Epidemiological survival pattern, risk factors, and estimated time to develop tuberculosis after test and treat strategies declared for children living with human immune deficiency virus.

BACKGROUND: Due to their age category and the immune-suppressing effects of HIV, children were more vulnerable to experience endogenous reactivation of latent bacilli in the lung and increased risk of active tuberculosis incidence. The aim of this study is to assess the survival pattern, risk factors, and estimated time to develop TB after children started ART at selected health facilities of North Wollo, Ethiopia, from November 1, to September 30, 2021. METHODS: Facility-based retrospective cohort study was employed from November 1 to September 30, 2021. Cox proportional hazard regression model was used to assess factors associated with incidence of tuberculosis. AHR with 95% CI was used to declare statistical significance for tuberculosis incidence. RESULTS: During follow-up, 54 (10.9%) new cases of tuberculosis was reported. At the end of follow-up period, overall cumulative survival probability was determined as 43.8% (95%CI: 28.2-54.3). WHO clinical stage III&IV (AHR: 2.4 (95% CI: 1.4, 4.7), Hgb≤10 gm/dl (AHR = 2.2: (95%CI: 1.12-5.8), missed isoniazid preventive therapy (AHR = 2.5 (95%CI: 1.56-10.3) and Viral Load (≥400 cell/ml) (AHR = 2.02 (95%CI: 2.03-6.8) were significant risk factors for tuberculosis incidence. CONCLUSION: Nearly ten % of HIV-positive children experienced new cases of tuberculosis with median time of 25(IQR = ±12) months. It would be better to give special attention to children who missed isoniazid preventive therapy with WHO stages III&IV Viral load (≥400 cells/ml), and Hgb≤10 gm/dl to prevent tuberculosis incidence and prolonged quality of life.

Polymerase chain reaction-positivity and predictors for SARS-CoV-2 infection among diagnosed cases' in North West Ethiopia.

Background: The lack of sophisticated diagnosing equipment for polymerase chain reaction (PCR) during the incidence of variant types of COVID-19 underestimates the morbidity and mortality patterns of this pandemic. Thus, this study aimed to estimate seropositive and confirmatory predictors for COVID-19 suspected and tested cases through polymerase chain reaction (RT-PCR) in two diagnosing. Methods: A facility-based descriptive cross-sectional study was employed among COVID-19 suspected cases from January 2, 2022, to June 9, 2022. The data were collected both using a structured interviewees and nasopharyngeal (NP) swabs. The nasal swab (NS) was analyzed in the laboratory for RNA detection of the virus using PCR. The collected data were entered into Epi Data version 4.2 and then exported to STATA (SE) version R-14 software for further analysis. multivariable logistic regression was used to assess the associated risk. Results: A total of 285 suspected cases have participated in this study. The overall mean (±SD) age of the participants was 37.5 (±18.5) years. The majority, 174 (61.1%) of the tested groups were symptomatic when diagnosed. The positivity of RT-PCR for suspected and COVID-19 diagnosed cases were confirmed in 62/285 (21.75%). In multivariable analysis, they were aged 26-50 years (adjusted odds ratio [AOR] = 4.2, 95% confidence interval [CI] = 1.5-10.75), had comorbidity (AOR = 5.8; 95% CI = 2.1-12.2), and cigarette smokers (AOR = 13.5; 95% CI = 5.3-36.6) were significantly associated with developing COVID-19 infection. Conclusion: More than two in every nine suspected cases were positive RT-PCR tests, and the infectivity of COVID-19 was significantly associated with age 25-50 years, comorbidities, and cigarette smoking. The deployment of high-quality diagnostic kits like RT-PCR is crucial for the early detection and risk stratification of suspected cases.

Incidence and Predictors of Inpatient Mortality Rate After Cases Started Care in the Intensive Care Unit in Debre Markos Referral Hospital.

