#gjorm

Një ngjarje e rëndë ka tronditur mbrëmjen e së shtunës zonën e Selenicës. Dalan Alliaj, 36 vjeç, është viktima e atentatit me armë zjarri që ndodhi në fshatin Gjorm, ku i riu u gjet pa shenja jete nga familjarët e tij. Si ndodhi ngjarja Sipas të dhënave paraprake, Alliaj ishte banues në Fier dhe kishte shkuar në Gjorm për të vizituar kushëririn e tij, djalin e xhaxhait. Pak orë më pas, ai është…

Abstract

Endometrioma, when its size is ≥ 5 cm, can be complicated by a torsion of the ovary. In this case it is a diagnostic and therapeutic emergency with respect to the many complications of ovarian torsion including necrosis.

We report a case of endometrioma diagnosed by a torsion of the ovary. The context clinic was dominated by acute pelvic pain; the ultrasound showed a huge left cystic ovary, and the laparotomy revealed a torsion of the left adnexa. A detorsion and cystectomy was performed and the confirmation of the endometrioma was provided by the histology of the surgical specimen.

The difficulty lies in the diagnostic and therapeutic choice to preserve or not the ovary. The indications are therefore discussed on a case-by-case basis and depend on many parameters, the most important of which is the intraoperative viability of the ovary after its detorsion.

Conclusion

Adnexal torsion induced by endometrioma has rarely been reported. Due to associated pelvic adhesions. However, it constitutes the fifth gynecological emergency. It is important to be aware of the possibility of adnexal torsion in all patients of all ages presenting with acute pelvic pain, as it can have consequences for potential fertility if not treated promptly. The therapeutic choices are discussed on a case-by-case basis and depends on many parameters, the most important of which is the intraoperative viability of the ovary after its detorsion.

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Abstract

Reproduction, one of the most active and appealing area of research for endocrinologists and reproductive biologists since many a years, has several faces that remains to be unmasked in terms of its regulatory aspects. Available information on the regulation of oocyte development and maturational competence are gaping and needs elucidation to achieve utmost quality of eggs, a major area of concern. The notion of the somatic follicular cells providing an appropriate microenvironment for the development of oocyte throughout its journey has been replaced with the current perception of a complex yet regulated cross-talk between the granulosa-and oocyte-derived factors to orchestrate follicle development. Interestingly, actions of FSH and LH are mediated or modulated by these locally produced non-steroidal peptide factors from the follicular layer and the oocyte itself (insulin-like growth factors (IGFs), epidermal growth factor (EGF) family members, TGFβ super family members etc.), forming an intimate regulatory network within the ovarian follicles. Present article will provide a deeper insight into the need and underlying mechanisms of action of these growth factors in the intraovarian network to sustain a healthy oocyte.

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Authored by:  Zekarias Mengistu*

Introduction

The total cattle population for the rural sedentary areas of Ethiopia is estimated to be 43.12million, of which 55.41% are females. Out of the total female cattle population, only 151,344 (0.35%) and 19,263 (0.04%) heads are hybrid and exotic breeds, respectively. With an average lactation length of 6 months and an average daily milk production of 1.44 liters per cow, the total milk produced during the year 2006/07 was recorded to be 2.634 billion liters. This suggests that the total number of both exotic and hybrid female cattle produced through the crossbreeding work for many decades in the country is quite insignificant indicating unsuccessful crossbreeding work. This again suggests that Ethiopia needs to work hard on improving the work of productive and reproductive performance improvements of cattle through appropriate breeding and related activities [1].

In spite of the presence of large and diverse animal genetic resources, the productivity (i.e., meat and milk) of livestock remains low in many developing countries including Ethiopia for various reasons such as inadequate nutrition, poor genetic potential, inadequate animal health services, and other management related problems [2].Cattle breeding are mostly uncontrolled in Ethiopia making genetic improvement difficult and an appropriate bull selection criterion have not yet been established, applied and controlled [3].

Although, artificial insemination, the most commonly used and valuable biotechnology, [4]. has been in operation in Ethiopia for over 30 years, the efficiency and impact of the operation has not been well-documented [5]. Reproductive problems related to crossbreed dairy cows under farmers’ conditions are immense [6]. It is widely believed that the AI service in the country has not been successful to improve reproductive performance of dairy industry [7]. The problem is more aggravated by wrong selection and management of AI bulls along with poor motivations and skills of inseminators [8].

A successful breeding program requires an effective and sustainable method of transferring genetic materials from one population to another. This can be performed through either natural service (NS) or reproductive technologies including artificial insemination (AI), embryo transfer, invitro maturation and fertilization and cloning. However, AI is the most practical reproductive technology to be used in developing countries [1]. Therefore, the objective of this paper is to review the available literatures and provide integrated information on history of AI, advantages and disadvantages of AI, recruitment of semen producing bulls, Semen collection and assessment of ejaculates, and application of AI of cattle

Artificial Insemination of Cattle in Ethiopia

Cattle production in Ethiopia

Ethiopia has an estimated cattle population of about 41.5 million heads. Around 99.45 are indigenous breeds with very few hybrids, 0.5%, and exotic 0.1%. Cattle production together with the production of other livestock sectors has been known to be an important component of the agricultural sector. Livestock contributes much by providing meat, milk, cheese, butter, export commodities (live animals, hides and skins), draught power, manure, near-cash capital stock [9]. It is known that not enough selection and improvement for productivity has been performed on the indigenous cattle. Nevertheless, the indigenous cattle are known to have special merit of coping with the harsh environments of the country. On the other hand, the high performing exotic cattle cannot cope with the harsh environments of the country. Therefore, improvement on the indigenous cattle for productivity without losing traits, which are essential for survival, has been proposed [10].

Artificial insemination

Artificial insemination (AI) has been defined as a process by which sperm is collected from the male, processed, stored, and artificially introduced into the female reproductive tract for the purpose of conception [4]. Semen is collected from the bull, deep-frozen and stored in a container with Liquid Nitrogen at a temperature of minus 196 degrees Centigrade and made for use. Artificial insemination has become one of the most important techniques ever devised for the genetic improvement of farm animals. It has been widely used for breeding dairy cattle as the most valuable management practice available to the cattle producer and has made bulls of high genetic merit available to all [11].

In livestock rearing, the producer makes efficient use of the generous supply of sperm available from an individual male in a manner that greatly increases genetic progress, as well as improving reproductive efficiency in many situations. Today, many bulls have been reported to produce sufficient semen to provide enough sperm for 40,000 breeding units in one year. Using the long-accepted standard of 10 x 106 motile sperm at the time of insemination with an average initial motility of 60% and a 33.3% loss of sperm during freezing and thawing, the number of breeding units would entail 1 x 1012 total sperm.

By using sexual stimulation and more frequent collections, many sperm have been obtained from most bulls in a year without adversely affecting conception rate [11]. The use of AI in Ethiopia is growing but estrus detection is difficult owing to poorly expressed estrus of Zebu breeds. The short duration and low intensity of estrus signs in Ethiopian Zebu cattle caused most estrus detection failures which indicate a need for the use of current advances in AI such as estrus synchronization [12].

