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.

Factors associated with poor glycemic control among adult patients with type 2 diabetes mellitus in Gamo and Gofa zone public hospitals, Southern Ethiopia: A case-control study.

BACKGROUND: Diabetes mellitus is a serious global public health problem that affects the whole life of people in terms of their biological, psychological, and social effects. Complications and death from diabetes occur from poorly controlled blood glucose levels. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess factors associated with poor glycemic control among type2 diabetes patients in public hospitals of Gamo and Gofa zone southern, Ethiopia, 2021. METHODS: An institution-based unmatched case-control study was employed among 312 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identify factors associated with poor glycemic control using IBM SPSS version 25. The strength of association was assessed by using an Adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULT: Factors associated with poor glycemic control based on multivariable analysis were, having comorbidity (AOR = 2.35, 95% CI (1.39-3.95)), adhering to dietary recommendations (AOR = 0.31, 95% CI (089-0.51)), poor social support (AOR = 3.31, 95% CI (1.59-6.85)), physical exercise (AOR = 1.86 95% CI (1.11-3.12)), and having poly-pharmacy (AOR = 2.83, 95% CI (1.39-5.74)). CONCLUSION AND RECOMMENDATION: This study indicated a significant association of comorbidity, physical exercise, poly-pharmacy, low social support, and adherence to dietary recommendations with poor glycemic control. We suggest that the health care providers and concerned bodies encourage patients to have regular check-ups and work on providing necessary social support.

Modeling spatial determinants of initiation of breastfeeding in Ethiopia: A geographically weighted regression analysis.

BACKGROUND: The World Health Organization (WHO) encourages breastfeeding to begin within the first hour after birth in order to save children's lives. In Ethiopia, different studies are done on the prevalence and determinants of breastfeeding initiation, up to our knowledge, the spatial distribution and the spatial determinants of breast feeding initiation over time are not investigated. Therefore, the objectives of this study were to assess spatial variation and its spatial determinant of delayed initiation of breastfeeding in Ethiopia using Geographically Weighted Regression (GWR). METHODS: A cross-sectional study was undertaken using the nationally representative 2016 Ethiopian Demographic and Health Survey (EDHS) dataset. Global Moran's I statistic was used to measure whether delayed breastfeeding initiation was dispersed, clustered, or randomly distributed in study area. Ordinary Least Squares (OLS) regression was used to identify factors explaining the geographic variation in delayed breastfeeding initiation. Besides, spatial variability of relationships between dependent and selected predictors was investigated using geographically weighted regression. RESULT: A total weighted sample of 4169 children of aged 0 to 23 months was included in this study. Delayed initiation of breastfeeding was spatially varies across the country with a global Moran's I value of 0.158 at (p-value<0.01). The hotspot (high risk) areas were identified in the Amhara, Afar, and Tigray regions. Orthodox religion, poor wealth index, caesarian section, baby postnatal checkup, and small size of a child at birth were spatially significant factors for delayed breastfeeding initiation in Ethiopia. CONCLUSION: In Ethiopia initiation of breastfeeding varies geographically across region. A significant hotspot was identified in the Amhara, Afar, and Tigray regions. The GWR analysis revealed that orthodox religion, poor wealth index, caesarian section, baby postnatal checkup, and small birth weight were spatially significant factors.

Variation in Glucose-6-Phosphate Dehydrogenase activity following acute malaria.

Primaquine and tafenoquine are the only licensed drugs with activity against Plasmodium vivax hypnozoites but cause haemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Malaria also causes haemolysis, leading to the replacement of older erythrocytes with low G6PD activity by reticulocytes and young erythrocytes with higher activity. Aim of this study was to assess the impact of acute malaria on G6PD activity. Selected patients with uncomplicated malaria were recruited in Bangladesh (n = 87), Indonesia (n = 75), and Ethiopia (n = 173); G6PD activity was measured at the initial presentation with malaria and a median of 176 days later (range 140 to 998) in the absence of malaria. Among selected participants (deficient participants preferentially enrolled in Bangladesh but not at other sites) G6PD activity fell between malaria and follow up by 79.1% (95%CI: 40.4 to 117.8) in 6 participants classified as deficient (<30% activity), 43.7% (95%CI: 34.2 to 53.1) in 39 individuals with intermediate activity (30% to <70%), and by 4.5% (95%CI: 1.4 to 7.6) in 290 G6PD normal (≥70%) participants. In Bangladesh and Indonesia G6PD activity was significantly higher during acute malaria than when the same individuals were retested during follow up (40.9% (95%CI: 33.4-48.1) and 7.4% (95%CI: 0.2 to 14.6) respectively), whereas in Ethiopia G6PD activity was 3.6% (95%CI: -1.0 to -6.1) lower during acute malaria. The change in G6PD activity was apparent in patients presenting with either P. vivax or P. falciparum infection. Overall, 66.7% (4/6) severely deficient participants and 87.2% (34/39) with intermediate deficiency had normal activities when presenting with malaria. These findings suggest that G6PD activity rises significantly and at clinically relevant levels during acute malaria. Prospective case-control studies are warranted to confirm the degree to which the predicted population attributable risks of drug induced haemolysis is lower than would be predicted from cross sectional surveys.

