Maternity and Reproductive Health Nursing

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    Health Related Quality of Life of People Leaving with HIV/AIDS in Hawassa University Referral Hospital
    (Addis Ababa University, 2010-01) Kassa Andargachew; Aga Fekadu (Bsc)
    Background: Understanding the health related quality of life in people living withHIV/AIDS has become increasingly a key measurement of treatment outcome Purpose: This study was intended to assess the health related quality of life (HRQQL) of people living with HIV/AIDS in Hawassa University Referral Hospital by using theWilson and Cleary model. Methods: Using a cross-sectional design and convenience sampling method, a quantitative exploratory survey was conducted on HIV patients attending the ARTclinic (n=392). Using pretested questionnaires the data collected on demographic and clinical characterist ics, symptom status, and patients’ perceptions of quality of life were organized based on the Wilson and Cleary framework for analyzing variables related to quality of life. Then, by using SPSS for Windows version 15 a hierarchical multiple regressions was conducted with quality of life as dependent variable Result: The sample of 392 persons was 259(66.1%) female with mean age of 32.5(SD=8.6) years .On the day of the interview, few 37(9.4%) individuals presented with opportunistic infections(OI).Similarly the average types of symptoms, out of the possible 64 symptoms, experienced per person on the date of visit was 4(SD=4.5).Twenty three predictor variables explained 65.1% of the variance in patients’ overall quality of Life. Those participants with higher health related quality of life scores were those who had greater functioning, fewer financial worries, lower symptom intensity, with fewer health worries and had no opportunistic infection. In addition social support and disclosure worries made statistically significant relationship with HRQOL at Pvalue less than0.05. Conclusion: The Wilson and Cleary model of quality of life serve as useful organizing framework for developing an understanding of the correlates of quality of life for a sample of persons living with HIV/AIDS in Hadassah University Referral Hospital. Health related quality of life for this sample was primarily defined as over all functional abilities, absence of financial worries, control over symptom intensity, lack of health worries and also absence of opportunistic infections. These findings are similar with finding studied both in developed and developing countries. Based on the finding of this study, recommendations are forwarded.
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    Cross Sectional Study on Assessment of Parturient Need of Continuous Nurses Labor Support in Labor Wards in Public Hospital under Addis Ababa City Administration Health Bureau.
    (Addis Ababa University, 2011) Hadra Nebiha; Araya Tekebash(PhD)
    Introduction: Supporting women at delivery is an essential part care during labor. The term 'labor support' refers to continuous non-medical care of a laboring woman. It includes physical comforting such as touching, massaging, bathing, grooming, applying warmth or cold; and emotional support such as continuous companion reassurance, encouragement, anticipatory guidance, information provision, and non-medical advice. Labor support and care may also involve procedures and facilitation of communication between the woman and staff to assist her in making informed choices .Furthermore; it may comprise emotional support for woman's partner. Objectives: To assess parturient need and satisfaction of continue nurse support in labor wards in Public Hospital under Addis Ababa city administration Health Bureau. Methods: Institutional based descriptive quantitative cross-sectional study was employed. The study was conducted in Hospitals under Addis Ababa City Administration Health Bureau. The data collection was carried out using structured questionnaires filled by trained student nurses. Data was be analyzed using EPI 3.04 and transformed to SPSS version 16.00 in the computer for further analysis. Result: About 91.1% of need women continuous nurses support during labor. The women rated the most important supporting nurses’ behavior were emotional need followed by tangible support. Conclusion: the nursing behaviors that tap into emotional support were found to be the most important. Emphasizing the emotional dimension of the process of labor in addition to the technical aspect can be very important. To maintain high standards of professional quality care in reproductive health, nurses need to recognize helpful nursing support behaviors to laboring women.
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    Assessment of Knowledge and Practice of Women for Birth and Emergency Preparedness in Hawassa City,SNNPR, Ethiopia.
    (Addis Ababa University, 2011-05) Tsegaye Meseret; Aga Fikadu (MSN)
    A cross-sectional community-based comparative study was conducted to assess knowledge and practices of birth preparedness and complication readiness and factors associated with their practices among women who gave birth in the last 12 months preceding the survey in Hawassa city, SNNPR, Ethiopia. The study was undertaken between October 2010 to April 2011 pre tested structured questionnaire was used to obtain relevant information. Data were obtained from 550 mothers. Including both unprompted and prompted responses, 85.6% of the respondents mentioned identifying place of delivery, 90.4% mentioned saving money, 45.5% mentioned identifying skilled provider and 81.8%mentioned identifying a mode of transportation as elements of birth preparedness. Two hundred twenty two (40.4%) of the respondents reported that they identified place of delivery, saved money and identified a mode of transport ahead of childbirth. In multivariate analysis birth preparedness was higher among literate mothers (OR= 2.41, 95% CI= 1.97,4.37), women who have a good income (OR=3.28, 95% CI= 1.91,5.64), women with history of still birth (OR= 3.37, 95% CI= 1.47,7.75), having ANC follow up (OR= 4.13, 95% CI= 1.33, 12.82)and awareness about BPCR (OR= 8.25,95% CI=4.47,15.22). About 82.2% of the respondents gave birth by a skilled provider. Skilled provider at birth was higher among those who were literate, with better income, first births, those who had ANC follow up and those who were birth prepared. The study identified poor comprehensive knowledge and practices of birth preparedness in general and very poor knowledge on danger signs in particular. Improve the information given during ANC follow up, with special emphasis given to birth preparedness in general and information on obstetric danger sign in particular, community education about birth preparedness, particularly about danger signs, empowerment of women, improving the information given during the ANC follow up with are recommended.
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    Assessment of Client Satisfaction on Quality of Antenatal Care Service Provided to Pregnant Women Attending Defense Hospitals, Addis Ababa, Ethiopia.
