Obstetrics and Gynecology

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Assessment of Comprehensive Postnatal Care Service Utilization and Associated Factors during Discharge at Three Teaching Hospitals, Addis Ababa, Ethiopia:A Cross Sectional Study,2021.
(Addis Abeba University, 2021-10) Basha, Ferhia; Dr.Abdella, Ahmed (Associate Professor of Obstetrics and Gynecology, AAU); Dr.Fantahun, Yitbarek (Assistant Professor of Obstetrics and Gynecology, AAU)
Background – Comprehensive postnatal care (CPNC) includes full assessment of physical, social and psychological well-being determining the health and survival of the mother and her newborn. Ethiopia is one of the low income countries with high maternal and neonatal mortality and morbidity and low utilization of postnatal care (PNC) services. The inconsistent transition from inpatient to outpatient may end up in missed opportunities to counsel on various healthy behaviors and behaviors with long term health risks and manage postpartum problems early to prevent presenting late with severe complications and even death of the mother and her newborn. Objectives - Assessing CPNC service utilization and associated factors among postpartum women during discharge at 3 teaching hospitals to identify gaps and recommend areas for actions to be undertaken to improve quality of care. Methods - An institution based cross-sectional study was conducted in three teaching hospitals in Addis Ababa, Ethiopia. Medical records and pretested structured questionnaire for interviewing postpartum mothers were used to collect data and convenience sampling method was used to select among postpartum mothers at three teaching hospitals. The collected data was entered and analyzed by Statistical package for social sciences (SPSS) version 25. Results – The study participants were 398. The overall comprehensive postnatal care utilization of all components was 0. Factors that affect comprehensive postnatal care utilization were educational level, ANC, time of information about comprehensive post-natal care utilization, mode of delivery and length of hospital stay. Those who delivered via CD had twice the likelihood of getting good counseling services. Conclusion and recommendations – CPNC utilization according to this study is very low. It is recommended that all postpartum women at any educational level should be informed about postnatal care and those informed during pregnancy are more likely to get full package of the postnatal care and therefore encouraging further effort at the antenatal care services. Additional effort is needed on counseling messages and measures have to be taken at each step to develop minimal standard of quality of care, quality indicators and pre-discharge checklist to avoid too early discharges prior to completion of the care.
Assessment of Knowledge, Attitude, and Practice, and Associated Factors of OBGYN Residents, and Obstetricians & Gynecologists in Tikur Anbessa Specialized Hospital (TASH), and Saint Paul Hospital Millennium Medical College (SPHMMC) towards Provision of Safe Abortion Care, Addis Ababa, Ethiopia
(Addis Abeba University, 2021-07) Mengistu, Mekonnen; Dr.Demissew, Rahel (MD, Ass. Prof of OBGYN); Dr. Kumbi, Solomon(MD, Ass. Prof of OBGYN)
Introduction: The demand for sexual and reproductive health services and education for women over the globe has increased gradually. Studies show that, 99 % maternal deaths recorded in middle, low-income countries are die due to birth, and pregnancy related complications. Abortion is one of the leading causes of maternal death. Unsafe abortion accounts for at least 13% of global maternal mortality and 95% of unsafe abortions occur in developing countries where abortion is restricted by laws. Objective: To assess knowledge, attitude and practice, and associated factors towards safe abortion provision among residents, and Obstetricians & Gynecologists in Tikur Anbessa Specialized Hospital and Saint Paul Hospital Millennium Medical College. Method: Cross sectional survey used from March to June, 2021 and using proportional simple random sampling with sample size of 174 (seniors n= 32 and residents, n=142) at Tikur Anbessa Specialized Hospital & Saint Paul Hospital Millennium Medical College Obstetrics & Gynecology residents who were attending their specialty programs and Gynecologists & Obstetricians working in both hospitals. Data collected via self-administered questionnaires with closed ended questions from study participants. Data entered and analyzed by SPSS Version 20. Descriptive frequency & analysis used for socio-demographic characteristics. Binary and multivariable logistic regression analysis conducted to identify associated factors. P-value <0.05, 95% confidence level were used to declare statistical significance. Result: The prevalence of good knowledge on safe abortion care was 56.6% and using subgroup analysis 54.2% of residents and 67.8% seniors had good knowledge. Accordingly, the odds ratio OBGYN seniors had much knowledgeable than year one residents. [AOR=4.6 (1.35, 16.56, P<0.05)]. Participants having good practice on safe abortion care had favorable attitude than those who had poor practice on safe abortion care [AOR=4.3 (2.19, 8.37)]. Male had good practice towards safe abortion 2.5times than females (AOR = 2.5, CI = 1.08, 5.62). Providers who had favorable attitude towards safe abortion had a better practice on SAC (AOR= 4.7, 2.27, 9.79). Ninety-four point eight percent (94.83%) were providing post abortion family planning; Implanon was the most common (86.1%). Conclusion: In this, study the overall good knowledge, favorable attitude and good practice of physicians on safe abortion care provision were 56.6%, 57.2% and 54% respectively. Level of education affects knowledge score. Male had good practice towards safe abortion. Had a good practice on safe abortion care had significantly influenced providers’ attitude, towards favorable attitude than those who have poor practice. Based on the study the overall knowledge, attitude and practice score was lower and works to be done to improve residents’ knowledge on safe abortion care through onsite or induction training at the beginning of residency program.
