Optimal cut-off for obesity and markers of metabolic syndrome for Ethiopian adults.

BACKGROUND: Metabolic syndrome (MetS) is defined as the presence of central obesity plus any two of the following markers: high triglycerides (> 150 mg/dl), low high density lipoprotein (HDL) cholesterol < 40 mg/dl in men and < 50 mg/dl in women, hypertension (blood pressure > 130/85 mmHg or use of antihypertensive medication), high fasting blood glucose (> 100 mg/dl or use of treatment for diabetes mellitus). Since recently, metabolic syndrome and obesity have become emerging problems of both low and middle income countries, although they have been the leading cause of morbidity and mortality in high income countries for the past decades. It has been indicated that the international anthropometric cut-off for detecting obesity is not appropriate for Ethiopians. This study developed optimal cut off values for anthropometric indicators of obesity and markers of metabolic syndrome for Ethiopian adults to enhance preventive interventions. METHODS: A total of 704 employees of Jimma University were randomly selected using their payroll as a sampling frame. Data on socio-demographic, anthropometry, clinical and blood samples were collected from February to April 2015. Receiver Operating Characteristic Curve analyses were used to determine optimal anthropometric cut-off values for obesity and markers of the metabolic syndrome. WHO indicators of obesity based on body fat percent (> 25% for males and > 35% for females) were used as binary classifiers for developing anthropometric cut-offs. Optimal cut-off values were presented using sensitivity, specificity and area under the curve. RESULTS: The optimal cut-off for obesity using body mass index was 22.2 k/m2 for males and 24.5 kg/m2 for females. Similarly, the optimal waist circumference cut-off for obesity was 83.7 cm for males and 78.0 cm for females. The cut-off values for detecting obesity using waist to hip ratio and waist to height ratio were: WHR (0.88) and WHtR (0.49) for males, while they were 0.82 and 0.50 for females, respectively. Anthropometric cut-off values for markers of metabolic syndrome were lower compared to the international values. For females, the optimal BMI cut-offs for metabolic syndrome markers ranged from 24.8 kg/m2 (triglycerides) to 26.8 kg/m2 (fasting blood sugar). For WC the optimal cut-off ranged from of 82.1 cm (triglyceride) to 96.0 cm(HDL); while for WHtR the optimal values varied from 0.47(HDL) to 0.56(fasting blood sugar). Likewise, the optimal cut-offs of WHR for markers of metabolic syndrome ranged from 0.78(fasting blood sugar) to 0.89(HDL and blood pressure). For males, the optimal BMI cut-offs for metabolic syndrome markers ranged from 21.0 kg/m2 (HDL) to 23.5 kg/m2 (blood pressure). For WC, the optimal cut-off ranged from 85.3 cm (triglyceride) to 96.0 cm(fasting blood sugar); while for WHtR the optimal values varied from 0.47(BP, FBS and HDL) to 0.53(Triglyceride). Similarly, the optimal cut-offs of WHR form markers of metabolic syndrome ranged from 0.86(blood pressure) to 0.95(fasting blood sugar). CONCLUSION: The optimal anthropometric cut-offs for obesity and markers of metabolic syndrome in Ethiopian adults are lower than the international values. The findings imply that the international cut-off for WC, WHtR, WHR and BMI underestimate obesity and metabolic syndrome markers among Ethiopian adults, which should be considered in developing intervention strategies. It is recommended to use the new cut-offs for public health interventions to curb the increasing magnitude of obesity and associated metabolic syndrome and diet related non-communicable diseases in Ethiopia.

Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia.

BACKGROUND: Diabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine. METHODS: A total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine. RESULTS: CKD, defined as eGFR<60 ml/min/1.73 m2, was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR<60 ml/min/1.73 m2 had abnormal serum creatinine values, i.e. >1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2-3 CKD) despite normal creatinine levels. CKD, eGFR<60 ml/min/1.73 m2, was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively. CONCLUSION: CKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2-3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.

Magnitude of Thrombocytopenia and Associated Factors among Pregnant Women Attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia.