Background: The intensive care unit (ICU) is a separate area in which potential health care services for patients who are in critical condition with detailed observation, monitoring, and advanced treatment than other units. This study aimed to assess the incidence and predictors of inpatient mortality after inpatient treatment was started in Debre Markos Comprehensive Specialized Hospital. Methods: A facility-based retrospective cohort study was employed among 384 ICU-admitted patients from December 30, 2020 to January 1, 2022. The collected data were entered into Epi Data version 4.2 and exported to STATA 14.0 for further analysis. The Cox proportional hazard regression model was fitted after checking using the Schoenfeld residual and log-log plot test. A categorical variable with an adjusted hazard ratio of 95% CI was claimed for predictors. Result: Overall, 384 admitted adult patients were included in the final analysis with a mean (±SD) age of 42.1 (±17.1) years. At the end of the follow-up period, 150 (39.06%) cases died in the ICU. The overall incidence of the mortality rate was 16.9 (95% CI: 13.7-19.55) per 100 person per day. Epidemiologically, 347 (90.36%) cases were medical illness, 25 (6.51%) surgical, and 12 (3.13%) were obstetric cases, respectively. The median length of inpatient stay was found to be 4.9 (IQR ± 2.8) days. In multivariable analysis; being (+) for human immunodeficiency virus (AHR = 0.59, 95% CI: 0.39-0.91), age ≥65yearas (AHR = 1.61, 95% CI: 1.11-2.32), and admission on weekend-time (AHR = 1.48, 95% CI: 1.06-2.06) were predictors of inpatient death. Conclusion: The overall in-hospital mortality rate was significantly higher than in the previous study in this hospital with a short median survival time. The inpatient mortality rate was significantly associated with age ≥65 years, being HIV positive, and admission during weekend time. Therefore, effective intervention strategies should be highly needed for ICU team members for early risk factors prevention.

Exploring multi-level risk factors and post-war burdens of trachomatous trichiasis among displaced population in Raya Kobo districts, implication for urgent action.

AIM: To estimate post-war burdens of trachomatous trichiasis (TT) and multi-level risk factors among displaced population in Raya Kobo districts, implication for urgent action. METHODS: A community-based cross-sectional study was conducted among 603 participants from randomly selected 14 displaced slums in the Raya Kobo district. The data was collected from February 16th to March 30th, 2023. Study participants were selected using the multistage sampling technique. A structured questionnaire and ophthalmic loupe with ×2.5 magnificence were used to collect from participants. Multi-level binary logistic regression was used to determine associated factors with TT infection. Adjusted odds ratio (AOR) with 95% confidence interval (CI) were claimed for the strength of association at P<0.05. RESULTS: We recruited 602 (99.9%) participants for the final analysis. From the total, 126 (20.9%) and 98 (16.3%, 95%CI: 13.5%-19.4%) participants were diagnosed with active trachoma & TT infection, respectively. Being age ≥45y (AOR=7.9, 95%CI: 2.4-25.3), having multiple eye infections (AOR=2.73, 95%CI: 1.47-5.29), poor wealth index (AOR=9.2; 95%CI: 2.7-23.7) and twice face washing per day (AOR=0.082, 95%CI: 0.03-0.21) has identified as individual as factors for TT infection. Whereas, distance between clean water source ≥10 km (AOR=6.5, 95%CI: 3.9-31.3), and latrine availability (AOR=0.35, 95%CI: 0.21-0.58) were the two community-level factors associated with TT infections. CONCLUSION: The high prevalence of TT infection post-war throughout the study districts indicates a need for urgent clinical intervention in addition to rapid scaling up surgery, antibiotics, facial cleanliness, and environmental improvement (SAFE) strategies, strategy for high-risk population. Age≥45y, distance from the clean water source, poor wealth indexes, and eye infection are identified to be risk factors for TT infection. Furthermore, community-level preventative factors for TT infection are found as latrine availability and face washing practice.

Prevalence of active trachoma infection and associated factors post-war resettled population in raya kobo districts, North East Ethiopia: A community-based cross-sectional study in 2022.

Background: Active trachoma infection poses a serious threat to public health, particularly for those who live in an unprivileged area and has practiced open-field defecation. This study aimed to estimate the prevalence of active trachoma infection and associated factors in the post-war resettled population in Raya Kobo district, North East Ethiopia: a community-based cross-sectional study in 2022. Methods: A community-based cross-sectional study was conducted among 602 participants randomly selected in 14 slum villages in Raya Kobo from February 16th to March 30th, 2023. After the data was collected using a semi-structured questionnaire and entered into Epi-data version 3.2. The study participants were chosen using a two-stage sampling process. Binary logistic regression was used to identify factors for active trachoma infection. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were claimed for the strength of association at p < 0.05. Results: Overall, 602 (99.9%) study participants were included in the final analysis. At the end of the study period, 126 (20.9) participants developed active trachoma infection. On multivariable analysis, were aged ≥45 years (AOR = 7.9, 95% CI = 2.4-25.3), history of eye infection (AOR = 3.7, 95% CI = 2.4-10.4, p = 0.001), were poor wealth index (AOR = 9.2, 95% CI = 2.7-23.7), having separated kitchen (AOR = 4.05, 95% CI = 1.86-8.86), living with animals (AOR = 5.92, 95% CI = 2.31-14.7) and having got administration of mass-drug (AOR = 8.9, 95% CI = 2.36-33.6) were significant risk factors for active trachoma infection. Whereas, face washing practice regularly (AOR = 0.23, 95% CI = 0.127-0.43), and toilet availability (AOR = 0.35, 95% CI = 0.20-0.97) were preventive factors for active trachoma infection. Conclusion: A significant prevalence of active trachoma infection was reported in the area as compared with previous findings and urgent clinical intervention, and the WHO critical SAFE strategies (surgery, antibiotics, facial cleanliness, and environmental improvement) implementation is highly needed in the area. In addition, healthcare providers should focus on information dissemination on proper latrine utilization, and washing the face regularly to prevent active trachoma infection is highly recommended.

