Association of Maternal Cervical Cancer Screening Adherence with Adolescent HPV Vaccination Among Adolescent-Mother Pairs.

Less than two-thirds of US adolescents are up-to-date with HPV vaccination. While mothers engaged in preventive care are more likely to seek preventive care for their children, current studies on associations between maternal cervical cancer screening (CCS) and adolescent HPV vaccination are needed. We assessed associations between maternal preventive service utilization and adolescent HPV vaccination using electronic health record data from a healthcare system in Washington State. We included adolescents (11-17 years) and their mothers with ≥ 1 primary care visit between 2018 and 2020. Outcomes were HPV vaccine initiation and completion. The primary exposure was maternal adherence to guideline-recommended CCS. Secondary exposures were maternal breast cancer screening adherence (for mothers ≥ 52 years) and ≥ 1 wellness visit ≤ 2 years. We used Generalized Estimating Equations to estimate prevalence ratios, and explore effect modification by adolescent sex, adolescent provider characteristics, and maternal language interpreter use. Of 4121 adolescents, 66% had a CCS-adherent mother, 82% initiated HPV vaccination, and 49% completed the series. CCS adherence was associated with higher initiation (adjusted prevalence ratio (APR):1.10, 95%CI:1.06-1.13) and completion (APR:1.16, 95%CI:1.08-1.23). Associations were stronger for male vs. female adolescents, adolescents who had a primary care provider in family practice vs. pediatrics, and adolescents who had the same primary care provider as their mother vs. not. Recent maternal wellness visit was also associated with higher initiation (APR:1.04, 95%CI:1.01-1.07) and completion (APR:1.12, 95%CI:1.05-1.20). Results suggest that delivering healthcare through a family-centered approach and engaging mothers in broad preventive care could increase adolescent HPV vaccination coverage.

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study.

The burden of multidrug-resistant tuberculosis (MDR-TB) related to mortality in resource-poor countries remains high. This study aimed to estimate the incidence and predictors of death among MDR-TB patients in central Ethiopia. A retrospective follow-up study was conducted at three hospitals in the Amhara region on 451 patients receiving treatment for MDR-TB from September 2010 to January 2017. Data were collected from patient registration books, charts and computer databases. Data were fitted to a parametric frailty model and survival was expressed as an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). The median follow-up time of participants was 20 months (interquartile range: 12, 22) and 46 (10.20%) of patients died during this period. The incidence rate of mortality was 7.42 (95% CI 5.56-9.91)/100 person-years. Older age (AHR = 1.04, 95% CI 1.01-1.08), inability to self-care (AHR = 13.71, 95% CI 5.46-34.40), co-morbidity (AHR = 5.74, 95% CI 2.19-15.08), low body mass index (AHR = 4.13, 95% CI 1.02-16.64), acute lung complications (AHR = 4.22, 95% CI 1.66-10.70) and lung consolidation at baseline (AHR = 5.27, 95% CI 1.06-26.18) were independent predictors of mortality. Most of the identified predictor factors of death in this study were considered to be avoidable if the TB programme had provided nutritional support for malnourished patients and ensured a close follow-up of the elderly, and patients with co-morbidities.

Incidence and predictors of second-line antiretroviral treatment failure among adults living with HIV in Amhara region: a multi-centered retrospective follow-up study.

BACKGROUND: Second-line Antiretroviral Therapy (ART) regimens are used when patients develop treatment failure for first-line drug regimens. It is costly unaffordable and it is not widely available for patients in resource limiting setting, there is a need to maximizing the duration of stay on second-line regimen. This study was conducted to estimate the incidence rate of second-line treatment failure and to identify its predictors among adults living with HIV in the Amhara region. METHODS: An institution based retrospective follow-up study was conducted from May to June 2017. A total of 1,011 adults on second-line ART who were enrolled between February 2008 and April 2016 were included for final analysis. Kaplan-Meier estimator curves were used to describe the survival function. Semi-parametric proportional hazard model was fitted to identify the predictors of treatment failure. RESULTS: The overall incidence of second-line treatment failure was 9.86 per 100 person-years. It was high during the first and the last year of follow-up. The rate of second-line treatment failure was higher for patients who didn't change second-line regimens (HR: 1.55, 95%CI: 1.18-2.04), who had poor ART adherence (HR: 1.40, 95%CI: 1.06-1.85), and not taking INH (HR: 1.68, 95%CI: 1.23-2.30) as compared to their counter group. The rate of treatment failure for patients who were under WHO clinical stage III at switch (HR: 0.68, 95%CI: 0.50-0.91) was also lower as compared to clients who were under WHO clinical stage I. Furthermore, the rate of treatment failure was higher for clients who were under second-line regimen "TDF-3TC-LPV/r" (HR: 1.55, 95%CI: 1.03-2.32) and "AZT-3TC-LPV/r" (HR: 3.00, 95%CI: 1.86-4.85) as compared to patients under "ABC-ddI-LPV/r" regimens. CONCLUSIONS: A high incidence rate of second-line treatment failure was noticed in the study setting. The rate of second-line treatment failure was higher for patients who didn't change drug regimens, who had poor ART adherence, and who were not taking INH. Therefore, addressing significant predictors to prevent treatment failure among ART patients is essential and sustainable monitoring to reduce the risk of treatment failure is also desirable.