    (Addis Ababa University, 2011-05) Belay Senait ; Kalku Yemesirach(MSc)
    Background Maternal mortality occurs from risks attributable to pregnancy and child birth as well as from poor availability and quality of health services. ANC is the key entry point of a pregnant woman to receive quality health service, broad range of health promotion and preventive services which promote the health of the mother and the baby. The UN millennium Development goal (MDG 52000) aims to reduce the number of women who die in pregnancy and childbirth by three-quarters between 1990 and 2015. Objective- This study aimed on assessing the quality of antenatal care service provision at Defense Hospitals: Addis Ababa and Debrezeit. Methodology- It was a cross sectional qualitative and quantitative study performed on the antenatal care attendees during the study period. Data collection was performed using structured questionnaire and focus group discussion with clients and facility observation checklist. Result- Data on clients’ satisfaction on quality of antenatal care were collected from 403 respondents. Findings indicated overall clients’ satisfaction with respect to indicators of quality care was around 85.6%. The odds of satisfaction of women who got information on danger signs were about five times more than those who did not get the information [AOR (95% CI) 4.883(2.007-11.8800)].The qualitative study identified an imbalance regarding information provision between clients’ expectation and received information and facility observation showed the presence of adequate material and human resource for providing antenatal care. Conclusion– In general this study has revealed majority of the clients’ were satisfied with the service. Information provided to clients during the antenatal checkup was not as expected by the respondents. The facility observation checklist has revealed adequacy of available material and manpower to provide the necessary ANC. Recommendation- The high satisfaction level from the antenatal care service in the health institutions should be sustained. The health care providers should be aware of the importance of meeting women’s information needs during antenatal visits and then be prepared to satisfy them by increasing their consultation time and mechanism of providing similar information to clients should be established and strengthen in both hospitals.
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    A Community Based Cross Sectional Study on Assessment of Skilled Birth Attendant Utilization among Women of Childbearing Age (15-49) in SNNP Region Gedeo Zone ,Yirgacheffe Town.
    (Addis Ababa University, 2011-06) Kebede Dagnachew; Mekonnen Baize
    Background: Skilled attendant for every pregnant woman during childbirth is the most critical intervention for improving maternal and child health. Evidence showed that the majority of births are delivered at home and the proportion of deliveries assisted by skilled birth attendant is very low. Every day, at least 1,600 women die worldwide from the complications ofpregnancy and childbirth, 90% of which occurring in Asia and sub-Saharan Africa. Maternal mortality rate was shown to have the largest discrepancy between developed and developing countries. A lifetime risk of maternal death in developing countries is forty times higher than that of the developed world. In Ethiopia, maternal and infant mortality and morbidity levels are among the highest in the world. Studies had clearly demonstrated that the utilization of existing maternal health services is very low in the country. Only a quarter of Ethiopian women received antenatal care (ANC) and less than 10 percent of mothers deliveries assisted by skilled birth attendant. Objective: To assess utilization of skilled birth attendant at delivery, among mothers who gave birth the past two year prior to the survey in yirgachefe town. Methods: A community based cross-sectional quantitative study method was conducted among women residing in Yirgacheffe town. The study populations were randomly selected women who gave birth in the last two year in the town. After establishing the sampling frame of each household, systematic random sampling technique was used to identify the list of households in each kebele’s to reach to 440 women included in the survey. Data was collected using adapted interviewee administered Amharic version questionnaires and data analyzed using SPSS version16. A different proportion was computed and crude and adjusted Odds ratios and confidence intervals were performed for the association between variables and stepwise multiple logistic regressions were used to identify factors that affect utilization of skilled birth attendant. Result: A total of 440 women were included in the study. 58.9% of the women utilize skilled birth attendant during delivery. Reasons given for home delivery includes, feeling of more comfortable just being at home, usual practice, close attention from relatives & family members, short and smooth labor, to exercise cultural values, not liking health facility due to bad experience, unwelcoming approach of health workers and other reasons. Births to women with primary education are two times more likely (OR=2.3 and 95% CI=1.24-4.2), and births to women with secondary and above education are four times more likely (OR=3.6 and95%CI=1.5-8.4) to utilize SDA as compared to illiterate women. Women who are Governmental employee were four times more likely to utilize SDA than those who had private bissnuss(OR=3.6 and 95%CI=1.5-8.4). Women with one and two to four pregnancies and births were three and two times more likely utilize SDA than women who have >=5 pregnancies and births(OR=2.6, 95% CI= 1.17 to 4.45) and (OR=2.3, 95% CI=1.41 to 4.65) respectively. Women who have ANC visits (,OR=16.7 and (95%CI= 8.2, 33.89), more likely utilized SDA than who did not visit. Preference of the respondent’s husbands and families, those who prefer delivery with health professional were four times and five times more likely to utilize skilled delivery attendant as compared with those, their husbands and families prefer delivery without health professional (TTBA,TBA and family and relatives) OR= 4.03 (95%CI=1.37 to 11.8),OR=4.6,95%CI=1.5 to13.9) respectively. Conclusion: The study finding revealed that utilization of SDA was more than half, still there isa gap between users and providers and those are interrelated to each other. Consequently, Community members should be discouraged harmful traditional and usual practices that hinder health facility delivery care utilization. Incourage favorable influences from their husbands and relatives about their delivery practices, women empowerment, promotion of maternal education, prenatal care utilization, communication on obstetric risks and general health service expansion were recommended.
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    Assessment of Knowledge of Breast Cancer and Screening Methods among Nurses in University Hospitals in Addis Ababa, Ethiopia, 2011.
