Measles Outbreak Investigation in Aneded District, Northwest Ethiopia: A Case-Control Study.

BACKGROUND: Between 2000 and 2018, global measles deaths decreased by 73%, but the disease remains prevalent in many developing countries, especially in Africa and Asia. Although Ethiopia was attempting to eliminate the measles, it still ranks fourth in the world in terms of the number of cases. The aim of the investigation was to describe the outbreak and identify its determinants in the Aneded district. METHODS: Between March 3, 2020, and April 2, 2020, the 89 patients and 178 controls participated in a case-control study. Data were gathered by means of in-person interviews with household leaders. The attack and case fatality rates were determined. In multivariable logistic regression analysis, variables having a p-value of less than 0.05 were considered statistically significant cut-off points. RESULTS: An investigation was conducted on a total of 89 measles cases, with 3 deaths and 178 controls. In total, there were 1.65 attacks per 1000 people, or 3.4% of the case fatality rate. There were 155 days of outbreak duration. The disease was significantly associated with being female [adjusted odds ratios (AOR) = 2.66; 95% confidence interval (CI) = 1.38-5.11], under 5 years old [AOR = 7.24; 95% CI = 2.58-20.31], positive in attitude [AOR = 0.22; 95% CI = 0.11-0.42], and having a contact history [AOR = 3.19; 95% CI = 1.67-6.10]. CONCLUSION: The measles outbreak, with its higher attack and case fatality rate, has been influenced by factors like household attitudes, age, sex, contact and travel history and needs to be reduced through early detection, active surveillance, and fostering favorable attitudes towards disease prevention and control.

Attack Rate, Case Fatality Rate and Predictors of Pertussis Outbreak During Pertussis Outbreak Investigation in Ethiopia: Systematic Review and Meta-Analysis.

BACKGROUND: Pertussis, a highly contagious, vaccine-preventable respiratory infection caused by Bordetella pertussis, is a leading global public health issue. Ethiopia is currently conducting multiple pertussis outbreak investigations, but there is a lack of comprehensive information on attack rate, case fatality rate, and infection predictors. This study aimed to measure attack rates, case fatality rates, and factors associated with pertussis outbreak. METHODS: This study conducted a systematic review and meta-analysis of published and unpublished studies on pertussis outbreaks in Ethiopia from 2009 to 2023, using observational study designs, using the guideline Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study utilized databases like Science Direct, MEDLINE/PubMed, African Journals Online, Google Scholar and registers. The data were collected using an Excel Spreadsheet and then exported to STATA version 17 for analysis. Subgroup analysis was conducted to identify potential disparities. A random effects model was used to consider heterogeneity among studies. I2-squared test statistics were used to assess heterogeneity. The attack rate, case fatality rate, and odds ratio (OR) were presented using forest plots with a 95% confidence interval. Egger's and Begg's tests were used to evaluate the publication bias. RESULTS: Seven pertussis outbreak investigations with a total of 2824 cases and 18 deaths were incorporated. The pooled attack and case fatality rates were 10.78 (95% CI: 8.1-13.5) per 1000 population and 0.8% (95% CI: 0.01-1.58%), respectively. The highest and lowest attack rates were in Oromia (5.57 per 1000 population and in the Amhara region (2.61 per 1000 population), respectively. Predictor of pertussis outbreak were being unvaccinated [odds ratio (OR) = 3.05, 95% CI: 1.83-4.27] and contact history [OR = 3.44, 95% CI: 1.69-5.19]. CONCLUSION: Higher and notable variations in attack and case fatality rates were reported. Being unvaccinated and having contact history were the predictors of contracting pertussis disease in Ethiopia. Enhancing routine vaccination and contact tracing efforts should be strengthened.

Measles outbreak investigation in Tocha district, southwestern Ethiopia: an unmatched case-control study.

