Impact of Covid -19 incidence rate and government-initiated risk communication measures on individual's NPI practices.

BACKGROUND: Non-pharmaceutical interventions (NPI) are the most widely recognized public health measures recognized globally to prevent the spread of Covid-19. NPIs' effectiveness may depend on the type, combination of applied interventions, and the level of proper public compliance with the NPIs. The expected outcome of behavioural practices varies relative to the intervention duration. OBJECTIVES: This study aimed to assess the trend of community compliance to NPI with Covid-19 incidence and government-initiated interventions, and its variation by residence and sociodemographic characteristics of people. METHODS: A weekly non-participatory field survey on individuals' NPI practices was observed from the 41st epidemiological week of October 5th, 2020, to the 26th epidemiological week of July 4th, 2021, a total of 39 weeks. The survey covered all 14 regional and national capital cities in Ethiopia. Data collection for the three NPI behaviours (i.e., respiratory hygiene, hand hygiene, and physical distance) was managed weekly at eight public service locations using the Open Data Kit (ODK) tool. The Covid- 19 incidence data and public health measures information from August 3rd, 2020 to July 4th, 2021 were obtained from the Ethiopian Public Health Institute (EPHI). RESULTS: More than 180,000 individuals were observed for their NPI practice, with an average of 5,000 observations in a week. About 43% of the observations were made in Addis Ababa, 56% were male and 75% were middle age group (18-50 years). The overall level of NPI compliance was high at the beginning of the observation then peaked around the 13th- 15th epidemiological weeks then declined during the rest of the weeks. The peak NPI compliance periods followed the high Covid-19 death incidence and government-initiated intensive public health measures weeks. Respiratory hygiene had the highest compliance above 41% whereas hand hygiene was the lowest (4%). There was a significant difference between residents of the capital city and regional cities in their level of compliance with NPI. Females comply more than males, and individuals had increased NPI compliance at the bank service and workplaces compared to those in the transport services at P = 0.000. CONCLUSION: An increased level of compliance with NPI was observed following intensive government-initiated Covid-19 prevention measures and an increased Covid-19 death incidence. Therefore, the intensity of government-initiated risk communication and public advocacy programs should be strengthened, possibly for similar respiratory disease pandemics in the future.

Exploring Community Perceptions of COVID-19 and Vaccine Hesitancy in Selected Cities of Ethiopia: A Qualitative Study.

Even though the COVID-19 vaccine has been available and free of charge to the targeted population in Ethiopia, the vaccination rate was lower than needed to achieve herd immunity at community level. This study aimed to explore community perceptions of COVID-19 and vaccine hesitancy in selected cities of Ethiopia involving 70 in-depth interviews and 28 focused group discussions. The audio-taped data were transcribed verbatim, translated into English, and analyzed using a qualitative content analysis approach using the ATLAS.ti software version 8. The findings revealed that COVID-19 was perceived as evil and caused fear and frustration upon its emergence. The community initially used traditional remedies for its prevention but later transitioned to employing non-pharmaceutical interventions. The primary reasons for vaccine hesitancy were misinformation and misconceptions, such as connecting the vaccine with the mark of the beast, a lack of trust due to the multiple vaccine types, a shorter production timeline resulting in distrust of its effectiveness, and a fear of pain and side effects. Based on our findings, we recommend monitoring the use of social media and countering misinformation with the correct information and continuous public health campaigns. Further studies should be conducted to assess the types and magnitude of impacts from the myths and misconceptions on vaccination uptake.

Assessment of paper dust exposure and chronic respiratory symptoms among paper factory workers in, Ethiopia; a comparative cross-sectional study.

