Routine Collection of Patient-Reported Data to Support the Needs of Primary Care Within an Integrated Healthcare System.

Ontario Health Teams (OHTs), models of integrated care, are responsible for measuring and improving patient experience. However, routine collection of patient-reported data has not been fully realized, presenting a significant system-wide gap. We conducted a pilot study to implement routine collection of patient-reported data in the Frontenac, Lennox and Addington (FLA) OHT. Each clinic integrated the survey, which captured encounter experience, health and well-being and demographics into their workflow. During the five-month pilot, over 1,200 patients shared their experiences. Clinics reported that the data were valuable for ongoing quality improvement, boosting staff morale and providing a voice to patients. Each site needed flexibility for deployment and to ensure that they captured data relevant to their practice needs. A balance is needed to meet differing needs at each level of the system, requiring cross-sectoral commitment for integrated care systems to truly understand the patient experience and health of the population.

Prevalence and associated factors of malaria among pregnant women in Sherkole district, Benishangul Gumuz regional state, West Ethiopia.

BACKGROUND: Malaria during pregnancy leads to serious adverse effects on mothers and the fetus. Approximately 25 million pregnant women in sub-Saharan Africa live at risk of malaria. This study would help to achieve Sustainable Development Goals (SDGs) by improving programs that deal with the prevention of malaria. Therefore, this study aimed to assess the prevalence and associated factors of malaria among pregnant women. METHODS: A community-based cross-sectional study was conducted from July to August 2018 in Sherkole district, West Ethiopia. A multi-stage sampling technique was used to select 504 pregnant women. The interviewer-administered semi-structured questionnaire was used for data collection. Malaria was also diagnosed using a rapid diagnostic test. The data was entered using EPI info version 7.2.2.2 and transferred to SPSS version 20 for analysis. Descriptive statistics were done using frequency and percentages. Both bivariable and multivariable logistic regression models were employed. Variables having p-value < 0.2 were included in the final multivariable model. Variables having p-values < 0.05 from the multivariable model were considered to be significantly associated with the dependent variable. The adjusted odds ratio with its 95% confidence interval (CI) was used as a measure of association. RESULTS: Of the total 498 pregnant women who participated in this study, 51(10.2, 95% CI: 7.72-13.24) were found to have malaria. Of these, 46 (90.2%) and 5 (9.8%) were caused by Plasmodium falciparum and Plasmodium vivax, respectively. Decreasing Age (Adjusted Odds Ratio (AOR) 0.78; 95% CI 0.67-0.911), not using insecticide-treated bed net (ITN) (AOR 12.5; 95% CI 4.86-32.21), lack of consultation and health education about malaria prevention (AOR 7.18; 95% CI 2.74-18.81), being on second-trimester pregnancy (AOR 7.58; 95% CI 2.84-20.2), gravidae II (AOR 5.99; 95% CI 1.68-21.44) were found to be significantly associated with malaria during pregnancy. CONCLUSION: Malaria is still a public health problem among pregnant women in the Sherkole district. Age, ITN use, gravidity, gestational age, and health education had a significant association with malaria. Screening pregnant women for asymptomatic malaria infection and educating and consulting on the appropriate malaria preventive methods shall be provided.

Factors affecting current khat chewing among male adults 15-59 years in Ethiopia, 2016: a multi-level analysis from Ethiopian Demographic Health Survey.

