Rubella outbreak in the school children, Addis Ababa, Ethiopia: February-April 2018.

BACKGROUND: Rubella is a vaccine-preventable contagious disease causing an estimated 100,000 children to be born with congenital rubella syndrome each year globally. Studies documented that 18 rubella outbreaks were occurred each year in Ethiopia. Yeka sub-city woreda 13 public health emergency management office reported two measles suspected cases on 8 February, 2018. We investigated this outbreak to identify its etiology, describe the outbreak and implement control measures. METHODS: We described the outbreak using descriptive epidemiology. The study population was defined as students learning in the school where the outbreak occurred. Suspected rubella case was defined as student with generalized rash whereas confirmed case was suspected case tested positive for rubella IgM. Questionnaires, checklists and students record review were used to collect data. We searched for new cases in classes daily and excluded them from classes. The school environment was assessed and the outbreak was described in person and time. RESULTS: We identified 58 cases (median age: 4.6 years; IQR: 4-5 years) with six of them rubella IgM positive and 52 epidemiologically linked. The outbreak began on 8 February 2018 having multiple intermittent peaks during its course reaching its highest peak at 2 April, 2018 and ended on 20 April, 2018. Index cases were reported from two classes; however, cases were occurred in 13/15(86.67%) of the classes during the entire outbreak. Fifty five percent (32/58) and 45/58(77.59%) of the cases were females and 3-5 years children, respectively. Overall attack rate was 58/531(4.05%). Attack rate was higher in females 32/252 (12.7%) than in males 26/279 (9.32%), and higher 45/275(16.36%) in 3-5 years than those in 5-8 years 13/256(5.08%) children. Case fatality ratio was zero. All cases were vaccinated against measles but unvaccinated against rubella. CONCLUSIONS: Attack rate was higher in females than in males and higher in 3-5 years than 5-8 years children. We recommended establishing rubella surveillance system, conducting sero-prevalence of rubella among child bearing age females and establishing CRS surveillance among young infants to provide evidence-based information for RCV introduction. It was also recommended to develop a national rubella surveillance guideline which aid to exclude rubella cases from schools during outbreak.

Ethiopian teachers: their knowledge, attitude and practice towards epilepsy.

BACKGROUND: In Ethiopia where the burden of epilepsy is highest among school age children and teenagers, and where people with epilepsy (PWE) and their relatives suffers from high level of perceived stigma, there had not been any study that assessed the knowledge, attitude and practice of teachers towards PWE. This study aims to assess and understand the social and demographic determinants of knowledge, attitude and practice of teachers towards PLW in Addis Ababa, Ethiopia. METHODS: Multistage cluster sampling procedure was used to identify twenty schools from three sub cities of Addis Ababa, Ethiopia. Standardized self administered questionnaire was used to collect data from 845 volunteer teachers in the pre identified schools. Frequencies were used to characterize the demographic variables while multiple response frequencies were used to characterize the multiple response variable sets. Non-parametric statistical methods were used to describe the association among the demographic variables of interest and the count sums of multiple response variables which were grouped into biologically and culturally plausible responses. RESULTS: The most common biologically plausible responses were: brain diseases (26.5 %) from causes, allow my offspring to play with PWE (19.1 %) from attitude, protect the subject from injury (20.4 %) from first aid measures and seek help from medical doctors (52.2 %) from epilepsy treatment. On the contrary, the most common culturally plausible responses were: psychiatric illness (12.9 %) from causes, epilepsy be cured before attendance to school (21.6 %) from attitude, smelling the smoke of struck match (14.2 %) from first aid measures and Holy water treatment (20.3 %) from epilepsy treatment suggestions. The biologically and culturally plausible responses were negatively correlated. Level of education was positively associated with biologically plausible responses while teaching experience was negatively correlated with culturally plausible responses. CONCLUSION: A high percentage of teachers in Addis Ababa considered epilepsy as a psychiatric illness closely linked to insanity. This explains their suggestions of Holy water treatment and Church healing sessions as epilepsy remedies. This is in agreement with Ethiopian culture, in which evil spirit and insanity are believed to be better treated by religious remedies than with modern medical treatments. Incorporating special needs educational training courses in the curriculum of teachers training may help them shift their knowledge, attitudes and practices from that of the culturally plausible to biologically plausible one.