BACKGROUND: Workers in pulp and paper factories are continuously exposed to paper dust. Excessive exposure to paper dust can cause respiratory disease. Information about the prevalence of chronic respiratory symptoms and dust exposure levels among workers in pulp and paper factories is not available in Ethiopia. The aim of this study was, therefore, to assess personal total dust exposure levels, the prevalence of chronic respiratory symptoms and their associated risk factors among workers in Ethiopian pulp and paper factories. METHODS: A comparative cross-sectional study was conducted. A total of 40 dust measurements were carried out on 20 randomly selected workers. To assess chronic respiratory symptoms and associated factors, 434 workers from two paper factories and controls were interviewed using a standard questionnaire adapted from the American Thoracic Society (ATS). Gravimetric analyses of the filters were undertaken using a standard microbalance. Poisson regression was performed for comparing the prevalence of symptoms and risk factors for the two groups. Multivariable analyses were conducted to identify factors associated with chronic respiratory symptoms. RESULT: The arithmetic mean (AM) and geometric mean (GM) of dust exposure levels among the paper factories workers were 11.3 (± 7.7) and 10.2 (± 1.4) mg/m3 respectively. This exposure level exceeded the threshold limit value recommended for total dust (10 mg/m3). The prevalence of having at least one chronic respiratory symptom was about 51% among the workers in paper factories. The prevalence ratio of having chronic respiratory symptoms among paper factory workers was 5.6 times higher (PR = 6, 95% CI 3.5-10.3) than in the controls. Chronic respiratory symptoms were significantly associated with factors such as an educational status of less than grade 9, being employed in the work sections of the factories, having work experience of 5 years and above, working more than 8 h per day and having a past history of occupation and respiratory illnesses. CONCLUSION: The dust concentration in the paper factories exceeded the acceptable recommended limit value of 10 mg/m3. The prevalence of chronic respiratory symptoms among paper factory workers was higher than among controls. The main determining factors for chronic respiratory symptoms among the workers were the specific work section such as production section, low income, having past history of respiratory illnesses, the number of years of working and low educational status. This finding indicated the need for improving the working conditions in paper factories in Ethiopia.

"Blood lead level among battery factory workers in low and middle-income countries: Systematic review and meta-analysis".

Introduction: Lead is one of the most health-hazardous causes of acute and chronic poisoning at workplaces. A limited study was conducted on the blood lead concentration among battery factory workers in low and middle-income countries. Therefore, this study will improve workplace health and safety conditions of workers in this sector and serve as baseline data for further studies in this segment of the working setup. Objective: This review aims to identify the pooled mean blood lead level among battery factory workers in low and middle-income countries. Methods: The search methods considered the following electronic bibliographic databases: google scholar, PubMed, and other gray literature. A funnel plot and Begg test were used to see the publication bias. The heterogeneity of studies was checked using I-square statistics with a cut of point 75% and the Joanna Briggs Institute (JBI) quality assessment tool was applied to ensure the quality of the included articles. A random-effect model was applied to pool the blood lead level intoxication. The sub-group analysis and Meta-regression analysis were conducted by country and year of publication to control heterogeneity and to show variation. We included the articles published from 2000 to 2021 year in the English language. Results: Through the search strategies, 135 articles were identified and 43 full-text articles were selected for evaluation, and finally, eighteen (18) articles fit the inclusion criteria. From the 18 studies included in the meta-analysis, the mean pooled blood lead level of workers was 37.996 µg/dl (95% CI: 30.680-45.312) which is higher than the threshold limit value set by American conference of governmental industrial hygienists (20 µg/dl). In subgroup analysis by year in the random effect model, the pooled mean of blood lead level from 2006 to 2011= 43.20 µg/dL (35.91-50.50), 2012-2015 = 37.78 µg/dl (25.23-50.29), and 2016-2020 = 36.53 µg/dl (19.44-53.62). Conclusions: This review showed that the pooled mean blood lead level of workers exposed to lead battery factories was (37.996 µg/dl) which is above the threshold limit value (20 µg/dl). Therefore, attention should be given by employers, government, and researchers to improve the health of working populations exposed to lead exposure in low and middle-income countries through the provision of occupational health and safety services like periodical medical checkups, treatments, and provision of training and adequate and appropriate personal protective equipment.Systematic review registration: Identifier: CRD42022322827.

Trends in non-pharmaceutical intervention (NPI) related community practice for the prevention of COVID-19 in Addis Ababa, Ethiopia.

