The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model.

BACKGROUND: Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART. METHODS: A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05. RESULTS: The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level. CONCLUSIONS: A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Prevalence and associated factors of goiter among rural children aged 6-12 years old in Northwest Ethiopia, cross-sectional study.

BACKGROUND: Goiter, an indicator of chronic iodine deficiency, is a major public health problem for populations living with iodine deficient environment, particularly for young children. It is a threat to the social and economic development of many developing countries including Ethiopia. The aim of the study was to assess the prevalence and associated factors of goiter among rural children aged 6-12 years, Northwest Ethiopia. METHODS: A community based cross-sectional study was employed from July to December 2012 in Lay Armachiho district. A total of 698 children aged 6-12 years were included in the study. Multistage sampling was used. Children were examined for the presence/absence of goiter using a criterion set by World Health Organization. The level of Iodine of the salt was estimated by using spot testing kits. Descriptive and summary statistics were employed. Bivariate and multivariate logistic regressions were used to identify associated factors. The degree of association was assessed by using Odds ratio with 95% confidence interval were computed to see the presence and strength of association. RESULTS: Totally 694 children were included in the analysis. The prevalence of goiter was found to be 37.6%. Goiter of grade 1 was 28.5% and that of grade 2 was 9.1%. 29.7% of the samples had adequate iodine content. The age of child (AOR: 1.24,95% CI: 1.12, 1.36), being female (AOR=1.98, 95% CI: 1.38-2.85), salt iodine level (AOR=0.44, 95% CI: 0.27, 0.71), family history of goiter (AOR=3.18, 95% CI: 2.08, 4.858), fish consumption (AOR=0.42, 95% CI; 0.22, 0.80) were factors associated with goiter. CONCLUSION: Chronic iodine deficiency was a severe public health problem in the study communities. Ensuring the consumption of iodized salt and promotion of fish intake at the household level are highly recommended.

HIV1 drug resistance among patients experiencing first-line treatment failure in Ethiopia: protocol for a systematic review and meta-analysis.

BACKGROUND: The emergence of HIV drug resistance presents a substantial challenge. Current antiretroviral treatments, along with current classes, face the danger of becoming partially or entirely inactive. As a result, alternative treatment regimens are limited, and treatment choices are complicated. According to the recommendation of the WHO, nations should consider changing their first-line ART regimen if HIV drug resistance exceeds 10%. In spite of the fact that a number of primary studies have been performed on HIV drug resistance in Ethiopia, their pooled prevalence rate has not been determined in a systematic review and meta-analysis, which may provide stronger evidence. Therefore, the objective of this systematic review and meta-analysis will be to estimate the pooled prevalence rate of HIV1 drug resistance in patients with first-line treatment failure in Ethiopia. METHODS: Primary studies will be identified from PubMed/MEDLINE, Scopus, Embase, Web of Science Core Collection, and Google Scholar. The period of search will be from 01 April to 30 June 2024. Studies identified through the search strategies will first be screened by titles and abstracts. Included studies meeting established criteria will be evaluated for risk of bias using the JBI checklist. Data will be extracted, and the pooled prevalence rate of HIV drug resistance will be computed using STATA 14 software. Random effect models will be used when heterogeneity is suspected. The I2 statistic and its corresponding P value will be checked to distinguish heterogeneity. Additionally, publication bias and heterogeneity will be checked using visual funnel plots, Egger's test, trim-and-fill tests, meta-regression, and subgroup analysis. To present and synthesize the results, narrative synthesis will be performed to describe study characteristics and findings, and forest plots will be used to visually represent effect sizes and confidence intervals from individual studies. DISCUSSION: Estimating the pooled prevalence rate of HIV drug resistance through a systematic review and meta-analysis improves the reliability of the evidence, the availability of effective HIV treatment options, and the ability to assist in making decisions for both clinical practice and public health policy in Ethiopia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024533975.

Pelvic floor disorders among women in Dabat district, northwest Ethiopia: a pilot study.

INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders affect many women in high-income countries. Since little is known about such disorders in Africa, this study aimed at assessing the prevalence and risk factors in an Ethiopian community. We also assessed the validity of a prolapse questionnaire. METHODS: A community-based cross-sectional study was conducted among 395 women, recruited by a systematic random sampling technique. Women were interviewed about symptoms of urinary incontinence, faecal incontinence and pelvic organ prolapse by female nurses. Additionally, pelvic examinations were performed in 294 (74.2%) participants to assess anatomical prolapse using the simplified Pelvic Organ Prolapse Quantification staging system. Descriptive statistics and logistic regression analyses were employed. RESULTS: The median age of participants was 35.0 years. Thirty-one women reported urinary incontinence (7.8%), 25 (6.3%) symptomatic pelvic organ prolapse and 2 (0.5%) faecal incontinence. Anatomical pelvic organ prolapse stage II-IV was detected in 162 (55.1%) of women who underwent pelvic examination. The questionnaire for prolapse assessment had poor validity (38.3% sensitivity and 95.4% specificity) even in cases of clinically relevant prolapse (stage III or IV). After adjustment, carrying heavy objects for 5 or more hours a day, history of prolonged labour and highland rural residence were associated with anatomical pelvic organ prolapse. CONCLUSIONS: Self-reported incontinence seems low in northwest Ethiopia. The prevalence of symptomatic prolapse was low despite a high prevalence of prolapse signs. Notably, heavy carrying and prolonged labour increased the risk of anatomical prolapse stage II-IV. The methods of assessing pelvic floor disorders in a low-income context need further development.

Modeling on number of children ever born and its determinants among married women of reproductive age in Ethiopia: A Poisson regression analysis.

Background: One of the main components of population dynamics that determine the size, structure, and composition of a country's population is the number of ever-born children. Psychological, economic, social, and demographic factors all have a strong influence on and predict it. However, there is little information on its current status in Ethiopia. As a result, modeling the number of children ever born and its determinants is critical for the Ethiopian government to develop appropriate policies and programs. Methods: A total of 3260 eligible women were used as a study sample in this study to assess the number of children ever born and determinants among married reproductive age women in Ethiopia. Secondary data were culled from the 2019 Ethiopian Demography and Health Survey datasets. The factors associated with the number of children born were identified using a Poisson regression model (CEB). Results: The average number of children per mother was 6.09, with a standard deviation of 8.74. There were 2432 (74.6%) rural residents among the total respondents, 2402 (73.7%) have no formal education, and three out of five women are not currently working. The participants' average age was 41.66, with a standard deviation of 3.88. When compared to urban residents, the number of CEB for rural residents is 1.37 times higher. When compared to women with no education, the number of CEB for women with higher education was reduced by 48%. For every unit increase in respondents' current age, the percent change in the number of children ever born increases by 2.4%. For every unit increase in the family's wealth index status, the percent change in the number of children ever born decreases by 1.7%. Conclusion: When compared to the target of Ethiopia's health transformation plan, the average number of children born is higher. Improving the household wealth index, women's education, and employment status all contribute to a reduction in the number of CEB, which is important in balancing population growth with natural capacity and the country's economic development.

Demand for long acting and permanent methods of contraceptives and factors for non-use among married women of Goba Town, Bale Zone, South East Ethiopia.

BACKGROUND: Contraceptive use including short acting, long acting and permanent methods positively influence the socio-economic development of a nation by allowing families to space and limit their family size to their economic capacity. Demand for LAPMs of contraception as detrmined by utilization and unmet need for LAPMs of contraception can provide realiable information for providers. OBJECTIVE: To determine the utilization of long acting and permanent contraception and its associated factors among married women of Goba town, South East Ethiopia. METHODS: A cross sectional community based study was conducted among 734 systematically selected married women of reproductive age in Goba town in September/ 2009. A structured and pretested, interview questionaire was used to collect data on socio-demographic, behavioral factors and data related to demand for LAPMs of contraception. Data were analyzed using EPI INFO and SPSS version 16. RESULT: The demand for Long Acting and Permanent Methods (LAPMs) of contraception was 18.1%. Utilization of LAPMs of contraception in the town was 64 (8.7%) and the unmet need for LAPMs was 69 (9.4%). Information on LAPMs in the town was 636 (86.6%). Media (radio and television) was the major sources of information 641 (87.3%). The use of LAPMs was significatly associated with ever use AOR[17.43, 95% CI:9.19, 33.03], number of times discussions made on methods AOR[4.6, 95% CI: 1.72,12.17] and main decider of using methods AOR[ 2.2, 95% CI:1.03, 4.65]. It was not associated with socio-demographic variables. CONCLUSION AND RECOMMENDATION: The utilization of LAPMs in the town was less although higher than the Ethiopian demographic and health survey 2005 result. Moreover, there was a considerable unmet need. Increase the method mix of LAPMs by incorporating varaies of implnats in order to increase utilization. Proper counseling of client and partners discussion were some of the recommendation forwarded.

Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia.

BACKGROUND: Depression has a multitude of clinical and public health consequences for HIV patients. The magnitude of HIV patients who failed first-line antiretroviral treatment and switched to second-line therapy is becoming a growing public health concern. However, unlike first-line therapy, to date, little attention has been given to mental health problems in such patients, particularly in the era of the COVID-19 pandemic. Thus, this research was conducted to determine the magnitude of depression and its determinants among HIV patients on second-line antiretroviral therapy. METHODS: A multi-centered cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling. Data were collected in personal interviews as well as document reviews. The nine-item patient health questionnaire score was used to assess depression, while the three-item Oslo Scale was used to assess social support. The associations between exogenous, mediating, and endogenous variables were identified simultaneously using structural equation modeling. Statistical significance was declared at a P-value less than 0.05, and the effect sizes were presented using 95% CI. RESULTS: Depression was reported in 27.7% of HIV patients on second-line therapy [95% CI: 24.7-31.1%]. Social support has a direct [[Formula: see text] = - 0.9, (95% CI: - 1.11 to - 0.69)] and indirect [[Formula: see text] = - 0.22, (95% CI: - 0.31 to - 0.13)] negative effect on depression. Perceived stigma was a mediator variable and significantly associated with depression [[Formula: see text] = 0.40, (95% CI: 0.23-0.57)]. Co-morbid illness [[Formula: see text] = 0.49, (95% CI: 0.35-0.63)], high viremia [[Formula: see text] = 0.17, (95% CI: 0.08-0.26], moderate and high-risk substance use [[Formula: see text] = 0.29, (95% CI: 0.18-0.39)], and not-workable functional status [[Formula: see text] = 0.2, (95% CI: 0.1-0.31)] were all positively associated with depression. CONCLUSIONS: This study revealed that there was a high prevalence of depression among HIV patients on second-line antiretroviral therapy. Social and clinical factors were associated with depression risk. As a result, screening, prevention, and control strategies, including psychosocial support, should be strengthened in routine clinical care.

Treatment failure, death, and predictors among PLWHIV on second-line antiretroviral therapy in Dessie Comprehensive Specialized Hospital, northeast Ethiopia: A retrospective cohort study.

BACKGROUND: The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern, especially in a low-income country setting. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy in the Ethiopia context. Thus, this study was conducted to determine the rate of treatment failure, death, and their predictors among HIV patients receiving second-line therapy. METHODS: A retrospective cohort study was conducted on 642 people living with HIV in Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. Poisson and competitive risk survival models were computed to explore predictors of treatment failure and death, respectively. RESULTS: During follow-up period, 39 (6.87%, 95% CI: 5-9.2%) of 568 patients had second-line treatment failure with 4.07 per 100 person-year rate of failure. Being on anti-TB treatment [Rate ratio, RR = 2.57 (95% CI: 1.25-5.25)], not having optimal medication adherence [RR = 2.29 (95% CI: 1.09-4.78)], and not timely switched [RR = 5.89 (95% CI: 1.36-25.54)] were positively associated with treatment failure. Similarly, 44 (6.85%, 95% CI: 5-9%) of 642 patients died with 4.5 per 100 person-year rate of death. Being on advanced clinical condition [Sub distribution Hazard ratio, SHR = 2.49 (95% CI: 1.31-4.74)], not having optimal medication adherence [SHR = 2.65 (95% CI: 1.31-4.74)], lower CD4 cell counts, and high viral load measurement were positively associated with death. CONCLUSIONS: A significant number of patients had failed to respond to second-line therapy. A large number of patients had also died. Patient medical profile and monitoring practice were associated with treatment failure and death. Hence, patient-centered monitoring and interventions should be strengthened, besides treatment switch.

Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study.

BACKGROUND: In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy. METHODS: A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral re-suppression (viral load less than 1000 copies/mL) and attrition to care. RESULTS: Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24-85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17-1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02-1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49-0.91)] had lower likelihood with viral re-suppression. In the current study, attrition to care was 11% (95% CI: 8.7-13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40-4.87)]. Similarly, being not virally re-suppressed [AHR = 6.87 (95% CI: 3.86-12.23)] and CD4 count ≤450 cells/mm3 [AHR = 2.61 (95% CI: 1.40-4.87)] were also positively associated with attrition to care. CONCLUSION: A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patient-centered intervention should be strengthened, besides treatment switch.

Prevalence and Predictors of Contraceptive Use Among Women of Premenopausal Period in Ethiopia: A Retrospective Cross-Sectional Data Analysis.

BACKGROUND: Contraceptive use is internationally endorsed as a human right and an indicator of the highest standard of sexual and reproductive health life. But reports from countries including Ethiopia showed a lower and capricious rate due to wider factors. Thus, the current study aimed to determine the prevalence and the predictors of contraceptive use among women of the premenopausal period. METHODS: A retrospective cross-sectional data analysis was performed from Ethiopian Demographic and Health survey 2019 in January 2021. A total of 3260 premenopausal women were included by stratified sampling, and data were analyzed using SPSS version 25 software. Data were initially analyzed descriptively, and tests were done for variable multicollinearity, and model goodness of fit and predictive capacity. Subsequently, bivariate and multivariable logistic regression analyses were performed successively for the crude and adjusted odds ratio, and finally declared variables with a p-value of <0.05 as predictors of contraceptive use. RESULTS: The study included 3260 women with an average age of 41.66 (standard deviation ±3.9) years. The overall prevalence of contraceptive use was reported 17% and explained to vary by women's age, place of residence, education level, wealth index, and current working statuses. However, only the age, education, and wealth index of women have predicted a statistical significance with contraceptive use. Accordingly, an increase in women's age was found to increase contraceptive use more likely by 89% [AOR=0.89 (95% CI: 0.87, 0.92)]. Similarly, primary [AOR = 1.53, (95% CI: 1.20, 195)], secondary [AOR = 2.57, (95% CI: 1.70)] or higher [AOR = 2.64, (95% CI: 1.67, 4.20)] level educated women were about twice more likely to use contraceptive methods than uneducated women. Finally, women in poorer [AOR = 3.11 (95% CI: 2.17, 4.46)], middle [AOR = 3.03 (95% CI: 2.09, 4, 37)], rich [AOR = 3.70, (95% CI: 2.58, 5.31)] or richest [AOR = 3.42, (95% CI: 2.39, 4, 88)] wealth index were more than 3 times more likely use contraceptive methods when compared to women of the poorest wealth index. CONCLUSION: The prevalence of contraceptive use among premenopausal women in Ethiopia is low and utmost related to age, education level, and wealth index of women.

Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study.

OBJECTIVE: Despite the presence standard protocol for management of severe acute malnutrition case-fatality rates in African hospitals remain unacceptably high. The case in Ethiopia is not different from others. Therefore, this study was aimed to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to stabilization centers of general hospitals in Tigray region, northern Ethiopia. A 24 months retrospective longitudinal study was conducted among 569 randomly selected medical records of children admitted to stabilizing centers. Both bi-variable and multivariable Cox regression analysis was conducted to identify predictors of mortality. Association was summarized using AHR, and statistical significances were declared at 95% CI and P-value < 0.05. RESULTS: During follow up, 456 [82%] of children had got cured, 37 [6.65%] were absconded and 21 [3.8%] were died. The overall mean survival time was 41.93 [95% CI 40.17-43.68] days. Impaired conscious level [AHR = 6.69, 95% CI 2.43-19.93], development of comorbidity after admission [AHR 12.71, 95% CI 2.79-57.94] and being urban in residence [AHR = 2.73, 95% CI 1.12-6.64] were predictors of mortality. Therefore, interventions to reduce further mortality should focus in children having impaired consciousness level and who developed comorbidity after admission.

