Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial.

Background: In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. Objective: This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. Methods: A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. Discussion: The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.

Risky sexual practice and associated factors among street children of Wonago town, Gedeo zone, Southern Ethiopia.

Introduction: A "risky sexual practice" is any sexual act that might put an individual's social, physical, and psychological health at risk and increase the likelihood of adverse sexual and reproductive health consequences. Street children have risky sexual practices, which place them at all kinds of health risks. Therefore, the aim of this study is to assess risky sexual practices and associated factors among street children in Wonago Town, southern Ethiopia. Methods: A community-based cross-sectional study design was employed. About 214 street children, aged 10-18, residing in Wonago Town from September 1-30, 2021, participated in the study. Data was gathered from all of the street children in Wonago town. A pre-tested and structured interviewer-administered questionnaire was used to collect data. Epi data software was used to enter the collected data, which was then exported to SPSS for analysis. A logistic regression model was applied to identify the associated factors. A p value <0.05 was used to declare the significant variables. Results: A total of 214 street children were involved in the study. Overall, the magnitude of risky sexual practices was 43.46 percent (95% CI: 38.3-48.62). About 52.7% of participants had ever had sexual intercourse in the last year, and of them, around 43.5% had more than one sexual partner. Among sexually active street children, 40.9% never used a condom during sexual intercourse. Age (Adjusted Odd Ratio (AOR): 1.42, 95%CI: 1.03-2.37), educational status (AOR: 5.73, 95%CI: 1.49-10.51), substance use (AOR: 1.24, 95%CI: 1.03-2.07), duration on the street (AOR: 2.14, 95%CI: 1.03-4.12), and daily income (AOR: 0.68, 95%CI: 0.32-0.98) were found to be significantly associated with risky sexual practices. Conclusion: Risky sexual practices among street children were more prevalent in Wonago Town, Southern Ethiopia. Children's age, educational status, daily income, duration on the street, and status of substance use were the factors that contributed to risky sexual practices. As a result, conducting information and education campaigns, developing income-generating activities for children, increasing children's school enrollment and attendance, improving access to sexual and reproductive health services, and providing capacity-building training for health care providers may all help to reduce risky sexual practices.

Predictors of mortality among severe acute malnourished children. A multi-center prospective follow-up study.

BACKGROUND & AIMS: Severe acute malnutrition (SAM) is a public health problem in developing countries including Ethiopia, because of the high risk of death, most severely malnourished children are managed in hospitals. Hence, the aim of this study was to assess the predictors of mortality among severely malnourished children admitted in Gedeo zone hospitals, Southern Ethiopia. METHODS: Multicenter institution-based prospective follow-up study was conducted among 568 severely malnourished children with age <5 years in Gedeo zone hospitals from December 2018 to April 2020. Survival analysis with Cox proportional hazard model was conducted to determine factors associated with mortality rate. Variables with a p-value <0.05 in multivariate regression were considered statistically significant. RESULTS: From a total of 568 children admitted with SAM; 54(9.5%), 306(53.9%), 179(31.5%) and 29(5.1%) died, recovered, transferred out and defaulted respectively. Over the study period, the rate of mortality was eight per 1000 person-days. Comorbidity after admission (Adjusted hazard ratio (AHR) = 2.96; 95% CI 1.35, 6.47), being HIV reactive (AHR = 1.31; 95% CI 1.12, 1.72), hospital stay for more than one week (AHR = 1.78; 95% CI 1.03, 3.12), no formal education of the mother (AHR 2.25; 95% CI 1.24, 4.08) and Nasogastric (NG) tube (AHR = 1.87; 95% CI: 1.562-2.37) given were the significant predictors of mortality. CONCLUSIONS: Maternal/caregiver educational status, co-morbidity after admission, being HIV reactive, vaccination status, hospital stay for more than one week and NG tube given were found as significant determinant factors of mortality rate. Hence, the government of Ethiopia and stakeholders should implement strong interventions focusing on these predictors.

Predictors of Hand-Washing Practices at Critical Times Among Mothers of Under-5 Years Old Children in Rural Setting of Gedeo Zone, Southern Ethiopia.

