Dietary diversity, meal frequency and associated factors among infant and young children in Northwest Ethiopia: a cross- sectional study.

BACKGROUND: Inappropriate feeding practice increases risk of under nutrition, illness, and mortality amongst children less than 2 years of age. The objective of this study is to assess minimum dietary diversity, meal frequency and its associated factors among infant and young children aged 6-23 months in Dangila Town, Northwest Ethiopia. METHODS: A community based cross sectional study was conducted. Simple random sampling technique was used to select study participants. Interviewer administered questionnaire were used. Bivariate and multivariable logistic regression analyses was employed to identify factors associated with minimum dietary diversity and meal frequency. RESULTS: A total of 920 children 6-23 months were included. Proportion of children who met the minimum dietary diversity and meal frequency was 12.6 and 50.4 %, respectively. Mothers education [AOR =2.52], age of a child [AOR = 2.05], birth order of index child [AOR = 2.08], living in urban area [AOR = 2.09], having home gardening [AOR = 2.03], and media exposure [AOR = 2.74] were positively associated with dietary diversity. Moreover, age of the child [AOR = 3.03], birth order of index child [AOR = 1.58], mothers involvement in decision making [AOR = 1.51], media exposure [AOR = 2.62], and having postnatal visit [AOR = 2.30] were positively associated with meal frequency. CONCLUSION: The proportion of children who received minimum dietary diversity and meal frequency was low. Being at younger age, first birth order, and lack of media exposure affect both dietary diversity and meal frequency. Increasing mother's education, home gardening, mass media promotion and empowering women in decision making are highly recommended to increase dietary diversity and meal frequency.

Health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy attending Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study.

OBJECTIVE: To determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy. DESIGN: Institution-based cross-sectional study based on random case selection was conducted. SETTING: The study was carried out at Mizan-Tepi University Teaching Hospital located in Southwest Ethiopia. PARTICIPANTS: A total of 346 patients with epilepsy who visited the psychiatric clinic for follow-up for at least 3 months and who were 18 years or older were included in the study. MAIN OUTCOME MEASURE: Health-related quality of life in epilepsy measured using quality-of-life in epilepsy (QOLIE)-31 health survey evaluated as a dependent variable with simple and multivariable linear regressions. RESULTS: The overall weighted mean score of health-related quality of life was 55.6 (SD=20.9). Only 50.3% of patients scored above a total score of 50. Age (ß=-0.35, 95% CI-0.46 to -0.23), anxiety (ß=-6.79, 95% CI -9.26 to -4.32), depression (ß=-7.36, 95% CI -10.16 to -4.55), low self-esteem (ß=-5.29, 95% CI -8.07 to -2.51), perceived stigma (ß=-3.62, 95% CI -6.30 to -0.94), taking medication two times or more times per day (ß=-2.4, 95% CI -4.58 to -0.27), being illiterate (ß=-4.1, 95% CI -6.87 to -1.31) and having more than two seizures for a year (ß=-4.18, 95% CI -6.97 to -1.39) were negatively affecting health-related quality of life while income of >1000 birr per month (ß=4.5, 95% CI 2.00 to 6.99), social support (ß=0.34, 95% CI 0.27 to 0.40) and being free of seizure for a year (ß=6.5, 95% CI 3.66 to 9.33) were positively affecting health-related quality of life. CONCLUSIONS: Only half of the patients with epilepsy in the study area are leading a better quality of life and the overall mean health-related quality of life score is lower than the global mean score. Health-related quality of life was inversely associated with age, anxiety, depression, low self-esteem, perceived stigma, taking medication two times a day or more, being illiterate and experiencing more than two seizures in a year. Besides controlling seizures, public educational campaigns should be conducted to raise public awareness regarding the need for social support.

Development and validation of an intrinsic capacity score in the UK Biobank study.