Rate, risk factors and estimations of time to develop severe acute malnutrition after children receiving antiretroviral therapy at selected health facilities in northwest Ethiopia.

Severe acute malnutrition (SAM) affects up to 50 % of children with HIV, especially those who reside in resource-constrained healthcare setting like Ethiopia. During subsequent follow-up of children factors related to incidence of SAM after antiretroviral therapy (ART) is set on, however, there is no prior evidence. An institution-based retrospective cohort study was employed among 721 HIV-positive children from 1 January to 30 December 2021. Data were entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. Bi-variable and multivariable Cox-proportional hazard models were employed at 95 % confidence intervals to identify significant predictors for SAM. According to this result, the overall mean (±sd) age of the participants was found to be 9⋅83 (±3⋅3) years. At the end of the follow-up period, 103 (14⋅29 %) children developed SAM with a median time of 30⋅3 (13⋅4) months after ART initiation. The overall incidence density of SAM was found to be 5⋅64 per 100 child (95 % CI 4⋅68, 6⋅94). Children with CD4 counts below the threshold [AHR 2⋅6 (95 % CI 1⋅2, 2⋅9, P = 0⋅01)], disclosed HIV status [AHR 1⋅9 (95 % CI 1⋅4, 3⋅39, P = 0⋅03)] and Hgb level ≤10 mg/dl [AHR 1⋅8 (95 % CI 1⋅2, 2⋅9, P = 0⋅03)] were significant predictors for SAM. Significant predictors of acute malnutrition were having a CD4 count below the threshold, children who had previously reported their HIV status, and having haemoglobin <10 mg/dl. To ensure better health outcomes, healthcare practitioners should improve earlier nutritional screening and consistent counselling at each session of care.

Rate, risk factors and estimated time to develop attrition after under-five children started moderate acute malnutrition treatment in Gubalafto, North East Ethiopia.

Lost from follow-up, after starting moderate acute malnutrition (MAM) is an ongoing challenge of public health until the admitted children reached the standard weight of a reference child. Thus, the present study aimed to assess the rate and estimated time to attrition after under-five children started treatment for MAM in the Gubalafto district. A facility-based retrospective cohort study was employed among 487 participant children who had been managed targeted therapeutic feeding from 1 June 2018 to 1 May 2021. The overall mean (±sd) age of the participants' children was 22⋅1 (±12⋅6) months. At the end of the study period, 55 (11⋅46 %) under-five children developed attrition from the treatment after starting ready use of therapeutic feeding. After checking all assumptions, a multivariable Cox regression model was used to claim independent predictors for time to attritions. The median time of attrition after starting treatment of MAM was 13 (IQR ±9) weeks, with the overall incidence of attrition rate reported at 6⋅75 children Per Week (95 % CI 5⋅56, 9⋅6). In the final model of multivariable Cox regression, the hazard of attrition was significantly higher for children from rural residence (AHR 1⋅61; 95 % CI 1⋅18, 2⋅18; P = 0⋅001), and caregivers with their dyads did not get nutritional counselling at baseline (AHR 2⋅78; 95 % CI 1⋅34, 5⋅78; P = 0⋅001). The findings of the present study showed that nearly one in every eleven under-five children was attrition (lost to follow-up) in a median time of 13 (IQR ±9) weeks. We strongly recommended for caregivers provisions of diversification of daily nutrition supplementation of their dyads.

Iodine status, impact of knowledge, and practice for adequate iodized salt utilization in house hold at North West Ethiopia.