Infection with HIV and intestinal parasites among street dwellers in Gondar city, northwest Ethiopia.

In Ethiopia human immunodeficiency virus (HIV) infection is a major health and socioeconomic problem. Sex workers, youth, and mobile populations all show increasing prevalence of HIV. However, there is currently no information about the seroprevalence of HIV and the knowledge of HIV among street dwellers in the country. To fill this gap, 404 street dwellers residing in Gondar, northwest Ethiopia, were included in this cross-sectional study. Socio-demographic data, factors that prompted the subjects to become street dwellers, and their knowledge about HIV were all assessed using a structured questionnaire. Stool samples for diagnosis of intestinal parasites and venous blood for HIV antibody testing were collected and processed following standard procedures. Poverty-associated movement to urban areas in search of work was reported as a major factor that forced them to live in the streets, followed by divorce, family death, and addiction and peer pressure. One or more intestinal parasites were found in 67.6% of the street dwellers. Multiple parasitic infections were detected in 27.7%. The prevalence of HIV in the street dwellers was 6.9%. Fifty-nine (16.6%) participants responded that HIV can be transmitted by eating food together. Seventy-three (18%) believed an infected needle cannot transmit HIV, while 51 (12.6%) said HIV can be transmitted by hand shaking. One hundred ninety-two (47.5%) responded that antiretroviral therapy will not prolong the life of HIV-infected individuals. In summary, the prevalence of HIV and intestinal parasitic infection was quite high among street dwellers in Gondar. Therefore, strategies to control HIV and other infectious diseases should include this group, and regular mass deworming may help to reduce the burden of infection.

Immunological Response of Hiv-Infected Children to Highly Active Antiretoviral Therapy at Gondar University Hospital, North-Western Ethiopia.

BACKGROUND: The effectiveness of highly active antiretroviral therapy (HAART) in children has not been well studied specially in developing countries where the burden of HIV is high. This study was aimed to assess the immunologic response of HIV-infected children to HAART at Pediatric ART Clinic Gondar University Hospital. METHODS: Institution based cross-sectional study was conducted at the Pediatric ART Clinic Gondar University Hospital from March 01-April 30, 2014. The study included 283 HIV-infected children who were on HAART for 6 months and above. Medical records of HIV-infected children were reviewed using pre-tested questionnaire. CD4 count/percent was collected every 6 months retrospectively. For all statistical significance tests, the cut-off value was p<0.05. Poison Regression was used for further analysis. RESULTS: The mean age of children was 6.9 years with a standard deviation of 3.4 years. The median CD4 count/percent was 232/13%, 450/21%, 540/25% and 608/27% at the time of initiation, 6, 12 and 18 months of ART, respectively. HAART initiated at higher CD4 count, good adherence and HIV status disclosure were found to have positive effects for immunological response. CONCLUSION: The study revealed that there was good Immunological response to ART, and that the maximum response was in the 1(st) 6 months of ART. Low CD4 count at initiation, undisclosed HIV status and lack of good adherence were found to cause low immunological response to HAART.

Prevalence and associated factors of timely initiation of breastfeeding among mothers at Debre Berhan town, Ethiopia: a cross-sectional study.

