Comparison of metrics for assessing face washing behaviour for trachoma control.

There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.

Active Trachoma Prevalence and Related Variables among Children in a Pastoralist Community in Southern Ethiopia in 2021: A Community-Based Cross-Sectional Study.

An estimated 30% of trachoma burden is borne by Ethiopia. Data on the prevalence of active trachoma and related factors in a pastoralist population are currently lacking. Additionally, no research has been conducted in the Oromia, Guji Zone of the Liben District. A community-based cross-sectional study was conducted among 538 children 1-9 years old in the pastoralist community of the Liben District from March 1 to April 30, 2021. A multistage systematic sampling method was applied to choose the sample. A structured questionnaire and WHO's trachoma grading scheme were used to identify active trachoma. Bivariate and multivariable logistic regression models were fitted to determine associated factors. An adjusted odds ratio with 95% confidence interval was calculated to decide the level of significance: 157 (29.2%) (95% CI: 24.9, 33.1) of children had clinical signs of active trachoma, 103 (66%) had trachomatous follicles, 41 (26%) had trachomatous intense, and 13 (8%) had both. There was an independent relationship between active trachoma and open defecation (adjusted odds ratio [AOR]: 2.75; 95% CI: 1.24, 6.09), defecating outside close to a house (AOR: 2.5; 95% CI: 1.07, 6.08), not having a latrine (AOR: 3.70; 95% CI: 1.60, 8.60), children who did not wash their faces with soap (AOR: 1.85; 95% CI: 1.10, 3.07), and being in a widowed household (AOR: 3.26; 95% CI: 1.57, 6.63). The study's findings revealed that about one-third of the children had clinical signs of trachoma. Research indicates that trachoma is a major concern for children in rural communities. Therefore, attention to trachoma control with antibiotics, facial hygiene, and environmental sanitation is strongly encouraged.

Risk perception, community myth, and practices towards COVID-19 pandemic in Southeast Ethiopia: Community based crossectional study.

OBJECTIVE: The objective of this study was to assess risk perception, community myths, and preventive practice towards COVID-19 among community in Southeast Ethiopia, 2020. METHODS: Community-based cross-sectional study was conducted among 854 participants selected using a multistage sampling technique. Data were collected using a structured questionnaire adapted from previous literature. Descriptive statistics were done to summarize the variables. A generalized linear model with binary logistic specification was used to identify factors associated with risk perception and practice. Accordingly adjusted odds ratios with 95% confidence intervals were calculated and those with p-value < 0.05 were considered as significant factors associated with risk perception and practice. Cluster analysis using a linear mixed model was performed to identify factors associated with community myth and those with p-value <0.05 were reported as significant factors associated with community myth. RESULTS: All 854 respondents gave their answer yielding 100% response rate. Of these 547 (64.1%) were male, 611 (71.5%) were rural residents, 534 (62.5%) got information about COVID-19 from TV/radio, 591 (69.2%) of them live near health facility, 265 (30.8%) have a history of substance use and 100 (11.7%) have a history of chronic illness, and 415 (48.6%) of them have a high-risk perception, 428 (50.1%) have a wrong myth about COVID-19 and 366 (42.9%) have poor practice respectively. Residence, distances from health facility and myths were significantly associated with risk perception. Occupation, knowledge, and practice were significantly associated with community myths. Also level of education, living near health facilities, having good knowledge and wrong myth were significantly associated with the practice of utilizing COVID-19 preventive respectively. CONCLUSION: The study found high-risk perception, high wrong community myth, and relatively low utilization of available practices towards COVID-19 and factors associated with them.

The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia.

INTRODUCTION: Cessation attempts for smokeless tobacco (SLT) have been studied in the countries that provide comprehensive cessation services, but there is no evidence about SLT cessation in Ethiopia, where there are no comprehensive tobacco cessation services. The objective of this study was to determine cessation attempts and related factors among daily SLT users. METHODS: We analyzed the data obtained from a cross-sectional survey of SLT users in Borena zone, Ethiopia, focusing on a subset of 600 daily SLT users. Participants were adult SLT users aged ≥18 years. The dependent variable was SLT cessation attempt. Multivariable logistic regression was performed to identify association between cessation attempts and explanatory variables. Analyses were performed using SPSS version 20. RESULTS: Overall, 18.5% reported having tried to quit SLT in the past 12 months. In multivariable analyses, SLT cessation attempts were significantly associated with being male (AOR=1.96, 95% CI: 1.13-3.40), current dual-product user (AOR=2.11, 95% CI: 1.31-3.38), being advised by α health professional (AOR=1.82, 95% CI: 1.13-2.92), current knowledge (AOR=1.20, 95% CI: 1.00-1.44), and risk perception (AOR=1.06, 95% CI: 1.02-1.10). CONCLUSIONS: A low cessation attempt rate among daily SLT users calls for comprehensive cessation intervention. More attention to factors such as knowledge of the health consequences of SLT use, risk perception and health workers advice will be required to encourage cessation attempts.

Prevalence and factors that influence smokeless tobacco use among adults in pastoralist communities of Borena Zone, Ethiopia: mixed method study.

BACKGROUND: Deaths due to tobacco consumption are on the rise, from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 of which more than 80% will be in developing countries. Smokeless tobacco use is a significant health risk and cause of disease. Over 300 million people use smokeless tobacco worldwide. More than 250 million adult smokeless tobacco users are in low- and middle-income countries, the total burden of smokeless tobacco use is likely to be substantial. In Ethiopia, nationally representative data on the smokeless tobacco use is not available. Most studies conducted in the country focused on cigarette smoking. METHOD: A community based cross-sectional study using quantitative and qualitative approaches was conducted from September 14-29, 2015. The study was conducted among adults in pastoralist communities in Borena zone, Ethiopia. A total of 634 households were selected randomly for interview. An interviewer-administered questionnaire and in-depth interview guide was used to assess adults' practice, attitude, knowledge, and perception on Smokeless Tobacco use. Logistic regression was used to assess association between dependent and independent variables. RESULT: Out of 634 participants, 287 (45.3%) of them were current users of smokeless tobacco. Being Muslim (AOR = .21, 95% CI: .13, .33), being Christian (AOR = .38, 95% CI: .22, .67), and having good health risk perception toward smokeless tobacco use (AOR = .49, 95% CI: .34, .70) were protective factors for smokeless tobacco use, whereas favorable attitude (AOR = 2.12, 95% CI: 1.48, 3.04) and high social pressure towards smokeless tobacco use (AOR = 1.73, 95% CI: 1.21, 2.47) were factors independently associated with smokeless tobacco use. CONCLUSION: This study concludes that smokeless tobacco use is very common in the selected districts of the Borena zone. The practice is strong linked to the lifestyle of the community.