Background: Thrombocytopenia is the second most common hematological disorder in pregnancy after anemia worldwide and affects 7-8% of all pregnancies. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, exudation at the cesarean section, and neonatal thrombocytopenia. Therefore, the main aim of this study was to assess the magnitude of thrombocytopenia and its associated factors among pregnant women attending the Antenatal Care Service Unit of Wachemo University Nigist Ellen Mohammed Comprehensive Specialized Hospital Hosanna, Southern Ethiopia. Materials and Methods: A cross-sectional study was conducted from June 1 to August 30, 2022, involving 209 consecutive pregnant women who came to the hospital during the study period for antenatal care follow-up. Sociodemographic, reproductive, and other clinical data were collected using a structured questionnaire. A four-milliliter venous blood specimen was collected for complete blood analysis and peripheral blood smear. The data were analyzed by using SPSS version 25. Descriptive statistical analysis and bivariate and multivariate logistic regression analyses were performed. A P value ≤0.05 was considered to indicate statistical significance. Results: The overall magnitude of thrombocytopenia among pregnant women was 14.8% (95% CI: 10, 19.6). The prevalence of mild, moderate, and severe thrombocytopenia was 77.4%, 16.1%, and 6.5%, respectively. Multivariate logistic regression revealed that rural residence (AOR = 2.6 and 95% CI = 1.02, 7.12), cigarette smoking (AOR = 8.4 and 95% CI = 1.86, 38), anemia (AOR = 8.3 and 95% CI = 2.7, 25.6), and alcohol consumption (AOR = 8.2 and 95% CI = 2.17-31) were significantly independent factors associated with the development of thrombocytopenia. Conclusion: The magnitude of thrombocytopenia in this study was 14.8%. Rural residence, cigarette smoking, alcohol consumption, and anemia were significantly associated with thrombocytopenia. Therefore, the platelet count should be routinely determined during antenatal care visits for proper diagnosis and to minimize bleeding during and/or after childbirth.

Magnitude, Associated Factors and Morphological Types of Anemia Among Hospitalized 6-59 Months Age Children at Jimma Medical Center, Southwest Ethiopia - A Hospital-Based Cross-Sectional Study.

Background: Anemia is among the major public health problems that cause significant morbidity and mortality among children around the world. Anemia in children of age 6 months to 5 years is a major health problem in most developing world countries with estimated prevalence of about 43%. Objective: To determine the magnitude, associated factors and morphological types of anemia among hospitalized 6-59 months age children from June 15 to October 15, 2022 at Jimma Medical Center, southwest Ethiopia. Methodology: Hospital-based cross- sectional study design was conducted from June 15 to October 15, 2022 at Jimma Medical Center, involving 383 hospitalized children aged 6-59 months by employing convenient sampling technique. Data of sociodemographic characteristics and other associated factors of the study individuals waere collected using a pre-structured questionnaire. Clinical data were collected by physical examination and from history of client by medical interns and nurses. Then 3 mL venous blood was collected and analyzed for complete blood count. Data were coded, cleared and entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable binary logistic regression was used to identify associated factors. Results: The overall prevalence of anemia among hospitalized 6-59 months age children was 57.2%; out of them 30.82% were moderate. In the present study children with malaria infection, AOR = 1.15 (95% CI: 0.017, 0.781), Cchildren with severe malnutrition, AOR = 2.046 (95% CI: 0.306, 1.366), and children with low family income, AOR = 2.6 (95% CI 0.475, 0.894) were independent variables associated with anemia. Conclusion and Recommendation: Anemia among study participants is found to be a severe public health problem. Based on this finding, more intervention is needed with health education on nutrition and child feeding.

Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study.

Background: Numerous biomarkers are used as diagnostic, prognostic, and predictive indicators of myocardial ischemia. The most commonly used biomarkers are cardiac troponin I (Tn-I) and creatinine kinase (CK-MB). However, in developing nations, their availability in primary care settings is extremely limited. In such situations, easily available assays such as complete blood count (CBC) should be investigated as prognostic indicators in individuals with acute coronary syndrome (ACS). Objective: This study aimed to compare the pattern of haematological indices and blood cell ratios of ACS patients compared with apparently healthy controls. Methods: Patients diagnosed with ACS were recruited consecutively between 01 May 2022 and 31 October 2023 at Jimma Medical Center (JMC). Biochemical analyses and complete blood counts were performed. Analysis of variance was performed to compare the continuous variables. Spearman correlation coefficient tests were performed to correlate hematologic parameters with high sensitive troponin-I (hs-Tn-I) levels. Results: This study enrolled 220 participants (110 patients with ACS and age, sex, and place of residence matched 110 non-ACS controls). From ACS group 99 (90%) were diagnosed with ST-elevated myocardial infarction. The ACS group had a significantly greater mean platelet volume (MPV), white blood cell count, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009) were significantly positively correlated with hs-Tn-I levels in the ACS group. MPV, RDW, and monocyte count were significantly higher in non-survivor ACS patients (p <0.05). Conclusion: The significant differences observed in haematological parameters between individuals with ACS and healthy controls suggest the potential utility of these easily accessible and cost-effective diagnostics in predicting future morbidity and ACS risk. Incorporating these routine evaluations into clinical practice could enhance risk assessment and improve patient outcomes.

Predictive role of hematological indices in patients with acute coronary syndrome in Ethiopia: Intrahospital outcomes.

