regression analyses were performed.

Results

Incidence of uterine rupture was 345 in 13,500 live births (25.5 in 1000 live births) in the study period. Of these, 331 cases were included. Poor maternal outcome occurred in 224 (67.7%) women. There were 13 (3.7%) maternal deaths and 320 (96.7%) stillbirths. Wound site infection (131; 39.6%) and anemia (129; 39%) were the most common post-operative complications. Prolonged duration of labor (more than 24 h) (adjusted odds ratio (aOR) 3.6; 95% CI 1.7–7.4), women with sepsis on admission (aOR 2.9; 95% CI 1.4–6.1), hemoglobin level < 7 g/dl prior to surgical intervention (aOR 4.5; 95% CI 1.1–17.8), delayed surgical intervention after hospitalization (4 h or more before surgery) (aOR 3.8; 95% CI 1.8–8), women who did not receive blood transfusion (aOR 4.0; 95% CI 2.1–7.9) and prolonged intraoperative time (aOR 5.5; 95% CI 2.8–10.8) were all factors associated with poor maternal outcome of uterine rupture.

Conclusion

Poor maternal outcome of uterine rupture was high in the study area as compared to other studies. Proper management of anemia, prompt surgical treatment, proper labor progress monitoring, surgical skills, improved infection prevention, maximizing blood transfusion availability and improving the quality of maternal healthcare all play a significant role in reducing uterine rupture and enhancing the chance of good outcomes.

Retrospective review of maternal deaths in Hawassa Comprehensive Specialised Hospital, in Southern Ethiopia

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility-based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting.What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths.What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.

Health Extension Workers Involvement in the Utilization of Focused Antenatal Care Service in Rural Sidama Zone, Southern Ethiopia: A Cross-Sectional Study

Background:

Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC).

Methods:

A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software.

Results:

The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244 (46.47%; 95% CI: 43.5-47.7%) of mothers. The FANC utilization was less likely among those who were illiterate (adjusted odds ratio [AOR]: .32; 95% CI: .18-.57) and those who attended first cycle (AOR: .41; 95% CI: .23-.74), those who attended secondary cycle (AOR: .47; 95% CI: .27-.82), primipara (AOR: 0.53; 95% CI: .35-.83), and those who gave birth at home (AOR: .66; 95% CI: .51-.84). Mothers who had knowledge of pregnancy danger signs (AOR: 1.42; 95% CI: 1.2-1.7) and exposure to mass media (AOR: 1.35; 95% CI: 1.1-1.66) were more likely to utilize FANC.

Conclusions:

FANC utilization in this study was low compared to other studies. The HEWs had a major contribution to the services. However, it is low when compared to the plan set by the state ministry of health. The existing health extension program could be strengthened by increasing the number of HEWs. Empowering rural mothers through continuous education program to enhance the utilization of maternal health services.

Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia

BACKGROUND

Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation remains a major concern for family planning programs. In less developed countries, contraceptive discontinuation due to health concerns is generally higher, these complaints are often related to service quality. Significant numbers of women become exposed to conception after discontinuation and accidental pregnancies that end up with abortion & stillbirth. The aim of this study was to assess the early discontinuation rate of Implanon and identify its associated factors among women who ever used Implanon in 2016 in Dale district, Southern Ethiopia.

METHODS

Community based cross-sectional study design was conducted from January to February, 2017. A total number of 711 women who ever used Implanon in 2016 were selected using multistage sampling. The data were entered and cleaned in Epi Info and analyzed using SPSS. Multivariate logistic regression analysis was used to determine the effect of factors on the outcome variables. Finally, the results were presented using adjusted odds ratio (AOR) & confidence interval of 95%.

