Background: Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics. Worldwide, about 18.5 million CSs are conducted annually. Of this, 21-33% are performed in middle-and high-income countries. The effectiveness of the CS in preventing maternal and prenatal mortality and morbidity is medically justifiable. However, cesarean delivery without demanding obstetrical indications, by mere maternal request, may expose the child to several risks over benefits. Therefore, we aim to compare spontaneous vaginal delivery (vaginal delivery other than operative vaginal deliveries) and elective CS (CS before the onset of labor, but not including emergency CS) in decreasing the risk of neonatal respiratory morbidity. Objective: To compare the risk of neonatal respiratory morbidity in ECS and spontaneous vaginal delivery. Methods: A literature search was performed through visiting an electronic database (MEDLINE, PubMed, EMBASE, and CINAHL) and gray literature sources, including Google and Google Scholar, from January 2000 to May 2018. Original observational studies that reported the risk of neonatal respiratory morbidity in relation to mode of delivery conducted in the English language were identified and screened. Joanna Briggs Institute's quality assessment tool for observational studies was used to critically appraise the methodological quality of studies. Synthesis of individual studies was conducted using the Review Manager Software version 5.3 for Windows. Heterogeneity among studies was explored using the Cochran's Q-test and the I 2 statistics. Pooled effect sizes in relative risk ratios with 95% confidence intervals were calculated. The flow of the study was prepared according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Tefera et al. ECS Is Risk for Neonatal Respiratory Morbidity Results: Sixteen studies were reviewed. A total of 327,272 neonates born by vaginal delivery and 55,246 born by ECS were included in this study. The risk of neonatal respiratory morbidity was increased by 95% in neonates delivered by ECS (RR = 1.95; 95% CI: 1.40-2.73) as compared with neonates born by spontaneous vaginal delivery. Conclusion: This study investigated the effect of mode of delivery on the respiratory morbidity without considering other risks and found that the ECS has a high risk of developing neonatal respiratory morbidities when compared to spontaneous vaginal delivery. So, we recommend discouraging unnecessary CS. registration: CRD42018104905.

Background: One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.

Reference 1. Roba, et al. Application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries: a systematic review and metaanalysis.

Onchocerciasis is a filarial disease caused by onchocerca volvulus and transmitted by a black fly. Onchocerciasis is a killer of livestock and wild animals so Onchocerciasis prevention and control is helpful for health planners and health educators providing basic information to focus on its prevention and control. The objective of this study was to assess the knowledge, attitude and practice of onchocerciasis prevention and control in Becho woreda, Illu Ababora, Oromia regional state, south west Ethiopia, 2018. Community based cross sectional study design was employed through systematic sampling technique. The data were collected from every seven houses after randomly selecting the first house from 1 to 7 until calculated sample size reached. A total of 322 households included in the study. A structured questionnaire was used for gathering the data. Data was coded, entered and analyzed by using SPSS version 16. Out of 322 respondents; 177(59%) were male and 123(41%) were female. The response rate was 300(93%) and the age of respondents ranged from 18-60 years and the majority were 26-45 years with the mean age of 31 years. The study showed that only 59(19.7%) of the total respondents knew the right cause of onchocerciasis and majority of them 233(77.7%) responded that black fly is the cause of the disease. Of the study population, 66% had poor knowledge, 4.7% had unfavorable attitude and 77.3% of them had unsafe practice. As in the result, the study undergone on onchocerciasis prevention and control program showed that; of the study population, 66% had poor knowledge, 4.7% had unfavorable attitude and 77.3% of them had unsafe practice.

ObjectiveThe aim of the study was to explore women's birth in public hospitals in the Harari Region of eastern Ethiopia.DesignAn exploratory phenomenological qualitative study design was used.SettingTwo public hospitals (Hiwot Fana Specialized University Hospital and Jugal General Hospital).Participants and methodsThe study enrolled women who gave birth at the selected hospitals through purposive sampling. We conducted in-depth interviews with 38 women who gave birth to singleton, full-term babies via vaginal delivery (47%; n=18) or caesarean section (53%; n=20) with no pregnancy-related complications. Interviews were audio-recorded and transcribed on the spot and the interviews were analysed using a deductive content analysis approach. Data were analysed using the four components of Roy’s Adaptation Model (RAM) as a guiding framework of women’s experiences: physiological, self-concept, role and function, and interdependence.ResultsVarious behaviours were identified: under physiological mode, common behaviours identified included labour pain, fatigue, surgical site pain and anaesthesia-related complication. The women’s major problems in self-concept mode were concern for future pregnancy, lack of privacy, newborn health status, relationship with healthcare providers and lack of family support. Due to the prolonged hospital stay and surgical site pain, the women who were unable to care for themselves, their newborn babies and their families adapted poorly to role and function mode. Finally, women who had no family support and who got less attention from healthcare providers reported ineffective adaption for interdependence mode.ConclusionsApplication of RAM principles could be used to improve care for Ethiopian women, providing an intervention framework that can gauge and respond to interacting factors that can make women vulnerable to negative birth experiences.