BACKGROUND: Regular khat chewing causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems. Based on the Ethiopian Demographic and Health Survey (EDHS) 2016, 12% of women and 27% of men have reported having ever chewed khat. Even though khat addiction is a major public health problem, studies that consider both individual level and community level factors are limited. Therefore, this study aimed to determine the prevalence and factors affecting current khat chewing among male adults in Ethiopia. METHODS: Data from EDHS, a community-based cross-sectional study conducted from January 18, 2016, to June 27, 2016, was used. A multistage stratified cluster sampling technique was used to select participants. Both descriptive and analytical statistics were done. Bi-variable and multivariable multilevel logistic regression analyses were performed to determine factors affecting current khat chewing. Adjusted Odds ratio (AOR) with 95% Confidence Interval (CI) for variables with P-value < 0.05 was used as a measure of association. RESULT: A total of 12,595 male adults were included. The prevalence of current khat chewing was 23.61% (95% CI: 22.87, 24.36). Age 20-24 years; (AOR = 2.68, 95% CI: 2.02, 3.56), being uneducated (AOR = 1.62, 95% CI: 1.10, 2.39), professional/technical/managerial job (AOR = 3.59, 95% CI: 2.18, 5.91), Muslim religion (AOR = 18.30, 95% CI: 13.54, 24.74), poorest wealth index (AOR = 0.67, 95% CI: 0.51, 0.89), being divorced (AOR = 0.38, 95% CI: 0.21, 0.69), history of alcohol drinking in the last 30 days (AOR = 2.15, 95% CI: 1.69, 2.73), and history of cigarette smoking in the last 30 days (AOR = 14.92, 95% CI: 10.88, 20.47), and Amhara region (AOR = 0.07, 95% CI: 0.04, 0.14) were significantly associated with khat chewing. CONCLUSION: Khat chewing remains high in Ethiopia with certain regional variations. The uneducated, older age, Alcohol and cigarette users, Muslims, and professional workers were at higher risk of khat chewing whereas the poorest wealth index and being divorced reduced its risk. Policymakers should consider a multi-faceted policy approach that accounts for regional variation and the identified risk factors to alleviate the problem.

Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis.

BACKGROUND: Antenatal depression is a serious problem worldwide that has devastating consequences not only for the mother but also for the child and family. The pooled evidence regarding the prevalence and associated factors of antenatal depression is rare in Africa. Hence this review aimed to investigate the prevalence and associated factors of antenatal depression in Africa. METHODS: We searched CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases for English written observational studies conducted in Africa from 2007 to 2018.Quality of studies was assessed using the Newcastle Ottawa Scale (NOS), and studies with good quality were included in the final review. Heterogeneity across studies was assessed using the I2 and Higgins test. Publication bias was checked using Funnel plot symmetry, and Egger's regression test and adjustment was made by using Duval and Tweedie's Trim and Fill analysis. A random effect Meta-analysis was employed to determine the pooled estimates with 95% confidence interval (CI). Stata 14 was used for analysis. The review protocol has been registered in PROSPERO number CRD42018106717. RESULT: Of the 175 studies identified, 28 studies with an overall sample size of 17,938 were included. According to the random effect model following trim and fill analysis, the pooled prevalence of antenatal depression in Africa was 26.3% (95%CI: 22.2, 30.4%). Economic difficulties [POR = 1.87;95%CI:1.25,2.78,I2 = 88.1%], unfavorable marital condition [POR = 4.17;95% CI:1.75, 9.94, I2 = 81.2%], poor support from relatives [POR = 1.36;95% CI:1.18, 1.56, I2 = 78.0%], bad obstetric history [POR = 2.30;95% CI:1.81, 2.92), I2 = 81.7%], and history of mental health problem [POR = 2.97; 95% CI:1.74, 5.06, I2 = 92.0%]were the factors associated with antenatal depression. CONCLUSION: The prevalence of antenatal depression is high in Africa, which showed that one in four pregnant women had depression. Pregnant mothers who had economic difficulties, bad obstetric history, poor support from relatives, previous mental health problems, and unfavorable marital conditions were at higher risk of antenatal depression. Therefore these factors should be considered while designing mental health care services for pregnant mothers.

Factors affecting infant mortality in the general population: evidence from the 2016 Ethiopian demographic and health survey (EDHS); a multilevel analysis.

BACKGROUND: Infant mortality is one of the leading public health problems globally; the problem is even more staggering in low-income countries. In Ethiopia seven in ten child deaths occurred during infancy in 2016. Even though the problem is devastating, updated information about the major determinants of infant mortality which is done on a countrywide representative sample is lacking. Therefore, this study was aimed to identify factors affecting infant mortality among the general population of Ethiopia, 2016. METHODS: A Community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. A total of 10,641 live births were included in the analysis. Data were analyzed and reported with both descriptive and analytic statistics. Bivariable and multivariable multilevel logistic regression models were fitted by accounting correlation of individuals within a cluster. Adjusted odds ratio (AOR) with 95% confidence interval was reported to show the strength of the association and its significance. RESULTS: A total of 10,641 live-births from the Ethiopian demographic and health survey (EDHS) data were included in the analysis. Being male infant (AOR = 1.51; 1.25, 1.82), Multiple birth (AOR = 5.49; 95% CI, 3.88-7.78), Preterm (AOR = 8.47; 95% CI 5.71, 12.57), rural residents (AOR = 1.76; 95% CI; 1.16, 2.67), from Somali region (AOR = 2.07; 1.29, 3.33), Harari (AOR = 2.14; 1.22, 3.75) and Diredawa (AOR = 1.91; 1.04, 3.51) were found to be statistically significantly associated with infant mortality. CONCLUSION: The study has assessed the determinants of infant mortality based on EDHS data. Sex of the child, multiple births, prematurity, and residence were notably associated with infant mortality. The risk of infant mortality has also shown differences across different regions. Since infant mortality is still major public health problem interventions shall be done giving more attention to infants who were delivered multiple and who are preterm.

Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia.

BACKGROUND: Globally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association. RESULTS: In this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child's age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease. CONCLUSION: There was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.

Incidence and predictors of loss to follow-up among pregnant and lactating women in the Option B+ PMTCT program in Northwestern Ethiopia: a seven-year retrospective cohort study.

Introduction: Although Ethiopia has implemented the Option B+ program over the past 7 years, loss to follow-up among HIV-positive women remains a major problem for antiretroviral therapy (ART) treatment. This study was conducted to investigate the number of women who dropped out of follow-up after the Option B+ program. Methods: A retrospective follow-up study was conducted among 403 pregnant and lactating women between June 2013 and December 2019 at health facilities in Northwest Ethiopia. The Cox proportional hazards regression model was used to identify predictors of loss to follow-up. The results were reported as hazard ratios with 95% confidence intervals (CIs) at a significance level of p = 0.05. Results: The overall incidence rate of loss to follow-up was 9.4 per 1,000 person-months of observation (95% CI: 7.40-11.90). According to the multivariable Cox regression, rural residency [adjusted hazard ratio (AHR): 2.30; 95% CI: 1.08-4.88], being a Muslim religion follower (AHR: 2.44; 95% CI: 1.23-4.81), having no baseline viral load measurement (AHR: 4.21; 95% CI: 2.23-7.96), being on ART before enrolment (AHR: 0.30; 95% CI: 0.15-0.62), having drug side effects (AHR:1.82; 95% CI: 1.01-3.33), same-day ART initiation (AHR: 3.23; 95% CI: 1.53-6.84), and having suboptimal adherence level (AHR: 3.96; 95% CI: 2.18-7.19) were significant predictors of loss to follow-up. Conclusion: The incidence of loss to follow-up is lower as compared to evidence from most African countries but slightly higher than the WHO target. It is better to strengthen and expand viral load measurements for all women and to pay attention to women residing in rural areas with fair or poor adherence levels.

Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis.

INTRODUCTION: Multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are major public health threats that are significant causes of physical sequelae and financial consequences for infected people. Treatment for MDR- and XDR-TB are more toxic and take longer duration than for drug-susceptible-TB. As a result, the long-term sequelae are thought to be more common among patients with MDR- and XDR-TB than drug-susceptible-TB, but this is yet to be quantified. Hence, the aim of this systematic review and meta-analysis is to quantify the global burden and types of long-term physical sequelae and financial burden associated with both MDR- and XDR-TB. METHOD AND ANALYSIS: We will search CINHAL, MEDLINE, Embase, Scopus, and Web of science for studies that report physical and financial sequelae associated with rifampicin-resistant (RR), MDR- and XDR-TB or their treatments. The search will be conducted without time, language, and place restrictions. A random-effects meta-analysis will be conducted to estimate the pooled prevalence of each physical sequela. Heterogeneity will be measured using the Higgins I2 statistics. We will assess publication bias visually using the funnel plot and statistically using Egger's test. Adjustments for publication basis will be made using Tweedie's and Duval Trim and Fill analysis. ETHICS AND DISSEMINATION: Since the study is based on published evidence, ethics approval is not required. The findings of the systematic review will be presented at various conferences and will be published in a peer-reviewed journal. PROTOCOL REGISTRATION: The protocol is published in the PROSPERO with registration number CRD42021250909.

Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa.

Importance: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals. Objective: To evaluate key modifiable risk factors associated with childhood stunting in SSA. Design, Setting, and Participants: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries. Exposures: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel. Main Outcomes and Measures: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors. Results: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA. Conclusions and Relevance: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.

Midwifery-led researches for evidence-based practice: Clinical midwives engagement in research in Ethiopia, 2021.