Utilization of information and communication technology (ICT) among undergraduate health science students: a cross-sectional study.

BACKGROUND: We already know that incorporating information and Communication technology (ICT) into every aspect of human activity result in significant change and makes tasks easier to complete. It can help in areas of healthcare systems and medical education. Therefore, this study aimed to assess utilization ICT and its associated factors among Arba Minch University College Medicine and Health Science students. METHODS: A cross sectional study design was conducted in June through August 2021 among under graduate students in college of medicine and health science at Arba Minch University, Ethiopia. A self-administered questionnaire was used to collect information on the students' socio-demographic factors as well as the utilization ICT. The data entry form was prepared with Epi-data 3.1 versions software and STATA version 14 software was used to analyze the data. RESULTS: A total of 355 participants enrolled in the study, with a response rate of 98.34%. The percentage of students who used ICT was 55.77% [95% CI, 0.50, 0.60]. Regarding of field of study, health informatics students (84%) used the most ICT, while midwifery students (52%) used the least. Urban resident [AOR = 1.85, 95% CI = 1.08, 3.16], ICT knowledge [AOR = 3.8, 95% CI = 2.25, 6.40], having formal training of ICT [AOR = 1.9, 95% CI = 1.06,3.48], having IT in current course study [AOR = 2.2, 95% CI = 1.23, 3.84], and had good IT skill [AOR = 2.4, 95% CI = 1.34, 4.23] revealed a significant and positive correlation with the use of ICT. CONCLUSION: In the current study previous residence, ICT knowledge, having formal training, having IT in current courses, and IT skill were significantly associated with student ICT utilization. Therefore, the university should continue to invest in professional development in order to improve teaching and student performance, as well as provide the college with student-centered ICT computer labs to encourage students to use technology.

Chronic Obstructive Pulmonary Disease and Associated Factors in Arba Minch Health and Demographic Surveillance Site, 2020.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a common, preventable and treatable disease characterized by progressive airflow limitation. Nowadays, COPD has become the third leading cause of death and fourth cause of mortality in the world. OBJECTIVE: To assess chronic obstructive pulmonary disease and associated factors in Arba Minch - Health and Demographic Surveillance Site (AMU-HDSS) of Arba Minch University. METHODS: A community-based cross-sectional study was conducted in AMU-HDSS among 615 individuals who were >15 years of age. Study participants were selected randomly by the lottery method. Spirometer device was used to measure lung function. Binary logistic regression analysis was computed to assess the crude association between dependent and independent variables. Finally, variables which showed association in binary logistic regression analysis and have a P-value less than 0.3 were entered into multivariable logistic regression model to identify significant factors. RESULTS: The prevalence of spirometry diagnosed COPD was 10.6%. Highland residence showed higher proportion of COPD case which accounts 63.8% compared to 36.2% in lowland residence. Study participants who were in advanced age >41 years adjusted odd ratio (AOR) 3.65 (1.83, 7.28), living in highland area AOR 1.71 (1, 2.92), those who are elementary education level 2.45 (1.13, 5.28), who had no separate house for domestic animals AOR 2.84 (1.38, 5.85), having house which had no windows AOR 3.05 (5.79, 1.12) and living in traditional hut (tukulu), AOR 5.92 (1.19, 29.42) were significantly associated with chronic obstructive pulmonary disease in the study area. CONCLUSION AND RECOMMENDATION: Chronic obstructive pulmonary disease was one of respiratory illnesses in people who live in highland and traditional house lacking windows for air circulation. Improving housing condition of traditional hut by constructing window, separating domestic animals house from humans and minimizing animal dung smoke exposure is necessary to reduce the respiratory illness.

Coverage Validation Survey for Lymphatic Filariasis Treatment in Itang Special District of Gambella Regional State of Ethiopia: A Cross-Sectional Study.