BACKGROUND: In 2015, the World Health Organization introduced the concept of intrinsic capacity (IC) to define the individual-level characteristics that enable an older person to be and do the things they value. This study developed an intrinsic capacity score for UK Biobank study participants and validated its use as a tool for health outcome prediction, understanding healthy aging trajectories, and genetic research. METHODS: Our analysis included data from 45,208 UK biobank participants who had a complete record of the ten variables included in the analysis. Factor adequacy was tested using Kaiser-Meyer-Olkin, Barthelt's, and the determinant of matrix tests, and the number of factors was determined by the parallel analysis method. Exploratory and confirmatory factor analyses were employed to determine the structure and dimensionality of indicators. Finally, the intrinsic capacity score was generated, and its construct and predictive validities as well as reliability were assessed. RESULTS: The factor analysis identified a multidimensional construct comprising one general factor (intrinsic capacity) and five specific factors (locomotor, vitality, cognitive, psychological, and sensory). The bifactor structure showed a better fit (comparative fit index = 0.995, Tucker Lewis index = 0.976, root mean square error of approximation = 0.025, root mean square residual = 0.009) than the conventional five-factor structure. The intrinsic capacity score generated using the bifactor confirmatory factor analysis has good construct validity, as demonstrated by an inverse association with age (lower intrinsic capacity in older age; (ß) =-0.035 (95%CI: -0.036, -0.034)), frailty (lower intrinsic capacity score in prefrail participants, ß = -0.104 (95%CI: (-0.114, -0.094)) and frail participants, ß = -0.227 (95%CI: -0.267, -0.186) than robust participants), and comorbidity (a lower intrinsic capacity score associated with increased Charlson's comorbidity index, ß =-0.019 (95%CI: -0.022, -0.015)). The intrinsic capacity score also predicted comorbidity (a one-unit increase in baseline intrinsic capacity score led to a lower Charlson's comorbidity index, ß = 0.147 (95%CI: -0.173, -0.121)) and mortality (a one-unit increase in baseline intrinsic capacity score led to 25 % lower risk of death, odds ratio = 0.75(95%CI: 0.663, 0.848)). CONCLUSION: The bifactor structure showed a better fit in all goodness of fit tests. The intrinsic capacity construct has strong structural, construct, and predictive validities and is a promising tool for monitoring aging trajectories.

Determinants of neonatal hypothermia among neonates admitted to neonatal intensive care unit northwest, Ethiopia, case-control study.

BACKGROUND: Neonatal mortality is a global public health problem disproportionally high in developing country including Ethiopia. Hypothermia plays a significant role in neonatal mortality. This study was conducted to identify determinants of neonatal hypothermia among neonates admitted to the neonatal intensive care unit (NICU) of public hospitals. METHODS AND MATERIALS: Institutional based unmatched case-control study was conducted in Bahir Dar town public hospitals among neonates admitted in the NICUs in 2019. A total of 387 participants were included in the study. Pretested, structured questionnaire, and data extraction checklist were used to collect results. Data analysis was done by using Stata version 14 . RESULTS: Low birth weight (adjusted odd ratio (AOR)=3.01, 95%CI: 1.50-5.58), nighttime delivery (AOR = 1.90, 95%CI: 1.13-3.13), lack skin to skin contact (AOR = 2.43, 95%CI: 1.42-4.16), delayed initiation of breast feeding (AOR = 2.24, 95%CI: 1.30-3.88), not wearing cape (AOR = 1.87, 95%CI: 1.07-3.26), and low Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score (AOR = 2.17, 95%CI: 1.15-4.10) were determinant variables of the neonatal hypothermia. CONCLUSIONS: Skin to skin contact, initiation of breast feeding, birth weight, time, low APGAR score, and not wearing cape were identified as independent determinates of neonatal hypothermia.

Assessing the diagnostic performance of a novel RT-PCR fluorescence method for the detection of human plasmodium species.