BACKGROUND: The COVID-19 pandemic has affected Ethiopia since March 13, 2020, when the first case was detected in Addis Ababa. Since then, the incidence of cases has continued to increase day by day. As a result, the health sector has recommended universal preventive measures to be practiced by the public. However, studies on adherence to these preventive measures are limited. OBJECTIVE: To monitor the status of preventive practices of the population related to hand washing, physical distancing, and respiratory hygiene practices at selected sites within the city of Addis Ababa. METHODS: Weekly cross-sectional non-participatory observations were done during the period of April-June, 2020. Data was collected using the Open Data Kit (ODK) tool in ten public sites involving eight public facilities targeted for individual observations. Ten individuals were randomly observed at each facility over two days a week at peak hours of public services. WHO operational definitions of the preventive behaviors were adopted for this study. Observations were conducted anonymously at gates or entrances of public facilities and places. RESULTS: A total of 12,056 individual observations with 53% males and 82% in an estimated age range of 18-50 years age group were involved in this study. There was an increase in the practice of respiratory hygiene from 14% in week one to 77% in week 10, while those of hand hygiene and physical distancing changed little over the weeks from their baseline of 24% and 34%, respectively. Overall, respiratory hygiene demonstrated an increased rate of 6% per week, while hand hygiene and physical distancing had less than a 1% change per week, Females and the estimated age group of 18-50 years had practice changes in respiratory hygiene with no difference in hand hygiene and physical distancing practices. Respiratory hygiene took about six weeks to reach a level of 77% from its baseline of 24%, making an increment of about 9% per week. CONCLUSION: The public practice of respiratory hygiene improved threefold whereas hand hygiene and physical distancing revealed no change. Regularly sustained public mobilization and mass education are required to sustain the achievements gained in respiratory hygiene and further hand hygiene and physical distancing.

The pattern of orthopedic fractures and visceral injury in road traffic crash victims, Addis Ababa, Ethiopia.

BACKGROUND: Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. OBJECTIVE: The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. METHODS: A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants' information was maintained. RESULTS: The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected-311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians-220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type-92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215-17.417)); P = 0.025. CONCLUSION: Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.

Unintentional Injuries and Sociodemographic Factors among Households in Ethiopia.

Background: Unintentional injuries are a public health problem throughout the world including Africa. Most of the injury studies in Ethiopia are from the healthcare facility or workplace that does not reflect the problem at the community level. Therefore, this study aimed to assess the unintentional injuries and sociodemographic factors among households in Ethiopia. Methods: This study was done from the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about unintentional injuries and injury mechanisms in the past 12 months among 16,650 households. The selection of households was from nine regions and two city administrations of Ethiopia using a stratified cluster sampling procedure. Descriptive statistics were used to characterize the data and the chi-square test was applied as a test of significance and a p value of <0.05 was considered statistically significant. Result: Of the 16,650 households that participated in the study, 394 (2.4%) reported that at least one household member suffered from an unintentional injury in the past 12 months. The leading mechanisms of injury were unintentional falls (152 falls, 33.2%) and road traffic incidents (96 incidents, 21.0%). Among household members who were injured, 84.3% survived and 15.7% died because of the injury. Divorce marital status of the household head [AOR: 2.12, 95% CI (1.12-4.41)] and family size of the household ≥ 6 [AOR:1.65, 95% CI (1.21-2.26)] were associated with high likelihood of occurrence of an injury, while lowest household wealth index [AOR: 0.69, 95% CI (0.50-0.95)] was protective against injuries. Conclusion: A low prevalence of unintentional injury was found from the community in this survey, which might be due to the tendency of the community to report severe injuries. Fall and road traffic accidents were the leading mechanisms of selected sociodemographic factors of the households that were associated with unintentional injuries. Injury prevention efforts should focus on falls and transportation injuries with special attention to the sociodemographic context of the communities.

Magnitude and Factors Associated with Optimal Complementary Feeding Practices among Children Aged 6-23 Months in Bensa District, Sidama Zone, South Ethiopia.