RESULT

Early Implanon discontinuation rate in this study was 160 (23.4%) with a mean duration of Implanon use of 9.6 ± 2.5 months. The main reasons for discontinuation of Implanon were 55 (34.4%) the facing of side effects. Factors for discontinuation of Implanon were women age 20-24 years (AOR =. 44 (95% CI: 23-. 85), 25-29 years (AOR =. 52 (95% CI: 27-. 96), 35+ years, (AOR =. 08 (95% CI: 02-. 41), less likely to discontinue. Women who weren't counseled about the side effects during Implanon insertion were 1.93 times (AOR = 1.93 (95% CI: 1.27-2.93), women who didn't satisfied by the service (AOR = 2.55(CI: 95%: 1.63-3.97), women who didn't appointed for follow up (AOR = 3.13 (CI: 95%: 2.0-4.95), women who didn't choose the method by themselves (AOR = 1.83 (CI: 95%: 1.18-2.83) and women who didn't have information on family planning before Implanon insertion (AOR = 1.52 (CI: 95%: 1.1-2.28) were the predictors of Implanon discontinuation.

CONCLUSIONS

Implanon discontinuation rate in this study area was high. Appropriate counseling prior to insertion and proper follow up, autonomous choice will improve the continuation rate of Implanon.

Home-based neonatal care by Health Extension Worker in rural Sidama Zone southern Ethiopia: a cross-sectional study

BACKGROUND

Home-based neonatal care is associated with a reduction in neonatal mortality in settings with poor access to health facility-based care. The first day of a child's life is a day of unparalleled opportunity to spare lives and sets the level for a sound future. The aim of this study was to evaluate the prevalence and timing of home-based neonatal care by health extension workers (HEWs) in the rural Sidama Zone of southern Ethiopia.

SUBJECTS AND METHODS

A community-based, cross-sectional study was conducted, and a total of 2,040 mothers who had a live birth in the last 6 months were studied from 1 to 31 January 2017. Interviewer-administered data were collected using a standard questionnaire developed by the Saving Newborn Lives Program. A descriptive analysis and logistic regression analyses were done.

RESULTS

It was found that 252/2,040 (12.4%) mothers and their neonates were visited by the HEWs during the first month of birth. Out of all households who had a history of visits, 139 (55.2%) had a single visit. Of these, only 66/252 (26.2%) of the first visit were within the first 24 hours. Mothers who received postnatal home visit by the HEWs were at 1.35 times greater odds to have good postnatal practice compared to unvisited mothers (adjusted odds ratio [AOR] 1.35, 95% CI [1, 1.71]). Mothers who gave their last birth at home were 36% less likely to have good postnatal practice compared to those who gave birth in a health institution (AOR 0.64, 95% CI [0.53, 0.79]).

CONCLUSION

Majority of the neonates did not get the recommended number and frequency of home visits. Postnatal home visit by HEWs had a great role in mothers having good postnatal practice. Therefore, all stakeholders should give attention on strengthening supportive supervision, proper implementation of community-based maternal and neonatal care is very crucial.

Less Than One-Third of Caretakers Sought Formal Health Care Facilities for Common Childhood Illnesses in Ethiopia: Evidence from the 2011 Ethiopian Demographic Health Survey

Background. Most of the childhood illnesses can be proven with effective interventions. However, countless children die needlessly in developing countries due to the failure of their guardians to seek care timely. The aim of this study was to assess health care seeking behavior of caretakers of children under the age of five years for treatment of common childhood illnesses. Methods. Further analysis of the Ethiopian 2011 demographic and health survey was done. All children under the age of five reported to have been ill from the three common childhood illnesses and their caretakers were included in the analysis. A complex sample logistic regression model was employed to determine factors associated with the health care seeking behavior of caretakers. Result. A total of 2,842 caregivers who reported that their index child had at least one of the three common childhood illnesses in the two weeks preceding the survey were captured, of which 849 (29.87%; 95% CI: 28, 32%) sought formal health care facilities. Conclusion and Recommendation. In Ethiopia health care seeking behavior of caretakers for common childhood illnesses is low. Increasing mass media exposure can possibly improve the health seeking behavior of caretakers.