INTRODUCTION: Health workers involvement in research had an impact on studies and whole system. They influence the clinical practice and help to implement evidences. Although International Confederation of Midwives (ICM) put research as one of the midwifery competencies and professional development activity, clinical midwives are poorly involved in research. Therefore, this study is aimed to assess clinical midwives engagement in research and bridge the gap through applicable strategies. METHOD: Institution-based cross-sectional study was conducted among clinical midwives working at public health facilities of Central and North Gondar Zone, Ethiopia from September to October, 2020 G.C. A structured and pre-tested self-administered questionnaire was used to collect data and entered into Epi-info version 7. Descriptive statistics was used to describe study population. Bi-variable and multi-variable logistic regression analysis was performed using STATA Version 14 and significance level declared at 95% confidence interval, p-value ≤ 0.05 and respective odds ratios. RESULT: Out of 335 clinical midwives, 314 were participated making the response rate 93.7%. Among the midwives, one hundred seventy two (54.8%) (95% CI: 49.08%, 60.37) have good skill on conducting a research. Clinical midwives with mothers with formal education [AOR: 1.90, 95% CI: (1.03, 3.51), currently work on referral hospitals [AOR: 2.33, 95% CI: (1.19, 4.53)] and having good level of knowledge on research [AOR: 2.19, 95% CI: (1.25, 3.82)] have significant association with having good research skill. Forty eight (15.2%) (95% CI: 11.5%, 19.7%) ever participated in research during their clinical practice. Clinical midwives who have good knowledge on research [AOR: 0.31, 95% CI: (0.14, 0.70)] are about 0.3 times less likely to participate on research than who have poor knowledge [AOR: 0.31, 95% CI: (0.14, 0.70)]. CONCLUSION AND RECOMMENDATION: Although more than half have good research skill, only a small proportion of midwives were involved in research. Capacity building activities are crucial to strengthen midwives skill on research and ensure their involvement.

Effect of perinatal depression on birth and infant health outcomes: a systematic review and meta-analysis of observational studies from Africa.

BACKGROUND: Antenatal depression is associated with intrauterine growth retardation, preterm birth, and low birth weight. Infants born to mothers with postnatal depression also may suffer from malnutrition and other health problems. Even though there are few single studies conducted so far, a systematic review of these studies is highly important to highlight the effect of antenatal and perinatal depression on adverse birth and infant health outcomes in Africa. METHODS: We used the Preferred Report Items for Systematic Review and Meta-analysis (PRISMA) when conducting this study. Databases like CINAHL (EBSCO), MEDLINE (via Ovid and PubMed), PsycINFO, Emcare, Psychiatry Online, and Scopus were searched. In addition, Google Scholar and references from a list of eligible studies were explored. We included good quality observational studies based on Newcastle Ottawa Scale which are published in the English language between 2007 and 2018.  Heterogeneity and publication bias were assessed. Meta-analysis with a random effect model was employed to determine the pooled effect sizes with a 95% confidence interval. The review protocol is registered in PROSPERO (CRD42018106714). RESULT: We found three studies (1511 participants) and 11 studies (22,254 participants) conducted on the effect of antenatal depression on birth outcomes and perinatal depression on adverse infant health outcomes, respectively. The overall risk of having adverse birth outcomes was 2.26 (95% CI: 1.43, 3.58) times higher among pregnant mothers with depression. The risk of preterm birth and low birth weight was 1.77 (95% CI: 1.03, 3.04) and 2.98 (95% CI: 1.60, 5.55) respectively. Similarly, the risk of having adverse infant health outcomes namely malnutrition and febrile illness was 1.61 (95% CI: 1.34, 1.95) times higher among mothers who had perinatal depression. CONCLUSIONS: We have found a significant association between antenatal depression and adverse birth outcomes, low birth weight and preterm birth. Similarly, a significant effect of perinatal depression on adverse infant health outcomes namely, malnutrition, and febrile illnesses was observed. The findings highlight that it is time to integrate mental health services with routine maternal health care services to improve birth outcomes and reduce infant morbidity.

The Role of GeneXpert MTB/RIF in Reducing Treatment Delay Among Multidrug Resistance Tuberculosis Patients: A Propensity Score Matched Analysis.