Effect of early and current Helicobacter pylori infection on the risk of anaemia in 6.5-year-old Ethiopian children.

BACKGROUND: Epidemiological and clinical studies in high income countries have suggested that Helicobacter pylori (H. pylori) may cause anaemia, but evidence is lacking from low income countries.We examined associations between H. pylori infection in early childhood and anaemia at the age of 6.5 years in an Ethiopian birth cohort. METHODS: In 2011/12, 856 children (85.1 % of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Haemoglobin level and red cell indices were examined using an automated haematological analyzer (Cell Dyn 1800, Abbott, USA), and stool samples analyzed for H. pylori antigen. The independent effects of H. pylori infection (measured at age 3.5 and 6.5 years) on anaemia, haemoglobin level, and red cell indices (measured at age 6.5 years) were determined using multiple logistic and linear regression. RESULTS: The prevalence of anemia was 34.8 % (257/739), and the mean (SD) haemoglobin concentration was 11.8 (1.1) gm/dl. Current H. pylori infection at age 6.5 years was positively, though not significantly related to prevalence of anaemia (adjusted OR, 95 % CI, 1.15; 0.69, 1.93, p = 0.59). Any H. pylori infection up to age 6.5 years was significantly associated with an increased risk of anaemia at age 6.5 (adjusted OR, 95 % CI, 1.68; 1.22, 2.32, p = 0.01). A significant reduction in haemoglobin concentration and red cell indices was also observed among children who had any H. pylori infection up to age 6.5 (Hb adjusted ß = -0.19, 95 % CI, -0.35 to -0.03, p = 0.01; MCV adjusted ß = -2.22, 95 % CI, -3.43 to -1.01, p = 0.01; MCH adjusted ß = -0.63, 95 % CI, -1.15 to - 0.12, p = 0.01; and MCHC adjusted ß = -0.67, 95 % CI, -1.21 to -0.14, p = 0.01), respectively. CONCLUSION: This study provides further evidence from a low income country that any H. pylori infection up to age 6.5 is associated with higher prevalence of anaemia, and reduction of haemoglobin level and red cell indices at age 6.5.

Injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: a prospective hospital based study.

BACKGROUND: Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people. More than a million people die each year on the world's roads, and the risk of dying as a result of a road traffic injury is highest in Africa. METHODS: A prospective hospital based study was undertaken to assess injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A structured pre-tested questionnaire was used to gather the required data. The collected data were analyzed using SPSS version 20.0. Hierarchical multiple regression analysis was used to identify predictors of fatalities among the road traffic crash victims. RESULTS: A total of 230 road traffic accident victims were studied. The majority of the study subjects were men 165 (71.7%) and the male/female ratio was 2.6:1. The victims' ages ranged from 14 to 80 years with the mean and standard deviations of 32.15 and ± 14.38 years respectively. Daily laborers (95 (41.3%)) and students (28 (12.2%)) were the majority of road traffic accident victims. Head (50.4%) and musculoskeletal (extremities) (47.0%) were the most common body region injured. Fractures (78.0%) and open wounds (56.5%) were the most common type of injuries sustained. The overall length of hospital stay (LOS) ranged from 1 day to 61 days with mean (± standard deviation) of 7.12 ± 10.5 days and the mortality rate was 7.4%. Hierarchical multiple regression analysis showed that age of the victims (ß = 0.16, p < 0.05), systolic blood pressure on admission (ß = -0.35, p < 0.001) and Glasgow coma scale (ß = -0.44, p < 0.001) were statistically significant predictors of fatalities among the victims. CONCLUSIONS: This study showed diverse injury characteristics and high morbidity and mortality among the victims attending Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. The findings reflect that road traffic accident is a major public health problem. Urgent road traffic accident preventive measures and prompt treatment of the victims are warranted in order to reduce morbidity and mortality among the victims.

ASSESSMENT OF THE MAGNITUDE OF TEENAGE PREGNANCY AND ITS ASSOCIATED FACTORS AMONG TEENAGE FEMALES VISITING ASSOSA GENERAL HOSPITAL.