History of Artificial Insemination: The first successful AI was performed in Italy in 1780 and over 100 years later, in 1890, it was used for horse breeding [13]. In Russia, however, the method was first taken up seriously as a means of improving farm animals [14]. According to the history of AI is interesting in that old Arabian documents dated around 1322 A.D [4]. indicate that an Arab chieftain wanted to mate his prize mare to an outstanding stallion owned by an enemy. He introduced a wand of cotton into the mare’s reproductive tract, and then used it to sexually excite the stallion causing him to ejaculate.

The semen was introduced into the mare resulting in conception. Spallanzani has been recognized as the inventor of AI. His scientific reports of 1780 have indicated successful use of AI in dogs. In 1899, Ivanoff of Russia pioneered AI research in horses, cattle and sheep, and was apparently the first to successfully inseminate cattle artificially. Mass breeding of cows via AI was first accomplished in Russia where 19,800 cows were bred in 1931 [2]. Denmark was the first European country to establish an AI cooperative association in of New Jersey visited the AI facilities in Denmark and established the first United States AI cooperative in 1938 at the New Jersey State College of Agriculture.

The first artificial vagina (AV) was reportedly devised by G. Amantea, which was used to collect semen from the dog [15]. In the years that followed, numerous Russian researchers developed artificial vagina for the bull, stallion, and ram. The method of semen collection using artificial vagina has been reported to be closest to the natural conditions and is assumed to yield the most normal ejaculate of all methods used. An attempt has been made to simulate the normal or best temperature, pressure, lubrication, and position to obtain the optimum response of the male. The AV consists of an outer rigid or semi rigid support with an inner jacket containing controlled-temperature water and pressure and collecting funnel and container.

In Ethiopia, AI was introduced in 1938 in Asmara, then part of Ethiopia, which was interrupted due to the Second World War and restarted in 1952 [16]. It was again discontinued due to unaffordable expenses of importing semen, liquid nitrogen and other related inputs requirement. In 1967, an independent service was started in Arsi Region, Chilalo Awraja under the Swedish International Development Agency (SIDA). [17]. has described that the technology of AI for cattle has been introduced at the farm level in the country over 35 years ago as a tool for genetic improvement. The efficiency of the service in the country, however, has remained at a very low level due to infrastructure, managerial, and financial constraints and also due to poor heat detection, improper timing of insemination and embryonic death.

In Ethiopia, there is often complaint of the AI service, by service users for imbalance female and male ratios of calves born in which the latter exceeds in percentage, which is against the interests of most of the beneficiaries. Breeding using AI or natural mating affected male: female calf ratio, which gives sense and can be applicable if the system works. However, the reason why natural mating gave more female progenies than males for cows mating to AI is not clearly known.

Advantages and disadvantages of artificial insemination: The worldwide scale and importance of the artificial insemination industry in cattle breeding are beyond question [18]. Maximum use of superior sires has been considered as the greatest advantage of AI while natural service has been linked to limit the use of one bull, probably, to less than 100 mating per year [4]. The author further showed that AI usage enabled one dairy sire to provide semen for more than 60,000 services in one year has listed many advantages of AI including prevention of reproductive diseases, control of inbreeding, minimizing the cost of keeping bulls for natural service and others [19]. Besides, the availability of accurate breeding records such as breeding dates, pregnancy rates, inter-estrus intervals, and days to first service used to monitor fertility are other advantages of AI [7].

Artificial insemination, however, has disadvantages that include poor conception rates due to poor heat detection and inefficiency of AI technicians, dissemination of reproductive diseases and poor fertility rates if AI centers are not equipped with appropriate inputs & are not well managed. Other disadvantages include high cost of production (collection and processing), storage and transport of semen as well as budget and administrative problems and inefficiency of AITs

Recruitment of semen producing bulls

The selection criteria of bulls for AI service must include record-based pedigree information, individual performance as regularly recorded starting from the time of birth, which should include birth weight, subsequent weight increments. Later on, and general health status should also be parts of the selection criteria [20]. Recruitment of bull Calves for the purpose of semen production must be free from a known contagious disease. Bulls selected for AI have been shown to transmit to their offspring the genetic potential for well-above-average milk or meat production. In addition, the progeny must be of desirable conformation, be long wearing, have quiet disposition, and be free of genetic defects. Genetic improvement of cattle using AI calls for a continual replacement of the lower-production-transmitting bulls by younger, proven bulls with superior genetic merit [21].

Bull health control: Disease prevention in bulls has been considered as essential as in breeding females and new bulls need to be screened by a qualified veterinarian for infectious agents prior to entering a new herd. Bulls have been recommended to be purchased only from reputable seed stock producers with adequate herd health plans; including vaccination against infectious diseases, e.g. leptospirosis and campylobacteriosis. Bulls are also recommended to be tested annually for brucellosis, but not be vaccinated for brucellosis. In some instances, bulls need to be vaccinated for bovine viral diarrhea (BVD), infectious bovine rhinotracheitis (IBR), and trichomoniasis [22]. Unless it is made possible to make full control of the health of bulls selected for semen production, the disadvantages of artificial insemination in disseminating diseases will be much higher [20].

The frequency of tests made, and the diseases tested at NAIC are not sufficient [23]. According to the international animal health code (2001) of the Office International des Epizooties (OIE)), donor and teaser animals should be tested for the following specific diseases: Bovine Brucellosis, Bovine Tuberculosis, Bovine Viral Diarrhea, Infectious Bovine Rhinotracheitis, Campylobacter fetus/subspecies veneralis, Trichomonas fetus. Nevertheless, semen-producing bulls at NAIC are tested only for brucellosis and tuberculosis and yet not on regular basis due to many associated constraints [23].

Semen collection and assessment of ejaculates

Semen collection has been considered like harvesting any other farm crop since effective harvest of semen involves obtaining the maximum number of sperms of highest possible quality in each ejaculate to make maximum use of sires. This involves proper semen collection procedures used on males that are sexually stimulated and prepared. The initial quality of semen has been determined by the male and cannot be improved even with superior handling and processing methods. However, semen quality can be lowered by improper collection and the processing techniques [11]. Realization of the maximum benefits of AI depends upon the collection of maximal numbers of viable sperm cells at frequent intervals from genetically superior males. The success of AI depends on the collection of a relatively large numbers of potentially fertile spermatozoa from genetically superior sires [24].

Facilities needed for semen collection: The routine collection of semen for AI in dairy and beef bulls is by using artificial vagina. Several essential features have been considered in designing facilities for collecting semen, of which the safety of the handler and the collector have been found to be the most important in bulls in dairy farm. Safety fences usually constructed of 7.6 cm. steel pipe with spaces large enough for a person to step through at 2.44 meters intervals should be provided. The collection area must provide good footing to prevent slipping and injury to the male being collected. An earthen floor in the immediate collection area best provides this. Means to restrain the teaser animals to minimize lateral as well as forward movement must be provided. At the same time, easy access for semen collection must be maintained [11].

Appropriate and specialized facilities, equipment’s, and procedures have been used during collection of semen to prevent injury to the bulls and their handlers, to maximize the physiological responsiveness of the bulls in producing semen and to enhance the quantity and the quality of the semen that can be collected. The area for semen collection has been preferred clean, relatively quiet free of distractions and any other stressful procedures. There has been a report of increase in spermatozoa motility by 50% through proper sexual stimulation of the bulls [24].