Background: Apart from troponins, various additional biomarkers that indicate myocardial injury, inflammation, thrombosis, and other routes are being studied to improve the treatment of acute coronary syndrome (ACS). Myeloid activity has been found to be elevated in ACS, and this has sparked a great deal of interest in hematological parameters since they might offer independent insights into pathophysiology and risk assessment. Objective: The purpose of this study was to evaluate the hematological markers' prognostic ability for all intrahospital causes of mortality in individuals with an ACS diagnosis. Methods: A long-term cohort study based at an institution was done. At Jimma Medical Center, patients with an ACS diagnosis were progressively brought in between May 1, 2022, and October 31, 2023. Complete blood counts (CBC) and biochemical analysis were carried out. Multilevel mixed effect logistic regression was computed to evaluate the predictive competence of hematological indices on intrahospital mortality. Prognostic performance of hematological parameters was done using the ROC curve analysis. Result: A total of 110 patients were included, of which 99 (90 %) were diagnosed ST-elevation myocardial infarction, and 74 (67.3 %) were men. The mean age was 56 (±11) years. RDW, platelet count, and MCV were independently associated with intrahospital mortality (AOR = 1.20 with P < 0.001, AOR = 0.995 with P < 0.03, and AOR = 0.897 with P < 0.025, respectively). The predictive power of RDW-SD for intrahospital mortality was evaluated by ROC analysis, the AUC value were 0.737 (95 % CI 0.669-0.805). Conclusion: This study found that red cell distribution width, mean corpuscular volume, and platelets were predictive factors for intrahospital death in patients with ACS. Thus, it is possible to predict the prognosis of an ACS patient using hematological data.

Hematological Parameters of Gasoline Station Workers at Hosanna Town, Southwest Ethiopia: A Comparative Cross-Sectional Study.

Background: Human exposure to benzene is associated with many adverse health effects. It is mainly related to impairment of the hematopoietic system and bone marrow suppression, causing abnormalities in hematological parameters. However, the reports obtained from different studies are contradictory, and there are little data regarding the hematological parameters of gas station workers in the study area. Therefore, this study aimed to evaluate the hematological parameters of gas station workers in Hosanna town, southwest Ethiopia, from May 01 to June 15, 2020. Methods: A comparative cross-sectional study was conducted by involving 180 (60 gas-stations workers and 120 controls) participants. Socio-demographic and related data of the study participants were collected using a pre-tested structured questionnaire through face-to-face-interviews. All phases of quality assurance were maintained, and hematological parameters were determined using Uni-Cel DxH 800 automated hematological analyzer. Independent sample T-test, Mann-Whitney U-test, and one-way ANOVA were used for data analysis. Statistical significance was declared at P<0.05. Results: Statistically significant difference was observed in hematological parameters of gasoline-workers and control groups. The mean of red blood cell count among gasoline-workers was significantly reduced as compared to control groups (p=0.007). In addition, the median of hemoglobin levels among gasoline-workers was significantly decreased as compared to the control groups (p=0.001). In contrast, a significant increase was observed in median of absolute eosinophil count among the gasoline-workers as compared to control groups (p=0.01). The mean of mean cell volume was significantly decreased with respect to the duration of work experience (p=0.04). Conclusion: In this study, a statistically significant difference was observed in some hematological parameters of gas station workers compared to the control group. Therefore, medical observation and periodic medical check-ups of the hematological profile should be considered to prevent the development of medical complications.

Hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia: A comparative cross-sectional study.

BACKGROUND: Diabetes is a global public health problem and associated with metabolic, cellular, and blood disturbances. Hematological changes have been reported in diabetes and play a major role in diabetes-associated complications. However, reports are contradicting and data on hematological parameters of type 2 diabetic patients in the study area are scarce. Therefore, the aim of this study was to assess the hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia from May 01 to June 30, 2020. METHODS: A comparative cross-sectional study was conducted on 268 (134 type 2 diabetic patients and 134 controls) study participants selected by systematic random sampling technique. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire and checklist. Ethical approval was obtained from Jimma University. All phase of quality assurance was maintained. Hematological parameters and blood glucose levels were determined using UniCel DxH 800 (Beckman Coulter, USA) and Biosystems A25 (Costa Brava, Spain) analyzers, respectively. Independent t-test, Mann-Whitney U-test, correlation, and logistic regression were used during data analysis. P-value <0.05 was considered as statistically significant. RESULTS: The current study found that total white blood cell count, absolute counts of neutrophil, lymphocyte, eosinophil, and basophil, red blood cell distribution width, platelet count, and mean platelet volume were significantly higher in type 2 diabetic patients as compared to the control group (P<0.05). On the other hand, the mean hemoglobin was significantly lower in type 2 diabetic patients than the control group (P = 0.007). Anemia was found in 17.9% of type 2 diabetic patients. Longer duration of diabetes (AOR = 3.05, 95% CI = 1.12-8.34) and milk consumption (AOR = 4.60, 95% CI = 1.50-14.00) were significantly associated with anemia. CONCLUSION: This study showed a statistically significant variation in some hematological parameters of type 2 diabetic patients compared to control group. Anemia among type 2 diabetic patients was found to be a mild public health problem. Therefore, routine screening of hematological parameters should be considered for proper management of type 2 diabetic patients. Close attention should also be given to the duration of diabetes and dietary practice.

Accurate Machine-Learning-Based classification of Leukemia from Blood Smear Images.

