The safety of a dolutegravir (DTG)-based antiretroviral treatment (ART) regimen for pregnancy and birth outcomes in Ethiopia: evidence from multicenter cohort study.

BACKGROUND: A dolutegravir (DTG)-based antiretroviral regimen has been rolled out for pregnant women in low- and middle-income countries since 2020. However, available safety data are limited to a few clinical trials and observational studies. Hence, we present real-world pregnancy and birth outcome safety data from a large sample multicenter cohort study in Ethiopia. METHODS: A retrospective cohort study was conducted in fourteen hospitals across Ethiopia from 2017 to 2022. HIV-infected pregnant women were followed from the date of prevention of mother-to-child transmission (PMTCT) care enrolment until the infant was 6-8 weeks old. The primary safety outcome was a composite of adverse pregnancy events comprising spontaneous abortion, intrauterine fetal death (IUFD) before onset of labor, preterm birth, and maternal death. Additionally, a composite adverse birth outcome was assessed, comprising intrapartum fetal demise, low birth weight, and neonatal death. Finally, a composite of adverse pregnancy or birth outcome was also investigated. The exposure of interest was the antiretroviral treatment (ART) regimen used during pregnancy for PMTCT of HIV. RESULTS: During the study period, 2643 women were enrolled in routine PMTCT care. However, 2490 (92.2%) participants were eligible for the study. A total of 136/1724 (7.9%, 95% CI: 6.7-9.3%) women experienced adverse pregnancy outcomes. Fewer women in the DTG-based group (5.4%, 95% CI: 3.7-7.5%) had adverse pregnancy outcomes than in the Efavirenz (EFV)-based group (8.3%, 95% CI: 6.6-10.3%), P = 0.004. After controlling for baseline differences, the DTG group had a 43% lower risk of adverse pregnancy outcomes (adjusted odd ratio (AOR), 0.57; 95% CI, 0.32-0.96%) and a 53% lower risk of preterm birth (AOR, 0.47; 95% CI, 0.22-0.98%) compared to the EFV group. A total of 103/1616 (6.4%, 95% CI: 5.2-7.7%) women had adverse birth outcomes. Although the difference was not statistically significant, fewer women in the DTG group (30/548; 5.5%, 95% CI: 3.7-7.7%) than in the EFV group (57/830; 6.9%, 95% CI: 5.2-8.8%) had adverse birth outcomes. CONCLUSIONS: In this study, we observed that DTG-based regimens were associated with better pregnancy and birth outcome safety profiles, reaffirming the WHO recommendation. However, a prospective study is recommended to assess uncaptured maternal and perinatal adverse outcomes, such as congenital abnormalities, and infant growth and neurocognitive development.

Determinants of underweight, stunting and wasting among schoolchildren.

BACKGROUND: The cause of under-nutrition in schoolchildren is complex and varying from region to region. However, identifying the cause is the basic step for nutritional intervention programs. METHODS: School based cross-sectional survey was conducted among 450 schoolchildren aged 7-14 years, using multi-stage sampling techniques in Dale Woreda, southern Ethiopia. A structured questionnaire and 24-hour recall methods were administered to determine the sociodemographic and dietary intake of participants. Stool microscopic examination was done. Weight and height were measured using a standard calibrated scale. Odds ratio generated from logistic regression was used to determine the strength of variables association. RESULTS: Older age group (10-14 vs. 7-9) (AOR = 3.4; 95% CI, 1.7-6.6) and having Trichuris Trichura infection (AOR = 3.9; 95% CI, 1.4 -11.6) increased the risk of being stunted. Children whose mothers have completed primary education are less likely to be stunted than children whose mothers do not have formal education (AOR = 0.3; 95% CI, 0.2-0.8). Having large family size (AOR = 3.3; 95% CI, 1.4-7.9) and inadequate intake of carbohydrate (AOR = 3.1; 95% CI, 1.4-6.8) were independent predictors of wasting. Children whose mothers completed primary education are less likely to be underweight (AOR = 0.3; 95% CI, 0.1-0.9). Children live in food insecure households are more likely to be stunted, under-weight and wasted than children live in food secure households (AOR = 2.5; 95%, 1-5.6; AOR = 3.9; 95% CI, 1.2-12.0; AOR = 4.8; 95% CI, 1.7-13.6;). CONCLUSION: Household food insecurity, low maternal education and infection with Trichuris trichura were some of the major factors contributing to under-nutrition in the study area.

Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia.

AIM: Magnesium sulfate is an evidence-based anticonvulsant drug used to prevent and control eclampsia. Controversy persists on routine administration of magnesium sulfate in cases of pre-eclampsia without severe features. Our objective was to assess the pattern of blood pressure and maternal symptoms preceding eclamptic seizure based on the current published work. MATERIAL AND METHODS: A comprehensive computer-based publication search was conducted in the African Journals Online, Google scholar, HINARI, PubMed, and MEDLINE databases and the Cochrane library to identify descriptive study reports for blood pressure, severity symptoms or stage of pregnancy during convulsion in women with eclampsia. RESULTS: A total of 59 publications were eligible for this review. Overall, 21,149 eclamptic women from 26 countries were included for the interest of one or more of the selected variables. Out of 18,488 eclamptic women, the proportion of antepartum, intrapartum and post-partum eclampsia was 59%, 20% and 21%, respectively. Out of 3443 eclamptic women, 25% were normotensive; 20% had mild-to-moderate hypertension; 32% had severe hypertension; and 21% were hypertensive but unclassified. Out of 2163 eclamptic women, 66% and 27% had a headache and visual disturbance, respectively, preceding the occurrence of convulsion. Out of 2053 eclamptic women, 25% had epigastric area pain, and out of 1092 women with eclampsia, 25% were asymptomatic. CONCLUSION: Although eclampsia is known to result from severe pre-eclampsia with or without organ function derangement, this review has revealed that a significant number of eclamptic women had either normal blood pressure or mild-to-moderate hypertension immediately before seizure. The findings are apparently in support of initiating magnesium sulfate prophylaxis to all women with mild pre-eclampsia.

Predictors of labor abnormalities in university hospital: unmatched case control study.

BACKGROUND: Abnormal labor is one of the common emergency obstetric problems contributing for more than two-thirds of the unplanned cesarean section. In Ethiopia, although labor abnormality and its complications like obstetric fistula are highly prevalent, there is no published study that determines the predictors of labor abnormalities. METHODS: The study design was an unmatched case control which included 844 women (408 cases and 436 controls). Cases were identified when a woman was diagnosed to have one of the labor abnormalities at term (prolonged latent stage, active phase disorder, prolonged second stage, descent disorder and obstructed labor). Subgroup logistic regression analyses were done taking the different type of labor abnormalities as the dependent variable. RESULTS: Nearly half of the cases (48.6%) were found to have the active phase disorder. Obstructed labor alone accounted for about 16.8% of the cases. The mean gestational age of cases and controls was almost comparable. More than a quarter of cases and controls came to the hospital in the second stage of labor. More than two-thirds of the cases (67.4%) gave birth by cesarean section. The logistic regression analysis demonstrated an independent association of overall labor abnormality with pelvic inadequacy. The subgroup analysis, however, revealed that several obstetric factors were associated with one or more types of labor abnormalities. CONCLUSION: Active phase disorders were the commonest type of labor abnormalities. Cases were late in reporting to the hospital. Malposition, inadequate pelvis and inadequate uterine contraction were some of the predictors of specific types of labor abnormalities.

Absenteeism among medical and health science undergraduate students at Hawassa University, Ethiopia.

BACKGROUND: Student absenteeism is a major concern for university education worldwide. This study was conducted to determine the prevalence and causes of absenteeism among undergraduate medical and health sciences students at Hawassa University. METHODS: We conducted a cross-sectional study using a pretested self-administered structured questionnaire from May-June 2013. The primary outcome indicator was self-reported absenteeism from lectures in the semester preceding the study period. The study included all regular undergraduate students who were enrolled in the University for at least one semester. The data was entered and analyzed using SPSS version 20. The association between class absenteeism and socio-demographic and behavioral correlates of absenteeism was determined by bivariate and multivariate analyses. Results were reported as crude odds ratios (COR), adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: 1200 students consented and filled the questionnaire. Of these students, 43.7% had missed three or more lectures and 14.1% (95% CI = 12.2-16.2) missed more than 8 lectures in the preceding semester. There was a significant association between missing more than 8 lectures and age of students, chosen discipline (medicine), and social drug use. The main reasons reported for missing lectures were preparing for another examination, lack of interest, lecturer's teaching style, and availability of lecture material. CONCLUSION: At Hawassa University College of Medicine and Health Science student habits and teacher performance play a role in absenteeism from lectures. A university culture that promotes discipline and integrity especially among medical and older students discourages social drug use will likely improve motivation and attendance. Training in teaching methodologies to improve the quality and delivery of lectures should also help increase attendance.

