Home based postpartum care and determinants in Ethiopia: A multilevel analysis

Introduction

Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia.

Methods

A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care.

Conclusion

Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother’s knowledge about neonatal danger sign.

Perception towards preeclampsia and perceived barriers to early health-seeking among pregnant women in selected Hospitals of South Gondar Zone, Northwest Ethiopia: A qualitative study

Background

Preeclampsia is one of the top maternal morbidity and mortality that disproportionately affects pregnant women in low and middle-income countries where access and quality of health services are limited. People in different areas perceive preeclampsia differently which directly or indirectly affects the timing and place of heath seeking. Positive perception about perceived causes, perceived complications, and prevention of preeclampsia is central for the prediction and early diagnosis of the disease. However, little is known about the perception of pregnant women towards preeclampsia in Ethiopia. This study aimed to assess the perception towards preeclampsia and perceived barriers to early health-seeking among pregnant women in selected Hospitals of South Gondar Zone, Northwest Ethiopia.

Methods

A qualitative study using phenomenological approach was implemented among 20 purposively selected pregnant women who visited health facilities for antenatal care service in four selected Hospitals of the South Gondar Zone of the Amhara Region. Data were collected through an in-depth interview (IDI) using a semi-structured interview guide from January to February 2020. Thematic analysis was executed using Open Code Software version 4.03.

Results

The majority of the participants believed preeclampsia as a pregnancy-specific hypertensive disease and mainly associated it with overweight and nutritional problems. With regards to the perceived severity, the study participants agreed that preeclampsia can lead women to death. Personal delay, lack of awareness about the disease, transport problem, and low socioeconomic condition were perceived as the major reasons for the delay to early health-seeking (the 1^st and the 2^nd delay). While poor service provision and long waiting times were the barriers to receive services at the health facility level (the 3^rd delay).

Conclusion

The majority of the participants believed preeclampsia as a pregnancy-specific hypertensive disease and mainly associated it with overweight and nutritional problems. The finding of this study implied that awareness creation about the danger of hypertension during pregnancy and its risk reduction mechanisms shall be emphasized. The care provision at health facilities shall be improved by decreasing long waiting time which discourages service utilizations aside from improving early seeking behavior of pregnant women through different interventions.

Correlations between directional and orientational tuning of cells in cat striate cortex

Simple (N = 284) and complex cells (N = 125) in the central projection area (0-5 degrees eccentricity) of the striate cortex of cats were stimulated with moving light bars and the responses to different directions of movement were recorded and plotted as polar-plots. Fourier analysis was applied to polar plots (SDO-analysis, Wörgötter and Eysel 1987; Wörgötter et al. 1990) to determine the general sensitivity (S) of the cells to visual stimulation, the directional (D) and orientational (O) tuning strength as well as preferred direction (PD) and preferred orientation (PO). Statistical distributions of the S, D and O parameters were determined for simple and complex cells of the cortical layers II-VI. Simple cells were more strongly tuned for direction and orientation than complex cells, whereas complex cells had a greater general sensitivity to visual stimulation. Directional tuning was significantly stronger in layer VI than in layer IV simple cells, otherwise no differences were detected between these two layers. We found that cells with large D and small O components are generally rare. The D and O components were plotted against each other to determine any possible correlation between the tuning strengths. The correlations were statistically significant for simple and complex cells but the correlation coefficients were very small (r less than 0.3). It is suggested that only a very weak coupling between directional and orientational tuning exists, preferentially in the deeper layer simple cells.

Lateral interactions at direction-selective striate neurones in the cat demonstrated by local cortical inactivation

1. Single neurones were recorded with glass-coated tungsten electrodes from area 17 of the cat's visual cortex. The cats were anaesthetized and artificially respirated with a mixture of halothane, nitrous oxide and oxygen. 2. For local cortical inactivation a multibarrel pipette was placed 0.5-2.5 mm posterior (or anterior) to the recording site, at a depth of 400-600 micron. Four separate barrels of the pipette were filled with gamma-aminobutyric acid (GABA); the fifth was filled with Pontamine Sky Blue for labelling of the centre of the inactivation site. 3. Direction-selective cells, of differing optimal orientations and preferred directions of motion, were classified as simple or complex and tested with computer-controlled stimuli presented on an oscilloscope. 4. During continuous recording GABA was microionophoretically applied for different durations and with different ejection currents. The effectiveness of GABA microionophoresis was evident from the direct GABAergic effects (strong overall inhibition of the recorded cells) observed with high ejection currents and prolonged application. 5. Two discrete effects could be observed during local inactivation distant from the cortical cell under study: an increase of the response in either the non-preferred or the preferred direction; or a decrease of the response in the preferred direction. All GABA-induced changes were reversible. 6. The depressant action of GABA was independent of the relative topography between recording and inactivation site and affected mainly the response to the preferred direction of stimulus motion. 7. Disinhibition was only observed when the stimulus-evoked response moved on the cortical map in a direction from the GABA pipette towards the recording electrode. It is concluded that GABA reversibly silences inhibitory interneurones that are situated in the vicinity of the micropipette tip and are involved in generation of direction selectivity. 8. No fundamental differences between cells from different cortical layers were observed. The disinhibitory effects of GABA inactivation were more pronounced and more frequently seen in simple cells (61%) than in complex cells (38%), while the opposite was true for reduced excitation during lateral GABA inactivation (observed in 62% of the complex vs. 39% of the simple cells). Accordingly, lateral inhibition statistically prevails in simple cells and lateral excitation in complex cells. 9. Among the inhibitory and excitatory mechanisms affected by lateral GABA inactivation, inhibition is organized with a higher topographic specificity.(ABSTRACT TRUNCATED AT 400 WORDS)