Browsing by Author "Fantahun, Mesganaw (PhD)"

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    Birth Preparedness, Complication Readiness, Neonatal Care Practices and Their Effect on Neonatal Health Status in Jimma Zone, Southwest Ethiopia
    (Addis Abeba University, 2015-02) Tura, Gurmesa; Fantahun, Mesganaw (PhD)
    Background In spite of global efforts for many decades, saving the lives and improving the wellbeing of neonates have been global challenges. Recent estimate shows that about 3 million neonates die each year globally. The greatest burden (98%) of this neonatal death is shouldered by the low and middle-income countries. In Ethiopia, despite promising achievement in under-five mortality reduction, the rate of decline in neonatal mortality remained very slow, with recent status of 37 deaths per 1000 live births. Birth preparedness and complication readiness and the minimum neonatal care package along the continuum of care starting form pregnancy, during labour and delivery and the immediate postpartum period have been identified as comprehensive strategies to address the high neonatal mortality. However, the status of birth preparedness and complication readiness, the provisions of the minimum neonatal care package, their determinants and effects on neonatal health status have not been well investigated at the local context. Moreover, studies on the causes and determinants of the high neonatal mortality in Ethiopia in general and in Jimma Zone in particular are very scarce. Thus, there is a need to conduct a study and identify gaps for policy and program improvement. Objectives The objectives of the study were to assess the status of birth preparedness, complication readiness, neonatal care practices and their effect on neonatal health status in Jimma zone, Southwest Ethiopia. Methods This study was conducted in Jimma Zone, Southwest Ethiopia, from September 2012 to December 2013. Mixed study designs, including cross-sectional and prospective follow up, involving both quantitative and qualitative methods were employed. A sample of 3612 pregnant women, who were identified from 73 clusters selected by multistage sampling techniques were included in the study. Community based surveys by using structured interviewer-administered questionnaires were conducted to collect the quantitative data. In-depth interviews and focus group discussions were conducted with purposively selected participants to collect the qualitative data. Descriptive analyses were done by computing ix summary statistics and proportions. Univariate, bivariate and multivariate analyses were done based on the objectives of the study. Because of the multistage-clustered sampling method, multilevel analyses were done to identify factors affecting the outcomes of interest at different levels. Odds ratios and β-coefficients along with 95%CI were used to show the strengths of associations. Verbal autopsies were also conducted to ascertain the causes of neonatal death. The qualitative data were transcribed in to English and analysed thematically. Results From 3612 pregnant women enrolled to the study at the baseline, 3463 live births occurred and included in the final analysis making a response rate of 95.9%. The status of birth preparedness and complication readiness practice was 23.3% (95% CI: 21.8%, 24.9%). Place of residence and access to health centres were cluster level factors having significant association with birth preparedness and complication readiness. Maternal educational status, husband‘s occupation, wealth quintiles, knowledge of key danger signs during labour, attitude towards birth preparedness and complication readiness and antenatal care use were identified as individual level factors affecting birth preparedness and complication readiness. The coverage of skilled care use in this study was 17.5% (95% CI: 16.2%, 18.8%). The most common reasons for not using skilled care were lack of transport (31.1%), home delivery was the usual place (24.0%) and perception that home delivery was more comfortable (23.1%). Place of residence and access to health centres were identified as higher-level factors affecting skilled care use. Maternal educational status, husband‘s occupation, wealth quintiles, gravida, inter-birth interval, knowledge of key danger signs during labour, antenatal care use and birth preparedness and complication readiness plan were identified as lower level determinants of skilled care use. The status of neonatal care practice was 59.5% (95%CI: 57.6%, 61.3%). Place of residence, maternal education, husband‘s occupation, wealth quintiles, birth order and inter-birth interval were identified as factors affecting neonatal care. x This study found neonatal mortality rate of 35.5 (95%CI: 28.3, 42.6) per 