BACKGROUND: Conventional identification of blood disorders based on visual inspection of blood smears through microscope is time consuming, error-prone and is limited by hematologist's physical acuity. Therefore, an automated optical image processing system is required to support the clinical decision-making. MATERIALS AND METHODS: Blood smear slides (n = 250) were prepared from clinical samples, imaged and analyzed in Jimma Medical Center, Hematology department. Samples were collected, analyzed and preserved from out and in-patients. The system was able to categorize four common types of leukemia's such as acute and chronic myeloid leukemia; and acute and chronic lymphoblastic leukemia, through a robust image segmentation protocol, followed by classification using the support vector machine. RESULTS: The system was able to classify leukemia types with an accuracy, sensitivity, specificity of 97.69%, 97.86% and 100%, respectively for the test datasets, and 97.5%, 98.55% and 100%, respectively, for the validation datasets. In addition, the system also showed an accuracy of 94.75% for the WBC counts that include both lymphocytes and monocytes. The computer-assisted diagnosis system took less than one minute for processing and assigning the leukemia types, compared to an average period of 30 minutes by unassisted manual approaches. Moreover, the automated system complements the healthcare workers' in their efforts, by improving the accuracy rates in diagnosis from ∼70% to over 97%. CONCLUSION: Importantly, our module is designed to assist the healthcare facilities in the rural areas of sub-Saharan Africa, equipped with fewer experienced medical experts, especially in screening patients for blood associated diseases including leukemia.

Anemia and its association with Helicobacter pylori infection among adult dyspeptic patients attending Wachemo University Nigist Eleni Mohammad Memorial Referral Hospital, Southwest Ethiopia: A cross-sectional study.

BACKGROUND: Anemia is a worldwide public health problem and also associated with Helicobacter pylori (H. pylori) infection. Determining the association of anemia with H. pylori infection is important to develop evidence-based decision and intervention strategies, which is not well known in Ethiopia. Thus, this study aimed to determine the association between anemia and H. pylori infection among adult dyspeptic patients attending Wachemo University Nigist Eleni Mohammad Memorial Referral Hospital in Southwest Ethiopia. METHODS: A cross-sectional study was conducted from January to April 2019 involving 362 consecutive adult dyspeptic patients who came to the hospital during the study period. Socio-demographic, clinical and other related data were collected by structured questionnaires. Four milliliters of the venous blood sample was collected for hematological parameters analysis and blood film preparation. A stool sample was collected to detect H. pylori antigen and intestinal parasites. Data were analyzed by SPSS version 21. Logistic regression analyses were performed and p-value <0.05 was considered as statistically significant. RESULTS: The overall prevalence of anemia among dyspeptic patients was 24.3% (95%CI: 19.9-28.7). Among H.pylori infected participants 29.2% were anemic, of which 69.2% had mild anemia and 63.5% had normocytic normochromic anemia. Rural residence (AOR: 1.9, 95%CI: 1.1-3.3), H. pylori infection (AOR: 1.77, 95%CI: 1.05-2.98) and intestinal parasitic infection (AOR: 2.14, 95%CI: 1.14-4.03) were significantly associated with anemia. CONCLUSION: The prevalence of anemia in this study indicated that it is a moderate public health problem. Rural residence, H. pylori and intestinal parasitic infection were significantly associated with anemia. The findings of this study should be taken into account for the prevention and control of anemia among dyspeptic adults.

Anemia and Related Factors Among Highly Active Antiretroviral Therapy Experienced Children in Hawassa Comprehensive Specialized Hospital, Southern Ethiopia: Emphasis on Patient Management.

BACKGROUND: Human Immunodeficiency Virus (HIV) and its therapy cause a variety of hematological abnormalities that have been known to be one of the most common causes of morbidity and mortality in HIV-positive children. One of the commonly observed hematologic manifestations in HIV-positive children is anemia and it has a multifactorial source. We intended to assess the prevalence, as well as its related factors of anemia among Highly Active Antiretroviral Therapy (HAART), experienced children. METHODS: A hospital-based cross-sectional study was employed at Hawassa comprehensive specialized hospital from February 15-June 15, 2018. Overall, 273 HAART-practiced children were included in the study. Socio-demographic variables and clinical data were collected using a standard and pretested questionnaire. Medical records were reviewed for each study participant using a standard checklist. Blood specimens were collected and examined for complete blood count, CD4 cell count and blood film for hemoparasites and morphological classification of anemia, whereas stool specimens were collected and examined for intestinal parasites. Data were entered into Epidata and transferred to SPSS (Statistical Package for Social Science) version 20 software. Descriptive analysis was done for prevalence and binary and multivariate logistic regression was used to determine factors associated with anemia. Statistical significance was stated at P-value<0.05. RESULTS: The overall prevalence of anemia in this study was 11.4%. Morphologically the predominant anemia was Normocytic Normochromic anemia which accounted for 64.5%. In the current study, children within the age group of <7years (AOR: 3, CI: 1.2-7.5, P=0.02), those who were rural residents (AOR: 2.6, CI: 1.0-6.6, P=0.042) and those with viral load >150 copies/mL (AOR: 3.4, CI: 1.36-8.3, P=0.009) were found to be significantly associated with anemia. CONCLUSION: The prevalence of anemia in this study was 11.4%. It was significantly associated with different factors such as age, residence and viral load. Therefore, regular follow-up management should be emphasized for HAART-experienced children. Hence, there is a need for a longitudinal study to be conducted further to explore the causes of anemia due to HIV and the pattern of hemoglobin changes with HAART- experienced children will be very important.