BACKGROUND: GeneXpert MTB/RIF testing is a rapid molecular diagnostic test that is performed with an automated cartilage-based machine that makes treatment initiation prompt. This study aimed at evaluating the impact of GeneXpert in the reduction of treatment delay among multidrug-resistant tuberculosis (MDR-TB) patients in Amhara regional state of Ethiopia. METHODS: A facility-based retrospective follow-up study was conducted from January to February 2019, and a total of 465 MDR-TB patients were included in the study. Socio-demographic, clinical, and treatment-related characteristics were collected from patient's chart retrospectively using data abstraction sheets. Binary logistic regression model was fitted to identify factors associated with treatment delay; adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. A propensity score-matched (PSM) analysis was used to assess the impact of the GeneXpert MTB/RIF test on treatment delay through calculation of average treatment effect (ATE). RESULTS: The majority, 92.4%, of patients had the pulmonary form of TB, and 46.7% of patients were diagnosed by GeneXpert MTB/RIF. The presence of cavitation (AOR = 0.62, 95% CI: 0.39 0.96), extrapulmonary form of TB (AOR = 0.34, 95% CI: 0.14 0.81), and GeneXpert (AOR = 0.15, 95% CI: 0.10 0.24) were factors associated with treatment delay. The average treatment effect (ATE) of PSM analysis showed that GeneXpert MTB/RIF has significantly reduced treatment delay by 41% compared to matched control groups. CONCLUSION: This study revealed that GeneXpert test has a strong association with the reduced treatment delays among MDR-TB patients. This underscores that rapid molecular tests could help improve the health system and lead to prompt initiation of MDR-TB treatment. Therefore, expansion and decentralization of GeneXpert tests to peripheral health facilities are highly recommended. In turn, the case detection and control of the disease will be hastened.

Rural Vaccination Coverage Among Children Aged 12-23 Months Was Higher Than the Urban Counterparts: A Comparative Cross-Sectional Study in Pawi District, Ethiopia.

BACKGROUND: In developing countries like Ethiopia, about 3 million children's deaths are attributed to vaccine-preventable diseases. Studies especially that try to explain the urban to rural vaccination coverage discrepancy are limited in the study area. This study aimed to assess full vaccination coverage and associated factors among children aged 12-23 months in rural and urban kebeles of Pawi district. METHODS: A community-based comparative cross-sectional study among urban and rural kebeles was conducted. A multistage sampling method was used to select 456 rural and 229 urban. Data were collected from mothers/caregivers using interviewer-administered questionnaires and vaccination cards. Full vaccination coverage was estimated for both urban and rural kebeles. Multivariable logistic regression analysis was used to identify factors associated with full vaccination. Adjusted Odds Ratio with a 95% confidence interval was reported. RESULTS: Full vaccination coverage was 67% (95% CI 63% -71%) and 60% (95% CI: 54% -66%) among rural and urban residents, respectively. Educational status of the father (AOR=2.69; 95% CI, 1.61-4.48), using postnatal care (PNC) (AOR=2.60; 95% CI, 1.58-4.29), discussion on side effect and contraindications of vaccines (AOR=1.82 95% CI, 1.16-2.88), and Institutional delivery (AOR=4.39, 95% CI 2.17-8.87) were factors significantly associated with full vaccination among rural children, whereas using Knowledge on immunization schedules (AOR=1.92 95% CI, 1.03-3.60), PNC (AOR=3.19; 95% CI, 1.57-6.47), discussion on side effects and contraindications of vaccines (AOR=2.75; 95% CI, 1.4-5.3) were notably associated with full vaccination among urban children. CONCLUSION: The study reveals vaccination coverage was higher in rural compared to urban kebeles but it is still far below the WHO recommended target. Therefore interventions shall be made to improve the coverage especially by using the identified factors like improving PNC service and promoting institutional delivery and health education.

Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study.

BACKGROUND: Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals. METHODS: A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p-value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association. RESULTS: About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia. CONCLUSIONS: This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.

High burden of depression among cancer patients on chemotherapy in University of Gondar comprehensive hospital and Felege Hiwot referral hospital, Northwest Ethiopia.

