Practical contribution of women development army on growth monitoring and promotion service at Dembya and Gondar Zuria districts, Central Gondar Zone, North West Ethiopia: a community based mixed study.

BACKGROUND: The United Nations' Sustainable Development Goal (SDG)-2 aims to eliminate child hunger or end all forms of child malnutrition by 2030. To achieve this goal the cost-effective method is the implementation of growth monitoring and promotion service with the contribution of Women Development Army (WDA) as community volunteers. However, According to the data, the program's implementation varies throughout the country and lack of evidence on the practical contribution of the WDA to enhancing child nutritional care outcomes. Therefore this study aimed to determine practical contribution of WDA and associated factors on growth monitoring and promotion service in two rural districts of central Gondar zone, Northwest Ethiopia. METHODS: A community based mixed study was conducted from March 6 to April 7, 2022 among 615 Women Development Army. Multistage sampling technique was used to select study participants. A structured questionnaire was used to collect quantitative data and in-depth interview were used to generate qualitative information. Qualitative data were coded and grouped and discussed using identified themes. Binary logistic regression was fitted, odds ratio with 95% confidence interval was estimated to identify factors of practical contribution of WDA and qualitative data was analyzed using thematic analysis. RESULTS: In this study practical contribution of WDA on growth monitoring was 31.4% (95% CI: 28.0-35.3%). Having GMP training (AOR = 4.2, 95%CI: 1.63, 10.58), regular community conversation (AOR = 6.0, 95%CI: 3.12, 11.54), good knowledge about GMP (AOR = 2.1, 95%CI: 1.17, 3.83) and not having regular schedule of GMP service in the area (AOR = 0.04, 95%CI: 0.02, 0.09), were statistically significantly associated with practical contribution of growth monitoring. During in-depth interview, lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were mentioned among the problems faced during growth monitoring service. CONCLUSION: In this study, practical contribution of growth monitoring among WDA was low. GMP training regular community conversation, knowledge about GMP and regular schedule of GMP service in the local area were significantly associated for practical contribution of growth monitoring service. Lack of training, low motivation or commitment among WDA and low communication between WDA and health extension workers were reasons for did not contribute effectively for GMP service. Therefore, giving training for WDA and improving community conversation at kebeles level are important to improve GM service. .

Exploring barriers to diversified dietary feeding habits among adolescents in the agrarian community, North West Ethiopia.

Introduction: Adolescence is a critical and neglected age group of the population in any form of nutritional intervention. A comprehensive study that assesses barriers that influence their diversified feeding habit is not well investigated in qualitative approaches. Therefore, this study was conducted to fill this gap by providing evidence on exploring barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia. Objective: The aim of the study was to explore barriers to diversified feeding habits of adolescents in the agrarian community, North West Ethiopia. Methods: A phenomenological qualitative study design was conducted among adolescents in the age group of 10-19 years, and adults in the age range of 25 to 64 years (representatives of farmers, agricultural, health, and education sectors). We conducted 24 in-depth interviews (12- adolescents, 4-health, 2- agricultural extension, 3-education, and 3-farmer representative) among purposively selected community groups. In-depth interview guides and observation checklist were utilized for data collection. The audio-recorded qualitative data were transcribed word by word into English. Finally, the translated data were exported to ATLAS ti version 7.1 software for thematic analysis based on inductive content analysis. All coded quotations, including memos written throughout the coding process, were then analyzed to identify themes inductively. Results: Dietary habit of adolescents in the study area was predominantly plant-based cereals with low protein, vitamins, and mineral contents. Adolescents have limited consumption of fruits, vegetables, and animal source foods. Adolescents with these feeding habits had suboptimal intake of micronutrients and proteins, which are crucial for their rapid growth stage. Individual-level barriers, family-level influence, dietary tradition of community, agricultural practice (poor agroforestry practice of the community, and poor agricultural practice to produce year-round diverse food items), and week multi-sectorial collaboration for nutritional intervention all influenced adolescent dietary habits. Conclusion: Multiple layers of barriers influenced the diverse dietary habits of adolescents in the study setting. These multiple and interconnected influences ranged from individual level to multi-sectorial collaboration. Nutritional interventions should be implemented at the individual, family, agricultural, and multi-sectorial levels to improve adolescents' diverse dietary habits.

Validation of in-house liquid direct agglutination test antigen: the potential diagnostic test in visceral Leishimaniasis endemic areas of Northwest Ethiopia.