    (Addis Ababa University, 2011-06) Berhe Semary; Sinishaw Worknish(BSC)
    BACKGROUND: Breast cancer is the leading cause of cancer mortality worldwide; therefore has become a global health problem. According to the American Cancer Society; about 1.3 million women will be diagnosed with breast cancer annually worldwide and about 465,000 will die from the disease. Breast cancer was considered as a disease of the developed countries but now a day the incidence of breast cancer in the developing countries is rising. In Ethiopia breast cancer is the second most often occurring cancer (cervical cancer is first) among women. Early diagnosis is especially important for breast cancer because the disease responds best to treatment before it has spread. To do this knowing the screening techniques like breast self examination, clinical breast examination and mammography is legitimate. It is therefore important for nurses as educators to have appropriate information and positive attitude toward breast cancer early detection (screening techniques) of breast cancer. Nurses’ knowledge and awareness of breast cancer screening behavior for themselves and would also impact patients’ behavior by increasing their awareness. OBJECTIVE: Assessment of Knowledge of Breast Cancer and Screening methods among Nurses in University Hospitals in Addis Ababa, Ethiopia. METHOD: Descriptive cross-sectional design was used with simple random sampling technique, on sample of 281 nurses at university hospitals of Addis Ababa. Data collection took place on March, 2011 using self administered questionnaire to obtain information such as demographic characteristics, knowledge of breast cancer and screening method. To see the association between the independent and the dependent variable bivariate analysis was made and crude OR correspondence to 95% C.I was calculated. Multivariate analysis was manipulated to see the independent variable effect on the dependent variable and adjusted OR on 95 % C.I and statistical significance at p<0.05. Tables and charts were used for data presentation. RESULTS: the main findings revealed among the 270 nurses, only 156(57.8%) of them were knowledgeable about breast cancer and its screening and 114(42.2%) were not knowledgeable. Knowledge of breast cancer was found to be significantly associated with regular course in nursing, family history of respondents and unit of work. Further inverse association has been made with years of nursing experience and marital status. CONCLUSION AND RECOMMENDATION: The results of this study indicate the knowledge of nurses is not satisfying. And highlights the need to improve breast cancer content in the nursing curriculum and undergo more workplace training in the area of breast cancer and screening methods.
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    Assessment of Determinant Factors on Preference and Practice of Modern Contraceptive use Among Women of Reproductive Age Groups at Shire Endaslasie Town, Northern Ethiopia, 2011.
    (Addis Ababa University, 2011-06) Tilahun Weyzer; Mengistu Daniel(MSC)
    Introduction: A woman’s preferences, practice and tolerance for various methods attribute vary according to the type of relations and other aspects of her life. The discrepancy between fertility preferences and contraceptive practice is regarded as an indicator of unmet demand for family planning. So far, it is explained that there is alarming increase in population. Ethiopia is one of the highest ranking countries in reproductive health risk worldwide with a maternal mortality ratio 673 per 100,000 deliveries. Objective: To assess factors determining preference and practice of modern contraceptive use among women of reproductive age groups at Shire Endaslasie town, Tigray Region, Northern Ethiopia Method: A Community based cross – sectional study designs were employed on 367 sample women of reproductive age groups in Shire Endaslasie town in 2011. Stratified sampling techniques were used to select the study subjects. The sample size has been obtained by a single population proportion formula. Three kebeles were selected randomly from all five kebeles in the town. The required sample size was obtained from the sum of all sample population in each kebeles or stratum using systematic random sampling technique. Kth was calculated from each selected kebeles to get the sample of each stratum. After developing a structured questionnaire, pretest was under taken on 10% of the study subjects one week before data collection i.e. 37 mothers on similar and non-selected community. Data was collected from February 01/2011 to21/2011 February days and 15 voluntary kebele oriented outreach workers and above 10 grade data collectors were assigned after appropriate modification of the questionnaire have been done. Then, data was collected through face to face interview using structured questionnaire. Data-entry, cleaning and statistical analysis was done using Version 16 SPSS soft ware. Prior to the study, approval of ethical clearance was obtained from Addis Ababa University, College of health sciences, Department of Nursing and Midwifery and Mekelle Regional health Bureau. Result: A total of 367 study participants were approached; of these 294 (80.1%) respondent use of MCMs but 73 (19.9%) not use of MCMs. Reason for using MCMs the majority of them 170 (57.8%) for child spacing and 112(38.1%) for preventing unwanted pregnancy. Reason for not using MCMs most respondent don’t have sexual partner at present 25 (34.2%). Conclusion and Recommendation: This study have clearly described that women use MCMs after they had higher number children and less desire to limit family size. It recommended that strong behavioral change intervention targeting the high fertility desire of women and MCMs utilization is needed.
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    Assessment of Factors Affecting Utilization of Antenatal Care in Dessie Town ,Amhara Region ,Ethiopia.
    (Addis Ababa University, 2011-06) Assefa Zenebework; Demissie Asrat(Prof)
    Background: Every year, approximately 500,000 women die and some 62 million women suffer from pregnancy and delivery related problems at the height of their productivity and family responsibility. Around 80% of maternal deaths are the result of complication arising during pregnancy, delivery and puerperium. However, most of such deaths can be prevented by proper utilization of maternal health care services provided in health institutions. Objective: The aim of this study is to identify factors influencing the utilization of antenatal carein Dessie Town. Methods: The community based cross sectional study was conducted on the assessment of factor affecting utilization of antenatal care among 682 reproductive age group women in Dessie town,2011. Single population proportion formula had been used to determine the sample size. A multistage sampling technique was employed to select the study subjects. The town has ten kebeles and of these, four kebeles were selected through simple random sampling technique. After obtaining the total number of households from selected kebeles, participants were selected through systematic random sampling technique based on population proportion to size method.Before data collection, pre-test were undertaken on 10% of the total sample size i.e. i.e. 68 mothers on non-selected kebeles in Dessie town to control the quality of data and the restructuring of questionnaire. Then, a face to face interview was carried based on the structured questionnaire. The collected data was analyzed by using Soft ware Statistical Package for Social Sciences (SPSS) and possible association were made by using Chi-square and P-value. The findings were statistically interpreted and comparison was made with other findings. Result-A total of 682 mothers who gave birth within one year were interviewed among them 630(92.4%) of mothers have used ANC in their previous (last) pregnancy. which showed that there is a high coverage of antenatal care in Dessie town. Associations were sought between ANC service utilization during pregnancy by different socio demographic, obstetric and delivery characteristics. Women having college & university (post secondary) education have used antenatal care 8 times greater compared with women who have no formal education, AOR=8.2(1.1, 65). There was significant association between total number of children & antenatal care that is for each additional child, the probability of having antenatal follow up increased by twice , AOR= 2(1.4, 3.0). Conclusions & Recommendations- In conclusion, this study showed better utilization of antenatal care as compared to the national coverage. Family income, women education, number of children were important determinant factors for ANC. Mothers’ educational level, monthly family income, religion, number of children, showed statistically significance association with antenatal care. Education was found to have an impact on the use of antenatal care services suggests that improving educational opportunity for women may have a large impact on improving utilization of ANC services in the nation.
