Vaccination Coverage and Predictors of Vaccination among Children Aged 12-23 Months in the Pastoralist Communities of Ethiopia: A Mixed Methods Design.

This study assessed vaccination coverage and its associated factors among children aged 12-23 months in pastoralist Ethiopia. It was conducted in three woredas of the Afar region using a community-based cross-sectional mixed methods design with quantitative and qualitative methods. A total of 413 mothers with children aged 12-23 months participated in the quantitative study via a simple random sampling technique. Logistic regression was used to identify factors associated with vaccination, and thematic analysis techniques were used for qualitative data. The percentage of patients who received full vaccination was 25%. Based on vaccination card observations, the dropout rate from Pentavalent-1 to Pentavalent-3 was found to be 2.9%. Logistic regression analysis revealed significant associations between mothers and caretakers with formal education, those who owned mobile phones, had antenatal care (ANC) visits, and birthed at a health facility with full vaccination. The overall proportion of full immunization is lower than the target set by the World Health Organization (WHO). The findings suggest that programs and policy makers should prioritize improving the access and enrolment of women and caretakers, promoting mobile phone ownership, and encouraging ANC visits and the promotion of health facility deliveries, as these are associated with higher rates of immunization.

Exploring the Influence of Sociocultural Factors on the Non-Utilization of Family Planning amongst Women in Ethiopia's Pastoralist Regions.

This study aimed to explore the sociocultural determinants of family planning (FP) utilization among women in pastoralist areas of Ethiopia. A community-based cross-sectional survey was conducted involving 682 reproductive-aged women selected from three regions in pastoralist districts. Hierarchical logistic regression was used to identify factors associated with women who did not use FP. This study revealed that 47% of women did not use FP. Women who did not use FP were more likely to have shorter spacing between births, lack their partner's support, not be involved in decisions regarding large household purchases, and have low household expenditures. Overall, the prevalence of not using FP is significantly high in pastoralist communities in Ethiopia. The authors recommend that investment in women's health and FP be targeted at educational campaigns to raise awareness about FP and its importance. Engaging men and community leaders, promoting their support for FP and contraceptive use, and providing financial assistance to address financial barriers, such as transportation costs and healthcare fees, are important aspects that can increase the utilization of FP methods.

Assessment of Trend, Indication, Complications, and Outcomes of Pacemaker Implantation in Adult Patients at Tertiary Hospital of Ethiopia: Retrospective Follow Up Study.

Background: A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia. Methods: The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications. Results: The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications. Conclusion: Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow.

Response of stream water quality to the vegetation patterns on arid slope: a case study of Huangshui River basin.

Vegetation patterns on slopes strongly affect the water cycle processes in a basin, especially the water yield and confluence in arid areas. Quantifying and evaluating the effects of hydrological change on the migration and transformation of pollutants are challenging. Based on 4-year stream water quality data of 13 monitoring sites in the Huangshui River basin, a typical arid watershed of the Chinese Loess Plateau, the redundancy analysis (RDA) and structural equation modeling (SEM) analysis tools were used to quantify its relationship with vegetation patterns. In the study, land use and the enhanced vegetation index (EVI) were used as a metric of vegetation patterns; accordingly, the 13 catchments were divided into three groups via the cluster analysis, including large (over 80%), medium (70 ~ 80%), and small (below 70%) proportion vegetation patterns (LVP, MVP, SVP). The results of the LVP group showed that vegetation patterns negatively affected the contamination of total phosphorus (TP), ammonia nitrogen (NH3-N), permanganate index (CODMn), and biochemical oxygen demand (BOD5) in the stream water, and the contribution rates were - 0.57. While the proportion of urban area positively correlated with stream water quality in the groups of MVP and SVP, the contribution rates were 0.46 and 0.36, respectively. Moreover, the precipitation in the groups of MVP and SVP negatively correlated with pollutants (- 0.24 and - 0.26). Those results revealed the response of stream water quality to vegetation patterns on the slope with the consideration of precipitation, land use, and socio-economic factors for the regional water and land resource allocation. This study has important management implications for vegetation patterns on slope of fragile ecosystems in arid areas.

