Institutional Delivery Research Articles

Assessment of infant and young child feeding practices and associated factors among less than two years' children in Leka Dullecha District, East Wollega, Ethiopia.

Leka Dullecha District, situated in East Wollega, Ethiopia, represents a region where infant and young child feeding practices play a crucial role in the health and well-being of the population. Understanding the prevailing feeding practices among children under 2 years old is essential for devising effective interventions to improve child nutrition and reduce mortality rates. The context of this study involves examining various factors influencing infant and young child feeding (IYCF) practices, including socioeconomic, cultural, and environmental determinants. The main aim of the study was conducted to investigate the infant and young child feeding practice and associated factors among mothers of children 0-23 months in Leka Dullecha District, East Wollega, and Ethiopia. A community-based, cross-sectional study design was carried out using 590 sample sizes. A stratified sampling method was used with simple random sampling technique. Bi-variable and multivariable logistic regression models were used to identify factors associated with infant and young child feeding practices. The overall prevalence of appropriate infant and young child feeding practice was estimated to 62.3%. According to this finding, age of child, place of delivery, and knowledge of mother were positively associated factors for inappropriate Infant and Young Child Feeding Practices. The overall infant and young child feeding practices in this study is not meeting the WHO guidelines for appropriate feeding practices. To achieve better feeding practices among 0-23 months aged children, intervention should focus on encouraging institution delivery and capacitating all health workers providing health education focusing on infant and young child feeding practices.

Respectful maternity care during childbirth: Experiences and observation among mothers in a tertiary-care institute in Manipur.

Respectful maternity care (RMC) refers to the humane and dignified treatment of a childbearing woman throughout her pregnancy, childbirth and immediate postpartum period. Disrespect and abuse of women during labour, childbirth and immediate postpartum period in health facilities is one of the reasons which deter them from further utilizing maternal healthcare services. The present study was thus undertaken to determine to what extent RMC practices are being followed in a health facility in Manipur. A cross-sectional study was conducted from May 2022 to August 2022 in a Health facility among women coming for institutional delivery along with direct observations of the labour room. The study tool comprises a semistructured questionnaire related to respectful maternity care which was adapted from the Person-Centered Maternity Care Scale, a validated instrument. The direct observation method was carried out using a checklist adapted from a standardized tool developed by the United States Agency for International Development (USAID). Descriptive statistics were generated and approval of the study was obtained from the Institutional Ethics Committee. A total of 336 (99.1%) women reported at least one form of disrespect or abuse during childbirth. Maximum abuse (91.4%) was reported in the facility and environment domain. Direct observation done on 22 deliveries in the labour room found that 72.7% of the women experienced at least one form of disrespect and abuse. Two (9.1%) women were observed to face physical force or abusive behaviour. Almost all the women reported at least one form of disrespect or abuse during childbirth. There is a need to improve the health facilities and women need to be treated with dignity and respect as it is being violated according to the findings in many studies as with ours.

Analysing Determinants of Institutional Delivery in NFHS-5: A Comprehensive Study in India with a Focus on Caste Dynamics

The benefit of institutional delivery not only impacts maternal health but also reduces newborn mortality and increases overall well-being. This study focused on differences in the determinants of delivering at institution settings in India, with specific importance given to mothers within different caste groups. This is one area that was given less importance in the existing literature, particularly in studies that focused on the determinants of institutional delivery in India. Using data from the National Family Health Survey 5 (NFHS-5), the research explores factors influencing the choice between institutional and non-institutional delivery. Using logistic regression, and after removing influential and large residual observations (outliers), the analysis reveals that sociocultural determinants, including caste, religion, economic status and maternal education, significantly impact delivery preferences. Mothers from Scheduled Castes and Other Caste categories exhibit a higher likelihood of opting for institutional delivery. Economic factors, partner support, family size, maternal education, health-seeking behaviours, age, perceived distance to health facilities and media engagement also play crucial roles. Comparative analyses across caste groups emphasize the influence of wealth and education on institutional delivery choices. The findings underscore the need for having targeted interventions addressing diverse sociocultural contexts to improve maternal healthcare outcomes and reduce health disparities in India. Efforts should focus on awareness campaigns and overcoming challenges to promote the benefits of institutional delivery.

