Eskinder Kebede | Addis Ababa University (original) (raw)

Papers by Eskinder Kebede

Ethiopian Journal of Reproductive Health, 2017

ABSTRACT BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an im... more ABSTRACT BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on women’s health, risk of transmission to her family and her fertility decisions. Contraception has a great importance in preventing unintended pregnancy and decrease maternal to child transmission of the virus. OBJECTIVE: This study was aimed to assess attitudes of HIV-positive pregnant women towards family planning in selected Public Health institutions of Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted among HIV-positive pregnant women attending ANC clinics in purposely selected three teaching hospitals in Addis Ababa from April to July 2016. A total of 173 women were participated in the study. Data was collected using interviewer administered structured questionnaire and the data was analyzed using SPSS version 21 statistical software. Binary and multiple logistic regression were done to identify the associated factors of intensions to use contraception. A level of P<0.05 was considered statistically significant. RESULT: Out of the total 173 respondents, about 87.9% were intended to use contraception after delivery. Unintended pregnancy rate of the current pregnancies was 34.7%. Condom use other than its contraceptive purpose was 27% and 26% before pregnancy and during current pregnancy respectively. Prior history of use of contraception and age of the woman had shown an independent association with intention to use contraception. Conclusion: Every effort should be made to satisfy the good attitude for the contraception so as to minimize unintended pregnancy and pediatric HIV. At all levels knowledge should be transmitted and condom should be available easily and offered. KEY WORDS: Unintended pregnancy, contraception, family planning (Ethiopian Journal of Reproductive Health 2017;9:25-35)

PubMed, Nov 1, 2021

Background: Operative vaginal delivery refers to the use of measures to accomplish vaginal delive... more Background: Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics. Methods: A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables. Results: The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July 2011 to 9.9% in June 2016, while it shows a noticeable rise in cesarean section rate 25.4% to 33.8%. The trend in the use of vacuum has shown a sharp decrease from 58% in the 1st year to 10.5% in the fifth year of the study period. There is a rise in the use of forceps from 42% of all operative vaginal delivery in the first year to 89.5% in the fifth year. Conclusion: This study shows that the rate of operative vaginal delivery has declined. The use of vacuum-assisted delivery has especially decreased compared to that of forceps-assisted delivery.

PubMed, Sep 1, 2018

Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP ... more Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP helps clinicians to individualize care for sub-fertility/infertility. Published studies on TTP are very limited in African setting. This cross-sectional study assessed TTP and associated factors among couples with natural planned conception in Addis Ababa, Ethiopia. Data was collected interviewing a representative sample of 1150 pregnant women. The mean and median TTPs were 6.4 (±9.4) and 3.0 months respectively. Only 11.8% (136/1,150) achieved pregnancy in the first month of attempt. Majority, 81.7% (938/1,150), achieved pregnancy by 12 months. The odds of sub-fecundity (TTP more than 12 months) was lowest in age group of 25-29 years (AOR 0.37; 95% CI 0.20-0.70). Women working more than 60 hours/week (AOR 1.87; 95% CI 1.02-3.42), who drink more than 3 cups of coffee/day (AOR 1.87; 95% CI 1.02-3.42), and whose partners chew khat (AOR 1.66; 95% CI 1.06-2.60) had significantly higher odds of sub-fecundity. Use of contraceptive implants (AOR 0.28; 95% CI 0.15-0.51) and pills (AOR 0.53; 95% CI 0.32-0.89) before the index pregnancy had significantly lower odds of sub-fecundity. This study did not consider amount, duration and frequency of khat chewing, hence its dose dependent effect on fecundability/TTP needs further investigation.

BMC Pregnancy and Childbirth, Sep 21, 2021

Background: Ethiopia is a Sub-Saharan country that has made significant improvements in maternal ... more Background: Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births. Methods: This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death. Results: During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098-2.780), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031). Conclusion: Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.

Ethiopian Journal of Reproductive Health, Aug 3, 2021

Uterine inversion is a condition where the uterus is inverted downward with prolapse of the fundu... more Uterine inversion is a condition where the uterus is inverted downward with prolapse of the fundus in to the endometrial cavity and to the cervix. It is broadly classified as puerperal and non-puerperal based on cause of the uterine inversion with puerperal uterine inversion being the more common type of inversion. Here is a rare form of non-puerperal uterine inversion with fundal submucous myoma.

