Hospital-based Unmatched Case-control Study Research Articles

Determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, Central Ethiopia: A case-control study.

Birth asphyxia is one of the leading causes of death in low and middle-income countries and the prominent cause of neonatal mortality in Ethiopia. Early detection and managing its determinants would change the burden of birth asphyxia. Thus, this study identified determinants of birth asphyxia among newborns delivered in public hospitals of West Shoa Zone, central Ethiopia. A hospital-based unmatched case-control study was conducted from May to July 2020. Cases were newborns with APGAR (appearance, pulse, grimaces, activity, and respiration) score of <7 at first and fifth minute of birth and controls were newborns with APGAR score of ≥ 7 at first and fifth minute of birth. All newborns with birth asphyxia during the study period were included in the study while; two comparable controls were selected consecutively after each birth asphyxia case. A pre-tested and structured questionnaire was used to collect maternal socio-demographic and antepartum characteristics. The pre-tested checklist was used to retrieve intrapartum and fetal related factors from both cases and controls. The collected data were entered using Epi-Info and analyzed by SPSS. Bi-variable logistic regression analysis was done to identify the association between each independent variable with the outcome variable. Adjusted odds ratio (AOR) with a 95% CI and a p-value of <0.05 was used to identify determinants of birth asphyxia. In this study, prolonged labor (AOR = 4.15, 95% CI: 1.55, 11.06), breech presentation (AOR = 5.13, 95% CI: 1.99, 13.21), caesarean section delivery (AOR = 3.67, 95% CI: 1.31, 10.23), vaginal assisted delivery (AOR = 5.69, 95% CI: 2.17, 14.91), not use partograph (AOR = 3.36, 95% CI: 1.45, 7.84), and low birth weight (AOR = 3.74, 95% CI:1.49, 9.38) had higher odds of birth asphyxia. Prolonged labor, breech presentation, caesarean and vaginal assisted delivery, fails to use partograph and low birth weights were the determinants of birth asphyxia. Thus, health care providers should follow the progress of labor with partograph to early identify prolonged labor, breech presentation and determine the mode of delivery that would lower the burden of birth asphyxia.

Identifying Risk Factors of Breast Cancer Among Women Attending Selected Hospitals of Addis Ababa City: Hospital-Based Unmatched Case-Control Study.

BackgroundBreast cancer, one of the chronic diseases, is the most common cancer among women in the world. In Ethiopia, late-stage breast cancer is widely diagnosed and women have very little access to adequate medication, pain relief, or palliative care. In addition, there are few research on risk factors for breast cancer in Ethiopia. A safer way out of this is to concentrate on prevention; one of the prevention methods is to recognize risk factors sooner. The study therefore aimed to establish risk factors for breast cancer among women in hospitals in the city of Addis Ababa.MethodsHospital-based, unmatched case-control research conducted in selected Addis Ababa hospitals from April to September 2017 (Case=110 and Control=110). Data were collected by standardized questionnaires for both cases and controls. Cases were initially detected by mammography screening accompanied by histopathological examinations, while controls were those women who were negative by mammogram testing, stress levels were assessed by perceived stress scale (PSS) and body mass index measured by WHO norm. Summary statistics Computed and binary logistic regression analysis to classify risk factors for breast cancer modified odds ratio (AOR) with 95% confidence interval (CI) calculated.ResultsThe participants’ mean age of was 43.80 years (SD ±12.63) and 39.64 years (SD ±12.91) for cases and controls, respectively. Physical activity (AOR=0.2, 95% CI: 0.10, 0.41) was correlated with lower probability of breast cancer, while never breastfeed (AOR=3.4, 95% CI: 1.21, 9.67); menopausal state (AOR=6.8, 95% CI: 1.92, 24.16), and body mass index above 25. 1 kg/m2 (AOR=5.9, 95% CI: 2.16, 16.48) were factors risk factors for breast cancer.ConclusionThis research shows the importance of physical exercise, breastfeeding, menopausal status, and nutritional status in the occurrence of breast cancer. Actions aimed at increasing physical activity, breastfeeding habits and keeping a balanced diet will help to minimize the incidence of breast cancer.

