Facility Delivery Research Articles

Vaccination card loss and associated factors in Ethiopia: A multilevel analysis using Ethiopia Mini Demographic and Health Survey 2019 data.

The loss of vaccination cards is a momentous public health challenge in the prevention of vaccine-preventable diseases in most developing countries. There is a paucity of studies on the magnitude of vaccination card losses and associated factors in Ethiopia. Therefore, the aim of the current study was to assess the level of vaccination card loss and associated factors in Ethiopia. Data were extracted from the 2019 Ethiopia Mini Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years with children aged 0-35 months. Data from a total of 3208 mother-child pairs was extracted for the study. A multilevel logistic regression model with random effect analysis techniques was used to identify individual and regional-level determinants of vaccination card loss. We checked the model's fitness by using Akaike Information Criteria and Bayesian Information Criteria. Odds ratios with a 95% Confidence intervals were used to declare statistical significance. A total of 3208 mother-child pairs from nine regions and two city administrations were included in the analysis. The result revealed that 1933 (60.26%) mother-child pairs did not have vaccination cards during home visits. illiterate mother 2.239 (95% CI: 1.297, 3.864), lowest wealth index category 2.089 (95% CI: 1.432, 3.048), ANC non-user 2.047 (95% CI: 1.605, 2.609), children living with their caretaker 6.749 (95% CI: 1.425, 13.654), having no access to television 1.384 (95% CI: 1.150, 1.664), longer birth interval 1.325 (95% CI: 1.027,1.710), giving birth at home and private health facilities 1.985 (95% CI: 1.579, 2.497), 1.696 (1.086, 2.648), contraceptive non-users 1.295 (95% CI: (1.042,1.609) and children aged 12-23 months and 24-35 months 1.577 (95% CI: 1.252, 1.985) and 2.282 (1.803, 2.889) were associated with vaccination card loss. Overall vaccination card loss among mothers of 0-35-month-old children is considerably high. To enhance maternal awareness regarding the significance of vaccination cards, promote antenatal care and public health facility delivery, and future researchers have to explore how to enhance vaccination card retention in Ethiopia.

Inequalities in the geographic access to delivery services in Brazil

BackgroundDespite Brazil’s recent social progress, access to health services is still unequal. This article analyzes the inter-municipal distances traveled by pregnant women to access delivery services, documenting their magnitude and relationship to socioeconomic and risk factors for over a decade in Brazil.MethodsUsing data between 2007 and 2017 from the Brazilian Information System of Live Births and a matrix of inter-municipal distances, we describe the evolution of (i) the share of pregnant women that traveled across municipalities and (ii) the average distance they traveled. Next, we assess which of the previous variables explains the changes in travel distance over time. Finally, we estimate the difference in the average travel distance by individual risk factors and use regression analysis to measure the association between this distance and municipal socioeconomic determinants from the Brazilian census.ResultsWe observe that, on average, (i) the share of women traveling for childbirth increased, reaching 31% in 2017, and (ii) distances got longer, approaching the 60-kilometer mark by 2017. The increase in distance is mainly due to more women traveling. Nevertheless, regional disparities persist, especially between the north/inland and coastal regions. Women with high-risk pregnancies or newborns with risks such as low birth weight tend to travel longer distances. However, those residing in higher-development municipalities tend to travel shorter distances.ConclusionLong distances remain an obstacle to accessing delivery facilities. This matter affects the most vulnerable disproportionately. Policymakers must consider the geographic accessibility of mothers when expanding birth-related services. Additionally, more research is required to understand the decision to travel and the distance effectively traveled as different accessibility facets.

Low utilization of skilled delivery services in rural sub-Saharan Africa: a case for facility delivery improvement.

Maternal mortality remains a pressing global challenge, with sub-Saharan Africa (SSA) disproportionately affected. Despite efforts to improve access to skilled delivery services, utilization remains low, especially in rural areas. This paper synthesizes the extant literature and empirical evidence from rural Ghana to highlight the critical issue of low-skilled delivery services uptake in rural SSA. The literature review findings reveal a pooled prevalence of 54.9% skilled delivery services utilization, while the empirical survey in Ghana indicates a lower rate of 48.7%. These findings underscore the urgent need for targeted interventions to improve access to skilled delivery services in rural SSA. We recommend addressing harmful gender norms, evaluating existing interventions, and integrating qualitative and quantitative approaches to better understand barriers to skilled delivery services utilization in rural Africa. Urgent action is needed to ensure safer childbirth experiences and better maternal and child health outcomes in the region.