BMC Psychology, 2022

Background Psychological stress is commonly found among infertile women. Untreated stress can aff... more Background Psychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility. Method This cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using ...

Nepal Journal of Obstetrics and Gynaecology, 2018

Aims: To establish the prevalence of urinary incontinence and its determinants among pregnant wom... more Aims: To establish the prevalence of urinary incontinence and its determinants among pregnant women in Addis Ababa, Ethiopia. Methods: This was a facility based cross-sectional study. Data was collected in July 2016 by trained data collectors using the International Consultation on Incontinence criteria qualified questionnaire interviewing333 consenting pregnant women aged 15 to 42 years who were attending antenatal care (ANC) through an exit interview. Data was entered and cleaned using Epi Info, and analyzed using SPSS version 20.0 statistical software. The univariate analysis such as proportions, percentages, ratios, frequency distributions and appropriate graphic presentations were used for describing data. Bivariate analysis of socio-demographic, co-morbidities, mode of deliveries, and parity were included. Then multivariate logistic regression model was employed to control confounding factors. Results: A big number of the pregnant women, 82(24.6%), reported Urinary Incontinenc...

BMC Infectious Diseases, 2019

Background: Group B streptococcus (GBS) is reported as the leading cause of neonatal sepsis and m... more Background: Group B streptococcus (GBS) is reported as the leading cause of neonatal sepsis and meningitis. Newborns from GBS colonized pregnant women are at high risk of infection. Method: A Hospital based cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital from November 05, 2014 to March 25, 2015. A total of 280 pregnant women along with their newborns were screened for GBS using standard method recommended by Center of Disease Control and Prevention. GBS strains were serotyped by using serotype specific antisera. A structured questionnaire was used to collect sociodemographic, obstetrics and clinical data of pregnant women and newborns. Data was analyzed by using chi-square and logistic regression to determine factors associated with prevalence of GBS among pregnant women and newborns. Descriptive statistics was used to determine prevalence of GBS among pregnant women and newborns. P value less than 0.05 was considered statistically significant. Result: Prevalence of GBS among pregnant women, newborns and vertical transmission rate at Hawassa University Comprehensive Specialized Hospital were 44(15.7%), 26(8.9%) and 59.1% respectively. Among 26 GBS colonized newborns one developed sign and symptoms of early onset disease. Serotype distribution of GBS isolates collected from pregnant women and newborns was Ia 13(18.6%), Ib 9(12.9%), II 24(34.3%), III 8(11.4%), V 14(20%), and NT 2 (2.9%). Conclusion: In our study we found relatively high prevalence of GBS among pregnant women and vertical transmission rate. The most prevalent GBS serotypes identified in this study were serotype II followed by V, Ia and Ib. Therefore, appropriate prevention strategies such as intrapartum antibiotic prophylaxis and vaccine development should be considered.

Ethiopian Journal of Reproductive Health, Aug 3, 2020

Ethiopian Medical Journal, Sep 24, 2021

Introduction: Menarche is the first menstrual period of a girl. Age at menarche is a complex trai... more Introduction: Menarche is the first menstrual period of a girl. Age at menarche is a complex trait and has a strong genetic component. The mean age of menarche varies from population to population and is known to be a sensitive indicator of various characteristics of the population, including nutritional status, geographical location, environmental conditions, and magnitude of socioeconomic inequalities in society. Objectives: To determine the mean age of menarche, and assess influencing factors and menstrual patterns of secondary school adolescent females in Addis Ababa, Ethiopia. Methods: This is a cross-sectional study conducted from January to May 2017 in selected high schools in Addis Ababa, Ethiopia. Female adolescents in the selected schools who were in grades 9 th and 10 th and who fulfilled the eligibility criteria were included. A self-administered questionnaire tool was used to collect data. Data was cleaned, entered and analyzed using SPSS version 21. Results: The mean and median ages at menarche in this study were 13.75 (±1.30) and 13 years, respectively. The mean age at menarche was 0.96 years younger for private school girls (12.82 years) compared to government school girls (13.78 years). The private school girls had about 4 times higher odds of having menarche at an earlier age (AOR 4.12; 95% CI 2.44-6.95). The most common perimenstrual symptoms experienced by the students were dysmenorrhea (abdominal cramps) 303 (75.8 %), backache 188 (47.0 %), and headache 16%. In this study, abnormal menstrual cycle lengths occurred in 25.1 % of our respondents. Of the total study population, 77 (19.3%) adolescents had a menstrual cycle length shorter than 21 days. Conclusion: The mean age at menarche in this study was 13.26 ±1.319 years. This age at menarche was earlier than prior reports from Ethiopia. Socioeconomic status was identified as a factor significantly associated with the age at menarche. Dysmenorrhea was the commonest perimenstrual symptom.

