Compliance with research ethics in epidemiological studies targeted to conflict-affected areas in Western Ethiopia: validity of informed consent (VIC) by information comprehension and voluntariness (ICV).

BACKGROUND: The conduct of research is critical to advancing human health. However, there are issues of ethical concern specific to the design and conduct of research in conflict settings. Conflict-affected countries often lack strong platform to support technical guidance and monitoring of research ethics, which may lead to the use of divergent ethical standards some of which are poorly elaborated and loosely enforced. Despite the growing concern about ethical issues in research, there is a dearth of information about ethical compliance in conflict areas. Valid and ethically informed decision-making is a premier pact with research participants in settling possible ethical issues before commencing the research, which is ensured by gaining informed consent from prospective participants of the research. AIMS: This research aimed to explore compliance with research ethics and consent validity in community-based epidemiological research conducted previously. METHODS: Research participants were recruited in the western part of Ethiopia in three districts subjected to conflicts. A community-based cross-sectional study design was utilized, and 338 residents were enrolled as study participants. All participants had previously been enrolled as research participants in epidemiological studies. Data was collected using a questionnaire that was pilot-tested before the commencement of the main data collection. The questionnaire focused on participants' experiences of the informed consent process followed when they were recruited for an epidemiological study and covered themes such as essential information provided, level of comprehension, and voluntarism of consent. RESULTS: Over half of the study participants, 176 (52%), were not provided with essential information before consenting. And 135 (40%) of them did not comprehend the information provided to them. One hundred and ninety (56%) participants freely and voluntarily agreed to partake in one of these epidemiological studies, with over a quarter (97; 28.7%) of them reporting they were subjected to undue influence. Written consent was obtained from only 32 (9.4%) of the participants.

Impact of the COVID-19 pandemic on the cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia: a hospital-based, cross-sectional study.

OBJECTIVE: Globally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct impact of COVID-19 on healthcare provision and utilisation, the impact of the pandemic on the cost of chronic disease treatment and care from a patient perspective was scanty. So, the study aimed to determine the impact of the COVID-19 pandemic on cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia, from 1 August to 31 August 2020. METHODS: An institutional-based cross-sectional study design was used, and the sample size for the study (n=642) was determined using a single population mean formula. Data were collected using interviews and analysed using SPSS V.25. Descriptive statistics were performed, and the cost of follow-up care before and after the pandemic was compared using a related-samples Wilcoxon signed-rank test, declaring the level of significance of the median cost difference at p<0.05. RESULTS: A total of 642 patients were included in the study, of whom 605 (94.2%) responded to the interviews. There was a significant median cost difference (n=593, Z=5.05, p=0.001) between the cost of chronic diseases among follow-up patients during the pandemic and the costs incurred by these patients before the pandemic. CONCLUSION: The cost of follow-up care among chronic disease patients during the COVID-19 pandemic was significantly higher compared with before the pandemic era. Therefore, healthcare providers should arrange special fee waiver mechanisms for chronic disease healthcare costs during such types of pandemics and provide the services at proximal health facilities.

Magnitude and associated factors of depression among prisoners in Wollega zones, Oromia region, Ethiopia: A cross-sectional study.

BACKGROUND: Mental health is for everybody, but the individuals in prisons require more focus. Depression is a contributor to the global burden of disease and affects people in prisons in particular. There were limited studies on depression among prisoners. Therefore, the study aimed to assess the magnitude of depression and factors associated with it among prisoners in Wollega Zones Prisons, western Ethiopia. METHODS: Institutional based cross-sectional study was conducted on randomly selected 368 prisoners from June 1, 2019, up to August 1, 2019, in Wollega zones prisons. Data were collected by trained data collectors through interviewer-administered questionnaires. Data were entered into EpiData version 3.1 and analyzed using SPSS version 20. Bivariable and Multivariable logistic regression model was computed to identify factors associated with depressive symptoms. In the final model, the strength of the association between independent variables and depression was measured using the Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI). Then, in the final model, variables having a p-value of less than 0.05 were considered factors significantly associated with depression. RESULTS: Of the total study respondents, 166/368 (45.1%) had symptoms of depression. Lack of job opportunity in prison (AOR = 6.64, 95%CI: 3.65, 12.06), not attending religious place at all (AOR = 3.51, 95%CI: 1.30,10.00), and Unsentenced for suspected crime (AOR = 7.36, 95%CI: 2.08, 26.04) were associated with depression. CONCLUSION AND RECOMMENDATION: This finding showed that the magnitude of depression in prisons was high. Prisoners in the young age group, attending religious places, being married, prisoners who were sentenced for suspected crime on timely and prisoners performing work in prison were less likely to have depression. The prison institution needs to facilitate income-generating activities in prison, promoting prisoners to attend their religious places and promoting timely sentencing.