The importance of concomitant mitral regurgitation for estimates of mitral valve area by pressure half time in patients with chronic rheumatic heart disease.

AIMS: Aim was to study how concomitant mitral regurgitation (MR) assessed by qualitative and quantitative methods influence mitral valve area (MVA) calculations by the pressure half time method (MVAPHT) compared to reference MVA (planimetry) in patients with rheumatic heart disease. METHODS AND RESULTS: In 72 patients with chronic rheumatic heart disease, MVAPHT was calculated as 220 divided by the pressure half time of the mitral early inflow Doppler spectrum. Direct measurement by planimetry was used as reference MVA and was mean (SD) 0.99 (0.69-1.99) cm2. Concomitant MR was present in 82%. MR severity was assessed qualitatively in all, semi-quantitatively by measuring the vena contracta width in 58 (81%), and quantitatively by calculation of the regurgitant volume in 28 (39%). MVA was significantly underestimated by MVAPHT, with increasing MR. In regression analyses MVAPHT underestimated MVA by 0.19 cm2 per higher grade of MR severity in qualitative assessment, and by 0.12-0.13 cm2 per mm larger vena contracta width and 10 ml larger regurgitant volume, respectively. The presented associations were more evident when i) MR severity was quantified compared to qualitative assessment and ii) reference measurements were made by three-dimensional transoesophageal recordings compared to transthoracic recordings. CONCLUSION: MVAPHT underestimated mitral valve area compared to planimetry in patients with MS and concomitant MR. This study highlights the importance of taking the MR severity into account when evaluating MVA based on the PHT method. Direct measurements should be included in clinical decision making.

Effectiveness of curriculum-based sexual and reproductive health education on healthy sexual behaviors among year one students at Arba Minch University: A quasi-experimental study.

INTRODUCTION: Curriculum-based sexual and reproductive health education (CBSRHE) is one of the preventive strategies targeting youth in higher institutions to protect them from sexual and reproductive health problems, despite never assessing the effect in Ethiopia. Therefore, this study aimed to assess the effect of CBSRHE on knowledge and attitude about SRH services to have safer sexual behaviors among first-year students of Arba Minch University. METHOD: We conducted a quasi-experimental study among purposively selected campuses. The campuses were allocated to (i) an intervention arm consisting of curriculum-based sexual and reproductive health, or (ii) a control arm for those who were free from intervention. Data was collected, at baseline and immediately after the intervention ended by using a structured self-administered questionnaire. To compare differences in the change from baseline to post-intervention between the two arms we use the chi-square test and independent-samples t-test. To see the effect of the CBSRHE by controlling the effect confounding inverse probability-weighted analysis was conducted. RESULT: A total of 832 and 820 students participated in a baseline and post-test respectively. The proportion of youth who practice receptive penetrative sex decreases from 40.9% to 28.3% in the intervention arm compared to 37.6% to 37.3% in the non-intervention arm between baseline and end line, with statistically significant differences between groups. However, there are statistically significant differences between the intervention and control groups in terms of changes in contraception utilization (X2 = 1.21; P>0.05). Furthermore, there were significant improvements in knowledge and attitude among the intervention arm a comprehensive knowledge of HIV/AIDS (ATE = 0.22,95% CI, 0.14 to 0.29; p < 0.01), an average change of attitude toward HIV/AIDS(ATE = 1.32, 95% CI, 1.18 to 1.47; p < 0.01), comprehensive condom knowledge score (ATE = 0.23, 95% CI, 0.13 to 0.33; p < 0.01) and the average change of attitude toward condom score (ATE = 1.83, 95% CI, 1.19 to 2.77; p < 0.01). CONCLUSION AND RECOMMENDATION: It was found that there was a significant difference in knowledge and attitude toward a disk sexual behaviors among r one student. This implies that the educational authority o the country can gain through the adoption of courses to all universities across the country, besides doing further comparative studies to determine the long-term effect of the course supported with models and/or theories like the theory of change.

