Undernutrition and associated factors among adults with mental and neurological disorders in public health hospitals, Eastern Ethiopia, 2019: a cross-sectional study.

BACKGROUND: Poor nutritional status can be consequence of impaired mental health that may lead to involuntary weight gain, weight loss, or deficiency of essential nutrients. However, little has been documented about the nutritional status of adults with mental disorders and the contributing factors in low-income countries like Ethiopia. The aim of this study was to assess the magnitude of undernutrition and associated factors among adults with mental disorders in public hospitals of Eastern Ethiopia. METHODS: Institution-based, cross-sectional study was conducted among 507 adults with mental disorders from March 1, 2019 to April 1, 2019. Interviewer administered pretested structured questionnaire was used to collect data. Anthropometric data were collected using calibrated weighing scale and height measuring board. Descriptive statistics was computed to describe the data. Bivariable and multivariable logistic regression analyses were applied to identify factors associated with the undernutrition. Odds ratio alongside 95% confidence interval (CI) were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05. RESULTS: Undernutrition affected 62.7%; 95% CI: (58.3%, 67.7%) of the patients. Undernutrition was associated with meal frequency < 3 per day (adjusted odds ratio [(AOR = 2.07, 95% CI: (1.18, 3.63)], use of multiple medication (adjusted odds ratio [(AOR = 3.02, 95% CI: (1.88, 4.84)], being non-smoker [(AOR = 0.50, 95%CI: (0.25, 0.91)], and use of prescribed diet [(AOR = 0.45, 95%CI: (0.26, 0.78)]. CONCLUSIONS: The magnitude of undernutrition was high among the study participants. Multiple medication, cigarette smoking, frequency of meal and taking prescribed diet were significantly associated with undernutrition. Nutrition education for patients with mental disorders and their caregivers about the impact of taking multiple medication and substance use needs to be emphasized alongside nutritional screening and support to improve their nutritional status.

Healthcare Workers' Compliance With Standard Precautions and Associated Factors in Bahir Dar Town, Ethiopia.

Background: According to the literature analysis, the majority of the studies focused primarily on public health institutions. Although assessing the compliance of healthcare workers in private and public institutions would give comprehensive evidence on existing problems and appropriate prevention method, as a result, research on adherence to standard precautions are still required. Rely on existing research, to the best of the investigator's knowledge, compliance with standard precautions in hospitals of Bahir Dar town has not been assessed. Therefore, this study will contribute to narrowing these gaps and determining the scope of problems with standard precautions. Methods: An institution-based cross-sectional study design was conducted among 442 healthcare workers working in hospitals from June 10 to 30, 2021. A stratified random sampling technique was employed to select the study participants. Pre-tested and structured questionnaires and an observational checklist were used to collect the required data. The data were entered into EpiData and analyzed using SPSS version 22. Bivariate and multivariable analyses were used to assess the association between independent and outcome variables. Odd ratios at 95% CI were used to measure the strength of the association between the outcome and explanatory variables. Finally, a P-value of <.05 was considered as a cut-off point for statistical significance. Results: Of the 442 healthcare workers who participated in the study, 41% were compliant with standard precautions. Furthermore, 68.1% and 51.8% of the respondents had good knowledge and a positive attitude toward infection prevention, respectively. Consistent water supply availability (AOR = 1.92 and 95% CI = 1.63, 6.27), and access to infection prevention guidelines (AOR = 1.73 and 95% CI = 1.08, 2.77), and availability of personal protective equipment (AOR = 2.32 and 95% CI = 1.35, 3.98) were some of the factors significantly associated with health care workers' compliance. Conclusions: The current study found that only about two-fifths of the healthcare workers complied with standard precautions. The study suggests that there is a significant risk of developing an infection. Therefore, the concerned organizations; Bahir Dar Zonal Health Office, and respective sectors including Amhara Regional Health Office and the Federal Ministry of Health must take appropriate measures to improve the implementation of safety practices.

Occupational Injuries and Associated Factors Among Municipal Solid Waste Collectors in Harar Town, Eastern Ethiopia: A Cross Sectional Study.

