Kersa Health Research Articles

Association of drinking water and environmental sanitation with diarrhea among under-five children: Evidence from Kersa demographic and health surveillance site, eastern Ethiopia.

Diarrhea remains one of the leading causes of mortality and morbidity, despite the global progression of eradicating the burden of diarrhea-related morbidity and mortality in the past two decades. In Sub-Saharan African (SSA) countries, there is inadequate supply and sanitation of safe water. However, there is a lack of literature that estimates the impact of drinking water and sanitation service on childhood diarrhea in Kersa Demographic and Health Surveillance. Therefore, the current study aimed to assess the prevalence and effect of water supply and environmental sanitation on diarrhea among under-five children from 2017 to 2021 in Kersa Demographic and Health Surveillance, Eastern Ethiopia. A prospective cohort study design was implemented among 6,261 children from the Kersa Health Demographic Surveillance System (HDSS), Eastern Ethiopia, from 1 January 2016 to 31 December 2021. STATA statistical software was used to extract data from the datasets. The binary logistic regression was used to identify the impact of water supply and environmental sanitation on diarrhea by controlling important confounders. The adjusted odds ratio (AOR) with a 95% confidence interval measures this association. The current study showed that among 6,261 under-five children, 41.75% of them had developed active diarrhea during the follow-up time. The final model depicted that having media exposure of 22% [AOR - 0.78 CI: (0.61, 0.98)], a protected tube well source of drinking water of 50% [AOR - 1.50, CI: (1.32, 1.71)], unprotected tube well source of drinking water of 66% [AOR - 1.66 CI: (1.27, 2.18)], having toilet facility of 13% [AOR - 0.87 CI: (0.78, 0.97)], and accessibility of source of water [AOR - 1.17 CI: (1.05, 1.30)] showed a significant association with diarrhea among under-five children. The prevalence of diarrhea is found to be high in the Kersa District. The main predictors of diarrhea under five were a lack of latrines, an unimproved source of drinking water, and a distance from access to drinking water. The study setting should focus on increasing the adequacy of safe drinking water and sanitation.

Fear of childbirth among pregnant women in Eastern Ethiopia: A community-based study

IntroductionFear of childbirth refers to feelings of uncertainty and anxiety before, during, or after childbirth by thinking about future labor and birth or experience of others. Evidence on burden of fear of childbirth and its associated factors is limited in Ethiopia. In this study, we assessed magnitude of fear of childbirth and its associated factors among pregnant women in Eastern Ethiopia. MethodsA community-based cross-sectional study was conducted among randomly selected pregnant women recruited from Kersa Health and Demographic Surveillance System—an open cohort consisting of continuous registry of health and demographic conditions in eastern Ethiopia. Women were interviewed and fear of childbirth was assessed using the Wijma Delivery Expectancy Questionnaire. Data were entered using EpiData 3.1 and analyzed using SPSS 20. Factors associated with fear of childbirth were identified using binary and multiple logistic regression and described using adjusted odds ratio (aOR) along with 95% confidence interval (CI). Finally, statistical significance was set at p < 0.05 in the multiple logistic regression. ResultsOf a total of 476 pregnant women included in the study, 111(23.3%; 95% CI 19.3-26.9) had fear of childbirth. Fear of childbirth was more likely among women who had no antenatal care (aOR = 2.6; 95% CI:1.22-5.50), no husband support (aOR = 5.7; 95% CI: 2.32-13.10), unplanned pregnancy (aOR = 7.8; 95% CI: 3.92-15.42), and had history of complication in labor and pregnancy (aOR = 10.4; 95% CI: 5.20-20.81). ConclusionA quarter of pregnant women in eastern Ethiopia had fear of childbirth. Helping women to have positive pregnancy experience requires strengthening antenatal care, partner support, and prevention of unwanted pregnancy.