Background: Measles continues to be a public health challenge in Ethiopia. Rumors of suspected measles were notified on April 8, 2023 from Tocha district. We conducted an assessment to describe measles outbreak and determine risk factors for measles infection in the Tocha district of the Dawuro zone, Southwest Ethiopia. Methods: We conducted a 1:2 unmatched case-control studies from April to May 2023. We took all 147 cases registered on line list for descriptive analyses. We used a total of 74 randomly selected cases and 147 controls for case-control part. Any person in Tocha district with laboratory-confirmed measles IgM antibody; or any suspected person epidemiologically linked to confirmed measles cases from March 23 to April 26 2023, were included in the case. Neighborhood who did not fulfill this standard case definition were included in controls. Data were collected using standardized questionnaires deployed on Kobo Collect. Descriptive analyses were conducted using Epi info version 7.2.5.0. The analyses were performed using Statistical Package for Social Science (SPSS) version 26. Binary logistic regression analyses were utilized to select candidate variables. We conducted multiple logistic regression analysis to identify determinants of measles infection at a p value ≤0.05 with 95% confidence interval. Results: The overall attack rate of 22.64/10,000 for general population and 104.59/10,000 among under-five children were attributed to the outbreak with a case fatality rate of 2.72%. Vaccine coverage in the last year and this year were 73.52 and 53.88%, respectively, while vaccine effectiveness in the district was 79%. Poor house ventilation (AOR = 3.540, 95% CI: 1.663-7.535) and having contact history with the case (AOR = 2.528, 95% CI: 1.180-4.557) were positively related to measles infection while being previously vaccinated for measles (AOR = 0.209, 95% CI: 0.180-4.577) reduce risk of measles infections. Conclusion: The highest attack rate was observed among children under 5 years of age, with a case fatality rate of 2.72%. Vaccination coverage was less than what expected to develop herd immunity. Strategies to increase vaccination coverage and strengthening surveillance systems for rumor identification and early responses to prevent person to person transmission are recommended.

Sickle Cell Disease With Ulcerative Colitis in An Ethiopian Child.

Sickle cell disease (SCD) is a hereditary blood disorder characterized by abnormal hemoglobin, resulting in various clinical manifestations. Recognizing the complex clinical picture of SCD is crucial for physicians to effectively diagnose and manage the disease. While typical presentations may be absent, it is important to consider the possibility of SCD in patients presenting with ulcerative colitis (UC). The concurrent occurrence of UC and SCD is extremely rare. Therefore, a comprehensive investigation is warranted for individuals at risk of developing SCD with UC. In this report, we presented the first documented case of a child in Ethiopia with both SCD and UC.

Patterns and Clinico-Radiological Characteristics of Primary Liver Masses in Children Treated at a Tertiary Referral Hospital, in Ethiopia.

Background: Liver masses are a cause of morbidity and mortality in children worldwide. Although the patterns and clinical-radiological characteristics of primary liver masses have been studied in developed countries, few studies have been conducted in developing countries. Studying the patterns of liver mass in children helps to improve the outcome of liver masses and to design preventive strategies if the identified risk factors are preventable. Material and Method: A hospital-based cross-sectional study was conducted on children who met the inclusion criteria, using a self-administered structured questionnaire. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Statistical significance was set at P < 0.05. Descriptive and logistic regression analyses were used to assess the determinant factors. Results: A total of 74 children were included, with most patients being males (60.8%). More than one-third (n = 27) of the participants were between 1 and 4 years of age and the mean age at diagnosis of the liver mass was 4.6 years. The duration of illness at presentation to Tikur Anbessa Specialized Hospital was between 4 and 8 weeks, in 42% of the patients. The most common presenting symptom was abdominal swelling, accounting for 70.3% (n = 52) of the patients. Benign hepatic mass lesions accounted for 57.5% (n = 42), and 43.2% (n = 32) were malignant liver masses. Most lesions were solitary and involved the right lobe of the liver. The common benign hepatic masses were pyogenic liver abscesses (38.1%), and the most common malignant hepatic masses were hepatoblastomas (78.1%). Conclusion: Pyogenic liver abscess was the most common benign hepatic mass and hepatoblastoma was the most common malignant hepatic mass in our study. Most lesions were solitary and involved the right lobe. Understanding the patterns of liver masses will help in the early diagnosis and improve treatment outcomes in children with liver masses.

On-Time Appointment Keeping and Associated Factors among Human Immunodeficiency Virus-Positive Adult Patients Accessing Antiretroviral Therapy at Health Centers in East Gojjam Zone, Northwest Ethiopia, 2019.