Background: Municipal solid waste collection is one of the most dangerous jobs in the world since it exposes the workers involved to occupational hazards and predisposes them to certain occupation-related morbidities. Occupational injuries among municipal solid waste collectors have not been adequately addressed or reported in developing countries, including Ethiopia. Therefore, this study aimed to determine the prevalence of occupational injuries and associated factors among municipal solid waste collectors in Harar Town, Ethiopia. Methods: A cross-sectional study was conducted in Harar town, Eastern Ethiopia from May 25, 2021 to June 25, 2021. Three hundred eighty-nine (389) municipal solid waste collectors were selected using a simple random sampling method. A self-administered structured questionnaire and an observational checklist were used to collect the data. The collected data was analyzed using SPSS version 20. Bivariate and multivariable logistic regression were used to determine the association between independent variables and the outcome variable. A P-value of <.05 was considered as a cut-off point for statistical significance. Results: The current study found that about 60.4% of municipal solid waste collectors were exposed to occupational injuries. Furthermore, the study found a statistically significant association between the prevalence of occupational injuries and having a primary education [AOR = 0.10, 95% CI (0.03-0.38)], a secondary education [AOR = 0.04, 95% CI (0.03-0.45)], work experience [AOR = 5.975, (95% CI (2.01-17.75)], the use of personal protective equipment [AOR = 0.09, (95% CI: 0.02-0.46)], and training [AOR = 0.10, 95% CI (0.03-0.30)]. Conclusions: The current study found that more than three-fifth of municipal solid waste collectors were exposed to occupational injury. Furthermore, the current study found that there was an statistical relationship between the prevalence of occupational injuries and having a primary education, a secondary education, work experience, the use of personal protective equipment, and training. Before and after hiring solid waste collectors, employers should provide personal protective equipment and tailored training on safety measures.

Bacteriological Quality of Locally Prepared Fresh Fruit Juice Sold in Juice Houses of Eastern Ethiopia.

BACKGROUND: Currently, fresh fruit juices are widely consumed as a drink worldwide due to their nutritional values and health benefits. Fresh fruit juices are an important source of nutrients, vitamins, and fibers that are important for human health. Fruit juices are nutritious and perishable food that can serve as an ideal medium for the growth and multiplication of pathogenic microorganisms. Therefore, this study aimed to determine the bacteriological quality of locally prepared fresh fruit juices sold in juice houses of eastern Ethiopia from 4 April to 12 June 2020. METHODS: A cross-sectional study was used that included administrative questionnaires and laboratory-based investigations. A total of 78 fruit juice samples that include mango, avocado, papaya, and mixed juices were collected aseptically from the juice houses. The most probable number method was used to determine the total coliform, fecal coliform and Escherichia coli. The pour plate count method was used to determine the total viable bacteria count. Finally, data were analyzed using descriptive statistical tests that included analysis of variance, Chi-square and Fisher's exact tests. A P-value of .05 was considered as a cut-off point for statistical significance. RESULTS: Among the 78 juice samples analyzed, 85.9% of the samples had total viable bacterial count, 64.1% had total coliform count, 60.3% had fecal coliform, and 33.3% of the samples had Escherichia coli higher than the maximum permitted level of Gulf standard 2000. The study found a significant association between bacterial contamination and educational status (χ2 = 31.663), training in food hygiene and safety (χ2 = 23.04), method of fruit preservation (χ2 = 17.98), place to keep the juice (χ2 = 13.7), action done with the juice gone bad (χ2 = 12.78), frequency of cleaning materials used to keep the juice (χ2 = 12.78), type of dish washing (χ2 = 19.75), availability of hand washing equipment (χ2 = 12.78), and types of waste receptacles (χ2 = 26.25) (P-value <.05) (Table 5). CONCLUSION: In general, majority of fruit juice samples were contaminated with one or more different bacteria species higher than the maximum permitted level. Furthermore, the study found the association between bacterial contamination and other variables such as hygienic and safety conditions. Therefore, the implementation of adequate hygiene and safety practices is very important to prevent the consumption of contaminated fruit juices, which leads to foodborne illness.

Household Water Treatment Practice and Associated Factors in Gibe District Southern Ethiopia: A Community Based Cross-Sectional Study.

