Abstract BACKGROUND: The Apgar score is a method to quickly summarize the health of newborn children. It establishes a simple and clear classification of newborns, which could be used to predict survival and to compare methods of resuscitation and perinatal experience across hospitals and obstetric practices. Low Apgar score is associated with various immediate and long-term adverse health outcomes of newborns. Hence; in order to decrease the risk/complications, identifying the determinant factors of low Apgar is crucial to act on the modifiable risk factors. This study is aimed to investigate the determinant factors of a low Apgar score in newborn children.METHOD: The study was conducted in Lemelem Karl general hospital; northern Ethiopia. An institutional-based unmatched, case-control study was implemented. Data were retrieved from medical charts of 662 newborns’ mothers who gave birth in the hospital from Sep 2014 to Sep 2017. Among these, 221 of them were cases (charts of mothers whose newborns’ fifth minute Apgar score was <7) and 441 of them were controls (charts of mothers whose newborns’ Apgar score was 7 and above). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was done to determine the association and statistical significance was declared at P-value of ≤0.05. RESULTS: This study revealed that low Apgar score was significantly associated with antepartum hemorrhage [Adjusted odss ratio (AOR) 3.509; 95% confidence interval (CI) 1.526-8.067), P= 0.003], pregnancy-induced hypertensive disorders [AOR 2.69; 95% CI (1.351-5.357), P= 0.005], prolonged second stage of labor [AOR 2.63; 95% CI (1.399-4.944), P= 0.003], Cesarean delivery [AOR 2.005; 95%CI (1.223-3.287), P= 0.006],meconium-stained liquor [AOR 6.955; 95% CI (3.721-13.001), P<0.001], and low birth weight [AOR 4.38; 95% CI (2.216-8.657), P<0.001].CONCLUSION: Result from this study showed a remarkable linkage of low Apgar score with antepartum hemorrhage, pregnancy-induced hypertensive disorders, meconium-stained liquor, and low birth weight. Therefore, meticulous antenatal care and labour management service are recommended to prevent low Apgar score and the concomitant neonatal death.

BACKGROUND: The Apgar score is a method to quickly summarize the health of newborn children. It establishes a simple and clear classification of newborns, which could be used to predict survival and to compare methods of resuscitation and perinatal experience across hospitals and obstetric practices. Low Apgar score is associated with various immediate and long-term adverse health outcomes of newborns. Hence; in order to decrease the risk/complications, identifying the determinant factors of low Apgar is crucial to act on the modifiable risk factors. This study is aimed to investigate the determinant factors of a low Apgar score in newborn children.METHOD: The study was conducted in Lemelem Karl general hospital; northern Ethiopia. An institutional-based unmatched, case-control study was implemented. Data were retrieved from medical charts of 662 newborns’ mothers who gave birth in the hospital from Sep 2014 to Sep 2017. Among these, 221 of them were cases (charts of mothers whose newborns’ fifth minute Apgar score was <7) and 441 of them were controls (charts of mothers whose newborns’ Apgar score was 7 and above). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was done to determine the association and statistical significance was declared at P-value of ≤0.05. RESULTS: This study revealed that low Apgar score was significantly associated with antepartum hemorrhage [Adjusted odds ratio (AOR) 3.509; 95% confidence interval (CI) 1.526-8.067), P= 0.003], pregnancy-induced hypertensive disorders [AOR 2.69; 95% CI (1.351-5.357), P= 0.005], prolonged second stage of labor [AOR 2.63; 95% CI (1.399-4.944), P= 0.003], Cesarean delivery [AOR 2.005; 95%CI (1.223-3.287), P= 0.006],meconium-stained liquor [AOR 6.955; 95% CI (3.721-13.001), P<0.001], and low birth weight [AOR 4.38; 95% CI (2.216-8.657), P<0.001].CONCLUSION: Result from this study showed a remarkable linkage of low Apgar score with antepartum hemorrhage, pregnancy-induced hypertensive disorders, meconium-stained liquor, and low birth weight. Therefore, meticulous antenatal care and labour management service are recommended to prevent low Apgar score and the concomitant neonatal death.