Interventions to Enhance Facility Deliveries in Low- and Middle-Income Countries: A Scoping Review.

The objectives of this review were to identify and map evidence of interventions to enhance facility deliveries in low- and middle-income countries (LMICs). A search for all relevant existing reports in the literature was conducted in December 2020 using the following online bibliographic databases: PubMed, EMBASE, and CENTRAL. A manual search of the reference lists of relevant systematic reviews and all identified studies was performed to identify additional studies. Two reviewers independently screened the titles and abstracts of the retrieved studies, and then screened the full text identified as inclusion in the initial screening. The search of electronic databases and hand searching identified a total of 6682 articles. A total of 40 reports were identified for full-text review, and 31 reports were excluded. Finally, nine trials were included in the scoping review, and a total of 29,892 women were included in this review. Of nine trials, one was conducted in Nepal, and the other eight trials were performed in Africa: Kenya, Uganda, Nigeria, Tanzania, and Zambia. Our review found the following effective interventions to enhance facility deliveries: group antenatal care (ANC), birth plans, full vouchers, conditional cash transfers (CCTs), non-monetary incentives, and short message service (SMS). Women who received group ANC, promotion of birth plans, full vouchers, CCTs, non-monetary incentives, and SMS were significantly more likely to deliver at a facility.

Home delivery and associated factors among women who gave birth after antenatal care follow-up in the last 6 months in Jabitehnan District, Northwest Ethiopia: mixed community-based study

IntroductionMaternal mortality is a global issue, with developing countries accounting for over 99% of maternal deaths, with 30% of Ethiopian mothers dying from pregnancy-related causes. This study aimed to assess the magnitude, associated factors, and reasons for home delivery among women who gave birth after antenatal care follow-up in the last 6 months in Jabitehnan District, Northwest Ethiopia.MethodsA mixed community-based study was conducted on women who gave birth after antenatal care follow-up in the last 6 months. Data was collected through face-to-face interviews and structured questionnaires. Bivariate and multivariable logistic regressions were performed to identify factors associated with home delivery. Qualitative data were collected through focus group discussions and in-depth interviews and analyzed using a thematic content analysis method.ResultIn this study, the magnitude of home delivery after ANC follow-up among mothers who gave birth in the last 6 months was 37%, with a 95% CI of 32.5 and 41.5. Pregnancy plan [AOR: 4.56 (2.65, 7.86)], experience of abortion AOR: 3.01 [1.631, (5.55)], ANC follow-up at public hospitals [AOR: 1.89 (1.119, 3.18)], and pregnant mothers visited at home by healthcare providers during their ANC follow-up absent [AOR: 1.61 (1.02, 2.53)] were predictors of home delivery. Poor counseling during ANC, and lack of pregnancy plans, traditions, and beliefs were reasons for home delivery.ConclusionThe study reveals a high magnitude of home delivery as compared to a study done in Bahir Dar (21.2%). Factors include pregnancy plans, health institution type, abortion experience, and absence from antenatal care. Poor counseling during ANC, and lack of pregnancy plans, traditions, and beliefs were reasons for home delivery. Health professionals should receive training in communication and counseling techniques, and they should encourage mothers to plan their pregnancies and visit facility delivery services during ANC follow-up.