Porous fiber materials can alleviate the risk of farmland drought and flooding disasters and prompt crop growth.

Floods and droughts on farmland seriously damage agricultural production. Porous fiber materials (PFM) made from mineral rocks have high porosity, permeability, and water retention and are utilized widely in green roofs and agricultural production. Therefore, studying the impact of PFM on the improvement of farmland is of great importance for soil and water conservation. We set 64 extreme rainfalls to analyze the impact of PFM on soil water content (SWC), runoff, nutrient loss, microorganism, and plant growth. The results showed that PFM can effectively reduce runoff and improve soil water distribution, and enhance the soil water holding capacity. Furthermore, PFM reduced the loss of nitrogen and phosphorus by 18.3% to 97% in the runoff, and the soil erosion of summer corn was more strongly influenced by lower vegetation cover, compared with winter wheat. Finally, when PFM was buried in the soil, the wheat yield increased by -6.7%-20.4%, but the corn yield in some PFM groups decreased by 5.1% to 42.5% under short-duration irrigation conditions. Our study emphasizes that the effectiveness of PFM depends mainly on the following: First, PFM with high porosity can increase soil water holding capacity and timely replenish the water lost from the surrounding soil. Second, PFM with high permeability can increase infiltration during rainfall and decrease runoff and nutrient loss, reducing the risk of farmland flooding and pollution. Finally, PFM consists of gold ions and alkali metal oxides, which can stabilize agglomerates and improve soil enzyme activity, thereby increasing the relative abundance of some microbial strains and promoting crop growth. However, when the rainfall amount was low or PFM volume was large, PFM could not store water sufficiently during rainfall, which seriously reduced the maximum saturated moisture content and water absorption performance. Meanwhile, the PFM could not release water in time and replenish the soil water deficit, which increased drought risk. In conclusion, the appropriate volume of PFM and irrigation system may enhance soil water storage capacity, minimize agricultural pollution, and promote crop production.

Health professionals' readiness to implement electronic medical record system in Gamo zone public hospitals, southern Ethiopia: an institution based cross-sectional study.

BACKGROUND: The adoption of Electronic Medical Records (EMR) by the healthcare sector can improve patient care and safety, facilitate structured research, and effectively plan, monitor, and assess disease. EMR adoptions in low-income countries like Ethiopia were delayed and failing more frequently, despite their critical necessity. The most popular way to solve the issue is to evaluate user preparedness prior to the adoption of EMR. However, little is known regarding the EMR readiness of healthcare professionals in this study setting. Therefore, the objective of this study was to assess the readiness and factors associated with health professional readiness toward EMR in Gamo Zone, Ethiopia. METHODS: An institution-based cross-sectional survey was conducted by using a pretested self-administered questionnaire on 416 study participants at public hospital hospitals in southern Ethiopia. STAT version 14 software was used to conduct the analysis after the data was entered using Epi-data version 3.2. A binary logistic regression model was fitted to identify factors associated with readiness. Finally, the results were interpreted using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value less than 0.05. RESULTS: A total of 400 participants enrolled in the study, with a response rate of 97.1%. A total of 65.25% (n = 261) [95% CI: 0.60, 0.69] participants had overall readiness, 68.75% (n = 275) [95% CI: 0.64, 0.73] had engagement readiness, and (69.75%) (n = 279) [95% CI: 0.65, 0.74] had core EMR readiness. Computer skills (AOR: 3.06; 95% CI: 1.49-6.29), EMR training (AOR: 2.00; 95% CI: 1.06-3.67), good EMR knowledge (AOR: 2.021; 95% CI: 1.19-3.39), and favorable attitude (AOR: 3.00; 95% CI: 1.76-4.97) were factors significantly associated with EMR readiness. CONCLUSION: Although it was deemed insufficient, more than half of the respondents indicated a satisfactory level of overall readiness for the adoption of EMR. Moreover, having computer skills, having EMR training, good EMR knowledge, and favorable EMR attitude were all significantly and positively related to EMR readiness.

COVID-19 Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional Study.

