Surgical site infection following cesarean section and its predictors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Worldwide, surgery related deaths within 30 days of the procedure accounts the third contributor among all causes of deaths, with an estimated 4.2 million people annually and half of these deaths occur in low and middle income countries.

OBJECTIVE

To determine the pooled prevalence of surgical site infection following cesarean section and its predictors in Ethiopia.

METHODS

A systematic review and meta-analysis were conducted by using PRISMA guideline. An appropriate and comprehensive search of PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI and Scopus was done. This SRMA included all articles conducted in all regional state of Ethiopia reporting the prevalence/proportion/incidence of SSI after cesarean section and/or associated factors. All observational study designs were included in this SRMA. Articles which lack our outcome of interest: SSI following cesarean section and its predictors were excluded from this SRMA. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of SSI. Adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 17 software.

RESULT

Initially 6334 studies were identified and finally 19 studies were found eligible for the analysis. Studies with a score of 7 and above were included for the final systematic review and meta-analysis. The review was comprised of 14 cross sectional studies, 4 cohort and one case control studies. The pooled estimate of SSI in Ethiopia was 11.13% (95%CI, 9.29-12.97%). Prolonged labor (AOR = 3.16, 95% CI; (2.14-4.68)), chorioamnionitis (AOR = 4.26, 95% CI; (1.99-8.91)), prolonged PROM (AOR = 3.80, 95% CI; (2.51-5.62)), repeated vaginal examination (AOR = 3.80, 95% CI; (2.45-5.88)), decreased hemoglobin level (AOR = 4.57, 95%CI; (3.16-6.60)), vertical skin incision (AOR = 3.09, 95% CI; (2.04-4.67)) and general anesthesia (AOR = 1.82, 95% CI (1.21-2.75)) are significantly associated with SSI after cesarean section in Ethiopia.

CONCLUSION

SSI after cesarean section in Ethiopia is high. Prolonged labor, chorioamnionits, prolonged PROM, repeated vaginal examination, decreased Hgb level, vertical skin incision and general anesthesia were positively associated. Thus, evidence based intra-partum care should be practiced.

Exploring the perceptions of health service providers and adolescents on the utilization of adolescent sexual and reproductive health services in Tikur, 2023: A qualitative study

Objectives

Globally, twenty-three million adolescents aged 15-19 years have an unmet need for sexual and reproductive health services and are at risk of unintended pregnancy. In Sub-Saharan Africa, including Ethiopia, it might be difficult for adolescents to get access to sexual and reproductive health services that are acceptable to use. Privacy, a fear of sharing health concerns, a sociocultural environment, the unfriendliness of current services, and traditional taboos are some of the key reasons. This study aimed to explore the perspectives of service providers and adolescents on the use of sexual and reproductive health services.

Methodology

A qualitative phenomenological study was conducted from January to February 2023 in the Tikur Anbessa specialized hospital. Purposive sampling was applied to select the study participants. A total of 17 in-depth interviews (with 7 adolescents and 10 health providers) were held. Instead of relying on the number of participants, data saturation was used. Thematic analysis was employed in analyzing the data.

Result

The findings indicate that obstacles to the use of sexual and reproductive health services include challenges related to the availability of resources and accessibility; resistance from religious beliefs, cultural beliefs, and customs; quality and institutional-related challenges; and stigma and discrimination in sexual and reproductive health services, which pose the biggest barrier to health professionals providing standardized sexual and reproductive health services.

Conclusion

A multi-pronged approach should be created to overcome these challenges, including community outreach for sexual and reproductive health and increasing awareness of the importance of early access to sexual and reproductive health through appropriate community forums. Existing sexual and reproductive health services are not promoted to adolescents and youth, and a lack of and difficulty getting resources for sexual and reproductive health services should be resolved.

Determinants of evidence-based practice among health care professionals in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Evidence-based practice (EBP) is the art of using up-to-date information for clinical decision-making. Healthcare professionals at all levels are expected to use the latest research evidence for quality care. In Ethiopia inclusive and nationally representative summarized evidence regarding the level of EBP among health professionals is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of EBP utilization and its determinants among Ethiopian health professionals.

METHOD

A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Factors associated with EBP were identified using STATA v. 14.

RESULT

Overall, 846 articles were retrieved and finally 23 articles were included in this review. The pooled prevalence of good EBP among health professionals was 52.60% (95%CI; 48.15%-57.05%). Knowledge about EBP (AOR = 2.38, 95% CI: (2.08-2.72)), attitude (AOR = 2.09, 95% CI: (1.67-2.60)), educational status (AOR = 3.12, 95% CI: (2.18-4.47)), work experience (AOR = 2.59, 95% CI: (1.48-4.22)), EBP training (AOR = 2.26, 95% CI: (1.87-2.74)), presence of standard guideline (AOR = 1.94, 95% CI: (1.51-2.50)), internet access (AOR = 1.80, 95% CI: (1.47-2.20)), presence of enough time (AOR = 2.01, 95% CI: (1.56-2.60)) and marital status (AOR = 1.73, 95% CI: (1.32-2.28)) were determinants of EBP.