Procedure for collection of semen from the bull: Standard semen collection procedures normally include sexual stimulation and sexual preparation [21].

a) Sexual stimulation: Providing a stimulus situation that elicits mounting behavior in the bull is termed “Sexual Stimulation” .The stimulation process has been best practiced by exposing the bull to a mount animal in a collection environment and allowing to move briefly around female/ teaser for a couple of minutes [21].

b) Sexual preparation: This has been found to determine the intentional prolongation of sexual stimulation. It is achieved through a series of false mounts (allowing the bull to mount but not ejaculate) and restraint and ultimately results in an increase in the quantity and quality of sperm ejaculated. In dairy bulls, one false mount plus two minutes of restraint plus two additional false mounts before each ejaculation will help obtain the maximum amount of good quality semen [25].

c) Methods of semen collection: Semen has been collected in a number of ways, and the methods of collection are governed by the intended purpose for future use. A sample for evaluation may need to be only a very small volume and not as clean a sample as one for use in artificial insemination. The following various methods have been used in collection of semen [26].

Recovery: Follows normal copulation and can be applied in different ways. A pipette such as an inseminating catheter with an attached suction bulb may be inserted into the vagina following ejaculation and the semen is, then, siphoned into it. This semen is contaminated with the fluids of the female tract but is satisfactory for evaluation. It may also be used for artificial insemination when trying to overcome some obstruction in the cervix or satisfy breeding restrictions of some pure-bred societies. This method can be applied using different mechanisms and includes spooning, using a sponge, using a cup, and blotting [26].

a) Massage: Semen has been collected from the bull, in most instances, by massage. The bull is restrained, and the gloved arm and hand are lubricated before inserting through the anus into the rectum. The area of the ampulae, vesicular glands, and prostate is located under the rectum. The fingertips then are used to exert a downward pressure milking this area caudally. This stimulates and mechanically causes the sperm to be passed through the urethra by gravity to drip from the prepuce [26].

b) Vaginal insert: Consists of a tapered insert with a flange on the end that may be placed in the vagina prior to copulation [11].

c) The electro ejaculation method of semen collection: Has been derived from observations of persons being electrocuted that ejaculated in response to the electrical stimulus. The semen collected by electro ejaculation is equal in quality to that collected by the artificial vagina, and processing, storage, and later use are comparable. The method of electro ejaculation for semen collection is preferred to the artificial vagina method under certain conditions. It has been used for dairy bulls that have become crippled, have low sexual activity due to age, or for other reasons are unable to serve the artificial vagina. However, semen should not be collected and used from males that have not demonstrated normal sexual behavior or ability to ejaculate, as the cause may be genetic and transmitted to the offspring [11].

Assessment of ejaculate: Monitoring of qualitative semen characteristics has been indicated to be an important function of the AI Laboratory. Seasonal and even daily fluctuations in a bull’s seminal characteristics are possible. Therefore, to maintain a quality AI program constant vigilance is required. An integral part of this monitoring is an accurate system for keeping records of the bull’s seminal quality. Such records document the bull’s history of seminal quality and provide information on which to base production related decisions [25].

a) Physical appearance: The gross appearance of freshly collected bull semen has been described usually to be the first measure of quality made by the semen laboratory. Neat (unaltered) semen normally appears as a thick whitish to slightly yellowish fluid whose consistency is mainly determined by the number of spermatozoa it contains. Normal bull semen has very little odor [25]. The microscopic appearance of bull’s semen varies between ejaculates, individual bulls, breed, and age. Normal bull semen is generally white or yellowish creamy in color

b) Volume: The volume of the ejaculate is readily measured by collecting the sample directly into a graduated vial [24]. Alternatively, it can be done by weighing the tubes after semen collection on top-loading balance, and later converting the reading into milliliter by using a computer program. The latter has been known to reduce error associated with visual reading of the tube specially when small volume or bubbles are found by 10% [27]. The volume has been reported to decline when young bulls are used or when there is frequent ejaculation or incomplete or failure of ejaculation and in bilateral seminal vesiculities [28].

Furthermore, those authors have described in summary that a number of factors like season of the year, method of collection, and the sexual preparation of the bull have been known to affect semen volume. The volume of bull’s semen varies between ejaculates, individual bulls, breed, and age. However, a bull with less than 2ml of semen per ejaculate is not acceptable [29]. Semen volume for Bostaurus bulls in Brazil was reported to be 6.9ml and 8.2ml in different years [30]. Crossbred bulls had higher values of semen volume while Friesian bulls had better values in the rest of the parameters and age had significant effect only on semen volume [7]. Differences between reports on semen volume could be attributed to differences in age, breed, nutritional status, geographic locations and seasons of year of study, method of semen collection and handling of bulls during collection, procedure and frequency of collection [31].

c) Spermatozoa motility: Motility of spermatozoa has been defined as the percentage of sperm cells that are motile under their own power and progressive motility of spermatozoa has been defined as those spermatozoa that are moving or progressing from one point to another in a more or less straight line [27].Spermatozoa are driven by a propulsive apparatus, the flagellum, which is equipped with contractile proteins strategically arranged in longitudinal organelles, the coarse fibers, and with associated sub filaments, and micro tubes, which provide the propulsive force necessary to overcome internal structural resistance and external viscous drag of extra cellular fluids [28].

Motility of spermatozoa at time of collection has been used commonly as a measure of the fertilizing ability of the sperm [26].However, spermatozoa have been found to lose their fertilizing capacity before they lose motility, which puts motility estimation to be not necessary indicative of fertilizing capacity of the sperm [28]. In general, however, a definite correlation has been found between concentration, morphology, and motility of spermatozoa and the proportion of the total number of actively motile normal spermatozoa in the ejaculate has been found to show levels of fertility of the bull [26].

The individual sperm motility is evaluated by taking small drops of semen onto a slide with cover slip under high magnification (200X). Sperm cells moving in a straight-line forward direction are considered in the motility measure. In order to be acceptable bull semen should have at least 70% and 40% motility respectively at the time of collection and after freezing [29].

d) Live-dead sperm evaluation (vital staining): The percentage of live sperm has been determined by means of a differential vital stain. The measure of the live-dead sperm ratio may be useful in conjunction with the motility examination for a more complete analysis. A certain percentage of dead sperm may not be apparent in initial microscopic motility examinations, since these inactive sperm might be moved about merely by action of the live motile sperm. In addition, a proportion of sperm estimated to be motile may be weak and show only slow oscillatory movements. Differential live-dead staining may help reveal these differences, thus supplementing initial motility estimations and providing more conclusive results [21].

e) Sperm morphology: The normal morphology of spermatozoa is composed of a head and a tail that is divided into a mid-piece, main-piece, and end-piece [11].Films for microscopic examination under the oil immersion lens are made immediately after the motility estimation, but the examination can be made, subsequently, in the laboratory [32]. To obviate temperature shock and the assumption of spurious morphological defects, a drop of semen is mixed with two drops of Indian ink previously raised to body temperature on a warm slide. The drops are mixed and spread like a blood film. Between 200 and 300 sperms are examined and classified according to their shape and appearance. Fertile bulls show about 90 percent of the morphologically normal sperms.