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    Reproductive Health Needs and Service Utilization among Youth in Bule Hora Town Southern Oromia, Ethiopia.
    (Addis Ababa University, 2012-05) Hotessa Yimar; Tsigie Yoseph
    Background: According to the world health organization, youth age group encompasses between 15-24 years (1). Recent estimates indicate that 17.0% of the global population, 20.0%of Sub-Saharan Africa and 17.9% of Ethiopian population is composed of youth aged 15-24years. In Ethiopia, the sexual and reproductive health of young people has become a major public concern due to a high prevalence of STIs like HIV/AIDS among young people. Objective: The objective of this study was to assess reproductive health needs of youth in BuleHora town Methos and material: The community based quantitative cross sectional survey was conducted among 422 youth in Bule Hora town, Southern Oromia Region from September 2011 to may2012. Data collection method was interview administered with structured questionnaires only for illegible participants. Result and discussion: A total of 422 households were visited in three kebeles of which only 394(93.4%) agreed to be interviewed. Generally mass media were the major source of information on the sexual maturation and STD/HIV. Out of the study subject 140(35.5%) of them had reported that there is pressure from their peers to have premarital sex and 331 (84%) reported taht there is no support from their family members not to have premarital sex. As it was revealed by logistic regression age, and marital status were found to be the main predictors, independently and negatively associated with sexual activities. But sex (being a female) was independently and positively associated with sexual activities. According to this study females have more risk of sexual engagement compared to males. The proportion of youth who ever used modern contraceptives did not go parallel with their knowledge of methods. Also after controlling for confounding variables logistic regression show that living patterns (living with both family)was found to be the main predictors, independently and negatively associated with use of modern contraceptive. Despite having all these health problems only, 47.6% of them had visited public health institutions. Conclusion and recommendation: Generally there were reproductive health problems like lack of adequate information, and the existence of risk sexual and RH behaviours, in approprate health service utilization and socio cultural factors affecting youth reproductive health.Finally,programs that comprise both promotional activities and reproductive health services that could serve the hard to reach youth should be designed and implemented as a matter of priority.
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    Assessment of Health Promotion Practices Among Pregnant Women Attending ANC Services in Public Health Institutions of Shashemene Town ,Oromiya ,Ethiopia,2012.
    (Addis Ababa University, 2012-05) Biza Nejimu; Sinishaw Workinesh
    Background:-A number of potentially modifiable risk factors are known to be associated with poor pregnancy outcomes. Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable. Systematic assessment of health impact of a rapidly changing environment – particularly in areas of technology: These include maternal lifestyle and behavioral factors such as nutrition, physical exercise, family planning, substance use, mental health promotion and domestic violence. Objective:-To assess health promotion practices among pregnant women attending ANC services in public health institutions of Shashemene town, Oromiya, Ethiopia, 2012. Method: An institution based descriptive cross-sectional study design was carried out, and data was collected from systematically selected 295 pregnant women, who are attending ANC service from governmental health institutions of Shashemene town. Result- Almost half (49.8%) of total respondents have encountered deliberate food restrictions; to avoid one or more food items during pregnancy. Age of the women educational status shown significant associations with belief of balanced diet: 0.175 (0.001-3.812) and 57 (1.212-2.682) respectively. (37.8%) of mothers have experienced home delivery and this is significantly associated with delivery place preference of health institution. Surprisingly, mothers with previous institutional deliver were less likely to use health institutions again for current delivery, i.e those mothers with previous institutional delivery were preferred to have home delivery, AOR of 16.971(5.311-54.234) at 95% CI. Knowledge of mothers about PMTCT is relatively high (35.6%). About 88.1% of the study participants drink coffee with the majority (70%) within range of 2-3 cups/day. Substance uses during pregnancy were found to be significantly associated with still birth, having a crud ratio of 3.243 (1.147-9.170) at 95% CI. 7.5% of the respondents reported to have violence during pregnancy times; this Violence was strongly associated with ethnicity, religion, and mental status. Conclusion-Although majority of pregnant women in the study, were practicing different health promotion practices, this study identified a number of individual, demographic, socioeconomic and health promotion related behavioral factors that influence the use of effective health promotion practices for better outcome of pregnancy and child birth. Recommendation- The general recommendation of the study concerned on strengthening actions towards improving health promotion practices. MCH clinics to play a leading role in coordinating this effort and to put in place mechanisms. Other governmental and non-governmental organizations and various public associations, such as Farmers Associations and Women's Associations should also be actively involved in eliminating thesenonscientific harmful beliefs towards pregnant women in terms of nutrition and safe delivery practice. Further studies to explore why some groups to differ in healthy behaviors, should be investigated,
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    Knowledge and Utilization of Pantograph among Obstetric Care Givers in Public Health Institutions of Addis Ababa, Ethiopia, in 2012.