BACKGROUND: Teenage pregnancy is directly related to high incidence of pregnancy related complications contributing to maternal morbidity and mortality and social problems. There are no enough data on teenage pregnancy and related complications in Ethiopia and in Benishangul Gumuz region in particular. OBJECTIVE: To investigate the magnitude and factors associated with teenage pregnancy among teenage females visiting Assosa general hospital for health care services. METHODS: Facility-based quantitative cross-sectional study was carried out among 783 randomly selected teenage females using structured and pre-tested questionnaire from January to April 2014. RESULTS: Teenage pregnancy is estimated at 20.4% in this study. The median age of subjects at first sexual intercourse and at first marriage being 16 and 17 years respectively. High proportion of (46.8%) teenagers had engaged in premarital sex. Among sexually active teenage females, 46.7% experienced their first sexual encounter by coercion. Being young [AOR = 0.21, 95% CI = 0.06-0.67], single [AOR = 0.06, 95% CI = 0.03-0.12], housemaid [AOR = 3.93, 95% CI = 1.71-9.04] and use of family planning [AOR = 2.39, 95% CI = 1.20-4.75] have statistically significant association with teenage pregnancy. CONCLUSIONS AND RECOMMENDATIONS: A range offactors including age, marital status, level of education, occupational status, average family income and use of family planning have influence on teenage pregnancy in the study area. Behavioral change communication, strengthening school health program, empowering young women specifically the rural women, and promoting parent-children discussion on sexuality is recommended.

MAGNITUDE OF DISABILITY AND ASSOCIATED FACTORS AMONG PATIENTS IN BORU MEDA HOSPITAL, SOUTH WOLLO ZONE, AMHARA REGION, ETHIOPIA.

BACKGROUND: Leprosy is a chronic infectious disease affecting the skin and peripheral nerves. Early diagnosis and full course treatment are critical for preventing lifelong neuropathy and disability to minimize the occurrence of disability. OBJECTIVE: The objective of this study is to assess the magnitude of disability and associated factors among leprosy patients after treatment in Boru Meda Hospital. METHODS: Facility based cross sectional study was conducted among 128 leprosy patients registered at Boru Meda Hospital from January 1, 2010 to December 31, 2012. Data was collected from charts, entered into a computer, cleaned, edited using EPI Info Version 3.53 for windows and analyzed by SPSS. RESULTS: Five patients (4%) had Grade 2 disability at discharge; the remaining 123 (96%) were discharged with either disability grading 0 or disability grading 1, which are considered to be normal disability grading. Males and rural people were more affected by the diseases: 72% and 92% respectively. Sixty percent of disability occurred due to type one reaction. The mean age of patients and treatment duration were 39.3 years and 60 days respectively. Among the factors type of reaction was significantly associated with disability grading (P = 0.02). CONCLUSION AND RECOMMENDATION: Rural people and males are more affected by leprosy and the prevalence of disability is decreasing. This findings suggest that we need to work on awareness creation on rural people and patients with leprosy to see healthcare providers as early as possible.

EVALUATING THE VALIDITY AND RELIABILITY OF CHEST RADIOGRAPHY IN THE DIAGNOSIS OF TUBERCULOSIS AMONG SMEAR NEGATIVE PULMONARY TUBERCULOSIS PATIENTS.

BACKGROUND: Tuberculosis (TB) is a mycobacterial infection mainly affecting the lungs. Early and correct diagnosis of sputum smear negative patients by chest radiography (CXR) is challenging since it depends on reader's ability to detect abnormal findings and to interpret it correctly. OBJECTIVES: To evaluate the validity and reliability of CXR the diagnosis of TB among smear negative pulmonary tuberculosis (PTB). METHODS: An institutional based cross-sectional study was conducted at seven selected health facilities from October 2011 to September 2012 on 159 adults aged 18 years and above who were newly diagnosed smear negative for PTB patients diagnosed using Chest X-ray (CXR). Morning sputum was collected and cultured from each patient using Lowenstein Jensen media. All the CXRs were revised by senior radiologists in conjunction with the principal investigator. A structured questionnaire was used to collect socio-demographic, clinical and radiological data. Sensitivity and specificity measures of the CXR findings were calculated in comparison to the gold standard sputum culture results. RESULTS: The mean (SD) age of patients involved in the study was 37.1 (16.7), ranging from 18 to 87 years. Of the total 159 smear negative PTB patients, the most common CXR finding was consolidation (40.3%) followed by cavitations (23.9%) and nodular lesions (17.0%). Sputum culture results showed that, 47 (29.6%) were culture positive, 103 (64.7%) were culture negative and 9 (5.6%) were contaminated. About 14% (22/159) of the study subjects were HIV positive. The sensitivity and specificity of CXR findings were 77.1% (37/48) and 36.9% (41/111), respectively. The positive and negative predictive values were 34.6% (3 7/107) and 78.8% (41/52), respectively. CONCLUSION: CXR can be used as supportive investigative modality to diagnose smear negative Pulmonary TB in conditions where TB culture is no more feasible.