Background: The magnitude of on-time appointment keeping among HIV-positive adult patients was not identified in Ethiopia. Hence, this study aimed to assess on-time appointment keeping and associated factors among human immunodeficiency virus-positive patients accessing antiretroviral therapy in the East Gojjam Zone, Northwest Ethiopia. Methods: A community-based cross-sectional study was performed on 830 HIV-positive patients from April 1 to May 10, 2019, in East Gojjam Zone. A systematic random sampling technique was used to include study subjects, and data were collected through face-to-face interviews. Bivariable and multivariable binary logistic regression analyses were performed. Independent variables with a P value of <0.05 were considered statistically significant cut points. Results: The prevalence of on-time appointment keeping was 62.1%. Being >24 years old (adjusted odds ratio (AOR) = 2.13; 95% confidence interval (CI) = 1.54-4.25), being unmarried (AOR = 0.59; 95% CI = 0.45-0.82), taking a drug regimen of tenofovir + lamivudine (3TC) + efavirenz (EFV) (AOR = 2.11; 95% CI = 1.84-3.62), taking ART ≥12 months (AOR = 4.32; 95% CI = 2.22-8.40), having a mobile (AOR = 2.22; 95% CI = 1.44-3.64), and getting adherence support (AOR = 1.83; 95% CI = 1.16; 95% 1.16-3.50) were significant factors. Conclusion: On-time appointment keeping was low. Adherence support and appointment reminders should be strengthened.

Attack rate, case fatality rate and determinants of measles infection during a measles outbreak in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Although Ethiopia is working towards measles elimination, a recurrent measles outbreak has occurred. To take appropriate measures, previously, many fragmented and inconsistent outbreak investigations were done, but there is no consolidated evidence on attack rate, case fatality rate, and determinants of measles infection during the measles outbreak. This systematic review and meta-analysis aimed to identify cumulative evidence on attack rate, case fatality rate, and determinants of measles infection during the outbreak. METHODS: A systematic literature review and Meta-analysis was used. We searched Google Scholar, Medline/PubMed, Cochrane/Wiley Library, EMBASE, Science Direct, and African Journals Online databases using different terms. Investigations that applied any study design, data collection- and analysis methods related to the measles outbreak investigation were included. Data were extracted in an Excel spreadsheet and imported into STATA version 17 software for meta-analysis. The I2 statistics were used to test heterogeneity, and 'Begg's and 'Egger's tests were used to assess publication bias. The odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots. RESULTS: Eight measles outbreak investigations with 3004 measles cases and 33 deaths were included in this study. The pooled attack rate (A.R.) and case fatality rate were 34.51/10,000 [95% CI; 21.33-47.70/10,000] population and 2.21% [95% CI; 0.07-2.08%], respectively. Subgroup analysis revealed the highest attack rate of outbreaks in the Oromia region (63.05 per 10,000 population) and the lowest in the Amhara region (17.77 per 10,000 population). Associated factors with the measles outbreak were being unvaccinated (OR = 5.96; 95% CI: 3.28-10.82) and contact history (OR = 3.90; 95% CI: 2.47-6.15). CONCLUSION: Our analysis revealed compelling evidence within the outbreak descriptions, highlighting elevated attack and case fatality rates. Measles infection was notably linked to being unvaccinated and having a contact history. Strengthening routine vaccination practices and enhancing contact tracing measures are vital strategies moving forward.

Voltammetric determination of tryptophan at graphitic carbon nitride modified carbon paste electrode.

Herein, we reported carbon paste electrode modified with graphitic carbon nitride (g-C3N4-CPE) to determine of tryptophan (Trp) using voltametric techniques. Various spectroscopic and electrochemical techniques were used to characterize the as-synthesized g-C3N4 and the assembled electrodes. The transfer coefficient, rate constant and the diffusion coefficient of Trp in this system were found to be 0.28, 1.9 × 104 M-1s-1 and 3.2 × 10-5 cm2s-1, respectively. The linear range was obtained for the detection of Trp using LSV is from 0.1 µM to 120 µM at pH 5. The limit of detection (LOD) (3σ/m) was 0.085 µM. The demonstrated modified CPE was also effectively used for the detection of Trp in milk with percentage recovery of 98 %-105.2 %. Furthermore, the modified CPE exhibited good repeatability, reproducibility and appropriate selectivity.

Adherence to antiretroviral therapy and associated factors among human immunodeficiency -positive patients accessing treatment at health centers in East Gojjam Zone, Northwest Ethiopia, 2019: Community-based cross-sectional study.