Introduction: Iodine is one of the crucial micronutrients required for the normal growth of humans from the fetal stage to adulthood through the synthesis of thyroxin (t3) and triiodothyronine (t4) hormones in the thyroid gland for regulation of metabolism, protein synthesis, and brain development. This study aimed to assess iodine status, the impact of knowledge and practice for adequate iodized salt utilization in household levels in North West Ethiopia. Method: A population-based cross-sectional study was carried out using multistage sampling among 1398 residents from 28 December 2021 to 30 January 2022. A systematic random sampling technique was used to select the study participants. The collected data were entered into Epi-Data version 3.1 and then exported to STATA/R version 14 for further analysis. An adjusted odds ratio with 95% CI was used to declare statistical significance at p < 0.05. Result: The overall mean (±SD) age of participants was 34.9 (±12.8) years. About 678 (48.5%) had 15-80 ppm, 23 (1.6%) had >80 ppm, 533 (38.13%) had 1.1 ppm to 14.9 ppm, and 147 (10.5) had no iodine in salt (0 ppm) after assessed by Rapid Test Kit. Only 48.5% of the sampled household had used adequate iodized salt with ≥15 ppm. The overall burden of goiter was estimated at 11.4/1000 population. Adequate iodized salt utilization was significantly associated with having formal education (adjusted odds ratio = 1.89: 95% confidence interval: 1.4, 2.6, p = 0.001), monthly income ≥5000 ETB/month (adjusted odds ratio = 1.99: 95% confidence interval: 1.5, 2.9, p = 0.001), and good knowledge score (adjusted odds ratio = 1.6: 95% confidence interval: 1.12, 2.6, p = 0.03) were predictors for proper iodized salt utilization. Conclusion: Coverage of adequately iodized salt was low and respondents' formal education, monthly income ≥5000 Ethiopian Birr/month, and good knowledge score were all significantly associated with proper iodized salt utilization. While the prevalence of goiter was not significantly identified as a public health problem as compared in the regions, however, in light of previous iodine deficiency in this region of Ethiopia, the salt iodization program should be done continually.

Incidence and predictors of attrition rate after children started inpatient treatments for complicated severe acute malnutrition in North West Ethiopia.

BACKGROUND: Retaining children for inpatient treatment of complicated severe acute malnutrition (SAM) is a growing challenge until achieved the reference weight of a child. In Ethiopia, there is limited information regarding the time to be lost from the stabilizing centers after initiation of treatment. Thus, this study aimed to identify incidence and predictors of attrition for children suffering from SAM after started inpatient treatment in North West Ethiopia. METHODS: A retrospective cohort study was conducted among under-five children admitted and started inpatient treatment for complicated SAM from 2015/2016 to 2020/2021. Data were entered using Epi-data version 4.2 and then exported to STATA (SE) version R-14 software for further analysis. The analysis was computed using Cox proportional hazard regression model after checking all proportional hazard assumptions. Covariates having < 0.2 of P values in the bi-variable analysis were candidates transferred to the multivariable Cox proportional hazard regression model. Finally, a statistical significance was declared at a P value of < 0.05. RESULT: Overall, 760 files of under-five children were analyzed with a mean (± SD) age of participants 27.8 (± 16.5) months. About 6944 child-days of treatment observation were recorded with the crude incidence of attrition rate of 9.7% (95% CI 7.9-12.6). The overall median time of attrition and half-life time S(t1/2) of survival rates was determined as 14 (IQR = ± 7) days and 91.6% (95% CI 88.2-93.1), respectively. The attrition rate was significantly associated with cases living in rural residents (AHR = 6.03; 95% CI 2.2; 25.2), being re-admitted SAM cases (AHR = 2.99; 95% CI 1.62; 5.5), and caregivers did not have formal education (AHR = :5.6, 95% CI 2.7; 11.7) were all independent predictors for attrition from inpatient treatment. CONCLUSIONS: Nearly one in every ten severely acute malnourished under-five children defaulted at the end of treatment observation with a median time of 14 (IQR = ± 7) days. Living in a rural residence, being re-admitted cases, caregivers who did not have a formal education were significantly associated with the attrition rate. Hence, it is crucial to detect and control the identified causes of defaulting from treatment observation promptly. Furthermore, serious counseling during admission and nutritional provision strategies are essential for virtuous treatment outcomes.

Does Therapeutic Zinc Level of Supplementation for Diminutions of Acute Diarrheal Morbidity Varied in Public and Private Health Institutions in Ethiopia, Data from EDHS 2016?