REDUCING PMTCT ATTRITION: PERSPECTIVES OF HIV+ WOMEN ON THE PREVENTION OF MOTHER-TO-CHILD HIV SERVICES IN ADDIS ABABA, ETHIOPIA.

BACKGROUND: Only 41% of eligible Ethiopian women completed (PMTCT) therapy in 2012, with MTCT rate of 20%. OBJECTIVE: This study elicited the perspectives of HIV positive mothers on the situation and the unique beliefs, attitudes, cultural norms and individuals who have influence over them during their pregnancy. METHODS: The mixed-methods parent study included community level surveys, focus groups and in-depth individual interviews of HIV positive women with a child at least one year of age in Addis Ababa, Ethiopia: only focus group and interview data are presented here. All tools were completed in Amharic with English translation. RESULTS: 23 women completed in-depth interviews; 27 participated within 4 focus groups. The greatest barriers to PMTCT completion were: feelings of hopelessness and carelessness, lack of understanding of the efficacy of ARV, and negative religious influences. The advice to improve PMTCT adherence most frequently offered included increasing PLWHIV peer support and improving and extending current HIV educational efforts. Participants recommended that PLWHIV mothers be utilized in all PMTCT planning and interventions in the future. CONCLUSION: Maintaining the motivation to adhere to the entire PMTCT cascade requires that a PLWHIV mother understands the validity of the steps she is taking and receives support for the many challenges she faces. Engaging PLWHIV peers as active members of the health care workforce and expanding their use as educators and counselors is important. Health officials can consider these findings to develop innovative and effective PMTCT interventions.

Critical appraisal of an article published in the Ethiopian Medical Journal.

Research involves gathering data, then collating and analyzing it to produce meaningful information. However, not all research is good quality and many studies are biased and their results untrue. Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. This paper attempted to point out the weak and strong points of the study, taking into account sources of bias that were introduced in the article "Visual acuity and road traffic accident (RTA) in Jimma town" published in the Ethiopian Medical Journal.

TOWARDS A 'GLOBAL' STRATEGY FOR TACKLING THE GLOBAL BURDEN OF COMMUNICABLE AND NON-COMMUNICABLE DISEASES IN RESOURSE LIMITED SETTINGS.

The global burden of communicable diseases (CD) and non-communicable diseases (NCD) in low and middle-income countries (LMICs) likely stems from a common substratum of societal and system inadequacies. In order to appropriately control these conditions and to manage the determinants and deterrents of both CDs and NCDs related deaths and disabilities, joint strategies aimed at both systemic and population levels are warranted. Although deficiencies exist within the health systems of LMICs, assets which could be leveraged efficiently to produce desirable outcomes also abound. Significant changes are already taking place through health initiatives within LMICs, opening up opportunities for further success through the involvement of international agencies. The role of these agencies, including donor countries and LMICs' Diaspora, is to strengthen and support the opportunities offered by on-going changes at the country level. There is a need to better understand and support the drivers and processes of positive change within LMICs in order to harness them for more widespread benefit through scale-up efforts. Strategies for addressing CDs and NCDs should be devised and implemented as complementary rather than competing 'sides of the same coin'.

Prevalence and correlates of maternal anemia in rural Sidama, Southern Ethiopia.

