Gestational Diabetes Mellitus Risk Factors in Pregnant Women Attending Public Health Institutions in Ethiopia's Sidama Region: An Unmatched Case-Control Study.

Background: Gestational diabetes mellitus (GDM), a chronic condition leading to glucose intolerance during pregnancy, is common in low- and middle-income countries, posing health risks to both the mother and fetus. Limited studies have been done in Ethiopia, especially using WHO's 2013 universal screening criteria. Therefore, this study aimed to evaluate the risk factors linked to GDM in women attending antenatal (ANC) clinics in Hawassa town public health institutions, located in the Sidama regional state of Ethiopia. Methods: An Unmatched case-control study was carried out in Ethiopia's Sidama Region from April 1st to June 10th, 2023, involving 510 pregnant women. The Oral Glucose Tolerance Test (OGTT) was utilized for universal screening and diagnosing GDM based on the updated 2013 WHO diagnostic criteria. Data analysis included descriptive and analytical statistics, with variables having p-values below 0.1 deemed suitable for bivariate analysis. Statistical significance was assessed using the adjusted odds ratio (AOR) with a 95% confidence interval and a p-value < 0.05. Results: The study involved 633 participants (255 cases and 378 controls), resulting in a 100% response rate, with women having an average age of 29.03 years.Variables such as: age at first conception (AOR=0.97, P=0.01, 95% CI (0.95,0.99)), urban residency (AOR=1.66, P<0.01, 95% CI(01.14,2.40)), widowed marital status (AOR=0.30, P=0.02, 95% CI (0.30,0.90)), parity (AOR=1.10, P<0.01, 95% CI (1.03,1.17)), history of stillbirth (AOR=1.15, P=0.03, 95% CI(1.04,2.30)), and previous cesarean section (AOR=1.86, P=0.01, 95% CI (1.13,2.66)) were identified as independent factors associated with GDM. Conclusion: The study concluded that factors like age at first conception, place of residence, marital status, parity, history of Caesarian section, and stillbirth were independently associated with GDM. Surprisingly, upper arm circumference (MUAC), a proxy for pre-gestational BMI, was not identified as a risk factor for GDM. It is recommended that healthcare providers conduct comprehensive GDM risk assessments in pregnant women to identify and address risk factors, and propose specific screening and intervention strategies.

Low-level physical activity predictors among adults living with HIV in Ethiopia's southern region, focusing on work, transportation, and recreation domains: unmatched case-control study.

BACKGROUND: Low-level physical activity (LLPA) is crucial for the well-being of adults living with HIV (PLWHs). However, many do not engage in enough physical activity, leading to adverse health outcomes. Identifying the determinants of LLPA can aid in developing effective interventions. Despite this, Ethiopia lacks evidence on this topic. This study aimed to identify predictors of LLPA among PLWHs in the Gedeo zone, located in southern Ethiopia. METHODS: An unmatched case-control study was conducted on PLWHs in the Gedeo zone who visited two hospitals and healthcare institutions between December 29th, 2017 and January 22nd, 2019. Respondents were classified into three categories based on their total physical activity levels: high, moderate, and low. Cases were defined as those meeting the criteria for LLPA, while controls were those who did not fall under the cases category. Data was collected using the WHO Stepwise surveillance tool and analyzed using Epidata v3.1 templates and SPSS v22. Predictor variables with a P-value < 0.25 in bivariable analysis and < 0.05 with a 95% confidence interval in multivariable analysis were selected. RESULTS: The study involved 633 HIV-positive adults, with a response rate of 92.41%. Most participants were under 34 years old, with an average age of 36.47±(9.055) for cases and 36.38±(8.389) for controls. The multivariable analysis revealed that educational status (AOR = 4.85, P = 0.02, 95%CI (1.28-18.44)), sex (AOR = 0.24, P = 0.04, 95%CI (0.07-0.90)), duration on ART being exposed for 1-4 Years (AOR = 0.12, P < 0.001, 95%CI (0.03-0.44)) and being exposed for 5-9 Years (AOR = 0.03, P < 0.001, 95%CI (0.01-0.16)), and former alcohol use (AOR = 0.11, P < 0.01, 95%CI (0.02-0.56) were significant predictors of LLPA performance. CONCLUSIONS: The study concluded that educational status, sex, ART duration, and past alcohol use are key determinants of LLPA performance among PLWHs in southern Ethiopia. This suggests that policymakers should implement public health campaigns to promote healthy habits, particularly low-level physical activity, among PLWHs.

Non-Disclosure of HIV-Positive Serostatus: Unmatched Case-Control Study in People Living with HIV in Public Health Facilities of Gedeo Zone, Southern Ethiopia.