Neonatal Sepsis Risk Factors in Public Hospitals in Wollega Zones, Ethiopia

Background Globally, neonatal death accounts for almost half of the under-five children’s mortality rate. In Ethiopia, neonatal sepsis is among the leading causes of neonatal morbidity and mortality. Several studies had assessed the prevalence and associated factors of neonatal sepsis in Ethiopia. However, limited studies examined the risk factors of neonatal sepsis. Thus, this study aimed to assess risk factors for neonatal sepsis among neonates admitted to the neonatal intensive care unit of the selected public hospitals in Wollega Zones. Methods A hospital-based unmatched case-control study was conducted in public hospitals in Wollega zones among 300 newborns admitted to neonatal intensive care units with their index mothers. Neonatal sepsis was diagnosed by a physician based on hematologic records and newborn danger signs. Neonates who were diagnosed for neonatal sepsis were recorded to cases; meanwhile, controls were who had not had sepsis. The consecutive sampling technique was employed to collect data from the study subjects using a 1:1 ratio for cases and controls. The data were entered into Epi Data version 3.1 and exported to SPSS version 20 for analysis. The binary logistic regression model was used to examine the association between dependent and independent variables. Variables were considered as an independent risk factor of neonatal sepsis if the p-value is <0.05 in stepwise backward analysis in multivariable logistic regression. Findings Three hundred neonates with their index mothers (150 cases and 150 controls) were included in this study. Multivariable logistic regression analysis showed that mothers who had experienced premature rupture of the membrane [AOR=2.94, 95% CI(1.39-6.06)], mothers who had a history of UTI/STI [AOR=2.11, 95% CI(1.06-4.19)], neonates’ who had APGAR scores of <7 at the fifth minute [AOR=3.69, 95% CI(2.08-6.53)] and neonates who was resuscitated at birth [AOR=2.93, 95% CI(1.67-5.14)] were the independent risk factors of neonatal sepsis to neonates admitted to neonatal intensive care units. Conclusions This study highlights both maternal and neonatal factors contributing to neonatal sepsis. Maternal counseling, early identification and prompt management of maternal urinary tract infections/sexually transmitted infections during antenatal care service should be emphasized. Also, enhancing safe neonatal resuscitation and infection prevention practice of delivery unit staff through provision of refreshment course. DOI: 10.7176/JHMN/87-02 Publication date: March 31 st 2021

Predictors of Preterm Birth among Mothers Who Gave Birth in Silte Zone Public Hospitals, Southern Ethiopia.

Background A preterm birth is the leading cause of death in both neonatal and children under five years of age every year throughout the world, particularly in Sub-Saharan Africa. The causes of a preterm birth are complex and multifactorial; many risk factors that contribute it are not fully understood. The aim of this study was to identify predictors of a preterm birth among mothers who gave birth in Silte Zone Public Hospitals, Southern Ethiopia (2019/20). Methods and Materials A hospital-based unmatched case-control study design was carried out from July 15th to October 30th, 2019, by assigning mothers who gave preterm births as cases and those with term births as controls. A total of 365 respondents (91 cases and 274 controls) were selected by a consecutive simple random sampling until the required sample size was achieved. For each case, three consecutive controls were included. Data were collected using a structured interview questionnaire complement with record reviewing. The data were entered into Epi Info 7 and exported into SPSS 25 for analysis. Descriptive analysis was computed to obtain summary values for cases and controls separately. All candidate variables in bivariate analysis were entered into the multivariable logistic regression model by using the backward likelihood ratio selection methods. Finally, variables with p value ≤ 0.05 were considered as potential determinants of a preterm birth and reported in the form of adjusted odds ratio with 95% confidence interval. Results Among a total of 365 mothers who gave live birth, 91 (24.9%) were cases compared to 274 (75.1%) which were controls. The final multivariable logistic regression analysis results showed that having history of a previous preterm birth (AOR = 3.51; 95%CI = 1.40 − 8.81), having shorter interpregnancy interval (AOR = 4.46; 95%CI = 1.95 − 10.21), experiencing obstetric complication (AOR = 3.82; 95%CI = 1.62 − 9.00), and having infant born with low birth weight (AOR = 5.58; 95%CI = 2.39 − 13.03) were found to be independent predictors of a preterm birth. Conclusions According to this finding, mothers having previous history of a preterm birth, experiencing obstetric complication, having shorter interpregnancy interval, and having infant born with low birth weight were reported as the independent predictors of a preterm birth. Improving the quality of antepartum and intrapartum, counseling on birth space, creating awareness on family planning, and early screening of preterm determinants are mandatory.