Determinants of adverse birth outcomes among women delivered in public hospitals of Ethiopia, 2020.

BACKGROUND: Adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. Factors such as the age of the mother, antepartum hemorrhage, history of abortion, gestational age, anemia, and maternal undernutrition have predisposed the mother to adverse birth outcome. For appropriate prevention of the adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. Therefore, this study was aimed to assess the determinants of adverse birth outcomes among women who give birth in public hospitals of western Ethiopia. METHODS: An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. From mothers who gave birth in public hospitals of Wollega zones, 165 cases and 330 controls were selected. Mothers with adverse birth outcomes were cases and mothers without adverse birth were controls. Data was collected by structured interviewer-administered questionnaires. In addition to the interview, the data collectors abstracted clinical data by reviewing the mother and the babies' medical records. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Finally, multivariable logistic regression was used to identify determinants of adverse birth outcomes at P-value < 0.05. RESULTS: A total of 495 mothers (165 cases and 330 controls) were included in the study with a mean age of 28.48 + 5.908. Low ANC visit (AOR = 3.92: 95% CI; 1.86, 8.2), premature rupture of membrane (AOR = 2.83: 95% CI; 1.72,4.64), being Anemic (AOR = 2: 95% CI; 1.16,3.44), pregnancy induced-hypertension (AOR = 2.3:95% CI; 1.4,3.85), not getting dietary supplementation (AOR = 2.47:95% CI; 1.6,3.82), and physical abuse (AOR = 2.13: 95% CI; 1.05,4.32) were significantly associated with the development of the adverse birth outcome. CONCLUSION: Low antenatal care visit, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve antenatal care follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

The adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Birth outcomes are measures of health at birth and their magnitude is dramatically decreased in the past 40 years. However; there is still a large gap between developing and developed countries. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. For appropriate prevention of adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. In this study, low Antenatal care (ANC) visits, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve ANC follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

Ergonomic Risk Factors for Low Back Pain among Three-Wheel Drivers in Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Driving a three-wheel car is an emerging job opportunity in most parts of developing countries. Drivers are at risk for developing low back pain (LBP). However, very little is known about the association between ergonomics factors and LBP among three-wheel drivers. OBJECTIVE: This study was aimed to identify ergonomic risk factors of LBP among three-wheel drivers. METHODS: A community-based cross-sectional study on 396 participants was conducted in the Jimma city on all selected public three-wheel drivers in March, 2020. The data were collected using a standard questionnaire adapted from the Nordic Musculoskeletal questionnaire, anthropometric measurements, and observation checklist. The collected data were entered into Epi Data and exported to SPSS version 21.0. Logistic regression analysis was used for analysis based on the p value less than 0.05, 95% C.I. Results. Among 422 planned respondents, 396 (93.8%) have given the complete response. The mean age of the study population was 27.94 (±5.45). One hundred four (26.26%) out of 396 participants had experienced low back pain in the last 12 months. Driving in sitting upright position OR = 0.32 (95% CI = 0.12-0.86), steer wheel handling OR = 3.02 (95% CI = 1.58-5.77), not holding extra passengers OR = 0.35 (95% CI = 0.21, 0.60), rest breaks, and brand of the three-wheel vehicles were significantly associated with LBP. CONCLUSION: Nearly more than one-fourth of three-wheel drivers in our study had LBP. The finding implies a significant number of three-wheel drivers are at risk of developing reduced well-being. An appropriate health visit, lifestyle modification, and adequate policy should be established in the study area.

Prevalence of Depressive Symptoms and Its Associated Factors among People Living with HIV Attending Public Hospitals of Nekemte Town, Western Ethiopia, 2021.

