Prevalence and Factors Associated with Delayed Initiation of Antiretroviral Therapy Among People Living with HIV in Nekemte Referral Hospital, Western Ethiopia.

BACKGROUND: Ethiopia has adopted the "Universal Test and Treat" strategy to its national policy in 2016 to put all people living with HIV/AIDS (PLHIV) on antiretroviral therapy (ART) regardless of their World Health Organization (WHO) clinical stage or CD4 cell count level. A significant percentage of PLHIV start therapy has been delayed despite the availability of ART, which results in poor treatment outcomes including HIV-related morbidity and mortality, and continued HIV transmission. METHODS: This cross-sectional study was conducted to determine the magnitude and associated factors of delayed ART initiation among PLHIV at ART Clinic, Nekemte Referral hospital, Western Ethiopia between January 1, 2020 and March 31, 2020 for the time period of January 1, 2016 to December 31, 2019. A consecutive sampling method was used to recruit 417 study subjects. The collected data were entered into Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Logistic regression analysis was used to identify associated factors with delayed ART initiation among PLHIV. P-values<0.05 were used to declare significant association. RESULTS: A total of 417 PLHIV were included in the study. The mean age of study subjects was 33.49 (SD±9.81) years. The majority of participants attended formal education (77%) and were urban dwellers (82%). One-third (34%) of them initiated ART delayed, beyond 7 days of confirmed HIV diagnosis. Subjects with normal nutritional status (BMI=18.5-24.9kg/m2) (AOR=3.12, 95% CI=1.29-7.57; P=0.012), CD4 count ≥351cells/mm3 (AOR=2.89, 95% CI=1.27-6.58; P=0.011), tuberculosis (TBC) co-infection (AOR=2.76, 95% CI=1.13-6.70; P=0.025), use of traditional treatment (AOR=4.03, 95% CI=2.03-8.00; P<0.001) and did not know other ART user(s) (AOR=2.86, 95% CI=1.52-5.37; P=0.001) were significantly associated with delayed ART initiation. CONCLUSION: Early HIV testing mechanisms and timely linkage to HIV care by advocating "Test-and-Treat" should be strengthened.

Poor child complementary Feeding Practices in northwest Ethiopia: Finding from the Baseline Survey of Nutrition Project, 2016.

BACKGROUND: Improving infant and young child feeding practices is critical to improved nutrition, health, and development of children. Ethiopia adopted the WHO recommendations of child feeding practices and developed the national guideline. In spite of this fact, only few children start and received appropriate complementary feeding based on the recommendation. Therefore, the study aimed to determine dietary diversity score and its associated factors among under five children at Dabat Health and Demographic Surveillance System site (HDSS), northwest Ethiopia. METHODS: A cross-sectional community based study was carried out from February to June 2016. All children aged 6-59 months old who lived in HDSS site were included in the survey. Odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of association. Finally, variables with a P-value of < 0.05 were considered statistically significant.. RESULTS: In this study, a total of 3433 children were included. About 34.87% (95%CI: 33.27, 36.49%) of the children received adequately diversified diet. The odds of receiving adequately diversified diet was higher among children whose mother had secondary and above education (AOR = 6.51; 95%CI: 4.95, 8.56), had antenatal care (AOR = 1.90; 95%CI: 1.60, 2.26) and postnatal care visits (AOR = 1.31; 95%CI: 1.00, 1, 72), and children who feed with their family (AOR = 1.39; 95%CI: 1.17, 1.65). However, a lower dietary diversity score was observed among younger children; 6-11 months old (AOR = 0.59; 95%CI: 0.41, 0.85), and children from food insecure household (AOR = 0.76; 95%CI: 0.63, 0.92). CONCLUSIONS: Diversified diet feeding practice is low in Dabat HDSS site. Age of the child, maternal education, antenatal and postnatal care visits, and household food insecurity were significantly associated with dietary diversity of children. Hence, ensuring household food security and enhancing the coverage of maternal health care utilization are recommended to increase dietary diversity of children.

Household food insecurity predisposes to undiversified diet in northwest Ethiopia: finding from the baseline survey of nutrition project, 2016.