The current healthcare system's efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Does Voluntary Family Planning Contribute to Food Security? Evidence from Ethiopia.

This study aims to explore the effects of voluntary family planning (FP) utilization on food security in selected districts of Ethiopia. Quantitative research methods were used to conduct a community-based study among a sample of 737 women of reproductive age. The data were analyzed using a hierarchical logistic regression constructed in three models. The findings showed 579 (78.2%) were using FP at the time of the survey. According to the household-level food insecurity access scale, 55.2% of households experienced food insecurity. The likelihood of food security was lower by 64% for women who used FP for less than 21 months (AOR = 0.64: 95%CI: 0.42-0.99) in comparison to mothers who used FP for more than 21 months. Households having positive adaptive behaviors were three times more likely (AOR = 3.60: 95%CI 2.07-6.26) to have food security in comparison to those not having positive adaptive behaviors. This study also revealed that almost half of the mothers (AOR: 0.51: 95%CI: 0.33-0.80) who reported being influenced by other family members to use FP had food security, in comparison to their counterparts. Age, duration of FP use, positive adaptive behaviors, and influence by significant others were found to be independent predictors of food security in the study areas. Culturally sensitive strategies need to be considered to expand awareness and dispel misconceptions that lead to hesitancy around FP utilization. Design strategies should take into account households' resilience in adaptive skills during shocks, natural disasters, or pandemics which will be invaluable for food security.

Blood Pressure Control among Adults with Hypertension at a Tertiary Hospital in Ethiopia.

Background: Uncontrolled hypertension is a leading modifiable risk factor for cardiovascular disease morbidity and mortality. Despite the availability of several effective blood pressure lowering drugs, hypertension control rates remain poor globally. This study aimed to define the level of blood pressure control and to determine the factors associated with poor hypertension control. Methods: A hospital-based cross-sectional study was conducted from January to March 2019 at Tikur Anbessa Specialized Hospital among randomly selected 369 patients with hypertension. Data were collected using a pre-tested structured questionnaire. Multivariate binary logistic regression was used to identify determinants of blood pressure control. Results: The mean (SD) age of the study participants was 55.5 (13.2) years; 188 (50.9%) were males and 28 (7.6%) were active smokers. More than half of the patients (56.0%) were overweight or obese. The most commonly identified comorbidities were diabetes mellitus (48.0%), dyslipidemia (50.9%), and chronic kidney disease (56.1%). The mean (SD) systolic blood pressure was 140.6 (22) mmHg, and diastolic blood pressure was 85.8 (14) mmHg. About two-thirds of the patients (60.2%) had uncontrolled blood pressure. The factors associated with poor blood pressure control with an AOR (95% CI) were increasing age: 1.05 (1.00-1.11), increasing household income: 1.25 (1.04-1.49), being physically inactive: 7.64 (1.14-51.13), chronic kidney disease: 5.36 (1.14-5.16), and use of home blood pressure monitoring: 0.31 (0.102-0.94). Conclusion: The rate of blood pressure control in patients with hypertension was suboptimal. Age, household income, level of physical activity, chronic kidney disease, and use of home blood pressure monitoring were independent predictors of blood pressure control. It is important to optimize the treatment of hypertension in this high-risk group by implementing effective strategies.

Determinants of early initiation of breast feeding among mothers of children aged less than 24 months in Ethiopia: A community-based cross-sectional study.