Ethiopian Journal of Health Sciences, 2021

Background Operative vaginal delivery refers to the use of measures to accomplish vaginal deliver... more Background Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics Methods A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables Results The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July ...

Ethiopian Medical Journal, 2020

Background: Group B streptococcus (GBS) was identified as the leading cause of neonatal disease i... more Background: Group B streptococcus (GBS) was identified as the leading cause of neonatal disease in developed countries. The surrogate for early onset neonatal disease caused by GBS is rectovaginal colonization of pregnant women before delivery. In this study we sought to determine colonization rate of GBS among pregnant women and their new born, vertical transmission rate and serotype distribution at Tikur Anbessa Specialized Hospital (TASH).Methods: A cross-sectional study was conducted at TASH from March 2015 to August 2015. 280 pregnant women and their newborn were screened for GBS. Isolated GBS were serotyped by using serotype specific antisera. Structured questionnaire was used to collect socio-demographic and obstetric data. Logistic regression was used to compare colonization rate obtained from pregnant women and their newborn with different risk factors. P value less than 0.05 was considered statistically significant.Result: Maternal, newborn GBS colonization rate and verti...

African journal of reproductive health, 2018

Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP ... more Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP helps clinicians to individualize care for sub-fertility/infertility. Published studies on TTP are very limited in African setting. This cross-sectional study assessed TTP and associated factors among couples with natural planned conception in Addis Ababa, Ethiopia. Data was collected interviewing a representative sample of 1150 pregnant women. The mean and median TTPs were 6.4 (±9.4) and 3.0 months respectively. Only 11.8% (136/1,150) achieved pregnancy in the first month of attempt. Majority, 81.7% (938/1,150), achieved pregnancy by 12 months. The odds of sub-fecundity (TTP more than 12 months) was lowest in age group of 25-29 years (AOR 0.37; 95% CI 0.20-0.70). Women working more than 60 hours/week (AOR 1.87; 95% CI 1.02-3.42), who drink more than 3 cups of coffee/day (AOR 1.87; 95% CI 1.02-3.42), and whose partners chew khat (AOR 1.66; 95% CI 1.06-2.60) had significantly higher odds ...

BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on w... more BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on women’s health, risk of transmission to her family and her fertility decisions. Contraception has a great importance in preventing unintended pregnancy and decrease maternal to child transmission of the virus. OBJECTIVE: This study was aimed to assess attitudes of HIV-positive pregnant women towards family planning in selected Public Health institutions of Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted among HIV-positive pregnant women attending ANC clinics in purposely selected three teaching hospitals in Addis Ababa from April to July 2016. A total of 173 women were participated in the study. Data was collected using interviewer administered structured questionnaire and the data was analyzed using SPSS version 21 statistical software. Binary and multiple logistic regression were done to identify the associated factors of intensions to use contraception. A level of...