Predictors of husbands in supporting wives to use obstetrics care services by health professionals, Dire Dawa administration, Ethiopia: a community based cross sectional study

Background: Husbands’ support in obstetric care services is a process of social and behavioral change that husbands must undergo to prevent obstetric complications. But so far, studies across Ethiopia have been inconsistent and lacking in the study area. Therefore, this study was aimed at assessing husbands’ predictors, which could help in interventions. Methods: A community-based cross-sectional study was conducted in the Dire Dawa administration, Ethiopia, from July 1-30, 2022. Participants were selected using a systematic sampling technique. Data were collected through interviews using a structured questionnaire, entered into EPI data (Version 3.1), and analyzed using SPSS (Version 22). A p=0.05 or less at multivariate with 95% confidence intervals was considered statistically significant. Results: Of a total of 610, 51.8% of husbands support wives in using obstetrics care services. The predictors were urban residence (AOR=2.55, 95% CI: 1.75-3.73), education level of diploma and above (AOR=2.00, 95%CI: 1.10-3.74), perceived importance (AOR=1.98, 95% CI: 1.30-3.00), antenatal care visit accompanying experience (AOR=1.79, 95% CI: 1.04-3.07), and institutional delivery accompanying experience (AOR=6.20, 95% CI: 3.4-1.33). Conclusions: One in two husbands supports wives to use obstetrics care services provided by health professionals. Findings are helpful in advancing knowledge of husbands’ factors and highlight the need for health facilities and stakeholders to strengthen and create continuous community awareness.

Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia

BackgroundSince 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households.ObjectivesTo determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023.MethodsA facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model.ResultThe median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504–2766) ETB. Monthly income of the family (β = 0.019), obstetrics complications (β = 0.033), distance from the health facility (β = 0.003), and mode of delivery (β = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (β = −0.041) was negatively associated with the outcome variable.ConclusionThis study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.

Continuum of care in maternal and child health in Indonesia.

This paper aims to empirically analyze the socioeconomic and demographic correlates of maternal and child health (MCH) care utilization in Indonesia using the continuum of care (CoC) concept. The concept of CoC has emerged as an important guiding principle in reproductive, maternal, newborn, and child health. Indonesia's maternal mortality rate, neonatal mortality, and under-five mortality rates are among the highest in the Southeast Asian region. Using pooled data from four successive waves of the nationally representative Indonesian Demographic and Health Survey (IDHS) conducted in the years 2002, 2007, 2012, and 2017, we use multivariate regression models to analyze care across four components of the continuum: antenatal care (ANC), institutional delivery, postnatal care for children, and full immunization (IM). CoC at each stage of MCH care has improved continuously over the period 2002-2017 in Indonesia. Despite this, just less than one out of two children receive all four components of the CoC. The overall coverage of CoC from its second stage (four or more ANC visits) to the final stage (full child IM) is driven by the dropouts at the ANC visit stage, followed by the loss of postnatal checkups and child IM. We find that the probability of a child receiving CoC at each of the four stages is significantly associated with maternal age and education, the household's socioeconomic and demographic characteristics, and economic status. Complete CoC with improved, affordable, and accessible MCH care services has the potential to accelerate the progress of Sustainable Development Goal 3 by reducing maternal and childhood mortality risks. Our findings show that in Indonesia, the CoC continuously declines as women proceed from ANC to other MCH services, with a sharp decline observed after four ANC visits. Our study has identified key socioeconomic characteristics of women and children that increase their probability of failing to access care.

