Maternal and Child Health Services Utilization During COVID-19 in Eastern Ethiopia.

Objectives: This study aimed to describe the impact of COVID-19 on maternal and child health service utilization in the Eastern part of Ethiopia. Methods: Comparative analysis was used to examine 2 years of maternal and child health service utilization. Data were extracted from client registers. A traditional Expert Modeler and one-way Analysis of Variance were used to compare service utilization before and during the COVID-19 pandemic. Results: A total of 34,576 client records were reviewed, of which 17,100 (49.5%) and 17,476 (50.5%) had visited the MCH service before and during the COVID-19 pandemic, respectively. The total client visit has shown a 2% percentage point increase. However, postnatal care and child immunization services showed a decrease. Moreover, there was a significant difference between service visits before and during COVID-19 (f = 4.6, p < 0.04). Conclusion: Mothers and children have missed or unattended facility appointments due to protective impositions or fear of getting infected with COVID-19, which might suggest a higher proportion of MCH issues were not addressed during the pandemic. The health system should therefore improve its resilience and strengthen its access at the lowest health care inlets.

Major dietary patterns of community dwelling adults and their associations with impaired blood glucose and central obesity in Eastern Ethiopia: Diet-disease epidemiological study.

BACKGROUNDS: Unhealthy dietary intake is an important preventable risk factor for obesity and impaired blood glucose (IBG), ultimately increasing the risk of non-communicable diseases. When compared to individual food intakes, dietary patterns are a stronger predictor of health outcomes and should be systematically evaluated where such evidence is lacking. This study evaluated dietary patterns and their association with the risk of central obesity and IBG among adults. METHODS: A community-based survey was conducted among 501 randomly-selected adults from Eastern Ethiopia. Data was collected using a semi-structured questionnaire during a face-to-face interview that included sociodemographic and lifestyle factors, as well as a validated 89-item food frequency questionnaire (collected over one month). Principal component analysis was used to derive the dietary pattern. While central obesity was assessed using waist and/or hip circumference measurements, fasting blood sugar was used for IBG. A multivariable logistic regression model was fitted with an odds ratio, 95% confidence intervals, and p-values reported. RESULTS: A total of 501 adults (95.3%) were interviewed, with a mean age of 41 years (±12). Five major dietary patterns explaining 71% of the total variance were identified: "nutrient-dense foods", "high fat and protein", "processed foods", "alcohol drinks", and "cereal diets". While 20.4% (17.0-24.2%) had IBG, 14.6% (11.8-17.9) were centrally obese, and 94.6% (92.3-96.3) had an increased waist-to-hip circumference ratio. Central obesity is associated with upper wealth status (AOR = 6.92; 2.91-16.5), physical inactivity (AOR = 21.1; 2.77-161.4), a diet high in nutrient-dense foods (AOR = 1.75; 0.75-4.06), processed foods (AOR = 1.41; 0.57-3.48), and cereal diets (AOR = 4.06; 1.87-8.82). The burden of IBG was associated with upper wealth status (AOR = 2.36; 1.36-4.10), physical inactivity (AOR = 2.17; 0.91-5.18), upper tercile of nutrient-dense foods (AOR = 1.35; 0.62-2.93), fat and protein diet (AOR = 1.31; 0.66-2.62), and cereal diet consumption (AOR = 3.87; 1.66-9.02). CONCLUSION: IBG and central obesity were prevalent and predicted by upper tercile consumption of nutrient-dense foods, high fat and protein diets, processed foods, and cereal diets, which could guide dietary interventions.

Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult patients with diabetes in Ethiopia: ROC analysis.

BACKGROUND: Poorly controlled blood glucose is prevalent and contributes to the huge burden of diabetes related morbidity, and central obesity has a great role in the pathogenesis of diabetes and its adverse complications, which could predict such risks, yet evidence is lacking. Hence, this paper is to evaluate the predictive performance of central obesity indices for glycemic control among adult patients with diabetes in eastern Ethiopia. METHODS: A survey of 432 randomly chosen patients with diabetes was conducted using a pretested questionnaire supplemented by chart review, anthropometrics, and biomarkers by trained data collectors. The poor glycemic control was assessed using a fasting blood glucose (FBS) level of above 130 and/or an HgA1c level above 7%. Weight, height, waist circumference (WC), and hip circumference (HC) were measured under standard procedures and we calculated waist-to-hip circumference ratio (WHR) and waist-to-height ratio (WHtR). The receiver operating characteristics curve was used to assess the predictive performance of obesity indices for glycemic control using area under the curve (AUC) and corresponding validity measures. RESULTS: A total of 432 (92%) patients with diabetes were enrolled with a mean age of 49.6 (±12.4) years. The mean fasting blood glucose level was 189 (±72) mg dl-1 where 330 (76.4%) (95% CI: 74.4-78.4%) and 93.3% of them had poor glycemic control based on FBS and HgA1c, respectively. WC (AUC = 0.90; 95% CI: 0.85-0.95), WHR (AUC = 0.64; 95% CI: 0.43-0.84), and WHtR (AUC = 0.87; 95% CI: 0.83-0.94) have a higher predictive performance for poor glycemic control at cut-off points above 100 cm, 0.95, and 0.62, respectively. However, obesity indices showed a lower predictive performance for poor glycemic control based on FBS. Body mass index (BMI) had a poor predictive performance for poor glycemic control (AUC = 0.26; 95% CI: 0.13-0.40). CONCLUSIONS: Poor glycemic control is a public health concern and obesity indicators, typically WC, WHR, and WHtR, have a better predictive performance for poor glycemic control than BMI.