BACKGROUND: Timely initiation of breastfeeding is defined as putting the newborn to breast within one hour of birth. It serves as the starting point for continuum of care for the newborn health and development. In Ethiopia, there is a considerable variation on timely initiation of breastfeeding among regions. The main aim of this study was to determine prevalence rate and investigate factors associated with timely initiation of breastfeeding practice among mothers in Debre Berhan town, Ethiopia. METHODS: A community based cross-sectional study was conducted at Debre Berhan town from April 1 to 30, 2013. A total of 416 mothers who had given birth within the last six months were selected by using simple random sampling technique. Descriptive statistics, bivariable and multivariable logistic regression analysis were employed to identify factors associated with timely initiation of breastfeeding. RESULTS: The prevalence rate of timely initiation of breastfeeding was 62.6 %. The odds of timely initiation of breastfeeding was high among mothers who have monthly income of greater than 1969 Ethiopian Birr (ETB) (adjusted odds ratio [AOR] 2.77; 95 % Confidence Interval [CI] 1.21, 6.32). Having extended family (AOR 0.5; 95 % CI 0.27, 0.95), not being counseled about timely initiation of breastfeeding during antenatal care (AOR 0.40; 95 % CI 0.18, 0.88), delivered by cesarean section (AOR 0.11; 95 % CI 0.04, 0.33), delivery attended by traditional birth attendants or relatives (AOR 0.22; 95 % CI 0.05, 0.87), and not feeding colostrum (AOR 0.07; 95 % CI 0.02, 0.23) were negatively associated with timely initiation of breastfeeding. CONCLUSION: The practice of timely, also known as early, initiation of breastfeeding was suboptimal. Nearly 40 % of the mothers did not start breastfeeding within one hour after delivery. Findings suggest that in order to improve timely initiation of breastfeeding practice, interventions need to target mothers with extended family, poor socioeconomic status and caesarean delivery. Moreover, mothers who discard colostrum and those who do not deliver under the assistance of health care professional need attention and emphasis has to be given for the breastfeeding counseling service given at antenatal service outlets.

Burden of diseases in Amhara region, Ethiopia.

This community based cross sectional study was conducted to estimate the Burden of Diseases in Amhara region of Ethiopia in 1997 - 1998 A total of 7 urban and 14 rural kebeles (social administrative units) were included in four administrative zones where questionnaire on morbidity, disability and mortality were administered. A total of 17780 people were included in the study. The total DALY was 51775 per 100000 population. The highest number of DALY lost were obtained for acute respiratory tract infections (especially children), malaria, diarrhoea, tuberculosis, and maternal and perinatal causes. Communicable and maternal and perinatal problems contributed to about 68% of the DALY lost. Whereas the contribution of noncommunicable diseases was about 17%. Accidents and injuries accounted for 6.4% of the DALY lost. The rest 4.9% and 3.7% were attributed to long-term disabilities where the cause could not be determined and undetermined causes of death respectively. It appears that while the traditional public health problems still persist in high prevalence, the so called "diseases of civilization" are also emerging thus further stretching the available resources for health. The findings of this study can be used to design appropriate strategies and use health resources efficiently.

The electrocardiogram in healthy northwest Ethiopians.

The normal values for ECG have not been fully investigated on Ethiopians. This cross sectional study was conducted in 1999/2000 to obtain baseline ECG information on normal healthy northwest Ethiopians and to find out whether normal ranges of ECG parameters in our population differ from those of Caucasians or other black Africans. A standard 12-lead electrocardiogram was done in 690 selected healthy northwest Ethiopians. They were 392 (56.8%) male and 298 (43.2%) female with a median age of 23 years. The systolic and diastolic blood pressures were within the normal range in all subjects. The total incidence of deviation from the accepted normal ECG was recorded in 393 (57.0%) subjects. This was found in 294 (75.0%) male and 99 (33.2%) female subjects. The most common type of "abnormalities" were high peaked T wave, 104 (26.5%), elevated S-T segment, 70 (17.8%), and elevated ST segment with high peaked T wave, 32 (10.9%) in male and negative or flat T wave, 35 (11.7%) in female. All types of variations were more pronounced in young subjects of both sexes and less common in those aged 40 years and above. The normal ECG variants found in Ethiopians were similar to those found in other subjects of black African origin. In conclusion, the normal variants identified in this study must be taken into consideration in the interpretation of ECG from cardiac patients which prevents this useful test from being understood wrongly.