Electrocardiogram and echocardiography findings and the outcomes of patients with myocardial infarction: Retrospective study in tertiary care hospitals in Northwest Ethiopia.

BACKGROUND: Myocardial infarction (MI) is diagnosed when there is a rise in cardiac biomarkers along with supportive evidence in the form of typical symptoms, suggestive electrocardiographic (ECG) changes, or imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality. The data regarding the use of ECG and echocardiography (Echo) findings and their impact on mortality are still lacking in Ethiopia. This study assessed the utilization of ECG and Echo findings and outcomes of patients with MI in tertiary care hospitals in Northwest Ethiopia. METHODS: A retrospective chart review was conducted on patients with MI who were admitted to the adult intensive care units (ICUs) of two selected hospitals between January 2018 and July 30, 2021. Data was entered and analyzed using the SPSS 25 software. Logistic regression analysis was used to assess the association between in-hospital mortality and other variables. A P-value < 0.05 was considered significant. RESULTS: Among the 203 participants, 67.5% were male, and the mean age of the participants was 59 (13.8). Around two-thirds (66.5%) of patients had STEMI and a regional all-motion abnormality. More than half (54.1%) of the cases were in the anteroapical region. For MI, there was a 23.2% inconsistency between ECG and Echo findings. The rate of in-hospital mortality for patients with MI was 23%. Pulmonary hypertension [AOR = 7.8, 95% CI: 1.72-34.93], inferobasal regional wall motion abnormality [AOR = 7.9, 95% CI: 1.340-46.093], Killip's classes III and IV [AOR = 2.7, 95% CI: 1.103-6.314], infection [AOR = 3.2, 95% CI: 1.108-10.65], and ischemic stroke [AOR = 1.9, 95% CI: 1.091-5.222] were significantly associated with in-hospital mortality compared with their counterparts. CONCLUSIONS: The mortality of patients with MI in this study was higher than in other reports. Killip's class, pulmonary hypertension, infection, ischemic stroke, and inferobasal regional wall motion abnormalities were significantly associated with the in-hospital mortality of the patients with MI. There was a higher degree of inconsistency between ECG and Echo findings. The treatment of patients with MI should be tailored to their specific risk factors and causes.

Remote sensing of environmental risk factors for malaria in different geographic contexts.

BACKGROUND: Despite global intervention efforts, malaria remains a major public health concern in many parts of the world. Understanding geographic variation in malaria patterns and their environmental determinants can support targeting of malaria control and development of elimination strategies. METHODS: We used remotely sensed environmental data to analyze the influences of environmental risk factors on malaria cases caused by Plasmodium falciparum and Plasmodium vivax from 2014 to 2017 in two geographic settings in Ethiopia. Geospatial datasets were derived from multiple sources and characterized climate, vegetation, land use, topography, and surface water. All data were summarized annually at the sub-district (kebele) level for each of the two study areas. We analyzed the associations between environmental data and malaria cases with Boosted Regression Tree (BRT) models. RESULTS: We found considerable spatial variation in malaria occurrence. Spectral indices related to land cover greenness (NDVI) and moisture (NDWI) showed negative associations with malaria, as the highest malaria rates were found in landscapes with low vegetation cover and moisture during the months that follow the rainy season. Climatic factors, including precipitation and land surface temperature, had positive associations with malaria. Settlement structure also played an important role, with different effects in the two study areas. Variables related to surface water, such as irrigated agriculture, wetlands, seasonally flooded waterbodies, and height above nearest drainage did not have strong influences on malaria. CONCLUSION: We found different relationships between malaria and environmental conditions in two geographically distinctive areas. These results emphasize that studies of malaria-environmental relationships and predictive models of malaria occurrence should be context specific to account for such differences.

Comparing malaria early detection methods in a declining transmission setting in northwestern Ethiopia.