Thirty Years of United Nations Inter-Agency Working Group's Global, Regional, and National Maternal Mortality Estimates Revisited.

Over the last three decades, the United Nations interagency working group series of model-based maternal mortality estimation showed a significant reduction in maternal mortality ratio (MMR) at global, regional, and national levels. However, the contribution of sub-Saharan Africa for the global maternal deaths in 2020 was nearly two-fold higher than before, and the top five countries with high burden of maternal deaths remained unchanged after four decades. In this commentary, we argue that not all countries with high maternal deaths had high MMR; the lower MMR was noted as shadowing the large number of maternal deaths in countries with high rates of total births. We critically appraised the changes and challenges in maternal mortality measurements. We recommend the use of multiple indicators and categorizing the absolute number of maternal deaths to assess individual countries' maternal health status. As the majority of maternal deaths are preventable and all maternal deaths are catastrophic to the family, estimating the absolute number of maternal deaths should be given equal weight in future research undertakings.

Meta-analysis on risky sexual behaviour of men: consistent findings from different parts of the world.

The aim of this analysis was to determine the consistency of higher-risk sex practice among educated and/or wealthy men in different parts of the world. Meta-analysis was done on risky sexual behaviour of men using the recent Demographic and Health Surveys (DHS 2003-2009) data from 26 countries in and outside Africa. DHS data were accessed through electronic databases. In this analysis, since there was significant heterogeneity (I(2)>50%) among surveys findings, random effects analytic model was applied. Mantel-Haenszel statistical method was used to calculate the pooled odds ratios across countries. Out of 79,736 men aged 15-49 years who had sexual intercourse in 12 months preceding the respective survey, 35.7% reported to have higher-risk sex. The proportion of higher-risk sex was found positively correlated with increased wealth index. In 24 countries, higher-risk sex was found to have highly statistically significant association with men living in urban areas, educated to secondary and above, and owned middle to highest wealth index. The overall condom use during the last higher-risk sexual encounter was 47% but condom use was better practiced by educated men. Nearly in two-thirds of countries reported HIV-prevalence, the proportion of HIV infection was highest among better educated. In conclusion, this meta-analysis has shown that risk taking sexual behaviour is invariably associated with high educational attainment, urban residence and better wealth index regardless of geographic location of men participated in the surveys.

Efficacy of alogliptin in type 2 diabetes treatment: a meta-analysis of randomized double-blind controlled studies.

BACKGROUND: Alogliptin is a new dipeptidyl peptidase (DPP-4) inhibitor, which is under investigation for treatment of type 2 diabetes either alone or in combination with other antidiabetic drugs. The aim of this meta-analysis was to assess the efficacy and tolerability of alogliptin in patients with type 2 diabetes. METHODS: Computer based search was performed in MEDLINE, Cochrane library, and HINARI (Health InterNetwork Access to Research Initiative) databases. Meta-analysis was carried out by incorporating double-blind randomized controlled studies done on the efficacy of alogliptin in patients with type 2 diabetes. The efficacy and tolerability of alogliptin was determined by standardized mean differences (SMDs) and Mantel-Haenszel odds ratio. Heterogeneity was assessed by the chi-squared test (Cochran Q test) and I2 statistics. RESULTS: The pooled SMDs demonstrated a significant reduction in HbA1c in patients treated with alogliptin 12.5 mg (SMD = -0.81; 95% CI, -1.11 to -0.51) or alogliptin 25 mg (SMD= -0.98; 95%CI= -1.30 to -0.66) as compared with controls. The SMD for reduction in fasting plasma glucose level (FPG) from baseline was also statistically significant among alogliptin treated patients. However, the effect of alogliptin on body weight change was inconclusive. The proportion of patients who discontinued alogliptin due to adverse events was not different from controls. Similarly, the meta-analyses of specific adverse events did not demonstrate statistically significant differences. CONCLUSIONS: Alogliptin alone or in combination with other antidiabetic drug has shown a significant reduction in HbA1c and FPG level in patients with type 2 diabetes. However, its consistent efficacy for longer duration of therapy needs further investigation.

Meta-analyses of fertility desires of people living with HIV.