Hemostatic Abnormality and Associated Factors in Diabetic Patients at Jimma University Specialized Hospital, Jimma, Southwest Ethiopia: A Comparative Cross-sectional Study.

BACKGROUND: Diabetes mellitus is a group of heterogeneous disorders of multiple etiologies characterized by chronic hyperglycemia resulting from defects in insulin secretion and/or insulin action. Diabetes mellitus has been reported to disturb normal hemostasis by various mechanisms. However, data on hemostasis of diabetic patients in the study area are lacking. This study was aimed at determining hemostatic profile and associated factors of hemostatic abnormality in diabetic patients. METHODS: A comparative cross-sectional study was conducted involving a total of 238 (119 diabetic and 119 apparently healthy) individuals who came to the chronic care clinic, Jimma University Specialized Hospital. Socio-demographic and clinical data were collected through a structured questionnaire. A blood sample of 10ml was collected in EDTA (4ml), citrate (3ml) and chemistry (3ml) tubes to do platelet count, coagulation tests, and glucose and lipid profile analysis, respectively. Descriptive statistics as well as the median (25th, 75th) percentile and Mann Whitney U test were used during data analysis. RESULTS: The overall hemostatic abnormality in diabetes individuals was 58.8%. The median (25th, 75th percentile) prothrombin time for diabetic and non-diabetic subjects was (12.8, 15.6) vs. (12.8, 14.2), respectively, and the difference was not statistically significant (p>0.05). The median (25th, 75th percentile) activated partial thromboplastin time was significantly different between the two groups (p<0.0001); (24, 36.8) vs. (36, 39.6). The median (25th, 75th percentile) fibrinogen level was significantly different between the two groups (p<0.0001); (277, 462) vs. (243, 328). The median (25th, 75th percentile) platelet count was also significantly different between the two groups (p<0.0001); (146,248) vs. (190,319). All variables were not significantly associated with hemostatic abnormality in multivariate regression analysis. CONCLUSION: An overall hemostatic abnormality in diabetic patients was found to be high. The APTT and platelet count were lower in diabetic patients whilst the fibrinogen level was higher. Routine coagulation tests should be part of tests among diabetic patients. Advanced coagulation tests should also be considered to identify specific markers so as to pinpoint the particular problem.

Performance of newly developed body mass index cut-off for diagnosing obesity among Ethiopian adults.

BACKGROUND: Obesity is defined as unhealthy excess body fat, which increases the risk of premature mortality from noncommunicable diseases. Early screening and prevention of obesity is critical for averting associated morbidity, disability, and mortality. Ethiopia has been using the international (WHO's) BMI cut-off for diagnosing obesity even though its validity among Ethiopian population was questioned. To address this problem, a new body mass index cut-off was developed for Ethiopian adults using population-specific data. However, its performance in diagnosing obesity has not been validated. Therefore, this study determined the performance of the newly developed Ethiopian and World Health Organization (WHO) BMI cut-offs in detecting obesity among Ethiopian adults. METHODS: A cross-sectional study was carried out among 704 employees of Jimma University from February to April 2015. The study participants were selected using simple random sampling technique based on their payroll. Data on sociodemographic variables were collected using an interviewer-administered structured questionnaire. Anthropometric parameters including body weight and height were measured according to WHO recommendation. Body fat percentage (BF%) was measured using the air displacement plethysmography (ADP) after calibration of the machine. The diagnostic accuracy of the WHO BMI cut-off (≥ 30 kg/m2) for obesity in both sexes and Ethiopian BMI cut-off (> 22.2 kg/m2 for males and >  24.5 kg/m2 for females) were compared to obesity diagnosed using ADP measured body fat percentage (> 35% for females and >  25% for males). Sensitivity, specificity, predictive values, and kappa agreements were determined to validate the performance of the BMI cut-offs. RESULTS: In males, WHO BMI cut-off has a sensitivity of 5.3% and specificity of 99.4% (Kappa = 0.047) indicating a slight agreement. However, the Ethiopian cut-off showed a sensitivity of 87.5% and specificity of 87.7% (Kappa = 0.752) indicating a substantial agreement. Similarly, in females, the WHO BMI cut-off showed a sensitivity of 46.9%, while its specificity was 100% (Kappa = 0.219) showing a fair agreement. The Ethiopian BMI cut-off demonstrated a sensitivity 80.0% and a specificity 95.6% (Kappa = 0.701) showing a substantial agreement. The WHO BMI cut-off underestimated the prevalence of obesity by a maximum of 73.7% and by a minimum of 28.3% among males, while the values for underestimation ranged from 31.4-54.1% in females. The misclassification was minimal using the newly developed Ethiopian BMI cut-off. The prevalence of obesity was underestimated by a maximum of 9.2% and overestimated by a maximum of 6.2%. The WHO BMI cut-off failed to identify nearly half (46.6%) of Ethiopian adults who met the criteria for obesity using BF% in the overall sample. CONCLUSIONS: The findings suggest that WHO BMI cut-off (≥ 30 kg/m2) is not appropriate for screening obesity among Ethiopian adults. The newly developed Ethiopian BMI cut-off showed a better performance with excellent sensitivity, specificity, predictive values, and agreement indicating the diagnostic significance of it use as a simple, cost-effective, and valid indicator in clinical and community setups.