Objective: The objective of this study was to determine the prevalence and associated factors of preterm births among mothers who gave birth in Axum and Adwa public hospitals, North Ethiopia, 2018. Result: This study showed that 13.3% from the total 472 mothers gave a preterm birth. Being a rural resident (AOR=2.13,95% CI:(1.07,4.22), short inter pregnancy interval (AOR= 5.4, 95% CI: (1.32, 22.05), previous preterm birth(AOR= 3.74, 95% CI: (1.03, 16.34), Premature rupture of membrane(AOR=4.14, 95% CI: (1.92, 8.89), induced onset of labor(AOR=2.49, 95% CI: (1.06, 5.85) multiple pregnancy(AOR= 5.69, 95% CI: (2.27, 14.28), malaria during pregnancy (AOR= 4.71, 95% CI: (1.98, 11.23), Presence of chronic illness (AOR= 4.55, 95% CI: (1.83, 11.26) were significantly associated with preterm birth.

Background: Antenatal care is one of the medical services delivered to pregnant women for the safety of the mother and the neonate. Guidelines are developed to ensure quality, uniformity and consistency of care for clients. One of the guidelines is focused antenatal care. Despite this fact, there is a paucity of information regarding the adherence of health professionals in the implementation of the guidelines and its effect on the perinatal outcomes.Objective: To assess adherence level of health care providers to first visit antenatal care guidelines and its effect on perinatal outcomes among mothers in Tigray Public health institutions in 2017/18.Methods: Cohort study design was employed with sample size of 1545. Among the participants 501(496 with complete follow up) were recruited to exposed groups and 1044 for non-exposed groups. The ratio of exposed to non-exposed group was 1:2. In the selection of study sites simple random sampling method was used but to select study participants consecutive sampling technique was employed. Women with full adherence to the first antenatal guideline were considered as exposed group, whereas those with incomplete adherence were considered as non- exposed group. It was assumed that the risk of complication among the non-exposed group was twice as that of the exposed group. Data was entered to Epi data version 3.51 and exported to SPSS version 20 for further analysis. Binary logistic regression was employed to determine the associated factors and multivariable analysis was done to control the confounding factors and significance was declared at CI of 95% and p-value of <0.05. Relative risk was used to express the association and effect of adherence on the perinatal outcome. Result: Overall, the level of complete adherence to antenatal care guideline was 32.2% .The risks of antenatal, intranatal and neonatal complication was 21%, 41.3% and 26.8% respectively. The risk of maternal and neonatal complication is higher in non-exposed groups, pregnancy induced hypertension and postpartum hemorrhage risks were 1.6%:6.2% and 2.6%:4.3% among exposed and non-exposed groups and a neonatal complication of low birth weight and preterm labor was 5.8%:8.2% and 6.7%:8% among exposed and non-exposed groups respectively. Effect of complete adherence was found to be significant in reducing maternal and neonatal complications. Neonatal complications, anemia, postpartum hemorrhage and early neonatal death was reduced by 40% among the women with complete adherence, maternal sepsis and neonatal sepsis were reduced by 60% among the exposed groups and pregnancy induced hypertension was reduced by about 70% in women with complete adherence.Conclusion and recommendations: Overall providers’ complete adherence to antenatal care guideline at first visit influences both maternal and neonatal outcomes. On average the risks of developing antenatal, intranatal and post natal complications were reduced by almost 50% among the exposed groups. The Federal Ministry of Health and teaching institutions should capacitate their staff to strictly adhere to the implementation of the guidelines

Objective: The objective of this study was to determine the prevalence and associated factors of preterm births among mothers who gave birth in Axum and Adwa public hospitals, Tigray, North Ethiopia, 2018. Result: This study showed that 13.3% from the total 472 mothers gave a preterm birth. Being a rural resident (AOR=2.13,95% CI:(1.07,4.22), short inter pregnancy interval (AOR= 5.4, 95% CI: (1.32, 22.05), previous preterm birth(AOR= 3.74, 95% CI: (1.03, 16.34), Premature rupture of membrane(AOR=4.14, 95% CI: (1.92, 8.89), induced onset of labor(AOR=2.49, 95% CI: (1.06, 5.85) multiple pregnancy(AOR= 5.69, 95% CI: (2.27, 14.28), malaria during pregnancy (AOR= 4.71, 95% CI: (1.98, 11.23), Presence of chronic illness (AOR= 4.55, 95% CI: (1.83, 11.26) were significantly associated with preterm birth.