BACKGROUND: Literature review has shown that some years back the fertility desires of people living with HIV was low but in the recent years, it was reported as increasing. However, little is known about the strength of association of fertility desire of HIV positive people with antiretroviral therapy (ART) experience, age, sex, education level, and number of children. METHODS: In these meta-analyses, twenty studies from different parts of the world were included. The odds ratios of fertility desires were determined using the random-effects model. Heterogeneity among the studies was assessed by computing values for Tau(2), Chi-square (Q), I(2) and P-value. Sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias, respectively. RESULTS: The pooled analysis demonstrated that fertility desires of study participants had no association with ART. Similarly, the overall odds ratio did not show statistically significant association of fertility desires with sex and educational attainment of study participants although forest plots of some studies fall on increased and some others on decreased sides of fertility desires. The two variables that demonstrated a strong association with fertility desires were age less than 30 years and being childless. The lowest heterogeneity was found in a meta-analysis comparing ART experienced and ART naïve HIV positive people. In all meta-analyses, the sensitivity analyses showed the stability of the pooled odds ratios; and the funnel plots did not show publication or disclosure bias. CONCLUSION: Although the fertility desires among childless and younger age group was very strong, we realized that quite a significant segment of HIV-infected people have desire for fertility. Therefore, including fertility issue as integral part of HIV patient care may help several of them in their reproductive decision making (letting them know the risks and methods of prevention while anticipating pregnancy).

Polysubstance use and its linkage with risky sexual behavior in university students: significance for policy makers and parents.

BACKGROUND: Despite the high prevalence of polysubstance use in low income countries, little has been done to investigate the linkage between polysubstance use and risky sexual behaviors. OBJECTIVE: To assess the association of polysubstance use with risky sexual behaviors, economic, educational and geographic factors. METHODS: A cross-sectional study on aspects of risky behavior towards HIV-infection was conducted on a sample of 1220 university students. Logistic regression analysis was applied to examine the linkage between polysubstance use and risky sexual behavior--having sex with multiple partners, commercial sex workers and failure to use condom. RESULTS: About one fourth of study participants reported to use one or more types of substance (mainly cigarette, alcohol and khat) in one year period. Of these students, more than three-fifths started using the substance before joining university and more than two-fifths were polysubstance users. Students from urban areas were more likely to be polysubstance users and to engage in sexual practice. Logistic regression analysis demonstrated a strong association of polysubstance use with male gender, being born and growing up in urban areas, good income, taught in private school, academically senior and born to more educated parents (P < 0.05 each). The majority (42%) of polysubstance users was also practicing sex with multiple partners and commercial sex workers, had sex without condoms and developed active sexually transmitted infection (STI) symptoms (P < 0.0001 for each). CONCLUSION: This analysis unveils the strong association of polysubstance use with better socioeconomic circumstances, better education and risky sexual behaviors. Primary prevention strategies should target students in elementary and secondary schools, mainly in the urban setting, and preferably by involving their parents.

Antenatal care coverage in a low-resource setting: Estimations from the Birhan Cohort.

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. The study population were women enrolled and followed during pregnancy between December 2018 and April 2020. ANC visits were measured by prospective facility chart abstraction and self-report at enrollment. The primary study outcomes were the total number of ANC visits attended during pregnancy and the coverage of at least one, four, or eight ANC visits. Additionally, we estimated ANC retention patterns. We included 2069 women, of which 150 (7.2%) women enrolled <13 weeks of gestation with complete prospective facility reporting. Among these 150 women, ANC coverage of at least one visit was 97.3%, whereas coverage of four visits or more was 34.0%. Among all women, coverage of one ANC visit was 92.3%, while coverage of four or more visits was 28.8%. No women were found to have attended eight or more ANC visits. On retention in care, 70.3% of participants who had an ANC visit between weeks 28 and <36 of gestation did not return for a subsequent visit. Despite the high proportion of pregnant women who accessed ANC at least once in our study area, the coverage of four visits remains low. Further efforts are needed to enhance access to more ANC visits, retain women in care, and adhere to the most recent Ethiopian National ANC guideline of at least eight ANC visits. It is essential to identify the factors that lead a large proportion of women to discontinue ANC follow-up.

The Protracted Civil and Armed Conflicts in Ethiopia Fueling the COVID-19-Related Health Crisis: Perspective on Building a Resilient Health System to Shocks.