BACKGROUND: Malaria elimination effort is hampered not only by the lack of effective medication but also due to the lack of sensitive diagnostic tools to detect infections with low levels of parasitemia. Therefore, more sensitive and specific high-throughput molecular diagnostic approaches are needed for accurate malaria diagnosis. METHODS: In the present study, the performance of a novel single-tube MC004 real-time polymerase chain reaction (PCR) assay (MRC-Holland, Amsterdam, the Netherlands) was assessed for the detection of infection and discrimination of Plasmodium species. Blood samples (n = 150) were collected from malaria suspected patients at Adama malaria diagnosis and treatment centre, Adama, central Ethiopia. The positive predictive value (PPV), negative predictive value (NPV), analytical sensitivity and specificity of the assay were assessed against the conventional microscopic method. RESULTS: Plasmodium species were detected in 59 (39.3%) of the samples by microscopy and in 62 (41.3%) by the novel MC004 RT-PCR. Plasmodium vivax, Plasmodium falciparum and mixed infections with Plasmodium falciparum & Plasmodium vivax accounted for 47.5%, 40.6% and 11.9% respectively as detected by microscopy. The MC004 RT-PCR assay identified 59.7% and 40.3% of the samples positive for Plasmodium vivax and Plasmodium falciparum respectively. The sensitivity, specificity, PPV, and NPV of the MC004 RT-PCR assay were 95.8%, 97.8%, 92%, and 98.9%, respectively. No mixed infections were detected using the MC004 assay. CONCLUSION: The MC004 RT-PCR assay is a useful tool for the early detection of malaria and identification of Plasmodium species with a high degree of sensitivity and specificity. Due to its high sensitivity, and simplicity (being a single-tube assay), the MC004 is suitable for use in clinical settings and epidemiological studies.

Surgical output within the Fast Track Initiative against trachoma in Amhara region, Ethiopia.

INTRODUCTION: Trachomatous trichiasis (TT) is the advanced stage of trachoma where lashes touch the globe of the eye causing permanent damage. Without eyelid surgery, TT can lead to irreversible blindness. In 2015 the Ethiopian Ministry of Health launched the Fast Track Initiative with the aim of enhancing the provision of surgical services for TT. The aims of this study were to determine the productivity of individual surgeons during the 2017 Initiative, to compare this productivity with the Ministry's annual target indicator of ≥ 200 surgeries, and to assess the factors associated with surgical output. METHODOLOGY: This retrospective cross-sectional study utilized programmatic data on surgical output from 140 surgeons active from January 2017 through December 2017 in the eastern half of Amhara region, Ethiopia. Data were collected from a surgery monitoring dataset, analyzed, and compared to the performance targets set by the Ministry. RESULTS: The mean annual number of surgeries carried out per surgeon was 169 (standard deviation: 111) for a total of 23,616 surgeries. Among the 140 surgeons, 38% achieved the target set by the Ministry. Location of surgical training site and estimated surgical backlog were signficantly associated with a higher surgery output. CONCLUSIONS: An increase in surgical output was observed compared to productivity prior to the Initiative, although the average annual output during the 2017 Fast Track Initiative was lower than the Ministry's target. Using data driven approaches to setting annual productivity goals should be considered, particularly in light of fewer remaining TT cases as a result of the successful Initiative.

Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia.

BACKGROUND: The risk of death from complications relating to pregnancy and childbirth for women's lifetime is higher in developing countries. Improving maternal and child health through a well-organized institutional delivery service is central to achieving reduced maternal and child mortality. Despite the efforts that have been made to improve maternal health outcomes in Ethiopia, institutional delivery is still unacceptably low. OBJECTIVE: This study was conducted to assess institutional delivery service utilization and associated factors in the study area. METHODS: A Community-based cross-sectional study was conducted. A multi-stage sampling technique was used to employ a total of 546 women. Data were collected using an interviewer-administered questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0. for analysis. Logistic regression models were used to determine factors associated with the outcome variable. Adjusted Odds ratios with 95% CI were computed to measure the strength of association and statistical significance was declared at p-value <0.05. RESULTS: The Prevalence of institutional delivery in the study area was 38% (34%-42%). Factors significantly associated with institutional delivery were ANC visit 1.80 (1.12-2.91), knowledge of danger sign during pregnancy 3.60 (2.25-5.76), urban residency 2.09 (1.15-3.81), Parity 0.49 (0.25-0.95) accessibility of health facility 4.60 (2.01-10.89), husbands educational level: primary 2.50 (1.27-4.91), secondary and above 2.36 (1.24-4.48), mothers occupation: governmental employee 2.05 (1.00-4.18), and Private employee 2.42 (1.09-5.35). CONCLUSIONS: The prevalence of institutional delivery in the District was low. Antenatal visits, residency, knowledge of pregnancy danger signs, parity, and accessibility of health facilities, maternal occupation, and husband education were factors significantly associated with institutional delivery.