The following morphological abnormalities can be investigated. These include: tailless sperms and sperms with looped tail, the commonest sperm abnormalities which are detachment of the sperm head and bending of the middle piece and tail around and over the sperm head (looped tails), sperms with coiled tails (this abnormality is of two types: the coil involves the extremity of the tail, or the coil, which includes the whole of the tail & sometimes the middle piece) immature or unripe sperms (these are characterized by the presence of a droplet of protoplasm at the junction of the sperm head with the middle piece at the so-called neck), abnormalities of the sperm head and cytogenic disturbances, and other defective sperms [11].

f) Overall assessments: Evaluations routinely conducted by the AI laboratory that have been used to determine whether the semen that is collected and processed for use could be used for practical purpose are screening tests for quality and number of spermatozoa in order to eliminate any substandard ejaculates. This initial screening also avoids wasting expensive supplies, antibiotics, semen extenders, etc., because substandard samples are not processed [21].

Semen that passes initial screening have been further extended, cooled, packaged into straws, and frozen. After freezing, a representative sample is normally thawed and evaluated using various laboratory tests. These post-thaw evaluations not only reflect the ability of the semen to withstand the processing conditions (process quality control) but also can give some indication of the potential fertility of the semen (fertility prediction). Assessing the progressive motility of the semen sample is probably the most common evaluation made for post-thaw viability [21].

Application of artificial insemination

Estrus and estrus detection: Estrus has been defined as a period when the female shows characteristic sexual behavior in the presence of a mature male, such as immobility, raising the hind quarters or arching the back, pricking of the ears-features that are collectively termed lordosis in small laboratory animals; mounting and riding behavior between females is also common (Where AI or hand mating is being used, estrus detection is the most important limiting factor [19]. Insufficient and/or inaccurate estrus detection leads to delayed insemination. Since the fertile life of eggs in most species is relatively short and sperm may require capacitation before they are capable of fertilizing ova, insemination should precede ovulation. Ovulation is difficult to determine routinely, so inseminations are usually related to the time of onset of estrus. Estrus in the cow is characterized by the psychic manifestation of heat. The cow may bawl frequently, is usually restless, may attempt to mount other animals, and will stand to be mounted/standing heat [21].

Timing of insemination: In the cow, maximum fertility has been achieved if inseminated from mid estrus to the end of estrus. Fertilization of the ovum has been reported to occur in the oviduct at the junction of the isthmus and ampulla. The life span of the ovum is around 12 – 18 hours and its viability decrease with time. About 8 hours after service sufficient spermatozoa have reached the isthmus of the oviduct. For fertilization to take place, capacitation of the spermatozoa is required. Capacitated sperm cells show a hyper motility and have undergone the acrosome reaction. The life span of spermatozoa is limited. If insemination takes place too early, the sperm cells will die before fertilization of the ovum can occur. Conversely, when insemination is over delayed, the ovum has lost its capacity to be fertilized [33].

Factors affecting success of artificial insemination: The site of semen deposition has been an important factor in the success of AI in cattle. In addition, the deposition of semen in the uterine body resulted in a 10% higher non-return rate than did cervical deposition. An increase in the conception rate has been reported when semen was deposited in the uterine horns rather than the uterine body [34]. In contrast, no difference was found in the fertilization rate, conception rate or non-return in uterine body and uterine horn inseminations [35].

The major factors that determine AI efficiency are heat detection skills, fertility level of the herd, semen quality, and efficiency of inseminators. Similarly, a successful insemination requires the acquisition of quality semen from a bull, the detection of estrus in the female, and the ability to properly place the semen in the reproductive tract of the female [36]. Detection of estrus has been known to be one of the most difficult tasks for successful AI activities, which in turn is affected by diseases of testis, epididymis, and accessory glands in the male [37]. and diseases of the female reproductive tract [26].

The success of AI depends upon various factors such as the efficiency, capacity and commitment of AI centers in procedurally and ethically producing, processing, handling and distributing semen; the commitments and efficiencies of AITs; presence of appropriate breeding policy along with proper control of indiscriminate crossbreeding; proper heat detections by farmers and other factors [19].

Artificial insemination and fertility rates: Fertility is measured by calving rate to first service for artificially inseminated dairy cattle [38]. Conception rate at first breeding provides a useful estimate of the conception rate for a herd. However, it is a measurement that combines the effects of semen quality, fertility of the cow, timing of insemination, semen handling and insemination techniques, as well as factors such as high environmental temperature and stress [39].

In USA, conception rate of virgin heifers has been found relatively constant at approximately 65% to first service conception; whereas the first service conception rates for lactating cows has decreased approximately 33% from 60 to 40 % [40]. Number of services per conception as an indicator of reproductive efficiency has been defined as the number of services required for a successful conception [41, 42]. The number of services per conception is directly related to the conception rate in the herd. Female fertility, male fertility, environmental factors, and techniques used in AI are the four general multitude factors that determine the ultimate outcome of conception per insemination.

Female fertility refers to any factor directly related to the heifer/cow that may alter her probability of becoming pregnant, including condition of the reproductive tract, nutritional status, changes in body condition from calving to insemination, age, and breed. The mean first service conception rate for Virginia Dairy Herd Institute herds over the past 12 months in USA has been found 40 ± 13% [40]. There is a great reduction in fertility during the summer for lactating cows than for non-lactating heifers. High milk yield intensifies the effects of heat stress on conception and is related to increased metabolic rates and reduced thermoregulatory ability for cows with high milk yield.

Techniques used in AI include accuracy of heat detection, timing of insemination, semen handling, and placement in the reproductive tract. Fertility in cattle is affected by environmental, genetic, disease, and management factors. These influence the reproductive process at ovulation, fertilization, or implantation during gestation and parturition [12].

In Ethiopia, several factors have been reported to influence the number of services per conception. Breeding taking place during the dry season required more services per conception than the short and long rainy seasons [41]. Management factors such as accuracy of estrus detection, timing of insemination, insemination technique, semen quality, skill of pregnancy diagnosis have been reported to affect number of services per conception [42]. Higher number of services per conception might also result from repeat breeding due to infectious and/or noninfectious diseases [43]. In postpartum cows, the mean number of services per conception as 2.4 and 2.7 for sub clinical endometritis positive cows, fourth and eighth weeks postpartum, respectively as compared to 1.7 for sub clinical endometritis negative cows showing that sub clinical endometritis has a significant effect on number of services per conception [44].

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Conclusion and Recommendations

AI service in Ethiopia has been given little or no emphasis at the federal, regional or wereda levels during the last years though it is an important and the most widely practiced animal biotechnology all over the world. Hence, it can generally be concluded that the AI service in Ethiopia is on the verge of total collapse unless urgent corrective measures are taken. The most important constraints associated with AI in Ethiopia include loss of structural linkage between AI Center and service giving units, absence of collaboration and regular communication between NAIC and stakeholders, lack of breeding policy and herd recording system, inadequate resource in terms of inputs and facilities, Based on the above conclusions the following points are recommended:

1. Selection of bulls for AI should strictly follow the standard guidelines and procedures set for the purpose and also the national livestock development policies of the country

2. Establishment of a functional breeding policy and strategy should be given at most priority and each stakeholder and professional should work hard towards its implementation;

3. Import semen of the desired quality for the immediate use in accordance with the rules and regulations for the import of genetic materials to be followed by creating reliable source of semen producing bulls through reestablishing the Milk recording Scheme of the center in a more strengthened status;

4. The AI service provision should be restructured in such a way that it responds well to the breed improvement programs of the country. It should be well organized with clearly defined duties and responsibilities of stakeholders.