BACKGROUND: Household water treatment practice or managing water at the point-of-use provides a means of improving drinking water quality and preventing diarrheal diseases. However, evidence regarding household water treatment practice and associated factors in Ethiopia, particularly in Southern Ethiopia are limited. This study was, therefore, designed to assess household water treatment practice and associated factors among households in Southern Ethiopia. METHODS: A community-based cross-sectional study design was conducted among 627 households in Southern Ethiopia. A stratified random sampling technique was used in this study and a pre-tested structured questionnaire was used to collect data about household water treatment practice and associated factors among selected households through face-to-face interviews. The data were analyzed using descriptive statistical tests and binary logistic regression was performed to assess the association between independent and dependent variables. Odds ratio with 95% confidence intervals were used to determine the level of association. RESULTS: This study revealed that the level of household water treatment practice was 34.3% with 95% CI (30.7-38.1) and boiling was the most common method of household water treatment in the study area. Educational status of having formal education (AOR = 2.01, 95% CI = 1.34-3), withdrawing water from storage vessel by dipping (AOR = 1.86, 95% CI = 1.2-2.87) and frequency of fetching water 3 or more times and above a day (AOR = 2.65, 95% CI = 1.45-4.88) were significantly associated with household water treatment practice. CONCLUSION: Household water treatment practice is low in the study area. Educational status of having a formal education, drawing water by dipping, and those who collect their drinking water 3 or more times a day were predictors of household water treatment practice. Thus, efforts should be made to increase the level of household water treatment practice especially among those with no formal education and further studies should be conducted to understand the behavioral factors associated with household water treatment practice.

Practice and Factors Associated with Informed Consenting Process for Major Surgical Procedures Among Health-Care Workers, South Eastern Ethiopia.

BACKGROUND: Medical malpractice, poor patient outcome and medical suits among health-care workers result from improper consenting practices. Therefore, this study aimed to assess practice and factors associated with the informed consenting process for major surgical procedures among health-care workers in public hospitals of Bale Zone, South Eastern Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from March 9 to 24, 2020, among all nurses, midwives, doctors (general physicians, surgeons, gynecologists), emergency surgery officers, anesthetists) who were working at Bale Zone public hospitals during the study period. A self-administered pretested questionnaire was employed. Variables with a p-value of less than 0.25 (age group, sex, educational profession, working unit, work experience, adequate content of consent form, training on informed consent, policy/regulation in institution, administrative support, average number of patient cared per shift, time spent for consent process, knowledge, attitude) at 95% confidence interval in the binary logistic regression analysis were considered for multivariable regression model to control for possible confounding effect. RESULTS: Of the total sample size (639 health-care workers), 621 (97.2%) were included in this study, of which 311 (50.1%, 95% CI: 46.1-53.8) practiced proper informed consent during major surgical procedures. Being age above 35 (AOR: 3.032, 95% CI: 1.148-8.010), male (AOR: 1.607, 95% CI: 1.047-2.465), above 10 years of working experience (AOR: 2.339, 95% CI: 1.104-4.955), adequate content of consent form (AOR: 2.785, 95% CI: 1.772-4.377), having training on informed consent (AOR: 2.305, 95% CI: 1.204-4.414), spending more time (>30minutes) for consent process (AOR: 3.014, 95% CI: 1.095-8.298), having good knowledge (AOR: 1.808, 95% CI: 1.195-2.737) and favorable attitude (AOR: 2.188, 95% CI: 1.456-3.287) were significantly associated with good informed consent practice. CONCLUSION: Only half of health-care workers practiced good informed consent. Further emphasis needs to be given to improve consent practice.

Bacteriological quality of drinking water from source and point of use and associated factors among households in Eastern Ethiopia.

BACKGROUND: Biological deterioration of drinking water is the major cause of waterborne disease globally. However, there is a paucity of information on identifying the point where deterioration of the bacteriological quality of drinking water occurs (source or point of use) and associated factors among households in developing countries, especially in Ethiopia. METHOD: A community based cross-sectional study design was conducted among 425 households in Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. A total of 448 Water samples (425 from households and 23 from water sources) were collected and analyzed by the membrane filtration method to identify Thermotolerant coliform. Binary logistic regression was performed to assess the association between each independent and dependent variable. Adjusted Odd Ratios along with 95% Confidence intervals were estimated to identify factors associated with the outcome variable. RESULT: This study revealed that 21.7%; 95% CI (4.5%, 39.1%) of water sources and 83.3%; 95% CI (79.8%, 87.1%) of households' drinking water were contaminated by thermotolerant coliform. Drinking water samples from households with poor wealth index [AOR = 9.63; 95%CI (2.92, 31.69)], households with unimproved sanitation facility [AOR = 2.81; 95%CI (1.31, 6.01)], households which shares their house with animal [AOR = 3.73; 95%CI (1.66, 8.37)], households that didn't practice household water treatment [AOR = 3.42; 95%CI (1.60, 7.31)] and not washing hands before water collection [AOR = 7.04; 95%CI (2.22, 22.30)] were significantly associated with deterioration of bacteriological quality of household drinking water. CONCLUSION: This study indicates that the bacteriological quality of drinking water deteriorates from source to point of use. Thus, health education programs on water, sanitation, hygienic practice must be enhanced to improve the quality of drinking water.

