Determinants of intrauterine contraceptive device utilization at primary health care facilities in Mekelle City, northern Ethiopia.

BACKGROUND: Each year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, approximately 222 million of them have an unmet need for modern contraception. In spite of several advantages and potential effectiveness of Intra Uterine Contraceptive Device, its utilization still too low in Sub Saharan African countries including Ethiopia. OBJECTIVES: To identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city. METHOD: Facility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by structured questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20.0 statistical software. During analysis the variables were defined, categorized and the difference in variables was determined. Odds ratio used to show degree of association between independent variables with Intra Uterine Contraceptive Device. RESULT: Marital status ([AOR (95%CI) =8.59(2.60-28.43)], number of pregnancies (AOR (95%) CI = 5.69(1.020-31.802), number of alive children [AOR (95%CI) =3.5 (1.03-11.9) are variables continued to have statistically significant association with use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about availability of health care provider able to insert Intra Uterine Contraceptive Device. CONCLUSION: This study has identified marital status, Gravidity, number of alive children and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, it is vital at addressing the aforementioned determinants will be vital to improve utilization of Intra Uterine Contraceptive Device. Among long acting reversible modern contraceptive methods, Intra Uterine Contraceptive Devices (IUCDs) are the most reliable and effective as well as with fewer side effects. Despite these advantages and cost effective potential of Intra Uterine Contraceptive Device its utilization is still too low in Sub Saharan countries like Ethiopia. Thus, this study intended to identify the factors that limit the utilization of Intra Uterine Contraceptive Device among women of Ethiopia in Mekele City. The study identify that the utilization of Intra Uterine Contraceptive Device was determined by the marital status of the women, the number of previous pregnancy and recent alive children and the level of awareness about Intra Uterine Contraceptive Device of the women. Therefore, providers training that focus on promoting Intra Uterine Contraceptive Device, centering on increasing awareness and practice about Intra Uterine Contraceptive Device is very important.

Generalized Anxiety Disorder and Its Associated Factors Among Health Care Workers Fighting COVID-19 in Southern Ethiopia.

BACKGROUND: Healthcare workers (HCWs) are among the many groups of people who are in the frontline caring for people and facing heavy workloads, life-or-death decisions, risk of infection, and have been facing various psychosocial problems. So, monitoring mental health issues to understand the mediating factors and inform evidence-based interventions in a timely fashion is vital. PURPOSE: This study aimed to assess generalized anxiety disorder and its associated factors among HCWs fighting COVID-19 in Southern Ethiopia. PATIENTS AND METHODS: An institution-based cross-sectional study was conducted among 798 HCWs from 20 May to 20 June 2020. A pre-tested and structured interviewer-administered KOBO collect survey tool was used to collect data. The study participants were selected using a simple random sampling technique by allocating a proportion to each health institute. The association between the level of generalized anxiety disorder and its independent variables was examined by ordinal logistic regression. Assumptions for the proportional odds model were checked using parallel line tests. An adjusted proportional odds ratio with a 95% CI was used to calculate the strength of the statistical association between the independent and dependent variables. RESULTS: The prevalence of mild and moderate anxiety disorder among HCWs was 29.3% and 6.3%, respectively. Contact with confirmed or suspected cases (aPOR =1.97; 95% CI: 1.239, 3.132), no COVID-19 updates (aPOR=4.816, 95% CI=2.957, 7.842), no confidence on coping with stresses (aPOR=2.74, 95% CI=1.633, 4.606), and COVID-19-related worry (aPOR=1.85, 95% CI=1.120, 3.056) were positively associated with higher-order anxiety disorder. However, not feeling overwhelmed by the demands of everyday life (aPOR=0.52, 95% CI=0.370, 0.733) and feeling cannot make it (aPOR=0.44, 95% CI=0.308, 0.626) were negatively associated with a higher order of anxiety. CONCLUSION: The study revealed that the prevalence of anxiety disorder among HCWs was high in the study area. The findings of the current study suggest immediate psychological intervention for health care workers in the study area is vital. Therefore, proactive measures should be taken by the stakeholders at different hierarchies to promote the psychological wellbeing of HCWs in order to control the impact of the pandemic on the HCWs, and containing the pandemic.

Efficient regulation of VEGF expression by promoter-targeted lentiviral shRNAs based on epigenetic mechanism: a novel example of epigenetherapy.

RATIONALE: We studied a possibility that shRNAs can lead to transcriptional gene activation at the promoter level via epigenetic mechanism. OBJECTIVE: The purpose of this study was to test the effects on vascular endothelial growth factor (VEGF-A) expression by promoter targeted small hairpin RNAs (shRNAs) in vitro and in experimental animals in vivo using stable local lentiviral gene transfer. METHODS AND RESULTS: One shRNA was identified which strongly increased VEGF-A expression in C166 endothelial cells at mRNA and protein level whereas another shRNA decreased VEGF-A expression. Quantitative chromatin immunoprecipitation analysis revealed that the repressing shRNA caused epigenetic changes, which increased nucleosome density within the promoter and transcription start site and led to repression of VEGF-A expression. Epigenetic changes caused by the activating shRNA were opposite to those caused by the repressing shRNA. These results were confirmed in vivo in an ischemic mouse hindlimb model after local gene transfer where VEGF-A upregulation achieved by promoter-targeted shRNA increased vascularity and blood flow. CONCLUSIONS: We show that lentivirus-mediated delivery of shRNA molecules targeted to specific regions in the mVEGF-A promoter either induce or repress VEGF-A expression via epigenetic modulation. Thus, we describe a new approach of gene therapy, epigenetherapy, based on an epigenetic mechanism at the promoter level. Controlling transcription through manipulation of specific epigenetic marks provides a novel approach for the treatment of several diseases.