In order to assess the prevalence and correlates of prenatal anemia, a survey was conducted among 700 randomly selected pregnant women in rural Sidama, Southern Ethiopia. The prevalences of anemia, Iron Deficiency (ID) and ID anemia were 31.6%, 17.4% and 8.7%, respectively. The burden of anemia was significantly high among illiterates, women devoid of self-income, lowlanders, multiparas and women aged 25-34 years. Women who weren't on iron-folate supplementation had 1.90 (95% Confidence Interval (CI): 1.14-3.19) times increased odds of anemia. Anemia was associated with ID, zinc deficiency and elevated C-reactive protein with odds ratio of 2.46 (95% CI: 1.63-3.73), 2.29 (95% CI: 1.62-3.23) and 1.98 (95% CI: 1.12-3.47) respectively; however, it was not associated with vitamin A deficiency. Though ID was a significant correlate of anemia, only 11.8% of anemia was attributable to it. Zinc, iron and vitamin A deficiencies did not show synergistic interaction in associating with anemia.

Epidemiology in Ethiopia 200 years after John Snow's birth.

The year 2013 marks exactly 200 years since John Snow, known as the father of modern epidemiology, was born. In 19th century, epidemiologists like John Snow, concentrated almost entirely upon infectious diseases of humans measuring the burden of disease, describing pattern and attempting to understand the transmission dynamics. During the second half of the 20th century; big changes occurred so that epidemiologists in the developed world started to use systematized approaches to investigate the etiologies, conditions and to evaluate interventions through different study designs. However, the situation in the developing world is not the same as the rest of the world. Even 200 years after Snow's birth, epidemiological capacity is lowest in Africa. This article attempts to describe that Ethiopia is not exceptional. In the past few decades, there have been some attempts to build capacity in the country by launching training programs in clinical epidemiology, general epidemiology and field epidemiology. However, not only few epidemiologists are trained, but, limited funding, high-teaching burdens, poor working conditions and low salaries are among important contributors for epidemiological brain drain in Ethiopia. Thus, strengthening learning opportunities and rewarding career paths are required to increase human resource capacity and retain skilled personnel in the field of epidemiology.

Peer-review and editorial process of the Ethiopian Medical Journal: ten years assessment of the status of submitted manuscripts.

BACKGROUND: The Ethiopian Medical Journal (EMJ) is a peer-reviewed journal, now 50 years old. Many medical journals, including EMJ, follow a peer review system that has evolved from the 18th century process for reviewing submitted manuscripts. However, not much is known about peer review and editorial processes by many authors who submit manuscripts to the EMJ. OBJECTIVE: To describe procedures related to EMJ peer-review and editorial decision making and asses the status of manuscripts submitted to the journal in the ten year period between 2001 and 2010. METHODS: All the minutes of the editorial board meetings of the ten years period 2001-2010 and relevant documents were reviewed. The minutes have details including date of submission, dates to and from reviewers, date of decision, number of assigned peer reviewers and comments given by reviewers for each submitted manuscript. The length of time took in the processes and the decision made (accepted or rejected) for each submitted manuscript was calculated from the dates. RESULTS: All submitted manuscripts passed through three stages: internal per-review by an editorial board member, external peer review by selected reviewers and final editing stage by an assigned editorial member. A total of 615 manuscripts were submitted to EMJ in the ten years period 2001-2010. Five hundred and one (82.7%) manuscripts were accepted for publication by peer reviewers, while 74 (12.2%) were rejected and 31 (5.1%) were withdrawn. Acceptance was lowest among original articles (81.3%) followed by teaching or review articles (84.3%) and case reports (89.3%). Thirty-two (8.4%) manuscripts were accepted within 6 months following submission and 50% were accepted within in one year of submission. About 6% of manuscripts were delayed for more than two years with a maximum delay of 43 months. CONCLUSION: Even though, there is a decline trend on the delay of processing manuscripts, EMJ has long to go in order to improve the quality of the journal and shorten the slow peer review process. Expansion of the use of electronic technology to communicate with authors and reviewers and motivating reviewers by conducting workshops and continuing medical educations are recommended to strengthen the process of peer review in the EMJ.

Assessment of risk factors for development of active pulmonary tuberculosis in northern part of Ethiopia: a matched case control study.