Quick assessment of DNA damage in cervical epithelial cells using a chromatin dispersion test.

This study was aimed to quantify genomic DNA breakages in the cervical epithelium cells of patients diagnosed with different grades of cervical lesions using a quick test based on chromatin dispersion after controlled protein depletion. The association between the progressive stages of cervical dysplasia and the levels of DNA damage, taking into account the presence of papillomavirus human (HPV) infection, was investigated. A hospital-based unmatched case-control study was conducted during 2018 with a sample of 78 women grouped according to histological diagnosis as follows: 23 women with low grade-squamous intraepithelial lesion (LG-SIL), 34 women with high grade- squamous intraepithelial lesion (HG-SIL), and three women with cervical carcinoma (CC). In parallel, 15 women without cervical lesions were included as a Control cohort. DNA damage levels in cervical epithelial cells were assessed using the chromatin dispersion test (CDT) and controlled in parallel with DNA breakage detection coupled with florescent in situ hybridization (DBD‒FISH) using whole genomic DNA probes. CDT produces different morphotypes in the cervical epithelium that can be associated with the level of DNA breakage revealed with DBD‒FISH. A significant increase of DNA damage was correlated with the histological progression of the patients and human papillomavirus (HPV) infection. The CDT is a simple, accurate and inexpensive morphological bioassay to identify different levels DNA damage that can be associated with the level of abnormal cells present in the cervical epithelium in patients who commonly present HPV infection.

Determinants of Uterine Rupture and Its Management Outcomes among Mothers Who Gave Birth at Public Hospitals of Tigrai, North Ethiopia: An Unmatched Case Control Study.

Introduction Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai. Objective This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. Method A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. Result Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. Conclusion Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.

Determinants of Neonatal Jaundice among Neonates Admitted to Neonatal Intensive Care Unit in Public General Hospitals of Central Zone, Tigray, Northern Ethiopia, 2019: a Case-Control Study.

Background Neonatal jaundice is common a clinical problem worldwide. Globally, every year, about 1.1 million babies develop severe hyperbilirubinemia with or without bilirubin encephalopathy and the vast majority reside in sub-Saharan Africa and South Asia. Strategies and information on determinants of neonatal jaundice in sub-Saharan Africa are limited. So, investigating determinant factors of neonatal jaundice has paramount importance in mitigating jaundice-related neonatal morbidity and mortality. Methodology. Hospital-based unmatched case-control study was conducted by reviewing medical charts of 272 neonates in public general hospitals of the central zone of Tigray, northern Ethiopia. The sample size was calculated using Epi Info version 7.2.2.12, and participants were selected using a simple random sampling technique. One year medical record documents were included in the study. Data were collected through a data extraction format looking on the cards. Data were entered to the EpiData Manager version 4.4.2.1 and exported to SPSS version 20 for analysis. Descriptive and multivariate analysis was performed. Binary logistic regression was used to test the association between independent and dependent variables. Variables at p value less than 0.25 in bivariate analysis were entered to a multivariable analysis to identify the determinant factors of jaundice. The level of significance was declared at p value <0.05. Results A total of 272 neonatal medical charts were included. Obstetric complication (AOR: 5.77; 95% CI: 1.85-17.98), low birth weight (AOR: 4.27; 95% CI:1.58-11.56), birth asphyxia (AOR: 4.83; 95% CI: 1.617-14.4), RH-incompatibility (AOR: 5.45; 95% CI: 1.58-18.74), breastfeeding (AOR: 6.11; 95% CI: 1.71-21.90) and polycythemia (AOR: 7.32; 95% CI: 2.51-21.311) were the determinants of neonatal jaundice. Conclusion Obstetric complication, low birth weight, birth asphyxia, RH-incompatibility, breastfeeding, and polycythemia were among the determinants of neonatal jaundice. Hence, early prevention and timely treatment of neonatal jaundice are important since it was a cause of long-term complication and death in neonates.