Background: Various communicable and infectious diseases could be contained by proper hand washing leading to a reduction in mortality and morbidity of children. Objective: To assess predictors of hand-washing practices at critical times among mothers of under 5 years old children in rural setting of Gedeo zone, Southern Ethiopia. Method: An institutional-based cross-sectional survey was conducted among 422 women with children under the age of 5 attended the Dilla Zuria health facility and were chosen using a systematic sampling method. Data was gathered using pre-tested interview-administered structured questionnaires. Data was entered into EPI info version 17 and analyzed using SPSS version 25. Binary logistic regression was employed to identify the association between dependent and independent variables. Finally, for variables with a P < .05 in multivariable analysis, adjusted odds ratio (AOR) with a 95% confidence interval (CI) was determined and interpreted. Results: The hand washing practice of mothers at critical times was 44.9% [95% CI: 40.1, 49.7%]. The pertinent predictors were favorable attitude [AOR = 7.77, 95% CI: 4.56, 10.37], availability of water source near the household [AOR = 5.31, 95% CI: 3.56, 10.37], and constant availability of soaps at household [AOR = 2.32, 95% CI: 1.33, 6.70]. Conclusion: In our study, hand-washing practices at critical times was low. The pertinent predictors were attitude, the presence of a water source near the household, and the presence of soap. Therefore, it is advised to encourage domestic hygiene education to improve mothers' attitudes and to increase the availability of water and soap close to the household to promote handwashing with soap and water at critical times.

Effect of Prophylactic Intrathecal Pethidine on the Incidence of Shivering on Mothers Undergoing Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial.

Background: Shivering is the most common and unpleasant complication of anesthesia with an incidence of 70.7% in cesarean section done under spinal anesthesia which is associated with cardiovascular and respiratory complications. Even though it causes such devastating complications; the prevention of shivering is not well investigated. This study aimed to assess the effect of intrathecal pethidine on the incidence and severity of shivering in patients undergoing cesarean section under Spinal anesthesia. Materials and Methods: After obtaining ethical clearance double-blinded single centered a randomized controlled trial was conducted in a total of 86 pregnant mothers who were randomly allocated into two groups by computer-generated random number. Approximately 1 ml of 10 mg preservative-free pethidine was added to 12.5 mg of 0.5% bupivacaine for spinal anesthesia in the treatment group and 12.5 mg of 0.5% bupivacaine alone was given in the control group. Incidence and severity of shivering, as well as adverse effect was recorded intraoperatively, in post-anesthesia care unit (PACU) and ward. Independent sample t-test, Mann-Whitney U test and chi-square were used for analysis. A p-value less than 0.05 was considered statistically significant. Results: Shivering was observed in 53.5 and 20.9% in the control and treatment groups, respectively, which was statistically significant with p = 0.002. The risk of developing shivering was reduced by 61% in the treatment group with (RR = 0.39 and CI of 0.205-0.745); the intensity of shivering was also higher in the control group than in the treatment group with p = 0.004. Considering an adverse effect, the incidence of PONV was not significantly different between with p > 0.05 while the incidence of pruritus was higher in the treatment group than the control group with p = 0.003. Conclusion: Adding 10 mg of preservative free pethidine intrathecally during spinal anesthesia is effective in reducing incidence and severity of shivering, without causing significant adverse effects on mother.

Community-based new born care practice and its associated factors among women who give birth at home in Ethiopia: cross-sectional study.

BACKGROUND: In Ethiopia, perinatal mortality rate was 33 per 1000 pregnancies and 64.4% of this death was occurred within the first 7 days of neonatal life. Moreover, more than 2.1% of new born babies were died within their first seven days of life in Ethiopia. Majority of neonatal deaths are preventable by applying an effective and lifesaving interventions. However, little is known about newborn care practice at the community level. METHODS: A community-based cross-sectional study design was used. Multi-stage sampling techniques were used to get a total of 540 mothers who gave birth at home within the past six months from their kebeles in Ethiopia. Data was collected by using face-to-face interview with structured questionnaires. Then the data was coded, cleaned, and entered into Epidemiological data version 3.1 and exported to statistical package for social science version 23.0 for analyses. Bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio at 95% confidence interval with P-Value 0.05% was computed. RESULTS: A total of 540 women were participated with a response rate of 98.3%. Only 208 (44%) of the women had good practice towards essential newborn care. Head of households [AOR (95%CI) 2.7417 (1.80-4.25)], type of birth attendant [AOR (95%CI) 3.962 (3.329-7.171)] and bad obstetrical history [AOR (95%CI) 3.151 (2.209-4.969)] were significantly associated with maternal newborn care practice. CONCLUSION: Less than half of the mothers had good newborn care practice. In this study, head of household, type of birth attendant, and bad obstetrical history were significantly associated with maternal newborn care practice. Therefore, Ministry of Women and Woreda women and Child offices needs to promote the socioeconomic empowerment of women to increase the practice of essential newborn care practices.