Cesearean Section for Intrapartum Non-reassuring Fetal Status and Prediction for Neonatal Acidemia at Birth in Tikur Anbessa Specialized Hospital: A Prospective Observational Study,2021.
(Addis Abeba University, 2021-06) Heyi,Jemal Markos; Dr.Fantahun, Yitbarek (MD, Assistant professor of Obstetrics and Gynecology, AAU-CHS); Dr.Kebede, Eskendir (MD, Assistant professor of Obstetrics and Gynecology, AAU-CHS)
Background: NRFS is leading indication for cesarean section. The risks of maternal morbidity and mortality associated with a caesarean section may not be reasonably justified by the degree of neonatal compromise at birth. Objectives: This study was undertaken to evaluate prediction of clinical diagnosis of intrapartum NRFS for significant neonatal acidemia and short term adverse neonatal outcome. Methods: Facility based prospective observation study where all the deliveries by cesarean section for NRFS over 2 months period were included. Fetal patterns prior to delivery were obtained from labor follow up chart and interpreted. The primary outcome was fetal acidemia (umbilical artery pH 7.20); short term neonatal morbidities were also assessed. Area under the receiver operating characteristic curves was used to assess the test characteristics of individual models for acidemia and neonatal morbidity. Population from historical cohort of similar study was used to calculate predictive ability of NRFS for fetal acidemia. Results: During this study period 228 deliveries occurred at the selected health facility and 98 women by cesarean section. From cesarean section 51% (50 of 98) were emergency and 56% (28 of 50) was done for NFS. Fetal bradycardia was the most common type of NRFS indicating emergency CS constituting 60% (15 of 25) of emergency CS. The mean umbilical artery PH was 7.20±0.09 (SD) (range, 7.01-7.30). Incidence of acidemia was 32% (8 of 25), while pathologic acidemia (PH <7.10) account only for 20% (5 of 25). Although significant association was not found for all patterns of NRFS, fetal bradycardia seems non predictive for fetal acidemia with area under the curve of 0.41(OR 0.42, 95% CI (.075-2.36) P value 0.4) with PPV of 17.22%, while fetal tachycardia (AUC (.62), PPV 30.69) and MSAF (AUC (.68)) appears to have a fair prediction for fetal acidemia. Conclusion: None of NFS pattern had significant association with fetal acidemia and neonatal outcome. This may be due small sample size of this study and further study with large sample size is needed to establish existing association, if any.
Determinant of Anemia among Pregnant Women Attended Antennal Care Clinic in Selected Public Hospitals, Case Control Study,in Addis Ababa, Ethiopia, 2021
(Addis Abeba University, 2021-07) Seman, Asrar; Dr.Abdella, Ahmed(MD, MSC, PHDC,Associate prof.Consultant obstetrician and gynecologist, AAU); Dr.Mekonnen, Endalkachew (MD, MPH, Assistant prof.Obstetrician and gynecologist, AAU)
Background:Anemia is a common clinical problem contributing to increased maternal and fetalmorbidityand mortality during pregnancy. Anemia can be caused bydifferent factors apart fromknown diseases. The main aim of this study is to identify determinants of anemia amongpregnant women attending antenatal care at the public health facilities of GMH,ZMH andALERT hospitals Objective:-This studyaims to assess the determinantfactors of anemia among pregnant womenattending Antenatal Care (ANC) in three selected public hospitals (GMH, ZMH and ALERThospitals), Addis AbabaEthiopia,case-control study. Methods:-A health facility-basedunmatchedcasecontrolstudydesign wasapplied, among 126cases and 252 controls from JAN,2021-APRIL, 2021G.C in three public hospitals in A.A,Ethiopia. Data were collected using interviewer-administered questionnaires. Controls werepregnant ladieswhosehemoglobinlevel was 11 g/dl and above at their first antenatal care clinic,and cases were pregnant ladies whose hemoglobin level less than 11 g/dl in the first and 3rdtrimester and 10.5g/dl in the second trimester.collected data were entered using SPSS version 25for analysis. First Bi-variable logistic regressions were used to find out determinant factors ofanemia at P–value≤ 0.025, and thenmultivariable logistic regressions were used to control outconfounding variables. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value<0.05 will be used to see the significant association. Result:According to bivariate analysis result;educational level of mothers and occupationalstatusof respondents,family monthly income, those mothers havehistory of abortion,number offamily living together,parity of mothers,thoseothers hadhistory of abortionand thosewomen’shad intestinal parasite parity, were significantly associated with maternal anemia. Aftercontrolling the effect of confounding factors (variables)multiple logistic regression analysisrevealed that:family monthly income between1001–3500 ETB.,werewith (AOR꞊5.252; 95%CI (2.346,11.746), those motherswho had parity four and abovewith (AOR꞊5.623; 95% CI;(2.023, 15.592),and those mothers had History of abortion with (AOR= 1.971, 95% CI(1.124,3.459), had significant association with anemia. Conclusion. monthly family income, having previous history of abortion and parity arepositively associated with anemia in current pregnancy.Early identification of determinants ofanemia and appropriate interventions have paramount importance in fighting anemia to helpmothers enjoy their pregnancy. family planning, hemoglobin determination in all pregnantwomenare valuable
Determinants of Infertility among Married Women Attending Infertility Clinics, at two Teaching Hospitals in Addis Ababa, Ethiopia
(Addis Abeba University, 2021-09) Matewos, Seblewongel; Dr.Kebede, Eskinder (Associate Professor and Consultant Obstetrician and Gynecologist, Reproductive endocrinology and minimal access surgery subspecialist, AAU); Dr.Bedada, Abera(Assistant Professor and Obstetrician and Gynecologist, AAU)