INTRODUCTION: Cancer, the most stressful event a person may experience often triggers depression. Depression among these groups of people, in turn, affects chemotherapy adherence, length of hospitalization, quality of life and cancer treatment outcome. Even though the problem is enormous studies that address it are limited. Therefore this study was conducted to determine the prevalence of depression and associated factors among cancer patients on chemotherapy in Felege-Hiwot referral hospital and University of Gondar referral hospital, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from April to May 2019. A total of 302 cancer patients on chemotherapy were included. Depression was assessed using the patient health questionnaire (PHQ-9). Binary logistic regression was used to select variables and determine Crude Odds Ratio (COR). Variables with P value < 0.2 were entered into multivariable logistic regression. Adjusted Odds Ratio (AOR) with 95% confidence intervals for variables with P-value < 0.05 was estimated to show factors affecting depression among cancer patients. The fitness of the model was checked by using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: The prevalence of depression among cancer patients on chemotherapy was 70.86% (95% CI: 65.38, 75.92). Educational status of college and above (AOR = 0.1, 95% CI: 0.02, 0.43), Jobless (AOR = 0.15, 95% CI: 0.04, 0.58), Underweight(AOR = 2.39, 95% CI: 1.10, 5.19)chemotherapy duration ≥ 6 months or more (AOR = 2.36, 95% CI: 1.16, 4.79) were notably associated with depression. CONCLUSION: The burden of depression among cancer patients in this study was high. We recommend concerned bodies working to curve the problem to intervene based on the identified risk factors. Improving educational status, reducing work stress and maintaining normal weight would reduce depression.

The Burden of Hypertension and Associated Factors Among Adults Visiting the Adult Outpatient Department at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2016.

BACKGROUND: Hypertension is a global health concern that can lead to cardiovascular disease and death. In Ethiopia, the risks for cardiovascular disease have been increasing dramatically. But due to the high burden of communicable diseases, less emphasis is given to non-communicable diseases like hypertension. This study aimed to fill the information gap by determining the prevalence and the key determinants of hypertension in the study area. METHODS: Institution-based cross-sectional study was conducted in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia from September to October 2016. A total of 414 adults visiting medical OPDs were selected using systematic random sampling. Data were collected by blood pressure measurements and a pre-tested structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression analysis was used to determine the adjusted odds ratio with a 95% confidence interval. The goodness of fit of the model was also checked by Hosmer and Lemeshow test. RESULTS: The overall prevalence of hypertension in the study area was 38.9% (95% CI: 34.1-43.7). Age above 55 years (AOR = 3.33, 95% CI: 1.88-5.90), family history of hypertension (AOR = 2.71, 95% CI: 1.37-5.36), diabetes (AOR = 4.15, 95% CI 1.77-9.72), obesity (AOR = 5.50, 95% CI: 2.07-14.62), knee arthritis (AOR = 1.71, 95% CI: 1.24, 2.36), and not walking at least for 10 minutes continuously on daily basis (AOR = 2.86, 95% CI: 1.15 -7.12) were found to be independent predictors of hypertension. CONCLUSION: Prevalence of hypertension was high in the study area, and a large proportion of them were also newly diagnosed. Factors like age, family history of hypertension, diabetes, obesity, knee arthritis, and exercise were found to be independent predictors of hypertension. Therefore, we recommend people who have these risk factors to have screening for hypertension.

Epidemiology of postnatal depression and its associated factors in Africa: A systematic review and meta-analysis.

INTRODUCTION: Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of postnatal depression is high. However, it is under-investigated hence under-treated. To fill this information gap and to advise further interventions, we aimed at analyzing its epidemiology in Africa. METHODS: We searched observational studies conducted in Africa and published in between 01/01/2007 and 30/06/2018 in CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases. We assessed the quality of the studies using the Newcastle Ottawa Scale (NOS) and included studies with good quality. We evaluated the heterogeneity using the Higgins I2 statistics. We used a random-effects model to pool estimates. We assessed publication bias using the funnel plot and Egger's test statistics and adjusted using Tweedie's and Duval Trim and Fill analysis. The protocol has been registered in the PROSPERO (Protocol No. CRD42018100461). RESULTS: Nineteen studies involving 40,953 postnatal mothers were part of this systematic review and meta-analysis. The overall pooled prevalence of PND was 16.84% (95% CI: 14.49% -19.19%). The odds of having PND was higher among women with a poor obstetric condition (POR = 2.11; 95% CI: 1.11-4.01) and history of adverse birth and infant health outcomes (POR = 2.85; 95% CI: 1.29-6.25). Having a history of common mental health disorders (POR = 2.47; 95% CI: 1.51-4.04), poor social support (POR = 2.06; 95% CI: 1.05-4.05), lower economic status (POR = 2.38; 95% CI: 1.75-3.23), and those who had exposure to a different form of intimate partner violence (POR = 2.87; 95% CI: 1.60-5.16) had higher odds of PND. CONCLUSION: While robust prevalence studies are scarce, our review indicated a high prevalence rate of postnatal depression. The analysis also identified postpartum women at increased risk of PND. Therefore, there is a need to design and escalate comprehensive strategies to decrease its burden, focusing on those women at risk of PND.