Preconception of folic acid supplementation knowledge among Ethiopian women reproductive age group in areas with high burden of neural tube defects: a community based cross-sectional study.

Periconceptional folic acid supplementation is effective in the prevention of neural tube defects (NTDs). The aim of the present study was to determine the level of knowledge about the benefits of preconceptional folic acid supplementation in a sample of women of childbearing age and its associated factors. A cross-sectional community-based study design was carried out on a total of 441 women of childbearing age. Questionnaires included knowledge of preconception of folic acid supplements and socio-demographic characteristics. The χ 2 was used to compare categorical data. Multivariate logistic regression was used to isolate the predictive variables and examined individually by calculating the adjusted odds ratio. Statistical significance is declared as P < 0·05. We found that 35·1 % (n 155) knew preconceptional folic acid supplementation could prevent NTDs, and 3·8 % (n 17) knew the right time to take preconceptional folic acid supplementation and only 1·7 % (n 7) who had a history of NTDs. Attended secondary education (OR 2·7; 95 % CI 1·1, 6·0, P = 0·017), governmental employee (OR 3·5; 95 % CI 2·3, 17·8, P < 0·001), current pregnancy status (OR 3·0; 95 % CI 2·1, 4·2, P = 0·043), history of visiting the antenatal care service during pregnancy (OR 2·9; 95 % CI 1·07, 7·8, P = 0·03), history of taking folic acid supplement (OR 4·5; 95 % CI 2·9, 7·1, P < 0·001) were associated. More than half of the participant women did not know about preconception of folic acid supplements that reduce the risk of NTDs. Identification of the level of knowledge on preconception of folic acid may allow for targeted educational or other interventions to further encourage folic acid use.

Nutritional status and associated factors among lactating women in Dire Dawa, Ethiopia.

BACKGROUND: Lactating women's nutritional status is critical since it influences the health of their infants. However, there was a scarcity of data on maternal nutrition in low-income countries such as Ethiopia, particularly in the study area. METHODS: Institutional-based cross-sectional study was conducted among 401 lactating women in Dire Dawa town health facilities from February 10, 2019 to March 30, 2019. The sum of the number of food categories consumed by each respondent over the 24-h recall period is the women's diet diversity score. To identify factors linked to undernutrition, all variables with a p-value of less than 0.25 were included into multivariate logistic regression. RESULT: Prevalence of undernutrition was 22%. Women who age 15-25 years were four times more likely undernourished than older (adjusted odd ratio [AOR] = 4.04; confidence interval [CI]: [1.74, 9.40]). Unable to read and write women were almost five times more likely to be undernourished than formal education (AOR = 4.76; CI: [2.31, 9.81]). Women who have family size >7 were six times more likely to be undernourished than family size <3 (AOR = 5.53; CI: [1.15, 26.53]). Women not take additional food during lactating were 4.5 times more likely undernourished than take additional food (AOR = 4.56; CI [1.50, 13.9]). DD score <5 were four times more likely to be undernourished than (≥5) DD (AOR = 4; CI: [2.02, 7.90]). CONCLUSION: Prevalence of undernutrition in the study area was high. Factors associated with undernutrion were: age of lactating women, education status, family size, additional food during lactation and DD score. Thus, multisectoral collaboration targeted at improving women's educational status and increasing food during lactation need to be emphasized.

Magnitude and factors associated with anemia among diabetic patients in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: In Ethiopia, diabetes is estimated to affect about half a million people. About 35% of individuals with diabetes are complicated by microvascular diseases like retinopathy, nephropathy, cardiovascular, and anemia. Even though there are some studies conducted on prevalence and associated factors of anemia in diabetic patients, their findings were variable. Therefore, this meta-analysis is aimed to determine the pooled prevalence and factors associated with anemia among diabetic patients. METHODS: PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online, and Google Scholar were systematically searched to identify related studies. The heterogeneity of studies was assessed using Cochran's Q test and I 2 tests. A random-effects model was used to estimate the pooled prevalence of anemia among diabetic patients in Ethiopia. Publication bias was evaluated by employing Egger's tests. RESULTS: After reviewing 503 articles, 6 articles fulfilled inclusion criteria and remained for the final meta-analysis. The pooled prevalence of anemia among diabetic patients was 24.81% (95% confidence interval: 19.38-30.25). Age greater than 60 years old (pooled odds ratio, 95% confidence interval: 3.73 (2.23-6.77)), glomerular filtration rate less than 60 mL/min/1.73 m2 (pooled odds ratio, 95% confidence interval: 12.65 (8.71-18.37)), and being diabetic for more than 10 years (pooled odds ratio, 95% confidence interval: 10.21 (7.00-15.04)) were found to be determinants of anemia among diabetic patients in Ethiopia. CONCLUSION: Overall, one in four diabetic patients develops anemia in Ethiopia. Age, glomerular filtration rate, and duration of being diabetic are factors significantly associated with the occurrence of anemia in diabetic patients.

Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis.

BACKGROUND: Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. METHODS: The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran's Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg 's tests, and the association between determinant factors and NTDs was estimated using a random-effect model. RESULTS: Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19-0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04-10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99-5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27-4.31) were found to be determinants of NTDs. CONCLUSIONS: The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.

Hepatitis B and C virus infection among healthcare workers in Africa: a systematic review and meta-analysis.

BACKGROUND: Healthcare workers are at risk of acquiring hepatitis B and C virus infections through patients' blood and bodily fluids exposure. So far, there is no pooled data that shows the prevalence of HBV and HCV among health care workers in Africa. This study aimed to determine the pooled prevalence of hepatitis B and C infections among health care workers in Africa. METHODS: Studies reporting the prevalence of HBV and HCV were identified from major databases and gray literature. PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online (AJOL), and Google Scholar were systematically searched to identify relevant studies. A random-effect model was used to estimate the pooled prevalence of hepatitis B and C among health care workers in Africa. The heterogeneity of studies was assessed using Cochran Q statistics and I2 tests. Publication bias was assessed using Begg's tests. RESULT: In total, 1885 articles were retrieved, and 44 studies met the inclusion criteria and included in the final analysis. A total of 17,510 healthcare workers were included. The pooled prevalence of hepatitis B virus infection among health care workers in Africa is estimated to be 6.81% (95% CI 5.67-7.95) with a significant level of heterogeneity (I2 = 91.6%; p < 0.001). While the pooled prevalence of hepatitis C virus infection using the random-effects model was 5.58% (95% CI 3.55-7.61) with a significant level of heterogeneity (I2 = 95.1%; p < 0.001). CONCLUSION: Overall, one in fifteen and more than one in twenty healthcare workers were infected by HBV and HCV, respectively. The high burden of HBV and HCV infections remains a significant problem among healthcare workers in Africa.

Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study.

INTRODUCTION: Post cesarean section surgical site infection increases both the duration of a patient's hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities. METHOD: Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers' who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model. RESULT: Age 20-34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection. CONCLUSION: Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Dietary Diversity and Associated Factors Among Adult HIV Positive Patients on Anti-Retroviral Therapy in Public Hospitals of Kembata Tembaro Zone, Southern Ethiopia.

BACKGROUND: Nutrition is a significant factor in all stages of HIV. Dietary management of HIV-positive patients is key to supporting their capacity to continue participating in the workforce and contributing to socio-economic growth. Few studies have been conducted regarding this important public health problem of dietary diversity throughout the developing countries including Ethiopia. Therefore, this study assesses the magnitude and factors associated with dietary diversity among HIV-positive patients attending antiretroviral therapy (ART) clinics at Public Hospitals in Kembata Tembaro Zoni, Southern Ethiopia. METHODS AND MATERIALS: An institutional-based cross-sectional study was conducted from January 01/2019 to 30/2019 on 341 adult HIV-positive patients on ART at two randomly selected public hospitals in the study area. A systematic random sampling technique was applied to select study subjects from each facility proportionally. Bivariable and multivariable logistic regression analyses were done to identify factors associated with individual dietary diversity. Logistic regression analysis with 95% confidence interval (CI) was estimated to measure the strength of association. Level of significance for statistical tests was set at p <0.05. RESULTS: This study shows 60.1% (95% CI: 55-65) of patients had inadequate dietary diversity. Average monthly income of less than 1000 Ethiopian Birr (AOR: 1.82, 95% CI: 1.04-3.17), being female (AOR = 2.99, 95% CI: 1.67-5.37), duration of ART less than 1 year (AOR = 3.77, 95% CI: 1.42-10.02) and lack of dietary counseling (AOR =0.54, 95% CI: 0.30-0.97) were factors associated with low dietary diversity. CONCLUSION: Low dietary diversity was a major nutritional problem in HIV-positive patients. Low average monthly income, being female, duration of participants on ART, and lack of dietary counseling were the factors associated with low dietary diversity. To alleviate these problems, exceptional attention in nutritional care should be given to HIV-positive patients and they require appropriate counseling and support during early initiation of ART.