BACKGROUND: Depressive symptoms are the most common mental illness among people living with HIV/AIDS. Depressive symptoms impact negatively on the course of HIV infection and can lead to suicide and increased risk of mortality when it is a severe form. Although depressive symptoms are common among HIV/AIDS patients, only a few studies have been conducted in Ethiopia and no study, particularly at Nekemte town public hospitals. Therefore, this study was aimed at assessing the prevalence and risk factors for depressive symptoms among people living with HIV/AIDS attending Nekemte town public hospitals, Western Ethiopia. Methods. An institution-based cross-sectional study design was conducted on 425 HIV/AIDS patients at Nekemte town public hospitals, from March 30 to May 30, 2019. Data were collected through interviews and patient document reviews. The nine-item Patient Health Questionnaire (PHQ-9) was used to collect information concerning depressive symptoms and was defined by a PHQ-9 score ≥ 5. HIV stigma and discrimination scales were used to measure stigma. Social support was described by a sum score of the Oslo3 social support scale (OSS-3). The collected data was entered into EpiData Windows version 4.1 and then exported to Statistical Package for the Social Sciences (SPSS) Windows version 24.0 for analysis. All variables found to be significant at the bivariable level (p value < 0.25) were entered into a multivariable logistic regression model. p values of <0.05 and 95% confidence level were used to determine statistical significance. RESULTS: Out of the total of 384 study participants who participated in the study, 165 (42.96%) had depressive symptoms. Self-reported sleeping problems (AOR = 7.04, 95% CI: 3.23, 15.33), CD4 level of <200 (AOR = 5.45, 95% CI: 2.06, 14.42), poor social support (AOR = 2.79, 95% CI: 1.17, 6.67), and perceived stigma (AOR = 9.11, 95% CI: 1.17, 17.33) were significantly associated with depressive symptoms among HIV/AIDS patients at Nekemte town public hospitals. CONCLUSION: The level of depressive symptoms among HIV/AIDS patients in this study was high. Self-reported sleeping problems, CD4 level, social support, and perceived stigma were found to be significantly associated with depressive symptoms among HIV patients. Health care professionals should have to strengthen the linkage of mental health with antiretroviral therapy (ART) clinic to early detect and treat depressive symptoms.

Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat.

BACKGROUND: HIV continuum of care demands early ART initiation for all HIV-infected individuals. Early ART initiation reduces onward HIV transmission facilitating rapid viral suppression. Despite this, delayed ART use is a challenge among newly diagnosed HIV-positive individuals, and there is limited evidence on time to ART initiation among this group in Ethiopia. Thus, this study aimed to assess time to ART initiation and its predictors among newly diagnosed HIV-positive individuals in Nekemte town, Western Ethiopia. METHODS: An institution-based retrospective follow-up study was conducted on 518 newly diagnosed HIV-positive people from September 5, 2016 to December 20, 2020 at Nekemte town, Western Ethiopia. Data were collected from ART intake forms, registration log books and patient charts. The collected data were entered into Epi Data version 3.1 and STATA version 14.0 was used for analysis. Survival probability was checked graphically by Kaplan-Meier curve and statistically by Log rank test. Both bivariable and multivariable Cox Proportional hazards regression models were conducted to identify the predictors of ART initiation. Hazard ratio with 95% CI and p-value of <0.05 was used to declare a statistical significance. RESULTS: By the end of the follow-up, 371 (71.6%) individuals had initiated ART with an overall incidence rate of 51.9 per 1000 [95% CI: 54.07-66.32] person days; median time to ART initiation was 4 [IQR: 1-9] days. Being female (AHR = 1.33, 95% CI: 1.06-1.67), urban dwellers (AHR = 2.02, 95% CI: 1.37-2.97), having baseline OIs (AHR = 1.62, 95% CI: 1.60-4.30); being tested via VCT (AHR = 1.33, 95% CI: 1.02-1.74); linked from OPD (AHR = 0.64, 95% CI: 0.47-0.85); disclosing HIV sero-status (AHR = 2.07, 95% CI: 1.17-3.68); and college and above education level (AHR = 1.43, 95% CI: 1.00-2.0) were identified as significant predictors of early initiation of ART. CONCLUSION: The proportion and incidence of ART initiation was high; a short median time to ART initiation was revealed in this study. Strictly screening OIs, encouraging HIV sero-status disclosure and voluntary HIV testing are recommended to increase early ART initiation.

Impact of COVID-19 pandemic on chronic diseases care follow-up and current perspectives in low resource settings: a narrative review.

Coronavirus is a respiratory disease that spreads globally. The severity and mortality risk of the disease is significant in the elderly, peoples having co-morbidities, and immunosuppressive patients. The outbreak of the pandemic created significant barriers to diagnosis, treatment and follow-up of chronic diseases. Delivering regular and routine comprehensive care for chronic patients was disrupted due to closures of healthcare facilities, lack of public transportation or reductions in services. The purpose of this narrative review was to update how patients with chronic care were affected during the pandemic, healthcare utilization services and available opportunities for better chronic disease management during the pandemic in resources limited settings. Moreover, this review may call to the attention of concerned bodies to make decisions and take measures in the spirit of improving the burden of chronic diseases by forwarding necessary recommendations for possible change and to scale up current intervention programs.

Adherence to antiretroviral therapy and associated factors among Human immunodeficiency virus positive patients accessing treatment at Nekemte referral hospital, west Ethiopia, 2019.