BACKGROUND: Prevalence of optimal complementary feeding practices are lower than expected. Undernutrition contributes 35% of children mortality. Our study was aimed to assess magnitude and factors associated with optimal complementary feeding practices among children 6-23 months in Bensa Dstrict, Sidama Zone, South Ethiopia, 2016. METHODS: A community based cross sectional study was conducted from January to February 2016 in (8) randomly selected kebles found in Bensa District. Respondents were selected by using simple random sampling technique after sampling frame was prepared from rapid survey. Pre-tested questionnaire was used to collect information. Then, data were entered into SPSS version 20, Then, crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval were computed to examine statistical significance. RESULT: This study revealed that only 8.6% (95%CI: 6.4, 10.7%) of 6-23 months children had optimal complementary feeding practices. Mother's knowledge on optimal complementary feeding (AOR=5.4, 95%CI: 2.7, 11), postnatal care service utilization (AOR=3.4, 95%CI: 1.7, 7), and household food security (AOR=5, 95%CI: 2.5, 10.5) were positively associated with optimal complementary feeding practices. CONCLUSION: Mother's knowledge, postnatal care utilization and household food security positively affected optimal complementary feeding practices. Thus, Bensa District Health Office, Sidama Zone Health Departiment and other respective stakeholders should cooperatively work to enhance knowledge of mothers/care takers on optimal complementary feeding practices, household food security and on advantages of postnatal care service utilization.

Magnitude of road traffic accident related injuries and fatalities in Ethiopia.

BACKGROUND: In many developing countries there is paucity of evidence regarding the epidemiology of road traffic accidents (RTAs). The study determines the rates of injuries and fatalities associated with RTAs in Ethiopia based on the data of a recent national survey. METHODS: The study is based on the secondary data of the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about occurrence injuries and accidents including RTAs in the past 12 months among 75,271 members of 16,650 households. Households were selected from nine regions and two city administrations of Ethiopia using stratified cluster sampling procedure. RESULTS: Of the 75,271 household members enumerated, 123 encountered RTAs in the reference period and rate of RTA-related injury was 163 (95% confidence interval (CI): 136-195) per 100,000 population. Of the 123 causalities, 28 were fatal, making the fatality rate 37 (95% CI: 25-54) per 100,000 population. The RTA-related injuries and fatalities per 100,000 motor vehicles were estimated as 21,681 (95% CI: 18,090-25,938) and 4,922 (95% CI: 3325-7183), respectively. Next to accidental falls, RTAs were the second most common form of accidents and injuries accounting for 22.8% of all such incidents. RTAs contributed to 43.8% of all fatalities secondary to accidents and injuries. Among RTA causalities, 21.9% were drivers, 35.0% were passenger vehicle occupants and 36.0% were vulnerable road users including: motorcyclists (21.0%), pedestrians (12.1%) and cyclists (2.9%). Approximately half (47.1%) of the causalities were between 15-29 years of age and 15.3% were either minors younger than 15 years or seniors older than 64 years of age. Nearly two-thirds (65.0%) of the victims were males. CONCLUSION: RTA-related causalities are extremely high in Ethiopia. Male young adults and vulnerable road users are at increased risk of RTAs. There is a urgent need for bringing road safety to the country's public health agenda.

Prevalence of percutaneous injuries and associated factors among health care workers in Hawassa referral and adare District hospitals, Hawassa, Ethiopia, January 2014.

BACKGROUND: Accidental percutaneous injury and acquiring blood-borne diseases are common problems among health care workers (HCWs). However, little is known about the prevalence and associated factors for needle stick injury among HCWs in Ethiopia. METHODS: A cross sectional study was conducted by including 526 HCWs (physicians, nurses, laboratory technicians, midwives and others), working in two public hospitals (Hawassa Referral and Adare District hospitals), from January 1-30, 2014. Binary logistic regression was done to assess the association of selected independent variables with accidental percutaneous injury. RESULTS: The prevalence of at least one episode of percutaneous injury was about 46% of which more than half (28%) occurred within one year prior to the study period and only 24% took prophylaxis for human immune deficiency virus (HIV) infection. The adjusted logistic regression analysis revealed that HCWs who recap needles were twice as likely to face a percutaneous injury. Chance of exposure to needle stick or sharp injuries also increased with increase in educational status. Having a previous history of needle stick or sharp injury was found as one of the risk factors for the occurrence of another injury. Nurses and cleaners were also at increased risk for the occurrence of percutaneous injuries. CONCLUSION: Needle stick and sharp injuries were common among HCWs in the study hospitals, which warrants training on preventive methods.

Road traffic deaths and injuries are under-reported in Ethiopia: a capture-recapture method.