Background: Supplementation of zinc is a therapeutic medication for under-five children diminution incidence, severity, duration, and intensity of acute diarrhea morbidity. Nevertheless, levels of therapeutic zinc supplementation varied across public and private health institutions in Ethiopia. Thus, this study was aimed at estimating the levels of therapeutic zinc supplementation and factors associated for intent to be utilized among caregivers with their dyads, data from Ethiopia Demographic and Health Survey (EDHS 2016). Methods: The data used were from a secondary analysis of the Ethiopia Demographic and Health Survey in 2016 (EDHS). Overall, 1090 under-five children with acute diarrheal cases of two weeks before the EDHS 2016 were included. After cleaning, editing, and coding variables, the result was presented with frequency, tables, and graphs. Bivariable and multivariable logistic regression was conducted to identify and determine factors associated after zinc is prescribed for utilizations by caregivers. Result: The mean (±SD) age of participant children was found to be 36.4(±7.07) month. The overall levels of therapeutic zinc supplementation were 38.7% (95% CI: 35.8, 41.6) in public (29.08%) and private 138 (12.66%), respectively. The prescribed therapeutic zinc was influenced for utilization through maternal educational status (AOR = 2.55; 95% CI: 1.95, 3.47; P = 0.001), availability of health insurance (AOR = 10.7; 95% CI: 7.2, 16; P = 0.001), media exposure status (AOR = 2.1; 95% CI: 1.7, 3.6; P = 0.001). Conclusion: More than twofold time therapeutic zinc was prescribed in public than in private health institutions. Health care workers should be encouraged both in public and private health institutions for zinc prescription.

Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital.

BACKGROUND: Relapse or repeated episodes is the admission of a child with the diagnosis of severe acute malnutrition (SAM) after being discharged to a status of treated and cured from a stabilizing center. A child may experience more than one episode of SAM depending on the improvement of the underlying comorbidity. Thus, this study aimed to estimate the time to readmission of SAM and associated factors for under-five children in North West Ethiopia. METHODS: An institution-based retrospective cohort study was employed in 760 files of under-five children spanning from 2014/15 to 2019/20. The data extraction tool was developed from SAM treatment guidelines and medical history sheets. Epi Data version 3.2 and STATA version 14 were used for data entry and final analysis, respectively. After checking all assumptions, the multivariable Cox Proportional Hazard model was fitted to the isolated independent predictors for time to readmission. A categorical variable with p < 0.05 was considered a risk factor for the relapse of SAM. RESULT: The mean (± SD) age of participant children was 27.8 (± 16.5) months with mean (± SD) time to relapse of SAM cases were 30.4(± 21.39) weeks posttreatment discharge. The overall incidence density rate of relapse was determined as 10.8% (95% CI 8.3; 12.6). The average time (± SD) for treatment recovery from the first admission of the SAM case was 28.8(± 18.7) days. Time of readmission was significantly associated with living in rural resident (AHR 5⋅3 = 95% CI, 2⋅95, 13⋅87, p = 0.021), having HIV infection (AHR6⋅8 = 95%CI; 4.1-11.9 p = 0.001), and first admission with edema (AHR = 3.5 = 95% CI; 1.92, 6.2, p = 0.018). CONCLUSION: Nearly one in every ten severely acute malnourished under-five children relapsed within a mean time to relapse 30.4(± 21.39) weeks posttreatment discharge. Time to relapse was significantly associated with being a rural resident for children, having edema during the first admission, and being HIV-infected cases. A protocol ought to be drafted for extending Supplementary Nutrition in Acute Malnutrition management program following discharge is highly needed.

Malaria serosurvey among acute febrile patients come for health care seeking at the high malaria-endemic setting of North West Ethiopia.

Objectives: This study aimed to assess malaria seroprevalence among acute febrile illness cases who come for health care seeking in the high malaria-endemic setting of North West Ethiopia. Methods: Institutional-based descriptive serosurvey of malaria infections was employed among 18,386 febrile patients from September 2020 to August 2021. Data were entered using Epi Data version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Bi-variable and multivariable regression analyses were conducted to identify malaria infection. Finally, variables with P-value less than 0.05 were considered significant predictors for malaria infection. Results: The mean (±standard deviation) age of participants was 48.6 (±18.4) years. The overall seroprevalence of malaria infection was estimated as 27.8% (95% confidence interval = 27.2; 28.6, standard error = 0.003). Malaria infection was significantly associated with participants being female (adjusted odds ratio = 2.9; 95% confidence interval = 1.8; 3.7, P = 0.01), age 5-29 years (adjusted odds ratio = 2.2; 95% confidence interval = 1.7; 2.8, P = 0.02), rural (adjusted odds ratio = 3.9; 95% confidence interval = 1.9; 4.4, P = 0.001), and Hgb ⩽11 mg/dL (adjusted odds ratio = 3.4; 95% confidence interval = 1.9; 5.86, P = 0.01). Conclusion: Nearly every three to ten acute febrile cases were positive for confirmed malaria infection. The risk of malaria infection was significantly associated with respondents being female, aged 5-29 years, rural, and levels of hemoglobin were significantly associated with malaria infection.