Trends and determinants of pregnancy loss in eastern Ethiopia from 2008 to 2019: analysis of health and demographic surveillance data

BackgroundPregnancy losses remain a neglected issue and it will be taking more than a century before a pregnant woman in Sub Sahara has the same chance of her baby being born alive as a woman in a high-income country. Pregnancy loss data are limited and not universal in Sub Saharan countries. This study was aimed to assess the magnitude and determinants of pregnancy loss in eastern Ethiopia.MethodsThis study was conducted in, open continues and dynamic cohort of population, Kersa Health and Demographic Survillance site (HDSS) in Eastern Ethiopia in 2008–2019. All mothers who had known pregnancy outcomes during the period and reside in Kersa HDSS were considered. The prevalence proportions were calculated as the sum of all pregnancy loss divided by the number births in the specified year. Log-Binomial regression was used to determine factors associated with pregnancy loss. Prevalence Proportion Ratio (PPR) was used to report the magnitude and strength of association. A p-value of less than 0.05 was considered statistically significant.ResultsFrom 39,153 included pregnancies, 810 (20.7; 95%CI:19.32, 22.15 per 1000 births) experienced pregnancy loss. Stillbirth was higher than abortion (11.14 Vs. 9.55 per 1000 births). Lacking own income (aPPR:1.26; 95%CI: 1.01, 1.58), being daily laborer (aPPR:1.44; 95%:1.08, 306) history of previous pregnancy loss (aPPR:2.26, 95%CI:1.69, 3.03), unwanted pregnancy (aPPR:1.26; 95%CI:1.01, 1.80), not receiving antenatal care (aPPR:1.59; 95%CI: 1.19, 2.13) and not receive the TT-vaccine during pregnancy (aPPR:1.33; 95%CI: 1.08, 1.80) were positively associated with pregnancy loss.ConclusionsThe overall rate pregnancy loss was ranged between 19.32, 22.15 per 1000 births with higher still births than miscarriage or abortion. Pregnancy loss was positively associated with social factors reproductive health factors, and maternal health service utilization.

Intimate Partner Violence and Its Predictors among Pregnant Women in Eastern Ethiopia: Generalized Structural Equation Modeling.

Introduction Intimate partner violence (IPV) has a negative impact on women's physical, mental, sexual, and reproductive health. Identifying the determinant factors of IPV among pregnant women is of paramount importance to overcome its negative consequences thereby increasing the performance of women in all activities. Thus, this study applied a generalized structural equation model (GSEM) to determine the prevalence of intimate partner violence among pregnant women and its predictors in Eastern Ethiopia. Methods A community based cross-sectional study was conducted in Kersa Health and Demographic Surveillance System (KHDSS), Eastern Ethiopia. Data were collected form a sample of 1051 pregnant women using structured questionnaires. Descript findings were presented in percentage with 95% confidence interval. The generalized structural equation model was used to determine factors associated with each domain of IPV (physical, emotional, and social violence). Adjusted odds ratio (AOR) with a 95% CI were used to declare significant factors associated with intimate partner violence. Results The overall prevalence of IPV in the Eastern Ethiopia was 48.57% (95% CI: 45.45, 51.69). The highest intimate partner violence was observed in the sexual domain of IPV (31.6%, 95% CI: (28.8, 34.58)). In GSEM, being a farmer (AOR = 0.42, 95% CI: 0.19, 0.91) was significantly associated with psychological domain of IPV. Age (AOR = 0.97, 95% CI: 0.95, 0.99) and educational status (neither read nor write) (AOR = 2.50, 95% CI: 1.61, 3.89) were significantly associated with physical domain of IPV. Being in medium (AOR = 0.64, 95% CI: 0.46, 0.90) and rich (AOR = 0.53, 95% CI: 0.36, 0.78), wealth quintiles were significantly associated with sexual domain of IPV, whereas husband controlling behavior was significantly associated with all domains of IPV. Conclusions The magnitude of IPV among pregnant women was relatively high in Eastern Ethiopia. This finding pin a light to pay special consideration to pregnant women at each point of service delivery to alleviate consequence of IPV. Being a farmer, older ages and being in higher wealth quintiles were protective factor, whereas being uneducated increase the risk of IPV. Improving socioeconomic status and promoting legal rights of women is needed to alleviate the problem, and younger women require special attention.

Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia.

BackgroundDespite registering tremendous improvement as part of the Millennium Development Goals, Ethiopia has still one of the highest numbers of maternal mortality. Although maternal mortality is one of the commonest indicators for comparison or measuring progress, its measurement remained a challenge. In a situation where, vital registration is not in place and only few women gave birth in facilities, alternative data sources from population-based surveys are essential to describe maternal deaths. In this paper, we reported estimates of maternal mortality and causes in a predominantly rural setting in eastern Ethiopia.MethodsData were used from the ongoing prospective open cohort of Kersa Health and Demographic Surveillance System (HDSS), located in eastern Ethiopia. At enrolment, detailed sociodemographic and household conditions were recorded for every member, followed by household visit every six months to identify any vital events: births, deaths, and migration. Whenever a death was reported, additional information about the deceased – age, sex, pregnancy status, and perceived cause of deaths – were collected through interview of the closest family member(s). Then, the probable cause of death was assigned using an automated verbal autopsy system (InterVA). In this paper, we included all deaths among women during pregnancy, childbirth or within 42 days of termination of pregnancy. To describe the trends, we calculated annual maternal mortality ratio (MMR) along with their 95% Confidence Interval (CI).ResultsFrom 2008 to 2019, a total of 32 680 live births and 720 deaths among reproductive age women were registered. Of the 720 deaths, 158 (21.9%) were during pregnancy or within 42 days of termination of pregnancy, corresponding with an MMR of 484 per 100 000 live births. The three leading causes of deaths were pregnancy related sepsis, obstetric haemorrhage and anaemia of pregnancy. There was non-significant reduction in the MMR from 744 in 2008 to 665 in 2019, with three lowest ratios recorded in 2013 (172 per 100 000 live births), 2009 (280 per 100 000 live births) and 2016 (285 per 100 000 live births).ConclusionsThere was no significant decrement of MMR during the study period. Most deaths occurred at home from pregnancy related sepsis and haemorrhage implicating the unfinished agenda of ensuring skilled delivery and appropriate postnatal management.

Early Marriage Among Young Girls in Eastern Ethiopia: Trends From 2008 to 2018

This study examined the trend of early marriage among adolescent girls in eastern Ethiopia. We analyzed data extracted from the Kersa community-based surveillance database for girls in the age group of 10 to 17 for the decade ending in 2018. The Kersa Health and Demographic Surveillance System (Kersa HDSS) is a demographic and health surveillance and research center established in 2007 by Haramaya University to serve as a research center and source of health and demographic data in Eastern Ethiopia. The annual incidence of early marriage was calculated per 1,000 person-time. Chi-square test for linear trend was done using Epitools Software to examine the change in rates over time. The overall incidence of early marriage among the study participants was 40.48/1,000 per year (95% confidence interval [CI], 39.1–41.9) with an increasing incidence rate from 32.38/1,000 girls per year in 2008 (95% CI, 27.4–38.3) to 40.18/1,000 girls per year in 2018. A relatively high incidence of early marriage was observed among rural girls, those who had no formal education, and unemployed girls. Empowering rural girls through increased access to education is needed to reduce the incidence of early marriage.

Early Marriage among young girls in Eastern Ethiopia: trend during 2008-2018.