Assessment of quality of routine health information system data and associated factors among departments in public health facilities of Harari region, Ethiopia.

BACKGROUND: Despite the improvements in the knowledge and understanding of the role of health information in the global health system, the quality of data generated by a routine health information system is still very poor in low and middle-income countries. There is a paucity of studies as to what determines data quality in health facilities in the study area. Therefore, this study was aimed to assess the quality of routine health information system data and associated factors in public health facilities of Harari region, Ethiopia. METHODS: A cross-sectional study was conducted in all public health facilities in the Harari region of Ethiopia. The department-level data were collected from respective department heads through document reviews, interviews, and observation checklists. Descriptive statistics were used to data quality and multivariate logistic regression was run to identify factors influencing data quality. The level of significance was declared at P value < 0.05. RESULT: The study found good quality data in 51.35% (95% CI 44.6-58.1) of the departments in public health facilities in the Harari Region. Departments found in the health centers were 2.5 times more likely to have good quality data as compared to those found in the health posts. The presence of trained staffs able to fill reporting formats (AOR = 2.474; 95% CI 1.124-5.445) and provisions of feedbacks (AOR = 3.083; 95% CI 1.549-6.135) were also significantly associated with data quality. CONCLUSION: The level of good data quality in the public health facilities was less than the expected national level. Lack of trained personnel able to fill the reporting format and feedback were the factors that are found to be affecting data quality. Therefore, training should be provided to increase the knowledge and skills of the health workers. Regular supportive supervision and feedback should also be maintained.

Burnout and associated factors among nurses working in public hospitals of Harari region and Dire Dawa administration, eastern Ethiopia. A cross sectional study.

BACKGROUND: Burnout is a syndrome of emotional exhaustion, low personal accomplishment and depersonalization experienced by a health professional and it is more common in nurses due to high workload and job stress that is mostly caused by working proximity to patients and taking care of them. Burnout compromises the provision of quality health care. Despite this, there is no information in Ethiopia on burnout among nurses in study area. OBJECTIVES: To determine the magnitude of burnout and associated factors among nurses working in public hospitals of Harari regional state and Dire Dawa administration, eastern Ethiopia, February 1-29, 2020. METHODS: Institutional based quantitative cross-sectional study was employed from February 1-29 among 412 randomly selected nurses who have been working in hospitals for the last 6 months. Simple random sampling method was employed and data was collected by self-administered, standardized, reliable and valid, questionnaire (Maslachs Burnout Inventory- Human Services Survey). Data was entered into EpiData Version 3.1 and exported to statistical package for social science version 20 for analysis. All covariate with P-value less than 0.25 in bivariable analysis were candidate for multivariable analysis. Level of statistical significance was declared at p-value < 0.05. RESULTS: Among 412 nurses taking part in this study, 183(44.4%) of nurses with 95% CI, had experienced burnout. Married marital status [AOR:2.3,95%CI:(1.2-4.3)], poor current health status [AOR:4.8, 95% CI:(1.1-21.4)] and fair current health status [AOR:12, 95% CI:(4.5-32)], working greater than eight hour per-day[AOR:0.52, 95%CI:(0.29-0.92)], intention to leave a job [AOR:0.48,95%CI:(0.2-0.88), being working in emergency room [AOR:0.3,95%CI:(0.1-0.98)] and using a different medication related to work related health problems were factors associated with nurses' burnout. CONCLUSION: The nurses' burnout in this study is high and it is attributed by marriage, perceiving health status as poor and fair, whereas, having the intention to leave job, being working in emergency room and using a medication in relation to work related health problems reduced risk of developing burnout. So, the concerned bodies should provide trainings which focus on stress copying mechanisms and assertiveness program.