Determinants of neonatal jaundice among neonates admitted to five referral hospitals in Amhara region, Northern Ethiopia: an unmatched case-control study

BackgroundNeonatal jaundice is associated with a significant risk of neonatal morbidity and mortality. It is a major cause of hospital neonatal intensive care unit admission and readmissions during the neonatal...

Factors associated with malnutrition in children

BackgroundGlobally, under-nutrition accounts for > 3 million deaths annually among children < 5 years, with Kenya having ~ 35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged < 5 years in western Kenya.MethodsWe conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6–59 months with either z-score for weight-for-height ≤ −2SD or ≥ +2SD; weight-for-age ≤ −2SD or ≥ +2SD; or height-for-age ≤ −2SD. Controls were children aged 6–59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses.ResultsA total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR = 7.9; 95% CI: 1.5–41.2), deworming (OR = 0.8; 95% CI: 0.4–1.2), and pre-lacteal feeding (OR = 1.8; 95% CI: 1.1–3.0) were associated with under-nutrition. Delayed developmental milestones (AOR = 13.9; 95% CI: 2.8–68.6); low birth weight (AOR = 3.3; 95% CI: 1.4–7.6), and paternal lack of formal education (AOR = 4.9; 95% CI: 1.3–18.9) were independently associated with under-nutrition.ConclusionProper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

Determinants of VIA Positivity Among Women Screened for Cervical Precancerous Lesion in Public Hospitals of Oromia Region, Ethiopia: Unmatched Case-Control Study.

PurposeGlobally, cervical cancer is the fourth most frequent cancer among women. An estimated 570,000 cases of cervical cancer representing 6.6% of all female cancers were reported in the year 2018. Approximately, 90% of deaths from cervical cancer occurred in low- and middle-income countries. Screening cervical cancer at an early stage and providing access to effective treatment can significantly improve the likelihood of survival. Hence, this study aimed to assess the determinants of visual inspection of cervix with acetic acid (VIA) positivity among women screened in public hospitals of Oromia region, Ethiopia.MethodsA hospital-based un-matched case-control study was conducted in Oromia region, Ethiopia. Cases were women who have a positive result for the VIA test, and controls were women with a negative result. An interviewer-administered questionnaire was used to collect the data. Multiple binary logistic regressions were conducted to assess the determinants of VIA positivity. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported to describe the strength of associations. Statistical significance was declared at a p-value <0.05.ResultsA total of 74 cases and 148 controls were included in this study. The mean age of cases and controls was 40.5 ± 13.3 years and 37.1 ± 11.9 years, respectively. Women with parity of four or more children had two times higher odds being positive for VIA test compared to their counterparts (AOR: 2.1, 95% CI: 1.3–4.0). Women with a history of post-coital bleeding had three times higher odds of VIA positivity compared to their counterparts (AOR: 3.3, 95% CI: 1.2–8.0). History of sexually transmitted infection (AOR: 1.9, 95% CI: 1.1–3.5), having multiple sexual partners (AOR: 3.2, 95% CI: 1.2–8.0), and history of smoking (AOR: 8.9, 95% CI: 1.6–48.0) were also found to be determinants of VIA positivity.ConclusionThis study found that women with parity greater than four children, post-coital bleeding, history of sexually transmitted infections, having multiple sexual partners, and history of smoking were significantly associated with VIA positivity. Women with the mentioned characteristics should be encouraged to have a close follow-up for the screening. Additionally, awareness creation activities on the identified risk factors are strongly recommended for all women.

Maternal profiles and social determinants of severe acute malnutrition among children under-five years of age: A case-control study in Nepal