Minerva Ginecologica, 2020

BACKGROUND Poor communication between patients and providers can lead to misunderstanding and mis... more BACKGROUND Poor communication between patients and providers can lead to misunderstanding and misclassification of clinical information, including pregnancy outcomes by women. This qualitative study with maternity care providers explores patient-provider communications regarding stillbirths (SB) and early neonatal deaths (END) and potential SB-END misclassification in Ethiopia. METHODS Qualitative data were collected through 8 in-depth interviews and 3 focus group discussions with maternity care providers at Tikur Anbessa and Gandhi Memorial hospitals in Addis-Ababa. RESULTS Twenty-six maternity care providers (10 physicians;16 nurses/midwives) were interviewed. Providers noted that high patient loads negatively influence their provision of quality care to patients. Yet, despite patients generally not asking many questions during their delivery hospitalization, maternity care providers reported offering information about pregnancy outcomes at hospital discharge. The level of education was the most cited factor influencing patients' understanding of the information communicated to them, especially with regard to adverse pregnancy outcomes. Respondents reported that women do not have significant misconceptions about either SB or END. Nevertheless, they also revealed that both purposeful and accidental SB-END misclassification occurs. Reports of the direction of such misclassification differed by type of provider - physicians noted that misclassification of SB as END is most common, while nurses and midwives identified the opposite direction for this type of misclassification. CONCLUSIONS Maternity care providers' reporting practices and the quality of their communication with patients contribute to the SB-END misclassification in Ethiopia. There is need to increase providers' awareness of the importance of capturing and reporting reliable and valid information on pregnancy outcomes.

BMC pregnancy and childbirth, Jan 29, 2017

Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), whe... more Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services. A population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4-12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the associa...

BMC psychiatry, Jan 22, 2017

Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries ... more Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting. A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. M...

BMC Pregnancy and Childbirth, 2016

Background: Depressive symptoms during pregnancy can have multiple adverse effects on perinatal o... more Background: Depressive symptoms during pregnancy can have multiple adverse effects on perinatal outcomes, including maternal morbidity and mortality. The potential impact of antenatal depressive symptoms on maternal health care use, however, has been little explored in low and middle-income countries (LMICs). This paper investigates whether maternal health care utilisation varies as a function of antenatal depressive symptoms. Methods: In a population-based cross-sectional survey, 1311 women in the second or third trimesters of pregnancy were recruited in Sodo district, Gurage Zone, southern Ethiopia. Depressive symptoms were measured using a locally validated version of the Patient Health Questionnaire (PHQ-9). The association between antenatal depressive symptoms and number of antenatal care (ANC) visits was examined using Poisson regression and the association of depression symptoms with emergency health care visits using negative binomial regression. Binary logistic regression was used to investigate the association of depressive symptoms with initiation, frequency and adequacy of antenatal care. Results: At PHQ-9 cut off of five or more, 29.5 % of participants had depressive symptoms. The majority (60.5 %) of women had attended for one or more ANC visits. Women with depressive symptoms had an increased risk of having more non-scheduled ANC visits (adjusted Risk Ratio (aRR) = 1.41, 95 % CI: 1.20, 1.65), as well as an increased number of emergency health care visits to both traditional providers (aRR = 1.64, 95 % CI: 1.17, 2.31) and biomedical providers (aRR = 1.31, 95 % CI: 1.04, 1.69) for pregnancy-related emergencies. However, antenatal depressive symptoms were not significantly associated with initiation of ANC. Conclusions: Increased non-scheduled ANC and emergency health care visits may be indicators of undetected depression in antenatal women, and have the potential to overwhelm the capacity and resources of health care systems, particularly in LMICs. Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, may reduce antenatal morbidity and treatment costs and promote efficiency of the health care system.

Ethiopian Journal of Reproductive Health, Aug 3, 2021

Ethiopian Journal of Reproductive Health, 2017

ABSTRACT BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an im... more ABSTRACT BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on women’s health, risk of transmission to her family and her fertility decisions. Contraception has a great importance in preventing unintended pregnancy and decrease maternal to child transmission of the virus. OBJECTIVE: This study was aimed to assess attitudes of HIV-positive pregnant women towards family planning in selected Public Health institutions of Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted among HIV-positive pregnant women attending ANC clinics in purposely selected three teaching hospitals in Addis Ababa from April to July 2016. A total of 173 women were participated in the study. Data was collected using interviewer administered structured questionnaire and the data was analyzed using SPSS version 21 statistical software. Binary and multiple logistic regression were done to identify the associated factors of intensions to use contraception. A level of P<0.05 was considered statistically significant. RESULT: Out of the total 173 respondents, about 87.9% were intended to use contraception after delivery. Unintended pregnancy rate of the current pregnancies was 34.7%. Condom use other than its contraceptive purpose was 27% and 26% before pregnancy and during current pregnancy respectively. Prior history of use of contraception and age of the woman had shown an independent association with intention to use contraception. Conclusion: Every effort should be made to satisfy the good attitude for the contraception so as to minimize unintended pregnancy and pediatric HIV. At all levels knowledge should be transmitted and condom should be available easily and offered. KEY WORDS: Unintended pregnancy, contraception, family planning (Ethiopian Journal of Reproductive Health 2017;9:25-35)