OBJECTIVE: This study aims to assess the prevalence of early initiation of breast feeding (EIBF) and associated factors among mothers having children less than 2 years of age in Ethiopia. DESIGN: Community-based cross-sectional study. SETTING: In this analysis, data from 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) was used. The survey included all the nine regional states and two city administrations of Ethiopia. PARTICIPANTS: We extracted data of 2054 mothers who had last-born children and those mothers who ever breast fed or still breast feeding their children during the survey from the 2019 EMDHS datasets. MAIN OUTCOME MEASURES: We performed a two-stage multilevel mixed-effects logistic regression to identify individual and community-level determinants of EIBF. In the final model, variables with a p-value less than 5% and an adjusted OR with a 95% CI were reported as statistically significant variables with EIBF. RESULT: The prevalence of EIBF among mothers having children aged 0-23 months was 73.56% (95% CI: 71.65% to 75.47%). Women who delivered at a health facility (adjusted OR (AOR)=1.98; 95% CI: 1.39 to 2.79) and have children with birth order second-fourth (AOR=1.76; 95% CI: 1.24 to 2.49) were more likely to initiate early breast feeding than their counterparts. On the other hand, women who gave birth by caesarean section (AOR=0.21; 95% CI: 0.13 to 0.33), had multiple births (AOR=0.35; 95% CI: 0.13 to 0.92) and had postnatal check-up (AOR=0.62; 95% CI: 0.44 to 0.91) were less likely to practise EIBF as compared with their counterparts. Region of residence of women was also significantly associated with EIBF. CONCLUSION: In this study, the overall prevalence of EIBF was good. Place of delivery, mode of delivery, postnatal check-up, type of birth, birth order and region were factors significantly associated with EIBF. Therefore, government and stakeholders need to show commitment to improve access and utilisation of basic maternal health services to increase the practice of EIBF.

The perceived effects of COVID-19 pandemic on female genital mutilation/cutting and child or forced marriages in Kenya, Uganda, Ethiopia and Senegal.

BACKGROUND: The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child or Forced Marriages (CFM) have not been well documented. We examined respondents' perceptions on how the COVID-19 pandemic has affected FGM/C and CFM in Kenya, Uganda, Senegal, and Ethiopia. METHODS: A cross-sectional study design with a mixed methods approach was used. Data collection on participants' perceptions on the effects of COVID-19 on FGM/C and CFM took place between October-December 2020. Household surveys targeting women and men aged 15-49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight key informant interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). RESULTS: In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CFM cases. In Ethiopia, the COVID-19 pandemic had a limited perceived effect on changes in FGM/C and CFM. In Senegal, there were minimal perceived effects of COVID-19 on the number of FGM/C and CFM cases. The pandemic negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. CONCLUSIONS: The pandemic has had varied perceived effects on FGM/C and CFM across the four countries. Generally, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM amid COVID-19 is urgently required.

Midwives' job satisfaction and intention to leave their current position in developing regions of Ethiopia.

BACKGROUND: The aim of this research was to analyze midwives' job satisfaction and intention to leave in developing regions of Ethiopia. METHODS: A facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions. RESULTS: More than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd±4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with 'work environment' and less than half (45%) were satisfied with 'relationship with management' and 'job requirements'. Relatively better satisfaction rates were reported regarding 'professional status', of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with 'staff interaction'. Almost two-fifths (39%) of midwives intended to leave their current position. CONCLUSION: Job dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives' job satisfaction, and improve retention rates within the profession.

Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study.

OBJECTIVES: Rheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment. METHODS: Clinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital's waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis. RESULTS: Survival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working. CONCLUSIONS: Cardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.

The Effect of Women's Empowerment in the Utilisation of Family Planning in Western Ethiopia: A Structural Equation Modelling Approach.

This study examines the associations between women's empowerment and family planning use in Jimma Zone, Western Ethiopia. A total of 746 randomly selected married women of reproductive age were interviewed. The data were employed by structural equation modelling (SEM) to investigate the complex and multidimensional pathways to show women's empowerment domains in family planning utilisation. Results of the study revealed that 72% of married women had used family planning. Younger women, having access to information, having access to health facilities and being aware about family planning methods, living in a rural area, having an older partner and increased household decision-making power were associated with using family planning methods. Women's empowerment is an important determinant of contraceptive use. Women's empowerment dimensions included increased household decision-making power, socio-demographic variables and having access to information about family planning and accessible health facilities. These were found to be important determinants of contraceptive use. Future interventions should focus on integrating women's empowerment into family planning programming, particularly in enhancing women's autonomy in decision making. Further research is warranted on the socio-cultural context of women that influences women's empowerment and family planning use to establish an in-depth understanding and equity of women in society.