BackgroundAddressing the determinants of severe acute malnutrition (SAM) among children remains a challenge in Nepal. This study investigated the effect of maternal and social determinants of SAM among under-five children of Nepal. MethodsWe conducted a hospital-based unmatched case-control study with 256 under-five children (128 cases and 128 controls). The children aged 6–59 months were taken, and the cases and controls were defined based on mid-upper arm circumference (MUAC). ResultsBackward Stepwise logistic regression analysis of 6–59 months children showed that the odds of SAM were lower among male children (AOR = 0.50, 95% CI = 0.27–0.92), mothers from high socioeconomic status (AOR = 0.469, 95% CI = 0.26–0.83), breastfeeding 6–12 months (AOR = 0.21, 95% CI = 0.05–0.68), breastfeeding ≥13 months (AOR = 0.18, 95% CI = 0.05–0.54) and optimal complementary feeding (AOR = 0.40, 95% CI = 0.22–0.70). SAM was significantly higher among children of the age group 6–24 months (AOR = 2.57, 95% CI = 1.30–5.22) and children with a history of diarrhea (AOR = 1.75, 95% CI = 0.92–3.39). ConclusionsIn order to reduce the children's SAM, it is necessary to scale up services to improve the socioeconomic status which includes the education, occupation, and monthly income of the mother. Girls of age group 6–24 months were more likely to develop SAM. Two contributing factors to decrease SAM are the importance of exclusive breastfeeding practices and the availability and usage of soap in hand washing, which are ideal for low cost interventions. To reduce SAM in Nepal, a focus on enhancing complementary feeding through increased affordability of nutritious foods is also needed.

Determinants of Cesarean Section Deliveries in Public Hospitals of Addis Ababa, Ethiopia, 2018/19: A Case-Control Study.

Objective The objective of this study was to assess the determinants of cesarean section deliveries in public hospitals of Addis Ababa, Ethiopia, 2019. Method A hospital-based unmatched case-control study was conducted to study 780 (260 cases and 520 controls) women who delivered in public hospitals of Addis Ababa from August 22 to September 20, 2019. The cases were all mothers who delivered through caesarean section, and controls were all mothers who delivered vaginally in the same time in the study area. Data were collected from the randomly selected women and looking into their cards. Data were entered on EpiData 3.1 and exported to SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of caesarean section. Results Majority of the study participants were in the age category 20–34 years. Nearly more than 1/3rd of the participants (32.7% cases and 34.6% controls) have attended primary school. Most of the cases 217 (83.5%) and few of the controls 21 (4%) possess previous caesarean section. One hundred three (52.3%) of the cases and 329 (63.6%) controls were multi-parous. Previous caesarean delivery (AOR = 6.93, 95% CI; (3.39, 14.16)), singleton pregnancy (AOR = 0.34, 95% CI; (0.12, 0.83)), birth weight less than 2500 gm (AOR = 0.29, 95% CI; (0.18, 0.92)), birth weight greater than 4000 gm (AOR = 16.15 (8.22, 31.74)), completely documented partograph (AOR = 0.13, 95% CI; (0.078, 0.23)), and pregnancy-induced hypertension (AOR = 2.44, 95% CI; (1.46, 4.08)) were significant determinants of caesarean delivery in this study. Conclusion Previous caesarean section, number of delivery, birth weight, partograph documentation, and pregnancy-induced hypertension had significant association with caesarean section delivery in this study.

Predictors of Low Birth Weight at Lumbini Provincial Hospital, Nepal: A Hospital-Based Unmatched Case Control Study.

Background Low birth weight (LBW) is defined as the birth weight of live born infants below 2500 g, regardless of gestational age. It is a public health problem caused by factors that are potentially modifiable. The purpose of this study was to determine the socioeconomic, obstetric, and maternal factors associated with LBW in Lumbini Provincial Hospital, Nepal. Methods The study was conducted using case control study design with 1 : 2 case control ratio. A total of 105 cases and 210 controls were taken in this study. Data were entered on Epi data software version 3.1 and exported to Statistical Package for Social Science (SPSS) software version 25 for analysis. Characteristics of the sample were described using mean and standard deviation. Bivariate analysis was done to assess the association between dependent and independent variables. The ultimate measure of association was odds ratio. Variables found to be associated with bivariate analysis were entered into a multivariable logistic regression model to identify predictors of LBW. Results The mean age of the participants was 25.98 years with ±4.40 standard deviation. Mothers with literate educational background (AOR 0.32, 95% CI 0.13–0.81), housewife (AOR 2.63, 95% CI 1.11–6.20), vaginal mode of delivery (AOR 0.45, 95% CI 0.25–0.82), gestational age <37 weeks (AOR 2.51, 95% CI 1.15–5.48), history of LBW (AOR 5.12, 95% CI 1.93–13.60), and maternal weight <50 kilograms (AOR 2.23, 95% CI 1.23–4.02) were significantly associated with LBW. Conclusion Educational and occupational status, mode of delivery, gestational age, maternal weight, and history of LBW were found to be independent predictors of LBW. There is need of developing coordination with education sector for increasing educational status of mothers and adolescent girls. Social determinants of health need to be considered while developing interventional programs. Similarly, interventional programs need to be developed considering identified predictors of low birth weight.