Background: To achieve an effective treatment outcome, Antiretroviral Therapy (ART) for people living with the Human immunodeficiency virus (HIV) needs at least a 95% adherence level. The aim was to assess adherence to antiretroviral therapy and its associated factors among patients accessing treatment at Health centers in East Gojjam Zone, Northwest Ethiopia. Methods: A community-based cross-sectional study was conducted on 770 HIV-positive patients from April 1 to May 10, 2019, in East Gojjam Zone. The study participants were selected by simple random computerized sampling methods. Primary data was collected from the patients through face-to-face interviews and home-to-home visits. Bivariable and multivariable binary logistic regression analyses were done. Independent variables with a P-value of <0.2 in bivariable binary logistic regression analysis were considered for multivariable binary logistic regression analysis. A P-value of <0.05 was used as the cut-off point for the presence of statistical significance. Results: About 396 (51.8%) of the study participants had good adherence. Being 18-24 years old [Adjusted Odd Ratio (AOR) = 0.43; 95% CI = 0.21-0.86], having a marital status of being widowed (AOR = 0.29; 95% CI = 0.14-0.58), having a disease duration of >10 years (AOR = 0.47; 95% CI = 0.24-0.94), taking a drug regimen of Tenofovir (TDF) + Lamivudine (3 TC) + Nevirapine (NVP) (AOR = 2.94; 95% CI = 1.406.15), not being socially stigmatized (AOR = 0.52; 95% CI = 0.34-0.78), and having not encountered an opportunistic infection (AOR = 3.91; 95% CI = 2.68-5.72) were significant factors. Conclusions: The level of adherence was low. Opportunistic infection prevention, reduction of social stigma, and other intervention activities should be strengthened to increase the level of adherence.

Caregivers' Satisfaction of Teleconsultations and Associated Factors During COVID-19 Pandemic at Pediatric Clinics of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study.

Background: The COVID-19 pandemic led to a paradigm shift in routine care delivery with the widespread transition to virtual care without demanding preconditions. Caregivers' satisfaction is a critical parameter to ensuring the quality of clinical service in the pediatric population. Despite this fact, such patient-related factors are under-investigated and poorly documented in developing countries such as Ethiopia. The study was aimed to assess caregivers' satisfaction regarding teleconsultations and associated factors during COVID-19 pandemic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: Health institution-based cross-sectional survey was conducted in randomly selected caregivers who were served with phone-based medical consultations during the pandemic. Data were collected by means of a pretested, structured interviewer-administered questionnaire. Data were entered into Excel 2016 and analyzed using SPSS version 26. Logistic regression models were used to predict the association of study variables and adjusted for possible confounders. Results: Overall, 177 (61.5%) of participants reported satisfaction with the teleconsultation. Female caregivers (AOR=1.78; 95% CI 1.05, 3.01), having family support (AOR=2.6; 95% CI 1.45, 4.65), access to a nearby laboratory (AOR=2.18; 95% CI 1.24, 3.83), having access to nearby pharmacy (AOR=2.82; 95% CI 1.63, 4.86) were found to be predictors of caregivers' satisfaction with teleconsultation in the study area. Conclusion: A considerable number of caregivers were satisfied with the teleconsultation service during the COVID-19 pandemic. It is important for healthcare providers and policy makers to strengthen the provision of teleconsultation service options for caregivers including women and those with better access to diagnostic centers and pharmacies. They should try to make teleconsultation caregiver-friendly.

Sleep quality and associated factors among pregnant women attending antenatal care at Jimma Medical Center, Jimma, Southwest Ethiopia, 2020: cross-sectional study.

BACKGROUND: Sleep is a natural physiological process vital for the physical and mental wellbeing of pregnant women and their fetuses. Even though poor sleep quality is a common problem among pregnant women, it is not studied in developing countries including Ethiopia. Therefore, this study was aimed to assess the poor sleep quality and associated factors among pregnant women attending antenatal care at Jimma medical center, Jimma, Southwest Ethiopia, 2020. METHODS: A cross-sectional study design was conducted among 415 pregnant women at Jimma Medical Center (JMC). The study subjects were selected using a systematic random sampling technique. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality using face-to-face interviews. SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to sleep quality. In multivariable logistic regression variables with a p-value less than 0.05 was considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULTS: The prevalence of poor sleep quality among pregnant women was found to be 30.8% (95% CI (26.5, 35.2). In multivariable analysis, age ≥ 30 years old (AOR = 1.94;95%CI:1.03,3.66), Multigravida (AOR = 1.90;95%CI:1.90,3.32),depression (AOR = 4.26;95%CI:2.54,7.14),stress (AOR = 1.85;95%CI:1.20,3.02) were variables significantly associated with poor sleep quality. CONCLUSION: This study found a high prevalence of poor sleep quality among pregnant women. Older age, gravidity, depression, and stress were associated with poor sleep quality. It is better to have routine sleep pattern screening and teach sleep hygiene practice for pregnant women.