BACKGROUND: Despite remarkable progress in the reduction of malaria incidence, this disease remains a public health threat to a significant portion of the world's population. Surveillance, combined with early detection algorithms, can be an effective intervention strategy to inform timely public health responses to potential outbreaks. Our main objective was to compare the potential for detecting malaria outbreaks by selected event detection methods. METHODS: We used historical surveillance data with weekly counts of confirmed Plasmodium falciparum (including mixed) cases from the Amhara region of Ethiopia, where there was a resurgence of malaria in 2019 following several years of declining cases. We evaluated three methods for early detection of the 2019 malaria events: 1) the Centers for Disease Prevention and Control (CDC) Early Aberration Reporting System (EARS), 2) methods based on weekly statistical thresholds, including the WHO and Cullen methods, and 3) the Farrington methods. RESULTS: All of the methods evaluated performed better than a naïve random alarm generator. We also found distinct trade-offs between the percent of events detected and the percent of true positive alarms. CDC EARS and weekly statistical threshold methods had high event sensitivities (80-100% CDC; 57-100% weekly statistical) and low to moderate alarm specificities (25-40% CDC; 16-61% weekly statistical). Farrington variants had a wide range of scores (20-100% sensitivities; 16-100% specificities) and could achieve various balances between sensitivity and specificity. CONCLUSIONS: Of the methods tested, we found that the Farrington improved method was most effective at maximizing both the percent of events detected and true positive alarms for our dataset (> 70% sensitivity and > 70% specificity). This method uses statistical models to establish thresholds while controlling for seasonality and multi-year trends, and we suggest that it and other model-based approaches should be considered more broadly for malaria early detection.

A genetic algorithm for identifying spatially-varying environmental drivers in a malaria time series model.

Time series models of malaria cases can be applied to forecast epidemics and support proactive interventions. Mosquito life history and parasite development are sensitive to environmental factors such as temperature and precipitation, and these variables are often used as predictors in malaria models. However, malaria-environment relationships can vary with ecological and social context. We used a genetic algorithm to optimize a spatiotemporal malaria model by aggregating locations into clusters with similar environmental sensitivities. We tested the algorithm in the Amhara Region of Ethiopia using seven years of weekly Plasmodium falciparum data from 47 districts and remotely-sensed land surface temperature, precipitation, and spectral indices as predictors. The best model identified six clusters, and the districts in each cluster had distinctive responses to the environmental predictors. We conclude that spatial stratification can improve the fit of environmentally-driven disease models, and genetic algorithms provide a practical and effective approach for identifying these clusters.

Integrating malaria surveillance with climate data for outbreak detection and forecasting: the EPIDEMIA system.

BACKGROUND: Early indication of an emerging malaria epidemic can provide an opportunity for proactive interventions. Challenges to the identification of nascent malaria epidemics include obtaining recent epidemiological surveillance data, spatially and temporally harmonizing this information with timely data on environmental precursors, applying models for early detection and early warning, and communicating results to public health officials. Automated web-based informatics systems can provide a solution to these problems, but their implementation in real-world settings has been limited. METHODS: The Epidemic Prognosis Incorporating Disease and Environmental Monitoring for Integrated Assessment (EPIDEMIA) computer system was designed and implemented to integrate disease surveillance with environmental monitoring in support of operational malaria forecasting in the Amhara region of Ethiopia. A co-design workshop was held with computer scientists, epidemiological modelers, and public health partners to develop an initial list of system requirements. Subsequent updates to the system were based on feedback obtained from system evaluation workshops and assessments conducted by a steering committee of users in the public health sector. RESULTS: The system integrated epidemiological data uploaded weekly by the Amhara Regional Health Bureau with remotely-sensed environmental data freely available from online archives. Environmental data were acquired and processed automatically by the EASTWeb software program. Additional software was developed to implement a public health interface for data upload and download, harmonize the epidemiological and environmental data into a unified database, automatically update time series forecasting models, and generate formatted reports. Reporting features included district-level control charts and maps summarizing epidemiological indicators of emerging malaria outbreaks, environmental risk factors, and forecasts of future malaria risk. CONCLUSIONS: Successful implementation and use of EPIDEMIA is an important step forward in the use of epidemiological and environmental informatics systems for malaria surveillance. Developing software to automate the workflow steps while remaining robust to continual changes in the input data streams was a key technical challenge. Continual stakeholder involvement throughout design, implementation, and operation has created a strong enabling environment that will facilitate the ongoing development, application, and testing of the system.

Birth Preparedness and Complication Readiness Practice and Associated Factors among Pregnant Women, Northwest Ethiopia.