BACKGROUND: Understanding the role of various determinants of tuberculosis (TB) is particularly important in countries like Ethiopia where TB is endemic and the resources available to public health intervention are limited However, little information is available on risk factors of TB to be able to effectively and efficiently control TB. OBJECTIVE: To identify and determine the potential host and environmental-related risk factors for development of active pulmonary tuberculosis (PTB) in the Tigray region of Ethiopia. METHODS: A matched case-control study was conducted from April-August 2011. Cases were defined as all newly diagnosed of PTB patients aged 15 years and above, who were registered by directly observed treatment short-course (DOTS) program health centers found in the randomly selected 16 districts in the region. Controls were age matched with no previous history of TB and chronic cough. For each case, two controls were recruited. Trained nurses collected data using structured and pre-tested questionnaire. Predictors of caseness were identified using conditional logistic regression method. Odds ratio were calculated with 95% confidence intervals to assess the strength of association. RESULTS: Data was collected from 463 cases and 860 controls. The mean age of the cases and controls were 37 +/- 14.9 and 39 +/- 14.5 years, respectively. In the multivariable analysis significant risk factors for active PTB were illiteracy (OR = 1.90, 95% CI: 1.24, 2.93), household food shortage (OR = 2.38, 95% CI: 1.52, 3.73), HIV seropositivity (OR = 2.7, 95% CI: 1.42, 5.13), and past alcohol consumption (OR = 2.44, 95% CI: 1.08, 5.50). Marriage (OR = 95% CI: 0.37, 0.89) was identified as protective factor. Consumption of raw milk, history of imprisonment, having a separate kitchen, history of asthma and history of TB contact were significant risk factors on crude analysis but their significance was not maintained in multivariable analysis. CONCLUSION: Our study results indicated that household food shortage, HIV sero-positivity, illiteracy, being married, smoking and alcohol consumption before six months have a substantially increased risk of developing tuberculosis, independent of other risk factors in adults in the Tigray region of Ethiopia. Hence, prevention and control efforts must target on this identified factors toward facilitating and effective and efficient TB control program in the study area.

Costs of osteoporosis related fractures in hospital admitted patients, Tigrai, Northern Ethiopia: a retrospective study.

BACKGROUND: Osteoporotic fractures are among the non-communicable diseases imposing a growing morbidity and economic burden upon developing countries which have limited resources. Despite several studies from other countries, in Ethiopia sufficient information regarding the cost of illness related to osteoporotic fractures is not available. OBJECTIVE: The aim of the study was to estimate the direct and indirect costs attributable to osteoporotic fractures from a patient perspective. METHODS: A retrospective review of 1,169 medical records of cases of osteoporosis related fracture that had been diagnosed and treated over a two year period were selected systematically and included in the analysis. Cost of illness was estimated after developing a checklist to extract the direct patient side medical costs from individual based data and indirect costs were estimated using a human capital approach. RESULT: Analysis of the patient side direct medical costs of osteoporotic fracture according to the site of the fracture resulted in hip fractures identified as the most expensive fractures accounting for about 25% of the total (Median cost, was ETB 237.50 (US$14.09), and Mean = ETB 367.80 (US$ 21.83 per individual patient), while wrist fractures were the least expensive accounting for 6.2% (Median ETB 59.00 (US$3.50) and Mean ETB 59.40 (US$ 3.53 per individual patient). The average length of hospitalization was 22 days. The maximum number of days of hospitalization took place in cases with proximal femoral fracture and fractures of the hip and vertebrae, with a median of 25 days. For every single day increment in inpatient hospital stay there was an equivalent increment of ETB 23.27 (US$1.38). The hospital bed occupancy rate for the two years due to osteoporotic fractures was 6.8%. The total direct medical and indirect cost attributable to osteoporotic fractures during the two year period was ETB 1,314,979.00 (US$78,045.08). Of this total, direct medical cost and indirect costs incurred by the patients accounted for 49.2% and 50.9%, respectively. CONCLUSION: The total patient side cost attributable to osteoporotic fractures incurred over a two year time period was over ETB 1.3 million ($US 78,000). Over 50% of the cost was related to absenteeism from work due to hospitalization. From the patients' perspective the costs pose substantial burden on patients and their families. Hence, interventions to prevent osteoporosis should be implemented.

Treatment outcome of smear-positive pulmonary tuberculosis patients in Tigray Region, Northern Ethiopia.