Dietary diversity and physical activity as risk factors of abdominal obesity among adults in Dilla town, Ethiopia.

BACKGROUND: Globally, the prevalence of obesity is on the rise and has nearly tripled since 1975. In Ethiopia, despite not having well-documented evidence, abdominal obesity has been increasing dramatically, particularly in urban settings. Therefore, this study is intended to determine the prevalence and risk factors of abdominal obesity among adults in Dilla town, Ethiopia. METHODS: A community-based cross-sectional study was conducted between January and February 2018 in Dilla Town. A multi-stage sampling technique was employed to recruit 663 adults. The study was conducted in accordance with the World Health Organization (WHO) STEP wise approach. Waist circumference was measured using a flexible metric tape mid-way between the lowest rib and iliac crest with the participant standing at the end of gentle expiration. Abdominal obesity was determined using the International Diabetes Federation cutoff. A logistic regression model was fitted to identify risk factors of abdominal obesity. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was calculated to show the strength of association. RESULTS: A total of 634 adults participated in the study with a response rate of 95.6%. This study revealed that 155 (24.4%) [95% CI: (21.50, 27.80)] adults were abdominally obese. Higher odds of being abdominally obese were noted among adults with a high [AOR = 4.61, 95% CI: (2.51-8.45)] and middle [AOR = 3.22, 95% CI: (1.76-5.88)] wealth rank, consuming less diversified diet [AOR = 2.05, 95% CI: (1.31-3.19)], physical inactivity [AOR = 2.68, 95% CI: (1.70-4.22)] and being female [AOR = 1.92, 95% CI: (1.13-3.28)]. CONCLUSIONS: The prevalence of abdominal obesity among adults in Dilla town is considerably high, and became an emerging nutrition related problem. Being in the middle and high wealth rank, physical inactivity, consuming less diversified diet, and being female were the risk factors of abdominal obesity.

Perceived Clinical Practice Competency and Associated Factors Among Undergraduate Students of Medicine and Health Science Collage in Dilla University, SNNPR, Ethiopia.

BACKGROUND: The dynamic and uncertain nature of the healthcare environment requires competent health professionals to manage the changing environment. However, globally and regionally there is a shortage of competent health professionals. Understanding the causes of poor performance of healthcare is crucial to provide high-quality healthcare service. So this study aims to assess perceived clinical competence and associated factors among undergraduate medicine and health science students at Dilla University, medical and health Science College. METHODS: Institutional-based cross-sectional study was conducted among 267 students. Initially, departments were stratified, then simple random sample was used to select students. A 2 days of training was given for data collectors and supervisors. Data were entered into Epi-info version 7 and analyzed using Stata version 12. Logistic regression analysis was used to assess associated factors of clinical competency. RESULTS: A total of 267 students participated in this study. The majority of students were males 197 (73.8%) and more than half of the participants 186 (69.7%) were in the age group of 20 to 24 years. The study found only 39.3%, 95% CI (33.3, 44.9) of the participants perceived themselves as clinically competent. This study also identified instructor provided constructive feedback (AOR= 2.12, 95% CI =1.164-3.861), instructor orientation about assessment method (AOR=1.855 95% CI =1.03-3.408) and staff encouragement during clinical practice (AOR= 2.608, 95% CI= 1.425-4.77) were statistically significant factors. CONCLUSION AND RECOMMENDATION: In this study, perceived clinical competency was 39%. Teachers should give constructive feedback to their students to boost their confidence and ability. Furthermore, nationally there should be standard and clear assessment methods in which teachers, school administrators and responsible stakeholders should briefly explain assessment methods to their students and it also needs an action to improve the interaction between staff and students.