BACKGROUND: Visceral leishmaniasis in Ethiopia is a re-emerging threat to public health, with increased geographical distribution and number of cases. It is a fatal disease without early diagnosis and treatment; thus, the availability of affordable diagnostic tools is crucial. However, due to delays caused by import regulations, procurement and late delivery of imported test kits, accessibility remains a problem in the control program. Therefore, we aimed to produce and evaluate the performance of an in-house liquid (AQ) direct agglutination test (DAT) antigen. RESULT: The AQ-DAT was produced at the Armauer Hansen Research Institute, using Leishmania donovani strain (MHOM/ET/67/L82). Sera from 272 participants; 110 microscopically confirmed cases of VL, 76 apparently healthy and 86 patients who had infectious disease other than VL were tested with AQ-DAT, and standard kits: Freeze-dried DAT (FD-DAT) and rK39. Taking microscopy as a gold standard; the sensitivity and specificity of the AQ-DAT were 97.3 and 98.8%, respectively. It had high degrees of agreement (k > 0.8), with a significant (P < 0.05) correlation compared to microscopy, FD-DAT, and rK39. CONCLUSION: Although further standardization is required, the in-house AQ-DAT could improve diagnostic accessibility, minimize intermittent stock outs and strengthen the national VL control program.

TNF-α (-308) Gene Polymorphism and Type 2 Diabetes Mellitus in Ethiopian Diabetes Patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a metabolic disorder resulting from insulin insufficiency or function. Predisposing factors for T2DM are mainly genetic and environmental. Genetic polymorphism of cytokines like tumor necrosis factor-alpha (TNF-α) is suggestive of interference with insulin-sensitive glucose uptake and induces insulin resistance that ultimately could lead to T2DM. In this study, we assessed the effect of TNF-α (-308) G/A gene polymorphism and its association with the development of T2DM in an Ethiopian population. METHODS: An institutional-based cross-sectional study was conducted on study subjects with T2DM and non-diabetic healthy controls. DNA was extracted and genotyping was carried out by using amplification refractory mutation system polymerase chain reaction. A genetic-polymorphism on TNF-α (-308) G/A with T2DM was evaluated by logistic regression and Student's t-test. A P-value <0.05 was considered as statistically significant. RESULTS: In the present study, we observed a significant association between T2DM and TNF-α (-308) gene polymorphism's GG genotype [χ2 test P = 0.005, OR (95% CI) =2.667 (1.309-5.45d8)]. In contrast, no statistically significant differences were observed in the frequencies of genotypes AA and AG (χ2 test P=0.132 and 0.067, respectively). Moreover, T2DM individuals had higher concentrations of lipid profiles for those carrying the TNF-α (-308) GG genotype as compared to the control group. CONCLUSION: TNF-α (-308) genetic polymorphism may be implicated in the genetic susceptibility for, as well as the development of T2DM and lipid metabolism in the Ethiopian population. Therefore, a large-scale study and early screening of TNF-α (-308) genetic polymorphism may help in early management and control of diabetes and related outcomes.

Incidence of human rabies virus exposure in northwestern Amhara, Ethiopia.

BACKGROUND: Clinical Rabies is a widely distributed almost 100% fatal viral zoonotic disease. Most human rabies cases occur in developing countries, especially in Asia and Africa. It can be prevented by immunization, post exposure prophylaxis. Ethiopia is assumed to be among African countries with high incidence of human rabies exposure cases. However, there is limited documented data on the incidence of human rabies exposure in the study area in particular and in Ethiopia in general. Thus, this study aimed to determine the Incidence of Human Rabies Virus exposure in Northwestern Amhara, Ethiopia. METHODS: Retrospective cross-sectional study was conducted during August and September, 2017. The study was conducted at Addis Alem Hospital, a district level hospital in Bahir Dar. Data on human rabies exposure cases registered from September 1, 2015 to August 31, 2017 were collected from anti-rabies post exposure prophylaxis registration log book. Data was collected using a structured data collection questionnaire developed for this purpose. Descriptive statistics was used to describe relevant variables. THE RESULTS: A total of 924 human rabies exposure cases was recorded. The overall human rabies incidence per 100, 000 population was 6.5 in 2015 and 7.5 in 2016. Males (55.2%, 510/924) and children of age less than fifteen (46.3%, 428/924) were most affected groups. The majority of human rabies exposure cases (71.9%, 664/924) were from rural settings. Dogs were the principal sources of exposure (96.3%) followed by cat (1.5%) and donkey (1.3%). High incidence rate of rabies exposure was reported during spring (360, 39%) and summer (244, 26.4%) seasons. There was significant difference between rural and urban exposure cases (p = 0.001) in respect to the time of arrival to the hospital. CONCLUSION: Taking these into account, a significant proportion of the population was exposed to rabies virus during the study years. There was high human rabies exposure rate in children and in the rural community. This shows the need for organizing preventive and control strategies and to build community awareness.

Level of modern health care seeking behaviors among mothers having under five children in Dangila town, north West Ethiopia, 2016: a cross sectional study.