Early marriage practices undermine girls'autonomy and seriously affect their physical and mental wellbeing. Monitoring the trendsand understanding the drivers is essentialininterveningagainst early marriage. However, many studies on early marriage in Ethiopia are cross-sectional,focusing only on the magnitude at a single point in time.Hence, we extracted data of girls of 10-17 years from Kersa Health and Demographic Surveillance System (Kersa HDSS) database for the period of 2008-2018 in order to examine the trends of early marriage.In this data note we provide the details of a research database of 24,452 girls in the age group of 10-17 years.The extracted data include date of marriage andthegirls'socio-demographic variables. Other variables considered to be potentially associated with timing of marriage were also extracted.The purposeof this publicationisto describe the dataset for external researchers who may be interested in making use of it as a secondary use of their routinely collected data.This datasetis available at https://doi.org/10.6084/m9.figshare.15034812.

Perinatal mortality and its predictors in Kersa Health and Demographic Surveillance System, Eastern Ethiopia: population-based prospective study from 2015 to 2020

ObjectivePerinatal mortality is an important outcome indicator for newborn care and directly mirrors the quality of prenatal, intra partum and newborn care. Therefore, this study was aimed at estimating perinatal...

Incidence and Risk Factors of Neonatal Mortality in Eastern Ethiopia, A Prospective Cohort Study in Kersa Health and Demographic Surveillance System (Kersa HDSS)

Background: So far few studies were done to determine predictors of neonatal mortality in Ethiopia. This study was aimed to provide information on the incidence and risk factors of neonatal survival in Eastern Ethiopia from September, 2007 to August, 2012.&#x0D; Methods: The study uses data extracted from Kersa Health and Demographic Surveillance (Kersa HDSS) System database, which is located in the Oromiya Regional State, Eastern Ethiopia. The surveillance system is an open cohort, which was established in 2007. Data extraction includes all live births recorded in the system. The main outcome variable was the occurrence of death within 28 days after birth (neonatal death). The survival time was calculated in days using the time interval between the date of birth and date of event (death). Kaplan-Meier model and Cox-proportional hazard techniques were used to identify predictors of neonatal death.&#x0D; Results: The overall, Early and Late Neonatal Mortality Rate was 28.37, 19.55 and 8.82 per 1000 live births, respectively. A Neonatal Mortality Incidence Rate was 1 per 1000 (95% CI, 0.87-1.15) person days. Risk factors of neonatal survival include birth type (HR=5.40; 95% CI, 3.64-8.02), preterm birth (HR=11.17; 95% CI, 7.17-17.40), and previous infant sibling born (died HR=2.15; 95% CI, 1.39-3.33: no previous birth HR=1.78; 95% CI, 1.17-2.72).&#x0D; Conclusion: A significantly high level of neonatal mortality incidence rate was observed, which majority of the neonatal deaths were found to occur at early neonatal period. Therefore, efforts needs to be exerted in addressing the risk factors identified as predictors of neonatal mortality.

Magnitude, Trends, and Determinants of Institutional Delivery Among Reproductive Age Women in Kersa Health and Demographic Surveillance System Site, Eastern Ethiopia: A Multilevel Analysis.

BackgroundInstitutional delivery service utilization is a critical and proven intervention for reducing maternal and neonatal mortality. Institutional delivery service utilization can improve maternal health and wellbeing by ensuring safe delivery and reducing problems occurring during childbirth. In Ethiopia, almost all previous researches were cross-sectional studies and most of them were based on small sample sizes and there are no sufficient reports for the trends. Therefore, this study aimed to assess the magnitude, trends, and determinants of institutional delivery using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia from 2015 to 2020.MethodsThe study was conducted among reproductive-aged women selected from the Kersa HDSS site, Eastern Ethiopia for the duration of 2015 to 2020. Data were extracted from the Kersa HDSS database system. After coding and recoding, the data was exported to R software for further analysis. A chi-squared test was used for trends to examine the significance of the change. A multilevel logistic regression model was fitted to identify determinants of institutional delivery. An adjusted odds ratio with a 95% confidence interval (CI) was used to measure the strength of the associations. Statistical significance was declared at a p-value < 0.05.ResultsA total of 20,033 reproductive age women were employed for analysis. The overall magnitude of institutional delivery was 45.03% with 95% CI (44.33–45.72). The institutional delivery has shown a decreasing trend over the 6 years' and there is statistical significance for the declining. Semi-urban resident [AOR = 2.33, 95% CI: 1.37–4.48], urban resident [AOR = 7.18, 95% CI: 5.24, 8.71], read and write [AOR = 1.54, 95% CI: 1.18, 2.01], literate [AOR = 1.46, 95% CI: 1.34–1.59], and antenatal care [AOR = 1.73, 95% CI: 1.58–1.88] were significantly associated with institutional delivery.ConclusionThe magnitude of institutional delivery was relatively low and has shown a decreasing trend. Community-based interventions should be strengthened to reverse the decreasing trend of institutional delivery. Targeted information dissemination and communication should be provided to those mothers who have no formal education and attention should be given to rural residents.

Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia.

BackgroundAlthough Ethiopia was applauded for achieving the Millennium Development Goal (MDG) target of reducing child mortality, whether the gains sustained beyond the MDG era was rarely studied. In this study, we reported the trends and determinants of under-five mortality (U5M) from 2015 to 2020 in a population based cohort under the Kersa Health and Demographic Surveillance System (HDSS), eastern Ethiopia.MethodsWe followed pregnant women and their pregnancy outcomes from 2015 to 2020. Each year, data related to death and live births among the follow up population was retrieved. Automated verbal autopsy (InterVA-4) was used to assign the cause of death and Stata 14 was used for analysis. U5M rate was calculated as death among under five children divided by all live births during the study period and described per 1000 live births along with 95% Confidence Interval (CI). A multivariable Cox proportional regression model was used to identify determinant of U5M using adjusted hazard ratio (AHR). Finally, P value <0.05 was considered for declaring statistically significant association.ResultsFrom January 2015 to December 2020, a total of 28 870 live births were registered under the Kersa HDSS, of whom 1335 died before their fifth birthday. The overall U5M rate was 46.3 per 1000 live births (95% confidence interval (CI) = 43.79-48.79), with significant increase from 27.9 in 2015 to 54.7 in 2020 (P < 0.041). Diarrheal diseases, acute respiratory tract infection including pneumonia, meningitis and encephalitis, and HIV related deaths were the leading causes of U5M. The hazard of death was higher among children born to poor household (AHR = 1.52; 95% CI = 1.27-1.81), rural residents (AHR = 6.0; 95% CI = 3.65-9.91), born to adolescent mothers (AHR = 1.41; 95% CI = 1.02-1.95), whose mother didn’t receive antenatal care (AHR = 1.43; 95% CI = 1.21-1.69), were born preterm (AHR = 14.1; 95% CI = 9.96-19.89) and had low birth-weight (AHR = 1.74; 95% CI = 1.39-2.18).ConclusionWe found high level of U5M rate with an increasing trend in the aftermath of the praised MDG4 achievement. Achieving the ambitious U5M of 25 per 1000 live births by 2030 requires addressing diarrheal disease, and respiratory tract infections, and HIV/AIDS. Reasons behind the persistent increase over the study period require further inquiry.

Trends and Associated Factors of Under-five Mortality Based on 2008–2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia

Background: Of the 6.2 million estimated deaths of children under 15 years of age globally, the death toll of children under 5 years of age accounted for 5.3 million. In Ethiopia, even though significant progress has been made, facility-based research shows that the mortality rate of children under 5 is still high. In the country, particularly in the eastern part, evidence on trends in under-five mortality and associated factors from population-based longitudinal data is limited. Objective: The objective of the study was to assess under-five mortality focusing on the trends and associated factors based on 2008–2016 data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. The method: The study was based on 9 years of surveillance data. The surveillance site was founded in 2007 with the aim of producing community-based health and demographic data in the eastern Ethiopia. Data were collected from the surveillance site and analyzed with STATA version 15 (for factor analysis) and/or Statistical Package for Social Sciences (SPSS) version 26 (for trend analysis) and Microsoft (MS) Excel software. The autoregressive integrated moving average (ARIMA) model and Mann–Kendall were used to analyze mortality trends. Multi-level logistic regression was used to assess the associated factors. Result: There were a total of 18 759 newborns in the surveillance sites, of which 1602 died of children under 5 years of age, and the total mortality rate for children under 5 years of age was 85 per 1000 live births. Trend analysis shows that the mortality rate of children under 5 has been steadily declining during the study period. Multi-level logistic regression shows that the variance of the random component model related to the intercept term is statistically significant, which means that there is a change in the mortality rate of children under 5 between the survey years, which is explained by the random intercept term. Antenatal care visits by mothers (AOR = .61, 95% CI = .49, .74), primary education (AOR = .58, 95% CI = .49, .68), normal birth weight (AOR = .78, 95% CI = .64, .95), and having 2 or fewer total births (AOR = .37, 95% CI = .22, .37) were all associated with child death. Conclusion: Despite the downward trend, the mortality rate of children under 5 years old at the surveillance sites is high. Effective intervention measures should be implemented.

Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals.

BackgroundEvery year, immunization prevents about 4–5 million child fatalities from vaccine preventable morbidities. Conversely, in Ethiopia, achieving full coverage of vaccination has continued to be challenging. Socio-demographic, caregivers and child related factors determine vaccination coverage. Therefore, this study aimed to find out recent coverage, trends in coverage, and its predictors in eastern Ethiopia.MethodsA population-based longitudinal study design was conducted among 14,246 children aged 12–24 months from 2017 to 2021 in Kersa Health and Demographic Surveillance System site (KHDSS). The data were collected from caregivers of the child by face to face interview. Multinomial logistic regressions were used to identify predictors of vaccination. The association between vaccination coverage and its predictors was presented by adjusted odds ratio with 95% confidence interval. A p-value of <0.05 was used to establish statistical significance.ResultsFrom the 14,198 included children, only 39% of children were fully vaccinated, with highest proportion in 2020 (45%) and lowest proportion in 2019 (32%). In comparison to fully vaccinated, being partially vaccinated was positively associated with older maternal age, rural residence, unemployment, rich wealth index, no antenatal care, facility delivery, and birth order whereas negatively associated with semi-urban residence. In compared to fully vaccinated, being not vaccinated was positively associated with older maternal age, rural residence, maternal education, unemployment, and no antenatal care whereas negatively associated with semi-urban residence, poor wealth index, multipara, grand multipara, and facility delivery.ConclusionLess than two-fifths of children aged 12 to 24 months were fully vaccinated. Socio-demographic factors and maternity care utilization were found to be predictors of vaccination coverage. Therefore, strategies that emphasize women’s empowerment in terms of education, economy, and employment status, and enhancing maternal healthcare utilization may improve vaccination coverage.

Early Marriage among young girls in Eastern Ethiopia: trend during 2008-2018

Early marriage practices undermine girls’ autonomy and seriously affect their physical and mental wellbeing. Monitoring the trends and understanding the drivers is essential in intervening against early marriage. However, many studies on early marriage in Ethiopia are cross-sectional, focusing only on the magnitude at a single point in time. Hence, we extracted data of girls of 10-17 years from Kersa Health and Demographic Surveillance System (Kersa HDSS) database for the period of 2008–2018 in order to examine the trends of early marriage. In this data note we provide the details of a research database of 24,452 girls in the age group of 10-17 years. The extracted data include date of marriage and the girls’ socio-demographic variables. Other variables considered to be potentially associated with timing of marriage were also extracted. The purpose of this publication is to describe the dataset for external researchers who may be interested in making use of it as a secondary use of their routinely collected data. This dataset is available at https://doi.org/10.6084/m9.figshare.15034812.

Prevalence and determinants of concurrent wasting and stunting and other indicators of malnutrition among children 6-59 months old in Kersa, Ethiopia.