OBJECTIVE: Adolescence represents a critical stage of life, characterized by rapid physical growth and development; varying levels of physical, social and psychological maturity; and a transition from total socio-economic dependence to relative independence. Focusing on adolescents' nutrition, especially girls, provides a unique opportunity to break the intergenerational cycles of malnutrition. But, there is little information about the dietary diversity of adolescent girls in Dabat district. Therefore, the survey aimed to assess the prevalence and associated factors of dietary diversity among adolescent girls. RESULTS: The overall prevalence of adequate dietary diversity among adolescent girls was 14.5 (95% CI 12.9, 16.2). The prevalence of adequate dietary diversity among adolescent girls was very low and food insecurity is one of the predisposing factors for low dietary diversity. Therefore, working to enhance household's food security status is recommended to boost dietary diversification of adolescent's girls.

Iodine status five years after the mandatory salt iodization legislation indicates above requirement: a cross sectional study in Northwest Ethiopia.

BACKGROUND: Iodine deficiency is one of a major nutritional problem. The study aimed to assess the iodine status of populations in Dabat district using median urinary iodine concentration (UIC) in school-age children (6-12 years) and compared the results with goiter prevalence. METHODS: The study used a cross-sectional study design. The study was conducted in Dabat district, northwest Ethiopia in May 2016. Spot urine samples were used for the determination of UIC. Manual examination of the thyroid gland was performed to assess presence of goiter. The MBI international Rapid Test Kits (RTK) were used to determine the level of salt iodine content. Children aged 6-12 years were recruited from schools using a multistage stratified sampling. One-way Analysis of Variance (ANOVA) was used to compare mean of log-transformed UIC values among key variables. Significant was determined at P-value less than 0.05. RESULTS: A total of 358 school age children enrolled to the study. The mean age of children was 10.8((Standard Deviation (SD) = 1.45) years and 56.7% were males. The median UIC was 235 µg/l ((Inter Quartile Range (IQR): 161, 320]. Excessive iodine intake and inadequate iodine intake was observed on 29.1 and 8.7% of school aged children, respectfully. The coverage of iodized salt use in school-age children were 66.8%. The UIC was higher in urban children than rural counterparts and in those used adequately iodised salt than inadequately iodized salt (P < 0.05). Thirty-four percent of school-age children had a goiter. The prevalence of grade 1 and grade 2 goiter was 26.5 and 7.5%, respectively. There was a poor agreement between UIC and goiter (k = 0.1) in classifying iodine status of populations. CONCLUSIONS: The study population is classified as above requirements by median UIC in school-age children but severe iodine deficiency by goiter prevalence. Further research investigating the agreement between UIC and goiter prevalence in classifying iodine status of populations with various iodine status is warranted.

Determinants of prenatal anemia in Ethiopia.

BACKGROUND: Anemia is responsible for 20% of maternal mortality worldwide, and it is associated with premature birth, low birth weight, and infant mortality. In Ethiopia, about 22% of pregnant women are anemic. However, literatures are limited, therefore, this study aimed to investigate the prevalence and associated factors of anemia among pregnant women attending antenatal care (ANC) in Asossa Zone Public Health Institutions, northwest Ethiopia. METHODS: A facility based cross-sectional study was conducted from February to March 2016. Data were collected by interviewer administered, pretested and structured questionnaires. A multi-stage sampling technique was used to select 762 pregnant women. The hemoglobin level was determined by taking 5 ml of venous blood using Sahli's method. A multivariate binary logistic regression model was fitted to identify factors associated with anemia. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was computed to show the strength of association and statistical significance was determined at a P-value of <0.05. RESULTS: The prevalence of anemia was 31.8% [95% CI: 28.9, 35.5]. In the adjusted analysis, maternal age of 30-34 years [AOR = 0.34, 95% CI: 0.14, 0.86], household size of ≥6 [AOR = 4.27, 95% CI: 1.58, 11.45], dietary diversity [AOR = 0.58, 95% CI: 0.38, 0.93], no meat consumption [AOR = 1.80, 95% CI: 1.11, 2.91], not drinking soft beverages [AOR =1.96, 95% CI: 1.19, 3.23], undernutrition [AOR = 7.38, 95% CI: 4.22, 12.91], not consuming fruits [AOR = 3.29, 95% CI: 1.59, 6.82], inter-pregnancy interval of ≥2 years [AOR = 0.59, 95% CI: 0.34, 0.99], and third trimester of pregnancy [AOR = 0.33, 95% CI: 0.20, 0.57] were significantly associated with anemia. CONCLUSIONS: The prevalence of prenatal anemia is high in the Asossa Zone; suggesting a moderate public health concern. Socio-demographic and dietary intake characteristics were significantly associated with anemia. Therefore, improving dietary diversity and animal food consumption are the key to reduce the high burden of anemia. It is also important to strengthen interventions aiming to reduce closed birth interval and teenage pregnancy.