Late initiation of antenatal care and associated factors among pregnant women in Addis Zemen primary hospital, South Gondar, Ethiopia.

BACKGROUND: Antenatal care (ANC) is special care for pregnant women with the aim of preventing, detecting and treating health problems in both the fetus and mother. Early ANC attendance promotes early detection and treatment of complications which result in proper management during delivery and puerperium. However, the majority of pregnant women in Ethiopia initiate their ANC late. Therefore, this study aimed to assess the prevalence of late initiation of ANC and its associated factors among attendants in Addis Zemen primary hospital. METHOD: An institution-based cross-sectional study was conducted at Addis Zemen primary hospital from February 7 to June 122,018. The systematic random sampling technique was employed to select 369 pregnant women who attended ANC in the hospital. Data cleaning and analysis was done using SPSS version 25 statistical software. Descriptive statics and bi variable and multivariable logistic regression models were employed to assess the magnitude and factors associated with late initiation of ANC defined as making the first visit after 12 weeks of gestation. RESULT: This study indicated that 52.5% of the attendants initiated ANC late. The multivariable logistic regression analysis showed that being housewife (Adjusted odds ratio (AOR) = 2.85, 95% CI: 1.36, 5.96), self-employment (AOR = 2.38, 95% CI: 1.12, 5.04), travel expenses (AOR = 1.72, 95% CI: 1.05, 2.81), poor knowledge about ANC (AOR = 2.98, 95% CI: 1.78, 5.01) and unplanned pregnancy (AOR = 2.31, 95% CI: 1.28, 4.16) were significantly associated with late ANC initiation. CONCLUSION: The prevalence of late ANC initiation remains a major public health issue in Ethiopia. The major factors for being late were found to be poor knowledge, being housewife, and self-employment, travel expenses and unintended pregnancy. District and zonal health offices should work to create awareness about the importance of early initiation of ANC, make the service closer to the community and increase contraceptive utilization.

Sanitation predictors of childhood morbidities in Ethiopia: evidence from Dabat Health and Demographic Surveillance System.

BACKGROUND: Failure to provide adequate sanitation services to all people is perhaps the greatest development failure. Globally, billions of people have no access to improved sanitation facilities. Though the link between sanitation and childhood morbidities is established globally, the evidence is limited in rural parts of Ethiopia. This survey was, therefore, designed to determine the prevalence of common childhood morbidities and to identify sanitation predictors in rural parts of northwest Ethiopia. METHODS: A re-census reconciliation, which is a cross-sectional design, was employed from October to December 2014. All households found in the research and demographic sites were included as study subjects. A questionnaire and an observational checklist were used to collect data. Households' sanitation performances, house type, illumination, household energy sources, water supply, and waste management were assessed. The occurrence of childhood morbidities was determined from the occurrence of one or more water, sanitation, and hygiene (WASH) preventable diseases. Multivariable binary logistic regression analysis was done to identify the association of sanitation factors with childhood morbidities on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05. RESULTS: About 575 (7.00%) of under-five children had hygiene- and sanitation-related diseases. Gastrointestinal and respiratory health problems accounted for 287 (49.91%) and 288 (50.09%), respectively. Childhood morbidities among under-five children were associated with poor housing condition [AOR = 1.27, 95% CI = (1.04, 1.54)], dirty cooking energy sources [AOR = 1.52, 95% CI = (1.22, 1.89)], volume of water below 20 l/p/d [AOR = 1.95, 95% CI = (1.19, 3.18)], and narrow-mouthed water storage containers [AOR = 0.73, 95% CI = (0.56, 0.96)]. CONCLUSION: A significant proportion of under-five children had childhood morbidities in the study area. Housing condition, cooking energy sources, volume of water collected, and type of water storage containers were factors associated with the occurrence of childhood morbidities. Enabling the community to have the access to a safe and continuous supply of water and proper disposal of wastes, including excreta, is necessary with particular emphasis to the rural communities and semi-urban areas to reduce the occurrence of childhood morbidities.

