BACKGROUND: Insufficient iodine intake during pregnancy can result in abortion, stillbirths, neonatal mortality, cretinism and permanent cognitive impairment. Even although iodized salt is widely accessible in Ethiopia, pregnant women still experience persistent problems related to iodine deficiency disorders.
METHODS: A facility-based cross-sectional study was conducted among randomly selected 573 pregnant women who were attending antenatal care services at public health facilities. Bivariate and multivariable logistic regression models were used, and independent predictors were determined based on adjusted ORs with 95% CIs and p<0.05.
RESULTS: Knowledge and practice of pregnant women on iodized utilization were 35.6% (95% CI 31.8 to 39.6%) and 37.7% (95% CI 32.1 to 42.9%), respectively. Living in urban areas (adjusted OR [AOR]=1.976, 95% CI 1.136 to 3.435) and having a higher level of education (AOR=2.018, 95% CI 1.037 to 3.930) were associated with having adequate knowledge. Having a diploma or higher education (AOR=2.684, 95% CI 1.137 to 6.340) and adequate knowledge about iodized salt utilization (AOR=2.095, 95% CI 1.273 to 3.447) were significantly associated with good practice.
CONCLUSIONS: The current study highlights the level of knowledge and practices of pregnant women on iodized salt. It emphasizes the necessity for targeted programs about the benefits of iodized salt and how to use it correctly, particularly for those with low literacy levels and those living in rural areas.

UNASSIGNED: The paper aims to identify the factors for effective implementation and adherence to the behavioural intervention package by women experiencing domestic violence (DV) and attending ANC in a public hospital.
UNASSIGNED: A qualitative study was undertaken with 211 pregnant women experiencing DV and attending antenatal care (ANC) at the LN Hospital, New Delhi. The intervention was given to women recruited under the RCT study. The narratives were analysed under two broad themes, impeding and facilitating factors, with nine sub-themes.
UNASSIGNED: Impeding factors are external factors generated by the structural interaction of the participants, whereas facilitating factors are supplied internally in the trial to eliminate the influence of impeding factors and singulate the factors under study. Our results show that despite the plethora of impeding factors (nine), the overall sum impact of impeding factors falls short of the positive impact of facilitating factors (nine), which were minor adjustments but reinforce participation in the trial and adherence with 97% follow-up rates.
UNASSIGNED: Our study findings are expected to reset the treatment protocol, which entails converting impeding factors into facilitating factors for appropriate adherence and compliance and adequate access and utilization of public services. The sensitization of healthcare providers to the impact of the quality of human interaction on the patient and its impact on the uptake of healthcare services and adherence is needed, particularly in the public hospitals of India.
UNASSIGNED: Funds received for the research are from the Indian Council of Medical Research (ICMR), New Delhi, Government of India.

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexity of delivery. We sought to address implementation gaps in BEP interventions through a formative study designed to understand implementation outcomes. We conducted 52 in-depth interviews and 8 focus-group discussions with married women of reproductive age, family members, health care providers and pharmacists in three unions of the Gaibandha district in rural Bangladesh. Interviews were translated and transcribed in English and analysed using an analytic framework for implementation science in nutrition. BEP was viewed as an acceptable and appropriate intervention to combat undernutrition in this setting. There was a lack of clarity on who should or could be responsible for providing/distributing BEP in a way convenient to mothers. Many participants preferred door-to-door delivery and thought this approach could address social and gender inequities, but providers mentioned already being overworked and worried about adding new tasks. Participants were concerned about the affordability of BEP and opportunity costs associated with travel to proposed distribution sites such as ANC or pharmacies. Women in these communities do not always have the agency to travel without supervision or make purchasing decisions. BEP supplementation is a complex intervention; future trials seek to assess ways to overcome these implementation challenges and inform a long-term systems-owned BEP intervention.