Pathogenic Bacterial Species in Locally Prepared Fresh Fruit Juices Sold in Juice Houses of Eastern Ethiopia.

Fruit juices are important components of a healthy diet and a dietary source of nutrients, vitamins, and fiber and vital for human health. However, unless it is handled with safety and hygienic conditions, food can be a vehicle for the transmission of various agents of diseases resulting in food borne outbreaks. Thus, this study aimed to determine common pathogenic bacterial species in locally prepared fresh fruit juices sold in juice houses of Eastern Ethiopia. A cross-sectional study design was conducted from 1 January to 27 March 2020, in eastern Ethiopia. Seventy-eight juice samples were collected aseptically using a sterilized collecting jar from each juice house. Pour plate count method was used to determine Staphylococcus, Salmonella, and Shigella species. Finally, the data were analyzed using descriptive statistical tests such as Chi-square and Fisher's exact tests. P-value of .05 was considered as a cut point for statistical significance. The study found Staphylococcus count ranged from 1.68 log CFU/mL with the mean value of 4.204 log CFU/mL. Overall, 58 (74.4%) of the fruit juice samples had Staphylococcus count, 19 (24.4%) had Salmonella and 12 (15.4%) had Shigella higher than the maximum permitted limit of Gulf standard, 2000 set for any type of fruit juice. In general, the study found more than two-thirds of fruit juice samples had at least 1 pathogenic bacteria species higher than the maximum permitted limit and potentially hazardous to consumer health. Thus, regular supervision and application of food hygiene and safety are essential to improve the quality of fruit juice and to prevent the consumption of contaminated fruit juices, which leads to food borne illness.

The Utilization of Health Service Packages Among Mothers of Children Less Than 1 Year of Age in the Somali Region of Ethiopia.

Health Service Package is the package of services that the government is providing or is aspiring to provide to its citizens in an equitable manner. The Ethiopia Family Health Service Package is part of the health extension program consisting of antenatal care, delivery service, postnatal care, immunization, and family planning. This package facilitates the utilization of maternal, neonatal and child health services and contributes to the reduction of maternal and child mortality. However, there is no data on the utilization of this package in pastoralist societies. This study aimed to assess the utilization of the Family Health Service Package and associated factors among mothers of children less than 1-year-old. From February 18-March 6, 2017 we conducted a community-based cross-sectional study with 421 mothers who gave birth in the last year in the Afdem district of the Somali region in Ethiopia. Mothers who gave birth between January 1/2016 to January 1/2017 in the district were selected by systematic random sampling. The study analysis included descriptive and bivariate statistics and multivariate logistic regression model. The overall utilization of the package was 25.1% (95% CI of 21.1-29.5%). Factors associated significantly with family health service utilization were urban place of residence [(AOR 95% CI) = 3.8 (1.5-9.9)], mother visited by health extension workers [(AOR (95% CI) = 3.1 (1.6-6.3)] and mothers participation in health extension program activities [(AOR (95% CI) = 2.8 (1.5-5.4)]. The utilization of the Family Health Service Package was low. Mothers visited by health extension workers and participated in the health extension program were more likely to utilize family health services. It needs to expand services beyond urban areas and involve rural mothers in health extension program activities.

Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia.

BACKGROUND: Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. METHODOLOGY: We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. RESULT: The prevalence of diabetes mellitus in this study was 13.5%. Age 26-40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. CONCLUSION: This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.

Birth Preparedness among Women Who Gave Birth in the Last Twelve Months in Jardega Jarte District, Western Ethiopia.