COVID-19 Prevention Practices and Associated Factors Among Frontline Community Health Workers in Jimma Zone, Southwest Ethiopia.

BACKGROUND: A timely understanding of the frontline community health care workers' prevention practices towards COVID-19 is very crucial to combat the pandemic. Despite this, no study has been conducted among frontline community health workers in Africa, particularly in Ethiopia. The study aimed to determine the status of implementation of preventive measures of frontline community health care workers towards COVID-19 and its associated factors. METHODS: An institution-based cross-sectional study was conducted on 421 health extension workers among selected districts. Data were collected using a pretested structured questionnaire adapted from different pieces of literature. Respondents who scored above mean score on the item measurement such as knowledge, attitude, and practice questions were categorized as knowledgeable, having positive attitude, and having good prevention practices, respectively. Data were entered in EpiData 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A multivariable logistic regression model was used to identify significant predictors. P- values less than or equal to 0.05 were declared as statistically significant. RESULTS: The mean age of study participants was 31.35 years (±4.83 SD), and almost half (217; 51.54%) of respondents were single and 273 (62.47%) were trained for COVID-19 prevention measures. Of the total study subjects, 194 (46.08%; 95% CI=41.6-50.7%) had good prevention practices towards COVID-19. Being married (AOR=3.36, 95% CI=2.20-5.13), being trained (AOR=2.28, 95% CI=1.39-3.74), having good knowledge (AOR=2.4, 95% CI=1.52-3.99), and having positive attitude towards COVID-19 prevention measures (AOR=5.88, 95% CI=3.52-9.80) increase the likelihood of implementing prevention measures. CONCLUSION: This study showed that prevention status was low; therefore, government and non-governmental organizations working around the study area should emphasize providing training to increase their level of knowledge and to change the attitude towards implementation of prevention measures, and these can ultimately increase the status of prevention practices.

Suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma medical center, Ethiopia.

BACKGROUND: Suicidal ideation (SI) among pregnant women is a major public health concern worldwide and is associated with a higher risk of completed suicide. However, there are limited studies that determined the prevalence and the potential determinants of suicidal ideation in Sub-Saharan Africa, including Ethiopia. Therefore, this study aimed to explore the prevalence of suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma, Ethiopia. METHODS: An institutional-based cross-sectional study was conducted among 423 pregnant women attending Jimma medical center in Southwest, Ethiopia. A systematic random sampling technique was used to select the study participants. Suicidal ideation assessed using the Suicidality Module of the World Mental Health survey initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI). Other tools used are EPDS, Abuse Assessment Scale (AAS), DASS -21, PSS, Maternity Social Support Scale (MSSS), and Pittsburgh Sleep Quality Index (PSQI). A multivariable logistic regression analysis was used to explore the potential determinants of suicidal ideation among the participants. RESULT: The prevalence of SI among women who are on antenatal care was found to be 13.3% (95% CI (10.1,16.4). In multivariable analysis, marital status with lack of cohabiting partners (AOR = 2.80,95%CI:1.23,6.37), history of abortion (AOR = 2.45,95% CI:1.03,5.93), having depression (AOR = 4.28,95% CI:1.75,10.44),anxiety(AOR = 2.99,95% CI:1.24,7.20), poor sleep quality (AOR = 2.85,95% CI:1.19,6.79), stress (AOR = 2.50, 95% CI:1.01,5.67), and intimate partner violence (AOR = 2.43, 95% CI:1.07,5.47) were found to be significant predictors of suicidal ideation. CONCLUSION: The prevalence of SI among pregnant women was found to be huge. Lack of cohabiting partners, previous history of abortion, depression, anxiety, intimate partner violence, poor sleep quality, and stress were variables that are independent predictors of suicidal ideation. Screening and interventions of antenatal SI are needed.