PubMed, Nov 1, 2021

Background: Operative vaginal delivery refers to the use of measures to accomplish vaginal delive... more Background: Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics. Methods: A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables. Results: The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July 2011 to 9.9% in June 2016, while it shows a noticeable rise in cesarean section rate 25.4% to 33.8%. The trend in the use of vacuum has shown a sharp decrease from 58% in the 1st year to 10.5% in the fifth year of the study period. There is a rise in the use of forceps from 42% of all operative vaginal delivery in the first year to 89.5% in the fifth year. Conclusion: This study shows that the rate of operative vaginal delivery has declined. The use of vacuum-assisted delivery has especially decreased compared to that of forceps-assisted delivery.

PubMed, Sep 1, 2018

Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP ... more Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP helps clinicians to individualize care for sub-fertility/infertility. Published studies on TTP are very limited in African setting. This cross-sectional study assessed TTP and associated factors among couples with natural planned conception in Addis Ababa, Ethiopia. Data was collected interviewing a representative sample of 1150 pregnant women. The mean and median TTPs were 6.4 (±9.4) and 3.0 months respectively. Only 11.8% (136/1,150) achieved pregnancy in the first month of attempt. Majority, 81.7% (938/1,150), achieved pregnancy by 12 months. The odds of sub-fecundity (TTP more than 12 months) was lowest in age group of 25-29 years (AOR 0.37; 95% CI 0.20-0.70). Women working more than 60 hours/week (AOR 1.87; 95% CI 1.02-3.42), who drink more than 3 cups of coffee/day (AOR 1.87; 95% CI 1.02-3.42), and whose partners chew khat (AOR 1.66; 95% CI 1.06-2.60) had significantly higher odds of sub-fecundity. Use of contraceptive implants (AOR 0.28; 95% CI 0.15-0.51) and pills (AOR 0.53; 95% CI 0.32-0.89) before the index pregnancy had significantly lower odds of sub-fecundity. This study did not consider amount, duration and frequency of khat chewing, hence its dose dependent effect on fecundability/TTP needs further investigation.

BMC Pregnancy and Childbirth, Sep 21, 2021

Background: Ethiopia is a Sub-Saharan country that has made significant improvements in maternal ... more Background: Ethiopia is a Sub-Saharan country that has made significant improvements in maternal mortality and under-five mortality over the past 15 years. However, the nation continues to have one of the highest rates of perinatal mortality in the entire world with current estimates at 33 deaths per 1000 live births. Methods: This case-control study was conducted between October 2016 and May 2017 at Tikur Anbessa Hospital and Gandhi Memorial Hospital. All women who had a stillbirth or early neonatal death (i.e. death within 7 days) during this period willing to participate were included as cases. A systematic random sample of women delivering at the hospital were approached for recruitment as controls to generate a 2:1 ratio of controls to cases. Data on risk factors were retrieved from medical records including delivery records, and treatment charts. Statistical differences in background and social characteristics of cases and controls were determined by t-test and chi-squared (or fisher's exact test) for quantitative and categorical variables respectively. Binary logistic regression analysis was completed to determine any associations between risk factors and stillbirth/early neonatal death. Results: During the study period, 366 women delivering at the hospitals were enrolled as cases and 711 women delivering at the hospitals were enrolled as controls. Records from both hospitals indicated that the estimated stillbirth and neonatal mortality rates were 30.7 per 1000. Neonatal causes (43.4%) were the most common, followed by antepartum (32.5%) and intrapartum (24.5%). Risk factors for stillbirths and early neonatal death were low maternal education (aOR 1.747, 95%CI 1.098-2.780), previous stillbirth (aOR 9.447, 95%CI 6.245-14.289), previous preterm birth (aOR 3.620, 95%CI 2.363-5.546), and previous child with congenital abnormality (aOR 2.190, 95% 1.228-3.905), and antepartum hemorrhage during pregnancy (aOR 3.273, 95% 1.523-7.031). Conclusion: Antepartum hemorrhaging is the only risk factor in our study amenable for direct intervention. Efforts should be maximized to improve patient education and antenatal and obstetric services. Moreover, the most significant cause of mortality was asphyxia-related causes. It is imperative that obstetric capacity in rehabilitation services are strengthened and for further studies to investigate the high burden of asphyxia at these tertiary hospitals to better tailor interventions.