BACKGROUND: Lack of preparedness for rapid action in the event of obstetric complications was the major problem contributing for delay in receiving skilled obstetric care. This study aimed to assess birth preparedness and factors associated with it among women who gave birth in the last 12 months preceding the survey in Jardega Jarte district, Western Ethiopia. METHODS: A community-based cross-sectional study was conducted from January to February 2016. A total of 581 women who gave birth recently were randomly selected for an interview. Data were entered and analyzed using SPSS version 21. Binary logistic regression was performed to identify predictive factors. Statistical significance was declared at p<0.05. RESULTS: From 581 questionnaires distributed, 570 were completed making the response rate 98%. The mean age was 28 with a standard deviation of 5 years. Ninety percent of the respondents were rural in residency. The average family size was 6 with a range of 13. Majority of the respondents were grand multipara, 261(45.6%). Despite the majority (69.3%) of the respondents reported as they made arrangement for birth, only 27.5% of them were well-prepared for birth and its complication management. Urban residency (AOR=3.4, 95% CI: 1.7-6.9), primipara (AOR=5.12, 95% CI: 2.4-10.8), history of obstetric complication (AOR=4.05, 95% CI: 2.4-7.75), and attending antenatal care (AOR=2.9, 95% CI: 1.67-5.16) were independently associated with preparation for birth and its complication. CONCLUSION: This study revealed that only about a quarter of pregnant women were well-prepared for delivery and complication management. Urban residencies, history of past obstetric complications, availing antenatal care, primipara, and absence of an under-five child in the household during recent delivery were predictors of birth preparedness. On the other hand, availing health service to such rural areas, giving more attention to the grand multiparous mothers with large family size will be important interventions to prevent pregnancy-related complications. Such efforts would benefit from accessing antenatal care and family planning services.

Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern Ethiopia.

Healthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories, etc in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management. A facility based cross-sectional study design was applied on 400 health workers. All public health institutions inside Jigjiga town were included and the study participants were randomly selected from each health facility. Data were collected using pre-tested and self administered questionnaire. The collected data was analyzed using SPSS version 20. Multivariable logistic regression model was used to identify factors associated with knowledge and practice of health workers. Out of those involved in this study, 47.7% and 42.3% of respondents had good knowledge and good practice on healthcare waste management, respectively. Health workers in the age group of 35-44 years, nurses, midwifes, medical laboratory, were significantly associated with knowledge of health workers. On the other hand, only educational status was significantly associated with practice. In this study, both knowledge and practice of health workers about healthcare waste management was poor. To enhance both the knowledge and practice of health workers, on job training is recommended.

Trend and causes of adult mortality in Kersa health and demographic surveillance system (Kersa HDSS), eastern Ethiopia: verbal autopsy method.

BACKGROUND: The health problems of adults have been neglected in many developing countries, yet many studies in these countries show high rates of premature mortality in adults. Measuring adult mortality and its cause through verbal autopsy (VA) methods is becoming an important process for mortality estimates and is a good indicator of the overall mortality rates in resource-limited settings. The objective of this analysis is to describe the levels, distribution, and trends of adult mortality over time (2008-2013) and causes of adult deaths using VA in Kersa Health and Demographic Surveillance System (Kersa HDSS). METHODS: Kersa HDSS is a demographic and health surveillance and research center established in 2007 in the eastern part of Ethiopia. This is a community-based longitudinal study where VA methods were used to assign probable cause of death. Two or three physicians independently assigned cause of death based on the completed VA forms in accordance with the World Health Organization's International Classification of Diseases. In this analysis, the VA data considered were of all deaths of adults age 15 years and above, over a period of six years (2008-2013). The mortality fractions were determined and the causes of death analyzed. Analysis was done using STATA and graphs were designed using Microsoft Excel. RESULTS: A total of 1535 adult deaths occurred in the surveillance site during the study period and VA was completed for all these deaths. In general, the adult mortality rate over the six-year period was 8.5 per 1000 adult population, higher for males (9.6) and rural residents (8.6) than females (7.5) and urban residents (8.2). There is a general decrease in the mortality rates over the study period from 9.4 in 2008-2009 to 8.1 in 2012-2013. Out of the total deaths, about one-third (32.4%) occurred due to infectious and parasitic causes, and the second leading cause of death was diseases of circulatory system (11.4%), followed by gastrointestinal disorders (9.2%). Tuberculosis (TB) showed an increasing trend over the years and has been the leading cause of death in 2012 and 2013 for all adult age categories (15-49, 50-64, and 65 years and over). Chronic liver disease (CLD) was indicated as leading cause of death among adults in the age group 15-49 years. CONCLUSION: The increasing TB-related mortality in the study years as well as the relative high mortality due to CLD among adults of age 15-49 years should be further investigated and triangulated with health service data to understand the root cause of death.

Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study.