Metabolic Effects of Fasting and Animal Source Food Avoidance in an Ethiopian Adult Cohort.

Fasting is a religious practice to which the faithful comply strictly. The longest period of fasting in Orthodox religion is the lent (in Ethiopia known as "Hudade"). According to the doctrine of Ethiopian Orthodox Christianity, fasters should strictly avoid all animal source foods (ASF) and skip breakfast at least up to lunch time. This can be taken as a well-controlled natural experiment to evaluate the effect of breakfast skipping and avoidance of ASF for 55 days. However, there is no study that evaluated the effect of ASF fasting (avoidance of animal source foods  and breakfast skipping) on lipid profiles, fasting blood sugar and body composition in Ethiopian set up. A retrospective cohort study was carried out among 704 employees of Jimma University (253 fasters and 451 non-fasters) from February 2015 to April 2015. Data on socio-demographic, anthropometry, blood pressure and blood samples were collected according to WHO STEPS procedure. Descriptive statistics and multivariable linear regression models were used to compare the effect of fasting on outcome variables. There was a significant difference in the body fat percent (mean ± sd) between non-fasters (32.35 ± 11.12) and fasters (30.59 ± 11.22, P = 0.045). Similarly, the mean ± sd waist circumference was higher among non-fasters (84.96 ± 11.43 cm) compared to fasters (83.04 ± 11.43 cm, P < 0.033). High density lipoprotein was significantly (P = 0.001) high among fasters (68.29 mg/dl) compared to non-fasters (57.24 mg/dl). Total cholesterol (T.chol) was also higher among non- fasters (181.01 mg/dl) than fasters (173.80 mg/dl, P = 0.035). The mean Triglyceride level was significantly (P = 0.035) high among non-fasters (142.76 mg/dl) compared to fasters (129.39 mg/dl). Similarly, fasting blood sugar was high among non-fasters (100.14 mg/dl) compared to fasters (95.11 mg/dl), P = 0.009. On multivariable linear regression analyses after adjusting for different variables, fasters had a significantly high mean HDL and lower mean T.chol, Triglycerides, FBS and LDL levels. Similarly, fasters had a significantly low mean waist circumference and low mean body fat percent (P < 0.05). In conclusion, animal source food avoidanceand breakfast skipping has a significant desirable health effects on lipid profiles, fasting blood sugar and body composition. The findings imply the need for considering such a dietary practice as a basis for public health promotion. Future research should investigate the effect of ASF fasting and breakfast skipping on micronutrient intake and determine the minimum number of days of fasting required to generate clinically significant effects.

Reference intervals for hematology test parameters from apparently healthy individuals in southwest Ethiopia.

BACKGROUND: Clinical laboratory reference intervals are an important tool to identify abnormal laboratory test results. The generating of hematological parameters reference intervals for local population is very crucial to improve quality of health care, which otherwise may lead to unnecessary expenditure or denying care for the needy. There are no well-established reference intervals for hematological parameters in southwest Ethiopia. OBJECTIVE: To generate hematological parameters reference intervals for apparently healthy individuals in southwest Ethiopia. METHODS: A community-based cross-sectional study was conducted involving 883 individuals from March to May 2017. Four milliliter of blood sample was collected and transported to Jimma University Medical Center Laboratory for hematological analysis and screening tests. A hematological parameters were measured by Sysmex XS-500i hematology analyzer (Sysmex Corporation Kobe, Japan). The data were analyzed by SPSS version 20 statistical software. The non-parametric independent Kruskal-Wallis test and Wilcoxon rank-sum test (Mann-Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 percentile and 2.5 percentile were the upper and lower reference limit for the population. RESULTS: The reference interval of red blood cell, white blood cell, and platelet count in children were 4.99 × 1012/L (4.26-5.99 × 1012/L), 7.04 × 109/L (4.00-11.67 × 109/L), and 324.00 × 109/L (188.00-463.50 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in adults was 5.19 × 1012/L (4.08-6.33 × 1012/L), 6.35 × 109/L (3.28-11.22 × 109/L), and 282.00 × 109/L (172.50-415.25 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in geriatrics were 5.02 × 1012/L (4.21-5.87 × 1012/L), 6.21 × 109/L (3.33-10.03 × 109/L), and 265.50 × 109/L (165.53-418.80 × 109/L), respectively. Most of the hematological parameters showed significant differences across all age groups. CONCLUSION: Most of the hematological parameters in this study showed differences from similar studies done in the country. This study provided population-specific hematological reference interval for southwest Ethiopians. Reference intervals should also be established in the other regions of the country.

