Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2•5th and 97•5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62•6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, withincountry geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs asses...

Background Postdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache. Methods This prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow-up were performed. Data were entered into Epi info version 7 software and transported to SPSS version 20 for analysis. The odds ratio and 95% confidence interval were computed. The findings of the study were reported using tables, figures, and narrations. Variables that were found to be candidates (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache. Results One hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p < 0.05). In addition, twenty-five needles were identified as the strongest preoperative independent predictor of postdural puncture headache (AOR = 4.150, CI = 1.433–12.021) Conclusions A recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

Background Treatment seeking delay is defined as the time interval between the onset of the major symptoms of tuberculosis (TB) and the first visit to the formal health care facility. The patient was said to be delayed if the patient visited the health-facility after 3 weeks onset of major symptoms. However, in low-income countries like Ethiopia, the delay in treatment-seeking among tuberculosis patients contributes to a widespread transmission and high prevalence of tuberculosis. Methods Studies were retrieved from PubMed, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar by employing a combination of search terms with Boolean operators. Heterogeneity across studies was assessed using the Cochrane Q test. A funnel plot was used for visual assessment of publication bias. Subgroup analyses were performed to explore the possible causes of heterogeneity. Egger’s weighted regression test at a p-value < 0.05 was used to assess the presence of publication bias. Sensitivity analysis was performed to judge whether the pooled effect size was influenced by individual study. STATA software version 14 was used for all statistical analyses. Result A total of 12 studies with 5122 total sample size were included. The national pooled prevalence of treatment seeking delay was 44.29% (95% CI: 39.805, 48.771). The visual inspection of the funnel plot showed the asymmetrical distribution, and the Egger test showed insignificant (P = 0.348). Patients who did not seek formal health care providers on a first contact had about 7 times more likely to delay than patients who sought formal health care provider on a first contact (OR: 7.192 ((95% CI 5.587–9.257), P = 0.001, I2: 85%). The others independent predictors of delay were rural residence (OR: 3.459 ((95% CI 1.469–8.148), P ≤ 0.001), extra pulmonary TB (OR: 2.520 ((95% CI 1.761–3.605), 0.180), lower educational level (OR 11.720 ((95% CI 1.006–2.938), P <0.001), and distance more than 10km from health facility (OR: 1.631 ((95% CI (10.858–3.101), P = 0.001). Conclusion In this review, we identified a substantial treatment seeking delay among TB patients in Ethiopia. And, the independent predictors of delay were treatment sought before formal health care provider, residence of the patient, type of TB, educational level, and distance from a health facility. Thus, we recommend health extension workers, health professionals and other stakeholders to focus on patient education, and to continuously mobilize the whole communities on early treatment seeking with a special emphasis given to where treatment sought before formal health care provider, rural resident, extra pulmonary TB, and a patient living farther than 10km distance from health facility.

The World Health Organization recommends the utilization of partograph for all laboring mothers. Partograph is a cost-effective, single sheet of paper that is used to follow maternal and fetal condition and progress of labour. Obstructed and prolonged labours are major causes of maternal deaths. These causes can be minimized by routine utilization of partograph. However, several maternal and fetal deaths occur in health facilities due to poor quality of labour follow-up. Therefore, this study aims to assess the utilization of partograph and associated factors among obstetric care providers working in Wolaita zone health facilities, Southern Ethiopia. An institution-based cross-sectional survey was conducted from April to May 2016. A pretested and structured self-administered questionnaire was used to collect the data. Data entry and analysis was conducted using SPSS Version 21.0. Logistic regression was used to identify associations. A P value <0.2 in binary logistic regression were transferred to multiple logistic regressions. Odds ratio with 95% CI, P-value <0.05 were considered as statistically significant. Of a total of 442 participants, 73.6% utilize partograph routinely. From the total variables in the study, a midwifery profession showed a significant association with the dependent variable (AOR = 4.7,95% CI:1.8–12). The utilization of partograph in the study area was low as per the World Health Organization recommendation. This study recommends that assigning midwives in the obstetric ward other than other health professionals will increase the routine utilization of partograph.

Background: Post-dural puncture headache is one of the complications following spinal anaesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture which includes needle size, needle design, direction of the bevel and number of LP attempts. This study aimed to assess the incidence and risk of postdural puncture headache.Methods: This prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow up were made. Data was entered in to Epi info version 7 software and transported to SPSS version 20 for analysis. Odd ratio and 95% confidence interval was computed. The findings of the study were reported using tables, figures and narration. Variables that were found to be candidate (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache.Results: One hundred fifty eligible study participants were included in our study of which 28.67% had developed postdural puncture headache. This study found that needle size, number of CSF drops and multiple attempts as independent predictors of postdural puncture headache at significant level (p < 0.05). In addition, twenty five needle was identified as strongest pre-operative independent predictor with PDPH (AOR = 4.150, CI = 1.433–12.021)Conclusions: Recent study revealed that small size pencil-point spinal needle was much better to large size cutting spinal needle regarding the frequency of postdural puncture headache. Besides, frequent attempts during lumbar puncture and increased CSF leakage were associated with the events. In view of this, we recommend the use of small size pencil-point spinal needle; avoid more leakage of cerebrospinal fluid and multiple in spinal anesthesia and lumbar puncture.