Incidence and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at public hospitals in Southern Ethiopia.

BACKGROUND: Tuberculosis and human immune deficiency virus co-infections remained the most common cause of child mortality for the last ten years. Globally, 1.2 million cases of tuberculosis occurred in patients living with HIV/AIDS, of which 1.0 million cases occurred in children. The public health impact of tuberculosis and human immune deficiency virus co-infection among children is high in developing countries and Sub-Saharan Africa accompanied three fourth of the global burden. However, there are limited studies that assess the incidence and predictors of mortality among tuberculosis and human immune deficiency virus co-infected children in Ethiopia. METHODS: A facility-based retrospective cohort study was conducted at Public hospitals in Southern Ethiopia with a total of 286 randomly selected records of ART enrolled children from 1st January 2009 to 31stDecember 2018. Data were entered into Epi Data version 3.1 and exported to STATA version 14 for analysis. Bivariate and multivariable Cox proportional hazards model was fitted to identify the predictors of mortality. Variables that had a p-value<0.05 at 95%CI in the multivariable cox proportional hazard model were considered as statistically significant. RESULTS: A total of 274 tuberculosis and human immunodeficiency virus co-infected children's records were reviewed. The incidence of mortality among tuberculosis and human immunodeficiency virus co-infected children was 17.15 per 100 children. The overall incidence density rate of mortality was 2.97(95%CI: 2.2, 3.9) per 100 child year of observation and being anemic (AHR: 2.6; 95%CI: 1.28, 5.21), not initiating isoniazid prophylaxis therapy (AHR: 2.8; 95%CI: 1.44, 5.48), developing extrapulmonary tuberculosis (AHR: 5.7; 95%CI: 2.67, 12.56) and non-adherence (AHR: 5.2; 95%CI: 2.19, 12.39) were independent predictors of mortality. CONCLUSION: Mortality rate was high among TB/HIV co-infected children at the public hospitals in Southern Ethiopia. Extra-pulmonary tuberculosis, anemia, non-adherence, and isoniazid preventive therapy use were statistically significant predictors of mortality among TB/HIV co-infected children. Therefore, extra pulmonary tuberculosis, and anemia should be closely monitored to increase their adherence as well as they should be provided with isoniazid preventive therapy.

Health professionals practice and associated factors towards precautionary measures for COVID-19 pandemic in public health facilities of Gamo zone, southern Ethiopia: A cross-sectional study.

INTRODUCTION: Coronavirus disease-2019 (COVID-19) is a highly contagious acute respiratory disease, which caused by a novel coronavirus. The disease disrupts health systems and resulting in social, political, and economic crises. Health professionals are in front of this pandemic and always work in a high-risk environment. The best prevention for COVID-19 is avoiding exposure to the virus. Some studies reported health professional's practice of precautionary measures for COVID-19. Nevertheless, a few have identified factors affecting. As such, this study aimed to fill those research gaps in the study setting. METHODS: In this cross-sectional study, 428 health professionals involved from the public health facilities of the Gamo zone, southern Ethiopia. A simple random sampling method employed, and the data collected by the interviewer-administered Open Data Kit survey tool and observational checklist. The data analyzed in Stata version 15, and a binary logistic regression model used to identify factors. In this study, a statistically significant association declared at P< 0.05. RESULTS: In this study, 35.3% (95%CI: 30.7%, 39.8%) of health professionals' had a good practice on precautionary measures for the COVID-19 pandemic. Use hand sanitizer or wash hands continuously with soap and water (68.9%), cover nose and mouth with a tissue during sneezing or coughing (67.3%), and use facemask in crowds (56.8%) were the most common practice reported by study participants. Marital status, being married (AOR = 1.84, 95%CI: 1.06, 3.18), good knowledge on the COVID-19 pandemic (AOR = 2.02, 95%CI: 1.02, 3.18), and positive attitude towards precautionary measures for the COVID-19 were factors showed significant association with the practice. CONCLUSIONS: The magnitude of good practice of precautionary measures for the COVID-19 pandemic among health professionals was low. As such, different interventions to improve the knowledge and attitude of health professionals in the health care system are highly needed to boost the practice and to advance service delivery.