In low and middle income countries road traffic injuries are commonly under-reported. This problem is significantly higher among those less severely injured road users. The objective of this study was to determine the incidence and the level of ascertainment of road traffic injuries and deaths by traffic police and hospital registry. In this study two-sample capture-recapture method was applied using data from traffic police and hospital injury surveillance, through June 2012 to May 2013. The study was conducted on one of the busiest highways in Ethiopia, the Addis Ababa - Hawassa highway. Primary data were collected by accident investigators and hospital emergency nurses using a structured checklist. Four matching variables; name of the victim, sex, place and time of the accidents was used to get the matched cases. During the study period the police independently reported 224 deaths and 446 injuries/billion vehicle kilometer while hospitals reported 123 deaths and 1,046 injuries/billion vehicle kilometer. Both sources in common captured 73 deaths and 248 injuries/billion vehicle kilometer. Taking the two data sources into consideration, the capture-recapture model estimated the incidence of deaths and injuries ranged 368-390 and 1,869-1,895 per billion vehicle kilometer, respectively. The police source captured 57.4%-60.9% of deaths and 23.5%-23.9% of injuries while the hospital sources captured 31.5%-33.4% of deaths and 55.2%-56% of injuries. Deaths and injuries among females, younger age victims, cyclists/motorcyclists and pedestrians were under-reported by traffic police. In conclusion neither of the two sources independently provided accurate coverage of road traffic incident related deaths and injuries. Strengthening both systems is necessary to obtain accurate information on road accidents and human causalities.

Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study.

BACKGROUND: In recent years, there has been an increasing interest in implementing road safety policy by different low income countries. However; the evidence is scarce on its success in the reduction of crashes, injuries and deaths. This study was conducted to assess whether road crashes, injuries and fatalities was reduced following the road safety regulation introduced as of September 2007 by Oromia Regional State Transport Bureau. METHODS: Routine road traffic accident data for the year 2002-2011were collected from sixteen traffic police offices. Data on average daily vehicle flow was obtained from the Ethiopian Road Authority. Interrupted time series design using segmented linear regression model was applied to estimate the effect of an improved road safety policy. RESULTS: A total of 4,053 crashes occurred on Addis Ababa - Adama/Hawassa main road. Of these crashes, almost half 46.4% (1,880) were property damage, 29.4% (1,193) were fatal and 24.2% (980) injury crashes, resulting 1,392 fatalities and 1,749 injuries. There were statistically significant reductions in non-injury crashes and deaths. Non-injury crash was reduced by 19% and fatality by 12.4% in the first year of implementing the revised transport safety regulation. CONCLUSION: Although revised road safety policy helped in reducing motor vehicle crashes and associated fatalities, the overall incidence rate is still very high. Further action is required to avoid unnecessary loss of lives.

Effects of excessive speeding and falling asleep while driving on crash injury severity in Ethiopia: a generalized ordered logit model analysis.

The severity of injury from vehicle crash is a result of a complex interaction of factors related to drivers' behavior, vehicle characteristics, road geometric and environmental conditions. Knowing to what extent each factor contributes to the severity of an injury is very important. The objective of the study was to assess factors that contribute to crash injury severity in Ethiopia. Data was collected from June 2012 to July 2013 on one of the main and busiest highway of Ethiopia, which extends from the capital Addis Ababa to Hawassa. During the study period a total of 819 road crashes was recorded and investigated by trained crash detectors. A generalized ordered logit/partial proportional odds model was used to examine factors that might influence the severity of crash injury. Model estimation result suggested that, alcohol use (Coef.=0.5565; p-value=0.017), falling asleep while driving (Coef.=1.3102; p-value=0.000), driving at night time in the absence of street light (Coef.=0.3920; p-value=0.033), rainfall (Coef.=0.9164; p-value=0.000) and being a minibus or vans (Coef.=0.5065; p-value=0.013) were found to be increased crash injury severity. On the other hand, speeding was identified to have varying coefficients for different injury levels, its highest effects on sever and fatal crashes. In this study risky driving behaviors (speeding, alcohol use and sleep/fatigue) were a powerful predictor of crash injury severity. Therefore, better driver licensing and road safety awareness campaign complimented with strict police enforcement can play a pivotal role to improve road safety. Further effort needed as well to monitor speed control strategies like; using the radar control and physical speed restraint measures (i.e., rumble strips).