Impact of normal vs. caesarean deliveries on child nutritional status and mortality in India: insights from NFHS-5 data

ObjectiveSkilled birth attendance and place of delivery have a significant effect on child growth. The present paper examined the mode of delivery and its impact on child health among children 0–59 months in India.MethodsA total of 200,794 samples were used in the study. Among them, 45,784 births were delivered by C-section, and the remaining 150,010 births were delivered through normal delivery. Life table estimation of mortality, as well as bivariate and multivariate logistic regression, were used to identify the association between child health and mode of delivery using data from the fifth round of the National Family Health Survey conducted in 2019-21.ResultsThe study results indicate that children born through normal delivery had significantly lower rates of stunting, wasting, and underweight compared to those born via C-section. Additionally, the likelihood of a new-born baby dying during the neonatal period was higher for those delivered by C-section compared to those delivered vaginally, which holds true for various background characteristics. Mothers with a 3rd or higher order birth who deliver via C-section face a higher risk of their baby dying during the neonatal and infant periods compared to those with a 2nd order birth.ConclusionThe conclusion of the study found that C-section delivery may adversely affect child undernutrition as compared to normal birth. These findings would help formulate the policies and implement actions that would improve the quality of painless labor and immediate delivery in health facilities particularly public hospitals and shall reduce the C-section birth.

Postnatal cord care practices and associated factors in Arba Minch town, southern Ethiopia.

Cord care is one component of essential newborn care that reduces newborn morbidity and mortality. Poor cord care practice leads to a large amount of neonatal death due to infection. In Ethiopia, many women give birth at home, where neonates are exposed to unclean cord care practices or application of different traditional substances. Despite the severity of the problem, studies related to postnatal cord care practice are scarce. Hence, this study is aimed to assess umbilical cord care practices and associated factors in the postnatal period in Arba Minch town. To assess postnatal cord care practices and associated factors among mothers who gave birth in the last six months in Arba Minch Town, southern Ethiopia, 2019. Cross-sectional study design was conducted and using simple random sampling method 423 mothers who gave birth with in the last six months in Arba Minch town from November 11 to December 02, 2019, were selected. Data was collected using structured questionnaire administered by the interviewer. EpiData version 4.4 was used for data entry and SPSS version 25 was used for data analysis. Variables with p ≤ 0.25 in bivarible logistic regressions were considered as potential candidates for multivariable logistic regression analysis to control confounders. Adjusted Odds Ratio with 95% confidence interval was applied in multivariable logistic regression models, to identify variable, which has significant association. The overall proportion of women who had good postnatal cord care was 67.1%. The maternal age group of 25 to 29 years (AOR = 2.51; 95% CI: 1.35-4.68), maternal educational status of secondary school and above (AOR = 4.19; 95% CI: 2.05-8.54), mothers with good knowledge of cord care (AOR = 1.77; 95% CI: 1.03-3.05), and health facility delivery (AOR = 2.60; 95%CI: 1.05-6.41) were independent factors associated with good cord care. The proportion of good cord-care practice reported in this study was relatively worthy. Maternal age group of 25-29 years, maternal educational status of secondary school and above, having good knowledge of cord care, and delivering at health facility were factors that increased good postnatal cord care practice. Therefore, investing in improving these factors would positively affect maternal postnatal cord care practice. In order to reduce neonatal morbidity and mortality, routine counseling of cord care practice to mothers would attain good knowledge about postnatal cord care practices. Community health education would also increase awareness and practice of postnatal cord care.

Effects of COVID-19, control measures, and program adaptation on prevention of mother-to-child HIV transmission service uptake in Central Region, Uganda