To Know More About Please Click on: Journal of Reproductive Medicine

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Authored by: Achamyelesh Gebretsadik*

Background

Adolescents and youth comprise one-third of the world’s population [1], whom 90% live in developing countries [1]. Overall the proportion of adolescent and youth expected to rise from 20% to 50% within the coming thirty years [2]. Ethiopia is a young country with 71 % of the populations are under the age of thirty and 10-24 years were 33.8 % [3,4]. Investing in young people (ages 10 to 29) now will lay the groundwork for future. Adolescent and youth is a critical age for risk taking and critical period for professional intervention [5,6]. Intervention in this time help adolescent and youth to make appropriate decision for the future live and can prevent risk behaviors which can also affect their adulthood health. Adolescent and youth need different approach than adult in service provision. Currently adolescent and youth are not getting the expected services worldwide [6,7].

Mortality rate of adolescent and youth are rising due to several health problems. Especially road traffic accident is the first contributor for mortality. Non communicable diseases and mental illness also another contributor for morbidity and mortality of adolescent and youth [7]. Globally a number of initiatives have been taken place over the last decades to provide adolescent and youth responsive health care [8,9]. However, most of the initiatives were focusing only on sexual and reproductive health issues [10-12].

Similarly, in Ethiopia though it was not in an integrated and comprehensive manner there were a lot of straggles to address adolescent and youth health since 2000 [13-16]. However, with all the efforts made the intended improvement not achieved in the health of adolescents and youth due to health system was not responsive and young people not utilized the service. Therefore, federal ministry of health revised the previous strategy and launched a new strategy that comprise comprehensive adolescent and youth health care and to make the health system responsive for that comprehensive approach [17]. Therefore, the aim of this study was to assess facility readiness for the implementation of comprehensive adolescent and youth health care.

Methods

Study settings

The Southern Nations Nationalities and Peoples’ Regional State is the third largest administrative region of Ethiopia and represents about 20% of the country’s population with close to 20 million people. The central zones of Wolita and Hadiya zones and Halaba special district contributes more than 20% of the regions population. Wolaita zone has five hospitals, 69 health centers, 372 health posts and 98 private clinics. Hadiya zone has one general hospital, 4 primary hospitals 61 health centers and 305 health posts. In Halaba there are 7 health centers and 50 health posts.

Study area and period: This readiness assessment was conducted in 14 health centers of the central zones of Southern Nation Nationalities People Region health facilities from May 14- 26, 2017.

Study design: A cross-sectional study was conducted in two central zones namely Wolaita and Hadiya and one special district (Halaba).

Sampling criteria: The zones and special district were selected purposively. Since these two zones and districts have high population density and their proximity to the head quarter of the region might be a true representative of the general health facility of the region. From Wolaita zone, six health centers were selected from five districts (namely, Offa, Damot Pulasa, Damot Gale, Bodity and Sodo). And from Hadiya zone, three districts and six health facilities and from Halaba special district one from started and one from not started were selected based on their youth friendly service delivery status among started and non-started 1:1 ratio. The health centers were selected using lottery methods (Table 1).

Study population: Health care providers (nurse and health officers), health center managers and district health office heads of the selected health facility.

Data collection and sources: Data were collected from 7-19 May 2017. Five reproductive health professional data collectors/ technical assistant were hired and trained to collect the data. Data were collected through interview and observation using questionnaires and observation check list prepared to assess national adolescent and youth health service quality by Federal Ministry of Health (FMOH). Interview were done among health providers (nurse and health officers) those working in youth friendly service room from started health centers and maternal and child health nurses from non-started health centers and health center managers and district health office heads. The collected data were entered in to Microsoft Excel 2010 software and descriptive analysis was made using percentage.

Classification criteria: Readiness of the facility was assessed based on the standard set by World Health Organization for adolescent and youth health [18]. When the facilities fulfilled>=75% of the standards we considered ready for that element i.e. staff, basic amenities etc. Support letter was also taken from RHB maternal and child health and nutrition core process office to the two zones and Halaba special district and district health office heads also communicated officially to get consent from each health centers.

Result

Staffing

During the survey, 14 health facilities, their managers, one health care provider from each and 5 district health office heads were interviewed. Of all 6 (42.8%) of health facilities have at least five health officers, 9 (64.2%) have more than ten diploma nurses, 7 (50%) have diploma midwifery at least four and 6 (42.8%) have no bachelor nurse and midwifery (Table 1). Staff numbers and their orientation to the right and confidential delivery of service is important for provision of quality adolescent and youth friendly services. In this survey 12 (86%) of the health facility managers have no training for quality improvement in adolescent and youth health care and supportive supervision. All youth friendly service started health facilities have 2-3 trained health persons. Among non YFS started health facilities only one had training. During the survey time except one health center with YFS, they were closed due to community mobilization for community based health insurance, while other units are operating their routine activities. In all YFS available health centers service for adolescent and youth were in working hours.

Basic amenities

All started health centers have clearly visible signboard that mentions operating hours of the facility. Among all 13(92.8%) have functional toilet but, only 1/14(7.1%) have functioning hand washing facilities after toilet, 3/14(21.4%) of toilets were clean, 4/14(28.5%) had disposal bin in the toilet. About 11/14(80%) of health facilities do not have adequate and comfortable seating in their waiting area. Almost all health facilities are clean and well coming however; only 2/7(28.5%) health facilities have a clean and well coming separate waiting room and 5/7(75%) were working in a room where windows and doors have no curtains. 3/7(42.8%) have no screen to separate consultation area from the examination to maintain privacy during consultation. There is pipe water in the entire health centers compound but no drinking water facilities in waiting area. Nine out of fourteen (64.2%) has permanent electric supply during working hours. All the facilities have general waste disposal system in the health center. Communication equipment (phone or shortwave radio) found in 5/14 (35.7% %) of the health facilities.

Adequacy of furniture

Seven out of fourteen (50 %) of the health centers have adequate, whereas 5/14 (36%) need repair of their furniture and 2/14 (14 %) of the health facilities do not have furniture while having separate room prepared for YSFs (Figure 1). Computer is available in7/14 (50%) of health facilities and no internet access was observed in all health facilities.

Equipment supply

Equipment/material/supplies are available in all health facilities: Blood pressure measurement machine, binaural adult stethoscope, monaural fetal stethoscope, clinical thermometer, an adult weighing scales, latex gloves, single-use standard disposable or auto-disposable syringes, pregnancy test strips and haemoglobinometer. Materials inadequately supplied /found in surveyed health facilities: Measuring tape, Light source, for example a torch, height meter, soap or alcohol-based hand rubs for hand hygiene body mass index growth charts for adolescents, test strips for urine with 10 parameters, ophthalmoscope set and otoscope set were not found in any of the health centers.

Essential medicine supplies

Condoms, oral contraceptive pills, emergency contraceptive pills, injectable contraceptives, contraceptive implants, intravenous fluids, paracetamol, amoxicillin, Ceftriaxone, ciprofloxacin, cotrimoxazole suspension, diclofenac, omeprazole, diazepam and vaccines found in all health centers uniformly. Only 8/14 (59%) of health centers have magnesium sulfate. Atenolol, Salbutamol, Glibenclamide not available in all health centers, which are important for the treatment of diabetes mellitus, hypertension and asthma respectively.