1000 live births. Birth asphyxia (47.5%), neonatal infections (34.3%) and prematurity (11.1%) were the three leading causes of neonatal mortality. Cluster-level variables were found to have non-significant effect on neonatal mortality. Individual-level variables such as birth order, frequency of antenatal care use, delivery place, gestational age at birth, premature rupture of membrane, complication during labour, twin births, size of neonate at birth and neonatal care practice were identified as determinants of neonatal mortality. Conclusions The statuses of birth preparedness and complication readiness as well as skilled care use were found to be low in the study area. Though the status of neonatal care practice was relatively better, neonatal mortality was found to be high. The higher-level factors had significant effects on birth preparedness and complication readiness, skilled care use and neonatal care practice, but had non-significant effect on neonatal mortality. Instead, individual level factors related to intra-partum conditions and care as well as neonatal conditions and care had significant effect on neonatal mortality. Birth preparedness and complication readiness had significant effect on skilled care use, but had non-significant effect on neonatal mortality. Neonatal care practice had significant effect on neonatal mortality. The study identified birth asphyxia, neonatal infections and prematurity as major causes of neonatal death. Recommendations Increasing access to health facilities and means of transportation, strengthening community-based interventions to promote skilled care use, reducing the delays in care seeking for obstetric complications and neonatal care practices are recommended. Besides, designing appropriate context specific behaviour change communication strategies both at the facility and at the community levels to improve service use and minimize the existing barriers are needed. Key words: Birth preparedness, complication readiness, skilled care, neonatal care, neonatal mortality, Southwest Ethiopia
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    Comparison of CBD, Non-CBD, and Former CBD Areas to Assess Effectiveness of Community Based Family Planning Services
    (Addis Abeba Universty, 2000-12) Genna, Shimeles; Fantahun, Mesganaw (PhD)
    This is a retrospective cohol1 study designed to assess the effectiveness of COJ1U11l111ity based Family planning services in Eastern Showa Zone. The study was carried out in 30 PAs selected from five districts, where ten PAs were randomly selected from three areas: Community based distribution (CBO), Former community based distribution (FCBO) and Non-Community based distribution (NCBD) areas. A multistage sampling technique was used to select 310 women in the reproductive age groups( 1 5-49 years)for interview in each of the study areas. A questionnaire survey and focus group discussions were the methods of data collection. Focus group discussion was conducted among women aged 25- 35 years and 45-55 years, as well as among community representatives selected fi'om the study areas. Knowledge about modern contraceptive methods was significantly higher in the CBO communities, propOl1ion of women knowing one method being 89.1 % in CBO area compared to 76.6% in FCBD and 32.2% in NCBD. The most widely known MCM was pill followed by inj ectable hormone. The proportion of women who ever used MCM was significantly higher in CBO area. Ever use rate of of MCM was 57.2% in CBO, 39.2% in FCBD, and 18.3% in NCBD communities; Where as 43.4% ,22.7% , and 7.6% of the respective areas were current users, which was also a significant difference. In all areas over 65% of those who never used MCM expressed intention to use in the future. Although, clients in the CBD area generally claim to be satisfied with the service, they complained of being influenced by service provider. Most respondents approved family planning use. CBD area clients were found to use MCM relatively longer than NCBD area clients. Forty two percent ofCBO, 33.3% of FCBO, and 35.3% ofNCBO area clients used their method at least for one year. vii Lack of adequate information in non-CBD area and need for more chi ldren in CBO area were the major reasons for non-use offamily planning methods. Need for (more) children and side-effects were the major reasons mentioned for use di sco ntinuation in all of the three study areas. Controlling for possib le confounders the presence of community based family planning service was fou nd to be the most important ex planatory variable for increased current use of MCM. Therefore, a quality community based FP service is highly recommended in NCBO areas and fu rther study is necessary to look for fea sible mechanisms to sustain the service.