BACKGROUND: Health seeking behavior is an action taken by an individual who perceive to have a health problem. In most developing countries including Ethiopia the health of the children is strongly dependant on maternal health care behavior. Most childhood morbidities and mortalities are associated with low level of mothers health care seeking behavior. Therefore, the objective of this study was to assess level of modern health care seeking behavior among mothers having under five children in Dangila town, North West Ethiopia. METHODS: Community based quantitative cross-sectional study was conducted from April 15 to May 15, 2016. Systematic random sampling technique was used to select study participants. A total of273 mothers with children less than five years were included in this study. The data was collected from all five Kebeles using interviewer administered questionnaire. Descriptive and inferential statistics were used to present the data. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with level of modern health care seeking behavior. RESULTS: Prevalence of modern health care seeking behavior was 82.1%. Age of mothers (AOR = 2.4(1.1, 5.3), age of the child (AOR = 6.7(2.8, 22.2), severity of illness (AOR = 5.2(1.2, 22.6) and family number (AOR = 6.4(2.1, 20.2) were predictors of modern health care seeking behavior among mothers. CONCLUSIONS: Majority of the mothers preferred to take their children to modern health care when they got illness. Age of children, age of mother, number of family and severity of illness were the determinant factors for modern health care seeking behavior. Therefore, health care services should be strengthened at community level through community integrated management of childhood illness, information, education communication / behavioral change communication strategies to improve mothers health care seeking behaviors.

Implementation of nursing process in clinical settings: the case of three governmental hospitals in Ethiopia, 2017.

OBJECTIVE: The purpose of this survey was to evaluate the implementation of the nursing process at three randomly selected governmental hospitals found in Amhara Region North West Ethiopia. RESULT: From the total 338 reviewed documents, 264 (78.1%) have a nursing process format attached with the patient's profile/file, 107 (31.7%) had no nursing diagnosis, 185 (54.7%) of nurses stated their plan of care based on priority, 173 (51.2%) of nurses did not document their interventions based on plan and 179 (53.0%) of nurses did not evaluate their interventions. The overall implementation of nursing process among Felege Hiwot Referal hospital, Debretabor general hospital and Finoteselam general hospitals were 49.12, 68.18, and 69.42% respectively. Nursing professionals shall improve documentation required in implementing the nursing process. Nursing managers (matron, ward heads) shall supervise the overall implementation of nursing process. Hospital nursing services managers (matrons) shall arrange and facilitate case presentations by the nursing staffs which focus on documentation and updates on nursing process. Hospitals need to establish and support nursing process coordinating staff in their institution.

Knowledge, attitude and practice towards cervical cancer among women in Finote Selam city administration, West Gojjam Zone, Amhara Region, North West Ethiopia, 2017.

INTRODUCTION: Cancer of the cervix is the leading cause of cancer-related death among women, especially in developing countries affecting women at a time of life when they are critical to social and economic stability. METHOD: The study was conducted at Finote Selam City Administration from February 01 to March 01, 2017 using a community-based cross-sectional study design. The representative sample size was selected using multistage sampling technique. The data were collected using an interviewer-administered questionnaire adapted from the previous study. Data were entered using EpiData Version 3.1 statistical software and analyzed using SPSS version 20 statistical package. RESULT: One hundred seventy (23.1%) were knowledgeable about cervical cancer whereas 63% of participants had a negative attitude and only 7.3% had ever screened for the disease. Logistic regression analysis showed that age, marital status, religion, experienced sexual intercourse and age at 1st sexual intercourse were found to be significantly associated with the knowledge of cancer of the cervix. CONCLUSION: Ministry of health in collaboration with other concerned bodies should design a strategy to give education about cervical cancer including information on risk factors, signs and symptoms; and availability of screening should be provided for women and as well as for the public.

Women's social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: a community-based case-control study.