Ethiopian Journal of Reproductive Health, Aug 3, 2021

Uterine inversion is a condition where the uterus is inverted downward with prolapse of the fundu... more Uterine inversion is a condition where the uterus is inverted downward with prolapse of the fundus in to the endometrial cavity and to the cervix. It is broadly classified as puerperal and non-puerperal based on cause of the uterine inversion with puerperal uterine inversion being the more common type of inversion. Here is a rare form of non-puerperal uterine inversion with fundal submucous myoma.

BMC Psychology, 2022

Background Psychological stress is commonly found among infertile women. Untreated stress can aff... more Background Psychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility. Method This cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using ...

Nepal Journal of Obstetrics and Gynaecology, 2018

Aims: To establish the prevalence of urinary incontinence and its determinants among pregnant wom... more Aims: To establish the prevalence of urinary incontinence and its determinants among pregnant women in Addis Ababa, Ethiopia. Methods: This was a facility based cross-sectional study. Data was collected in July 2016 by trained data collectors using the International Consultation on Incontinence criteria qualified questionnaire interviewing333 consenting pregnant women aged 15 to 42 years who were attending antenatal care (ANC) through an exit interview. Data was entered and cleaned using Epi Info, and analyzed using SPSS version 20.0 statistical software. The univariate analysis such as proportions, percentages, ratios, frequency distributions and appropriate graphic presentations were used for describing data. Bivariate analysis of socio-demographic, co-morbidities, mode of deliveries, and parity were included. Then multivariate logistic regression model was employed to control confounding factors. Results: A big number of the pregnant women, 82(24.6%), reported Urinary Incontinenc...

BMC Infectious Diseases, 2019

Background: Group B streptococcus (GBS) is reported as the leading cause of neonatal sepsis and m... more Background: Group B streptococcus (GBS) is reported as the leading cause of neonatal sepsis and meningitis. Newborns from GBS colonized pregnant women are at high risk of infection. Method: A Hospital based cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital from November 05, 2014 to March 25, 2015. A total of 280 pregnant women along with their newborns were screened for GBS using standard method recommended by Center of Disease Control and Prevention. GBS strains were serotyped by using serotype specific antisera. A structured questionnaire was used to collect sociodemographic, obstetrics and clinical data of pregnant women and newborns. Data was analyzed by using chi-square and logistic regression to determine factors associated with prevalence of GBS among pregnant women and newborns. Descriptive statistics was used to determine prevalence of GBS among pregnant women and newborns. P value less than 0.05 was considered statistically significant. Result: Prevalence of GBS among pregnant women, newborns and vertical transmission rate at Hawassa University Comprehensive Specialized Hospital were 44(15.7%), 26(8.9%) and 59.1% respectively. Among 26 GBS colonized newborns one developed sign and symptoms of early onset disease. Serotype distribution of GBS isolates collected from pregnant women and newborns was Ia 13(18.6%), Ib 9(12.9%), II 24(34.3%), III 8(11.4%), V 14(20%), and NT 2 (2.9%). Conclusion: In our study we found relatively high prevalence of GBS among pregnant women and vertical transmission rate. The most prevalent GBS serotypes identified in this study were serotype II followed by V, Ia and Ib. Therefore, appropriate prevention strategies such as intrapartum antibiotic prophylaxis and vaccine development should be considered.