Background: Infertility is a global public health issue affecting approximately 8 to 12% of couples worldwide, with 9% of the global average. In Ethiopia, according to the DHS data, the prevalence of primary and secondary infertility in 2005 was 3.3% 4.6% respectively. The prevalence differs by place of residence, marital status, age of respondent, age at first marriage, and number of unions. The causes of infertility are various, including socioeconomic factors, lifestyle, reproductive history, and childbearing status. In developing societies, childlessness is often highly stigmatized and leads to profound social suffering for infertile women; however, most infertile people in the developing world have virtually no access to effective treatment. Objective: To identify the determinants of infertility among married women attending an infertility clinic at two teaching hospitals in Addis Ababa, Ethiopia Methods: An institution-based unmatched case-control study was conducted at two teaching hospitals, gynecology and obstetrics infertility clinics in Addis Ababa. A total of 234 women was included in the study. Study participants was selected using a systematic random sampling technique for both cases and controls. Data was collected using a pre-tested interviewer-administered structured questionnaire by trained data collectors. The data was checked for completeness, cleaned, entered, and analyzed using SPSS version 24.0. Results: Approximately 52.6% (41 females) of the samples had secondary infertility, while 47.4% had primary infertility (37 females). After logistic regression was made, the determinants of infertility identified were age of women (AOR=4.914; 95%CI: 2.3.60, 10.230), menstrual regularity (AOR= 2.859; 95%CI: 1.338, 6.109), history of TB infection (AOR = 8.518; 95%CI: 1.554, 46.702) and frequency of sexual intercourse (AOR= 5.304; 95%CI: (2.046, 13.749) Conclusion and recommendations: Secondary infertility accounts for 52.6% of the infertile women, while primary infertility accounts for 47.4% of them. Age of women, menstrual regularity, History of TB infection and frequency of sexual intercourse were found to be determinants of female infertility.
Factors Associated with Success of VBAC in threeteaching hospitals in Addis Ababa, Ethiopia: A casecontrol study
(Addis Ababa University, 2010-08) Birara, Malede; Gebrehiwot, Yirgu(MD, MSc.)
Brief BackgroundVaginal delivery after previous one cesarean section for a non recurringindication has been described with many evidences as a safe practice and success rate of 60-80%.Hence many centers are offering VBAC for candidates leaving the century old dictum of oncecesarean always cesarean. But predicting success of VBAC after TOL is still a difficult problemwith lack of a validated tool of prediction world wide.Studies on predictors of success are fewand most of them conducted in developed countries and difficult to generalize. Thereforeassessing factors associated with successful VBAC is very important to counsel mothers onVBAC.ObjectiveTo assess demographic, past and present obstetric factors associated with successfulVBAC In three teaching HospitalsinA.AMethodsA casecontrol studywasconducted to compare the factors associated with successfulVBAC in teaching hospitals in Addis Ababa in one year period. The cases were thosesuccessfully delivered vaginally and the controlswerethose with failed VBAC and delivered byC/S. The sample sizewas101vaginal deliveries and the controls were 103 failed VBAC patientswhich made the case to control ratio of 1:1.In this study the factors associated with success ofVBAC wereprim parity, history of still birth, historyof successful VBAC in thepast, ruptureofmembrane at admission, cervical dilatation at admission, presenceof meconium and presence ofmalposition.Also 66 % of the failed VBAC patients had indications for the second C/S whichcould have been corrected by augmentation if there was no scar.. CONCLUSIONS and RECOMMENDATIONSBit is possible to prepare a decision tool onthe success of VBAC by taking important past and present obstetric and reproductiveperformance history as predictor..
Knowledge, Attitudes and Practices Towards Cervical Cancer Screening among Health Care Professionals in Addis Ababa City Administration;Addis Ababa,Ethiopia ,2021
(Addis Abeba University, 2021-09) Dechasa, Tujo; Yigeremu, Mahlet (MD, Assistant professor in Gynecology and Obstetrics); Andualem, Samirawit (MD, Assistant professor in Gynecology and Obstetrics)
Back-ground: Cervical cancer is the commonest gynecologic cancer in the developing world. Over the past several decades, the incidence of cervical cancer has decreased in industrialized countries. This is mainly attributed to increased awareness and more effective screening and prevention strategies employed in these countries. Although there are evidence-based, affordable, fewer resources requiring, feasible interventions to carry out in low-level health facilities, and effective treatment modalities; the utilization of these screening methods is limited in low-income countries like Ethiopia. Prevention of cervical cancer in low-resource settings can be conducted by increasing the knowledge of cervical cancer screening and its practice by primary health care professionals (1, 2) Objective: To assess the knowledge, attitudes, and practice of cervical cancer screening among health professionals working in Addis Ababa City Administration Health Facilities Method: a cross-sectional study was conducted from May 1, 2021- June 15, 2021, among health professionals working in selected health Centers in Addis Ababa . A pre-tested, structured questionnaire and a checklist were used to collect data .The data was collected from 8 randomly selected health centers involving health professionals. Data was analyzed using SPSS version 25. Binary and multiple logistic regression analysis were used to look for an association between cervical cancer screening knowledge and socio-demographic variables. Result: In this study 36% of the participants had good knowledge on cervical cancer screening, , Majority of participants 71(57%) had favoreable attitude towards cervical cancer screening. Untrained, lost to follow up ,and difficulty of doing the screening procedure were some reasons not to do cervical cancer screening practice. Age ≥40 years (AOR=20.8, 95%CI=3.6,118.9), male health provider(AOR=2.3, 95%CI=1.27, 4.22) ,working area,and having functioning Cervical Cancer screening(AOR=5.2, 95%CI=1.71,16.5) were the factors associated with better knowledge of cervical cancer screening. Conclusion : The knowledge of the study participants on cervical cancer screening was low. Even those who had good knowledge on cervical cancer screening, has limited attitude and quite low practice at Work. There is a need to look into the cervical screening services and the health provides role in the Uptake of the service in Addis Ababa.