Availability of adequately iodized in Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Universal salt iodization is the most cost-effective, safe and sustainable strategy to eliminate iodine deficiency disorders. However, little is known about the availability of adequately iodized salt in the northwestern part of Ethiopia. Thus, the aim of this study was to assess the availability of adequately iodized salt at the household level and associated factors in Dabat District, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from February 21 to March 31, 2016. We included 705 households in the study. A stratified multistage followed by simple random sampling technique was employed to select households. The level of salt iodine content was determined using the rapid field test kit. Accordingly, the value of <15 parts per million (PPM) and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine content in the sampled salt. A multivariable binary logistic regression model was fitted to identify factors associated with the availability of adequately iodized salt. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association. RESULTS: This study indicated that about 33.2% [95% CI: 29.6, 36.7%] of households had adequately iodized salt. Urban residence (AOR = 2.15, 95% CI: 1.23, 3.76), use of packed salt (AOR = 2.23, 95% CI: 1.01, 4.89), and good respondents' knowledge on iodized salt use (AOR = 1.49, 95% CI: 1.08, 2.08) were positively associated with the availability of adequately iodized salt. However, longer distance to buy salt was inversely related with availability of adequately iodized salt (AOR = 0.68, 95% CI: 0.48, 0.99). CONCLUSIONS: The availability of iodized salt is well under the WHO recommendation in Dabat District in spite of the fact that Ethiopia has been implementing universal salt iodization since the last five years. Therefore, intensifying strategies targeting to enhance community awareness on the benefit and handling practice of iodized salt is essential to improve availability of iodized salt. In addition, the focus needs to be on improving accessibility of iodized salt.

Poor dietary diversity, wealth status and use of un-iodized salt are associated with goiter among school children: a cross-sectional study in Ethiopia.

BACKGROUND: Globally, more than two billion people are at risk of iodine deficiency disorders, 32% of which are school children. Iodine deficiency has been recognized as a severe public health concern in Ethiopia, however little is known about the problem. Therefore, this study aimed to assess the prevalence of goiter and associated factors among school children (6 to 12 years) in Dabat District, northwest Ethiopia. METHODS: A school-based cross-sectional study was conducted from February 21 to March 31, 2016. A total of 735 school children were included in the study. A stratified multistage sampling followed by systematic sampling technique was employed to select the study participants. Thyroid physical examination was done and classified according to the World Health Organization recommendations as grade 0, grade 1, and grade 2. The level of salt iodine content was determined using the rapid field test kit. The value 0 parts per million (PPM), <15 PPM and ≥15 PPM with the corresponding color chart on the rapid test kit were used to classify the level of iodine in the sampled salt. A multivariable logistic regression analysis was employed to identify factors associated with goiter. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered statistically significant. RESULTS: In this community, the overall prevalence of goiter was 29.1% [95% CI: 25.9, 32.6], in which about 22.4 and 6.7% had goiter grade 1 and grade 2, respectively. The age of children (AOR = 1.13; 95% CI: 1.01, 1.26), being housewife mother (AOR = 1.49; 95% CI: 1.08, 2.15), use of unprotected well water source for drinking (AOR = 6.25; 95% CI: 2.50, 15.66), medium household wealth status (AOR = 1.78; 95% CI: 1.18, 2.92), use of inadequately iodized salt (AOR = 2.79; 95% CI: 1.86, 4.19), poor dietary diversity score of the child (AOR = 1.92;95% CI: 1.06, 3.48) and medium maternal knowledge (AOR = 0.65; 95% CI: 0.42, 0.94) were significantly associated with goiter. CONCLUSIONS: The prevalence of goiter is higher in Dabat District, which confirmed a moderate public health problem. Therefore, regular monitoring of household salt iodine content, improving access to safe water, promoting the importance of diversified food for children is recommended to address the higher burden of iodine deficiency.

Family planning use and associated factors among pastoralist community of afar region, eastern Ethiopia.