    (Addis Ababa University, 2012-05) Yisma Engida; Dessalegn Berhanu; Astatikie Ayalew; Fesseha Nebreed
    Background. Globally, there was an estimated of 358,000 maternal deaths. Of which developing countries accounted for 99 % (355,000). Nearly three fifths of the maternal deaths (204,000) occurred in sub-Saharan Africa region alone. More than 70% of all maternal deaths are due to major complications of hemorrhage, infection, unsafe abortion, hypertensive disorders of pregnancy, and obstructed labor. A number of cases of obstructed labour do happen in health facilities, thus reflecting poor quality of intrapartum care. Use of the partograph is well known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. Objective: To assess knowledge and utilization of partograph among Obstetric care givers in public health institutions of Addis Ababa, Ethiopia from September 2011 to May 2012. Methods: A cross sectional quantitative study, supplemented by record reviews of 420 partographs, assessed knowledge and utilization of partograph in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire and observational checklists. The collected data was analyzed using SPSS version 16.0. Logistic regression was used to control confounding variables Results: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161(82.6%) correctly explained the function of action line. The study has shown that 112 (57.3%) of the obstetric care givers at public health institutions reportedly used partograph to monitor mother in labour. But partograph record reviews showed only 32.9%, 30.70% and 20.70% of the fetal heart rate, cervical dilation and uterine contraction were recorded according to the standard for monitoring of these three labour parameters. There was statistically significant association between utilization of the partograph and working in the health center level of care compared with Hospital level of care [67.9% vs 34.4% Adjusted OR=21.2 (6.6, 68.6)]. Conclusions and recommendations; A significant percentage of obstetric care givers had fair knowledge of partograph and why it is necessary to use it in the management of labour. In spite of fair knowledge of the partograph by obstetric care givers in this study, a large number of the partograph cards reviewed were not recorded or poorly filled. Training of obstetric care givers on use of the partograph with periodic workshops and seminars and mandatory health facility policy are recommended and vital to safety of women in labour in Addis Ababa, Ethiopia.
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    Assessment of Factors Affecting Utilization of Institutional Delivery Services among Child Bearing Age Women in Hadiyya Zone,SNNPR,Ethiopia.
    (Addis Ababa University, 2012-05) Lelago Tadesse; Dessalegn Berhanu(Bsc)
    Background: A women‘s health is critical to her own life, and to the well-being of her family and the economy of her community and her country. About 99% of maternal deaths occur in developing countries. Yet, most of these deaths could be avoided, if preventive measures were taken and adequate care was made. Objective: To assess factors affecting utilization of institutional delivery service among child bearing age women in Hadiyya zone SNNPR. Methodology: A cross sectional quantitative study was conducted among women who gave birth with in the last three years preceding the survey in Hadiyya zone, SNNPR. Concerning to sampling procedure a cluster sampling method was used to reach the eligible women in the randomly selected study area. Data was collected by interview administered semi-structured questionnaire by trained HEWs who able to speak local language. Data was entered at Epinfo version 3.4 software and exported to SPSS software version 16 for analyses. Result: A total of 414 women who had given at least one birth in the preceding three years before the survey were interviewed giving response rate of 98.8%. Even though majority of the mothers(86.2%) received ANC, only 24.6% of them delivered at health facilities and the rest (76.4%) delivered at home with the help of relatives or TBAs which revealed gap between ANC and delivery care utilization. The multivariate analysis revealed that women's residences, educational status, age, knowledge of danger signs, ANC frequency, and satisfactory attitude to institutional delivery were the major factors that affect maternal utilization of institutional delivery. Conclusion and recommendation: Findings of this study demonstrated that utilization of institutional delivery care among child bearing age women in Hadiyya zone is low. So promotion of maternal education, antenatal care, information education and communication on obstetric risks and general health service expansion were recommended
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    Assessment of Antenatal Care Clients’ Willingness for HIV Counseling and Testing in Asella Governmental Health Institutions, Ethiopia.
    (Addis Ababa University, 2012-05) Fikre Tadesse; Aga Fekadu(MSc)
    Background:- It has been well established that mother to child transmission (MTCT) accounts for the majority of HIV infections in children below the age of 15 years in developing countries. HIV counseling and testing (HCT) is an important entry point for HIV prevention and for early access to treatment, care and support. Willingness for accepting HCT is the key component and a starting point of overall HIV prevention efforts and represents a critical opportunity for stemming the tide of the HIV epidemic. Objective:- The main objective of this study was to assess the willingness of antenatal care clients for HIV counseling and testing in Asella governmental health institutions. Methods:- Institutional based cross sectional study was conducted on 321 pregnant women attended antenatal care during the study period using interviewer administered, pre-tested, structured questionnaire from March to April, 2012 in Asella governmental health institutions. Data was collected by convenient sampling technique after ethical clearance was obtained from the concerned authorities and then entered in Epi-info and analyzed using SPSS software. Result:- A total of 321 pregnant women (response rate 100%) attended antenatal care in Asella hospital and Asella health center were included in the study. Among the studied women 291(90.7%) were willing for HCT, and 30 (9.3%) were not willing for HCT. The strongest association with willingness for HCT rested with parity, number of ANC visits and perceived risk of HIV. Primipara women were about 12 times more likely willing for HCT than nullipara mothers (AOR=12.33, 95% CI=1.25,121.57), and also those who had 2 and above ANC visits were 9.6 times more likely willing for HCT than those who had only 1 ANC visit (AOR=9.64,95% CI=1.93,48.28). Women who were perceived themselves not at risk of acquiring HIV were more likely willing for HCT than those women who perceived themselves at risk (AOR=0.08,95% CI=0.01,0.41). Conclusion and Recommendation: This study revealed high-level of awareness about HIV, HCT, MTCT and PMTCT of HIV among pregnant women attended ANC in the study areas. Relatively increased proportion of willingness for HCT was seen when compared to other studies and it has to be encouraged more, since it is a cornerstone for PMTCT of HIV. Health education targeted on pregnant women on HCT, MTCT and PMTCT of HIV using different resources and male partner participation would have paramount importance and would be important factor to scale up HCT acceptance more at all levels.