Infection prevention

All health facilities have sharps/box/container and a general waste disposal incinerator in the compound. Nine out of fourteen (64.3%) have safe storage and disposal of clinical waste and potentially infectious waste that requires special disposal i.e. disposal of equipment that may have in contact with body fluids and safe storage and disposal of sharps. However, 5 (35.7%) have adequate hand hygiene facilities that are located in or adjacent to the office/examination room.

Adolescent participation

In health facilities where services are started 4/7 (57%) health care providers involved the adolescents in the planning, monitoring, evaluation and in any aspects of health service provision for adolescents. But the vulnerable groups of adolescents are not participating.

Overall facilities readiness

All health facilities were fulfilled criterion for the essential medical supply,11 for laboratory services ,9 for infection prevention ,5 for basic equipment’s and 6 for basic amenities (Table 2).

Discussion

Readiness assessment survey was conducted for the implementation of the national adolescent and youth friendly health care strategies in SNNPR. Out of nine standards, four of them were seen in this survey, which are important for the readiness assessment, this includes: facility characteristics, data and quality improvement, adolescents’ participation and intersect oral collaboration. This study showed majorities (86%) of manager lack to get training of adolescent and youth friendly services (AYFS). According to current Ethiopia AYHS, advocate for district managers to guarantee their ownership and support for implementation the designed strategy [17]. The health workers in YFS not started health facilities were deficient in training which is one of the tools for readiness assessment. This finding is in line with study in Uganda in which all staff including the managers lack training. For the implementation of comprehensive AYH all type of health worker received the basic knowledge and skill in preservice training, but at least one person needs to have a training on AYH and can provide orientation for others to overcome the staff shortage and turnover.

Facility characteristics: this is the third standard as this is a readiness assessment study it focusses on the input aspect of the standard: among the elements of the standard availability of essential medicines were acceptable >= 75% in all surveyed facilities. This finding is in line with study conducted in Sudan [19], and higher than Northern Rwanda in which up to 73% of health facilities faced a challenge of medium to high levels of stock outs and slightly higher than study done in South west Ethiopia, which one third of the health facilities are below the standard [20,21]. This variation may be explained that the drugs were used to assess the readiness in this study may varies in types.

To provide quality and standard health care it is important to fulfill the necessary equipment and availability of basic equipment. Only 35.7% fulfilled the standard equipment needed for AYHS. Among the listed infection prevention precautions 64.9% and 78.5% of HFs fulfilled laboratory service required for AYFHS respectively [22]. This also in line with study done in 10 developing countries [23]. One of the significances of health information management system is to make evidence-based decision at all level. We could not find age and sex disaggregated data in all non-started health facilities. This might be due to the national HMIS format not captured age and sex of adolescent and youth. In the revised HIMS format the above problem might be solved. Adolescent participation in planning, monitoring and evaluation of health services and in decisions regarding their own care, as well as in certain appropriate aspects of service provision is considered as very crucial according to the current AYHS [17]. However, in this study only 4/7 health facilities delivering youth friendly service were participated adolescent and youth in planning, monitoring, evaluation and in any aspects of health services provision. This is low according to the standard and study done in Uganda. Possible explanation for this low result may be currently the program was not running very well [22,24].

On the other hand, they were not participated in decision making none of them are member of facility governing board. Possible explanation for this might be the program is not implemented properly as the standard. This may be improved when the program is implemented throughout the health facilities in the region. In assigning health workers less priority was given for AYH rooms. In addition, the working hours were not convenient for adolescents most adolescents prefer out of working hours for YFS.

Conclusion

With available resources it is possible to implement AYHS in central zones of SNNPR. Lack of training for facility managers and health care providers, Essential medicines supply were in satisfactory manner. There were shortages of essential equipment, no intersectoral collaboration and also non-governmental partners working to support this program. Less attention was given for noncommunicable disease for adolescent and youth. Job description for each profession were not including about adolescent and youth health. Therefore, training of trainers at zone level, training of managers, providers at zone and district level is very important. Health facilities should include adolescents in facility governing board. Facility-level registers and health management information systems (HMIS) need to include client information about age, sex, presenting problem, diagnosis and services provided for adolescent and youth. Communication and collaboration with the community, different governmental and non-governmental organizations are very mandatory.

Declarations

Funding

The study not supported by any funding organization.

Availability of data and materials

The datasets generated and/or analyzed during the current study available from the corresponding author on reasonable request.

Authors’ contributions

AG: Supervised the data collection, coded the data, carried out the analysis, and wrote the of the article. NM &YS: Contributed design of the study and analysis, comments throughout the entire process. All authors approved the final version of the manuscript prior to submission

Ethics approval and consent to participate

The study was approved by the Southern Nation Nationalities People Regional health bureau Ethics Committee, and verbal consent was also taken from each respondent for participation.

Disclosure of interests

I declare that we have no competing interests.

Acknowledgements

Authored by:  Legesse Tadesse*

Background

Post-natal care refers to the assistance given to the mother and the baby for a period of six weeks from the time of delivery. Maternal and child health are the major concern of public health organization and researchers throughout the world. Health education for mother is strategy many countries have adopted to improve maternal and child health. Yearly over half a million women encounter complication due to child birth and many die [1].

Post-natal services are the primary comprised of physiotherapy, physical examination, immunization, health education and family planning service [2]. Lack of care in this time period may result in death or disability as well as missed opportunities to promote healthy behavior, affecting woman, newborn and children. Post-natal care is regarded as one of the most important maternal health care services for the prevention of impairment and disability resulting from child birth [3].

Different studies in developed countries showed the factor which affects utilization of post-natal care are distance from health service, cost including direct fees and cost of transportation, drug and supplies; multiple demands on women’s time; women lack of power on decision making within the family; and poor quality of services including poor handling by health providers [4]. Half of all post-natal maternal death in Bangladesh occur during the first week after the baby is born, and the majority of these occurrences during the first 24 hours after child birth [5].

In a very poor countries and regions, such as those in sub- Saharan Africa only 5% of women receive post-natal care. In Ethiopia, factors associated to utilization of PNC service have been the major cause of maternal and infant death for majority of people, especially for those having low income. Therefore, it is important to assess the factor that cause underutilization of postnatal care service [6].

Statement of the problem

Approximately 80% of maternal death globally occur due to hemorrhage, sepsis, unsafe induced abortion, hypertensive disorder of pregnancy and obstructed labor [7]. These deaths are unjust and can be avoided with key health interventions, like provision of ANC and medically assisted delivery [8]. The emphasis on two out of eight critical united nation millennium development goals, that is reducing under five mortality by 2/3, between 1990 and 2015 and reducing maternal mortality ratio by ¾ between 1990 and 2015 epitomize of the relevance of indicator sign global efforts towards human development [9]. A fully functioning mother-baby package intervention has been estimated to have post-natal cumulative effect of averting 75%-85% of maternal death in developing countries [10].

A woman living in sub-Saharan Africa high chance of dying in pregnancy, child birth and after child birth [11]. Post-natal service are also among the strategies aimed at preventing the onset of physical and mental impairments among women who have delivered [12]. Nearly 4.7 million mothers, newborns, and children die each year in sub-Saharan Africa: 265,000 mothers die due to complications of pregnancy and childbirth and 3,192,000 children, who survived their first month of life, die before their fifth birthday [13]. 1,208,000 babies die before they reach one month of age [14]; this toll of more than 13,000 deaths per day accounts for half of the world’s maternal and child deaths. In addition, an estimated 880,000 babies are stillborn in sub-Saharan Africa and remain invisible on the policy agenda [15].