Knowledge, Attitude and Practice of Health Professionals towards Neonatal Resuscitation in three Teaching Hospitals, Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-09) Eshetu, Selam; Dr.Teklu, Sisay(Associate Professor of OBGYN); Dr. Worku, Dawit (Assistant Professor of OBGYN and Gynecology Oncologist)
Background: Neonatal mortality is the issue of local, regional, national, continental and global. For example, it is observed in both middle- and low-income countries, especially sub-Saharan Africa including Ethiopia. Neonatal death is multi factorial, but the most important single causes of neonatal deaths were accounted for preterm birth, birth asphyxia, and sepsis. Effective resuscitation, if done timely, can drastically reduce neonatal deaths. Objective: To assess the knowledge, attitude and practice toward neonatal resuscitation among midwives, NICU nurses, Addis Ababa university pediatrics and OBGYN residents in Tikur Anbesa Specialized, Zewditu Memorial and Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Methods: A Cross-Sectional research design was conducted from March – June 2021 and the respondents were selected by using simple random sampling techniques, 204 have returned the questionnaire filled complete (response rate of 98.07%). The data collection tool was closed ended questionnaires. Data was verified, coded, and entered to Epi Data Software version 3.1 and was exported into SPSS version 25 Software for analysis. The degree of association between variables was assessed using logistic regression. Finally, p-value less than 0.05 were considered statistically significant. Results: The good knowledge level among midwifes, nurses, pediatrics residents and OBGYN residents were 30.9%, 28.2%, 42.4% and 42.9% respectively. Neonatal resuscitation training and the time training was given, was found to be the only predictor of knowledge score of respondents (AOR = 3.1, 95 % CI: 1.2 - 4.8, P value = 0.003) and (AOR =5.6, 95 % CI: 1.19 - 6.72, P value = 0.044) respectively. The majority 58.80% of the participants had good attitude towards neonatal resuscitation. Whereas the good practice score among midwifes, nurses, pediatrics residents and OBGYN residents were 59.8%, 33.3%, 59.6% and 39.4% respectively. The only determining factor associated with poor practice score was lack of availability of resuscitation guideline (AOR=2.55, 95% CI: 1.90-8.28, p=0.004). Having good knowledge were found to be the only predictor to have good attitude level (AOR=0.357, 95% CI: 0.18-0.67, p=0.001). Conclusion and recommendations: Knowledge, attitude and practice of nurses and midwifes toward neonatal resuscitation were inadequate. Training and the time training given were found to be predictor for knowledge while presence of guideline was predictors for practice. Continuous and regular training for health professionals should be strengthen.
Knowledge, Attitude, and Practice of Emergency Contraception among Female High School Students in Lideta Sub-city, Addis Ababa, Ethiopia, 2020/21 G.C.
(Addis Abeba University, 2021-09) Esayas, Binyam; Dr.Negash, Shiferaw (M.D, Associate Professor and Gynecologic Oncologist); Dr.G/Hiwot, Yirgu(M.D, Associate Professor and Gynecologic Oncologist); Dr. Sultan, Semir(M.D, Assistant Professor in Obstetrics and Gynecology)
Background: Each year, around 210 million women throughout the world get pregnant, of which 21 million girls aged 15–19 years in developing regions become pregnant. More than half of the teenage pregnancy in developing countries are unintended(1, 2). Emergency contraception is among the different methods for prevention of unintended pregnancy. Despite the existence of different modern and effective contraceptives methods worldwide, the problem of unintended pregnancy is still high (3). Objectives: To assess knowledge, attitude, and practice of Emergency Contraception in female high school students in Lideta sub-city, Addis Ababa, 2020/21 G.C. Methods: A mixed study was used. A cross-sectional, institution-based study was conducted from September 1 to November 30, 2020 E.C., and a systematic sampling technique was used for the quantitative study whereas for the qualitative study, an in-depth interview and purposive sampling techniques was used. Quantitative data were cleaned, coded and entered into, and analyzed using SPSS version 25. Data from in-depth interview was transcribed and translated to English then coded using QDA software, and categorized into similar themes. Descriptive statistics like frequency, measures of central tendencies were used to describe study participants and to summarize the results of the study. The association of the independent variables was done using logistic regression and chi-square test. Variables with P-value of ≤ 0.05 were declared as statistically significant. Result: A total of 257 female students have participated in the study with 100% total response rate. The finding of our study showed that 37.4% of the respondents have good knowledge and 47.9% have positive attitude towards the use of EC. The main source of information about EC was TV. Of the total respondents, only 8.2% have ever practiced sexual intercourse at least once in their lifetime. Of those respondents who had sexual intercourse, 66.6% have ever used EC. In the in-depth interview, when asked about the reason “why they don’t take or recommend EC “, most mentioned ineffectiveness of post-pill in preventing pregnancy. Conclusion: The result indicates that most of the respondents have heard about EC but the cumulative knowledge score is low and only around half having positive attitude about EC. Only a few of the respondents have used EC in their lifetime. We recommend a continuous information delivery to high school students and a separate and scaled-up study should be done to assess the knowledge, attitude, and utilization of EC among high school students.
