Background The prevalence of Gestational Diabetes Mellitus (GDM) varies worldwide among racial and ethnic groups, population characteristics (eg, average age and body mass index (BMI) of pregnant women), testing method, and diagnostic criteria. This study was aimed at determining the prevalence of GDM using the one-step 75-g Oral glucose tolerance test (OGTT) protocol, with plasma glucose measurement taken when patient is fasting and at 1 and 2 h and identify associated risk factors among pregnant women attending antenatal care clinic at St. Paul Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Methods Institution based cross sectional study was conducted from April, 2017 to October, 2017 at antenatal care clinic of SPHMMC among a randomly selected sample of 390 eligible pregnant women. Data were collected using a pretested questioner using 5% of the total sample size and later was modified accordingly to capture all the necessary data. Descriptive statistics, independent t-test and Binary Logistic Regression were used for analysis using SPSS version 23.0. Results The prevalence of GDM among the study population was 16.9%. Factors that affect prevalence of GDM were age group (AOR = 2.75, 95% CI: 1.03, 7.35 for 30–34 years old and AOR = 4.98, 95% CI: 1.703, 14.578 for ≥ 35 years old)and BMI (AOR = 2.23, 95% CI: 1.21, 4.11). Conclusions The prevalence of GDM among the study population is higher than previous reports in Ethiopia and even in other countries. This implies that these women and their newborns might be exposed to increased risk of immediate and long term complications from GDM including future risk of GDM and Type II Diabetes Mellitus.
Background Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. Method An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. Results Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. Conclusion Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
Eclampsia remains one of the five major causes of maternal mortality in developing countries. Advances in diagnosis and management have led to a significant reduction in maternal mortality and morbidity from this disease in developed countries. In developing countries the incidence of maternal death attributed to eclampsia remains high and, in Ethiopia, maternal mortality from this complication has instead risen over the last decade. The purpose of this study was to review the incidence of eclampsia at the largest feto-maternal center in the country over 1 year in an attempt to determine what quality improvement measures are needed and could realistically be implemented within the system to decrease this complication. There were a total of 104 eclamptic patients during the study period. The hospital incidence of eclampsia was 82/10,000 deliveries excluding those arriving to the hospital in the postpartum period (28 cases). There were eight maternal deaths making the case fatality rate one in 13 cases. The median convulsion to arrival time, referral to arrival time and magnesium sulphate administration time were found to be 3, 2 and 3 h, respectively. The probability of multiple seizures (≥3 episodes) was increased significantly with the prolongation of these time variables. Occurrence of multiple seizures was in turn significantly associated with adverse maternal outcomes (ICU admission, morbidities and mortalities). As expected, there was a high incidence of eclampsia and eclampsia related maternal death in the hospital. We recommend a thorough assessment of the referral system, upgrading and capacity building of more health facilities, organizing trainings and drills in health facilities; and availing magnesium sulphate in all health centers among others.
Background Provider-patient miscommunication in the health care setting can have fatal consequences. Our quality improvement project aims to evaluate an intervention deployed to overcome patient provider language barrier at Saint Paul’s Hospital Millennium Medical College (SPHMMC).Method A baseline assessment was conducted to assess the language mix of patients presenting to the hospital. Medical Afaan Oromoo (MAO) project was then designed to teach Afaan Oromoo to health care professionals in a 3-month period. The effectiveness of the project was evaluated with standardized pre and post training assessment tools.Results Most patients seeking care at the hospital speak Afaan Oromoo (56%), while only 8.9% of health care providers were able to communicate in Afaan Oromoo. The language training project was able to improve language proficiency from a baseline of Interagency Language Roundtable (ILR) scale Level 0 to Level 2 in 96% of trainees. Conclusions The tailored language training project was able to bring about a significant change in health professionals Afaan Oromo language proficiency. However, further research is needed to ascertain its impact in actual Afaan Oromoo language incongruous clinical settings.
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. Objectives 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. Conclusion 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.
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