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Sintayehu Asrat Beyene,1 Nahom Tadesse Bogale,1 Binyam Mohammedbirhan Berhe,2 Demis Degu Teshome3 1General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Pathology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Department of Obstetrics and Gynecology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, EthiopiaCorrespondence: Sintayehu Asrat Beyene; Nahom Tadesse Bogale, Email sintayehubeyene54@gmail.com; Tadnahi2@gmail.comIntroduction: Endometriosis is a disease condition characterized by the presence of endometrial glands and stroma outside the uterine cavity and musculature. It affects 7– 10% of women of reproductive age and usually involves pelvic organs. The common symptoms include dysmenorrhea, menorrhagia, pelvic pain, dyspareunia, and infertility. Umbilical endometriosis is the rarest form of extra-pelvic endometriosis.Case Presentation: A 32-year-old Para II mother presented with umbilical swelling and pain that worsened during the menses of 2 months. She had two caesarean scars, both transverse Pfannenstein incisions. There was a dark blue, firm to hard 2× 3 cm umbilical mass on physical examination. Laboratory results are normal. Ultrasound of the abdomen showed umbilical mass with homogeneous echotexture measuring 2 cm × 3 cm with an irregular border and hypoechoic texture. An excisional biopsy was performed and a biopsy showed umbilical endometriosis.Discussion: Primary umbilical endometriosis is a disorder first described by Villar in 1886, and among all cases of extra-genital involvement of endometriosis, primary umbilical endometriosis accounts for 0.5– 1%. The usual presentation of primary umbilical endometriosis is typically the presence of a discrete bluish-purple mass in the umbilicus, which becomes swollen, painful, and bleeds concomitantly with the menstrual cycle. Ultrasound and other imaging techniques help in making diagnoses, and the diagnosis is confirmed by cytological examination. The management of umbilical endometriosis involves surgical excision and reconstruction of the umbilicus.Conclusion: Umbilical endometriosis is an uncommon form of extra-pelvic endometriosis. There is a wide differential diagnosis for swellings of the abdominal wall; however, it should be suspected in any female patient of reproductive age with an umbilical lesion that becomes more painful and swollen during her menstrual period. Appropriate clinical examination and workup are helpful to make a diagnosis and do a surgical excision.Keywords: endometriosis, umbilical nodules, umbilical hernia, abdominal wall scar, caesareans section

Abstract Background Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. Objective The study aimed to assess clients’ satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. Methods A convergent parallel mixed methods design was conducted in Debre Markos town’s public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). Result The quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients’ knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients’ attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS. Qualitative result The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers’ skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). Conclusion According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Abstract Background Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. Methods The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. Results The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. Conclusion As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

Introduction: Global, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020–June 20/2020) in the rural Arsi zone of Ethiopia. Methods: A community-based Phenomenological study was conducted from January 10–25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020–June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. Results: Four major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. Conclusions: COVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Nahom Tadesse Bogale,1 Sintayew Asrat Beyene,1 Dawit Zerihun Desta,1 Eyob Hailu Tessema,1 Sebsbie Admas Birhanie2 1General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Radiology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, EthiopiaCorrespondence: Nahom Tadesse Bogale; Sintayew Asrat Beyene, General Surgery Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, PO Box: 26217/1000, Jigjiga, Ethiopia, Tel +251910182949, Email tadnahi2@gmail.com; sintayehubeyene54@gmail.comIntroduction: Colonic volvulus is an unusual cause of intestinal obstruction in pregnant women. Cecal volvulus, second only to sigmoid volvulus, accounts for 1– 2% of all cases of intestinal obstruction. Due to its infrequent occurrence, only a few articles have documented its diagnosis and management among pregnant women, and we assume this to be the first reported case in Ethiopia, as per the authors’ knowledge.Case Presentation: A 26-year-old Gravida 3, Para 2 mother who has had amenorrhea for the last five months presents with a complaint of upper abdominal cramps with associated vomiting, which is bilious, upper abdominal distension, and obstipation of five-hour duration. Her vital signs were in the normal range, and she had upper abdominal tenderness. Plain abdominal radiography suggested a cecal volvulus and exploratory laparotomy, a right hemicolectomy, and end-to-side ileotransverse colon anastomosis was performed. The postoperative course was uneventful.Discussion: The cecal volvulus is an axial twist of the cecum, segment of the terminal ileum, and ascending colon along its mesentery, resulting in closed-loop obstruction with early vascular compromise and ischemia. It requires an anatomic prerequisite, which makes the cecum hypermobile, unlike the sigmoid volvulus. Diagnosis is challenging in pregnant women, as there are many differential diagnoses and a reluctance to request radiological imaging.Conclusion: A high index of suspicion is of paramount importance whenever a pregnant woman comes with a complaint of persistent abdominal cramps and obstipation. Early diagnosis and management are crucial to improve patients’ outcome. Plain abdominal radiography is the safest option of imaging modality in low-resource areas where magnetic resonance imaging (MRI) is not available during pregnancy whenever intestinal obstruction is considered. Right hemicolectomy is the preferred surgical option.Keywords: Cecal volvulus, intestinal obstruction, pregnancy, right hemicolectomy