Background. Little is known about birth preparedness and complication readiness (BPCR) plan in resource limited settings to decrease maternal mortality. Therefore, this study was done to assess the status of BPCR and associated factors among pregnant women in South Wollo, Northwest Ethiopia, by involving 819 pregnant women from March to April, 2014. Data were collected by using pretested interviewer administered questionnaire and analyzed using a computer program of SPSS version 20.00. Results. Pregnant women who were prepared for at least three elements of BPCR were 24.1%. Pregnant women knowing at least three key danger signs during pregnancy, delivery, and postnatal period were 23.2%, 22.6%, and 9.6%, respectively. Women having secondary education and higher were 6.20 (95% CI = [1.36, 28.120]) times more likely to be prepared than illiterates. Women having a lifetime history of stillbirth [5.80 (1.13, 29.63)], attending ANC for last child pregnancy [5.44 (2.07, 14.27)], participating in community BPCR group discussion [4.36 (1.17, 16.26)], and having their male partner involved in BPCR counseling during ANC follow-up [4.45 (1.95, 10.16)] were more likely to be prepared. Conclusions. BPCR was very low and should be strengthened through health communication by involving partner in BPCR counseling.

Insecticide-treated net ownership and utilization and factors that influence their use in Itang, Gambella region, Ethiopia: cross-sectional study.

BACKGROUND: Malaria remains a major public health problem in Ethiopia. Consequently, Ethiopia designed the 2011-2015, Malaria Prevention and Control Strategic Plan to fight the vector. It was discovered that most of the studies conducted on the use of insecticide-treated nets (ITNs) were not in line with the strategic plan of the country. This study aimed to assess ITN ownership and utilization, and includes barriers related to its use among the target-area population at household (HH) level. MATERIALS AND METHODS: A cross-sectional design was employed in Itang for this study. Data were collected by trained nurses through face-to-face interview and observation. A total of 845 participants were selected through multistage sampling, and the size was determined by using a single-population proportion formula. EPI Info and SPSS was used for analysis, and all necessary statistical association was computed in order to explain the outcome variable through explanatory variables of this study. RESULTS: Among 845 HHs interviewed, 81.7% (690) had at least one ITN, while 52.3% (361) had used the ITN the night preceding the data-collection day. HH awareness of malaria prevention, number of ITNs, family size, number of family members sharing sleeping area/beds, sleeping patterns of adolescents, HH-head age, and inconvenience of using ITNs were found to be barriers to the use of ITNs in this study. CONCLUSION AND RECOMMENDATION: The study concluded that very few HHs owned ITNs and there was very low usage of ITNs. In recommendation, the regional health bureau and district health office should consider bigger nets that can accommodate family members who share the same sleeping area/bed in the area.

Knowledge of pregnant women on mother-to-child transmission of HIV, its prevention, and associated factors in Assosa town, Northwest Ethiopia.

INTRODUCTION: HIV/AIDS is a leading cause of death of children in sub-Saharan African countries. Almost all HIV-positive children acquire infection through mother-to-child transmission (MTCT) of HIV. Successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection is highly dependent on everyone; especially, women of child-bearing age should have accurate and up-to-date knowledge about HIV transmission, risk of transmission to babies, and possible interventions. However, knowledge of MTCT of HIV, its prevention, and associated factors among women was not well studied in Benshangul Gumuz Region (Ethiopia). METHODS: A facility-based cross-sectional study was conducted involving 398 pregnant women who attended antenatal care services at governmental health institutions from February to March 2014 in Assosa town. Based on the flow of antenatal care attendants, the calculated sample size was proportionally allocated to the health facilities before data collection. Following this, systematic sampling method was used, and data were collected using an interviewer-administered questionnaire. Bivariate and multivariate binary logistic regression analysis was done using SPSS version 20 statistical packages. RESULT: A total of 386 pregnant women participated with a response rate of 97%, and 222 (57.5%) of them had full knowledge about the three critical modes of HIV transmission from mother to child, but only 67 (17.4%) knew the possible prevention methods. Knowledge on MTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (adjusted odd ratio [AOR] =2.86, 95% confidence interval [CI] =1.54-5.32), women who had a favorable attitude to provider-initiated HIV counseling and testing (AOR =2.19, 95% CI =1.22-3.92), and women who did not expect any partner's reaction to positive HIV test result after testing (AOR =1.58, 95% CI =1.01-2.49). Correspondingly, knowledge on PMTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (AOR =2.64, 95% CI =1.24-5.65), women who had favorable attitude toward provider's counseling and testing (AOR =4.27, 95% CI =1.95-9.34), and women who did not expect any partner's reaction to positive HIV test result after testing (AOR =3.56, 95% CI =1.58-8.01). CONCLUSION: Knowledge on MTCT and its prevention among women is low in the study area. We recommend more efforts to be exerted on improving women's knowledge of PMTCT of HIV.