Effect of malaria infection on hematological profiles of people living with human immunodeficiency virus in Gambella, southwest Ethiopia.

BACKGROUND: Malaria and human immunodeficiency virus are the two most devastating global health problems causing more than two million deaths each year. Hematological abnormalities such as anemia, thrombocytopenia and leucopenia are the common complications in malaria and HIV co-infected individuals. The aim of this study was to determine the effect of malaria infection on hematological profiles of people living with HIV attending Gambella Hospital ART clinic, Southwestern Ethiopia. OBJECTIVE: To determine the effect of malaria infection on hematological profiles of people living with HIV attending Gambella Hospital ART clinic, Southwestern Ethiopia. METHODS: A facility based comparative cross-sectional study was conducted from May 25 to November 11, 2014 in Gambella Hospital. A total of 172 adult people living with HIV (86 malaria infected and 86 malaria non-infected) participants were included in the study. Demographic, anthropometric and clinical data were collected. Venous blood samples and stool specimen were collected for laboratory analysis. Microscopic examination of peripheral blood films was done for detection of malaria parasites. Descriptive statistics, student T- test, bivariable and multivariable analyses were performed using SPSS V-20. Statistical significance was set at p < 0.05. RESULTS: A total of 172 adult people living with HIV were included in the study. The prevalence of anemia, thrombocytopenia and leucopenia in malaria and HIV co-infected participants were 60.5%, 59.3%, and 43.0%, respectively. Resident (AOR: 4.67; 95% CI: 1.44, 15.14), malaria infection (AOR: 2.42; 95% CI: 1.16, 5.04) and CD4 + count were predictors for anemia. A predictor for thrombocytopenia was malaria infection (AOR: 9.79; 95% CI: 4.33, 22.17). Malaria parasitic density (AOR: 0.13; 95% CI: 0.03, 0.57) and CD4 + count (AOR: 4.77; 95% CI: 1.23, 18.45) were predictors of leucopenia. CONCLUSIONS: Findings suggest that the prevalence of anemia and thrombocytopenia were significantly higher in the malaria and HIV coinfected participants than the HIV mono-infected participants. Mean values of hematological profiles were significantly different in the two groups. Future prospective studies with larger sample size from other settings are needed to substantiate the findings.

Hematological Parameters and Hemozoin-Containing Leukocytes and Their Association with Disease Severity among Malaria Infected Children: A Cross-Sectional Study at Pawe General Hospital, Northwest Ethiopia.

Hematological parameter changes are the most common complications in malaria. We aimed to determine the hematological parameters and hemozoin-containing leukocytes and their association with disease severity in malaria infected children aged between 1 and 15 years. A facility-based cross-sectional study was conducted at Pawe General Hospital from July 31 to December 30, 2014. Demographic and clinical data were collected using structured questionnaire. Blood specimen was collected from each study participant for hematological investigations. Data were analyzed using SPSS version 20. The overall prevalence of anemia was 40.3%, most of which were mildly anemic. Leukocytosis was found in 15.4% of study participants. More than a fourth (27%) of the children had severe malaria. Hemozoin-containing monocytes and neutrophils were found in 80.1% and 58.9% of the study participants, respectively. Under-five years of age (AOR = 3.01, 95% CI: 1.83-7.39, P < 0.001), leukocytosis (AOR = 3.20, 95% CI: 1.65-6.24, P = 0.001), mean hemozoin-containing monocytes >5% (AOR = 6.26, 95% CI: 2.14-14.29, P < 0.001), mean hemozoin-containing neutrophils >5% (AOR = 7.93, 95% CI: 3.09-16.86, P < 0.001), and high density parasitemia (AOR = 1.90, 95% CI: 1.13-3.18, P = 0.015) were associated with severe malaria. Hemozoin-containing leukocytes, leukocytosis, and other identified associated factors should be considered for proper management of children with severe malaria.

Prevalence, Severity, and Determinant Factors of Anemia among Pregnant Women in South Sudanese Refugees, Pugnido, Western Ethiopia.