BACKGROUND: Antiretroviral therapy has a remarkable clinical effect in reducing the progress of Acquired Immune Deficiency Syndrome. The clinical outcome of Anti-Retroviral therapy depends on strict adherence. Poor adherence reduces the effectiveness of antiretroviral therapy and increases viral replication. With changes in service delivery over time and differences in socio-demographic status from region to region, it is essential to measure adherence. Therefore, this study aimed to assess adherence to antiretroviral therapy and its associated factors among HIV/AIDS patients accessing treatment at Nekemte referral hospital, West Ethiopia. METHODS: Institutional based cross-sectional study was conducted on 311 HIV/AIDS patients from March 01 to March 30, 2019. The study participants were selected by a simple random sampling method and interviewed using structured questionnaires. Bivariable logistic regression was conducted to find an association between each independent variable and adherence to antiretroviral medication. Multivariable logistic regression was used to find the independent variables which best predict adherence. The statistical significance was measured using odds ratio at a 95% confidence interval with a p-value of less than 0.05. RESULTS: Out of a total of 311 patients sampled, 305 were participated in the study, making a response rate of 98.07%. From these 305 study participants,73.1% (95% CI = 68.2, 78.0) were adherent to their medication. Having knowledge about HIV and its treatment (AOR = 8.24, 95% CI: 3.10, 21.92), having strong family/social support (AOR = 6.21, 95% CI: 1.39, 27.62), absence of adverse drug reaction (AOR = 5.33, 95% CI: 1.95, 14.57), absence of comorbidity of other chronic diseases (AOR = 5.72, 95% CI: 1.91, 17.16) and disclosing HIV status to the family (AOR = 5.08, 95% CI: 2.09, 12.34) were significantly associated with an increased likelihood of adherence to antiretroviral medication. CONCLUSION: The level of adherence to antiretroviral therapy was found low compared to WHO recommendation. The clinician should emphasize reducing adverse drug reaction, detecting and treating co-morbidities early, improving knowledge through health education, and encouraging the patients to disclose their HIV status to their families.

Nurses' knowledge about palliative care and attitude towards end- of-life care in public hospitals in Wollega zones: A multicenter cross-sectional study.

BACKGROUND: Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in the final stages of their life. Lack of knowledge of and negative attitude palliative care among nurses is one of the most common barriers to quality palliative care. This study, therefore, aimed to assess nurses' knowledge about palliative care and attitude toward end-of-life care in public hospitals in Wollega zones, Ethiopia. METHODS: A multicenter institutional-based cross-sectional study design was employed to collect data from 372 nurses working in public hospitals in Wollega zones from October 02-22, 2019. A self-administered questionnaire with three different parts: Demographic characteristics of nurses, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD). SPSS version 21 was used for analysis used for data analysis. The binary logistic regression test was used for analysis at p < 0.05. FINDINGS: Our final sample size was 422 nurses (response rate = 88%). With the mean total PCQN scores (9.34), the majority of them showed an inadequate level of knowledge about palliative care. The mean total FATCOD scores (79.58) displayed a positive attitude toward end-of-life care, with 52% of respondents eager to care for a dying person and their family. Nurses who had PC service experience [AOR = 1.94 CI (1.10-3.42), p = 0.02] and had ever attended training/lecture on PC [AOR = 1.87 CI (1.01-3.46), p = 0.04] were independently associated with nurses' knowledge about PC. Similarly, nurses who had no PC service experience [AOR = 0.41, CI (0.21-0.79), p = 0.008], who read articles/brochures about PC [AOR = 1.94, CI (1.11-3.39), p = 0.01] and had provided care for a smaller number of terminally ill patients [AOR = 1.74, CI (1.01-2.97), p = 0.04] were significantly associated with nurses' attitude towards end-of-life care. CONCLUSION: The study highlighted that nurses' knowledge about palliative care is inadequate, and showed a less favorable attitude toward end-of-life care. The findings also provide evidence for greater attentions and resources should be directed towards educating and supporting nurses caring for patients with palliative care needs in Wollega Zones.

Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia.