BACKGROUND: Monitoring the outcome of tuberculosis treatment and understanding the specific reasons for unsuccessful treatment outcome are important in evaluating the effectiveness of tuberculosis control program. This study investigated tuberculosis treatment outcomes and predictors for unsuccessful treatment outcome in the Tigray region of Ethiopia. METHODS: Medical records of smear-positive pulmonary tuberculosis (PTB) patients registered from September 2009 to June 2011 in 15 districts of Tigray region, Northern Ethiopia, were reviewed. Additional data were collected using a structured questionnaire administered through house-to-house visits by trained nurses. Tuberculosis treatment outcomes were assessed according to WHO guidelines. The association of unsuccessful treatment outcome with socio-demographic and clinical factors was analyzed using logistic regression model. RESULTS: Out of the 407 PTB patients (221 males and 186 females) aged 15 years and above, 89.2% had successful and 10.8% had unsuccessful treatment outcome. In the final multivariate logistic model, the odds of unsuccessful treatment outcome was higher among patients older than 40 years of age (adj. OR=2.50, 95% CI: 1.12-5.59), family size greater than 5 persons (adj. OR=3.26, 95% CI: 1.43-7.44), unemployed (adj. OR=3.10, 95% CI: 1.33-7.24) and among retreatment cases (adj. OR=2.00, 95% CI: 1.37-2.92) as compared to their respective comparison groups. CONCLUSIONS: Treatment outcome among smear-positive PTB patients was satisfactory in the Tigray region of Ethiopia. Nonetheless, those patients at high risk of an unfavorable treatment outcome should be identified early and given additional follow-up and social support.

Parent-young people communication about sexual and reproductive health in E/Wollega zone, West Ethiopia: implications for interventions.

OBJECTIVES: This study aims at examining parent-young people communication about sexual and reproductive health related topics and factors associated with it from both young people's and parents' perspectives. METHODS: A cross-sectional study was conducted among 2,269 young people aged 10-24 years in Nekemte town and semi urban areas, western Ethiopia. Chi-square and multivariate logistic regression analyses were conducted using SPSS for windows version 16. The qualitative data was coded, and categorized in to emerging themes using the open code software version 3.4. RESULT: About a third of young people-32.5% (32.4% of females and 32.7% males) engaged in conversation about sexual and reproductive health topics with their parents/parent figures during the last six months. In logistic regression analyses, young people who were aged 15-19 years were more likely to report parent-communication compared to the other age groups (AOR = 1.57; 95%CI = 1.26-1.97). Female young people are more likely to discuss with their mothers, (AOR = 1.89, 95% CI = 1.13-3.2), sister (AOR = 2.16, 95% CI = 1.19-3.9) and female friends (AOR = 11.7, 95% CI = 7.36-18.7) while males are more likely to discuss with male friends (AOR = 17.3, 95%CI = 10-4-28.6). Educated young people were more likely to parent-communicate(AOR = 1.70, 95%CI = 1.30-2.24). Fear of parent, cultural taboos attached to sex, embarrassments, and parents' lack of knowledge related to sexual and reproductive health were found to be barriers for parent communication. Parent-communication takes place not only infrequently but also in warning, & threatening way. CONCLUSION: Parent-young people communication about sexual health is occurring rarely in the family and bounded by certain barriers. Programmes/policies related to young people's reproductive health should address not only individual or behavioral factors but also cultural and social factors that negatively influence parent-communication about reproductive health.

Magnitude and pattern of osteoporotic fractures among adults in Tigiray, Ethiopia; a retrospective hospital based study.

INTRODUCTION: Osteoporotic fractures are devastating public health problems due to significant morbidity, mortality, and the socioeconomic burden. h2 Ethiopia, the weight of such fractures is often underestimated due to lack of epidemiological data. OBJECTIVE: To assess the magnitude and pattern of osteoporotic fractures among adults admitted to zonal hospitals in Tigrai, North Ethiopia. METHODS: Two years retrospective hospital based medical-record review was employed. All fractures that occurred from September, 01, 2009 to August, 31, 2011 where the source population and osteoporosis related fracture cases were extracted. A total of 1173 charts was retrieved for further characterization of the cases with osteoporotic fractures. The sample size was proportionally distributed to the six hospitals, the cards were selected using a systematic random sampling technique and descriptive analysis was done using SPSS version 19.0. RESULT: A total of 24.672 (15.402 males and 9,270 females) fractures of all types were extracted from medical records of the six zonal hospitals in the region (September 2009-August 2011), among which 2,294 (1,465 males and 829 females) were cases with osteoporotic fractures. The overall prevalence of osteoporotic fractures was 9.3 % and the sex specific prevalence rate was 9.5 and 8.9% for males and females respectively. Characterization in terms of the fracture site, cause, residence, age, and gender was done for 1173 patient charts with osteoporotic fracture. Eight hundred twenty nine (70.9%) of the cases were males. The mean age was 50 (+/- 12) with median age of 45 years. The highest proportion 441 (37.7%) of osteoporotic fractures were of the proximal femur; with higher proportion among males than females. The majority of the fractures, 688 (58.9%) were observed between the age group 40-49. CONCLUSION: Osteoporotic fractures are not infrequent in Tigrai, Ethiopia. Clinicians and other health care providers should be more aware of osteoporosis as the predominant underlying cause of fragility fractures in the region.