Predictors of vascular complications among type 2 diabetes mellitus patients at University of Gondar Referral Hospital: a retrospective follow-up study.

BACKGROUND: Type 2 Diabetes Mellitus is a serious metabolic disease that is often associated with vascular complications. There are 1.9 million people living with Diabetes in Ethiopia; diabetes mellitus is found to be the ninth leading cause of death related to its complications. Although the rate of vascular complications continues to rise, there is limited information about the problem. This study aimed to estimate the incidence and predictors of vascular complications among type 2 diabetes mellitus patients at University of Gondar Referral Hospital. METHODS: Institution based retrospective follow-up study was conducted at University of Gondar Referral Hospital with 341 newly diagnosed type 2 DM patients from September 2005 to March 2017 and the data were collected by reviewing their records. Schoenfeld residuals test and interaction of each covariate with time were used to check proportional hazard assumption. The best model was selected by using Akaike Information Criteria (AIC). Hazards ratio (HR) with its respective 95% confidence interval were reported to show strength of association. RESULT: The selected patients were followed retrospectively for a median follow up time of 81.50 months (Inter quartile range (IQR) = 67.2-103.3). The mean age (± Standard deviation (SD)) of patients at baseline was 51.7(SD: ±11.5 years) and 57.48% were females. The incidence rate of vascular complications was 40.6 cases/ 1000 person years of observation. The significant predictors for vascular complications where found to be male sex (Adjusted hazard ratio (AHR) = 0.50, 95% CI: 0.27, 0.94), having hypertension at baseline(AHR = 3.99, 95% CI: 1.87, 8.56), positive protein urea at base line (AHR = 1.69, 95% CI: 1.03, 2.78), high density lipoprotein cholesterol(HDL-C) level ≥ 40 mg per deciliter (mg/dl) (AHR = 0.43, 95% CI: 0.24, 0.77), low density lipoprotein cholesterol(LDL-C) level > 100 mg/dl (AHR = 3.05, 95% CI: 1.47, 6.35) and triglyceride > 150 mg/dl (AHR = 2.74, 95% CI: 1.28, 5.84). CONCLUSION: The incidence of vascular complications among type 2 diabetes patients remains a significant public health problem. Hypertension at baseline, LDL-C > 100 mg/dl, triglyceride > 150 mg/dl, HDL-C ≥ 40 mg/dl and male sex were significant predictors of vascular complication. In the light of these findings targeted interventions should be given to diabetes patients with hypertension comorbidity and dyslipidemia at follow up clinics.

Prevalence of unintended pregnancy and associated factors among married women in west Belessa Woreda, Northwest Ethiopia, 2016.

BACKGROUND: Unintended pregnancies can have adverse physical, mental, social, and economic outcomes. Illegal abortions and associated complications often follow unintended pregnancies and claim the lives of many women in developing countries. To better understand how unintended pregnancy impacts married women, this study aimed to assess the prevalence of unintended pregnancies and associated factors among married pregnant women in West Belessa woreda, Ethiopia. METHODS: A community-based cross-sectional study was conducted from August to September 2015.. A multistage stratified sampling technique was used to select nine kebeles, to participate in the study. A total of 619 married pregnant women were selected from these kebeles by the simple random sampling technique and data were collected with a structured questionnaire. Binary logistic regression analysis was used to identify factors associated with the unintended pregnancies. A p-value of < 0.05 in the multi-variable model was used to identify significance. RESULT: A total of 592 married pregnant women were surveyed regarding their intention to become pregnant. The prevalence of unintended pregnancy was 13.7%. Age at pregnancy (AOR: 15.2, 95% CI (1.9, 125.2)), history of stillbirth (AOR: 3.3, 95% CI (1.4, 7.9)), discussing pregnancy related issues with husbands (AOR: 2.3, 95% CI (1.1, 5.0)), making family planning decisions on their own (AOR: 0.4, (0.2, 0.8)), and making family planning decisions with their husbands (AOR: 95% CI 0.2 (0.1, 0.4)) were significantly associated with unintended pregnancies in this group. CONCLUSION: The magnitude of unintended pregnancy in the study area was low. Age at pregnancy, history of stillbirth and involvement of partners in making reproductive health choices were associated with unintended pregnancies. Empowering women to make family planning decisions and increasing partner involvement in reproductive health could decrease unintended pregnancies.

