Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study.

BACKGROUND: Traditional herbal medicine (THM) is frequently used in pediatric populations in many low-income countries as a form of healthcare and has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has not been thoroughly investigated. OBJECTIVE: This study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS. METHODS: This was a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS. RESULTS: A total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS. CONCLUSION: The incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.

Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching.

Background: Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. Methods: We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. Result: After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. Conclusion and recommendation: This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.

Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: a cross-sectional study.

OBJECTIVE: This study aimed to assess the prevalence and determinants of the triple burden of malnutrition among mother-child pairs in low-income and middle-income countries. DESIGN: Cross-sectional study. SETTING: Low-income and middle-income countries. PARTICIPANTS: Women and children. PRIMARY OUTCOME: Triple burden of malnutrition (overweight/obese mother with undernourished and anaemic under 5 years child). METHODS: Data for this study were drawn from recent 22 low-income and middle-income countries Demographic and Health Surveys. A total weighted sample of 116 795 mother-child pairs was included in the study. STATA V.14.2 was used to clean, code and analyse the data. Multilevel logistic regression was employed to identify factors associated with the problem. Adjusted OR (AOR) with 95% CI and a p<0.05 was reported to indicate statistical association. Model fitness and comparison were done using intraclass correlation coefficient, median OR, proportional change in variance and deviance. RESULT: The pooled prevalence of the triple burden of malnutrition among mother-child pairs was 11.39%. It showed statistically significant positive associations with mothers aged ≥35 years (AOR 2.25, 95% CI 2.08 to 2.44), family size >10 (AOR 1.17, 95% CI 1.08 to 1.26), delivery by caesarean section (AOR 1.93, 95% CI 1.83 to 2.03), the richest household (AOR 1.72, 95% CI 1.56 to 1.88), grand multiparous (AOR 1.62, 95% CI 1.46 to 1.81), age of child 36-47 months (AOR 1.77, 95% CI 1.64 to 1.90), at a p<0.05. Whereas breast feeding (AOR 0.94, 95% CI 0.89 to 0.99), married mothers (AOR 0.87, 95% CI 0.78 to 0.96), female children (AOR 0.88, 95% CI 0.84 to 0.92), improved toilet (AOR 0.23, 95% CI 0.17 to 0.29), improved source of drinking water (AOR 0.28, 95% CI 0.21 to 0.35), rural residents (AOR 0.66, 95% CI 0.62 to 0.69) had a contrasting relationship with the triple burden of malnutrition. CONCLUSION: About 1 out of 10 households suffer from the triple burden of malnutrition in low-income and middle-income countries. This study revealed that several maternal, child, household and community-level factors have a significant impact on the triple burden of malnutrition among mother-child pairs.

Six in ten children with epilepsy visiting the University of Gondar comprehensive specialized hospital were undernourished: a cross-sectional study.

BACKGROUND: The burden of undernutrition among children with epilepsy in low- and middle-income countries is not well studied. This study aimed to assess the magnitude of undernutrition and associated factors among children with epilepsy at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. METHOD: A single-center cross-sectional study was conducted on 239 epileptic children with epilepsy visiting the University of Gondar Comprehensive Specialized Hospital pediatric neurology clinic from June 2021 to September 2021. A pre-tested, researcher-administered questionnaire and medical record review were used for data collection. We included all participants who fulfilled the inclusion criteria. We did anthropometric measurements and defined undernutrition based on the world health organization criteria. Binary and multivariable logistic regressions were employed to determine factors associated with undernutrition. The statistical association between dependent and independent variables was declared at p-value of ≤ 0.05. RESULT: The mean(+/-SD) age was 9.38 ± 0.29 years, with a male to female ratio of 1.8: 1, and school-age children account for 35.6%. The overall magnitude of undernutrition was 141(59%) of which 89(63.1%) had moderate to severe stunting, 91(64.5%) moderate to severe wasting, and 39(27.7%) had both. Being male (AOR = 1.96, 95%CI, 1.05-3.69), low paternal level of education (AOR = 1.88, 95%CI, 1.01-3.50), presence of delay in motor development (AOR = 5.91,95%CI, 1.55-22.49), and gum hyperplasia (AOR = 0.32,95%CI, 0.12-0.81), were significantly associated with undernutrition. CONCLUSION: The magnitude of undernutrition among children with epilepsy was high. Male sex, low paternal level of education, presence of delay in motor development, and gum hyperplasia were significantly associated with undernutrition. Therefore, nutritional screening and intervention are recommended to be part of routine epileptic care.

Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019.

INTRODUCTION: The Bacille-Calmette-Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia. METHOD: Bacille-Calmette-Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia. RESULT: The overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia. CONCLUSION: Despite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia.

More Than Three-Fourths of AstraZeneca (ChAdox1 COV-19) COVID-19 Vaccinated Individuals Develop Post Immunization Adverse Event in Northwest Ethiopia.