Determinants of preeclampsia and eclampsia among women delivering in county hospitals in Nairobi, Kenya

Background: Preeclampsia is defined as the onset of a new episode of high blood pressure in a woman usually after 20 weeks gestation plus proteinuria, whereas eclampsia is defined as generalized seizures in a pregnant woman who generally has preeclampsia criteria. Preeclampsia and eclampsia are hypertensive disorders of pregnancy and thus, among the top causes of maternal death worldwide. The objective of this study was to investigate risk factors for preeclampsia/eclampsia. Methods: This was a hospital-based unmatched case-control study carried out among women of reproductive age (15-49 years) who have given birth at Nairobi County Hospitals and admitted to the postnatal ward July-September 2019 with a sample size of 352 participants (88 cases and 264 controls). All cases were selected, while controls were simple random sampled, as per eligibility criteria. Information or data were gathered using a structured interviewer-administered questionnaire and data abstraction tool. Descriptive analysis was carried out, where, categorical variables were presented in percentages or proportions, whereas; continuous variables were presented in means, standard deviations, and range. This was followed by a bivariable mixed-effect logistic regression analysis and a multivariable mixed-effect logistic regression analysis using the significant variables from bivariable analysis. Results: Of all the 88 cases enrolled in the study 5 (5.68%) had eclampsia and 83 (94.32%) had preeclampsia. There was a significant association between personal history of hypertension (AOR=7.1; 95% CI: 2.6-19.3, p=0.001), Occupation as a housewife (AOR=3.1; 95% CI: 1.1-8.8, p=0.034), nulliparity (AOR=7.5; 95% CI: 1.5-37.5, p=0.015) , primiparity (AOR=2.1; 95% CI: 1.1-4.2, p=0.031), advanced maternal age 35-49 years (AOR=5.9; 95% CI: 1.1-33.3, p=0.042), and the occurrence of preeclampsia/eclampsia. Conclusions: The following conclusions were made regarding the study findings: Personal history of hypertension, older/advanced maternal age (35-49 years), occupation, and parity were factors significantly associated with preeclampsia/eclampsia.

Determinants of Maternal Near Miss in Western Ethiopia.

Analysis of maternal near miss events and identification of factors resulting in maternal death are vital to improve the quality of obstetric care in any given setting. This study is aimed to determine the magnitude of maternal miss and identify its determinants. A hospital-based unmatched case-control study design was used. Sixty one maternal near misses (as cases) and 122 mothers who had a normal obstetric outcome (as controls) at obstetrics and gynecology ward of Nekemte Referral Hospital were included from May 1st, 2018 to July 31st, 2018. The criteria set by the World Health Organization were used to identify maternal near miss cases. The data were collected via face-to-face interviews using pretested structured questionnaires and analyzed using SPSS version 22. For every case, two controls were recruited. Descriptive statistics and logistic regressions were used. A 95% CI and p-value of <0.05 were considered to be statistically significant. The magnitude of maternal near miss was 4.97%. Factors including multigravidity (AOR= 3.84, 95% CI: 1.23-11.91), lack of antenatal care (AOR=6.02, 95% CI: 1.55-23.28), delays in accessing health facility (AOR=12, 95% CI: 2.55-56.57) and induction of labor (AOR =9.4, 95% CI: 2.97-29.71) were strongly associated with maternal near miss. Hypertension during pregnancy (40.9%) and obstetric hemorrhage (39.3%) were identified as the major causes of maternal near miss. The magnitude of maternal near miss was high but lower compared to magnitude in other parts of Ethiopia, and numerous preventable determinant factors were identified.