The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. A systematic review and meta-analysis of observational studies.

BACKGROUND: Globally, Severe Acute Malnutrition (SAM) has been reduced by only 11% over the past 20 years and continues to be a significant cause of morbidity and mortality. So far, in Sub-Saharan Africa, several primary studies have been conducted on recovery rate and determinants of recovery from SAM in under-five children. However, comprehensive reviews that would have a shred of strong evidence for designing interventions are lacking. So, this review and meta-analysis was conducted to bridge this gap. METHODS: A systematic review of observational studies published in the years between 1/1/2000 to 12/31/2018 was conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. Two reviewers have been searched and extracted data from CINAHL (EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases, and Google scholar. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with fair to good quality were included in the final analysis. The review presented the pooled recovery rate from SAM and an odds ratio of risk factors affecting recovery rate after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42019122085. RESULT: Children with SAM from 54 primary studies (n = 140,148) were included. A pooled rate of recovery was 71.2% (95% CI: 68.5-73.8; I2 = 98.9%). Children who received routine medication (Pooled Odds ratio (POR):1.85;95% CI: 1.49-2.29; I2 = 0.0%), older age (POR: 1.99;95% CI: 1.29-3.08; I2 = 80.6%), and absence of co-morbidity (POR:3.2;95% CI: 2.15-4.76; I2 = 78.7%) had better odds of recovery. This systematic review and meta-analysis suggestes HIV infected children had lower recovery rate from SAM (POR; 0.19; 95% CI: 0.09-0.39; I2 = 42.9%) compared to those non-infected. CONCLUSION: The meta-analysis deciphers that the pooled recovery rate was below the SPHERE standard, and further works would be needed to improve the recovery rate. So, factors that were identified might help to revise the plan set by the countries, and further research might be required to explore health fascilities fidelity to the WHO SAM management protocol.

Factors Affecting Under-Five Mortality in Ethiopia: A Multilevel Negative Binomial Model.

PURPOSE: Even though remarkable declines in under-five mortality rates noticed globally, nearly 5.6 million children still die annually before celebrating their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1000 live births died before the fifth birthday. This study aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016. MATERIALS AND METHODS: The data were retrieved from the EDHS 2016, and a total weighted number of 11,023 under-five children were included. Descriptive statistics were reported using tables, graphs, and texts. A multilevel negative binomial regression model was fitted, and adjusted incidence rate (ARR) with a 95% confidence interval (CI) and a p-value <0.05 were reported. The deviance test was used to check the goodness of fit. RESULTS: Mother attained higher education (ARR=0.25, 95% CI: 0.10-0.66), female-headed household (ARR=1.32, 95% CI: 1.05-1.66), age of household head (AIRR=1.07, 95% CI: 1.03,1.11), preceding birth interval ≥48 months (ARR=0.51, 95% CI: 0.42-0.61), child who had history of diarrhea (ARR=1.23, 95% CI: 1.08-1.41), multiple birth type (ARR=1.80, 95% CI: 1.34-2.42), mothers who delivered in health facility (ARR=0.86, 95% CI: 0.73,0.94), residents of Addis Ababa (ARR=0.52, 95% CI: 0.28-0.98), and Amhara region (ARR=1.43, 95% CI: 1.09, 1.88) were statistically significant with the number of under-five mortality. CONCLUSION: In this study, under-five mortality remains a public health problem in Ethiopia. Educational status of the mother, women delivered at health institution, preceding birth interval 24-35 and ≥48, and residents of Addis Ababa reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employed, having multiple births, and childhood diarrhea were associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to reduce the burden of under-five mortality.

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia.

OBJECTIVES: This study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia. DESIGN: An institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016. SETTING: Selected government health institutions in the Amhara region, Ethiopia. PARTICIPANTS: Children treated in therapeutic feeding units for SAM were included. OUTCOME MEASURES: Time to recovery from SAM. RESULTS: One thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11-28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery. CONCLUSIONS: The time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.