BACKGROUND: High maternal mortality has remained an unmet public health challenge in the developing world. Maternal mortality in Ethiopia is among the highest in the world. Since most maternal deaths occur during labor, delivery, and the immediate postpartum period, facility delivery with skilled birth attendants is recommended to reduce maternal mortality. Nonetheless, the majority of women in Ethiopia give birth at home. Individual attributes and availability and accessibility of services deter service utilization. The role of social networks that may facilitate or constrain service use is not well studied. METHODS: Community-based case-control study was conducted between February and March 2014 in Jabi Tehinan District, North West Ethiopia. Retrospective data were collected from 134 women who had uncomplicated births at health facilities and 140 women who had uncomplicated births at home within a year preceding the survey. Interviews were held with eight women who had uncomplicated births at health facilities and 11 who had uncomplicated births at home. The quantitative data were entered and analyzed using SPSS for Windows versions 16.0 and hierarchical logistic regression model was used for analysis. The qualitative data were transcribed verbatim and data were used to substantiate the quantitative data. RESULTS: The results indicated that social network variables were significantly associated with the use of health facilities for delivery. Taking social networks into account improved the explanation of facility use for delivery services over women's individual attributes. Women embedded within homogeneous network members (Adjusted OR 2.53; 95% CI: 1.26-5.06) and embedded within high SBA endorsement networks (Adjusted OR 7.97; 95% CI: 4.07-12.16) were more likely to deliver at health facilities than their counterparts. Women living in urban areas (Adjusted OR 3.32; 95% CI: 1.37-8.05) and had better knowledge of obstetric complications (Adjusted OR 3.01; 95% CI: 1.46-6.18) were more likely to deliver at health facilities. CONCLUSION: Social networks facilitate SBA utilization by serving as a reference for the behavior to deliver at health facilities. These findings inform health professionals and other stakeholders regarding the importance of considering women's social networks in designing intervention to increase the proportion of women who deliver at health facilities.

Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review.

BACKGROUND: Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia. RESULTS: Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072-0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059-0.664)] were the determinant factors for poor outcome of neonatal sepsis. CONCLUSION: The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.

Environmental and host-related determinants of tuberculosis in Metema district, north-west Ethiopia.

BACKGROUND: Each year, one third of the world's population is estimated to be infected with tuberculosis (TB). Globally in 2011, there were an estimated 8.7 million TB cases that resulted in 1.4 million deaths. In Ethiopia, TB is the leading cause of morbidity and the third most common cause of hospital admission. The aim of this study is to assess environmental and host-related determinants of TB in Metema district, north-west Ethiopia. METHODS: A community-based unmatched case-control study was conducted from March 12 to April 5, 2013. The study population included 655 subjects (218 cases and 437 controls in a ratio of 1:2). Cases were TB patients selected from a total of 475 cases registered and treated from March 2012 to February 2013 at the Metema District Hospital DOTS (direct observation therapy, short-course) clinic and selected randomly using a lottery method. Controls were people who had had no productive cough for at least 2 weeks previously and were selected from the community. RESULTS: A total of 655 respondents (218 cases and 437 controls) participated in the study. In multivariate analysis, being illiterate (adjusted odds ratio [AOR] 3.65, 95% confidence interval [CI] 2.31-5.76), households containing more than four family members (AOR 3.09, 95% CI 2.07-4.61), living space <4 m(2) per person (AOR 3.11, 95% CI 2.09-4.63), a nonseparated kitchen (AOR 3.27, 95% CI 1.99-5.35), history of contact with a TB patient (AOR 2.05, 95% CI 1.35-3.12), a house with no ceiling (AOR 1.46, 95% CI 1.07-2.21), and absence of windows (AOR 4.42, 95% CI 2.46-7.95) were independently associated with the development of TB. CONCLUSION: This study identified that the number of family members in the household, educational status, room space per person, history of contact with a TB patient, availability and number of windows, location of kitchen facilities within the house, and whether or not the house had a ceiling were independently associated with contracting TB. Every community should construct houses with the kitchen separated from the main living room, and include a ceiling and more than one window. Cigarette smoking should be avoided since this also contributed to the risk of transmission of TB. Further research focusing on coinfection with human immunodeficiency virus, helminth burden, and malnutrition is important for the control and prevention of TB.

Preliminary survey of domestic animal visceral leishmaniasis and risk factors in north-west Ethiopia.

OBJECTIVE: After the epidemics of L. donovani complex in 2004/05 in human patients, to investigate the presence of antibodies against L. donovani in domestic animals in north-west Ethiopia. METHODS: Two hundred and three domestic animals were screened. Serum and biopsy samples were collected. A modified direct agglutination test (DAT) for canine reservoirs was used to screen serum samples at ≥ 1:320 cut-off titre. Giemsa stain and culture on Novy macNeal Nicolae (NNN) media were used for biopsy samples. Pre-tested questionnaires were used to elicit information on potential risk factors. RESULTS: Antibody against L. donovani in domestic animals was detected in 30.5% of animals. The highest seropositivity rates were 41.9% in cattle, 40% in dogs, 33.3% in donkeys, 10% in goats and 4.8% in sheep. No Leishmania parasite was isolated from spleen, liver, skin snip and exudates, bone marrow or lymph node of dogs. Dogs owned by households with history of kala-azar treatment and humans sharing the house with cattle were more affected by visceral leishmaniasis (P < 0.05). CONCLUSION: This study showed a high serological prevalence of leishmaniasis in domestic animals. Their role in the epidemiology of visceral leishmaniasis remains unclear.