Nature and Prevalence of Sexual Harassment Against Female Medical Interns a Study at two Teaching Hospitals, Addis Ababa, Ethiopia 2020GC
(Addis Abeba University, 2021-06) Tesfa, Tigist; Dr.Hassan, Salih (Consultant and Assistant professor of Gynecology and Obstetrics); Dr.Alemu, Wolela(Consultant and Assistant professor of Gynecology and Obstetrics)
Background Violence against women is a deep-rooted problem in the world. For example, a report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that female medical students were 220% more likely than non-science, technology, engineering, and mathematics (STEM) disciplines to face sexual harassment from faculty or staff. Objective To determine the prevalence and nature of sexual harassment against female medical interns at Tikur Anbessa Specialized Hospital and Saint Paul's Hospital Millennium Medical College in 2020 GC Methodology Mixed concurrent nested qualitative and quantitative study conducted at Tikur Anbessa Specialized Teaching Hospital and St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia from 1 June 2020 GC to 30 June, 2021Gc using the female medical interns as target population and Semi-structured questionnaire for data collection after obtaining ethical clearance and data analysis was done by Statistical Package for Social Sciences (SPSS) version 23.0 program. Result A total of 76 female medical interns were included in the study. The prevalence of sexual harassment was 96.05%. The most common nature of sexual harassment was a suggestive comment (61 out of 76 respondents), "inappropriate remarks" (59/76 respondents) and "request for dates" (59 out of 76 respondents), and "unwanted physical contact," accounting for 76.31% or 58 out of the 76 respondents. One female medical intern reported attempted rape from TASH, and the perpetrator was "other school staff." Conclusion There is a high prevalence rate of sexual harassment against female medical interns at TASH and SPHMMC, and experiences of harassment range from subtle comments and suggestive gestures to overt behaviors and attempted rape Perpetrators are primarily institutional insiders (lecturers, supervisors, instructors), classmates, and other school staff; other students, patients, and patient attendants are also perpetrators Sexual harassment awareness-creation trainings at the beginning of the academic year for medical students and school staff. And briefing on how, to whom and where to report incidents is recommended A large scale research in Ethiopian medical schools for better understanding of the problem is recommended
Perinatal Outcomes of Pregnancies Complicated by Hypertensive Disorders of Pregnancy in Late Preterm in three Teaching Hospitals in Addis Ababa, Ethiopia
(Addis Abeba University, 2021-09) Girma, Getinet; Dr.Haile, Sofanit(MD, Ass. Prof. OBGYN ); Dr.Yigeremu, Mahlet(MD, Ass. Prof. OBGYN, Fellow REI); Dr.Negash, Shiferaw (MD, Ass. Prof. OBGYN, Gynecology Oncologist)
Background: Hypertensive disorders of pregnancy (HDP) are multisystem diseases known to increase the risk of perinatal mortality worldwide, with a significant proportion of these deaths occurring in low income countries. However, little is known about the obstetric and treatment predictors of perinatal mortality in women with HDP. Until now, only few studies focused on the management of women with hypertensive disorders between 34 0/7 and 36 6/7 weeks of gestational age in Ethiopia. General objective: To investigate the perinatal outcomes of late preterm pregnancies complicated by hypertensive disorders in low resource settings Methods: Hospital based cross sectional descriptive study was conducted on 274 newborns delivered from December 15, 2020 to June 15, 2021 at the three teaching hospitals. Structured and pretested questionnaire were used to collect socio-demographic data and medical records were reviewed. Neonatal status was checked every other day through phone call till 7 days after delivery date. Descriptive statistics were used to describe parameters collected from the files. Bivariate and multiple logistic regressions were done to determine factors associated with unfavorable perinatal outcome. A P-value of less than 0.05 was considered statistically significant. Result: Among 10,129 deliveries during the study period, 952 (9.4%) were preterm. Of these preterm deliveries 680 were late preterm and 274 neonates fulfill the inclusion criteria and analyzed. About 83(30.3%) neonates were delivered 34+0-34+6 weeks, 45 (16.4%) at 35+035+6 weeks and the majority 146 (53.3%) at 36+0-36+6 weeks. Cesarean section was the most common mode of delivery 191 (69.7%) followed by SVD, 74 (27%) and 6 (2.2%) by AVD. About 173 (63.1%) newborns were LBW (1500-2499 grams), 76 (27.8%) were NBW and the remaining 25(9.1%) were VLBW. Fifty eight (21.5%) of neonates need resuscitations at delivery. Hundred forty eight (55.2%) of these neonates were referred to NICU and 102 (68.9%) of them required NICU admission. On day seven neonatal assessment the cumulative survival was 93.7%. The survival rate of late preterm neonates is 87.7%, 90.9% and 97.9% at 34, 35, and 36 weeks respectively. The perinatal mortality rate in late preterm pregnancy in hypertensive disorders of pregnancy in this study was 76.6/1000 live births. Over half, 9/17 (52.9%) of neonatal deaths occurs within the first 48 hours while majority (76.5%) of neonatal deaths occurs with in the first 3 days. In this study one fourth (25.9%) of women had at list one maternal complication. Fetal weight at birth, gestational age during delivery and Apgar score at delivery found to be independent predictors of perinatal survival. Conclusion and Recommendation: During the study period the rate of late preterm birth was 71.4%. This study shows preeclampsia as the most common cause for late preterm birth (84.7%) from hypertensive disorders of pregnancy. Late preterm neonates are at higher risk for neonatal morbidities and mortality contrary to the belief that they are nearly mature. Neonatal birth weight and Apgar score during delivery were the important predictors for the neonatal survival. Critical attention should be paid on the first 72 hours of newborn life to reduce factors contributing to high neonatal loss at this particular time.