Examining Front-Line Administrative Services in a Selected Public Higher Education Institution

The South African government’s commitment to people-friendly public service since 1994 has influenced the quality of service provided by front-line administrative staff in public higher learning institutions. This study explores the experiences of front-line administrative staff at the Durban University of Technology (DUT), focusing on the challenges faced and their impact on teaching, learning, and overall academic activities. Against the backdrop of public higher education institutions (HEIs) in South Africa, the study addresses the persistent challenges in service delivery and the crucial role of front-line administrative staff. Employing a post-positivist paradigm, the research adopts a hybrid methodological approach, combining qualitative and quantitative methods. A survey design is utilized to gather data from first-time entry students (FTENs) enrolled in the Business and Information Management program at DUT, employing convenience sampling and a self-administered questionnaire. The study’s findings illuminate the inefficiencies in front-line administrative services, elucidating their impact on diverse stakeholders and emphasizing the pressing need for enhancement. The study found that the majority of students perceived the services positively, with only a small number expressing dissatisfaction and nearly all participants noted the institution’s adherence to the Batho Pele Principles positively, though a few had contrasting experiences. The findings further revealed areas of improvement for the service. By focusing on the experiences of FTENs, the study contributes to the broader discourse on enhancing service delivery in public higher learning institutions. Addressing these challenges is crucial for the fulfilment of the core mission of HEIs providing quality education and fostering a positive learning environment.

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia.

In impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern Ethiopia. A prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis. The cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%-39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5-23 days). Tachypnea [AHR 6.2 (95% CI: 1.5-9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3-3.5)], lethargy [AHR 1.8 (95% CI: 1.2-2.6)], preterm birth [AHR 1.8 (95% CI: 1.2-2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3-3.4)], home delivery [AHR 2.63 (95% CI: 1.1-6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1-3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3-8.6)] were found to be predictors of time to death in neonates with sepsis. The study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

Utilization of technology-enhance learning tools among vocational and technical education teachers in Nigerian tertiary institutions

The study determined training needs of teachers and issues in the utilization of Technology-enhanced Learning tools in Vocational and Technical Education in Nigerian tertiary institutions. Five research questions and one hypothesis guided the study. The sample for the study is 318 teachers from six tertiary institutions that offer majority of Vocational and Technical Education programmes in Nigeria. Instrument for data collection was developed by the researchers and was validated by five experts in Vocational and Technical Education. The overall reliability index of the instrument is 0.81. Results from collected data revealed that the teachers require training to enable them use Technology-enhanced Learning tools for instructional delivery; the current mode of instructional delivery in institutions is face-to-face approach; many institutions have Information and Communication Technology center and institution wide internet which are not effectively utilized for instructional delivery, among numerous other findings. Among the recommendations is that teachers should be given access to the available Technology-enhanced Learning facilities in their institutions to enable them learn how to use them at their own free times. It was concluded that most VTE teachers are eager to deploy Technology-enhanced Learning tools for instructional delivery but some institutional supports they need, especially trainings are inadequate.

Factors influencing pregnancy care and institutional delivery in rural Mali: a secondary baseline analysis of a cluster-randomised trial

ObjectiveThe vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity...

IJCM_20A: Understanding determinants of increased home deliveries in accessing antenatal care in the two blocks of the Chamba, Himachal Pradesh

Background: Maternal mortality has been declining over the years in India. Despite India achieving a maternal mortality ratio below 100 per 100,000 live births by 2020, Chamba, an aspirational district of Himachal Pradesh, still faces challenges. In Chamba, access to antenatal care (ANC) and postnatal care (PNC) remains suboptimal. Objective: To understand the perspectives of key stakeholders on barriers and facilitators for accessing ANC/PNC and institutional delivery services in the Chamba district. Methodology: The qualitative study was conducted in May and June 2023 in two blocks of the Chamba district. Around 5-6 villages were purposively selected in each block. The study encompassed 19 in-depth interviews and 7 focus group discussions involving lactating and pregnant women, family members, medical officers, and frontline healthcare workers. Additionally, the assessment of 2 labour rooms at the health facility was conducted using DAKSHATA standards. Results: The study revealed multifaceted barriers in Chamba, including challenging road conditions worsened by weather impeding timely health facility access. Women’s heavy workloads and limited awareness resulted in delayed ANC, PNC, and registration. Cultural preferences and myths hindered institutional deliveries. Transportation challenges, ambulance limitations, hospital overload, and health facility constraints amplified the difficulties. The DAKSHATA assessment indicated a mean score of 22 out of 30, stressing the need for improvements to enhance ANC, PNC, and institutional delivery access. Conclusion: The findings emphasize the critical need for interventions that enhance awareness among women, counteract cultural preferences for home deliveries and dispel prevalent myths and misconceptions. Furthermore, addressing transportation limitations, ambulance constraints, and hospital overload is crucial.