Determinants for tuberculosis in HIV-infected adults in Northwest Ethiopia: a multicentre case-control study.

OBJECTIVE: The objective of this study was to identify determinants for tuberculosis (TB) among HIV-infected adults in Northwest Ethiopia. DESIGN: Case-control study. SETTING: Three hospitals and 10 health centres in Northwest Ethiopia. PARTICIPANTS: A total of 446 individuals consented to participate in the study (150 cases and 296 controls). Cases were HIV-infected adults diagnosed with active TB, and controls were HIV-infected adults without active TB. MAIN OUTCOME MEASURE: The link between TB and determinants was assessed using logistic regression. Determinants were categorised as sociodemographic, host-related, clinical and environmental. RESULTS: Smoking (adjusted OR (AOR) 5.47; 95% CI 2.26 to 13.22), presence of a TB patient in the family (AOR 2.66; 95% CI 1.25 to 5.66), alcohol consumption (AOR 2.49; 95% CI 1.29 to 4.80) and chewing khat (AOR 2.22; 95% CI 1.11 to 4.41) were independent determinants for increased occurrence of TB. Highly active antiretroviral therapy (HAART) (AOR 0.25; 95% CI 0.13 to 0.51), isoniazid preventive therapy (IPT) (AOR 0.22; 95% CI 0.11 to 0.41) and cotrimoxazole preventive therapy (AOR 0.32; 95% CI 0.19 to 0.55) had a protective effect against TB. CONCLUSIONS: HIV-infected adults with substance abuse (tobacco smoking, khat chewing and alcohol) should be prioritised for TB screening. This study reaffirmed that HAART and IPT are some of the best strategies for reducing TB occurrence in HIV-infected adults. These findings provide impetus to intensify tracing of TB household contacts.

Acceptability of provider-initiated HIV testing as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women attending at Public Health Facilities in Assosa town, Northwest Ethiopia.

BACKGROUND: Despite more efforts for prevention of mother to child HIV transmission, still there are problems with provider-initiated HIV testing. This study was done to assess the acceptance rate of provider-initiated HIV testing among antenatal care attendants and its associated factors. METHODS: Institutions based cross sectional study with a sample size of 398 was conducted from February to March 2014 in two health facilities in Assosa town. Proportional allocation of the sample size of health facilities followed by systematic sampling method was done; data were collected using an interviewer administered questionnaire. Bivariate and multivariate regression analysis was employed using SPSS version 20. RESULTS: A total of 386 pregnant women participated with response rate 97 % and 312 (80.8 %) of them accepted provider-initiated HIV testing. The odds of acceptance of provider-initiated HIV testing was higher among rural residents (AOR 4.04; 95 % CI 1.24-13.11) than urban. It was also higher among students (AOR 6.00; 95 % CI 1.45-24.75), merchants (AOR 4.43; 95 % CI 1.18-16.68) and employed women (AOR 2.15; 95 % CI 1.08-4.30) than housewives. Pregnant women who had no stigmatized attitude towards people living with HIV/AIDS were more likely to accept testing (AOR 3.54; 95 % CI 1.23-10.16) than who had a strong stigmatized attitude. In addition, those who planned to disclose their test results from their husbands were higher odd of acceptance (AOR 14.85; 95 % CI 4.60-47.94) than who secreted. CONCLUSION: Acceptance of provider-initiated HIV testing among pregnant women attending for antenatal care services was relatively high. Mothers from urban residence, occupational satus being housewives, stigmatization and not having a plan to disclose the status of test results were negatively affect the acceptance of provider-initiated HIV testing. During counselling sessions, antenatal care providers should focus on barriers of provider-initiated HIV testing such as residence, occupational status, stigmatized attitudes and disclosure status of results of HIV tests.

Fertility desire and associated factors among clients on highly active antiretroviral treatment at finoteselam hospital Northwest Ethiopia: a cross sectional study.