Prevalence and Associated Risk Factors of Endoparasites among Under-Five Children in Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Northwest Ethiopia: A Cross-Sectional Study.

Many endoparasites are still considered neglected tropical illnesses. The term "endoparasites" refers to infections caused by both helminths and protozoa. In many places in Ethiopia, particularly Debre Tabor, epidemiological data on the prevalence and associated variables of endoparasites among under-five children is unavailable. Thus, the aim of this study was to gather baseline data on the prevalence of endoparasites and their associated variables among under-five children who visited the Debre Tabor comprehensive specialized hospital in Northwest Ethiopia. A hospital-based quantitative cross-sectional study was used. The study was carried out from May 1 to November 30, 2021. Study participants were selected by a systematic sampling technique. The stool specimen was examined for the presence of different stages of intestinal parasites (adult, trophozoite, larvae, cysts, and ova) using direct wet mount, modified formal-ether sedimentation, and modified Ziehl-Neelsen methods. The IBM SPSS statistical package (version 23) was used to enter and analyze the collected data. The data was summarized using frequency tables and a bar chart. The adjusted odds ratio and p value <0.05 were used to declare the final association. In the present study, a total of 258 under-five children and their mothers/guardians were involved in the study, with a response rate of 100%. More than half of the respondents, 137 (53.10%), were females, and 159 (61.63%) were in the age group of 24 to 59 months. The overall prevalence of one or more endoparasites among under-five children was 45 (17.44%). Multivariate logistic regression analysis showed that health supervision, child food freshness, regular trimming of fingernails, and children's playground cleanliness were significantly associated with childhood endoparasites. The present study demonstrated a higher prevalence of endoparasites among under-five children. Health supervision, child food freshness, regular trimming of fingernails, and children's playground cleanliness were significantly associated with endoparasites. Thus, strengthening health education about food, personal, and environmental hygiene for both children and their mothers/guardians is crucial.

Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia, 2009-2019.

OBJECTIVE: This study aimed to assess Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia 2009-2019. METHODS: Institutional-based retrospective cohort study was employed among 721 on antiretroviral therapy care seropositive children since 2009-2019. Data were entered using EpiData version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Beside, Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. Bivariable and multivariable Cox regression analyses were conducted to identify the predictors of mortality. Finally, variables with p-value less than 0.05 were considered significant predictors of mortality. RESULT: Overall, 721 (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. A median time of death was reported at 19.5 months (interquartile range = ±8.5). The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% confidence interval: 3.6-5.8). Severe stunting (height for age Z-score <-3) (hazard ratio = 2.9, 95% confidence interval: 1.8-6.4), admission with septic shock (hazard ratio = 2.3, 95% confidence interval: 1.2-4.3, p < 0.008), CD4+ count below threshold (hazard ratio = 1.6, 95% confidence interval: 1.19-7.9), and World Health Organization Stages III and IV (hazard ratio = 2.9, 95% confidence interval: 1.8-6.4) were at high risk of mortality. CONCLUSION: A high rate of SAM associated mortality rate within short median (±SD) time to death was reported as compared with previous finding in Ethiopia. Seropositive children presenting with CD4 counts being below a threshold, World Health Organization Stages III and IV, and being nutritionally stunted during antiretroviral therapy initiation were at high risk of early mortality.

Predictors for adult COVID-19 hospitalized inpatient mortality rate in North West Ethiopia.