Prevalence and Determinant of RH Alloimmunization in RH Negative Women in three Teaching Hospitals, Addis Ababa, Ethiopia, 2021
(Addis Abeba University, 2021-09) Benti, Melat; Dr. Tesfaye, Kiflom (MD,Associate Professor of Obstetrics and Gynecology); Dr.Berhanu, Esayas(MD,Associate Professor of Obstetrics and Gynecology)
Background: Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are reduced after the implementation of immunization to the D antigen, it’s still a concern for most Sub-Saharan African countries, where there is poor and sometimes no Alloimmunization prevention following potentially sensitizing events. This may result in the compromise of the woman’s obstetric care and increase perinatal morbidity and mortality. In Ethiopia the weight of the problem is less known and there is no study done in the study area. This study intended to fill this knowledge gap. Objective: To study prevalence and determinant of Rh Alloimmunization in Rh negative mother in three teaching hospitals (TAH, GMH and ZMH) Addis Ababa, Ethiopia. Methods and Materials: Hospital based cross-sectional study was conducted from 328 Rh negative pregnant women who booked for antenatal and delivery service utilization in TASH, GMH and ZMH from October 2020 to May 2021 to assess prevalence and determinant of Rh Alloimmunization in Rh negative women. The data were collected by means of structured questionnaires. The data were entered, coded and analyzed using Statistical Package for Social Science (SPSS) version 25. Descriptive and logistic regression analyses were conducted. Statistical tests were done at a level of odds ratio with 95% confidence intervals and significance of p < 0.05. Variables with P value < 0.25 during the bivariate analysis were included in the multivariate analysis to see the effect of confounding factors Results and conclusion: The study revealed that prevalence of Rh D negative and Rh Alloimmunization in the study area were 2.1% and 17.1% respectively. Being unemployed, not using prophylaxis’s anti-D, having previous sensitizing event and having two or more pregnancy were statistically significant with Rh alloimmunized (p<0.05). Recommendation: Improvement of access and affordability of anti-D medication. As a nation there is no data that assess the determining factor of Rh Alloimmunization so research must be done with a large sample size to improve the management. In addition assessment of knowledge and practice of the health professional also important.
Prevalence of Anal Incontinence Six Weeks After Vaginal Delivery: Prospective Study in the Three Teaching Hospitals in Addis Ababa, Ethiopia
(Addis Abeba University, 2021-07) Abdissa, Kumasa; Dr.Mesfin, Eyasu(Associate Professor of Obstetrics and Gynecology); Dr. Tesfaye, Kiflom(Asst. Professor of Obstetrics and Gynecology)
Background: Anal incontinence, defined as the involuntary loss of fecal material or flatus once in a week or more. It ranges in severity from an occasional involuntary leakage of stool or flatus to a complete loss of bowel control. The overall prevalence in the population is reported to be approximately 8.3%. It is associated with reduced quality of life, negative psychogenic effects, and social stigma, yet many women do not report their symptoms or seek treatment. For childbearing women Obstetric anal sphincter injury (OASIS) is a well-known risk factor for AI. However, only half the cases of AI after childbirth can be attributed to OASIS. The other half may in part be caused by clinically unrecognized sphincter injury visible on ultrasound (occult OASIS) or by chronic pudenda neuropathy. Because the long-term success of primary sphincter repair in resolving anal incontinence is reported to be as low as 44%, it is important for health care providers to reduce trauma to the perineum during the second stage of labor to avoid anal sphincter damage. In addition, postpartum care and follow up should not overlook detection and treatment of anal incontinence. Statement of the problem : The overall prevalence of anal incontinence in childbearing wome n ranges from 7% to 15% according to some literatures. Less than 3% of women who do self-report fecal incontinence will have this diagnosis recorded in their medical record. But the real figure of the problem in our population is unknown. The most common risk factor is OASIS which occurs during child birth. Despite the anticipated magnitude of this public health problem, there is limited data on the prevalence of AI after childbirth in our country. Rationale of the study : Obstetrician – gynecologists are in a unique position to identify women with anal incontinence because pregnancy, childbirth, obstetric anal sphincter injuries (OASIS), and pelvic floor dysfunction are important risk factors that contribute to anal incontinence in women. Thus, this study is meant to identify the magni tude of AI, associated factors and increase our diagnosis of AI and