Despite remarkable progress to reduce mortality of children under 5 years of age in Ethiopia, little change has occurred in neonatal mortality, which accounts for 42% of all under-5 deaths. The 2000 [16], 2005 [17], 2011 [18] and 2016 [19], Ethiopian Demographic and Health Surveys (EDHS) reported neonatal mortality rates of 49, 39, 37 and 35 per 1000 live births, respectively. The decline in neonatal mortality rates by 24% over 11 years is substantially less than the decline in infant (39%) and child (60%) mortality over the same period.

Use of maternal and newborn health care services is low in Ethiopia. According to the 2016 EDHS, only 62.4% of women who gave birth in the 5 years preceding the survey received any antenatal care from a skilled provider (eg, physician, midwife, nurse), and 9% received antenatal care from a health extension worker. Only 10% of women gave birth in a health facility or with a skilled birth attendant, and less than 1% gave birth with a health extension worker. Of note, only 7% of women received postnatal care within 48 hours of birth (6% from a skilled provider, <1% from a health extension worker). Substantially fewer mothers and newborns living in rural areas received postnatal care, compared to those living in urban areas (3% versus 32%) [19].

Low use of postnatal care services by rural Ethiopian women may be due to the tradition of a 40-day period of confinement to protect the mother and newborn from malevolent spirits [16]. However, other community-based projects in Ethiopia and elsewhere have achieved mixed results in terms of improving postnatal care coverage; none have achieved postnatal care coverage greater than 32% [19], even though the utilization of maternal health care service varies with the socio-economic characteristics of the population [20].

Significance of this study is taking in to consideration, that, post-natal health service utilization operates at various individual, house hold and community levels; authors aimed not only evaluating how postnatal care was conducted, but also tried describing why women did not receive postnatal care. Little is known in the study area on current magnitude of utilization of maternity services in health facilities especially postnatal care and associated factors for their utilization to the knowledge of the authors. This study, therefore, tried to assess extent of postnatal care utilization and attempted to describe factors that are assumed to be barriers to postnatal care utilization among mothers who gave birth. It provided relevant information to PNC programmers, Implementers and beneficent.

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Objectives

General objective

To assess post-natal care service utilization and associated factors in Asella town, Arsi Zone, Oromiya Regional State, Ethiopia, 2017.

Specific objectives

To determine the prevalence of PNC utilization

To describe the women who utilized PNC in socio-demographic characteristics.

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Methods and Materials

Study area and period

The study was conducted in Asella town. Asella is administrative town found in central Ethiopia, west of mount Chilalao. It is located in the Arsi zone which is one of the zones in Oromia Region divided into 26 districts, including two especial Administrative towns, namely Asella and Bokoji. Asella is the capital town of Arsi zone. It is located 175 KM from Addis Ababa, capital city of Ethiopia has a latitude and longitude of 7° 57′N39°7′Ewith an elevation of 2,430 meters. According to Ethiopian national census (CSA 2007), Assela town has a total population of 74,268 of whom 37,337 were male and 36,931 were females [21,22]. The study period was from March 14- September 30, 2017.

Study design

Community based descriptive cross sectional study was conduct to assess PNC utilization.

Population

Source population: The source of population was all households’ mothers in Asella town who gave birth in the last two years whose age is 15-49 years.

Study population: Study of population was systematically select households whose mothers age is15-49 and who gave birth in the last 2 years.

Inclusion criteria: All mothers who gave birth in the last two years and who are volunteer for study

Exclusion criteria: Mothers mentally ill or critically ill, and mothers who lost their children.

Sample size calculation

The required sample size was determined by using simple population proportion formula by considering 33.5% post-natal care service utilization [23].

Where,

n= the desired sample size

Zα/ 2 =standard normal score (95%)

p=prevalence of post-natal care service (33.5%)

d=degree of precision desired (5%)

Where,

Z=1.96

• But since the source of the study subject considered below 10,000 we use the correction formula.

Therefore,

Sampling technique

Asella town has fourteen kebeles, among these kebele 09 was select by using Convenience method. There was 1824 total population. Number of females aged 15-49 years is 800.There are seven ketenas in Assela kebele 09. The first ketene was select by using lottery method. Simple random sampling technique was conduct to select couples in each ketenas proportional to their number of currently married couples. The first household was select by lottery method and then K value will be used. K= total households / sample size =800/209=3.8=4 every 4th house hold was interview starting from the end of each village house until the allocated sample achieved. Couples who fulfilled the criteria of the study subject was interview and in the absence of illegible couples in that household the nearby household was interview (Figure 1).

Study variable

Independent variable: Socio-demographic, reproductive factors, knowledge, accessibility

Dependent variable: Utilization of post-natal care

Data collection procedures

Data collection instrument: Data was collected using interview administered structured questionnaire. The principal investigator was involved in the data collection. A structured interviewer administered questionnaire was adapted by investigators after review of different literatures to collect the information based on study objective.

First the questionnaire was prepared in English language and then it was translated to local language (Amharic) and which was again back translated to English. Comparisons were made on the consistency of two versions. The variable to being collected includes socio demographic, economic and question on prevalence of PNC and awareness of people on risk associated with not use PNC.

Data processing and analysis: The Data were entered using EPI-INFO version 3.5.4 and exported to SPSS version 21 for analysis. After it was edited, sorted, organized, and checked for completeness. Descriptive statistics were carried out to characterize the study population using different variables. The result was presented by using table, graph and texts as based on type of data.

Data quality assurance: To assure the quality of collected data the following measure was under taken. The appropriately designed data collection instrument was used. Every day the collected data was cross checked by group members and comments and measures was being undertaken throughout the data collection period for completeness and consistency of the response.

Operational definitions

i. Post-natal care: refers to the assistance given to the mother and the baby for a period of six weeks from the time of delivery.

ii. Utilization of service: It refers to use of post-natal service such as family planning, immunization and other services by women till six months after the delivery of the babies.

iii. Post-natal service: Is the service that consists of immunization, family planning and heath care education on child care, breast feeding, physiotherapy, physical examination, treatment and counseling service.

iv. Immunization: Is the process of administering vaccination to neonates, infant and child.

v. Conceptual frame work; A schematic presentation showing the association between factors and outcomes

vi. Puerperal sepsis: Is infection that occurs after delivery up to six weeks.

vii. Family planning: Is service important for spacing number of pregnancy and prevents unwanted pregnancy.

viii. Traditional birth attendants: Are unprofessional birth attendant who get skill from professionals.

Ethical consideration

Ethical clearance was taken from community and research committee. We were taken permission letter from Arsi University. Permission was being obtained from both the administrator to obtain the desired cooperation and participation.

Verbal informed consent was obtained from each study subject prior to the interview after the purpose of the study is explained to respondent. Confidentiality of the information was being assured and privacy of the respondent was being maintained. The respondents told to have the right to dropout the interview at any time she wishes. At the end of the interview, Information about advantage of postnatal care by skilled health professional explained to the respondents.