BackgroundCoronavirus disease 2019 (COVID-19) control measures presented impediments for prevention of mother-to-child transmission of HIV (PMTCT) programming in Uganda. Nationwide control measures implemented April—June 2020 included a public transport ban and mandatory travel permits for pregnant women to access clinics. Program adaptations instituted for continuity of services included community drug delivery and home-based DNA-PCR testing for HIV-exposed infants (HEI). We examined the effect of COVID-19 control measures and program adaptations on PMTCT service uptake in central Uganda.MethodsWe analysed data for pregnant women living with HIV (WLHIV) and HEI receiving PMTCT services in eight districts in central Uganda. We abstracted data from medical records at 96 public clinics for six months pre-lockdown (October 2019–March 2020), three months of lockdown (April–June 2020), and six months post-lockdown (July–December 2020). We measured monthly antiretroviral therapy (ART) refill attendance, health facility deliveries, and timely DNA-PCR testing of HEI for HIV (within two months of birth). We conducted segmented ordinary least squares regression of interrupted time series and adjusted for month-to-month changes using Cumby-Huizinga test. We reported results using coefficients and 95% confidence intervals (CIs).ResultsAt the start of pre-lockdown (October 2019), there were 448 deliveries, 2,676 ART refills and 556 timely HEI tests. The pre-lockdown trend for ART refills increased while deliveries and HEI tests declined. At the start of lockdown (April 2020), all indicators declined, although significantly for facility deliveries (-60; 95% CI: -102, -18). Lockdown monthly trends were positive with 68 more HEI tested per month (95% CI:42, 93) and 51 more deliveries (95% CI: 9, 94) but insignificantly negative for ART refills. At start of post-lockdown (July 2020), HEI testing declined (-28; 95%CI: -48, -8). Post-lockdown HEI testing trend was negative with 70 fewer HEI tested per month (95%CI: -79, -62) while no difference in trend for deliveries and ART refills.ConclusionCOVID-19 control measures had a significant immediate negative impact on pregnancy deliveries at health facilities. During lockdown, all service rates rapidly recovered through program adaptations, significantly for HEI testing and deliveries. Maintaining these adaptations might help restore the positive trend in timely HIV testing for HEI.

Mapping the prevalence and covariates associated with home delivery in Bangladesh: A multilevel regression analysis.

Bangladesh has made an intense effort to improve maternal healthcare facilities including facility delivery, but the number of home deliveries is still very high. Therefore, this study aims to find out district-wise prevalence and determine the individual and community-level predictors of home delivery among women in Bangladesh. Data were derived from the Multiple Indicator Cluster Survey (MICS) 2019, a nationwide cross-sectional survey in Bangladesh. A final sample of 9,166 (weighted) women who gave birth in the two years preceding the survey were included in this study. Considering the two-stage cluster sampling strategy adopted by MICS, we used multilevel (2-level) logistic regression analysis to find out the correlates of home delivery. The overall weighted prevalence of home delivery was 46.41% (95% confidence interval [CI]: 45.39-47.43). The highest prevalence was observed in Bandarban district (84.58%), while the lowest was found in Meherpur district (6.95%). The intercept-only regression model demonstrates that the likelihood of women from various clusters having home delivery varied significantly (variance: 1.47, standard error [SE]: 0.117), indicating the applicability of multilevel regression modeling. The multilevel regression analysis showed that women with higher education, wealth status and ANC visit, and those aged >18 years at first marriage/union were associated with lower odds of delivering child at home compared to their counterparts. While women from age group of 35-49 years, whose last pregnancy was unintended were more likely to deliver child at home. In addition, those respondents belonging to a community that had higher wealth status, women's education level, and exposure to media showed lower odds of having delivery at home. The finding indicates that delivery at home is still high in Bangladesh. Targeted interventions to reduce home delivery are urgently needed in Bangladesh to tackle adversities during deliveries and save mothers from the consequences.

Impacts of inequalities in utilization of key maternal health service on fertility preference among high parity women in four selected regions of Ethiopia

BackgroundFertility is one of the three main components which determines the size, structure, and composition of a population, and fertility preferences are important measures for forecasting fertility levels of a population. Therefore, this study aims to assess the impacts of the inequalities in the utilization of key maternal health services on fertility preference among high parity women in four selected regions (i.e., Afar, Beninshangul-Gumuz, Gambella and Somali) of Ethiopia.MethodsThe study used data collected for the 2016 Ethiopian Demographic and Health Surveys (EDHS) survey. It includes a total of 977 high parity women (104 urban and 873 rural) residing in the four regions of the study. Bivariate logistic regression was used to select the potential variables by using a cut off p-value < 0.2 and then the multivariable logistic regression analyses were performed to assess the association between the selected explanatory variables (i.e., control and exposure variables) and the outcome variable (i.e. fertility preference). Further, the study employed a Population Attributable Fractions (PAFs) to examine the population level impacts of the inequalities in maternal and child health service variables on fertility preference.ResultsThe results showed that religion, household wealth index, place of delivery and contraceptive use were significantly associated with fertility preference. The results of the PAFs analysis indicated that contraceptive use had the biggest impact (80%), meaning that non-use of contraceptive increased fertility preference among women in the four regions. Similarly, out of health facility delivery increased fertility preference by 37%.ConclusionThe study findings underscore the critical factors influencing women’s fertility preferences in the studied regions. Low utilization of maternal health services had an impact on fertility preference, accounting for more than half of the observed variations in fertility preferences. To address this issue, targeted interventions are recommended: enhancing access to maternal health services, strengthening fertility control programs, promoting the benefits of using these services, and actively addressing inequalities.