OBJECTIVE: COVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas (LGAs) in Nigeria and examine factors involved.
METHODS: A cross-sectional mixed-methods approach was used. A total of 315 pregnant women seen for antenatal care in 80 health facilities in three LGAs between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes related to health service utilization during the pandemic.
RESULTS: One quarter of women reported that they reduced or ceased health service. The biggest reported changes were in immunization (47 to 30%, p < 0.001) and a small but statistically significant decline in antenatal care (98.7 to 93.8%, p < 0.001) was observed. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons for not seeking care during this period of the pandemic.
CONCLUSIONS: The pandemic negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in state response could help inform future actions. The findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care.

BACKGROUND: The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications.
OBJECTIVE: This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia.
METHODS: This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul\'s hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05.
RESULTS: Factors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane.
CONCLUSIONS: Proper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.

UNASSIGNED: Every woman has the right to receive quality care during pregnancy. It is proven that antenatal care (ANC) reduces maternal and perinatal morbidity and mortality. The government of Ethiopia is also making intense efforts to increase the coverage of ANC. However, among pregnant women, the levels of satisfaction with the care provided are overlooked, as the percentage of women who complete all ANC visits is below 50. Therefore, this study aims to assess maternal satisfaction with ANC services rendered at public health facilities in the West Shewa Zone, Ethiopia.
UNASSIGNED: A facility-based cross-sectional study was conducted among women who were receiving ANC in public health facilities in Central Ethiopia between September 1 and October 15, 2021. A total of 411 women were selected using the systematic random sampling method. The questionnaire was pretested and the data were collected electronically using CSEntry. The collected data were exported to SPSS version 26. The characteristics of the study participants were described using frequency and percentage. Bivariate and multivariate logistic regression were used to identify the factors associated with maternal satisfaction with focused ANC service.
UNASSIGNED: This study revealed that 46.7% [95% confidence interval (CI) (41.7%-51.6%)] of women were satisfied with ANC service. Factors such as the quality of the health institution [adjusted odd ratio (AOR) = 5.10, (95% CI: 3.33-7.75)], place of residence [AOR = 2.38, (95% CI: 1.21-4.70)], history of abortion [AOR = 0.19, (95% CI: 0.07-0.49)], and previous mode of delivery [AOR = 0.30, (95% CI: 0.15-0.60)] were significantly associated with women\'s satisfaction with focused ANC service.
UNASSIGNED: More than half of pregnant women who received ANC were dissatisfied with the service they received. This should be a cause for concern, as the level of satisfaction is lower than that of the findings of previous studies conducted in Ethiopia. Institutional variables, interactions with patients, and previous experiences of pregnant women have an impact on the level of satisfaction. Due attention should be paid to primary health and communication of health professionals with pregnant women to improve the levels of satisfaction with focused ANC service.

BACKGROUND: Breast milk is the first natural food for babies. It has nutritional, immunological, developmental, psychological, societal and environmental advantages. Failing to feed children for twenty-four months has so many negative consequences to children. Though studies have well documented the duration of breast feeding in the first six months, the proportion of women completing the recommended duration and factors associated with it has not been well investigated in rural places of Ethiopia. Therefore, this study aims to fill this gap in evidence among mothers with children aged 2 to 3 years in Arba Minch Health and Demographic Surveillance Site in 2021 E.C.
METHODS: A community-based cross-sectional study was conducted in all kebeles of the surveillance site by employing multi-stage sampling technique. Descriptive statistics was done to summarize findings and binary logistics regression model was used to identify factors significantly associated with early breast-feeding cessation respectively. OR with its 95% CI was obtained to quantify the degree of association between explanatory variables and early breastfeeding cessation.
RESULTS: The proportion of early cessations of breast feeding was 29.30% (25.02, 33.64%). Being from a household with no fathers \'education or primary education [AOR=0.22; 95%CI (0.07, 0.74)] and [AOR=0.30; 95%CI (0.12, 0.76)], farmer mothers [AOR=6.40; 95%CI: (1.38, 29.74)], birth interval of less than 2 years [AOR=2.07; 95%CI: (1.03, 4.16)], and with mothers\' one or two to three antenatal care visits [AOR = 2.73; 95%CI: (1.27,5.88)] were factors significantly associated with early cessations of breast feeding.
CONCLUSIONS: The proportion of early cessations of breast feeding was high. Father\'s education, being farmer, birth interval and ante natal care visit were significant factors. Health education about proper breast feeding practice and improving ante natal care attendance might improve premature cessation of breast feeding among women.