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    Assessment of Contributing Factors for Late Initiation of Antenatal Care among Pregnant Women Attending Antenatal Clinic at Public Health Centers in Kambeta Timbaro Zone, South Nation Nationalities People Region, Ethiopia.
    (Addis Ababa University, 2012-06) Tekelab Tesefalidet; Berhanu Balcha (MSc)
    Background : For all women of reproductive age, especially for pregnant women, utilization of health care services is a key proximate determinant of maternal and infant outcomes, including maternal and infant mortality. It is evident that timely antenatal care is an opportunity to prevent the direct causes of maternal mortalities and reduction of fetal and neonatal deaths related to obstetric complications Objective: To assess factors that contributes for late initiation of antenatal care among pregnant women attending ANC Clinics in public health centers in Kembata Timbaro Zone, SNNPR, Ethiopia. Method: A facility based cross-sectional study with supplement of qualitative study design was carried out to collect data from 401 pregnant women who were attending antenatal care service at five randomly selected governmental health centres in Kembata Timbaro zone. Pretested and structured questionnaire was used to collect the data & data were entered onto a computer using Epi-info 3.5.1 statistical program then exported to SPSS Windows version 16.0 for further analysis. OR & 95% CI was used to measure the associations. Results: This study showed that prevalence of late entry to antenatal care was 68.6%. The mean timing was 5.5 + 1.8 months. Multivariate analysis revealed that Age, maternal education, family income, parity, previous utilization of ANC and type of pregnancy remained significant factors influencing late booking. Conclusion The findings of this study showed that most women book ANC late. This seems to be because antenatal care is viewed primarily as curative rather than preventive in the study population. Public enlightenment, health education coupled with women empowerment would be helpful in reducing the problem. In addition to that research is needed to determine the best approaches for health education programmes to correct the misconceptions about antenatal care.
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    Assessment of Knowledge and Practice of Midwives towards Care of New Born with ASPHYXIA in Addis Ababa Health Services, Ethiopia.
    (Addis Ababa University, 2012-06) Sentayehu Tsedale; Berhane Emebet(BSC)
    Background: In resource-rich countries, the incidence of severe perinatal asphyxia (causing death or severe neurological impairment) is about 1/1000 live births. In resource-poor countries, perinatal asphyxia is probably much more common. Data from hospital-based studies in such settings suggest an incidence of 5–10/1000 live births. Knowledge and skill of midwives has a great impact in prevention and management of perinatal asphyxia and decrease neonatal mortality rate. Yet there is no studies were conducted in Ethiopia to assess the knowledge and practice of midwives towards care of new born with asphyxia .Therefore this study was designed to investigate the level of knowledge and identify the resuscitation skill on new born with asphyxia. Objective: Assessment of knowledge and practice of midwives towards care of new born with asphyxia in Addis Ababa health services. Methods: Institutional based cross sectional study was conducted in Addis Ababa health service. There are 265 midwives who work in Addis Ababa health services since the attributes being measured are not distributed normally the entire population was surveyed. Among776 the health services in Addis Ababa 58 have midwives; 6 public, one army, one police and 22 private hospitals, 23 health center and 5 private clinics. All midwives from all institutions was included in the study. Data was collected from 253 midwives at the health service using self administered structured questionnaire. Data collectors were trained on how to use the data collection instrument, approach study participant. Result: On this study 253 midwives were participated .The result of the study showed that the level of knowledge of asphyxia was low. Only 37.5% of midwives attained high overall knowledge score. Statically significant association was found between high knowledge score and service year>21 year (OR=3.17895% CI=1.068, 9.466) p-value 0.038 compared to service year<21 years. Overall practice of midwives scoring favorable practice was 53.4% .the finding revealed Statically significant association between high score practice and age of midwives45-54years of age (OR=8.308 ,95%CI 1.557,44.32)P=.013 and place of work health center (OR=1.895 95%CI 1.o72,3.349)p=.028 when compared to other place work. Conclusion and Recommendation Generally overall knowledge and new born resuscitation practice of midwives were low in Addis Ababa health services. So incorporating and new born resuscitation in continuing education and professional training programs is recommended. Strength and integrate new born resuscitation with routine service through providing training for all midwives.
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    Assessment of Attitude towards Risky Sexual Behavior and Sexual Practice among Adama University under Graduate Students, Adama, Ethiopia.
    (Addis Ababa University, 2012-06) Tsige Meseret; Skebe Yezabnesh(MSC)
    Background Healthy adolescents and youth are the base of future generation. However, globally adolescents and youth are most frequently affected by STIs/ AIDS as the result of risky sexual behavior. In developing countries including Ethiopia the problem was found more serious and many young people engage in risky sexual behavior. Most of them were aware of the risk even though they failed to change their behavior. Objective: To assess attitude towards risky sexual behavior and sexual practice among Adama University under graduate students, Ethiopia. Method: institution based a cross sectional descriptive study was conducted between September, 2011 and February, 2012 G.C. A total of 563 students were assessed for their attitude towards risky sexual behavior and sexual practice in Adama University, Ethiopia. Multi stage and simple random sampling technique was used to select the school and participants. Data were collected using semi-structured self-administered questionnaire. A pre-test was conducted on 5% of comparable group other than the study population before actual data collection. Data were analyzed using EPI INFO and SPSS version 16. Result: Majority of the respondents (81.5%) was males and the mean age of the participant‘s was 21.45 years. Thirty percent of the study subjects currently chewing khat. Two-third (68.9%) of the participants had favorable attitude toward risky sexual behavior. Thirty four percent of respondents had sexual experience. Among sexual active respondents in the past one year 31.2% of them had not used condoms. In addition, 18.1% of the respondents practices homosexuality and significantly associated with current chewing khat (AOR 0.115) and drug intake (AOR 0.071). Conclusion: The attitude towards risky sexual behavior was favorable among Adama University under graduate regular students. However, the prevalence of premarital sex is high and sexual active respondents were engage in some risky sexual behavior like unprotected sex, sex with commercial sex worker and homosexuality. This indicates that the university students are exposed to health hazards through their risky sexual behavior. Therefore sexual and reproductive health issues should be included in the curriculum of both high schools and universities education to prevent risky sexual behavior and render sexual intercourse safe.