Background: Non-disclosure of HIV-positive status (NDHPSS) is the individual's experience of hiding their HIV status from other people or groups. People who fail to reveal their HIV-positive serostatus risk contracting the virus again, not receiving the best possible care, and even dying. Purpose: To assess predictors of NDHPSS in people living with HIV in public health facilities in Gedeo-Zone, Southern-Ethiopia. Methods: In Gedeo-Zone, Southern Ethiopia, a facility-based, unmatched, case-control study was carried out from the first of February to March 30, 2022GC. With a case-to-control ratio of 1:1, a total of 360 respondents (89 cases and 271 controls) were involved. The respondents were chosen using a sequential sampling technique. EpiData-V-3.1 was used to enter the data, and SPSS-V-25 was used to analyse it. To determine the factors that were connected to the result, a binary logistic regression analysis was performed. AOR at the 95% confidence interval and p-values under 0.05 were utilised to explain their statistical significance. Results: The study had 360 participants in total-271 controls and 89 cases-resulting in a response rate of 97.6%. The average age of the participants was 35.6 years (SD: 8.3). After adjusting the possible confounders, sex (AOR = 2.8, 95% CI: 1.04-7.56), residence (AORs = 3.52, 95% CI: 2.83-9.39), WHO clinical stage I (AORs = 4.68, 95% CI: 1.9-22.1), short duration of ART follow-up care (AOR = 4.21, 95% CI: 1.65-10.73), and number of lifetime sexual partners (AOR = 6.9, 95% CI: 1.86-26.3) were significantly associated factors with the outcome. Conclusion: According to this study, living in a rural area and being in WHO clinical stage one, in addition to being a woman and having multiple sexual partners during one's lifetime, were predictors of non-disclosure of an HIV-positive serostatus. As a result, encouraging people with HIV in WHO stage I and those who have had more than one sexual partner in their lifetime to disclose their status and expanding counselling services for rural residents and women have a substantial impact on reducing the HIV load.

Predictors of Metabolic Syndrome Among People Living with HIV in Gedeo-Zone, Southern-Ethiopia: A Case-Control Study.

BACKGROUND: Intensive access to antiretroviral therapy improved the prognosis of HIV. As a result, a non-communicable disease risk marker known as metabolic syndrome (MS) has emerged. It is a public health issue in sub-Saharan Africa including Ethiopia. However, there is little literature on predictors of MS among people living with HIV (PLHIVs) in the study area context. PURPOSE: To identify predictors of metabolic syndrome among PLHIVs, Gedeo Zone, Southern-Ethiopia. METHODS: Health institutions-based unmatched case-control study was conducted. All HIV-infected adult persons who are receiving routine care in the randomly selected two hospitals and two health centers of the Gedeo zone, southern Ethiopia were involved in the study, conducted from December 29th, 2017, to January 22nd, 2019. PLHIVs diagnosed with MS using ATP III criteria were considered as a case, and subjects free of MS in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. RESULTS: A total of 633 (139 cases and 494 controls) PLHIVs were included in the study. The multivariable analysis result found that age (AOR=1.09, 95% CI (1.05-1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.02-0.42)); occupational status being of students (AOR=0.11, 95% CI (0.24-0.51)); wealth index being in the middle quintile (AOR=0.22, 95% CI (0.06-0.79)); ART status exposed to ART (AOR=3.07, 95% CI (1.37-6.89)); total physical activity state being physically active (AOR=0.36, 95% CI (0.16-0.79)), and engaged in low levels physical activity (AOR=3.83, 95% CI (1.46-10.05)) were the factors significantly associated with MS. CONCLUSION: While education, occupation, wealth index, antiretroviral therapy status, total physical activity, and lower physical activity levels were concluded by the study as modifiable predictors of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic syndrome. There is a need for an ongoing effort to realize an integrated care plan that addresses both the routine care and regular screening programs to reduce the risks associated with MS and its traits in these subjects.

The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study.

BACKGROUND: HIV infection and Antiretroviral Therapy (ART) has been associated with metabolic syndrome (MS). The prevalence of MS varies substantially between populations and is not yet well-known in sub-Saharan Africa (SSA), including Ethiopia. The current study aims to estimate and evaluate the magnitude of MS among ART exposed and ART naïve HIV-infected patients. METHODS: A comparative cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals and two health centers, found in the Gedeo zone, southern-Ethiopia. Data collection was run beginning from December 29th, 2017 up to January 22nd - 2019, using the WHO steep tool; eventually, the completed data entered into Epidata (V-3.1) and exported to SPSS (V- 22) for analysis. The revised international diabetes federation criterion was used to define MS and its components. The mean, standard deviations and proportions were used as a descriptive summary. Categorical data and the proportion of MS in the two groups were compared using binary logistic regression, and results were reported statistically significant with p-value is less than 5%. RESULTS: A total of 633 (n = 422 on ART and n = 211 ART-naive) PLHIVS was involved, with an overall response rate of 96.2%. The cumulative proportion of MS was 42.5%(95% CI: 39.2-45.7), with 43.4%(95% CI: 39.1-47.4) among ART exposed and 40.8% (95% CI: 35.5-46.0) among ART naïve patients (P > 0.005). However, the difference was not statistically significant and signified that ART has no association with an increased proportion of MS. CONCLUSION: Overall this study demonstrated the presence of an elevated degree of overall MS among PLHIVs. Besides, although the difference was not statistically significant, a relatively higher proportion of MS was realized in the ART exposed than ART naïve groups. Implicated that at the time of the entire test and treatment approaches employed in this target group, routine screening of MS incorporated through HIV care and management system will be a vibrant action.