BACKGROUND: Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia. In order to alleviate this problem Mass drug administration (MDA) has been given once a year for the public living in endemic sites. Despite this fact there might be a difference between reported coverage and the actual coverage on the ground due to various errors, so assessing the actual coverage through coverage validation survey appears imperative. OBJECTIVE: The aim of this survey was to assess the difference between the reported coverage and actual coverage of Ivermectin (IVM) and Albendazole (ALB) treatment given for Lymphatic Filariasis in Itang special district of Gambella regional state, Ethiopia. SETTING: The study was conducted in Itang special district of Gambella region, the district was purposively selected for lymphatic filariasis treatment coverage survey. Eligible individuals aged 5 and above were interviewed. Data about the children were collected from parents or guardians and analyzed using STATA. RESULTS: The survey showed that the coverage for LF treatment was 81.5%. From 825 individuals that reported that they were offered the treatment 823 (99.6%) swallowed the drug. The coverage in school age children (5-14) shows significant difference with treatment coverage in individuals aged 15 and above (p<0.001) in the last mass drug administration campaign. The main reason for not being offered preventive chemotherapy (PC) during the mass drug administration campaigns was missing class during the MDA (37.2%). CONCLUSION: The treatment coverage is higher than the recommended coverage of 65% of the target population. The coverage in school age children (5-14) showed significant difference with treatment coverage in individuals aged 15 and above. Improving the coverage level beyond this can significantly contribute to the LF elimination goal.

Exploring Barriers to Effective Implementation of Public Health Measures for Prevention and Control of COVID-19 Pandemic in Gamo Zone of Southern Ethiopia: Using a Modified Tanahashi Model.

BACKGROUND: Since the occurrence of the COVID-19 pandemic, different public health measures have been implemented to prevent and control the further spread of the disease. However, barriers that influence the effective implementation of public health measures were not explore in Ethiopia especially in study Area. Therefore, this study tried to fill this gap by exploring the barriers to effective implementation of public health measures for prevention and control of the COVID-19 pandemic in the Gamo Zone of southern Ethiopia. METHODS: The study employed a qualitative study with a phenomenology approach among purposely selected 30 individuals in the community and selected institutions. Key informant interview was used to collect the data. The data were transcribed verbatim and translated into the English language. The transcribed data were read several times to clearly understand the content for further analysis. The analysis of the data was conducted based on the modified Tanahashi framework. RESULTS: The study identified different barriers under five main themes: accessibility, acceptability, availability, contact and use, and effective implementation of public health measures related to barriers. The main barriers to effective implementation of public health measures were resistance to change, negligence, lack of community engagement, insufficient training for front line workers, poor supportive supervision, poor law enforcement, and lack of continuous community awareness creation. Beside, acceptability related barriers like cultural and religious norms and availability related barriers like shortage of personal protective equipment and shortage of skilled health professional have also lion share barriers for implementation of the public health measures. CONCLUSION: The study identified different personal, institutional, and societal level barriers for effective implementation of public health measures for the COVID-19 pandemic. Therefore, proper and targeted continuous community awareness creation with further mandatory law enforcement activities should be implemented by the concerned bodies to mitigate individual and societal level barriers. In addition, the government with relevant stakeholders should give due attention to equip and protect the frontline professionals by availing the necessary logistic and provision of continuous capacity-building activities.

Ivermectin Treatment Coverage Validation in Two Onchocerciasis Endemic Districts in Ethiopia: A Community-Based Cross-Sectional Study, 2019.

BACKGROUND: Onchocerciasis is the second leading cause of blindness globally next to trachoma, thus eliminating the infection is an important health priority. It is estimated that 15.7 million people are at risk of infection in different parts of Ethiopia. Mass drug administration with ivermectin at community and school level is the basis for control and elimination of onchocerciasis. This study was aimed at validating onchocerciasis treatment coverage in the selected districts of Ethiopia. METHODS: A community-based cross-sectional study was employed in Itang special and Wombera districts of Ethiopia, from April 1 to 30, 2019 G.C. We used a coverage validation survey builder tool to compute sample size. Individuals aged five years old and above were eligible population. Data were entered into Microsoft Excel and exported to STATA 14 for cleaning and analyses. A chi-square test was used to note statistical association of the outcome variables with independent variables. MAIN FINDINGS: A total of 3765 individuals were interviewed. Of these, 3244 were offered onchocerciasis treatment. The overall treatment coverage of onchocerciasis in the two selected districts of Ethiopia was 85.9% of the eligible population (3235/3765) (95% CI, 84.8%, 87%). There was significant difference between the two districts in terms of ivermectin offering (X2=70.467, P<0.001). School attendance was also significantly associated with treatment offering and swallowing status (X2=77.29, P<0.001; and X2=30.581, P<0.001). The main reported reasons for not being offered ivermectin were "being absent" (40.86%) and "not knowing about the mass drug administration" (MDA) (25.29%). CONCLUSION: In conclusion, the treatment coverage of onchocerciasis in this survey was higher than minimum national desired therapeutic coverage. Treatment coverage in Wombera was higher than Itang special district. In addition, children who attended school had a higher chance of swallowing the drug.

Effects of comprehensive sexuality education on the comprehensive knowledge and attitude to condom use among first-year students in Arba Minch University: a quasi-experimental study.

