BackgroundInvestigating cases of severe maternal morbidity (SMM) and severe maternal outcome (SMO) and the quality of maternal health care using near-miss approach has become popular over recent years. The aim of this study was to determine facility based incidence and the determinants of severe maternal outcome (SMO) using this approach.MethodsProspective cross-sectional study among all mothers who presented to study facility while pregnant, during child birth and/or within 42 days after termination of pregnancy seeking care and found to have SMM and SMO during the study period was carried out.ResultsThere were total of 2737 live births, 202 SMM and 162 SMO (138 maternal near-misses (MNM) and 24 maternal deaths (MD)) cases. The SMO ratio was 59.2 per 1000 live births and the MNM mortality ratio, mortality index (MI) and maternal mortality ratio (MMR) were: 5.8:1, 14.8% and 876.9 per 100,000 live births respectively. Close to three-fourth of all women with SMO had evidence of organ dysfunction on arrival or within 12 h of hospitalization. The commonest underlying causes for SMO were uterine rupture 27%, followed by hypertensive disorders 24% and obstetric hemorrhage 24%. The highest case fatality rate was found to be associated with eclampsia 28%. Maternal age, residential area, educational status and occupation were associated with SMO (P < 0.0001). On binary multivariable logistic regression the occurrence of any delay, intrapartal detection of complication, the mode of delivery and duration of hospitalization had statically significant association with SMO (p < 0.05). Optimal number of antenatal care (ANC) visits and delivery by emergency cesarean section (C/S) were found to be protective of SMO.ConclusionThe occurance SMO in the facility thus in the population served was high. Most of these factors associated with SMO are modifiable; some amenable to social change and the others are within the control of the health system. Thus the finding of this research calls for planning for such changes which can enhance timely and proper detection and management of pregnancy related complications.

Background: Human papilloma virus (HPV) infection is the most common viral infection of the reproductive organ and other body parts causing a range of health problem both in females and males. It is associated with 99.7% of cervical cancers. Though different preventive strategies including HPV vaccine are proved to be effective in preventing cervical cancer that occur as a result of persistent HPV infection, it is the second commonest cancer among female in Ethiopia.

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Background. Small bowel obstruction is a common and dangerous surgical emergency which is associated with high morbidity and mortality if not managed appropriately and timely. Objective. To determine the causes and management outcome of small bowel obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia. Method. Institution-based retrospective cross-sectional study design was used. Three-year data (from January 1, 2014, to December 30, 2016) were collected from July 1 to August 30, 2017. Data were collected from medical records and checked for any inconsistency, coded, and entered into SPSS version 20 for analysis. Descriptive, binary, and multivariate logistic regression analyses were used. On binary logistic regression analysis, variables with p ≤ 0.25 were selected as a candidate for multivariate logistic regression analysis. The level of statistical significance was set at p ≤ 0.05 . Results. With 100% response rate, records of 211 patients with small intestinal obstruction were retrieved for analysis. One hundred thirty-seven (64.9%) were males. The commonest cause of small bowel obstruction was adhesion (35.1%). More than a quarter (26.5%) participants developed postoperative complications, and wound infection was the commonest postoperative complication (49.2%). A majority (84.8%) of patients improved and were discharged, and the rest 15.2% of patients died. Sex (AOR = 3.98, 95% CI: 1.51–10.52), duration of illness before surgical intervention (AOR = 4.4, 95% CI: 1.69–11.45), level of hematocrit (AOR = 4.25, 95% CI: 1.56–11.57), types of intestinal obstruction (AOR = 3.73, 95% CI: 1.09–12.64), and length of hospital stay (AOR = 4.69, 95% CI: 1.82–12.07) were independent predictors of the management outcome of patients with small bowl obstruction. Conclusion. Small bowel obstruction is a commonly encountered surgical emergency. Adhesion, small bowel volvulus, and intussusception were the leading causes of small bowel obstruction, respectively.

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Heart failure is a failure of the heart to pump blood with normal efficiency and a globally growing public health issue with a high death rate all over the world, including Ethiopia. The goal of this study was to identify factors affecting the survival time of heart failure patients. To achieve the aim, 409 heart failure patients were included in the study based on data taken from medical records of patients enrolled from January 2016 to January 2019 at Jimma University Medical Center, Jimma, Ethiopia. The Kaplan Meier plots and log-rank test were used for comparison of survival functions; the Cox-PH model and the Bayesian parametric survival models were used to analyze the survival time of heart failure patients using R-software. Integrated nested Laplace approximation methods have been applied. Out of the total heart failure patients in the study, 40.1% died, and 59.9% were censored. The estimated median survival time of patients was 31 months. Using model selection criteria, the Bayesian log-normal accelerated failure time model was found to be appropriate. The results of this model show that age, chronic kidney disease, diabetes mellitus, etiology of heart failure, hypertension, anemia, smoking cigarettes, and stages of heart failure all have a significant impact on the survival time of heart failure patients. The Bayesian log-normal accelerated failure time model described the survival time of heart failure patient's data-set well. The findings of this study suggested that the age group (49 to 65 years, and greater than or equal to 65 years); etiology of heart failure (rheumatic valvular heart disease, hypertensive heart disease, and other diseases); the presence of hypertension; the presence of anemia; the presence of chronic kidney disease; smokers; diabetes mellitus (type I, and type II); and stages of heart failure (II, III, and IV) shortened their survival time of heart failure patients.

Heart failure is failure of the heart to pump blood with normal efficiency and globally growing public health issue with high death rate over the world including Ethiopia. The aim of this study was to identify factors affecting the survival time of heart failure patients in Jimma University Medical Center. To reach the aim, 409 heart failure patients were including in the study based on data taken from medical record of patients enrolled during January, 2016 to January, 2019. Kaplan Meier plots and log rank test were used for comparison of survival function; Bayesian survival models was used to identify factors affecting the survival time heart failure patients. Of the total patients in the study 164 (40.1%) were died. The estimated median survival time of patients was 31 months. Bayesian log-normal accelerated failure time model fit heart failure data-set better than other Bayesian accelerated failure time models used in this study. From the results of this model shows that the survival time of heart failure patients significantly affected by age, chronic kidney disease, diabetes mellitus, etiology of heart failure, hypertension, anemia, smoking cigarette and stages of heart failure. Bayesian log-normal accelerated failure time model describes the heart failure data-set well. Age group (49 to 65 years and greater than 65 years); etiology of heart failure (rheumatic valvular heart disease, hypertensive heart disease and Other diseases); presence of hypertension; presence of anemic; presence of chronic kidney disease; smokers; diabetes mellitus (type I and type II diabetic); and stages of heart failure (II, III and IV) were prolong the timing death of heart failure patients. The hospital, Jimma University medical center, need to improve public awareness for early detection of heart failure.

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