Stillbirth rates and associated risk factors at the Buea and Limbe regional hospitals, Cameroon: a case-control study

BackgroundStillbirths bring grief to both mother and family but have been underreported in Cameroon. We aimed at determining the stillbirth rates and associated risk factors in the Buea Regional Hospital (BRH) and the Limbe Regional Hospital (LRH), Cameroon.Materials and methodsThis was a hospital-based unmatched case-control study in which files of women with stillbirth (cases) were analysed. A woman with a live birth in the same maternity during the same period served as a control. Data were collected using a pre-tested questionnaire. The stillbirth rate was the number of stillbirths per thousand births. Logistic regression analysis was used to identify independent factors associated with stillbirth.ResultsStillbirth rates at the BRH and LRH were 33.72 and 36.45 per 1000 live births. The factors that were independently associated with stillbirth were: referral status (AOR 3.95; 95% CI: 1.85–6.58, p = 0.000), late booking visit - after 12 weeks (AOR 13.64; 95% CI: 1.49–124.83, p = 0.021), preeclampsia (AOR 3.21; 95% CI: 1.23–8.35, p = 0.01), placental abruption (AOR 21.46; 95% CI: 2.36–194.77, p = 0.006), moderate anaemia (AOR 2.04; 95% CI: 1.09–3.83, p = 0.03), labour dystocia (AOR 5.37; 95% CI: 1.77–15.92, p = 0.003), low birth weight (AOR 5.27; 95% CI: 1.48–3.53, p = 0.000), and preterm delivery (AOR 2.81; 95% CI: 1.48–3.35, p = 0.002).ConclusionStillbirth rates are high in both health facilities. Risk factors of stillbirths include referral from another health facility, anaemia, preeclampsia and late booking visit, placental abruption, labour dystocia, preterm birth, and low birth weight. Term, post-term and macrosomia were protective of stillbirth. We recommend electronic data storage in hospitals in Cameroon.

Determinants of Diabetic Complication Among Adult Diabetic Patients in Debre Markos Referral Hospital, Northwest Ethiopia, 2018: Unmatched Case Control Study.

BackgroundDiabetes mellitus is a group of common metabolic disorders that share the phenotype of hyperglycemia, and are caused by a complex interaction of genetics and environmental factors. Diabetes mellitus produces change in the blood vessels and therefore affects almost every part of the body.MethodsA hospital-based unmatched case control study was conducted from February 2018 to April 2018 at Debre Markos Referral Hospital. Data were collected from 204 individuals, 136 controls and 68 cases using an interviewer-administered questionnaire and patient chart. Data were entered into EPI-data 3.1 software and exported to SPSS version 21 for analysis. Descriptive analysis including mean, median and proportions was carried out. In bivariate analysis, variables below 0.25 significance level were selected for multivariable analysis. For multivariable analysis, a backward model was selected and 95% confidence interval variables with P-values below 0.05 in multivariable analysis were declared as significant variables.ResultsOf the total respondents, 68 were cases and 136 were controls, with an overall response rate of 98.55%. Of these respondents, 57.4% and 57.8% were males and type 1 diabetic patients, respectively. This study found that ages of 38–47 (AOR= 5.60 (1.62–19.38)) and >47 (AOR=4.81 (1.32–17.5)), income of 1000–1499 (AOR=3.10 (1.05–9.08)), self-reported drug adherence (AOR=5.146 (1.651–16.04)), FBS of 70–130 mg/dL 0.095 (0.022–0.414) and ≥131 mg/dL (0.05 (0.011–0.223)) and type 1 diabetic mellitus (AOR=4.73 (1.765–12.72)) were significantly associated with diabetes mellitus complications.Conclusion and RecommendationsThe study identified important determinants of diabetic complications. Poor glycemic control, poor adherence, and income were found to be modifiable determinants; on the other hand, age and type of diabetic mellitus are non-modifiable determinants of diabetic complications. Clinicians should implement a comprehensive care plan that will address patients’ adherence and glycemic control problems.

Determinants of obstructed labor among women attending intrapartum care in Amhara Region, Northwest Ethiopia: A hospital-based unmatched case-control study.