BACKGROUND: The accessibility of antiretroviral treatment changed the lives of persons living with HIV from hopelessness to hopefulness. Thus, many of them decided to have children. In Ethiopia, where there is high prevalence of HIV, level of fertility desire among persons living with HIV could have significant part in safe motherhood and child health. The aim of this study was to assess the level of fertility desire and identify factors associated with it among clients on highly active antiretroviral treatment at Finoteselam Hospital, Northwest Ethiopia. METHODS: A cross-sectional study design supplemented by in-depth interview was conducted on 422 clients on Highly Active Antiretroviral Treatment from July 1 to August 12, 2013. Structured questionnaire was used to collect the data. Data were entered in to EPi Info version 3.5.1 and exported to SPSS software version 16 for further analysis. Descriptive and summary statistics were computed. Proportions were calculated to estimate fertility desire level. Binary logistic regression model was fitted to identify factors associated with fertility desire. RESULTS: A total of 422 clients were included in the study of which 217 (51.4%) were males. The median age was 33 (IQR = 12) years. A total of 141(33.4%) of clients had desire for having children. Male clients desire children than their female counterparts [AOR = 3.19, 95 % CI: (1.56, 6.51)]. Clients who had no child had more desire for having children than those who had three or more children [AOR = 6.78, 95 % CI: (2.38, 19.27)] and those who had ≤2 years duration on ART had more desire than those with >2 years duration on ART [AOR = 3.64, 95 % CI: (1.74, 7.64)]. Clients who had discussion with ART service provider about sexuality, Fertility desire and family planning had more child desire [AOR = 3.12, 95 % CI: (1.54, 6.32)]. CONCLUSIONS: One third of clients have desire to have a child/children in the future. Male clients and clients who have less than or equal to 2 years ART follow up, with no child and having discussion with ART service provider were associated with increased fertility desire. Guidelines formulated and counseling protocols developed shall consider this desire to achieve their reproductive goals in the healthiest and safest possible manner.

A cross sectional study: latrine coverage and associated factors among rural communities in the District of Bahir Dar Zuria, Ethiopia.

BACKGROUND: Lack of sanitation facilities is a serious health risk and obliges people to practice open defecation, thereby increasing the risk of disease transmission. The aim of this study was to assess latrine coverage and the associated factors among the rural communities in district of Bahir Dar Zuria, Ethiopia. METHODS: A community-based cross-sectional study was conducted on 608 households in district of Bahir Dar Zuria. First, the district was stratified based on the distance from Bahir Dar city. Then, ten kebeles (the smallest administrative units) were selected from the 32 rural kebeles in the district. After the kebeles had been identified, the households were selected by systematic sampling method using existing list of all households as a sampling frame. Intervals (Kth)) for selecting households were determined by dividing the number of households with the sample size allocated for each kebele. After determining the Kth interval, the first household was selected randomly. The next households were identified systematically onwards by adding cumulatively Kth intervals to the first selected household .Data were collected by means of a pretested, standardized questionnaire and observation checklist. Data analysis was carried out using SPSS version 16. RESULTS: Of the 608 households, 355 (58.4%) had pit latrines and only 220 (62.0%) were functional (providing services during data collection). One hundred eighty seven (52.7%) had been constructed two or more years prior to the time of the study and 202 (56.9%) latrines required maintenance. The availability of latrines was twice higher in households with an income of 5000 or more Ethiopian Birr (1USD = 17.5 Ethiopian Birr) per year (adjusted odds ratio [AOR], 1.55; 95% confidence interval [CI], 1.06-2.27) than those who hand an income less than 5000 Birr per year; the availability of latrines was twofold higher in households visited by health professional at least three times a month (AOR, 2.29; 95% CI, 1.33-3.93) than those that received no visits. The latrine coverage was about two times higher in households that were less than 30 minutes walk from a health institution (AOR, 1.57; 95% CI, 1.11-2.22) than households that were over 30 minutes walk. The latrine coverage was lower in households located in distant areas (AOR, 0.53; 95% CI, 0.36-0.77) than in households closer to the city. CONCLUSIONS: Latrine coverage in District of Bahir Dar Zuria was far from the national target of 100%. The availability of latrines was affected by income level, frequency of visits by health workers, walking time from local health institutions, and distance from Bahir Dar. Therefore, it is recommended that the frequency of supportive visits be increased and that special attention be given to households in inaccessible areas.