CONCLUSION

Around half of health professionals in Ethiopia have good EBP utilization which was low. Knowledge, attitude, educational status, work experience, EBP training, presence of standard guidelines, internet access, presence of enough time, and single marital status were positively associated with EBP. Therefore future interventions should focus on increasing their knowledge and changing their attitude through providing training and addressing organizational barriers like availing standard guidelines, accessing the internet, and minimizing professionals' workload that enables them to critically appraise and integrate the latest evidence for clinical decision-making to improve the quality of care.

Human papillomavirus vaccine acceptance among adolescent girls in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Cervical cancer is the fourth most common cancer affecting females. Human papillomavirus vaccination of adolescent girls is the primary strategy for cervical cancer prevention but in Ethiopia, it lacks emphasis. Despite different studies done and found a highly variable level of vaccine acceptance; however, there was no summarized evidence on the issues as a nation. Thus this systematic review and meta-analysis aimed to assess the pooled prevalence of human papillomavirus vaccine acceptance by adolescent girls and its associated factors in Ethiopia.

METHOD

A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I² statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Review manager software was used to identify factors associated with vaccine acceptance.

RESULT

Overall, 157 articles were retrieved and finally 7 articles were included in this review. The pooled prevalence of adolescent human papillomavirus vaccine acceptance was 46.52% (95%CI; 30.47-62.57%). Subgroup analysis showed that adolescent vaccine acceptance was highest in the Oromia region and lowest in Addis Ababa. Knowledge about human papillomavirus vaccination (AOR = 3.89, 95% CI: (2.85-5.32)) and attitude (AOR = 2.65, 95% CI: (2.03- 3.44)) were significantly associated with adolescent's vaccine acceptance.

CONCLUSION

Human papillomavirus vaccine acceptance of adolescent girls in Ethiopia was low. Knowledge about the vaccine and attitude to vaccination were positively associated with their vaccine acceptance. Therefore, policymakers and program planners should target school-aged adolescents in increasing their awareness and changing their attitudes to enhance their vaccine acceptance in order to prevent and control cervical cancer.

A genetic linkage map of tef [Eragrostis tef (Zucc.) Trotter] based on amplified fragment length polymorphism

A genetic linkage map of tef was constructed with amplified fragment length polymorphism (AFLP) markers using F(5) recombinant inbred lines (RILs) derived by single seed descent from the intraspecific cross of 'Kaye Murri'×'Fesho'. A total of 192 EcoRI/MseI primer combinations were screened for parental polymorphism. Around three polymorphic fragments per primer combination were detected, indicating a low polymorphism level in tef. Fifty primer combinations were selected to assay the mapping population, and 226 loci segregated among 85 F(5) RILs. Most AFLP loci behaved as dominant markers (presence or absence of a band), but about 15% of the loci were codominant. Significant deviations from the expected Mendelian segregation ratio were observed for 26 loci. The genetic linkage map comprised 211 markers assembled into 25 linkage groups and covered 2,149 cM of genome. AFLP is an efficient marker system for mapping plant species with low polymorphism such as tef. This is the first genetic linkage map constructed for tef. It will facilitate the mapping of genes controlling agronomically important traits and cultivar improvement in tef.

Genetic characterization of two Eragrostis species using AFLP and morphological traits

Tef [Eragrostis tef (Zucc.) Trotter] is the most important cereal crop in Ethiopia. An experiment was conducted to investigate genetic diversity among four cultivars of tef and 14 accessions of Eragrostis pilosa using radiolabelled and silver stained amplified fragment length polymorphism. Morphological traits were also evaluated. A total of 897 markers were obtained out of which 395 were polymorphic using 11 primer combinations. Cluster analysis revealed accessions of E. pilosa which are distantly related and others closely related to tef. Our previous experience also indicates that E. pilosa is crossable with tef. Those accessions distantly related to tef could be used in a crossing program to generate a population for selection and/or genetic mapping. Such genetic mapping populations will form an important entry point towards the molecular genetic dissection of the plant genus, Eragrostis, especially in the context of comparative mapping. Knowledge gained from such study, apart from tef improvement, will also be useful for many forage and turf grass species where little molecular genetic information is available. Nine cultivars or accessions had one or more unique fragments using one or more AFLP primers indicating the potential of the technology in fingerprinting tef in a breeding or seed multiplication program. The results also showed that clusters obtained using silver staining and gamma 33P-ATP labeling were similar, suggesting that silver staining could be used as an alternative to radiolabeling at least in genetic diversity analysis. Significant genetic variation was obtained for morphological traits. Of particular interest to tef breeding was short plant stature in E. pilosa which could be transferred to tef to minimize the problem of lodging. Diversity revealed at the morphological trait level was not commensurate with that observed for AFLP. This was due to the small number of available morphological traits and their interaction with the environment.

Bridging the gap between undergraduate and graduate school

This article discusses the experiences of six junior nursing students enrolled in the Baltimore area University of Maryland System Schools of Nursing Bridge Program, a graduate school preparatory program. The Program fosters personal and professional growth of academically talented nursing students who aspire to be nursing leaders of the future. Bridge Program experiences have been overwhelming and challenging; yet, motivating. Benefits of the Program include increased exposure to people and technological resources as well as the creation of scholarly projects and presentations. Major challenges were time management and the production of scholarly work. Students share reasons for joining the Program, what it is like to be a Bridge student, benefits, challenges, and recommendations for future Bridge students.