Adherence to Chemotherapy among Women with Breast Cancer Treated at Tikur Anbessa Specialized and Teaching Hospital, Addis Ababa, Ethiopia.

BACKGROUND: Adherence is important for women with breast cancer because it is a primary determinant for effectiveness of treatment and optimum clinical benefit. Though Breast cancer is the leading cancer in Ethiopia,adherance to chemotherapy is not investigated in Ethiopian women. OBJECTIVE: This study aimed to assess adherence to chemotherapy among women with breast cancer treated at Tikur Anbessa specialized and Teaching Hospital. METHODS: Cross-sectional study was conducted among 164 breast cancer patients with chemotherapy. After eligible participants were identified, data were collected using face-to-face interviews, card reviews and telephone interviews. Adherence was calculated as the number of doses taken divided by number of recommended or expected doses. Pearson chi-square test was used to evaluate predictors of adherence. RESULTS: Among a total of 164 breast cancer patients, majority, 119, (72.6%) of them were urban residents. The mean age of study participants was 41.99 + 10.9 years. The majority 149, (90.9%) of patients were married. More than half 94, (57.3%) of the women were literate. In this study, 137 out of 164 (83.5%) women were adherent to their chemotherapy. Of the 27 non adherent participants. he reason for non-adherence to chemotherapy was unknown for 7, (25.9%) of women. Among different identified reasons for non-adherent, sever illness prevents patients to receive chemotherapy. Based on Pearson chi square test, distance from referral center and treatment regimen were significantly associated with non-adherence rate. CONCLUSION: The present  study the results showed that the majority 137, (83.5%) of patients were in good adherence to their chemotherapy. The most identified factor of non-adherence was inability to come for their therapy as a result of severity of illness. Therefore, expansion of cancer diagnosis and treatment centers should be encouraged in order to maximize patient's access and adherence to chemotherapy.

Association of risk factors and breast cancer among women treated at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a case-control study.

OBJECTIVES: Many factors known to increase the risk of breast cancer, such as age, family history, early menarche and late menopause are not modifiable. Modifiable factors include obesity, use of menopausal hormones and breast feeding. This study aimed to assess risk factors associated with breast cancer among women at Tikur Anbessa Specialized Hospital. DESIGN: Facility based case-control study. METHODS: Case-control study was conducted from May 2018 to June 2019. A total of 230 cases and 230 controls participated in the study. Data were analysed using SPSS software. Multivariable logistic model based analysis was conducted to control the effect of potential confounding factors. ORs and 95% CI for the likelihood of developing breast cancer were calculated. RESULTS: The odds of breast cancer was higher among women between 40 and 49 years (adjusted OR (AOR): 3.29, 95% CI 1.39 to 7.77), and being unemployed (AOR: 4.28, 95% CI 2.00 to 9.16). Regarding life style risk factors, women consuming solid oil and using wood or animal dung as source of fuel had significantly higher odds of breast cancer. In addition, the odds of breast cancer was significantly higher among postmenopausal women, women who had previous benign surgery and women with early menarche (<12 years). On the other hand, the odd of breast cancer was significantly lower among women who had moderate physical activities. CONCLUSION: This study showed that occupational status, consumption of solid oil, and using wood or animal dung as source of fuel, early menarche, menopausal status and previous benign breast surgery were associated with breast cancer. On the other hand, physical activity was protective factor. Therefore, there is a need to design appropriate intervention to educate women about life style change or behaviour modification to decrease their breast cancer risk.