Treatment outcomes in patients with multidrug-resistant tuberculosis in north-west Ethiopia.

OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) is an emerging public health problem in Ethiopia. The aim of this study was to assess MDR-TB treatment outcomes and determine predictors of poor treatment outcomes in north-west Ethiopia. METHODS: A retrospective cohort study was conducted using all MDR-TB patients who were enrolled at Gondar University Hospital since the establishment of the MDR-TB programme in 2010. A Cox proportional hazard model was used to identify the predictors of time to poor treatment outcomes, which were defined as death or treatment failure. RESULTS: Of the 242 patients who had complete records, 131 (54%) were cured, 23 (9%) completed treatment, 31 (13%) died, four (2%) experienced treatment failure, 27 (11%) were lost to follow-up, six (2%) transferred out, and 20 (8%) were still on treatment at the time of analysis. The overall cumulative probability survival of the patients at the end of treatment (which was 24 months in duration) was 80% (95% CI: 70%, 87%). The proportion of patients with poor treatment outcomes increased over time from 6% per person-year (PY) during 2010-2012, to 12% per PY during 2013-2015. The independent predictors of time to poor treatment outcome were being anaemic [AHR = 4.2; 95% CI: 1.1, 15.9] and being a farmer [AHR = 2.2; 95% CI: 1.0, 4.9]. CONCLUSIONS: Overall, in north-west Ethiopia, the MDR-TB treatment success rate was high. However, poor treatment outcomes have gradually increased since 2012. Being a farmer and being anaemic were associated with poor treatment outcomes. It would be beneficial to assess other risk factors that might affect treatment outcomes such as co-infection with malaria, poverty and other socio-economic and biological risk factors.

Change in serum level of vitamin D and associated factors at early phase of bone healing among fractured adult patients at University of Gondar teaching hospital, Northwest Ethiopia: a prospective follow up study.

INTRODUCTION: Currently, Vitamin D deficiency is a major public health problem and it affects more than one billion people worldwide. Vitamin D is crucial for bone mineralization and ossification. Patients with fractures need Vitamin D for the healing of their fractured bone. The current study was carried out to determine if there is change in the serum level of Vitamin-D associated with factors at early phase of fractured bone healing (ossification) process among adult fractured patients at University of Gondar teaching hospital, Northwest Ethiopia. METHODS: This facility-based prospective follow up study was conducted from March to June 2016. Data was collected by an interviewer, and pretested and structured questionnaires were used. Biological samples were collected to determine the serum level of vitamin-D in all subjects. In addition, X-Ray findings were used to determine the early phase of bone healing process. Data was entered into EPI INFO version 3.5.3 and analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Both bivariate and multivariate logistic regression analysis was done to screen for factors associated with decreased serum levels of Vitamin-D. In the Multivariate regression analysis, those variables which had a P-value of <0.05 were considered as independently associated with change in serum level of Vitamin-D. RESULTS: A total of 118 adult patients with fractures participated in this study. The prevalence of patients' with decreased serum levels of vitamin-D at post-test was 63.6% [95% CI; (0.551-0.720)]. Inadequate intake of milk and milk products in the 1st week of fracture [AOR = 95%CI: 0.20 (0.05-0.90)], Poor Dietary Diversity Score [AOR = 95% CI: 29.1 (2.27-371.65)], and ossified bone [AOR =95% CI: 4.10 (1.12-14.95)] showed statistically significant association with decreased serum level of Vitamin-D. CONCLUSION AND RECOMMENDATIONS: Decreased serum level of Vitamin-D at early phase of fractured bone healing process was found in the majority of patients (>63%) raising concern for Vitamin D deficiency to be a significant public health problem in the study population. It was statistically associated with: poor dietary diversity score, in adequate intake of milk and milk products in the 1stone week of fracture and ossified (healed) bone. Introducing hospital based Vitamin-D supplementation and integrated with health and nutritional education is a vital intervention needed to improve serum levels of Vitamin-D.