Ethiopian Journal of Reproductive Health, Aug 3, 2020

Ethiopian Medical Journal, Sep 24, 2021

Introduction: Menarche is the first menstrual period of a girl. Age at menarche is a complex trai... more Introduction: Menarche is the first menstrual period of a girl. Age at menarche is a complex trait and has a strong genetic component. The mean age of menarche varies from population to population and is known to be a sensitive indicator of various characteristics of the population, including nutritional status, geographical location, environmental conditions, and magnitude of socioeconomic inequalities in society. Objectives: To determine the mean age of menarche, and assess influencing factors and menstrual patterns of secondary school adolescent females in Addis Ababa, Ethiopia. Methods: This is a cross-sectional study conducted from January to May 2017 in selected high schools in Addis Ababa, Ethiopia. Female adolescents in the selected schools who were in grades 9 th and 10 th and who fulfilled the eligibility criteria were included. A self-administered questionnaire tool was used to collect data. Data was cleaned, entered and analyzed using SPSS version 21. Results: The mean and median ages at menarche in this study were 13.75 (±1.30) and 13 years, respectively. The mean age at menarche was 0.96 years younger for private school girls (12.82 years) compared to government school girls (13.78 years). The private school girls had about 4 times higher odds of having menarche at an earlier age (AOR 4.12; 95% CI 2.44-6.95). The most common perimenstrual symptoms experienced by the students were dysmenorrhea (abdominal cramps) 303 (75.8 %), backache 188 (47.0 %), and headache 16%. In this study, abnormal menstrual cycle lengths occurred in 25.1 % of our respondents. Of the total study population, 77 (19.3%) adolescents had a menstrual cycle length shorter than 21 days. Conclusion: The mean age at menarche in this study was 13.26 ±1.319 years. This age at menarche was earlier than prior reports from Ethiopia. Socioeconomic status was identified as a factor significantly associated with the age at menarche. Dysmenorrhea was the commonest perimenstrual symptom.

Ethiopian Journal of Health Sciences, 2021

Background Operative vaginal delivery refers to the use of measures to accomplish vaginal deliver... more Background Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics Methods A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables Results The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July ...

Ethiopian Medical Journal, 2020

Background: Group B streptococcus (GBS) was identified as the leading cause of neonatal disease i... more Background: Group B streptococcus (GBS) was identified as the leading cause of neonatal disease in developed countries. The surrogate for early onset neonatal disease caused by GBS is rectovaginal colonization of pregnant women before delivery. In this study we sought to determine colonization rate of GBS among pregnant women and their new born, vertical transmission rate and serotype distribution at Tikur Anbessa Specialized Hospital (TASH).Methods: A cross-sectional study was conducted at TASH from March 2015 to August 2015. 280 pregnant women and their newborn were screened for GBS. Isolated GBS were serotyped by using serotype specific antisera. Structured questionnaire was used to collect socio-demographic and obstetric data. Logistic regression was used to compare colonization rate obtained from pregnant women and their newborn with different risk factors. P value less than 0.05 was considered statistically significant.Result: Maternal, newborn GBS colonization rate and verti...

African journal of reproductive health, 2018

Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP ... more Waiting time-to-pregnancy (TTP) of couples is closely related to fecundability. Knowledge on TTP helps clinicians to individualize care for sub-fertility/infertility. Published studies on TTP are very limited in African setting. This cross-sectional study assessed TTP and associated factors among couples with natural planned conception in Addis Ababa, Ethiopia. Data was collected interviewing a representative sample of 1150 pregnant women. The mean and median TTPs were 6.4 (±9.4) and 3.0 months respectively. Only 11.8% (136/1,150) achieved pregnancy in the first month of attempt. Majority, 81.7% (938/1,150), achieved pregnancy by 12 months. The odds of sub-fecundity (TTP more than 12 months) was lowest in age group of 25-29 years (AOR 0.37; 95% CI 0.20-0.70). Women working more than 60 hours/week (AOR 1.87; 95% CI 1.02-3.42), who drink more than 3 cups of coffee/day (AOR 1.87; 95% CI 1.02-3.42), and whose partners chew khat (AOR 1.66; 95% CI 1.06-2.60) had significantly higher odds ...

BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on w... more BACKGROUND: Human Immunodeficiency Virus infection of a reproductive age woman has an impact on women’s health, risk of transmission to her family and her fertility decisions. Contraception has a great importance in preventing unintended pregnancy and decrease maternal to child transmission of the virus. OBJECTIVE: This study was aimed to assess attitudes of HIV-positive pregnant women towards family planning in selected Public Health institutions of Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted among HIV-positive pregnant women attending ANC clinics in purposely selected three teaching hospitals in Addis Ababa from April to July 2016. A total of 173 women were participated in the study. Data was collected using interviewer administered structured questionnaire and the data was analyzed using SPSS version 21 statistical software. Binary and multiple logistic regression were done to identify the associated factors of intensions to use contraception. A level of...

Minerva Ginecologica, 2020

BACKGROUND Poor communication between patients and providers can lead to misunderstanding and mis... more BACKGROUND Poor communication between patients and providers can lead to misunderstanding and misclassification of clinical information, including pregnancy outcomes by women. This qualitative study with maternity care providers explores patient-provider communications regarding stillbirths (SB) and early neonatal deaths (END) and potential SB-END misclassification in Ethiopia. METHODS Qualitative data were collected through 8 in-depth interviews and 3 focus group discussions with maternity care providers at Tikur Anbessa and Gandhi Memorial hospitals in Addis-Ababa. RESULTS Twenty-six maternity care providers (10 physicians;16 nurses/midwives) were interviewed. Providers noted that high patient loads negatively influence their provision of quality care to patients. Yet, despite patients generally not asking many questions during their delivery hospitalization, maternity care providers reported offering information about pregnancy outcomes at hospital discharge. The level of education was the most cited factor influencing patients' understanding of the information communicated to them, especially with regard to adverse pregnancy outcomes. Respondents reported that women do not have significant misconceptions about either SB or END. Nevertheless, they also revealed that both purposeful and accidental SB-END misclassification occurs. Reports of the direction of such misclassification differed by type of provider - physicians noted that misclassification of SB as END is most common, while nurses and midwives identified the opposite direction for this type of misclassification. CONCLUSIONS Maternity care providers' reporting practices and the quality of their communication with patients contribute to the SB-END misclassification in Ethiopia. There is need to increase providers' awareness of the importance of capturing and reporting reliable and valid information on pregnancy outcomes.

BMC pregnancy and childbirth, Jan 29, 2017

Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), whe... more Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services. A population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4-12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the associa...

BMC psychiatry, Jan 22, 2017

Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries ... more Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting. A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. M...

BMC Pregnancy and Childbirth, 2016

Background: Depressive symptoms during pregnancy can have multiple adverse effects on perinatal o... more Background: Depressive symptoms during pregnancy can have multiple adverse effects on perinatal outcomes, including maternal morbidity and mortality. The potential impact of antenatal depressive symptoms on maternal health care use, however, has been little explored in low and middle-income countries (LMICs). This paper investigates whether maternal health care utilisation varies as a function of antenatal depressive symptoms. Methods: In a population-based cross-sectional survey, 1311 women in the second or third trimesters of pregnancy were recruited in Sodo district, Gurage Zone, southern Ethiopia. Depressive symptoms were measured using a locally validated version of the Patient Health Questionnaire (PHQ-9). The association between antenatal depressive symptoms and number of antenatal care (ANC) visits was examined using Poisson regression and the association of depression symptoms with emergency health care visits using negative binomial regression. Binary logistic regression was used to investigate the association of depressive symptoms with initiation, frequency and adequacy of antenatal care. Results: At PHQ-9 cut off of five or more, 29.5 % of participants had depressive symptoms. The majority (60.5 %) of women had attended for one or more ANC visits. Women with depressive symptoms had an increased risk of having more non-scheduled ANC visits (adjusted Risk Ratio (aRR) = 1.41, 95 % CI: 1.20, 1.65), as well as an increased number of emergency health care visits to both traditional providers (aRR = 1.64, 95 % CI: 1.17, 2.31) and biomedical providers (aRR = 1.31, 95 % CI: 1.04, 1.69) for pregnancy-related emergencies. However, antenatal depressive symptoms were not significantly associated with initiation of ANC. Conclusions: Increased non-scheduled ANC and emergency health care visits may be indicators of undetected depression in antenatal women, and have the potential to overwhelm the capacity and resources of health care systems, particularly in LMICs. Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, may reduce antenatal morbidity and treatment costs and promote efficiency of the health care system.

Ethiopian Journal of Reproductive Health, Aug 3, 2021