Epidemiology of High Fertility Status among Women of Reproductive Age in Wonago District, Gedeo Zone, Southern Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: High fertility remains one of the most important public health issues hampering the health and welfare of mothers and the survival of their children in developing nations. In Ethiopia, the high fertility rate has been seen for a long historical period with some pocket areas of high fertility still showing poor improvement. Hence, this study was aimed at determining the magnitude of high fertility status (number of children ever born alive ≥ 5) and associated factors among women of the reproductive age group in Wonago district. METHODS: A community-based cross-sectional study was conducted on randomly selected 512 women in Wonago district. Data were collected using a pretested structured interviewer administered questionnaire. Data was entered into EpiData version 3.1 and then analyzed by SPSS version 25. Logistic regression was used to analyze the data, and the adjusted odds ratio with the 95% confidence interval was computed, and a significant association was declared at p value ≤ 0.05. RESULT: This study revealed that 354 (69.1%) of the respondents have high fertility. High fertility is independently associated with residing in rural area [AOR = 4.88, 95% CI: 3.21, 7.86], desire for children [AOR = 6.97, 95% CI: 3.24, 11.40], history of under-five child mortality [AOR =5.32, 95% CI: 2.59, 8.43], poor knowledge of contraception [AOR = 2.67, 95% CI: 1.66, 4.04], and low wealth tertile [AOR = 2.21, 95% CI: 1.51, 3.58]. On the other hand, women with age at first birth above 18 years [AOR = 0.34, 95% CI: 0.17, 0.68] and those with birth interval ≥ 24 months [AOR = 0, 26, 95% CI: 0.14, 0.49] were less likely to have high fertility. Conclusion and Recommendation. The substantial number of women in the study area has high fertility status far away from the country's costed implementation plan of reducing the total fertility rate to 3.0. Considering these, much is needed to be done among poor, rural residents, who have not yet attained their desired number of children, and on enhancing the knowledge of mothers towards contraceptive methods.

Malnutrition: Prevalence and its associated factors in People living with HIV/AIDS, in Dilla University Referral Hospital.

BACKGROUND: Literatures on prevalence and factors associated with malnutrition among peoples living with HIV/AIDS are limited in Ethiopia and not well documented either. The proper implementation of nutritional support and its integration with the routine highly active antiretroviral therapy package demands a clear picture of the magnitude and associated factors of malnutrition. The objective of this study is, therefore, to assess the prevalence and factors associated with malnutrition among peoples living with HIV/AIDS. METHODS: Institution based cross sectional study was conducted in Dilla University referral Hospital including adult HIV patients who were in highly active anti retroviral therapy. Interview administered questionnaires were used to collect data on socio demographic factors. Besides, HIV related clinical information was extracted from anti retro viral therapy data base and clinical charts. The nutritional status of the patients was determined by Body Mass Index (BMI) where BMI < 18kg/m2 was defined as malnutrition according to World Health Organization (WHO). Binary logistic regression was used to assess association between different risk factors and malnutrition. Confidence interval of 95% was considered to see the precision of the study and the level of significance was taken at α <0.05. RESULTS: A total of 520 patients were included in the analysis. The overall prevalence of malnutrition was 12.3% (95% CI 9.5-15.0). After full control of all variables; unemployment (OR = 3.61, 95% CI: 3.6 - 7.76), WHO clinical stage four (OR = 12.9, 95% CI: 2.49- 15.25), gastrointestinal symptoms (OR = 5.3, 95% CI: 2.56 - 10.78) and previous (one) opportunistic infection (OR = 3.1, 95% CI 2.06 - 5.46), and two & above previous opportunistic infections (OR = 4.5, 95% CI: 3.38 - 10.57) were significantly associated with malnutrition. However, moderately poor economic condition was found to be protective factor for malnutrition (OR = 0.4, 95% CI: 0.14 - 0.95). CONCLUSION: Unemployment, WHO clinical AIDS stage four, one & more number of previous opportunistic infections and gastrointestinal symptoms were found to be important risk factors for malnutrition among People Living with HIV/AIDS. From this study it has been learnt that nutritional programs should be an integral part of HIV/AIDS continuum of care. Furthermore, it needs to improve household income of PLHIV with employment opportunity and to engage them in income generating activities as well.