Plan for dissemination of finding

The final report will be presented to Arsi University, School of Health science, Department of public health. The result of the study will be disseminated to Assela health desk, Arsi zone health desk through seminar or written formal report. It will also be communicated to Arsi University College of Health Science staff members and students through the university library

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Results

Socio demographic characteristics of the participants

A total of 209 women participated in the study with a response rate of 99.3%. Almost much of (46.9%) of the participants were found between the age of 25 to 29 years. The mean age of the Participants was 26.7 years (+SD=4.4). 111 (53.1%) of them were Muslim and 193 (92.3%) of them were married. With respect to level of education only 67(32.1%) of the respondents had college and above education. The average monthly house hold income was 3948 ETB. More than half 129(61.7%) of the participants were using foot for manse of transportation to the health facilities (Table 1).

About 176 (84.2%) of the participants didn’t have history of abortion,33(15.8%) have history of abortion. More than Half 164(78.5%) of the participants were multi gravid 135 (64.6%) of the previous pregnancy were Planned and support, 74(35.4%) was unplanned and support. More than half 180(86.1%) respondents had ANC follow up at least one, on top participants were 209(100%). Three fourth 151(72.2%) of the participants were given appointment for postnatal care by the health care professionals before discharge. The remaining 58(27.8%) participants were not informed to have postnatal care by the health professionals before discharge from the health institution. Among women who gave birth 124(59.3%) in governmental hospital, health center 73(34.9%,7(3.3% in privet clinic and home delivery 5(2.4%) (Table 2).

Prevalence of postnatal care utilization

About 152(72.7%) had PNC and 57(27.3%) didn’t have any PNC visit. The most frequent place of postnatal care were at government hospitals 75(49.3%) followed by the health centers 70(46.0%). The proportion of postnatal care visit across 2 weeks of discharge, after four week of discharge and at six weeks of postpartum were 23(15.1%), 65(42.7%) and 58(38.2%) respectively. Contraceptive use after delivery 118(56.4%) Contraceptive initiation period At 6 month 86(71.1%) (Table 3).

Concerning what was done for the women during postnatal care visit we found that nearly half 56.1% of the respondents provided contraceptives, 3.9% had physical examination,16.8% advice on danger signs, 18.1% provided TT vaccination, and 3.2%had laboratory investigations (Figure 2). Concerning what was done for the baby as it displayed on Figure 3, 87.5% of the babies had received immunization, 9.2% of women were counseled about danger signs of their baby, and only 0.7% of the babies had physical examination and 0.7% laboratory investigation (Figure 3).

Knowledge and awareness about PNC

About 156(74.2%) heard about PNC,53(25.4%) didn’t heard about PNC. From this who heard about PNC from Health works 118(75.6%), 26(16.7%) from mass media,12(7.7%) from neighbor.135(84.1%) know what is given in PNC,21(15.9%) didn’t know.

As shown in the Figure 4 women participated in study know PNC service as immunization 79.7%, Family planning 12.8% and treatment 7.4%.

Determinant of postnatal care utilization

Out of twenty independent variables categorized under Socio demographic, reproductive characteristic, knowledge, Six variables namely educational status, ANC follow up, whether or not PNC appointment given, were determinant of post-natal care utilization in our study (Figure 5). Over all 57(27.3%) of respondents were not using PNC, the major reasons explained by these Women were being not appointed by the health care provider 68.4 % and lack of knowledge on the importance of PNC service and 31.4% (Figure 5).

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Discussion

Post-natal care is one of the components of maternal and child health which plays an important role in the prevention of complications that occurs following delivery of the new baby. This study tried to assess the prevalence and knowledge of postnatal care utilization among selected village Assela Town of Arsi Zone, Ethiopia. The selected socio-demographic status of the participants showed most of them 193(92.3%) married, 164(78.5 %) were multiparous and 22(10.4%) were illiterate. This study indicated that (72.7%) of the participants had received a health checkup after delivery despite the fact that almost all women were given birth at health institution 204(97.6%). But this figure is very high when compared with the 2016 EDHS postnatal care utilization rate of 9.0% and 18.8% of institutional delivery rate respectively [5]. This difference might be due to the time difference and the presence of diverse intervention to improvement in accessing and utilizing maternal health care service in the urban area as the case in current study. This study finding on PNC prevalence was also higher than three similar studies conducted in Enderta District, Tigray, 49.7%) [24], Jabitena District, Amhara Region (20.2%) [25], and South Nation and Nationality Region (37.2%) in Ethiopia [26]. The discrepancies might be associated with the variation in the study areas and as well study population.

Similarly, the postnatal care utilization of this study finding also a bit higher when compared to the studies conducted in African and Asian countries; the prevalence of not using postnatal care in Bangladesh (73%), Nepal (72%), Rwanda (71%), Burkina Faso (44%), Cambodia (46%), Haiti (55%), and Kenya (46%) Malawi (41%).

Concerning the quality of postnatal care provided by the health professional, it was found that about more than half (56.1%) of the women were reportedly provided only contraceptives and less than one in three women received the remaining postnatal care services such as counseling on danger signs, physical examination, and health promotion. Similarly, the postnatal care provided to their babies mainly focused on providing immunization (87.5%). The remaining services accounted for less than 11.3 %. This was also true in a study done in southern Ethiopia [26].

The key determinant factor for PNC utilization in our study were educational status, ANC follow up, provision of PNC appointment given by health provider. Women who were counseled and given appointment for postnatal care service were utilized the PNC service higher than those women who didn’t informed about the PNC service on discharge. This was also supported by the reason given by those women who didn’t utilized PNC during this study. Similarly, a study done in northern Ethiopia found that those women who had got information about postnatal care services from Health Extension Workers and Midwife/Nurse had larger oddis (24.87) to attend postnatal care service compared to those women who had got information from other sources [25]. This finding may lead to a conclusion that the PNC service utilization is strongly influenced by the knowledge of women on postnatal care benefits.

Those mothers with secondary levels of education had more postnatal care utilization than mothers who didn’t have formal education. A study done on the assessment of factors affecting utilization of postnatal care services was conducted in Jabitena district, Amhara regional state in Ethiopia found that among the socio-demographic factors, the key predictor for PNC utilization was educational status of the respondents. A participant whose level of education was secondary school and above showed better utilization of PNC service as compared to illiterate women [25,26], similarly a study done in Nepal found that mothers who were educated had better score of using [27].

History of ANC follow up was one of the strongest predictors of postnatal care service utilization mothers who have history of ANC follow up utilize PNC more than women who didn’t have ANC follow up. Another community based study done in northern Ethiopia found that women who had ANC follow up were 4 times more likely to attend postnatal care services as compared to women who didn’t had [28]. A study done in Nepal a woman who had attended a four or more antenatal were more likely to report attending at least one postnatal care visit [27]. This is because it improves the knowledge of better outcome of having post-natal care service.

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Strength and Limitation

Strength of the study

The source of the data for this study was based on the selfreport of respondents and provided no validation of obtained information with any objective source such as health facility cards. A high response rate of 99.3% gained from the participants of the study.

Limitation of the study

Using non probability sampling method was one limitation. Recall bias was more likely since women were asked for events which have already happened within the past two years prior to this study despite the consideration of recent births. Study design was descriptive cross sectional and not association done to show determinants. Use of health professionals as data collectors may create bias as they might direct the respondents during the data collection.

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Conclusion