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    Early Discontinuation Rate of Implanon and Its Associated Factors among Women Who Ever Used Implanon in 2012/2013 in Ofla Woreda, Tigray, Northern Ethiopia,2014
    (Addis Ababa University, 2014-06) Birhane, Kalayu; Fantahun, Mesganaw (PhD)
    Background: Contraceptive use plays an important role in reducing fertility; and at times contraceptive prevalence has been used to evaluate the effect of family planning programs. Quality of family planning services is an important determinant of contraceptive use because it is likely to affect contraceptive adoption and, more significantly, contraceptive continuation i.e. poor access to quality Family Planning services, high discontinuation rate and low motivation to use modern FP methods. Objective; the objective of the study was to determine early discontinuation rate of Implanon and to identify its associated factors among women who ever used implanon in 2012/2013 in Ofla woreda, Tigray, North Ethiopia ,2014 Methods: a community based cross sectional study design with structured and pre tested questionnaires was administered for 244 participants from January 20-March 09, 2014. Six data collectors and two supervisors who were trained on the objective of the study and data collection techniques to administer the questionnaire were recruited in the data collection process. All women who ever used implanon in 2012/2013 were included in the study and the data was collected house to house by taking the list of the participants from the family planning registration book of each Health institutions. The data was entered and cleaned in Epi Info by the principal investigator then exported to SPSS version 20 for analysis. Multivariate Logistic regression was used identify factors associated with early discontinuation of implanon. Result: The mean (±SD) ages of the participants were 26.9±6.9 years. More than half of the participants 168(68.9%) were married, and 199(81.6%) were farmer by occupation. The overall early implanon discontinuation rate in this study was 16% with mean duration of implanon use of 6.6±2.8 months. The main reason for early discontinuation of implanon was Health concerns and side effects followed by desire to have more children. Women who have developed side effects during using of implanon, women who didn’t appointed for follow up and women who didn’t satisfied by the service given during the implanon insertion were the predictors of early implanon discontinuation. Conclusions: early implanon discontinuation rate in this study was in a considerable number and the main reason for discontinuation was Health concerns. Pre insertion counseling, close monitoring and follow up of implanon users should be made to increase implanon continuation rate
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    The Effect of Living Arrangements and Parental Attachment on Sexual Risk behaviors and Psychosocial Problems of Adolescents in Dessie Preparatory School, Ethiopia
    (Addis Abeba Universty, 2004-04) Shiferaw, Solomon; Fantahun, Mesganaw (PhD)
    The family environment is critical in supporting healthy adolescent development. Following the opening of technical and preparatory schools in Ethiopia, it has become necessary for students particularly of the rural areas to move to the nearby towns for the duration of their training. However, whether adolescents who come from rural areas (who might lack consistent adult supervision and exposed to a relatively new environment) are having an elevated sexual-risk taking behavior and more psychosocial problems remain unanswered. In an attempt to respond to questions posed on these differential vulnerabilities of adolescents, a comparative cross-sectional study that examined the effect of living arrangement and parent-teen connectedness on sexual risk behaviors and psychosocial problems of students was conducted in Dessie preparatory school, Ethiopia. A sample of 667 students (512 male and 155 female) completed a pre-tested structured anonymous questionnaire. Qualitative information was obtained from four focus group discussions and sixteen peer-to-peer interviews segregated by gender and residence. We found that living with friends (OR=2.77; 95%CI=1.47, 5.24), alcohol consumption (OR=1.94; 95%CI =1.24, 3.04), lower perceived family connectedness (OR=0.97; 95%CI=0.95, 0.99) and parental monitoring (OR=1.70; 95%CI=1.06, 2.73), older age (OR=4.37; 95%CI=2.11, 9.04), having peer pressure (OR=1.82; 95%CI=1.20, 2.77) and peers who are sexually experienced were associated with increased odds of sexual activity. Having a depressive symptom was associated with female gender (OR=1.96; 95%CI=1.18, 3.23) , lower family connectedness (OR=0.96; 95%CI=0.94, 0.99), lower grade-pointaverage (OR=1.93; 95%CI=1.01, 3.71), and living with friends (OR=3.16; 95%CI=1.66, 5.00), relatives (OR=2.52; 95%CI=1.28, 4.95) or alone (OR=2.15; 95%CI=1.04, 4.46). The study revealed that suicide attempt in the past 12 months was linked to having a history of suicide attempt in the family (OR=2.59; 95%CI=1.09, 6.15) or among friends (OR=4.32; 95%CI=1.88, 9.94), female gender (OR=2.60; 95%CI=1.05, 6.48) and sexual activity (OR=3.00; 95%CI=1.27, 7.11). viii The overall research finding indicate that living with both biological parents and good parentteen connectedness are related to better psychosocial health and being sexually abstinent. The evidence from this study suggests that parents need to know the continued importance of having good relationship with their adolescents. Youth programs should also address the central role of familial influences (specifically high levels of parental connectedness and monitoring) in protecting boys and girls from unsafe sexual behavior and psychosocial problems. Additional research needs to explore the impact of familial influences on adolescent reproductive and psychosocial health and preferably use longitudinal designs to determine the stability of the observed association over time. Key words: Adolescents, living Arrangements, parental attachment, sexual risk behaviors psychosocial problems, Ethiopia.