Objectives: The spread of severe acute respiratory syndrome coronavirus 2 in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths to other regions of the sub-Sahara African including Ethiopia. Timely and effective predictors for inpatient mortality rate were crucial for improving the management of hospitalized cases. This study aimed to assessed predictors for inpatient mortality of COVID-19 hospitalized adult patients in two diagnosed and treatment centers, North West Ethiopia. Methods: A facility-based retrospective cohort study was conducted among COVID-19 adult admitted cases in two treatment centers, Northwest Ethiopia, from 1 October 2020 to 30 December 2020. Data from the records of children were extracted using a standardized checklist. Epi-Data version 3.2 was used for data entry, and Stata version 14 was used for analysis. Bi-variable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Finally, variables with P < 0.05 were a significant predictor of inpatient mortality. Result: The mean (±standard deviation) age of participant cases was 48.6 (±18.8) years. The median (±interquartile range) time for death reported after was 13 (±6) days. The overall incidence rate inpatient mortality rate was determined as 1.8 (95% confidence interval: 1.72, 2.15) per100 person per days of observation. Cases at baseline age ⩾ 61 years (adjusted hazard ratio = 1.56; 95% confidence interval: 1.3, 2.4), being male gender (adjusted hazard ratio = 1.9; 95% CI: 2.1, 8.6), admission with comorbidity (adjusted hazard ratio: 4.4, 95% confidence interval: 2.3, 8.4), and decreased neutrophil count ⩽ 65 103/uL at (P < 0.03) were independent predictors for inpatient mortality. Conclusion: In general, 72.4% of COVID-19 inpatient deaths were occurred within 2 weeks after admission. The mortality risk factors for severe patients identified in this study using a multivariate Cox regression model included elderly age (⩾60 years), being male, baseline comorbidity, and neutrophil count ⩽65 103/uL were associated with inpatient mortality.

Effects of Undernutrition and Predictors on the Survival Status of HIV-Positive Children after Started Antiretroviral Therapy (ART) in Northwest Ethiopia.

Malnutrition and human immunodeficiency virus/acquired immunodeficiency syndrome have complex and multidirectional relationships. Ethiopia is one of the countries hardest hit by the HIV epidemic as well as malnutrition. This study was aimed at assessing the effects of undernutrition on the survival status of HIV-positive children who received HIV/AIDS care in Northwest Ethiopia. Materials and Methods. A facility-based retrospective follow-up was conducted from January 1, 2009, to December 31, 2020. The data was entered into EpiData version 4.2.0. Then, the entered data was exported to STATA 14 software for further analysis, and the Kaplan-Meier survival curve was used to estimate survival time after the initiation of ART. The Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality associated with undernutrition. Results. The mean (±SD) age of participant children was found 118.4 (±38.24) months. The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% CI: 3.6, 5.8). Children with CD4 cell counts below the threshold [AHR = 1.6; 95% CI (1.19, 7.85)], advanced WHO clinical stages (III and IV) HIV [AHR = 4.5; 95% CI (2.80, 8.40)], and being severe stunting at the beginning [AHR = 2.9; 95% CI (1.80, 6.40)] were significantly associated with mortality of HIV-positive children. Conclusion. The findings of the current study indicated that HIV-positive children on ART had a high rate of mortality. Baseline undernutrition has the mortality of children who had CD4 counts below a threshold, advanced WHO HIV clinical staging (III and IV), and being severe stunting (HAZ ≤ -3 Z score) which were found to be independent predictors for mortality of undernourished HIV.

Incidence and predictors of severe acute malnutrition mortality in children aged 6-59 months admitted at Pawe general hospital, Northwest Ethiopia.

BACKGROUND: Severe acute malnutrition (SAM) is defined as a weight-for-height < -3z scores of the median WHO growth standards, or visible severe wasting or the presence of nutritional edema. SAM related mortality rates in under-five children are well documented in Ethiopia but data on their predictors are limited. We aimed to document factors associated with SAM related mortality to inform better inpatient management. METHODS: A facility-based retrospective cohort study was conducted among children admitted due to SAM at Pawe General Hospital, Northwest Ethiopia, from the 1st of January 2015 to the 31st of December 2019. Data from the records of SAM children were extracted using a standardized checklist. Epi-Data version 3.2 was used for data entry, and Stata version 14 was used for analysis. Bi-variable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Variables with P<0.05 were considered significant predictors of mortality. RESULTS: Five-hundred sixty-eight SAM cases were identified of mean age was 27.4 (SD± 16.5) months. The crude death rate was 91/568 (16.02%) and the mean time to death was determined as 13 (±8) days. Independent risk factors for death were: (i) vomiting AHR = 5.1 (1.35-21.1, p = 0.026), (ii) diarrhea AHR = 2.79 (1.46-5.4, p = 0.002), (iii) needing nasogastric therapy AHR = 3.22 (1.65-6.26, p = 0.001), (iv) anemia AHR = 1.89 (1.15-3.2, p = 0.012), and (v) being readmitted with SAM AHR = 1.7 (1.12-2.8, p = 0.037). CONCLUSION: SAM mortality was high in under-five children in our setting. The identified risk factors should inform treatment and prevention strategies. Improved community health education should focus on healthy nutrition and seeking early treatment. Inpatient mortality may be reduced by stricter adherence to treatment guidelines and recognizing early the key risk factors for death.

Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009-2019.

The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4, T-lymphocytes, and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2-7.8, P=0.03), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1-8.1, P=0.001), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P=0.001) (AHR = 2.5; 95% CI, 1.4-4.7, P=0.021) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) IgG-antibody seroprevalence among quarantined population, during the first wave of COVID-19 pandemic, In North West Ethiopia (from 30 April to 30 May 2020).

OBJECTIVE: The spread of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) in Ethiopia is below par understood and to date has been poorly characterized by a lower number of confirmed cases and deaths as compared with other regions of the Sub-Saharan African (SSA) countries. We aimed to investigate the seroprevalence of SARS-CoV-2 specific IgG antibodies, using the Abbott anti-nucleocapsid IgG chemiluminescent microparticle immunoassay, in two COVID-19 diagnosed and treatment centers of quarantined population during the first wave of the COVID-19 pandemic (since 30 April-30 May 2020). METHODS: We analyzed data of 446 quarantined individuals during the first wave of COVID-19 pandemic. The data were collected using both interviewed and blood sample collection. Participants asked about demographic characteristics, COVID-19 infection symptoms, and its practice of preventive measures. Seroprevalence was determined using the severe acute respiratory syndrome coronavirus 2 IgG test. RESULTS: The mean (± standard deviation) age of the respondent was 37.5 (±18.5) years. The estimated SARS-CoV-2 infection seroprevalence was found 4.7% (95% confidence interval: 3.1-6.2) with no significant difference on age and gender of participants. Severe acute respiratory syndrome coronavirus 2 antibody seroprevalence was significantly associated with individuals who have been worked by moving from home to work area (adjusted odds ratio = 7.8, 95% confidence interval: 4.2-14.3, p < 0.019), not wearing masks (adjusted odds ratio = 2.4, 95% confidence interval: 1.9-3.8, p < 0.02), and baseline comorbidity (adjusted odds ratio = 6.3, 95% confidence interval: 2.3-17.1, p < 0.01) as compared to their counter groups, respectively. CONCLUSION: Our study concluded that lower coronavirus disease 2019 seroprevalence, yet the large population in the community to be infected and insignificant proportion of seroprevalence, was observed between age and sex of respondents. Protective measures like contact tracing, face covering, and social distancing are therefore vital to demote the risk of community-strengthening factors should be continued as effect modification of anticipation for severe course of coronavirus disease 2019.

Time to Develop and Predictors for Incidence of Tuberculosis among Children Receiving Antiretroviral Therapy.

Infection by the human immune deficiency virus (HIV) is the strongest risk factor for latent or new infection of tuberculosis (TB) through reduction of CD4 T-lymphocytes and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence of tuberculosis for children living with HIV. Thus, this study assessed time to develop and predictors for incidence of tuberculosis in children attending HIV/AIDS care in public hospitals: North West Ethiopia 2021. Methods. A facility-based retrospective cohort study was conducted among 421 seropositive children on antiretroviral therapy in two hospitals between January 1, 2011 and December 31, 2020. EPI-DATA version 3.2 and STATA/14 software were used for data entry and analysis, respectively. Tuberculosis-free survival time was estimated using the Kaplan-Meier survival curve. Bivariate and multivariable Cox regression model was fitted to identify predictors at a P value <0.05 within 95% CI. Results. In the final analysis, a total of 421 seropositive children were included, of whom, 64 (15.2%) developed tuberculosis at the time of follow-up. The mean (±SD) age of the children was 10.62 ± 3.32 years, with a median (IQR) time to develop TB that was 23.5 (IQR = ±19) months. This study found that the incidence of tuberculosis was 5.9 (95% CI: 4.7; 7.6) per 100 person-years (PY) risk of observation. Cases at baseline not taking cotrimoxazol preventive therapy (CPT) (AHR = 2.5; 95% CI, 1.4-4.7, P < 0.021), being severely stunted (AHR = 2.9: 95% CI, 1.2-7.8, P < 0.03), and having low hemoglobin level (AHR = 4.0; 95% CI, 2.1-8.1, P < 0.001) were found to be predictors of tuberculosis. Conclusion. A higher rate of tuberculosis incidence was reported in our study as compared with previous studies in Ethiopia. Cases at baseline not taking cotrimoxazol preventive therapy (CPT), being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk to developed TB incidence.