Prior to the intensified civil and armed conflicts in Ethiopia, remarkable progress was made in the health sector, which has persuaded the Ministry of Health to give special focus on building a responsive and resilient health system in the second five-year health sector transformation plan (HSTP II 2021-2025). However, the years-long civil and armed conflicts have been fueling the COVID-19 crisis and have caused multi-sectoral infrastructure damage, human life loss, and economic crisis. In 2021 alone, the conflict causes more than five million internal displacements of persons (IDP) and thousands civilian deaths. Review of reported government data has shown that 3,508 health posts, 750 health centers, and 76 hospitals were partially or completely damaged in four regions. Looting of medical equipment and facilities for amenities was devastating. More than 19 million people were affected by the armed and civil conflicts between 2020 and 2021. Unless peace is ensured across the nation the sooner possible, it is foreseen that the devastation may further worsen, and recovery may be a far-fetched possibility. Therefore, in addition to restoration of the disrupted health services, it is the right time for the Ministry of Health to incorporate the humanitarian-development nexus as a joint strategy with the Disaster Prevention and Preparedness Commission (DPPC) to ensure a resilient health system for similar multifaceted conflict-related health crisis, disasters, and infectious outbreaks.

Is the Sexual Behaviour of HIV Patients on Antiretroviral therapy safe or risky in Sub-Saharan Africa? Meta-Analysis and Meta-Regression.

BACKGROUND: Reports on the sexual behavior of people on antiretroviral therapy (ART) are inconsistent. We selected 14 articles that compared the sexual behavior of people with and without ART for this analysis. METHODS: We included both cross-sectional studies that compared different ART-naïve and ART-experienced participants and longitudinal studies examining the behavior of the same individuals pre- and post-ART start. Meta-analyses were performed both stratified by type of study and combined. Outcome variables assessed for association with ART experience were any sexual activity, unprotected sex and having multiple sexual partners. Random-effect models were applied to determine the overall odds ratios. Sub-group analyses and meta-regression analyses were performed to examine sources of heterogeneity among the studies. Sensitivity analysis was also conducted to evaluate the stability of the overall odds ratio in the presence of outliers. RESULTS: The meta-analysis failed to show a statistically significant association of any sexual activity with ART experience. It did, however, show an overall statistically significant reduction of any unprotected sex, having multiple sexual partners and unprotected sex with HIV negative or unknown HIV status with ART experience. Meta-regression showed no interaction between duration of ART use or recall period of sexual behavior with the sexual activity variables. However, there was an association between the percentage of married or cohabiting participants included in a study and reductions in the practice of unprotected sex with ART. CONCLUSION: In general, this meta-analysis demonstrated a significant reduction in risky sexual behavior among people on ART in sub-Saharan Africa. Future studies should investigate the reproducibility and continuity of the observed positive behavioural changes as the duration of ART lasts a decade or more.

Changes in nutritional, functional and immunological status of HIV-infected adults with antiretroviral therapy.

BACKGROUND: Literature has shown that there is vicious cycle between malnutrition and HIV infection. In Ethiopia, antiretroviral therapy (ART) was started about eight years back but, to the best of authors' knowledge, there was no published study that assessed treatment outcome indicators. OBJECTIVE: To assess the outcomes of ART from the perspective of nutritional, clinical, functional and immunological status. METHODS: A retrospective recored review was used to assess the nutritional status of adults before and after ART in Hawassa University referral hospital. This analysis included 358 living HIV positive adults who were on ART for 3 - 96 months. RESULTS: The mean age of the study participants was 33.75 +/- 9.12 years and the median duration of ART was 24 months (Inter-quartile range: 12, 36). After ART, cases with body mass index (BMI) < 18.5 kg/m2 dropped from 38% to about 20% and cases with CD4 count < 200/mm3 dropped from about 73% to about 9% (P < 0.0001 for each). However, there were 58 and 14 cases whose BMI and CD4 count were even below the Pre-ART levels, respectively. The regression line demonstrating an overall change in CD4 count showed a positive linear trend as the duration of ART increases but the change in BMI was a downward linear trend. In multiple linear regression, current nutritional status was found to have significant association with baseline low CD4 count, clinical stage III/ IV, low BMI and low meal frequency. Multiple logistic regression also demonstrated a significant association of low BMI after ART with low CD4 count before ART. With ART, decreased frequency of illness, baseline WHO clinical stage I/II and high BMI were independent predictors of improvement in functional status. CONCLUSION: Patients started on ART with low BMI, severely immunosuppressed and clinical stage III/IV illnesses were found to have poorer nutritional, functional and immunological response. This study provided another evidence to support the WHO recommendation on initiating ART before patients' nutritional, clinical and immunological statuses deteriorate. The nutritional care needs to be given more emphasis since the ART response was found to be unsatisfactory.