BACKGROUND: Self-stigma associated with mental illness has remained a global public health issue affecting social interactions, health care, productivity and acceptance among others. It is one of important factors contributing to non-adherence to medication that leads to increased hospitalization and higher healthcare costs. Hence, the study aimed to assess self-stigma and medication adherence among patients with mental illness treated at the psychiatric clinic of Jimma University Medical Center (JUMC). METHODS: A cross-sectional, community-level study was conducted at Jimma town. The patient's data was collected from records between April and June 2017 and the collected data was analyzed using SPSS version 21. The Internalized Stigma of Mental Illness (ISMI) tool was utilized to measure internalized stigma. Linear regression analysis was performed to get the final model. Statistical significance association was considered at p-values less than 0.05 and 95% confidence interval was used. RESULTS: Males comprised more than half (61%) of the total sample of 300 respondents and with a mean age of 34.99 (SD ± 11.51) years. About one-third (32%) of patients had a working diagnosis of schizophrenia followed by major depressive disorder (24.3%). More than half of them, 182 (60.7%) were adherent to their psychotropic medication. The overall mean value of self-stigma was 2.16 (SD = 0.867) and 84 (28%) of the respondents had moderate to high self-stigma. Using ISMI the mean score of alienation was 2.26 (SD = 0.95), stereotype endorsement 2.14 (SD = 0.784), perceived discrimination 2.18 (SD = 0.90), social withdrawal 2.10 (SD = 0.857) and stigma resistance 2.11 (SD = 0.844). Increasing age of the patients (std. ß = - 0.091, p = 0.009) and living with kids and spouse (std. ß = - 0.099, p = 0.038) were negatively associated with self-stigma whereas increased world health organization disability assessment schedule (WHODAS) score (ß = 0.501, p < 0.001), number of relapses (std. ß = 0.183, p < 0.01) and medication non-adherence (std. ß = 0.084, p = 0.021) were positively associated with self-stigma. CONCLUSION: The study revealed that there was high self-stigma among patients with mental illness and a significant association between overall ISMI score and level of medication adherence. These require mental health professionals and policy-makers should give attention to ways to overcome self-stigma and increase medication adherence among patients with mental illness.

Maternal Common Mental Disorder as Predictors of Stunting among Children Aged 6-59 Months in Western Ethiopia: A Case-Control Study.

BACKGROUND: Child malnutrition in low- and middle-income countries still continues to be an alarming. Africa and Asia bear the greatest share of all forms of malnutrition. The association between maternal common mental disorder and stunting has not been studied well even in developed countries; much less in developing countries and even the findings are conflicting. Thus, the purpose of the present research was to investigate the relationship of maternal common mental disorder and child stunting. METHODS: Institution based unmatched case-control study design was employed from March to April 2017. Two hundred thirty-four sampled children (78 cases and 156 controls) were randomly selected. Anthropometric measurements (height/length and weight) were taken by calibrated instruments. Maternal common mental disorder (CMD) was measured by using the locally validated Self-Reporting Questionnaire (SRQ-20). Data entry was done by Epi data version 3.1 and analysis was done by SPSS 21.0 statistical software. RESULT: Finding of this study found out about three-fourths of cases (71.8%) and three-fourths of controls (69.9%) were residing in rural and urban areas, respectively. Regarding maternal common mental disorder, more than half of cases mother (53.8%) and more than one-tenth of controls mother (13.5%) were found to have common mental disorder. The study showed that children of mothers who had common mental disorder were found to be three times more likelihood of developing stunting than children whose mothers had not common mental disorder. CONCLUSION AND RECOMMENDATION: The study indicated that maternal common mental disorder was significantly associated with stunting. Therefore, emphasis should be given in preventing, managing, and maintaining maternal mental health in order to prevent stunting.

Medication prescribing errors among hospitalized pediatric patients at Nekemte Referral Hospital, western Ethiopia: cross-sectional study.

OBJECTIVE: Incidence and clinical outcomes of medication prescribing errors are common and potentially more harmful in the pediatric population than in the adult population. Hence, this study was aimed to assess the prevalence and types of medication prescribing errors in the pediatric wards of Nekemte Referral Hospital (NRH). RESULTS: Of 384 pediatric patients included in the study, 241 (63%) were males and 116 (30.21%) of them were aged between 1-3 years. About 241 (62.76%) of the patients were treated based on empirical diagnosis and only 10 (2.60%) pediatrics had co-morbid disease. The most category of medication prescribing error was dosing error 251 (48.6%) followed by incorrect drug selection 98 (19.0%). Being critically ill (AOR = 5.31, 95% CI = 1.80-12.31, p = 0.003), route of administration via IV (AOR = 3.98, 95% CI = 1.85-11.15, p = 0.011) and via IV + IM route (AOR = 2.22, 95% CI = 1.05-9.25, p = 0.045) as well as 4-6 medications per patient (AOR = 3.10, 95% CI = 3.43-12.42, p = 0.012) and > 6 medications per patient (AOR = 7.23, 95% CI = 3.91-21.45, p < 0.001) were independent predictors of medication prescribing errors. Antibiotics were the most common classes of drugs responsible for prescribing errors.