Effects of global health initiatives on the quality of care for maternal health services in Sub-Saharan Africa: a scoping review protocol

IntroductionGlobal Health Initiatives (GHIs) have significantly improved access to healthcare globally. However, high maternal mortality rates persist in low- and middle-income countries (LMICs) such as Uganda. Despite heavy investment from...

Influence of severe pre-eclampsia in combination with premature rupture of members on the course of the early neonatal period

Aim. To assess the effect of preeclampsia in combination with premature rupture of membranes (PROM) on the condition of newborns in the early neonatal period.Materials and Methods. The study included 984 mothers and their newborns, divided into four groups. The main group comprised 94 women whose pregnancies were complicated by severe preeclampsia and PROM. The comparison group consisted of 840 patients, further divided into two subgroups: subgroup A included 70 patients with severe preeclampsia, and subgroup B included 770 patients with PROM. The control group comprised 50 healthy pregnant women.Results and Discussion. In the main group, 31 (33%) newborns were premature; in subgroup A, 21 (30%); and in subgroup B, 69 (9%). Newborns with extreme prematurity were born in the main group 3.1 and 5.4 times more often than in subgroups A and B, respectively (p = 0.013). It was found that the main group had a higher incidence of respiratory distress syndrome, apnea, and neonatal encephalopathy. Hypoglycemia was diagnosed in the main group 5.6 times more frequently than in cases of isolated PROM (p &lt; 0.001) and 1.3 times more frequently than with preeclampsia alone (p &gt; 0.05). In the Republic of Tajikistan, neonatal mortality reaches 56.3%.Conclusion. Reducing early neonatal morbidity and mortality in women with preeclampsia and PROM is possible through referral and delivery in tertiary care facilities.

Molecular Probing Coupled with Density Functional Theory Calculation to Reveal the Influence of Fe Doping on Fe-NiOOH Electrode for High Current Density of Water Splitting.

Fe-doped NiOOH electrocatalysts have attracted wide interest for the exceptional oxygen evolution reaction (OER) performance, but the precise role of Fe doping on the improved intrinsic activity remains unclear. Herein, the molecular probe technique combined with density functional theory calculation is used to reveal the influence of the Fe atom on the rate-determining step of the OER reaction, where the pre-catalyst of hierarchical self-supporting NiFe layered double hydroxide [LDH] nanosheets equipped on nickel foam (NiFe LDH/NF) is generated via a facile and industrially well-matched one-pot corrosion method. The physical characterization results reveal the reconstruction of NiFe LDH into Fe-doped NiOOH for promoted OER, which has a lower OH* adsorption energy with fast subsequent steps that help in obtaining an improved charge injection efficiency compared to NiOOH. In addition, more exposed electroactive species and facile delivery of mass/electron inside the catalytic procedure actually have a high-quality contribution to the outstanding catalytic activity. Therefore, the NiFe LDH36/NF electrocatalyst provides high catalytic activities of 241 and 320mV at 10mA cm-2 toward the OER and overall water-splitting in 1m KOH. This work provides a promising avenue for the rational design of durable self-supporting electrodes toward large-scale water splitting.

Effect of community – facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda

BackgroundImproving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the “Communities in which Mothers and Newborns Thrive (COMONETH) project” in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.MethodsWe used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.ResultsA total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07–1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06–4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20–1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80–1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93–1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06–1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27–1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03–1.14).ConclusionsThe findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

UAV 2D Path Planning Considering Ground Suitability for Flying Safety in Digital Twin

Abstract. The utilization of various UAVs such as facility inspection and delivery is increasing. Ensuring safety in carrying out various UAV missions is an important issue related to human and property damage. Safe operation of UAVs flying autonomously along pre-located routes requires safe route planning to prevent collisions between aircraft in consideration of ground and air obstacles. Pass flight is also essential to minimize damage in the event of a crash. This paper deals with the optimal UAV 2D routing plan considering ground compatibility for flight safety. High ground compatibility here means that the damage caused by the crash is less than when it is not. In this paper, we first defined dynamic and static obstacles. Next, we derived ground compatibility considering dynamic and static obstacles. We used estimation algorithms and land use data to calculate ground compatibility values for flight safety, and through experiments, we calculated an optimal 2DUAV route plan for flight safety.