Dietary pattern and its association with iodine deficiency among school children in southwest Ethiopia; A cross-sectional study.

BACKGROUND: Despite the universal iodization of salt in Ethiopia, iodine deficiency disorder remains a major public health problem and continued to affect a large segment of the population. It is thus essential to assess factors contributing to the unacceptably high endemic goiter rate in the country and avail evidence for further additional interventions. In line with this, we examined the association of dietary pattern and iodine deficiency among school-age children in Ethiopia. METHOD: We conducted a school-based cross-sectional study among 767 children aged 6 to 12 in southwest Ethiopia. We collected socio-demographic and other important health related information using a pre-tested structured questionnaire through the interview. Dietary pattern of children was measured using modified Hellen Keller's food frequency questionnaire. We measured iodine deficiency using urinary iodine concentration level and total goiter rate, according to the World Health Organization threshold criteria. We used a multivariate linear regression model to identify dietary and sociodemographic factors that affect urinary iodine level among children. RESULT: Out of the 767 children included in the study, 12% and 4% of children have grade 1 and grade 2 goiter respectively, making the total goiter rate 16%. While the prevalence of iodine deficiency based on urinary iodine concentration is 58.8% of which 13.7% had severe, 18.6% had moderate and 26.5% had mild form. The proportion of children who consumed godere/taro root/, banana, corn, Abyssinian cabbage, and potato, respectively at daily basis 57.8%, 53.1%, 37.9%, and 31.2%, respectively. Age (ß = -0.7, 95%CI = -1.1, -0.4), sex (ß = -22.3, 95%CI = -33.8, -10.8), consumption of taro root (ß = -27.4, 95%CI = -22.9, -31.8), cabbage (ß = -11.7, 95%CI = -5.7, -17.6), Abyssinian cabbage (ß = 12.4, 95%CI = 6.7, 18.2), and banana (ß = 5.6, 95%CI = 0.01, 11.2) significantly associated with urinary iodine level. CONCLUSION: Iodine deficiency remains an important public health problem in southwest Ethiopia. Over-consumption of goitrogenic foods and under-consumption of iodine-rich foods were prevalent and associated with lower urinary iodine level. Therefore, dietary counseling apart from universal salt iodization is recommended.

Intestinal parasitic infection among household contacts of primary cases, a comparative cross-sectional study.

BACKGROUND: Intestinal parasitic infection affects 3.5 billion people in the world and mostly affecting the low socio-economic groups. The objectives of this research works were to estimate the prevalence and determinants of intestinal parasitic infection among family members of known intestinal parasite infected patients. METHODS AND MATERIALS: A comparative cross-sectional study design was implemented in the urban and rural settings of Mecha district. The data were collected from August 2017toMarch 2019 from intestinal parasite infected patient household members. Epi-info software was used to calculate the sample size, 4531 household members were estimated to be included. Data were collected using interview technique, and collecting stool samples from each household contact of intestinal parasite patients. Descriptive statistics were used to estimate the prevalence of intestinal parasites among known contacts of intestinal parasite patients/family members. Binary logistic regression was used to identify the determinant factors of intestinal parasitic infection among family members. RESULTS: The prevalence of intestinal parasite among household contacts of intestinal parasite-infected family members was 86.14% [95% CI: 86.14% - 87.15%]. Hookworm infection was the predominant type of infection (18.8%). Intestinal parasitic infection was associated with sex, environmental sanitation, overcrowding, personal hygiene, residence, substandard house, role in the household, source of light for the house, trimmed fingernails, family size, regular handwashing practice. Protozoa infection was associated with habit of ingesting raw vegetable, playing with domestic animals, water source and the presence of household water filtering materials. CONCLUSION: High prevalence of intestinal parasitic infection was observed among household contacts of primary cases.