Tella intake among pregnant and lactating mothers: may it affect child growth?

Alcohol abuse among women is a public health importance that may impair prenatal and postnatal growth. Tella is among the most common homemade alcoholic beverages in rural Ethiopia, but little is known about the magnitude of tella intake during pregnancy and lactation or its effects on child growth. The present study investigated associations between maternal tella intake and the growth of their children. A cross-sectional mixed-methods study was conducted with mothers (n 228) and their 12-36-month-old children and with key informants (n 12). Tella intake during most recent pregnancy and lactation was estimated retrospectively by glasses per drinking event and frequency of events. Nearly 80 % of mothers had consumed some amount of tella during their most recent pregnancy and lactation. Furthermore, 72 % of children had tasted or drunk tella at some time during their life. Stunting was 42 % and was significantly associated with maternal tella consumption at least every other day during pregnancy (adjusted odds ratio (AOR) 4⋅97, 95 % confidence interval (CI) 2⋅20, 11⋅25), male sex (AOR 2⋅31, 95 % CI 1⋅27, 4⋅19), two or more under-5-year-old children in the household (AOR 3⋅52, 95 % CI 1⋅49, 8⋅33) and family size >5 (AOR 1⋅84, 95 % CI 1⋅01, 3⋅36). Underweight was 24⋅6 % and was associated with the child drinking tella with their mother (AOR 4⋅23, 95 % CI 1⋅99, 8⋅97), being male (AOR 3⋅73, 95 % CI 1⋅73, 7⋅94), having ≥3 diarrhoeal episodes in the last 3 months (AOR 11⋅83, 95 % CI 4⋅22, 33⋅14) and being in the older age group (AOR 2⋅98, 95 % CI 1⋅09, 8⋅13). The associations between tella intake and child growth suggest the need to mitigate the effects of tella on child anthropometry.

Universal Health Coverage Policy and Progress towards the Attainment of Universal Sexual and Reproductive Health and Rights Services in Ethiopia.

Critical interpretive analysis of literature review was applied to shed light on the status of universal access to Sexual and Reproductive Health and Rights (SRHR) and the progress towards Universal Health Coverage (UHC) in Ethiopia. Special emphasis was given to the determinations of the Ethiopian health policy frameworks to include comprehensive SRHR services in the UHC benefit package. Clinical services for pregnant women and newborn, abortion care, family planning, Female Genital Mutilation (FGM) complication treatment, Comprehensive Sexuality Education (CSE), and sexual health services are included in the national cost exempted services, but the latter three are not yet included in the health programs with defined objective and work plan. Capital intensive Sexual and Reproductive Health (SRH) services (such as infertility and reproductive cancers diagnosis and treatment) are not included in the UHC benefit package. Over the last two decades, a substantive progress is made in family planning service and maternal and child health, probably because they were taken as Millennium Development Goals (MDGs) indicators and have got better financial protection and political commitment. In order to include other SRHR services in the benefit package in due course and attain universal SRHR services without financial hardship in the Primary Health Care (PHC) setting, the domestic financing should be endorsed as a driving force. To make the multi-sectoral efforts towards achieving UHC and sustainable development goals (SDGs) complete, building resilient health systems through the humanitarian-development nexus for health systems strengthening in fragile setting should be equally prioritized, thereby leaving no one behind underserved.

Age and CD4 count of vertically HIV-infected children at the time of diagnosis: what are independent predictors for being symptomatic and CD4 counts drop?

A review of the literature has revealed that data on HIV-infected clinical presentations, age at the time of diagnosis and level of immunosuppression in resource-poor settings are very limited. A multicenter retrospective and cross-sectional method was used to analyze 1163 children <15 years of age. More than half of the children were >5 years of age (mean ± SD age 4.9 ± 3.2). About 54% of children were symptomatic. Tuberculosis and chronic dermatologic disorders were the commonest co-infections. The severity of immunosuppression was highest in preschool children (46.6%) and early adolescents (41.3%). After adjustment for sex, age, pattern of feeding and hemoglobin level, multinomial logistic regression showed that CD4 count 200-499, 500-999 and Tigray ethnicity were independently associated with being symptomatic. More than one-third of the children were in a state of severe immunosuppression and more than half were immunologically eligible for antiretroviral treatment.

