Browsing by Author "Worku, Alemayehu"

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    Assesment of Predictors of Survival in Patients living with Hiv/Aids after the Advent of Highly Active Antiretroviral Therapy in Addis Ababa Ethiopia
    (Addis Abeba Universty, 2009-06) Bedru, Abdo; Worku, Alemayehu
    BACKGROUND: The introduction of highly active antiretroviral therapy in 1996 dramatically improved survival and quality of HIV-infected patients in the industrialized world. This survival benefit of HAART in HIV infection has been well studied in the developed world. In resource-poor settings, where such treatment was started only recently, limited data exist on treatment results. More over mortality have been high particularly in the first month of initiating ART and factors contributing to this high mortality are poorly understood. OBJECTIVE: To asses predictors of survival in PLWHA after the advent of HAART. METHODS: A historical cohort study was conducted in Zewditu Hospital located in Addis Ababa, Ethiopia. Patient’s records enrolled between March, 2005 to July, 2008 were reviewed consecutively using patients ART unique identification number as a reference. Different documents for the same patient were triangulated in case of odd values, non logical or missed data. Deaths from all AIDS related cause occurring during the follow-up period were identified from physician reports or registration by drug adherence counselor. Univariate analysis was used to describe patient’s baseline characteristics. Actuarial table was used to estimate survival after intiation of ART, and log rank test was used to compare survival curves. Cox proportional-hazard regression was used to calculate the bivariate and adjusted hazard rate and then determine independent predictors of time to death. RESULT; One thousand seventy patients on ART were followed for a median of 34 month (IQR 6, 36.25). The mean age was 36.4 and the median weight of the cohort at the initiation of ART was 51kg (IQR, 45-60kg).The median CD4 count was 94cells/μl (IQR, 46-154). The estimated mortality was 24.9%, 29%, 31.7%, 33.1%, 33.5, and 34% at 6, 12, 18, 30, and 48 months respectively. After adjustment, the independent significant predictors of not surviving in patients living with HIV/AIDS after initiation of ART remain poor ART adherence (AHR=3.92[95%CI=3.13, 4.90]),Advanced WHO staging (AHR=2.47[95%CI= (1.58, 3.81]), being unemployed (AHR=1.87[95%CI= 1.49, 2.34]), moderate anemia (AHR=1.86[95%CI=1.35, 2.56), and Low CD4 count (AHR=1.85[95%CI= 1.35, 2.52]). CONCLUSION; A careful monitoring of patients with low CD4+ ,advanced WHO staging, moderate anemia and unemployed particularly during the first 3 months of HAART is necessary. Tracing poorly adhered patients and giving them drug counseling is crucial to improve their survival.
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    Determinants of Skilled Maternal Care Utilization: a Multilevel Analysis Using Mixed Method Investigation in North Gondar Zone, North West Ethiopia
    (2013-09) Gebeyehu, Abebaw; Worku, Alemayehu
    Historical and ecological evidences indicate that maternal care by skilled providers is one of the key strategies for maternal survival. However, the rate of maternal service utilizations and reduction of maternal mortality are very low in Ethiopia. Several factors, which vary according to different contexts and operate at different levels, can affect the utilization of skilled maternal care. Hence, a level-by-level analysis of all sources of poor skilled maternal care utilization has strategic relevance for the country. Objective This study was designed to describe skilled maternal care utilization and to identify associated factors operating at different levels Methods The study included a linked facility and population-based survey to assess the availability, utilization and correlates of maternal service utilization, and a prospective cohort study to evaluate the effect of the available skilled maternal care in reducing adverse pregnancy outcomes. The linked survey was conducted over three months (January - March 2012) in twelve randomly selected kebeles, their nearby twelve health centers, and three hospitals of North Gondar Zone, while the cohort study was conducted in 10 kebeles of Dabat district from December 1, 2011 to August 31, 2012 on 763 pregnant women. Data on potential correlates of skilled maternal care utilization were gathered using quantitative and qualitative data collection techniques. In the cohort study, data was collected at four time points: first contact, during the 9th month of pregnancy, within one week after delivery, and on the forty-second day of postpartum. During analysis, the effect of potential confounders was controlled using logistic regression models. The effect of cluster variation and a number of individual, communal (kebele), and facility-related variables for skilled maternal care utilization was examined using the multilevel modelling. Results All indicators of skilled maternal care service utilization were very low in North Gondar. Out of the total 1668 women, only 32.3%, 13.8%, and 6.3% utilized skilled providers for their routine XIV antenatal, delivery, and postnatal care, respectively. Most of these services were at health centers by nurses or midwives. Of the 476 women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Antenatal and delivery care were available in most of the visited facilities. However, important components of both the routine and emergency maternity services were incomplete. Signal functions including the administration of anticonvulsants and assisted vaginal delivery were missing in seven and five of the 12 health centers, respectively. The proportion of women according to the type of service they received at the time of their antenatal care was 79% (blood pressure checkup), 35% (urine testing), 45% (tetanus immunization), 64% (iron supplementation), 51% (birth preparedness counseling) and 71% (HIV testing). During delivery, only 24% of the providers used partograph consistently. In many of the facilities, important pieces of equipment were either absent or not functional. Most of the health centers also lacked laboratory tests, such as VDRL, hemoglobin, urine protein, and cross match. Interviewed midlevel providers had no adequate training on essential procedures like assisted vaginal delivery (vacuum extraction), manual vacuum aspiration, or evacuation and