suggest possible interventions to prevent the condition. Objectives: To A ssess Prevalence of Anal I ncontinence after vaginal delivery at 6weeks postpartum in three selected teaching hospitals (BLH, GMH and ZMH) in Addis Ababa, Ethiopia, 2021. Methods: A prospective cross sectional study was done to assess the prevalence of a nal incontinence after 6 weeks of vaginal delivery. The study participants will be those women who gave birth through vagin al delivery. Sample sizes of 384 women were studied. The data were collected through questionnaire developed using International Consultation on Incontinence Questionnaire on Urinary Incontinence – Short Form (ICIQ-UI-SF) and risks factors associated with anal incontinence mentioned in different literatures, immediat ely after delivery and 6 weeks later. After data collection, each questionnaire was checked for completeness based on the code given during data collection. Data were entered in to SPSS version 20.5 statistical package. Descriptive statistics like frequency, tables, graphs and descriptive summaries were used to describe the independent variables. The association of anal with independent variables is analyzed individually by binary logistic analysis and final association between dependent and independent variable is analyzed by multiple regression analysis. Result : The prevalence of anal incontinence at 6 weeks of vaginal delivery was 8.6%. Accordi ng to bivariate analysis result, fetal presentation (vertex} , mode of delivery (forceps) , d uratio n of second stage of labor (>120minutes) , peri nial te ar were significantly associated with AI. After controlling the effect of confound ing factors ( variables) , multiple logistic re gression analysis revealed that perineal tear is signi ficantly associated with AI ( AOR ꞊ 7.641; 95% CI (1.443, 40.453 ) P =0.17 , and those mothers had second degree of perinatal tear with ( AOR ꞊ 5.344; CI (1.144, 25.635) P=0.36, had significant association with AI. Conclusion and recommendation: The prevalence of AI at 6 weeks of vaginal delivery was 8.6%. Perineal tear was significantly associated with AI, especially with increasing degree of perineal tear. Thus, it is important to prevent perineal tear. In addition, creating awareness about AI and making integral part of postpartum follow is necessary.
Screening for Pelvic Organ Prolapsed without Physical Examination:Validation of the Pelvic Organ Prolapse Simple Screening Inventory (POPSSI)
(Addis Ababa University, 2014-09) Worku, Dawit; G/Hiwot, Yirgu(MD, MSc, Associate Prof. Obstetrics and gynecology)
INTRODUCTIONPelvic organ prolapse occurs with descent of one or more pelvic structures: the uterine cervix or vaginal apex, anterior vagina (usually with bladder, cystocele),posterior vagina (usually with rectum, rectocele), or peritoneum of the cul-de-sac(usually with small intestine, enterocele).However, a specific definition of whatconstitutes clinically significant prolapse remains elusive[1]. POP results from relaxation of the pelvic floor muscle and is estimated to have aprevalence of 30-50% among women aged 50and over[1].Although mortalityresulting from POP is not significant it has a huge impact on the daily activities ofwomen afflicted by this condition, often disruptingand decreasing their quality oflife[2].POP and its complications impose a considerable economic burden on the personand it has been estimated that about 11% of women undergo surgery for POPbefore the age of 79 and with29.2% require repeated surgery[3],[4],[5]. Highparity is the single most important risk factor for prolapse in rich and poorwomen in both more and less developed countries[6]. Many women with pelvic floor disorder do not seek medical advice and thismakes determining its incidence very difficult. In 1996, International Continence Societydefined a system of pelvic organprolapsequantification (POP-Q) demonstrating high inter and intra observerreliability. It allows researchersto report findingsin standardized, easilyreproduciblefashion. Prolapse in each segment is measured relative to thehymen, which is a fixedanatomic landmark that can be identifiedconsistently. Accordingly, it is stage one when the leading prolapsed part ismore than one centimeters above the hymenal ring; stage twowhen it isbetween one centimeter above and one centimeter below thehymenal ring;stage threewhen it is more than one centimeter below thehymenal ringbut less than total vaginal length(TVL) minus two centimeters, and stage fourif itis more than (TVL-2) cm below the hymenal ring[7].In Ethiopia, where accesstoobstetric care is very limited(institutional delivery being only 10 %) and thefertility rateis high(5.5 children per woman) little is known aboutthe prevalenceand risk factors for pelvic floor disorders.
To Describe Health Related Quality of Life, and its Predictive Factors on Cervical Cancer Patients in two Teaching Hospitals, Addis Ababa, Ethiopia, 2021.