Selamwit Gidey,1 Dawit Seyoum Gebremariam,1 Marta Yemane Hadush,1 Amanuel Berhe,1 Tedros Hailu Abay,1 Araya Abrha Medhanyie,2 Selemawit Asfaw Beyene,2 Tadele Tesfean Abraha,2 Yibrah Berhe Zelelow3 1Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 3Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Mekelle, EthiopiaCorrespondence: Dawit Seyoum Gebremariam, Department of Pediatrics and Child Health, Ayder Comprehensive Specialized Hospital, College of Health Science, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Tel +251911731454, Email dgseyoum@yahoo.comBackground: Kangaroo mother care is a proven intervention shown to be effective in reducing neonatal mortality among low-birth-weight infants. The paucity of evidence regarding the practice at home can be highlighted. This study aimed to assess the practice and outcome of kangaroo mother care at home among mothers having low-birth-weight infants discharged from two hospitals in Mekelle, Tigray, Ethiopia.Methods: A prospective cohort study was conducted among 101 paired mothers and low-birth-weight neonates discharged from Ayder and Mekelle Hospitals. Non-probability purposive sampling was used to select 101 infants. Data were collected from patient charts in both hospitals using interviewer-administered structured questionnaire, anthropometric measurements and were then analyzed using SPSS version 20. Characteristics were analyzed using descriptive statistics. Bivariate analysis was used, and variables with p-value < 0.25 were exported to multivariable logistic regression and statistical significance was set at a p-value < 0.05.Results: Kangaroo mother care was continued at home in 99% of the infants. Three of the 101 infants died before the age of 4 months with a possible cause of death from respiratory failure. Exclusive breastfeeding was provided for 67% of the infants, and it was higher in infants who started kangaroo mother care within 24 hours of life (AOR 3.8, 95% CI 1.07– 13.25). Malnutrition was higher in those with birth weight < 1500 grams (AOR 7.3,95% CI 1.63– 32.59); small for gestational age (AOR 4.8,95% CI 1.41– 16.31) and those provided kangaroo mother care for < 8 hours per day (AOR 4.5,95% CI 1.40– 16.31).Conclusion: Early initiation and prolonged duration of kangaroo mother care were associated with increased exclusive breastfeeding practice and decreased incidence of malnutrition. Kangaroo mother care should be promoted at the community level.Keywords: low birth weight, kangaroo mother care, malnutrition, exclusive breastfeeding