Contraceptive Utilization and Its Associated Factors Among Married Women in West African Countries: A Population-Based Survey Using Multinomial Logistic Regression.

The international development agenda emphasizes universal access to family planning, as seen in Sustainable Development Goal 3.7. However, the use of modern contraceptive methods remains low in developing countries, specifically in West Africa. This study aimed to assess the current status of contraceptive use in the region, focusing on different methods. We analyzed Demographic and Health Survey data from 13 West African nations (2012-2022) involving 117,165 married women. Using binary and multiple multinomial logistic regression, we identified key factors associated with contraceptive use. Adjusted odds ratios with 95% confidence intervals were utilized, and significance was determined at p ≤ 0.2 for binary regression and p < 0.05 for multiple multinomial regression. About 80.86% of women did not use any method, while 16.56% of women used modern methods. Maternal age of 35-49 years (RRR=0.77, 95% CI, 0.72,0.82), had given first birth after 20 years (RRR=0.80,95% CI, 0.77,0.83), cohabitation after 20 years old (RRR=1.24,95% CI, 1.18,1.29), being employed (RRR=1.38,95% CI, 1.33,1.43), women who have from 3-5, and more than five living children (RRR=2.06,95% CI,1.97,2.16, and (RRR=2.57, 95% CI, 2.42,2.74), primary(RRR=1.59, 95% CI, 1.52,1.66), secondary/higher education (RRR=2.08, 95% CI, 1.99,2.18), antenatal visit (RRR= 1.38, 95% CI 1.28,1.49), institutional delivery(AOR=1.42, 95% CI, 1.35,1.49), husband working status (RRR=1.39, 95% CI, 1.28,1.51), media exposure(RRR=1.23, 95% CI, 1.19,1.28), visited health facility more than once (RRR=1.09, 95% CI, 1.05,1.13), rural women (RRR=0.89,95% CI,0.85,0.93), female households (RRR=0.79, 95% CI,0.76,0.83), richer (RRR=1.42, 95% CI,1.33,1.51), and richest wealth indexes (RRR=1.69,95% CI,1.58,1.82) were associated. This study revealed a low level of contraceptive use among women in West Africa. Strengthening maternal reproductive health services, such as antenatal care, institutional delivery, and health visits, while also targeting mass media and disadvantaged women, has the potential to significantly increase the adoption of modern contraception techniques.

IJCM_404A: Newborn deaths in Maharashtra: A qualitative thematic analysis of newspaper articles

Background: As per statistics on infant mortality, the State of Maharashtra has done well in bringing down IMR from 33 to 16 per 1000 live births. However, in recent years many incidents come to light, especially in the case of institutional deliveries where newborns die either due to infrastructure failure or dysfunctional equipment. On a programmatic level, this has serious implications. Schemes such as Janani Suraksha Yojana promote institutional deliveries, but the institutes are unable to tend to the patient load efficiently. Analysing newspaper articles covering such incidents will throw light on actionable points for policy change. Experts from various fields tend to author such articles. Therefore it’s imperative to search every source available to bottleneck the areas for improvement. Objective: 1. To understand the perspectives of authors about newborn deaths in Maharashtra 2. To derive major areas of concern raised by such articles possibly causing newborn deaths in Maharashtra Methodology: All newspaper articles published in the last 2 years about newborn deaths in Maharashtra were identified. They were segregated according to the Name of the newspaper, author, incident, period etc. A thematic analysis was performed on 12 such articles to uncover different themes and sub themes. Results: Major themes that emerged were related to infrastructure issues and equipment failure. Another important theme was the higher patient load on secondary care due to excessive referrals from primary health facilities. The schemes promoting institutional deliveries did not anticipate the additional workload on district and subdistrict hospitals. Strengthening primary care remains the major area of concern. Conclusion: Lack of quality assurance is the major bottleneck at the infrastructure level. Strengthening primary care will reduce the excessive workload on district and subdistrict hospitals. All these are part of the same chain of events.