(Addis Abeba University, 2021-08) Terefe, Daniel; Negash, Shiferaw (MD, Associate Professor of Obstetrics and Gynecology); Haillu, Sofanit( (MD, Assistant professor of Obstetrics and gynecology)
Background: Cervical cancer is the second most prevalent malignancy in Ethiopia associated with high mortality and morbidity. Nonetheless, few efforts have been made to assess the patients’ HRQOL, and its predictive factors in Ethiopia. Objective: To describe Health Related Quality of Life, its predictive factors of cervical cancer patients in Tikur Anbessa Specialized Hospital and Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: An institutional based cross-sectional study was conducted in Tikur Anbessa Specialized Hospital and Saint Paul’s Hospital Millennium Medical College, from Feb to June, 2021G.C. A total of 264 cervical cancer patients were interviewed using the Amharic version of European Organization for Research and Treatment of Cancer module (EORTC QLQ-C30), and cervical cancer module (EORTC QLQ-CX24) .The Amharic versions of both instruments were previously validated .The data was analyzed using SPSS version 25 and Microsoft Office Excel 2010. ANOVA and stepwise binary and multivariable logistic regression were employed to determine mean difference and significant associations. Results: The mean Global quality of life (GQOL) was (mean± SD =42.57± 23.31) and with the least affected function being physical functioning (mean± SD =76.39± 23.24) and highest social function (mean± SD =50.40± 32.19). For the symptom scales, the financial difficulty had the highest mean of (mean± SD =57.83 ±35.34) and with the exception of diarrhea (mean± SD= 20.08± 29.87) and dyspnea (mean± SD= 22.89± 29.87), all the other items indicated moderate to high symptoms. The EORTC QLQ-CX24 symptom scales the least affected score was on Lymph adenoma (mean± SD =27.71±37.11) and highest affected score was for sexual worry (mean± SD= 51.81+32.197). As stage increases there was a statistically significant reduction in GQOL (p = 0.005) .Age, educational status and monthly income has association with GQOL .Being in the age group <40years affects 2.12 times the GQOL compared to the other variables (AOR =2.12, 95%CI =0.23-18.90). The patients monthly income <600ETB affects the GQOL 1.7 times (AOR=1.74, 95% CI = 0.34-8.93). Participants affected body image and feeling of lymph adenoma was the only two variables which had significant association with GQOL. Once sense of body image affected 1.88 times (AOR=1.88, 95%CI=0.42-8.45) the GQOL and 1.39 times (AOR=1.39, 95%CI=0.51-3.81) if affected feeling of lymph adenoma. Conclusions: GQOL, physical function, role function, cognitive functions, financial difficulties, insomnia and fatigue were the most affected however social function, dyspnea and diarrhea were less affected components of HRQOL of cervical cancer patients. Age , marital status, educational status, occupational status ,monthly income , stage of the disease ,time since diagnosis and planned type of treatment were some of the different socio demographic and medical factors which were associated with health related quality of life of cervical cancer patients.
The Trend of Deeterminants of Home Delivery in Ethiopia from 1995 to 2016
(Addis Abeba University, 2021-07) Alemayehu, Liben; Dr.Negash, Shiferaw(Assoc. prof. of obstetrics and gynecology and gynecologic oncologist); Dr.Arage, Seid(Asst. prof. of obstetrics and gynecology)
Back ground: The world health organization (WHO) has reported that the proportion of deliveries attended by skilled health providers rose from 58% in 1990 to 68% in 2008 worldwide, but remained at only about 50% in Africa. This study therefore tried to identify trends of home delivery and changes in each associated factor over time in Ethiopia. Objective: To analyze the trend of determinants of home delivery since 1995 to 2016 so as to identify areas of intervention to decrease home delivery in Ethiopia. Design: Retrospective analytical study design selected to assess the trend of determinants of home delivery rate since 1995 to 2016 so as to identify areas of intervention to decrease home delivery in Ethiopia using 2000, 2005, 2011 and 2016 demographic and health surveys. Analysis done based on 43,029 women who had given birth in the five-year preceding each survey. Result: Of all respondent 36163 (84%) of them gave birth at home and the remaining 6866(16%) delivered at health institutions. The highest home delivery prevalence is seen in Affar (94.2%), Oromiya (92%) and SNNPR (91%). The Home delivery rate decline is greater in women age greater than 34 years (1.4%/year) than women in other age group. The highest rate of 93.3% was reported among women whose age at first marriage was teenager. Interestingly, home delivery rate trend in women high level of education shows small increment by 0.3% each year. The analysis also found that plateau change of home delivery rate in married women. This study shows home delivery rate decline among women from the ‗rich‘ and ‗middle‘ household (2%/year) but for those women from the ‗poor‘ household (1.1%/year). About 17.6 times declineof home delivery rate in women who watch TV almost every day than who watch TV less than once a week. The trend line for women with no ANC visit almost had no change. Though the trend in rural area was not having change until 2010, but it show major curve (by about 7%) change since then. The steepest decline is seen in Tigray region by more than 3% per year. In Affar, Oromia and Somali regions the analysis show plateau home delivery rate. Discussion: With the current drop rate of home delivery revealed in this research i.e., 1.3% per year, it will take 32 year to achieve MDGs of universal access to reproductive health. Though history of abortion, contraceptive use and pregnancy plan are interrelated health issue, the finding show home delivery rate is less affected by whether the pregnancy is planned or not than the other two factors Conclusion: This study underscores that strategies to decrease home delivery prevalence in the country requires a multifaceted approach that encompasses several preventive interventions such as reduce the likelihood that a woman will become pregnant, improving women education, income and access to media, using ANC as utility to decrease home deliver, encouraging low enforcement in preventing teen age marriage and pregnancy and involving religious leaders; specially traditional religious leaders; in implementations of policy and strategy. This study couldn‘t unknot the real reason of the mothers not to utilize to institutional delivery services. Indepth qualitative study will further help to gain better insight into these.

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