Background. Anemia is one of the major health problems among refugee pregnant women in the world. Anemia among pregnant women is multifactorial and results in detrimental consequences on the mothers and infants. The aim of this study was to determine the prevalence, severity, and determinants of anemia among pregnant women in South Sudanese refugees, Pugnido western, Ethiopia. Methods. A facility-based cross-sectional study was conducted in Pugnido Administration Refugee and Returnee Affairs Health Center from April 15 to June 30, 2015. Demographic and related data were collected using questionnaire based interview. Complete blood count was done using CELL-DYN 1800 (Abbott USA). Blood smear and fecal specimen were examined for hemoparasite and intestinal parasite, respectively. Bivariate and multivariate logistic regression analyses were done using SPSS-Version 20.0. Results. The overall prevalence of anemia was 36.1%, from whom 2.3% had severe anemia. Being in third trimester, eating meat at most once a week, drinking tea immediately after meal at least once a day, having mid-upper arm circumference below 21 centimeters, and intestinal parasitic infection were identified as independent factors of anemia. Conclusion. More than one-third of pregnant women had anemia in this study. Intervention based strategies on identified determinant factors will be very important to combat anemia among the group.

Assessment of glycemic control using glycated hemoglobin among diabetic patients in Jimma University specialized hospital, Ethiopia.

BACKGROUND: Globally, diabetes mellitus (DM) has risen dramatically over the past two decades and is expected to keep rising for the next 20 years. If uncontrolled it may lead to complications to the patients that could be prevented or delayed. The disease could be diagnosed and monitored by blood glucose and/or glycated hemoglobin (HbA1) testing. HbA1 can tell long term hyperglycemia of the last 2-3 months period and can predict the risk of diabetic complications; however, the use of glycated hemoglobin test in the country, specifically, in the study area is almost none. Therefore, this study had the aim of assessing glycemic control and describing the risk of complications among diabetic patients using glycated hemoglobin. METHODS: Cross-sectional study was conducted in Jimma University specialized hospital among 148 diabetic patients from May to July 2012. After the study was ethically approved, HbA1, random blood sugar (RBS), socio-demographic data and clinical information were collected from every diabetic patients who were willing to participate in the study among patients coming to the hospital for their routine follow up visits. RESULTS: Even though all the study participants were on diabetes treatment, majority of them were found to be poor glycemic control. It was found out that the mean HbA1 and RBS level of the participants were 7.6 % and 280 mg/dL (15.5 mmol/L), respectively. Using HbA1,5 9.5 % of the patients had poor glycemic control and these patients were considered to be at higher risk of developing complications. Among all the study subjects with poor glycemic control, 70.8 % were within 15-30 years of age; 62.3 % were females; 60.8 % were urban dwellers; 67.4 % were illiterate; 69.6 % were with BMI less than 18.5 kg/m(2), and 61.4 % were taking injectable drugs. Among 136 patients whose clinical history was reviewed, 52.9 % had one or more documented history of major microvascular complications: visual disturbance accounting for 21.3 %, nephropathy 19.1 % and peripheral neuropathy 13.2 %. Eighty-four had poor glycemic control of which 54.7 % had already documented history of one or more complications but the remaining 45.2 % had no documented history. CONCLUSION: Even if all of the diabetic patients were on treatment, the mean HbA1 level as well as RBS level of the study subjects was above the normal range indicating poor glycemic control. More than half of diabetic patients in the hospital had poor glycemic control and were at higher risk of developing diabetic complications or they already developed the complications. Accordingly we recommended tracing the cause of this poor glycemic control for mitigating the problem.

Anemia and iron deficiency among school adolescents: burden, severity, and determinant factors in southwest Ethiopia.

BACKGROUND: Adolescence is the period of most rapid growth second to childhood. The physical and physiological changes that occur in adolescents place a great demand on their nutritional requirements and make them more vulnerable to anemia. Anemia in the adolescence causes reduced physical and mental capacity and diminished concentration in work and educational performance, and also poses a major threat to future safe motherhood in girls. The purpose of this study was to determine the prevalence of anemia and its associated factors among school adolescents in Bonga Town, southwest Ethiopia. METHODS: A cross-sectional study was conducted among 408 school adolescents in Bonga Town, southwest Ethiopia, from March 15, 2014 to May 25, 2014. An interviewer-administered questionnaire was used to collect sociodemographic and other data. A total of 7 mL of venous blood and 4 g of stool samples were collected from each study participant. Blood and stool samples were analyzed for hematological and parasitological analyses, respectively. Data were analyzed using SPSS Version 20 software for Windows. RESULTS: The overall prevalence of anemia was 15.2% (62/408), of which 83.9% comprised mild anemia. The proportion of microcytic, hypochromic anemia was 53% (33/62). Being female (adjusted odds ratio [AOR] =3.04, 95% confidence interval (CI) =1.41-6.57), household size ≥5 (AOR =2.58, 95% CI =1.11-5.96), father's illiteracy (AOR =9.03, 95% CI =4.29-18.87), intestinal parasitic infection (AOR =5.37, 95% CI =2.65-10.87), and low body mass index (AOR =2.54, 95% CI =1.17-5.51) were identified as determinants of anemia among school adolescents. CONCLUSION: This study showed that anemia was a mild public health problem in this population. School-based interventions on identified associated factors are important to reduce the burden of anemia among school adolescents.