Perceived barriers to the practice of preventive measures for COVID-19 pandemic among health professionals in public health facilities of the Gamo zone, southern Ethiopia: a phenomenological study.

BACKGROUND: Novel coronavirus is a global pandemic and killed many individuals, including health care professionals. It caused stress on the health care system of all countries. Presently, studies are emerging regarding the COVID-19 pandemic in different aspects. However, a few have explored barriers that affecting the practice of preventive measures for the COVID-19. As such, the study aimed to fill these research gaps in the study setting. METHODS: A semi-structured interview guide was used to conduct this phenomenological study among 16 key informants. Key informants were recruited by the purposive sampling method. To analyze that data, thematic content analysis was employed by using an inductive approach in NVivo 12 Pro software. RESULTS: In this study, six main themes were identified with the sub-themes. Overview of COVID-19 pandemic (with the six sub-themes), consequences (with the two sub-themes), perceived practice (with four sub-themes), perceived barriers (with four sub-themes), newfangled activities (with three sub-themes), and suggestion for improvement (with seven sub-themes) were the major themes. The participants perceived the influence of shortage of personal protective equipment and solutions for hand hygiene, negligence and ignorance, inadequate infrastructure, lack of training, and lack of attention and recognition for the staff on the practice of preventive measures. CONCLUSIONS: This study showed a gap in preventive measure practices for the COVID-19 in the health care system. Community influences, health care provider related barriers, institutional barriers, and lack of communication and support affect the practice. Hence, attention should give to fulfill the necessary supplies in the health facilities, improve the infrastructures, and equip health professionals by providing capacity-building activities. Besides, health care workers must recognize, and attention is needed.

Prevalence and risk factors of pulmonary hypertension among adult patients with HIV infection in Ethiopia.

Globally, non-communicable diseases are increasing in people living with HIV. Pulmonary hypertension is a rare non-communicable disease in people living with HIV with a reported prevalence of <1%. However, data on pulmonary hypertension in people living with HIV from Africa are scarce and are non-existent from Ethiopia. This study aimed to examine the prevalence and severity of echocardiographic pulmonary hypertension and risk factors associated with pulmonary hypertension in people living with HIV in Ethiopia. A total of 315 consecutive adult people living with HIV followed at the Tikur Anbessa Specialized Hospital HIV Referral Clinic were enrolled from June 2018 to February 2019. Those with established pulmonary hypertension of known causes were excluded. A structured questionnaire was used to collect data on demographics, respiratory symptoms, physical findings, physician-diagnosed lung disease, and possible risk factors. Pulmonary hypertension was defined by a tricuspid regurgitant velocity of ≥2.9 m/sec on transthoracic echocardiography. A tricuspid regurgitant velocity ≥3.5, which translates into a pulmonary arterial pressure/right ventricular systolic pressure of ≥50 mmHg, was considered moderate-to-severe pulmonary hypertension. The mean age of the participants was 44.5 ± 9.8 years and 229 (72.7%) were females. Pulmonary hypertension was diagnosed in 44 (14.0%) of participants, of whom 9 (20.5%) had moderate-to-severe disease. In those with pulmonary hypertension, 17 (38.6%) were symptomatic: exertional dyspnea, cough, and leg swelling were seen in 12 (27.3%), 9 (20.5%), and 4 (9.1%), respectively. There was no significant difference in those with pulmonary hypertension compared to those without the disease by gender, cigarette smoking, previous history of pulmonary tuberculosis treatment, physician-diagnosed chronic obstructive pulmonary disease or bronchial asthma, duration of anti-retroviral therapy therapy or anti-retroviral regimen type. Pulmonary hypertension looks to be a frequent complication in people living with HIV in Ethiopia and is often associated with significant cardiopulmonary symptoms. Further studies using right heart catheterization are needed to better determine the etiology and prevalence of pulmonary hypertension in people living with HIV in Ethiopia compared to other countries.