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    The Link Between Contents and Perceived quality of Antenatal Care With low Birth Weight among Term Neonates in Public Health Facilities of Bahir Dar Special Zone, North West Ethiopia
    (Addis Abeba Universty, 2015) Mitiku, Kindie; Fantahun, Mesganaw (PhD)
    Background: Low birth weight is not only an indicator of neonatal mortality and morbidity but also a morbidity risk in later life. Antenatal care is one of the evidence based interventions to decrease the probability of adverse birth outcomes such as low birth weight and preterm births. The effectiveness of antenatal care, however, relies on the quality of care and specific contents provided during each antenatal care visits. But, little information is available whether antenatal care contents and perceived quality are linked with weight at birth. Therefore, this study is aimed to assess the link between contents and perceived quality of antenatal care with low birth weight among term neonates in selected health facilities of Bahir Dar, North west Ethiopia. Methods: Facility based unmatched case control study was conducted among mother-newborn pairs in Bahir Dar special zone selected public health facilities. One referral hospital and four public health centers were selected for this study. The health centers were selected by random sampling technique whereas the referral hospital was selected without undergoing further sampling procedures (as it is the only public hospital in the study area). The sample size was calculated by using EPI info version 7.0 by considering ratio of control to case 2:1, power of 80%, confidence level of 95%, precision level of 5%, odd ratio of 2.014 and percentage of control exposed 21.39. Cases were selected consecutively where as two controls were assigned for each cases. Data was entered by using Epidata version 3.1 and then exported to statistical package for social science version 21 for analysis. Bi variant analysis was done to compare birth weight by each explanatory variable using binomial logistic regression. The adjusted odd ratio was used to determine strength of the association and the corresponding confidence interval was used to decide whether there was a statistical significant between the explanatory and outcome variables. Result: Among the contents of antenatal care, dietary advice AOR 2.29(CI 1.03-5.11) and iron intake of ≥30 days AOR 2.93(CI 1.34-6.42) were significantly associated with low birth weight at term. However, no significant association was observed between antenatal care level of satisfaction and low birth weight at term. Additionally, wealth, household food insecurity, number of ANC<4 and poor nutritional status of the mothers were significantly associated with low birth weight at term. Conclusion and recommendation: In this study setup, the risk of LBW at term was significantly associated with lack of antenatal care contents such as dietary advice and iron intake. It was also associated with other modifiable risk factors such as household food insecurity, wealth and nutritional status. Therefore, public health interventions targeting on antenatal dietary advice and iron intake preferably ≥ 30 days by giving special emphasis for poor and food in secured women during pregnancy is recommended to reduce LBW at term in this study setup.