Logistics Process of Last Mile Package Delivery Facilities

Logistics Process of Last Mile Package Delivery Facilities

Regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria: A national population based cross-sectional study.

Globally, about 810 women die daily from pregnancy and childbirth complications, and the burden is highest in Africa. The United Nations sustainable development goal has a maternal mortality ratio (MMR) target of 70 per 100,000 live births by 2030. Nigeria, the largest country in Africa, has an MMR of 512 per 100,000 live births, thus there is need for intensified efforts to reduce maternal deaths in the country. Proper utilisation of maternal health services including health facilities for delivery is crucial to achieving this. This study assesses the regional trends, spatial patterns and determinants of health facility delivery among women of reproductive age in Nigeria. This is a weighted secondary analysis of the Nigerian Demographic and Health Survey (NDHS). The sample included women who had a live birth in the preceding 5 years of the NDHS 2008, 2013 and 2018. Bivariate analysis and multilevel logistic regression were carried out to assess the determinants of health facility delivery. Trends analysis was done using bar graphs and spatial analysis showed the distribution of health facility delivery by State. Forty-one percent of women delivered their last child in a health facility. The proportion of women who delivered at a health facility increased from 2008 to 2018 for all regions, with exception of the South-south region. Determinants of facility-based delivery include; ethnicity, level of education, wealth index, exposure to mass media (AOR 1.34; 95% CI 1.20-1.50), number of childbirths, number of antenatal visits (AOR 4.03; 95% CI 3.51-4.62), getting a companion to go the health facility (AOR 0.84; 95% CI 0.72-0.98), community level poverty, community level of female education, community distance to health facility, and geographical region. There is an urgent need to deploy appropriate strategies and programme to improve health facility delivery in Nigeria.

Wealth-related inequality in vitamin A rich food consumption among children of age 6-23 months in Ethiopia; Wagstaff decomposition of the 2019 mini-DHS data.

Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6-23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6-23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women's education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18-23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. We found pro-rich wealth-related inequality in VAC among children of age 6-23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting.

Neonatal tetanus in South Sudan: a case series

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes. Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan. Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available. Results: Unfortunately, all three neonates died within 24 hours of admission. Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness. Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

Strategic Adaptation in Focus: Unfolding Stories of Novice Principals

Being novice principals is a transformative experience that entails effective leadership principles. Their ability to adapt to varied circumstances can yield excellent outcomes in the educational setting. This study explored the experiences of novice principals in strategic adaptation to the newly assigned schools. It utilized qualitative research design, particularly phenomenological approach. In-depth Interview was used to generate responses from the participants. There were ten novice principals involved in the study selected through purposive sampling. Based on their experiences in strategic adaptation, there were six themes emerged: strong support and collaboration with stakeholders, building good social relations and open communication, teacher empowerment, difficulty in adjusting to deeply rooted culture, shortage of budget allocation, and constraints on implementation of instructional delivery and maintenance of physical facilities. On the other hand, their collaborative planning practices were captured in four dominant themes: conducting interactive dialogue and consultation through regular meetings, practicing transformational leadership style, empowering teachers and stakeholders, and developing strong sense of commitment and shared responsibility. However, they adopted coping mechanisms to address the challenges by establishing democratic and consultative work environment, identifying priority improvement area, instituting generation of financial resources, adopting clear scientific approach to problem solving, and lobbying support from DepEd authorities and multi-stakeholders. The findings have implications on stressing the need to promote or develop more the principals’ leadership dimensions: educational, people, and strategic leadership especially in dealing with instructional delivery, financial management, collaboration with stakeholders, and instituting planning in schools.