Evaluation of adherence to national guideline for clinical follow up of HIV infected children using the proxy hematological, biochemical and anthropometric indicators of care.

BACKGROUND: In HIV-infected children, assessment of liver and renal functions, growth pattern, hematologic and immunologic profiles is highly recommended. However, no study has evaluated the regularity of these kinds of assessment in hospital population. OBJECTIVE: The objective of this study was to evaluate the regularity of selected haematological, biochemical and anthropometric monitoring METHODS: A Multi-Centre Retrospective Cohort Study was done to analyze 1163 HIV-infected children who had follow up in seven public hospitals in Ethiopia. The frequency of the following measures was used as a proxy indicator of the quality of assessment: weight & height measurement, absolute CD4 count, haemoglobin level and Serum glutamic oxaloacetic transaminase (SGOT). Paired sample t-test was done to evaluate the change in weight, haemoglobin and SGOT levels. RESULTS: Initially, for all children CD4 and haemoglobin levels were assessed. At 6 and 24 months after start of ART the proportion of children with a CD4 assessment was 68% and 37% respectively; 55% and 28% for haemoglobin; 62.7% and 6.4% for weight; and, 47% and 23% for SGOT. Mean weight for children age ten years and above, and mean height for children age two years and above was below the 5th percentile. Initially and at 24 months, the prevalence of all types of anemia was about 50% and 7%, respectively. There were no children with severe hepatotoxicity. CONCLUSION: The proportion of children being assessed for CD4, haemoglobin, SGOT and weight measures were initially two-third and markedly declined as the cohort progressed. The prevalence of anemia after two years follow up reduced by about 8-fold, growth appears to be poor in older children while hepatotoxicity is observed to be a rare phenomenon.

Change in absolute CD4 count with antiretroviral treatment in resource limited setting: a retrospective cohort study in children in Ethiopia.

BACKGROUND: Although antiretroviral treatment (ART) programmes began in 2003 in Ethiopia, there is scarcity of information about paediatric ART. OBJECTIVE: The purpose of this study was to describe the changes in absolute CD4 counts among children on ART METHODS: A multicenter retrospective cohort assessment was applied to analyze 336 HIV-infected children who were under 15 years old and on ART (September 2006 - March 2009) using a sample database from seven public hospitals in different regions. RESULTS: The mean age at the time of ART commencement of the cohort were 5.9 +/- 3.2 years. Median follow-up of the cohort was 12 (Inter quartile range 6 to 18) months. The overall absolute CD4 count change showed an increasing trend from the baseline in all age categories. At age 5 years and above, the baseline CD4 count was very low but the increment was very high up to 12 months. The mean absolute CD4 count change in relation to the duration of ART showed an increasing trend up to 12 months and declined after 18 and 24 months. Severe immunosuppression (SI) at initiation of ART (P < 0.0001; Adjusted OR, 5.3) and age 3-4.9 years were independent predictors of continuing SI up to 6 months. Only SI at 6 months was independently associated with SI at 12 months (P < 0.0001; AOR, 21.4). CONCLUSION: The majority of children have CD4 count rise after ART and that the slope of rise was greater in older children in the first 12 months of therapy.

COVID-19 Preventive Practices among Bus Station Workers in Ethiopia.

As of May 19, 2021, Ethiopia was among the five African countries most affected by COVID-19. A cross-sectional design was used to assess the level of knowledge, perceptions, and practices of bus station workers about COVID-19 between August 25 and September 17, 2020. Face-to-face interviewer-administered questionnaires were used. To identify the factors associated with the dependent variables, simple and multiple binary logistic regression analyses were used. A P value < 0.05 was considered significant. Data were analyzed using SPSS version 20 software. In this study, 427 workers from three bus stations participated. Approximately 84.5%, 84.8%, and 81.3% of the workers had good knowledge, positive perceptions, and good practices, respectively. Multivariable logistic regression analysis showed that workers with a monthly income of 3,001 to 4,000 birr were about four times more likely to have poor knowledge compared with higher income workers. Those workers with poor knowledge were 2.4 times, and security workers were 3.7 times, more likely to have poor practices compared with workers with good knowledge and drivers, respectively. In conclusion, workers used in security and those who had poor knowledge regarding COVID-19 failed to exhibit effective preventative practices against the virus.