OBJECTIVE: To assess the effect of comprehensive sexuality education on the comprehensive knowledge and attitude to condom use among first-year students at Arba Minch University. RESULTS: A total of 832 students participated at a baseline, and 820 students participated at the posttest. This study found that there was a significant effect on changing students' knowledge and attitude towards a condom. In the education group, the students' average change of comprehensive condom knowledge score was 0.229 higher than the average score of students' in the control group (ATE = 0.229, 95% CI 0.132 to 0.328; p < 0.001). The average change of attitude toward condom score of students' in the education group was 1.834 higher than the average change score of students' in the control group (ATE = 1.834, 95% CI 1.195 to 2.772; p < 0.001).This study provides further evidence on the effectiveness of comprehensive sexuality education in terms of knowledge and attitude towards a condom. Therefore, the implementation of this education should be strengthened in order the prevent youths from STI/HIV and unintended pregnancies.

Adjunctive dexamethasone therapy in unconfirmed bacterial meningitis in resource limited settings: is it a risk worth taking?

BACKGROUND: Bacterial meningitis is associated with significant morbidity and mortality despite advances in medical care. The main objective of this study was to assess the association of adjunctive dexamethasone treatment with discharge outcome of patients treated as bacterial meningitis in low income setting. METHODS: A retrospective study was conducted at four teaching hospitals across Ethiopia. Patients of age 14 years and older treated as cases of bacterial meningitis between January 1, 2011 and April 30, 2015 were included in this study. Information regarding sociodemographic data, clinical presentations, laboratory data, treatments given and status at hospital discharge were retrieved from patients' medical records using a structured questionnaire. Predefined outcome variables at discharge were analysed using descriptive statistics. Multivariable logistic regression was used to identify factors independently associated with poor outcome. RESULTS: A total of 425 patients treated with the presumptive clinical diagnosis of bacterial meningitis were included in this study (lumbar puncture done in 56 %; only 19 % had CSF findings compatible with bacterial meningitis, and only 3 % had proven etiology). The overall in hospital mortality rate was 20.2 %. Impaired consciousness, aspiration pneumonia, and cranial nerve palsy at admission were independently associated with increased mortality. Adjuvant dexamethasone, which was used in 50.4 % of patients, was associated with increased in-hospital mortality (AOR = 3.38; 95 % CI 1.87-6.12, p < 0.001) and low Glasgow outcome scale (GOS) at discharge (AOR = 4.46 (95 % CI 1.98-10.08). This association between dexamethasone and unfavorable outcome was found to be more pronounced in suspected but unproven cases and in those without CSF alterations compatible with bacterial meningitis. CONCLUSION: Most patients treated for suspected bacterial meningitis did not receive proper diagnostic workup. Adjuvant dexamethasone use in clinically suspected but unproven cases of bacterial meningitis was associated with an increased mortality and poor discharge GOS. These findings show that there are potential deleterious effects in unconfirmed cases in this setting. Physicians practising under such circumstances should thus abide with the current recommendation and defer the use of adjuvant corticosteroid in suspected cases of bacterial meningitis.

Challenges of bacterial meningitis case management in low income settings: an experience from Ethiopia.

OBJECTIVE: To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia. METHODS: This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records. RESULT: A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%. CONCLUSION: Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations.

Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases.

BACKGROUND: The increasing incidence and prevalence of chronic kidney disease is an important challenge for health systems around the world. Access for care of the disease in Ethiopia is extremely limited. The main purpose of the study was to investigate survival pattern and assess risk factors for poor outcome of patients on maintenance hemodialysis for end stage renal disease in Ethiopia. METHODS: Medical records of patients on maintenance hemodialysis for end stage renal disease at Saint Gabriel General Hospital between 2002 and 2010 were reviewed. The data was collected by complete review of patient's clinical data. Descriptive statistics was used for most variables and Chi-square test, where necessary, was used to test the association among various variables. Kaplan-Meier survival analysis was done to assess both short and long term survival. P-values of <0.05 were considered as statistically significant. RESULTS: A total of 190 patients were registered for hemodialysis at the hospital 91 of which were included in the final assessment. Mean age at dialysis initiation was 58±15 years. Fifty-five (60.4%) of the patients had prior history of diabetes. Almost all of them had serum creatinine of >5mg/dl and some degree of anemia at dialysis initiation. Forty-one (45.1%) deaths occurred during dialysis treatment and 21 (23.1%) of patients died within the first 90 days of starting dialysis. Only 42.1% of them survived longer than a year. The frequently registered causes of death were septicemia (34.1%) and cardiovascular diseases (29.3%). Use of catheter as vascular access was associated with decreased short term and long term survival. CONCLUSION: Dialysis as treatment modality is extremely scarce in Ethiopia and affordable to only the rich. Survival pattern in those on the treatment is less satisfactory and short of usual standards in the developed world and needs further investigation. We thus recommend a large scale analysis of national dialysis registry at all dialysis centers in the country.