Browsing by Author "Bitew, Tesera"

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    Effect of Antenatal Depressive Symptoms on Women’s Access to Healthcare and Perinatal Complications: A Population-Based Study in Rural Ethiopia
    (Addis Ababa University, 2017-03) Bitew, Tesera; Fekadu, Abebaw(PhD); Hanlon, Charlotte(PhD)
    Background Maternal Mortality in Low and Middle Income Countries (LMICs) remains a major public health challenge despite the encouraging achievement of the fifth Millennium Development Goal (MDG-5). Almost all (99.0%) of the global maternal deaths occur in LMICs where there are high resource constraints and low access to health care services. In Sub-Saharan Africa, more than half of perinatal women have no access to maternal healthcare services. The situation is reflected in Ethiopia where only 34% of women attended for antenatal care (ANC) and skilled practitioners attended only 26% of deliveries in 2015. Mental disorders, especially depressive disorders, are also common affecting about one in seven perinatal women. Perinatal depression has been shown to be an independent risk factor for maternal healthcare service utilisation on behalf of the child but there has been little exploration of its potential impact on utilisation of maternal healthcare services. Objective The main objective of this study was to investigate the impact of antenatal depressive symptoms on utilisation of maternal healthcare services (antenatal care, uptake of institutional delivery and postnatal care use) and its effect on perinatal complications. Methods Study Design: The study that formed the basis of this thesis was a population-based study that comprises three sub-studies linked to three main outcomes. Sub-study-I was a cross-sectional study carried out at the initiation of the prospective study. Sub-study-II and III were prospective follow-ups of participants identified with probable depression in sub-study-I to assess impact of depressive symptoms on (a) institutional delivery and postnatal care use; b) perinatal complications respectively. Participants: The participants were pregnant women in their second and third trimester residing in Sodo District, Gurage Zone, Southern Nations, Nationalities and Peoples Region of Ethiopia. Eligibility Criteria included: (1) Age 15 years and above; (2) permanent residence as defined by continuous residence in the area for at least the preceding six months; xiv (3) Able to provide informed consent; (4) Not having hearing or cognitive impairment to the extent of impairing capacity to give informed consent or to communicate adequately. Assessments: During baseline assessment, at the second and third trimesters of pregnancy, participants were screened for antenatal depressive symptoms and background demographic and socio-economic information along with other potential confounders such as intimate partner violence, social support, history of chronic medical conditions and adverse perinatal outcomes. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire-9 (PHQ-9). Participants scoring five or more on the PHQ-9 were considered to have probable antenatal depression. ANC attendance and pregnancy related emergency healthcare visits were cross-sectional outcomes that were assessed as part of the initial baseline assessment. At a median of eight weeks after childbirth, the participants were re-interviewed about their place of delivery, attendance of postnatal care services and whether they had experienced an of perinatal and postpartum complications. Statistical Analysis: Poisson and Negative binomial regression models were used for cross-sectional evaluation of the association of antenatal depressive symptoms with antenatal service use and pregnancy related emergency healthcare provider visits. Binary logistic regression was used to examine the association of antenatal depressive symptoms with early initiation and adequacy of ANC services. Binary logistic regression was also used to examine association of antenatal depressive symptoms with uptake of institutional delivery, having assisted delivery and women’s experience of perinatal complications. Results Participant Characteristics: Among study participants, 98.7% were married, 67.5% were non-literate, 92.2% were rural residents and the mean age of the participants was 26.8 years. The majority (64.8%) of women initiated ANC visits (37.0% by 16 weeks gestation) and nearly two-thirds (62.3%) delivered in healthcare institutions. Baseline (Cross-sectional) Study: At PHQ-9 cut-off of five or more, 29.5% of baseline participants and 28.7% of followed up participants had probable antenatal depression. Women with depressive symptoms had an increased risk of having greater number of un-scheduled ANC visits (adjusted Risk Ratio (aRR)=1.41, 95% CI: 1.20, 1.65). These group of women also had an increased number of emergency healthcare provider visits to both xv traditional healthcare providers (aRR=1.64, 95% CI: 1.17, 2.31) and biomedical healthcare providers (aRR=1.31, 95% CI: 1.04, 1.69) for pregnancy-related emergencies. Prospective Studies: Women with probable antenatal depression also had increased odds of reporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval (CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR=1.72, 95% CI: 1.10, 2.69) than women without these symptoms. In sub-group analysis of women with institutional deliveries, the increased odds of institutional delivery was associated with emergency reasons during labour (aOR = 1.62, 95% CI: 1.09, 2.42) rather than pre-planning to deliver in healthcare institutions. Furthermore, there was increased odds of pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and postpartum (OR=1.70, 95% CI: 1.23, 2.35) complications among these group of women compared to women without antenatal depressive symptoms. However, antenatal depressive symptoms were not significantly associated with early initiation of ANC or postnatal care visits, pregnancy loss or neonatal mortality. Conclusion Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, has the potential to reduce treatment costs and promote efficiency of the health care system through increased use of scheduled ANC and planned uptake of institutional delivery. It also has potential to reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality, as well as improved neonatal health. But, further studies should ensure whether early detection and treatment of depressive symptoms may reduce the risk of perinatal complications.
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    Investigating Into the Major Factors Responsible For the Spread of the Hiv/Aids Epidemic in Addis Ababa and Nazareth
    (Addis Ababa University, 2007-06) Bitew, Tesera; Sa, Bidyadhar (PhD)
    The only way to solve the problem of I-f/VIAIDS is prevention than treatment by identifYing the major f actors responsible for its drastic distribution. This paper tries to find the major factors that are responsible for the distribution of HIV AIDS in Addis Ababa and Nazareth. Therefore, the objective of this paper is to find out the major f actors thaI are responsible for the distribution of HIV epidemic. Specifically, it is intended to: 1. identifY the demographic factors those are associated with HIV 2. identifY the unique behavioral characteristics that lead to HIV infection 3. explore the effect of socio-cultural factors on HIV distribution 4. explore the impact of the socio-economicfactors on HIV distribution The study was conducted by distrib liling questionnaires with four categories of questions to HIV victims waiting medication in hospitals and in Dawn Hope of Ethiopia offices. The data are then analyzed by categorizing to four sections I) Analysis of behaviors versus demographic variables, 2) Behavioral versus Behavioral variables, 3) Behavioral versus economic variables and 4) Behavioral versus social-cultural variables. The data collected from 100 HIV patients in hospitals and Dawn Hope of Ethiopia in Addis Ababa and Nazareth is analyzed by using cross tabulations andfrequency tables to observe the association of one variable on the behaviors of individuals that are susceptive for HIV infection. To decide on the existence of association between a pair of variable using chi square test of independence, coefficient of contingencies were computed Variables that are associated with some behaviors such as lIIultiple sexes, drug addiction and others are explained in cross tabular forms and bar charts. The result indicated that the behavioral variables such as drug addiction, openness and interest to exchange about HIV and Condoms and the demographic variables such as sex, marital status, age and place of birth are the major factors for the distribution of HlVIAIDS follow ed by socio-economic factors such as occupation, average income and housing issues. But the socio-cultural factors such as rape, tal/ooing, ear piercing and FGM are found to have insignificant effect on the distribution of HIVIAIDS in Addis Ababa and Nazareth.