Micronutrient levels of tuberculosis patients during the intensive phase, a prospective cohort study.

INTRODUCTION: The objectives of this study were to estimate the micronutrient deficiency levels of tuberculosis patients at the start and end of the intensive phase, and to identify the predictors of micronutrient deficiencies in tuberculosis patients. METHODS: A prospective cohort study design was implemented. The sample size was calculated using Epi-info software. Systematic sampling technique was used. Descriptive statistics were used to estimate the micronutrient levels. The general linear model was used to predict the determinants of micronutrient level. RESULTS: At the start of DOTS (directly observed treatment strategy), 64% of tuberculosis patients had a serum iron level less than 60 µg/dl, 41.9% of tuberculosis patients had serum zinc level less than 52 µg/dl, 29.7% of tuberculosis patients had serum selenium level less than 70 ng/dl, 40.5% of tuberculosis patients had serum vitamin d level less than 20 ng/ml, and 60.4% of tuberculosis patients had urine iodine level of less than 60.4 µg/dl. At the end of the intensive phase, 16.7% of tuberculosis patients had a serum iron level less than 60 µg/dl, <1% of tuberculosis patients had serum zinc level less than 52 µg/dl, <1% of tuberculosis patients had serum selenium level less than 70 ng/dl, 20.4% of tuberculosis patients had serum vitamin d level less than 20 ng/ml, and 53% of tuberculosis patients had urine iodine level of less than 60.4 µg/dl. Serum iron level was affected by HIV infection, hookworm infection, and site of tuberculosis infection: serum vitamin d level was affected by HIV infection: and alcohol dependency affected the serum zinc level of tuberculosis patients during the course of tuberculosis treatments. CONCLUSION: Antituberculosis drugs were effective in normalizing the serum zinc and selenium level, but the serum level of iron, vitamin d and iodine were not normalized by the anti-tuberculosis drugs.

Concurrent Plasmodium infection, anemia and their correlates among newly diagnosed people living with HIV/AIDS in Northern Ethiopia.

The magnitude of concurrent malaria infection and the impact it has on hematological abnormalities, such as anemia in people living with HIV/AIDS, is not well studied in Ethiopian set up. In this cross sectional study, therefore, we assessed the prevalence of concurrent malaria infection and anemia among highly active anti-retroviral therapy (HAART) naive people living with HIV/AIDS between October, 2012 to May, 2013 in Northern Ethiopia. After obtaining consent, socio demographic, clinical, immunological and behavioural data was obtained. The overall prevalence of concomitant malaria infection was 17.4%. Rural residents and low to middle income class clients were more frequently co-infected with malaria (p<0.0001). Utilization of insecticide treated nets (p=0.0002) and co-trimoxazole intake (p=0.006) were protective factors against Plasmodium infection. The overall prevalence of anemia was also high (43%), being significantly higher (91.3%) in malaria positive people living with HIV/AIDS compared to malaria free HIV patients (32.8%) (p<0.0001). Female gender (p=0.011), history of opportunistic infections (P=0.0027) and late HIV stages (III and IV) (p=0.0001) were also significantly associated with anemia in HIV patients. In conclusion, concurrent malaria represents a common condition and there was a significant difference in the odds of anemia between malaria positive and negative people living with HIV/AIDS in Northern Ethiopia indicating a need for routine screening of people living with HIV/AIDS living in malaria endemic-areas and close monitoring of co-infected patients. Indeed utilization of ITNs, malaria prophylaxis and early HIV diagnosis are highly encouraged in people living with HIV/AIDS.

Efficacy of Chloroquine for the Treatment of Vivax malaria in Northwest Ethiopia.