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    Assessment of Primary Dysmenorrheal Risk Factors and its Effect on Students Academic Performance among Female Students in Debreberhan University.
    (Addis Ababa University, 2012-06) Hailemeskel Solomon; Demissie Astrat Prof)
    Background: Primary dysmenorrhea is the most common gynecologic compliant among adolescent females. There is a wide variation in the estimate of primary dysmenorrhea 50 to 90%. The disorder is the most common cause of short term school and class absenteeism, loss of class concentration and test taking skill by adolescent women. Objective: To assess associated risk factors of primary dysmenorrhea and its effect on student’s academic performance in Debre Berhan University, North shoa zone, Amhara regional state from September 2011- May 2012. Methods: A cross-sectional study was conducted in Debre Berhan University from September 2011 to May 2012 using multistage stratified sampling technique to select 440 female students. A structured and pretested self-administered questionnaire was used for data collection. The severity of dysmenorrheal pain was assessed by using verbal multidimensional scoring system and visual analog scale (VAS). The data was double entered into Epi Info version 3.1 and analyzed by using SPSS version 17. Data were analyzed using X2 test and logistic regression analysis. P-value<0.05 at 95%confidence interval (CI) for Odds Ratio (OR) was considered statistically significant. Result: a total of 440 students had participated in this study. The prevalence of primary dysmenorrhea was 368(85.4%). About 123 (28.5%) had mild, 164(38.1%) had moderate and 81(18.8%) had severe primary dysmenorrhea. 88.3% of dysmenorrheic students reported that primary dysmenorrhea had negative effect on academic performance. Of these 80% reported school absence, 66.8% reported lose of class concentration, 56.3% reported class absence, 47.4% reported lose of class participation, 37.8% reported limited sport participation, 31.7% reported limitation in going out with friends and 21% reported inability to do homework. Risk of primary dysmenorrhea was approximately 7 times higher in students who had monthly income of less than 150ETB (AOR= 6.671); 6 times higher in students who had history of attempt to lose weight (AOR=6.085); 14 times higher in students who had history of depression or anxiety (AOR=13.607); 3 time higher in students who had disruption of social network either of family, friends or people they love (AOR= 3.218); 19 times higher in students who consume more than four glass of tea per day (AOR= 18.938); 7 times higher among students who consume one and more than one coca or Pepsi per day (AOR= 6.786); 47 times higher in nulipara (AOR= 47.318) and 27 time higher in students with a family history of dysmenorrhea (AOR= 27.228). In the contrary students’ interval and duration of menstruation, student’s age at menarche and body mass index were not significantly associated to primary dysmenorrhea. Conclusion and recommendation: there is high prevalence of primary dysmenorrhea among Debre Berhan University students. The condition has a negative impact on student’s academic performance and it is found to be a significant health problem in students that requires attention. Future studies will be important to better identify risk factors for primary dysmenorrhea and lighten its effect on students’ academic performance.
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    Assessment of Risky Sexual Behavior among Substance User Adolescents in Adama City, East Showa Zone, Ethiopia, 2012
    (Addis Ababa University, 2012-06) Negewo Eyob; Birhane Emebet ( MSc)
    Back ground - Pre-marital sexual behavior among adolescents and youth remain poorly explored topics in Ethiopia. The available evidence in India suggests that between 20 and 30 %of all males and up to 10 % of all females are sexually active during adolescence. Sexual activity is frequently risky. The relationship between substance use and risky sexual behavior is complicated by the type, frequency, and mode of substance. These sexual high risk behaviors predispose the victims to a number of possible social, economic and psychological consequences. Objectives - To determine the risky sexual behaviour and its associated factors among substance user adolescents in Adama City. Method and material – A community based cross sectional exploratory study was used fromMarch – April 2012 at Adam City. Samples of 347 substance user adolescents who fulfilled the inclusion criterias were recruited by convenience sampling technique. Data was collected with a pretested structured self administered questionnaire. The collected data was controlled and cleaned properly for consistency and entered into Epi info version 3.5.1 software and transferred to SPSS version 15.0 for analysis. Multiple logistic regressions were used to predict the outcome variables and control the confounding factors. Finally, results were presented using frequency table. Results - The prevalence of risky sexual behavior among substance user adolescents of Adama City is found to be 75.1% for the sexually active participants. The use of substances like: Khat usage (AOR = 1.51), alcohol usage (AOR = 12.24), tobacco usage (AOR = 10.68), and illicit substance usage (AOR = 5.88) respectively were found to be significantly associated with having risky sexual behavior. Because of the risky sexual behavior they suffered from unwanted pregnancy 88.2%, abortion 88.2% of the total pregnancies, immediate outcomes of abortion like: psychological stress 73.3%, physical problems 40%, social stigma 33.3%, and STI 26.7%. Conclusions - The prevalence of risky sexual contact is found to be higher. Alcoholic use & illegal substances are among the leading causes for this. The study has also revealed that the substance user adolescents are suffering from various immediate physical, psychological, and financial problems related to the risky sexual behavior. Recommendations – The use of substances by adolescents should be tried to be minimized. The local police administration should work in diverse to make these substances less accessible to the adolescents particularly on illicit substances. School directors and families should also work together on the IEC activities particularly on the education and communication component to increase adolescents understanding and to promote their change of behavior on the use of substances and risky sexual behavior. IEC activities should be broadly provided by different stockholders who work on adolescent reproductive health.
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    Quality of Care in Delivery Service at Public Health Institutions in Bahir Dar Town, Ethiopia.
