Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study

Background

Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital.

Methods

A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis.

Results

The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09-11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79-11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08-9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85-12.43)], being referred [AHR: 2.90; 95% CI: (1.10-7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08-10.50)] were statistically significant predictors of puerperal sepsis.

Conclusion

The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis.

Lived Experience and Risk Reduction Behaviors Among Sero-Negative Discordant Male Partners Living with HIV-Positive Women in Addis Ababa, Ethiopia, 2019: A Qualitative Phenomenological Study

Objective

This study aimed to explore lived experience and risk reduction behaviors among sero-negative, discordant male partners living with HIV-positive women in Addis Ababa, Ethiopia, 2019.

Methods

A phenomenological study was conducted to explore lived experience and risk reduction behaviors. The study participants were purposively selected 13 sero-negative male partners living with HIV-positive women. An in-depth interview was used to explore important information. A semi-structured interview guide was used to execute the in-depth interview. The in-depth interview was analyzed thematically through the support of ATLAS-ti 7 software.

Results

Scientific explanation of discordant result is not well understood rather, it is associated with religious, cultural, natural resistance, and passive carrier explanations. Sero-negative partners faced several challenges and lived dilemmatic life related to partner mood or behavioral change, maintaining the marital relationship, the desire of child, psychosocial, sexual life, and lack of support system. Risk reduction behaviors like condom use, safe sex practice, preventing sexually transmitted infection, avoiding substance use, continuous checkup and follow-up were not well reflected in their lived experience and were poorly understood. Personalized use of sharp materials to avoid blood contact and support of a partner in the proper use of ART drugs were positively reported risk reduction behaviors.

Conclusion

Sero-negative partners need special attention just as HIV-positive partners in couples with the discordant result. Life suffering is not limited to HIV-positive partners, rather sero-negative partners also faced several challenges and dilemmatic life. HIV transmission risk reduction behavior is not well established and understood.

Rate of HIV Seroconversion Among Seronegative Male Partners Living with HIV Positive Women in Addis Ababa, Ethiopia, 2019: A Retrospective Cohort Study

Objective

This study aimed to assess rate of HIV seroconversion and predictors among seronegative male partners living with HIV-positive women in Addis Ababa, Ethiopia, 2019.

Methods

Institutional-based retrospective cohort was used to conduct the study. All eligible 227 sample medical records were used for the study. Kaplan–Meier analysis was used to estimate seroconversion time. Cox proportional-hazard regression was used to identify predictor variables.

Results

In this study, 227 seronegative male partners living with HIV-positive women were followed for 60 months retrospectively and 38 (16.7%) seroconversion was observed. The overall seroconversion rate was 6.4 (95%CI: 4.64–8.76) per 100 person-year observation. Time of antiretroviral therapy (ART) initiation, CD4 level, condom use, and having history of pregnancy after being diagnosed as discordant were identified significant predictors of seroconversion.

Conclusion

The risk of HIV transmission from seropositive partner to seronegative partner in a discordant couple is poorly controlled. Seronegative partners in discordant a couple can be seropositive at any time with influence of predictors unless proper protective measures, counseling, and follow-up are given emphasis.