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    Magnitude of Missed Opportunities on Infants Under one year Routine Immunization Services and Associated factors in Wolikte Health Center, Gurage Zone, Southern Regional State, Ethiopia, 2015,
    (Addis Abeba Universty, 2015-07) Assefa, Melese; Fantahun, Mesganaw (PhD)
    Background: Under five years deaths can be prevented through optimal use of currently existing vaccines. In 2012 nearly one in five infants missed the basic vaccines they need to stay healthy globally, and majority of the children missed in sub Saharan Africa including Ethiopia. Missed opportunities are an obstacle to raise immunization coverage among children and leading high infant morbidity and mortality. Objective: The objective of this study was to determine magnitude and the related factors for missed opportunity of routine immunization of infants under one year age in Wolikite health center Gurage zone, southern regional state, Ethiopia, May 2015 Methodology: The study was health facility based cross sectional design. Exit interview was administered for mothers who had under one infants and who came for any services for their infant at Wolikte health center, Gurage zone from March 27- April 22, 2015 using standard world health organization missed opportunity tool in the context of Ethiopia routine immunization schedule. The sample size was calculated by using single proportion formula with 95% confidence interval and a total of 346 mothers were interviewed. Result:The magnitude of missed opportunity for the study was 49.1% and the major vaccines with high missed opportunity were oral polio vaccine o (37.9), (Bacille Calmette Guerin 35), and measles (31.1) the major reason for immunization for missed vaccines was due to absence of adequate number of children to conduct immunization sessions which was around 81.2% among children who had missed opportunities. Age of children, stock out experience of care takers, knowledge of contact time and purpose of visit to health facility were independently associated factors for children missed opportunity of immunization. Conclusion: The overall magnitude of missed opportunity for the routine immunization is high influencing the success of immunization services. The major vaccines which highly contributed for the prevalence of immunization missed opportunity were measles, and Bacille Calmette Guerin and oral polio vaccine.
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    Measuring unmet need for family planning among wives husbands & couples
    (Addis Abeba Universty, 2005-04) Mubarik, Kerimudin; Fantahun, Mesganaw (PhD)
    Since husbands & wives differ in fertility desire and intention to use contraception which implies spouses individually & as couple have different level of need regarding contraception. To estimates unmet need level for contraception of couples data from both spouses are required; so community based cross sectional study was conducted between Jan 3-Jan 17, 2005 in six kebeles of Harar city, eastern Ethiopia. After 19 Kebeles of the city was stratified in to three strata based on socio-economic factors, two Kebeles from each of the three strata was selected by simple random sampling. 1/6th of sample size was selected from each of the 6 kebeles by systematic sampling. The study units were married couples with wives age ranges 15-49 year. Four hundred sixty couples were interviewed using pre tested questionnaires. Data were collected from both spouses regarding fertility desire & its timing; wanted-ness and timing of pregnant/lactating women at the time were used to determine level of un-met need among husbands, wives & couples and also to assess factors associated with un-met need. A minimum estimate of unmet need for contraception of couples not practicing contraceptives is produced when both partners have unmet need & a maximum estimate of unmet need for contraception of couples not practicing contraceptives occurs if either spouse having unmet need defines unmet need. Husbands are found to have more children and sooner than wives and wives have more desire to limit and intend to use contraceptives than husbands. Unmet need estimate level for wives’, husbands’ and coples’ (minimum) were found to be 15.3%, 16.5% and 4.7% respectively. All figures are (below expectation) very low in comparison to other study results. For example when compared with 36% unmet level for married women by the DHS Ethiopia survey with the one obtained from this study it is very low (15.3%). This is probably due to the constellation of the following factors. The presence of two hospitals, FGAE clinic & other facility in the city of harar, 86% of all couples in the study have alive vi children & out of them 58% have at least two children; more than 78% of couples reported usage of a method in the past, only 19% of wives and 10% of husbands are illiterates, mean time to reach the service point was is only 30 minutes, more than 82% of couples approve contraceptive use, 60% of couples have discussed contraceptive issue in the last six months, more than 90% of couples heard and knew about contraceptives, 67% of couples have both T.V and radio; resulting in higher contraceptive prevalence which is 69% for wives and 66% for husbands. Amongst the factors considered to be associated with unmet need like age, education, number of alive children, knowledge & attitude towards contraceptives and so on; only perceived approval of contraceptives use by spouses and discussion about contraceptives between spouses are found to be associated significantly (p=.00) (table8 ,9). This warrants promotion and promotion activity to enhance communication between spouses. Incorporating reproductive health need of male in the over all reproductive health planning and service delivery and to make them male friendly is very important.(3) Endeavour to enhance prevalence of permanent contraceptive methods including vasectomy, which is very low at the moment, for limiters. Studies on family planning should include both women and men to enhance successful family planning service delivery that targets couples.