BACKGROUND: Human immunodeficiency virus (HIV) compromises the nutritional status of infected individuals and in turn, malnutrition worsens the effects of the infection itself by weakening the immune system consequently accelerating disease progression and death. However, few studies have examined the association between nutritional status at antiretroviral therapy (ART) initiation and early mortality. Therefore, this study assesses pre-ART nutritional status and other baseline characteristics and mortality among adult patients on ART at Fiche Hospital, Ethiopia. METHODS: A retrospective cohort study was conducted among 489 ART enrolled adult patients between August 01, 2006 and September 30, 2013 in Fiche Hospital. Study participants were selected by using systematic random sampling method. Actuarial table was used to estimate survival of patients after ART initiation and log rank test was used to compare the survival curves. Cox proportional-hazard regression was used to determine independent predictors of time to death. RESULTS: Most of the study subjects were females 254 (51.9%). A total of 489 patients were included in the analysis, of whom 87 died during a median study follow-up of 22 months. The estimated mortality among malnourished was 21, 28, 33, and 38% at 5, 10, 15, and 25 months respectively with mortality incidence density of 5.63 deaths per 100 person years. The independent predictors of mortality were: BMI <18.5 kg/m2 (AHR = 5.4 95% CI 3.03-9.58), baseline ambulatory functional status (AHR = 3.84; 95% CI 2.19-6.74), bedridden functional status (AHR = 4.78; 95% CI 2.14-10.65), WHO clinical stage III (AHR 2.21; 95% CI 1.16-4.21), WHO clinical stage IV (AHR 4.05; 95% CI 1.50-10.97) and CD4 count less than 200 cells/µl (AHR = 2.95; 95% CI 1.48-5.88), two and more opportunistic infections (AHR 2.30; 95% CI 1.11-4.75). CONCLUSIONS: Undernutrition at the time of ART initiation was associated with increased risk of death, particularly during the first 3 months after ART initiation. Interventions to promote earlier HIV diagnosis and treatment and integrating nutrition counseling at all stages of ART implementation may improve ART outcomes in this vulnerable population.

Neonatal mortality and causes of death in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia, 2008-2013.

BACKGROUND: In the world, Neonatal mortality accounts for 40 % of death of children under the age of 5 years. Majority of neonatal deaths occur in developing countries outside of formal health system, among which death in the first hour of first day of their life constitute the huge bulk. This analysis is intended to estimate neonatal mortality rates and identify the leading causes of death based on the surveillance data over 6 years period in Kersa health and demographic surveillance system (Kersa HDSS) site, Eastern Ethiopia. METHODS: Kersa HDSS is an open dynamic cohort of population established in 2007. The surveillance started after conducting a baseline census followed by population update and events registration on house-to-house visits every 6 months. Data were collected using verbal autopsy (VA) questionnaire from close relatives (usually mothers in this case) and causes of deaths were assigned by 2 to 3 physicians. This analysis was done based on 301 neonatal deaths and 10,934 live births occurred during 2008 to 2013. RESULTS: The overall neonatal death rate during the study period was 27.5 per 1000 live births. Nearly all neonatal deaths (94 %) occurred at home. More than four-fifth (82.4 %) of the deaths was occurred in the first week of life. More than 80 % of the deaths were due to perinatal causes. Bacterial sepsis of the newborn accounted for 31.2 % followed by birth asphyxia and perinatal respiratory disorder (28.2 %), and prematurity (17.3 %). Higher number of death was observed in Tolla and Bereka sub-districts located at the southern parts of the study site which are away from the main road network. CONCLUSION: The overall neonatal mortality over 6 years is the same to the national average (27 per 1000 live births). The leading causes of neonatal death were bacterial sepsis of newborn and birth asphyxia. Community-based skilled health care delivery during birth should be emphasized.

Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia.