curettage. In addition, about one-third of the providers had no skill to manage preeclampsia and post-abortion complications. The multilevel analysis showed a significant heterogeneity among clusters for each indicator of skilled maternal care utilization (ANC, delivery and PNC). At the individual level, preference for skilled providers and previous experience of antenatal care were consistently strong predictors of all indicators of skilled maternal care utilization. First birth order, maternal education, and awareness about health facilities to get skilled professionals were significantly associated with skilled antenatal and delivery care utilization. At this level, variables related to awareness and perceptions were more important. At communal and facility level; cost requirements at health facilities, having different sources of income to cover transport and service costs, and the availability of important service components at health facilities were among the factors affecting skilled maternal care, especially delivery service. Seeking skilled care for complications was significantly affected by wealth, ANC use, and the readiness of a woman for possible complications. The follow-up study showed that the chance of the occurrence of adverse pregnancy outcomes was reduced by 9% (OR=0.91; 95% CI: 0.43, 1.69) among mothers with less than four ANC visits and by 25% (OR=0.75; 95% CI: 0.25, 2.75) among mothers with four or more ANC visits. XV In addition, delivery by a skilled attendant showed a 31% (OR=0.69; 95% CI: 0.36, 1.33) reduction in the occurrence of complications and death during delivery and postpartum period. However, the findings were not significant. Providing incomplete service (poor quality of care) was considered as the major explanation for the insignificant effects. Conclusions Most women did not use skilled care for the routine antenatal, delivery, and postnatal care. Nearly half of the women who faced complications also did not seek skilled maternal care. Both the routine and emergency maternity cares lack the full components of important services. Lack of facilities in the health institution and deficiencies in the skills of providers were the major reasons for missing essential components of maternal services. In general, the utilization of skilled maternal care depends on the separate and joint effects of individual, communal, and health facility level factors. Beyond its effect on health-seeking behavior of mothers, providing incomplete (poor quality) maternal service was an obstacle to the achievement of the goals of reducing morbidity and mortality. Therefore, the available skilled maternal care showed an insignificant reduction in adverse pregnancy outcomes (complications and deaths). Recommendations In order to create better community awareness and perception about skilled providers and their care, safe motherhood education, especially on the risk of pregnancy and the benefits of skilled maternal care should be promoted using the available communication networks in the rural communities. Such interventions should target underprivileged women. ANC service should be expanded through outreach programs and domiciliary service to attain higher coverage in all types of skilled maternal care. Improving the quality of both the routine and emergency maternity services (providing important service components) is the most urgent intervention to achieve the goals of maternal health programs. Providing in-service training and the necessary equipment as well as ensuring continuum of care and monitoring the health facility using the signal functions in regular bases are the major activities for effective maternal care.
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    Trend analysis of Preeclampsia/Ecclampsia, Maternal and Neonatal Complication among women delivering in Addis Ababa Government Hospitals, Ethiopia: Analysis of 2009-2013 Data.
    (Addis Abeba University, 2014-06) Wagnew, Maereg; Worku, Alemayehu
    ABSTRACT Background: Worldwide the burden of preeclampsia has been the major concern particularly in developing countries including, Ethiopia. Preeclampsia is associated with substantial maternal complications, both acute and long-term. Understanding the situation of preeclampsia/eclampsia help to design appropriate intervention means for both maternal and neonatal outcomes. Objectives: To determine the magnitude and trends of preeclampsia /ecclampsia, maternal and neonatal complications among women delivering in Addis Ababa government hospital, Ethiopia. Methods: Retrospectively, 1809 cases from 2009 to 2013 data collected by reviewing of the mothers with preeclampsia/ ecclampsia medical records using data abstraction form. Data entered and cleaned using EPI info and exported to SPSS for analysis. Descriptive analyses were employed. In addition, extended Mantel Haenszel chi square was used to check linear trend. Result: A five year average proportion of preeclampsia/ ecclampsia was 4.2% [95%CI (4.02%, 4.4%)].The proportion of preeclampsia was 2.2% in 2009 and increased to a proportion of 5.58 % in 2013 (p<0.001). The percentage increase over the five years was 154%. Of the total preeclampsia/ ecclampsia mothers, 36 % [95% CI (33.85%, 38.28%)] had at least maternal complication in the five years. It showed a percentage change of maternal complication over the time was 26.5% (p<0.01). The major complication were HELLP syndrome 257(39.5%), aspiration pneumonia 114(17.5%), Pulmonary edema 114(17.5%), and Abrabtio placenta 100 (15.3%). In mean time, the neonatal complication was, 66.4% [95%CI (64.24%, 68.59%)] had at least one neonatal complication in the study five years. Regarding to neonatal complication, a decreasing trend in 2009 (76%) to 2013 (66%), this showed the percentage of change of neonatal complication over time was -13.2%. Still births 363 (30.2%), prematurity 395 (32.8%), respiratory distress syndrome 456 (37.9%), and low birth weight 363 (30.2%) were the commonest cause of neonatal complication. Conclusion and recommendation: The trend of preeclampsia/ ecclampsia and maternal complication over five year period were increased. In contrast, neonatal complication had a significant decrement over the past five year though still the complication of neonate is a big concern in the study. The health facility has to be strength the data keeping system and special attention should be given at all level to alleviate the burden of mothers and the neonate.