Reduced burden on urban hospitals by strengthening rural health facilities: Perspective from India.

In India, rural-urban health disparities have been persisting over a period. Migration of patients from rural to urban is an integral part of population dynamics thereby creating an additional burden on urban hospitals. Over the decade, India has made significant advances in health in reducing the rural-urban gap. The article highlights how the strengthening of rural healthcare facilities has reduced the burden of urban hospitals. Secondary data on the usage of public and private healthcare facilities from two rounds of the National Family Health Survey (NFHS) conducted in 2016 and 2021 and the Rural Health Statistics 2021-2022 were analyzed. The proportion of beneficiaries seeking care from public health facilities has increased from 41.9% to 45.7% in rural areas and 31% to 35.3% in urban areas between 2014 to 2017. The institutional deliveries have increased from 56% to 69.2% in rural areas and from 42% to 48.3% in urban areas. The State and local level interventions such as the upgradation of existing physical infrastructure, human resources, regular supply of medicines and consumables, development of referral linkages, patient transportation, and enhancing community participation have strengthened the rural healthcare system. Adequate utilization of the resources is crucial to addressing the lag and alleviating the rural-urban divide.

IJCM_48A: Nutritional Challenges in Tribal Infants: The Tragic Link to Beriberi and Mortality

Background: Infant mortality is a critical public health indicator that reflects the well-being of a population. In India, infant mortality remains a poignant challenge, reflecting the nation’s diverse healthcare landscape. Despite commendable strides in recent years, infants continue to face a higher risk of mortality, influenced by a complex interplay of factors such as maternal health, socioeconomic disparities, and limited access to quality healthcare. Currently in India NNMR-24.9, IMR-35.2 (NFHS 5), As the SVYM tribal RCH program was implemented in 3 districts (Mysore, Chamarajanagar &amp; Kodagu Districts), recorded infant mortality in this area IMR- 62.93 (during Jan to Dec 2022), higher than the national average, most of infant deaths falls under are postneonatal deaths. This abstract will spotlight the impact of infant mortality in specific contexts, such as within tribal populations, considering unique socio-cultural aspects that influence health outcomes. Objectives: Identify factors responsible for infant deaths among tribal communities under intervention areas of SVYM Methodology: Identify factors responsible for infant deaths among tribal communities under intervention areas of SVYM Results: 73% of women who experienced infant deaths were aged &lt;25 years, 8% were illiterate and 96% depended on daily wages. 99 % of Pregnant mothers received ANC check-ups. 95 % were institutional deliveries and 5 % were home delivery. Out of 75 infant deaths, 51% were male, and 49% were female, 51(68%) were low birth weight, 22(29%) infant deaths in Hdkote &amp; 56(75%) were in Jenu kuruba, 2(3%) in Betta kuruba &amp; Paniya. Age of infants during death, 46(61%) infant deaths (29 days to 6 months) and 4 deaths (6 to 12 months) were postneonatal, 12(16%) were early neonatal deaths,13 (17%) were Late neonatal death. 68% of infant deaths were at Home, 32% in hospitals. 29% of babies were admitted to NICU due to various reasons like 10(48%) LBW, 4(19%) preterm &amp; Neonatal jaundice,1(3%) breathing difficulties, and 2(10%) not drinking milk and 88% started breastfeeding within 1 hour. As per verbal autopsy before the death Infants had the following symptoms, 55.47% breathing difficulty, 28.40 % fever, and excess crying, 24.30% cold, 18.9% vomiting, 14.90% cough, and change in voice 9.5%. Based on the FGD and personal interviews found that most of the tribes depend on the government rations in these high-risk regions, which results in Poor dietary diversity, food preparation, cooking practices, and traditional post-partum food restrictions. uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad non-specific clinical manifestations, that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis. Conclusion: The prevalence of beriberi in tribal populations presents a pressing health concern that demands attention and targeted interventions. Remains an important public health problem where highly polished rice is the major staple food and other primary dietary sources of thiamine are in short supply. The impact of nutritional deficiency on infant mortality within these communities underscores the need for comprehensive strategies addressing both prevention and treatment. Education on nutrition, promotion of diverse and nutrient-rich diets, and accessibility to fortified foods or supplements can play pivotal roles in mitigating the risk of beriberi.