BACKGROUND: Resistance to anti-malarials is a major challenge for effective malaria control in sub-Saharan Africa. This triggered a need for routine monitoring of the efficacy of the antimalarial drugs every two years in all malaria endemic countries. Chloroquine remained the drug of choice for the treatment of vivax malaria in Ethiopia. Though, a strong scientific evidence of chloroquine resistance to P.vivax that could have brought change of treatment regimen is yet to be established in Ethiopia, continuous and regular monitoring of drug's efficacy is critical for establishing rational anti-malarial drug policies. This study therefore, assessed the therapeutic efficacy of Chloroquine (CQ) for the treatment of Plasmodium vivax infections in Northwestern Ethiopia. METHODS: An observational, 28- day therapeutic clinical efficacy study was conducted from August to December, 2014, in Northwest Ethiopia. Patients confirmed to have monoinfection of vivax malaria, aged above 6 months were included. All subjects were treated with standard chloroquine dose of 25 mg/kg for three (3) days. Parasitological and clinical outcomes of treated patients were then evaluated on days 1, 2, 3, 7, 14, 21, and 28 during the entire 28-day follow-up period. A portable spectrophotometer (HemoCue Hb 301 System, Sweden) was used to estimate hemoglobin concentration. RESULTS: A total of 69 subjects had completed follow up. Some 57/69 (82.6%) had fever at enrolment and the rest 12 patients 48 hours before enrollment. Out of total, 65/69 (94.2%) and 66/69 (95.6%) of the study subjects were free of fever by day 1 and day 2 respectively but fever was cleared in all subjects by day 3. At base line the mean asexual parasitemia was 3540 parasites/µL of blood. Parasite carriage on day 3 was 3%. The overall cure rate (an adequate and clinical parasitological response) was very high (97%) [(95% CI = 93.1-99.4)]. The time to parasite, fever and gametocyte clearance as expressed in mean (SD) was 35 (3), 25 (4.6), 28 (3.2) hours respectively. Mean hemoglobin was significantly increased (P<0.001) from 12.2 (7-15) g/dl at day 0 to 13.3 (10-16) g/dl on day 28. CONCLUSIONS: In view of our findings, CQ remains efficacious for the treatment of vivax malaria in the study area. However, there is a need to monitor CQR regularly using molecular and or biochemical tools for better evaluation of treatment outcomes.

Predictors of Late HIV Diagnosis among Adult People Living with HIV/AIDS Who Undertake an Initial CD4 T Cell Evaluation, Northern Ethiopia: A Case-Control Study.

INTRODUCTION: Early HIV testing and timely initiation of ART is critical for the improved quality of life of PLWHIV. Having identified a higher rates of Late HIV diagnosis, this study was aimed to determine Determinants of late diagnosis of HIV among adult HIV patients in Bahir Dar, Northern Ethiopia. METHODS: A case control study was conducted between January 2010 to December 2011 at Bahir Dar Felege Hiwot Referral Hospital. The study subjects consisted of 267 cases and 267 controls. Cases were adult people living with HIV/AIDS whose initial CD4 T cell count was < 200/µl of blood. Controls were those with a CD4 T cell count of greater than 200/ µl. Trained staff nurses were involved in data collection using a semi-structured questionnaire. Data was entered and analyzed using SPSS version 20. Descriptive statistics and Binary logistic regression were performed. RESULTS: Subjects who hold a certificate and above (AOR = 0.26; 95% CI = 0.13. 0.54), being initiated by friends, families and other socials to undertake HIV testing (AOR = 0.65; 95% CI = 0.29, 1.48), who reported a medium and high knowledge score about HIV/AIDS and who undertake HIV testing while visiting a clinic for ANC (AOR = 0.40; 95% CI = 0.19, 0.83) were less likely to be diagnosed late. Subjects who undertake HIV testing due to providers' initiation (AOR = 1.70; 95%CI = 1.08, 2.68), who reported a medium internalized stigma (AOR = 4.94; 95% CI = 3.13, 7.80) and who reported a high internalized stigma score towards HIV/AIDS (AOR = 16.64; 95% CI = 8.29, 33.4) had a high odds of being diagnosed late compared to their counterparts. CONCLUSION: Internalized stigma, low knowledge level about HIV/AIDS, not to have attended formal education and failure to undertake HIV testing by own initiation were significant determinant factors associated with Late HIV diagnosis. Education about HIV/AIDS, promotion of general education, and encouraging people to motivate their social mates to undertake HIV testing are highly recommended.