Background: Ethiopia was using the ChAdOx1 COV-19 vaccine, and health professionals were targets of the first phase of the vaccination strategy. Evidence on the adverse events following immunization (AEFI) was barely available. The study aimed to assess the magnitude and associated factors of adverse events following ChAdOx1 COV-19 immunization among health professionals of the University of Gondar Specialized and Comprehensive Hospital, 2021. Methods: An institution-based cross-sectional study was conducted among health professionals of the University of Gondar Comprehensive and specialized referral hospital. All health professionals who took the ChAdOx1 COV-19 vaccine in the 1st phase were surveyed. A total of 314 health professionals who took the ChAdOx1 COV-19 vaccine were included. The EpiData version 4.6.0.0 and Stata 16 were used for data entry and analysis, respectively. A binary logistic regression was used to identify statistically significant factors associated with AEFI. Chi-square and multicollinearity assumptions were tested. A p-value <0.2 and 0.05 were used as cut-off values of significance in the bi- and multivariable logistic regression models, respectively. An adjusted odds ratio (AOR) with 95% CI was reported for statistically significant variables. Results: Among 314 study participants, 263 of them had at least one mild to severe AEFI of ChAdOx1 COV-19 with a prevalence of AEFI of 83.76% (95% CI: 79.23, 87.46). The commonest AEFI observed were injection site tenderness (n=198/263), fatigue (114/263), headache (n=107/263), and muscle pain (n=85/263). Females (AOR=2.75, 95% CI: 1.15, 6.58), and participants who felt the vaccine was unsafe (AOR=2.84, 95% CI: 1.03, 7.85) were having nearly three times more odds of AEFI immunization as compared to males and those who felt the vaccine was safe, respectively. Conclusion: Adverse event following immunization has been a public health problem in Northwest Ethiopia. Being female and having a feeling that the vaccine is unsafe were statistically significantly associated with AEFI.

Wasting and associated factors among critically ill children admitted to pediatric intensive care unit in Ethiopia.

BACKGROUND: Nutritional problems are increasingly associated with acute infections. It is also related to further complications of illnesses and poor treatment outcomes of medical conditions. This study aimed to assess wasting and associated factors among critically ill children admitted to intensive care units at the time of admission. METHODS: An institution-based prospective observational study was employed among children admitted to pediatric intensive care of the University of Gondar Comprehensive Specialized Hospital from February 1, 2018, to July 30, 2019. Data about socio-demographic, clinical, and anthropometric measurements were taken from children at the time of admission and length of hospital stay and treatment-related data were collected by chart review at discharge. Summary measures were computed and presented in the form of text, tables, and graphs. A p-value of less than 0.2 was used to select candidate variables for multivariable analysis. A binary logistic regression model was fitted to identify factors associated with wasting. Adjusted odds ratio with 95% confidence interval (CI) was calculated and variables with a p-value less than 0.05 in the multi-variable analysis were considered to declare factors associated with wasting. RESULTS: The median age at admission was 48 (IQR: 12 to 122) months. Of the total admitted children to ICU, 47.97% were undernourished, of which 32% (95%CI: (26.8% to 37.4%) were severely wasted. Caregivers who had no formal education (AOR=4.43, 95%CI 1.62 12.10), transferred from wards (AOR=2.98, 95%CI: 1.02 8.69), duration of illness ≥6 days before health facility visit (AOR=2.14, 95%CI: 1.22 3.72) and comorbidity (AOR=6.85, 95%CI: 2.93 16.05) were statistically significant factors associated with wasting. CONCLUSION: Wasting was high among children admitted to the intensive care unit. No formal education, transferred from wards and operation rooms, longer duration of illness before health facility visits, and comorbidity were factors associated with wasting. Wasted patients had higher mortality as compared to patients with no wasting. A multicenter study with larger sample size is recommended for a more generalizable result.

Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialised hospital, northwest Ethiopia: a prospective observational cohort study.

OBJECTIVE: To determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia. DESIGN: A single-centre prospective observational cohort study. PARTICIPANTS: A total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period. MEASUREMENTS: Data were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality. RESULT: The median age at admission was 48 months with IQR: 12-122, 28.1% were infants and adolescents accounted for 21.4%. Of the total patients studied, 59.7% were males. The median observation time was 3 days with (IQR: 1-6). One hundred and two (32.6%) children died during the follow-up time, and the incidence of mortality was 6.9 deaths per 100 person-day observation. Weekend admission (adjusted HR (AHR)=1.63, 95% CI: 1.02 to 2.62), critical illness diagnoses (AHR=1.79, 95% CI: 1.13 to 2.85), need for MV (AHR=2.36, 95% CI: 1.39 to 4.01) and modified PIM 2 Score (AHR=1.53, 95% CI: 1.36 to 1.72) were the predictors of mortality. CONCLUSION: The rate of mortality in the PICU was high, admission over weekends, need for MV, critical illness diagnoses and higher PIM 2 scores were significant and independent predictors of mortality.