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6–59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross‐sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height‐for‐age, weight‐for‐height and weight‐for‐age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6–17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12–2.75) compared with those aged 36–59 months, whereas children aged 18–35 months (aOR 2.4, 95% CI 1.65–3.47) and 36–59 months (aOR 1.6, 95% CI 1.07–2.37) had higher odds of stunting compared with those aged 6–17 months. Similarly, children aged 18–35 months (aOR 1.6, 95% CI 1.07–2.37) and 36–59 months (aOR 2.2, 95% CI 1.52–3.10) had higher odds of underweight compared with children aged 6–17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16–9.27) and stunting (aOR 1.9, 95% CI 1.31–2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m2 and maternal BMI between 18.5 and 25 kg/m2 were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point‐of‐use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community‐based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended.

A 12 Years Neonatal Mortality Rate and Its Predictors in Eastern Ethiopia.

Introduction. Surviving and thriving of newborn is essential to ending extreme poverty. However, the surviving and thriving of new born is depends on where neonates are born. The true feature of neonatal mortality rate and trends is not well known in the study area. Thus, we aimed to estimate a neonatal mortality incidence in each year, and determine factors associated though pregnancy observation cohort study in Eastern Ethiopia. Methods. The study was conducted in Kersa Health Demographic Surveillance System (KHDSS) among 36 kebeles. We extracted all events (38 541 live birth and 776 neonatal death) occurred between January 1, 2008 and December 30, 2019. Neonatal mortality rate was presented by neonatal death per 1000 live birth with 95% confidence interval in each years, and trends of neonatal morality was described with line regression. Cox proportional regression model was used to assess predictors and presented with an adjusted hazard ratio (AHR) and 95% CI. Results. The estimated cumulative average of neonatal mortality rate in this study was 20.3 (95% CI: 18.9-21.8) per 1000 live births. The rate was decline with regression coefficient β = −1.60. Risk of neonatal death was found to be significantly associated with neonate born to mother living in rural Kersa (AHR = 5.31; 95% CI: 3.07-9.18), born to mother not receiving antenatal care (AHR = 1.43; 95% CI: 1.15-1.78), low birthweight (AHR = 2.59; 95% CI: 2.05-3.27), and preterm newborn (AHR = 12.10; 95% CI: 9.23-15.86). Conclusion. Neonatal mortality in the study site is far from reaching the national and global target goals.

Consistent point-of-use water chlorination among households using unimproved water sources and treatment preference in Eastern Ethiopia

ABSTRACTA consistent and correct use of water treatment options is fundamental for health gain from point-of-use water chlorination. In Ethiopia, empirical evidence about the consistent use and preference for by end users is scarce. The current study is intended to explore these issues using Waterguard and Bishan Gari in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. Data were collected every 2 week for 4 months and analyzed using mixed effects logistic regression. Of 377 households, 31% consistently used Waterguard and Bishan Gari in all the study waves. Product use over time within a household varied based on the perception about the products and the type of products each household received. From the exit assessment, 56% of households stated a preference for Waterguard significantly different from 5.6% of households that stated a preference for Bishan Gari. An intervention for consistent use beyond their availability and accessibility to end users is needed.

Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, eastern Ethiopia

BackgroundDespite efforts at curbing maternal morbidity and mortality, developing countries are still burdened with high rates of maternal morbidity and mortality. Ethiopia is not an exception and has one of the world’s highest rates of maternal deaths. Reducing the huge burden of maternal mortality remains the single most serious challenge in Ethiopia. There is a paucity of information with regards to the local level magnitude and causes of maternal mortality. We assessed the magnitude, trends and causes of maternal mortality using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia.MethodThe analysis used surveillance data extracted from the Kersa HDSS database for the duration of 2008 to 2014. Data on maternal deaths and live births during the seven year period were used to determine the maternal mortality ratio in the study. The data were mainly extracted from a verbal autopsy database. The sample was comprised of all reproductive aged women who died during pregnancy, childbirth or 42 days after delivery. Chi-squared test for linear trend was used to examine the significance of change in rates over time.ResultsOut of the total 311 deaths of reproductive aged women during the study period, 72 (23.2%) died during pregnancy or within 42 days of delivery. The overall estimated maternal mortality ratio was 324 per 100,000 live births (95% CI: 256, 384). The observed maternal mortality ratio has shown a declining trend over the seven years period though there is no statistical significance for the reduction (χ2 = 0.56, P = 0.57). The estimated pregnancy related mortality ratio was 543 per 100,000 live births (95% CI: 437, 663). Out of those who died due to pregnancy and related causes, only 26% attended at least one antenatal care service. The most common cause of maternal death was postpartum haemorrhage (46.5%) followed by hypertensive disorders of pregnancy (16.3%).ConclusionThe magnitude of maternal mortality is considerably high but has shown a decreasing trend. Community-based initiatives that aim to improve maternal health should be strengthened further to reduce the prevailing maternal mortality. Targeted information education and communication should be provided.

Pelvic floor disorders associated with higher-level sexual dysfunction in the Kersa district, Ethiopia.

Objective:To assess the prevalence of female sexual dysfunction and its association with pelvic floor disorder (PFD) in a large scale, community-based study.Materials and Methods:A total of 2389 women who were married and still in union at the time of the study were drawn from 3432 women who had ever been married who participated in a PFD study. Study participants were selected through a multistage sampling procedure based on Kersa Health and Demographic Surveillance System database. The Female Sexual Function Index questionnaire was employed to collect data. The index score <26.55 was used as a cut-off point for sexual dysfunction. The content of the tool was validated and internal reliability was checked using Cronbach’s alpha. Poisson regression model with robust variance estimation was used to investigate the relationship between PFDs and sexual dysfunction.Results:From the total 2389 participants, 1127 [47.0%; 95% confidence interval (CI): 45.0-49.0] had sexual dysfunction. Sexual desire disorder was the most prevalent disorder (72.0%; 95% CI: 70.0-74.0). After controlling for confounding factors, the prevalence of female sexual dysfunction was found as 56% (adjusted prevalence ratio, 1.56; 95% CI: 1.44-1.69) higher with women with PFD as compared with women without PFD.Conclusion:In the rural community of Kersa, about half of the women have sexual dysfunction and it is significantly associated with PFD. This would call for an urgent intervention against PFD to maximize the women’s sexual and reproductive health.

Factors associated with pelvic floor disorders in Kersa District, eastern Ethiopia: a community-based study

Pelvic floor disorders, which diminish the quality of life, disproportionally affect women in developing countries. However, there is a knowledge gap in the understanding of the factors associated with the problem in many countries including Ethiopia. Therefore, we aimed to assess the factors associated with pelvic floor disorders in Ethiopia. A community-based cross-sectional study was conducted among 3432 ever-married women selected through a stratified multistage sampling procedure from the Kersa Health and Demography Surveillance System. Data were collected using structured questionnaires through face-to-face interviews. A Poisson regression model with robust variance estimation was used to investigate the association of the independent variable with pelvic floor disorder. The results are reported in adjusted prevalence ratios with 95% confidence intervals. Overall, the prevalence of pelvic floor disorders was 20.5% (95% CI: 19%-22%). Women who had no education (APR = 1.47; 95% CI: 1.06, 2.04) or had undergone five or more vaginal deliveries (APR = 1.56; 95% CI: 1.18, 2.05), an abortion (APR = 1.85; 95% CI: 1.43, 2.38) or episiotomy (APR = 1.39; 95% CI: 1.02, 1.90) were independently associated with having pelvic floor disorders. Obstetric events are strongly associated with pelvic floor disorders. This finding highlights the greater need for policies to focus on prevention, diagnosis and treatment services to mitigate women's suffering from pelvic floor disorders.