Rural households at risk of malaria did not own sufficient insecticide treated nets at Dabat HDSS site: evidence from a cross sectional re-census.

BACKGROUND: Malaria is the leading cause of disease burden across the world, especially in African countries. Ethiopia has designed a five year (2011-2015) plan to cover 100% of the households in malarious areas with one insecticide treated net (ITN) for every two persons, and to raise consistent ITN utilization to at least 80%. However, evidence on ownership of ITN among malarious rural households in northwest Ethiopia is quite limited. Hence, the present study aimed at assessing ownership of ITN and associated factors among rural households at risk of malaria at Dabat Health and Demographic Surveillance System site, northwest Ethiopia. METHODS: A cross sectional re-census was carried out in Dabat Health and Demographic Surveillance System site during peak malaria seasons from October to December, 2014. Data for 15,088 households at Dabat Health and Demographic Surveillance System site were used for the analysis. Descriptive measures and binary logistic regression were carried out. RESULTS: Among those who owned at least one ITN, 53.4% were living at an altitude >2500 m above sea level. However, out of households living at an altitude <2000 m above sea level, 15.8% (95% CI 14.4%, 17.3%) owned ITN at an average of 4.3 ± 2.1 persons per ITN. Of these, 69.5% (95% CI 64.7%, 74.1%) used the ITN. Among utilizing households at malarious areas, 23.7% prioritized pregnant women and 31.4% children to use ITN. The availability of radio receiver/mobile (AOR 1.60, 95%CI 1.08, 2.35) and secondary/above educational status of household member (AOR 1.54, 95%CI 1.19, 2.04) were predictors of ownership of ITN. CONCLUSION: Rural households at risk of malaria did not own a sufficient number of ITN though the utilization is promising. Moreover, prioritizing children and pregnant women to sleep under ITN remains public health problems. Programmers, partners and implementers should consider tailored intervention strategy stratified by altitude in distributing ITN. ITN distribution should also be accompanied by using exhaustive promotion strategies that consider people without access to any source of information, and educating households to prioritize pregnant and under five children to sleep under ITN.

Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State.

INTRODUCTION: Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS: We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18). CONCLUSION: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review.

Dehydration is a major cause of death among children with wasting and diarrhea. We reviewed the evidence for the identification and management of dehydration among these children. Two systematic reviews were conducted to assess 1) the diagnostic performance of clinical signs or algorithms intended to measure dehydration, and 2) the efficacy and safety of low-osmolarity ORS versus ReSoMal on mortality, treatment failure, time to full rehydration, and electrolyte disturbances (management review). We searched PubMed/Medline, Embase, and Global Index Medicus for studies enrolling children 0-60 months old with wasting and diarrhea. The diagnostic review included four studies. Two studies found the Integrated Management of Childhood Illness (IMCI) and the Dehydration: Assessing Kids Accurately (DHAKA) algorithms had similar diagnostic performance, but both algorithms had high false positive rates for moderate (41% and 35%, respectively) and severe (76% and 82%, respectively) dehydration. One further IMCI algorithm study found a 23% false positive rate for moderate dehydration. The management review included six trials. One trial directly compared low osmolarity ORS to ReSoMal and found no difference in treatment failure rates, although ReSoMal had a shorter duration of treatment (16.1 vs. 19.6 hours, p = 0.036) and a higher incidence of hyponatremia. Both fluids failed to correct a substantial number of hypokalemia cases across studies. In conclusion, the IMCI dehydration assessment has comparable performance to other algorithms among wasted children. Low osmolarity ORS may be an alternative to ReSoMal for children with severe wasting, but might require additional potassium to combat hypokalemia.

Clinical epidemiology of COVID-19 among hospitalized children in rural western Kenya.

The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection.

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia.

Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

Prevalence and associated factors of malaria in children under the age of five years in Wogera district, northwest Ethiopia: A cross-sectional study.