Incidence and determinants of mortality among adult HIV infected patients on second-line antiretroviral treatment in Amhara region, Ethiopia: a retrospective follow up study.

INTRODUCTION: Mortality of adult patients who are on antiretroviral therapy (ART) is higher in low-income than in high-income countries. After the failure of standard first-line treatment, patients switch to second-line regimens. However, there are limited data about the outcome of patients after switching to a second-line regimen in the study area. This study aimed to measure the rate of mortality and its determinants among HIV patients on second-line ART regimens. METHODS: Multicenter institution based retrospective follow up study was conducted among 1192 adult patients who started second-line ART between 2008 and 2016 in eight selected hospitals of Amhara region. Patients who started second-line treatment after the failure of first-line treatment were included. Patient medical records, registration books, and computer database were used to collect the data. Time to death after a switch to second-line ART was the primary outcome of interest. Cox proportional hazard model was fitted to identify determinant factors of mortality. RESULTS: Among 1192 patients who were on second-line ART, 136 (11.4%) died with 3,157 person-years of follow up. Over the study period, the mortality rate was 4.33 per 100 person-years. Not taking isoniazid preventive therapy (IPT) (Adjusted Hazard Ratio (AHR): 6.6; 95% CI: 2.9, 15.0), did not make modification on second-line regimen (AHR: 4.4; 95% CI: 2.8, 6.8), poor clinical adherence (AHR: 2.5; 95% CI: 1.4, 4.5), functional status of bedridden (AHR: 2.7; 95% CI: 1.5, 4.8), and having attained a tertiary level of education (AHR: 0.4; 95% CI: 0.2, 0.8) were independent determinants of mortality. CONCLUSION: The incidence rate of mortality was high and most of the deaths occurred within 12 months after switching to second-line ART. Higher mortality among adult HIV-infected patients was associated with poor adherence, no formal education, not taking IPT, being bedridden at the time of the switch, and not modifying second-line treatment. Improving treatment adherence of patients by providing consistent adherence counseling, providing INH prophylaxis and monitoring patient's regimen more closely during the first twelve months after switch could decrease mortality of HIV patients on a second-line regimen.

Bipolar spectrum disorders and associated factors among adults attending an antiretroviral therapy clinic in Gedeo zone health centers, southern Ethiopia.

BACKGROUND: Bipolar spectrum disorders (BPSDs) are more common among HIV-positive individuals than the general population. Although BPSDs have very diverse and devastating consequences (immune suppression, cognitive impairment and poor medication adherence), little is known about BPSDs among HIV-positive individuals in Ethiopia. Therefore, this study was aimed to assess the prevalence and associated factors of BPSDs among adults attending antiretroviral therapy (ART) clinics in Gedeo zone health centers, southern Ethiopia. PATIENTS AND METHODS: An institutional-based cross-sectional study was conducted by screening 412 randomly selected HIV-positive individuals using Mood Disorder Questionnaire. SPSS version 20 was used for data analysis. Bivariable and multivariable logistic regression models were fitted to identify factors associated with BPSDs. Adjusted OR (AOR) with corresponding 95% CI was computed to determine the association. RESULTS: Of the total 412 participants, 11.2% were screened positive for BPSDs. Lower CD4 count (AOR =2.97; 95% CI: 1.11, 7.90), past history of mental health problem (AOR =3.35; 95% CI: 1.576, 7.144), poor social support (AOR =2.6; 95% CI: 1.06, 6.63) and poor ART drug adherence (AOR =3.59; 95% CI: 1.78, 7.21) had a positive association with BPSDs. CONCLUSION: In this study, the prevalence of BPSDs was high among adult patients attending ART clinics in Gedeo zone health centers. Poor social support, poor ART drug adherence, lower CD4 level and history of mental illness had statistically significant association with BPSDs. This demonstrates a need for the integration of Mental Health and Psycho Social Support with HIV/AIDS care services. Moreover, establishing good social support and controlling ART adherence were found to be very crucial too.