UNASSIGNED: Antenatal care (ANC) is a recognized factor for favorable pregnancy outcomes. Despite the benefits associated with early initiation of antenatal care, late booking still predominates in sub-Saharan Africa including Nigeria.
UNASSIGNED: This study aimed to assess the factors, including family dynamics, associated with the booking gestational age among women attending ANC clinics in a Local Government Area of Osun State, Nigeria.
UNASSIGNED: A descriptive cross-sectional study was conducted among 255 pregnant women attending ANC at the Primary Health Centres in Osun State, who were selected by stratified random sampling technique. Data were obtained with aid of a semi-structured questionnaire and subjected to descriptive and inferential analyses.
UNASSIGNED: The mean age of respondents was 27.3 ± 5.1 years. Their mean booking gestational age was 23.0 ± 6.6 weeks, while the majority (85.3%) booked late for ANC. Most (122, 54.2%) of the respondents booked in the second trimester. The opinion of the husband influenced most women (54.2%) in the decision regarding the time of ANC booking. There was no association between the booking gestational age and each of respondents\' age, education, parity, perceived family support, level of family functioning, and other sociodemographic characteristics. The booking GA was however significantly related to the previous booking GA at the last pregnancy (p = .004).
UNASSIGNED: Late initiation of antenatal care was high among pregnant women attending PHCs in the study area and it was not associated with measures of family dynamics. The predominant influence of husbands\' opinion on time of booking suggests the need for strategic outreach to males through relevant reproductive health educational campaigns.

Pancreatic necroses are a major challenge in the treatment of patients with pancreatitis, causing high morbidity. When indicated, these lesions are usually drained endoscopically using plastic or metal stents. However, data on factors associated with the occurrence of failure or adverse events during stent therapy are scarce. We retrospectively analyzed all adverse events and their associated features which occurred in patients who underwent a first-time endoscopic drainage of pancreatic necrosis from 2009 to 2019. During the observation period, a total of 89 eligible cases were identified. Adverse events occurred in 58.4% of the cases, of which 76.9% were minor (e.g., stent dislocation, residual lesions, or stent obstruction). However, these events triggered repeated interventions (63.5% vs. 0%, p < 0.001) and prolonged hospital stays (21.0 [11.8−63.0] vs. 14.0 [7.0−31.0], p = 0.003) compared to controls without any adverse event. Important factors associated with the occurrence of adverse events during endoscopic drainage therapy were positive necrosis cultures (6.1 [2.3−16.1], OR [95% CI], p < 0.001) and a larger diameter of the treated lesion (1.3 [1.1−1.5], p < 0.001). Superinfection of pancreatic necrosis is the most significant factor increasing the likelihood of adverse events during endoscopic drainage. Therefore, control of infection is crucial for successful drainage therapy, and future studies need to consider superinfection of pancreatic necrosis as a possible confounding factor when comparing different therapeutic modalities.

In low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We aimed to assess AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso. We furthermore explored feasibility of adding urine culture to standard antenatal care in a rural sub-Saharan African setting.
Between October 2016-September 2018, midstream urine samples collected as part of routine antenatal care in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Significant growth was defined as a pure culture of Enterobacterales at counts of ≥ 104 colony forming units/ml.
Significant growth was observed in 202/5934 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates.
The E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Adding urine culture to the routine urine analysis (dipstick) of antenatal care was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.