BACKGROUND: Malaria is a major public health problem in sub-Saharan Africa, and children are especially vulnerable. In 2019, an estimated 409,000 people died of malaria, most (274,000) were young children and 94% of the cases and deaths were in Africa. Prior studies in Ethiopia focused on the adult population and high transmission areas. Hence, this study aimed to determine the prevalence and associated factors of malaria in children under five years in low transmission areas. METHOD: A facility-based cross-sectional study was conducted among 585 under-five children who attended public health facilities in the Wogera district from September to October, 2017. Health facilities were selected by stratified cluster sampling, and systematic random sampling was held to select study participants from the selected facilities. Multivariable logistic regression was used to identify correlates of malaria. RESULT: Of 585 children who provided blood samples, 51 (8.7%) had malaria. The predominant Plasmodium species were P. falciparum 33 (65%) and P. vivax 18 (35%). Regularly sleeping under long-lasting insecticide treated nets (LLIN) was associated with decreased odds of malaria (AOR = 0.08, 95% CI: 0.01-0.09), and an increased odds of malaria was observed among children who live in households with stagnant water in the compound (AOR = 6.7, 95% CI: 3.6-12.6) and children who stay outdoors during the night (AOR = 5.5, 95% CI: 2.7-11.1). CONCLUSION: The prevalence of malaria in the study population was high. Environmental and behavioral factors related to LLIN use remain potential determinants of malaria. Continued public health interventions targeting proper utilization of bed nets, drainage of stagnant water, and improved public awareness about reducing the risk of insect bites have the potential to minimize the prevalence of malaria and improve the health of children.

Incidence of Mortality and Its Predictors Among HIV Positive Adults on Antiretroviral Therapy in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Despite the accessibility and higher coverage of antiretroviral therapy (ART), HIV/AIDS is a leading cause of morbidity and mortality in low- and middle-income countries. Ethiopia also shares the high burden of HIV/AIDS-related morbidity and mortality. Therefore, this study aimed to assess the incidence of mortality and its predictors among adult HIV patients on ART in the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. PATIENTS AND METHODS: A retrospective follow-up study was conducted from January 2015 to January 2019 at the University of Gondar Comprehensive Specialized Hospital. A total of 475 patients who were on follow-up in this Hospital were included. The Cox proportional hazard model was fitted to assess the predictors of mortality. Both crude and adjusted hazard ratio (AHR) with their 95% confidence interval (CI) were calculated to show the strength of association. In multivariable analysis, variables with a P-value <0.05 were considered as statistically significant predictors of mortality. RESULTS: In this study, a total of 45 (9.5%) patients died with an incidence rate of 5.3 [95% CI: 3.4-7.1] per 100 person-years of observation. In the multivariable Cox regression analysis, the last known WHO stage III/IV [AHR= 15.02; 95% CI: 5.79-38.92], being anemic at baseline [AHR = 2.21; 95% CI: 1.02-4.78], and fair last known adherence level [AHR = 3.29; 95% CI: 1.39-7.78] were found to be significant predictors of mortality. CONCLUSION: In this study, the incidence of mortality was relatively high. The rate of mortality may be minimized by paying particular attention to individuals with advanced WHO stage, anemia at the baseline, and those with adherence problems.

Magnitude and Determinants of Adverse Perinatal Outcomes in Tefera Hailu Memorial Hospital, Sekota Town, Northern Ethiopia.

BACKGROUND: Of 133 million births globally, 3.7 million died in the neonatal period and 3 million are stillborn. The perinatal mortality rate in Ethiopia is 46 per 1000 pregnancies. However, area-specific information is limited in this regard. Therefore, this study aimed to determine the magnitude and determinants of adverse perinatal outcomes in Northern Ethiopia. METHOD: An institution-based cross-sectional study was conducted by reviewing the medical records of mothers who gave birth between September 2015 and August 2016. The completeness and consistency of data were checked. Descriptive statistics were computed. A multinomial logistic regression model was fitted to identify determinants of adverse perinatal outcomes. Odds ratio with 95%CI was used and variables that had a P-value of < 0.05 in the final model were considered statistically significant. RESULT: The magnitude of adverse perinatal outcomes was 214/799(27.47 %). Out of that, 10.8% had a perinatal mortality outcome, and 16.7% had a perinatal morbidity. Not using modern contraceptives(AOR = 1.7, 95% CI: 1.1-2.7), labor induction or augmentation(AOR = 3.0, 95% CI: 1.2-7.8), obstetric complications(AOR = 2.2, 95% CI: 1.1-4.5), attending antenatal care(AOR = 0.4, 95% CI: 0.2-0.8), primigravida (AOR = 0.5, 95% CI: 0.3-0.9), had no history of medical illness(AOR = 0.5, 95% CI: 0.3-0.8), and urban residency(AOR = 1.9, 95% CI, 1.1-2.9) were the significant determinants of perinatal outcome. CONCLUSION: The magnitude of adverse perinatal outcomes was considerable and 1 in 5 neonates either had morbidity conditions or died. Improving family planning utilization, ANC, referral linkage, and management of obstetric complications could help to reduce the undesirable consequences of perinatal outcomes.

Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study.

BACKGROUND: Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. METHODS: Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. RESULTS: A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). CONCLUSION: The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

Effect of intimate partner violence of women on minimum acceptable diet of children aged 6-23 months in Ethiopia: evidence from 2016 Ethiopian demographic and health survey.

BACKGROUND: The absence of proper infant and young child feeding practice results in malnutrition. Intimate Partner Violence (IPV) is potentially a major factor affecting child feeding practices. However, there is limited evidence about the effect of intimate partner violence (IPV) on a minimum acceptable diet. Therefore, in this study, we hypothesized that IPV will be associated with a lack of a minimum acceptable diet among children aged 6-23 months. METHODS: We conducted a cross-sectional analysis using the Ethiopian Demographic and Health Survey (EDHS) 2016. All child-mother pairs that participated in EDHS 2016 from all regions of Ethiopia were included. The analysis included mother-child pairs where 6-23 months aged children with mothers who were ever in a committed partnership and interviewed for domestic violence were involved. The data were weighted considering enumeration areas as a cluster and place of residence as a stratum. A binary logistic regression analysis was done to identify factors independently associated with a minimum acceptable diet. RESULT: Totally, 1307 observations were included in the final analysis. The mean age of mothers was 29 years (standard deviation ±6.54 years), the mean age of children was 14. ± 5.02 months, and 32% of women had intimate partner violence (IPV). Of the children, 8% had a minimum acceptable diet (minimum acceptable diet), 15% had a minimum dietary diversity, and 43% had a minimum meal frequency. Having intimate partner violence decreases children minimum acceptable diet by 65% (AOR: 0.35; 95% CI: 0.16, 0.77). The other factors associated with the minimum acceptable diet were caregivers attaining a secondary level of education (AOR: 4.01; 95% CI: 1.04, 15.45), currently working (AOR: 2.26; 95% CI: 1.01, 5.11), and undecided fertility desire (AOR: 4.72; 95% CI: 1.37, 16.28). CONCLUSION: Intimate partner violence against women had a negative association with the minimum acceptable diet children have received. Decreasing violence against women, educating, and increasing work opportunities for them would help in improving child feeding practice and reducing malnutrition and its consequences. Further studies that focus on possible community-based interventions aiming to decrease IPV are recommended.

Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling.

INTRODUCTION: Loss to follow up after the initiation of antiretroviral therapy (ART) is common in Africa, particularly in Ethiopia and it is a considerable obstacle for the effectiveness of the ART program. Mortality is a competing risk of loss to follow up but it is often overlooked and there is limited evidence about the incidence and predictors of loss to follow up in the presence of competing events. OBJECTIVE: To assess the Incidence and predictors of loss to follow up among adult HIV patients on ART in University of Gondar Comprehensive Specialized Hospital between January 1, 2015, and December 31, 2018. METHODS: Institution based retrospective follow up study was conducted in University of Gondar Comprehensive Specialized Hospital. A Gray's test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow up. Bivariable and multivariable competing risk regression models were fitted to identify the predictors of lost to follow up and those variables with p-value <0.05 in the multivariable analysis was considered as significant predictors of lost to follow up. RESULT: A total of 531 adult HIV patients on ART were included in the analysis. The incidence rate of loss to follow up in this study was 10.90 (95% CI: 8.9-13.2) per 100 person years. Being age group 15-30 years (aSHR = 2.01; 95%CI;1.11-3.63), being daily laborer(aSHR = 2.60; 95%CI;1.45-4.66), not receiving cotrimoxazole preventive therapy (aSHR = 2.66; 95%CI;1.68-4.21), not receiving isoniazid preventive therapy(aSHR = 4.57; 95% CI;1.60-13.08), ambulatory functional status (aSHR = 1.61; 95% CI; 1.02-2.51) and taking AZT-3TC-NVP medication at start of ART(aSHR = 2.01; 95% CI; 1.16-3.78) were significant predictors of lost to follow up. CONCLUSION: In this study the incidence of lost to follow up was high. Young people, daily laborer, ambulatory patients and those taking AZT-3TC-NVP as well as those who did not take opportunistic prophylaxis were at higher risk of loss to follow up. Therefore, giving special attention to the high-risk groups for lost to follow up highlighted in this study could decrease the rate of LTFU.