Kebede Dinsa, Beshea Gelana Deressa, Waju Beyene Salgedo Department of Health Policy and Management, Jimma University, Jimma, Oromia, EthiopiaCorrespondence: Beshea Gelana Deressa, Department of health policy and management, Jimma University, Jimma, Oromia, Ethiopia, Tel +251 921833996, Email tuniriyabesha@gmail.comBackground: The difference in nursing care quality by institution has implications for both the organization and its clients. Though disparities in patient satisfaction, which is an interpersonal patient outcome with nursing care, have been reported between public and private hospitals, there has been little research on the study area.Objective: To compare the level of patients’ satisfaction towards nursing care services among adult inpatients at Jimma Medical Center, and Oda Hulle hospital Jimma, southwest Ethiopia 2021.Methods: A comparative cross-sectional study design was used among 431 patients of Jimma medical center and Oda Hulle hospital from May 3 to July 3, 2021, using a systematic random sampling technique. The Newcastle scale of satisfaction was used to collect data, which was then entered into Epidata 4.6 and exported to SPSS version 26 for analysis. We used descriptive and logistic regression analysis.Results: Patient satisfaction at public and private hospitals was reported 54.2% (95% CI: 52.9– 59.3) and 57.1% (95% CI: 55.2– 61.7), respectively. In public hospital, the patient satisfaction was affected by being in the age group of 41– 50 years (P = 0.006, AOR = 3), duration of stay in the ward (P = 0.002, AOR = 0.42,), cleanliness of the ward (P = 0.018, AOR = 1.8,), and admission history (P = 0.049, AOR = 0.60,). In private hospital (Oda Hulle), the patient satisfaction was affected by history of admission (P = 0.035, OR = 0.456), ward space (p = 0.007, AOR = 2.8), the perceived capacity of nurses (P = 0.002, AOR = 5.8) to pharmacy services (P = 0.032, AOR = 2.3,).Conclusion: Relatively the patient satisfaction towards nursing care in public hospital was lower compared to the private hospital, though no statistical difference (p = 0.225) observed. Illness history, cleanliness of the ward, Nurses make adequate visits and get their support when needed, Adequacy of ward space, the perceived capacity of nurses, and Access to pharmacy services were positively associated with patient satisfaction.Keywords: nursing care, patients’ satisfaction, public–private, service quality

Marta Yemane Hadush,1 Dawit Seyoum Gebremariam,1 Selemawit Asfaw Beyene,2 Tedros Hailu Abay,1 Amanuel Hadgu Berhe,1 Yibrah Berhe Zelelew,1 Tirhas Asmelash,3 Fisseha Ashebir,3 Samson Yohannes Amare,4 Znabu Hadush,2 Araya Abrha Medhanyie2 1School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 3Tigray regional health bureau, Mekelle, Ethiopia; 4School of Computing, Mekelle University, Mekelle, EthiopiaCorrespondence: Marta Yemane Hadush, Email marsec112@yahoo.comBackground: Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC.Methods: This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software.Results: The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home.Conclusion: Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.Keywords: kangaroo mother care, KMC, implementation research, low birth weight, Ethiopia, newborn care, preterm birth, KMC implementation, enablers and barriers to KMC

This study identifies, analyses and describes the devices and functions of focus in information structuring in Hadiyya, a Highland East Cushitic language. Data, which were collected from native speakers, were dealt with based on the theory of Functional Grammar (Dik 1997). For focalization, the language uses morphological, lexical and syntactic means. The latter involves word-order change and cleft construction (including pseudo-cleft). Comparatively, the morphological mechanism is the most dynamic and frequent in use while the lexical means is limited both in the number of items employed and in frequency of occurrence.

Travelling compression regions (TCRs) are perturbations in the magnetotail lobe magnetic field caused by structures moving Earthward or tailward within the plasma sheet. Previous works have suggested that these structures are created by either time-dependant reconnection occurring at a single X-line, forming a flux-bulge-type structure, or space-variant reconnection at multiple X-lines, forming fluxrope- type structures. In this study we examine an event in which Cluster 2 observed a TCR while the 3 remaining Cluster spacecraft observed the underlying magnetic structure at a range of distances from the neutral sheet. The magnetic structure has a velocity of (99, 154, -31) km s-1 in GSM (∣V∣ = 186 km s-1), an estimated size of 1.19RE along the direction of travel and a size between 1.94 and 2.86RE in the direction perpendicular to the current sheet. As the structure passes the spacecraft, Cluster 1 and Cluster 4 observed a bipolar signature in BZ, plasma-sheet-like plasma and fieldaligned electron flows. Cluster 3 passed closest to the centre of the structure and observed two separate reductions in the plasma density (with field-aligned electron flows); these drop-outs in the plasma sheet were possibly created by the actions of X-lines. The second drop-out in the plasma sheet also includes a reversal of the ion flow, a signature consistent with the passage of a reconnecting X-line past the spacecraft. Between the X-lines, the plasma outflow from the X-lines caused an increase in pressure which led to a localised expansion of the plasma and also the observations at Cluster 1 and Cluster 4 and the TCR. Our observations do not uniquely match either of the flux rope or the flux bulge predictions although the observation of two plasma sheet drop-outs (interpreted as X-lines, one active, one dormant) with plasmasheet- like between them and only one TCR is a situation expected in multiple X-line reconnection. [ABSTRACT FROM AUTHOR]