    (Addis Ababa University, 2012-06) Tamene Michael; Tsigie Yoseph
    Background: Delivery and the time immediately after, is the most critical stage for every pregnancy, and this is the stage where quality of care available does matter. 99% of world’s maternal deaths occur in developing countries. More than half of these deaths occur in sub Saharan Africa including Ethiopia, and most were avoidable .Ethiopia’s maternal mortality rate continues at an unacceptably high level. The percentage of deliveries attended by skilled health personnel at health institutions declined from 18.4% in 2009 to 16.8% in 2010, which is much below the target of 37.0% .This percentage, is very low ,largely below the Sub Saharan Africa averageof 47% in 2009 and very far from MDG target of 90% coverage. This is because of actual quality of care for deliveries have received relatively less research attention than other areas of health care. Objective: The objective of this study is to assess the quality of delivery services at public health institutions in Bahir Dar town, Amhara regional state, Ethiopia. Methods: Quantitative cross-sectional study was conducted on three health facilities from September 2011 to May 2012. Convenient non-probability sampling technique was used and samples were allocated proportionally to each facility according to their previous year delivery uptake. Data was collected using three data collection instruments; Exit Interview, Observation and facility assessment. Data entry, cleaning and analysis, using descriptive values and binary logistic regression for association test, were done. Result: A total of 400 delivering mothers for exit interview and 40 deliveries for observation were participated from Felege Hiwot referral hospital, Bahir Dar and Han health centers. In exit interview, the study revealed that 216 (54%) of mothers were satisfied while 184 (46%) dissatisfied with the delivery care given. A total of 167 (41.8%) of mothers satisfy with the distance over home to facility. Among other facility related satisfaction; cleanliness of toilets, overall cleanliness and comfort of the waiting area and examination room satisfaction were the first three least values; 184 (46.0%), 179 (47.1%) and 198 (49.5%) respectively. Regarding care provider related satisfaction completeness of information given by health professionals, measures taken to assure privacy and feeling of confidentiality were the first least values according to mothers view; 163 (40.8%), 169 (42.2%) and 196 (49.0%) respectively. After adjusting for confounding socio demographic factors maternal age and monthly income were significantly associated with satisfaction of delivery services. When obstetric factors were adjusted; parity, maternal and fetal outcomes had significantly associated with mothers’ satisfaction (p-values<0.05). During observation, it was revealed that in 46% of cases health providers performed well while, 54% of them not performed well. Providers who introduce themselves were only 15% while only 40% of providers seen greeting the woman with kindness and respect. No provider encourages the woman to ask questions or explain procedures before performed except in one of cases for each. Three quarter of the providers did not maintained privacy. Labor and delivery services were available in all the three health institutions 24 hours a day, every day. However, availability of personnel as the main task in delivery care during duty times was abscent in both of health centers. Client privacy related issues were commonly lacking infrastructures in the delivery room of the three facilities. Drug shortage was prominent in Han health center. Basic equipment and supplies were fairly available and adequate than other components in all health facilities. Conclusion and Recommendation: The overall quality of care in delivery services at public health institutions found to be suboptimal and the current performance of providers was found to be below the average. There were a lack of service availability, infrastructure, personnel, essential drugs, equipments and supplies essential to quality of delivery care. Therefore, strengthen health systems by providing indicators to measure and compare the quality of delivery care services provided at each level of health facility, make provider training and capacity building the pillar of delivery services and improvement of basic infrastructures for performance of delivery service to reduce maternal and newborn mortality in line with MDGs 4 and 5 are recommended.
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    Assessment of optimal breast feeding practice and its associated factors among mothers of children aged less than two years in Dale Woreda,Sidama zone
    (Addis Abeba University, 2012-06) Getnet, Misrak; Sr. Mengistu, Zuryiash(RN, MSc)
    Background: Poor breastfeeding and complementary feeding practices, together with high rates of morbidity from infectious diseases are the prime proximate causes of malnutrition in the first two years of life. Objective: To assess optimal breast feeding practice and its associated factors in Dale woreda, Sidama zone, Southern Nations Nationalities and Peoples Regional State. Method: Community based quantitative cross sectional study was done to assess optimal breast feeding practice and its associated factors. A total of 634 mother-infant pairs were selected using multistage cluster sampling technique from the kebles then census was conducted to get the sampling frame for selecting mother- infant pairs by simple random sampling technique. The study subjects in each kebles were selected using population proportion to size. This study was conducted in Dale woreda, which is one among the 10 woredas in Sidama zone, Southern Nations Nationalities and People‘s Region (SNNPR) from February to March 2012. Data collection was made using a house-to-house visit, and household was used as a target unit, and kebeles as blocks. The raw data was entered, cleaned and analyzed using statistical software SPSS version 16.0. Result The prevalence of initiation of breast feeding within one hour, exclusive breast feeding at 6 month and complimentary feeding timely at the age of 6 months was 517(83.7%),474(87.1%) and 504(88,9%) respectively. Initiation of breast feeding practice had a statistically significant negative association with ownership of living place (P=0.42, CI, (0.16, 0.97)). Exclusive breast feeding practice had statistically significant positive association with ownership of living place (AOR=3.50(1.26, 10.2)) and employment status (AOR=2.94, (1.24, 6.98)) and it had statistical negative relationship with maternal age. Complimentary breast feeding practice had a statistical positive relationship with PNC follow up (AOR=2.25(1.49, 3.37)) and ANC follow up (AOR=1.61(1.07, 2.42)). Conclusion Breastfeeding is a common practice in the woreda. This is an encouraging practice in this study area. Employed mothers were found to have less practice of optimal breastfeeding as compared to those who stayed at home and mothers who are dependent have less practice of optimal breast feeding than mothers who live in their house. Recommendation Working mothers should be encouraged by institutions and co-workers to promote optimal breastfeeding practice by arranging working hours, baby friendly initiative at work places. Further studies are proposed to ascertain effective intervention in the study area and the region at large.