BACKGROUND: The global burden of mortality among children is still very huge though its trend has started declining following the improvements in the living standard. It presents serious challenges to the well-being of children in many African countries. Today, Sub-Saharan Africa alone accounts for about 50% of global child mortality. The overall objective of this study was to determine the magnitude and distribution of causes of death among children aged 5 to 14 year olds in the population of Kersa HDSS using verbal autopsy method for the period 2008 to 2013. METHODS: Kersa Health and Demographic Surveillance System(Kersa HDSS) was established in September 2007. The center consists of 10 rural and 2 urban kebeles which were selected randomly from 38 kebeles in the district. Thus this study was conducted in Kersa HDSS and data was taken from Kersa HDSS database. The study population included all children aged 5 to 14 years registered during the period of 2008 to 2013 in Kersa HDSS using age specific VA questionnaires. Data were extracted from SPSS database and analyzed using STATA. RESULTS: A total of 229 deaths were recorded over the period of six years with a crude death rate of 219.6 per 100,000 population of this age group over the study period. This death rate was 217.5 and 221.5 per 100,000 populations for females and males, respectively. 75% of deaths took place at home. The study identified severe malnutrition(33.9%), intestinal infectious diseases(13.8%) and acute lower respiratory infections(9.2%) to be the three most leading causes of death. In broad causes of death classification, injuries have been found to be the second most cause of death next to communicable diseases(56.3%) attributing to 13.1% of the total deaths. CONCLUSION AND RECOMMENDATION: In specific causes of death classification severe malnutrition, intestinal infectious diseases and acute lower respiratory infections were the three leading causes of death where, in broad causes of death communicable diseases and injuries were among the leading causes of death. Hence, concerned bodies should take measures to avert the situation of mortality from these causes of death and further inferential analysis into the prevention and management of infectious diseases should also be taken.

HDSS Profile: The Kersa Health and Demographic Surveillance System.

Kersa HDSS was established in 12 sub-districts of Kersa district, Eastern Hararge, Oromia Region, Ethiopia. The site is principally rural with two small towns (Kersa and Weter). The baseline census was conducted in 2007 and since then has been updated every 6 months, with registration of demographic and health events. Data are entered into the HRS-2 relational database. At baseline a total of 10,085 houses, 10,522 households and 50,830 people were registered. The sex ratio and number of persons per household were 1.0 and 5.1, respectively. At the end of 2013, the population was 60,694. Up to the end of 2013, 12,571 births and 3143 deaths were registered, respectively. Over 85% of births and deaths occurred at home. The annual net population growth ranges from 0.06 to 1.6. The majority of the population in Kersa are not working age group; hence the dependency ratio in most of the years is below 1. The total fertility rate ranges from 4.0 to 5.3. A reduction in neonatal, infant and under-five mortalities was observed. For all deaths, verbal autopsies were done. Tuberculosis is the leading cause of death among adults and malnutrition is the leading cause of death among children aged under 5 years. Kersa HDSS is ready to collaborate with interested researchers on health and demographic issues. For further details please visit: [http://www.haramaya.edu.et/research/projects/kds-hrc/].

Job satisfaction and associated factors among health care providers at public health institutions in Harari region, eastern Ethiopia: a cross-sectional study.

BACKGROUND: Human factor is the primary resource of health care system. For optimal performance of health care system, the workforce needs to be satisfied with the job he/she is doing. This research was aimed to assess the level of job satisfaction and associated factors among health care providers at public health institutions in Harari region, Eastern Ethiopia. METHOD: Health facility based cross-sectional study was conducted among 405 randomly selected health care providers in Harari regional state, Eastern Ethiopia. Data were collected by self-administered structured questionnaires. Epidata Version 3.1 was used for data entry and analysis was made with SPSS version 17. Level of job satisfaction was measured with a multi item scales derived from Wellness Council of America and Best Companies Group. The average/mean value was used as the cutoff point to determine whether the respondents were satisfied with their job or not. Multivariable logistic regression was used to analyze data and odds ratio with 95% CI at P ≤ 0.05 was used to identify associated factors with level of job satisfaction. RESULTS: Less than half 179 (44.2%) of the respondents were satisfied with their job. Being midwifery in profession [AOR = 1.20; 95% CI (1.11-2.23)], age less than 35 years [AOR = 2.0; 95% CI (1.67-2.88)], having good attitude to stay in the same ward for longer period [AOR = 3.21; 95 % CI (1.33, 5.41)], and safe working environment [AOR = 4.61; 95% CI (3.33, 6.92)] were found were found to be associated with job satisfaction. CONCLUSIONS: Less than half (44.2%) of the respondents were satisfied with their current job. Organizational management system, salary and payment and working environment were among factors that affects level of job satisfaction. Thus, regional health bureau and health facility administrators need to pay special attention to improve management system through the application of a health sector reform strategy.