IJCM_80A: A Study on Risk factors and outcome of post partum hemorrhage among postnatal mothers attending a tertiary care hospital in Guntur District

Background: Post Partum Haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. PPH is the most common form of major obstetric haemorrhage. Majority of deaths due to PPH are reported to be in developing countries and the major factors responsible were attributed to lack of access to reproductive health services, availability of skilled health personnel, timely intervention of obstetric emergencies and others such as appropriate equipment and supplies. With increase in rate of institutional deliveries and improvement in quality of services MMR can further be reduced with focus on the factors responsible for maternal deaths. Objective: The study was aimed to identify risk factors of postpartum hemorrhage among postnatal mothers and to analyze various factors and determinants that influence the outcome among mothers with PPH. Methodology: This was a descriptive observational retrospective study conducted in Department of obstetrics and Gynecology, government general hospital, Guntur. The target population included 50 postnatal mothers diagnosed as having PPH. Other causes of hemorrhage not related to delivery such as accidents and women with preexisting medical and other conditions were excluded. Data was collected from the available medical records Results: The prevalence of PPH was 0.96%. The causative factors identified were atonic uterus (80%), traumatic delivery (17.5%) and retained bits (1.7%). Induced labor (16%), prolonged labor (11.1%) and preeclampsia (3.4%) were the risk factors that lead to PPH. The mortality was 4% (2) and the cause of death in the 2 patients was due to shock. Conclusion: In the present study, the prevalence of postpartum hemorrhage (PPH) was recorded at 0.96%. Uterine atony emerged as the primary contributing factor, with induced labor identified as the leading risk factor associated with an increased predisposition to PPH. Shock stood out as the predominant cause of mortality.

Minimum acceptable diet and its predictors among children aged 6-23 months in Ethiopia. A multilevel cloglog regression analysis.

Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log-log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6-23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log-log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p-value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90-12.15) of the children meet the minimum acceptable diet. Child aged (18-23 month) (AOR = 1.78, 95CI:1.14-2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51-5.15), number of children three and above [(AOR = 0.78,95CI: 0.53-0.94], institutional delivery [AOR = 1.77,95CI: 1.11-3.11], having postnatal-check-up [AOR = 2.33,95CI: 1.59-3.41] and high community poverty level (AOR = 0.49,95CI: 0.29-0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check-ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children.

RetLLM-E: Retrieval-Prompt Strategy for Question-Answering on Student Discussion Forums

This paper focuses on using Large Language Models to support teaching assistants in answering questions on large student forums such as Piazza and EdSTEM. Since student questions on these forums are often closely tied to specific aspects of the institution, instructor, and course delivery, general-purpose LLMs do not directly do well on this task. We introduce RetLLM-E, a method that combines text-retrieval and prompting approaches to enable LLMs to provide precise and high-quality answers to student questions. When presented with a student question, our system initiates a two-step process. First, it retrieves relevant context from (i) a dataset of student questions addressed by course instructors (Q&amp;A Retrieval) and (ii) relevant segments of course materials (Document Retrieval). RetLLM-E then prompts LLM using the retrieved text and an engineered prompt structure to yield an answer optimized for the student question. We present a set of quantitative and human evaluation experiments, comparing our method to ground truth answers to questions in a test set of actual student questions. Our results demonstrate that our approach provides higher-quality responses to course-related questions than an LLM operating without context or relying solely on retrieval-based context. RetLLM-E can easily be adopted in different courses, providing instructors and students with context-aware automatic responses.

Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study.

Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.

Assessing the Impact of the COVID-19 Pandemic on Maternal and Child Health Services: A Comprehensive Analysis of Government Initiatives in Northern India.

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs. Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019. Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program. The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.