BACKGROUND: Ethiopia is the second most populous country in Africa with a total fertility rate (TFR) of 4.8 children per a woman and contraceptive prevalence rate (CPR) of 29 %. The overall prevalence of modern family planning in a pastoralist community, like Afar region, is low (9.1 %). This study aimed to assess family planning utilization and associated factors among married women of Afar region, Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted from January 10-28, 2013 among 602 women. Multistage sampling technique was used to select the study participants. Descriptive and multiple variable logistic regression analyses were done to isolate independent predictors on utilization of family planning using SPSS 20. RESULTS: The overall prevalence of family planning utilization in Afar region was 8.5 % (6.2-10.7). Majority of the women (92.2 %) had used injectable. The most common reasons mentioned in the non-use of family planning methods were religion-related (85.3 %), desire to have more children (75.3 %), and husband's objection (70.1 %). Women who had a positive attitude towards family planning utilization (AOR = 4.7, 95 % CI: 2.1, 10.3), owning radio (AOR = 1.8, 95 % CI: 1.02, 4.18), and literate (AOR = 4.4, 95 % CI: 1.80, 11.08) were more likely to use family planning methods as compared to their counterparts. The increase of monthly income was also associated with the likelihood of family planning methods utilization. The odds of using family planning methods were higher among those with monthly income of $27-$55.5 (AOR = 2. 0, 95 % CI: 1.9, 4.7) and > $55 (AOR = 4. 6, 95 % CI: 1.23-17.19) as compared to women with the lowest category of monthly income ($27 and less). CONCLUSION: The low coverage of family planning in the region could be due to the influence of husband, religious and clan leader. Attitude of women towards family planning methods, possession of radio, monthly income, and educational status could influence family planning utilization.

High Incidence of Tuberculosis in the Absence of Isoniazid and Cotrimoxazole Preventive Therapy in Children Living with HIV in Northern Ethiopia: A Retrospective Follow-Up Study.

OBJECTIVE: To identify the incidence of and predictors for tuberculosis in children living with HIV in Northern Ethiopia. DESIGN: Observational, retrospective follow-up study. METHODS: A total of 645 HIV-infected children were observed between September 2009 and September 2014. Cox regression analysis was used to identify predictors for developing TB. RESULTS: The incidence rate of tuberculosis was 4.2 per 100 child-years. Incidence of tuberculosis was higher for subjects who were not on cotrimoxazole preventive therapy, were not on isoniazid preventive therapy, had delayed motor development, had a CD4 cell count below the threshold, had hemoglobin level less than 10 mg/dl and were assessed as World Health Organization (WHO) clinical stage III or IV. CONCLUSION: Incidence of TB in children living with HIV was high. This study reaffirmed that isoniazid preventive therapy is one of the best strategy to reduce incidence of TB in children living with HIV. All children living with HIV should be screened for TB but for children with delayed motor development, advanced WHO clinical stage, anemia or immune suppression, intensified screening is highly recommended.

Emerging chronic non-communicable diseases in rural communities of Northern Ethiopia: evidence using population-based verbal autopsy method in Kilite Awlaelo surveillance site.

INTRODUCTION: In countries where most deaths are outside health institutions and medical certification of death is absent, verbal autopsy (VA) method is used to estimate population level causes of death. METHODS: VA data were collected by trained lay interviewers for 409 deaths in the surveillance site. Two physicians independently assigned cause of death using the International Classification of Diseases manual. RESULTS: In general, infectious and parasitic diseases accounted for 35.9% of death, external causes 15.9%, diseases of the circulatory system 13.4% and perinatal causes 12.5% of total deaths. Mortalities attributed to maternal causes and malnutrition were low, 0.2 and 1.5%, respectively. Causes of death varied by age category. About 22.1, 12.6 and 8.4% of all deaths of under 5-year-old children were due to bacterial sepsis of the newborn, acute lower respiratory infections such as neonatal pneumonia and prematurity including respiratory distress, respectively. For 5-15-year-old children, accidental drowning and submersion, accounting for 34.4% of all deaths in this age category, and accidental fall, accounting for 18.8%, were leading causes of death. Among 15-49-year-old adults, HIV/AIDS (16.3%) and tuberculosis (12.8%) were commonest causes of death, whereas tuberculosis and cerebrovascular diseases were major killers of those aged 50 years and above. CONCLUSION: In the rural district, mortality due to chronic non-communicable diseases was very high. The observed magnitude of death from chronic non-communicable disease is unlikely to be unique to this district. Thus, formulation of chronic disease prevention and control strategies is recommended.