Objectives:maternal and neonatal mortality in Ethiopia is a major reproductive health problem. Obstructed labor is one of the leading causes of maternal, fetal, and neonatal morbidity in developing countries. The evidence regarding its determinants at the tertiary level of care is sparse. Therefore, this study aimed to study the determinants of obstructed labor among women attending intrapartum care in Amhara region referral hospitals.Methods:A Hospital-based unmatched case-control study was conducted from March 1stto August 30, 2017. Cases were women whose labor was obstructed (n = 270), and controls were women whose labor was not obstructed (n = 540). Both cases and controls were selected randomly, and a proportional to size allocation was made to the referral hospitals selected for the study. A binary and a multivariable logistic regression model was computed to identify the determinant factors at 95% CI.Results:The mean age of the study participants was 27.66 years (27.4 ± 5.44 for cases and 28.15 ± 6.16 for controls), ranging between 16 and 45 years. Relatively, higher proportions of cases than controls were unable to read and write (58.5%) and were urban residents (53.7%). Distance from hospital, distance from health center, mothers inability to read and write, mothers primary level of education, more than 28 weeks of gestation at the first visit of antenatal care, 37 to 42 weeks at admission, above 42 weeks at admission, women of a merchant spouse, and history of pregnancy-related complications were the positive determinants of obstructed labor. However, mothers whose gestational age was 16 to 28 weeks at the first antenatal care visit were 62% less likely to be exposed to obstructed labor.Conclusions:Obstetric, service-related, and system factors were predictors of obstructed labor. Improving women’s literacy status, health service access, and utilization will help reduce obstructed labor.

Determinants of gonorrhea and syphilis infections among pregnant women attending antenatal clinic at Dilla University Referral Hospital, Ethiopia: Unmatched case-control study.

Objective:This study was designed to determine the risk factors associated with gonorrhea and syphilis infections among pregnant women attending antenatal care clinic at Dilla University Referral Hospital.Method:A hospital-based unmatched case-control study (64 cases and 128 controls) with 1:2 ratios was conducted from 29 January 2018 to 20 June 2018, at the antenatal care clinic of the Dilla University Referral Hospital. Venous blood and vaginal swab were collected to screen for gonorrhea and syphilis. A pretested interviewer-administered questionnaire was used to gather data on sociodemographic and predisposing factors. Logistic regression analysis used to identify risk factors for sexually transmitted infections among pregnant women at 95% confidence interval and p-value < 0.05.Result:A total of 64 cases of syphilis or gonorrhea were identified with a mean age of 26 years (±4.1 years.). Of those cases, 40 were syphilis seropositive and the remaining were gonorrhea cases. Lower educational status (adjusted odds ratio = 2.4, 95% confidence interval: 1.1–4.9), age of first sex <18 years (adjusted odds ratio = 2.8, 95% confidence interval: 1.3–5.9), history of abortion (adjusted odds ratio = 3.1, 95% confidence interval: 1.4–6.6), and having two or more sexual partners in the past year (adjusted odds ratio = 2.5, 95% confidence interval: 1.1–5.7) were significantly associated with gonorrhea and syphilis infection.Conclusion:Demographic, behavioral, and obstetric factors are associated with the occurrence of syphilis or gonorrhea among pregnant women. Strengthening the existing antenatal care services, providing health education on risk factors, and prioritizing women with the risk characteristics and initiation of gonorrhea and syphilis screening during antennal care are mandatory.

Magnitude and Obstetric Complications of Twin Deliveries at Nekemte Referral Hospital, Western Ethiopia: Facility-based Case Control Study

Background: Twin pregnancy is a high-risl pregnancy with increased risk of obstetric complications. Objective: This study is to identify magnitude and obstetric Complications of twin deliveries at Nekemte Referral Hospital. Method: Hospital-based unmatched Case-control study design was carried-out on 104 sets of twin deliveries as cases and 208 singleton deliveries as controls conducted in obstetrics ward of Nekemte Referral Hospital from March 1, 2016 to February 29, 2017. The data were collected through pretested structured questionnaires and analyzed using SPSS version 20.0. The association between twin delivery and different variables were assessed by using odds ratio (OR) along with 95%CI. Results: The magnitude of twin deliveries was 28.6 in 1000 deliveries. The odds ratio of twin deliveries were significantly higher for the occurrence of hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, pre-mature rupture of membrane, antepartum hemorrhage, cesarean delivery, anemia, postpartum hemorrhage, sepsis, and cord prolapse when compared to singleton deliveries. Conclusion: The magnitude of twin delivery in this study was high and numerous maternal complications were identified when compared to singleton deliveries. Thus, twin deliveries need greater attention during pregnancy, delivery and after delivery.