Risky sexual practice and associated factors among adult people living with HIV/AIDS in public hospitals of Kembata Tambaro Zone, Southern Ethiopia: a cross-sectional study.

OBJECTIVE: This study assessed the magnitude of risky sexual practices and associated factors among adult people living with HIV (PLHIV) attending antiretroviral clinics in public hospitals in Kembata Tembaro Zone, southern Ethiopia. DESIGN: A cross-sectional study was conducted. SETTING: A hospital-based study was conducted among adult PLHIV in the Kambata Tambaro Zone, southern Ethiopia. PARTICIPANTS: 300 men and women aged 15 years and older who had been receiving HIV/AIDS care and support in four public hospitals participated in this study. STUDY OUTCOME: Risky sexual practice was the study outcome. It was defined based on responses to four items: multiple sexual partnerships, casual sex, consistent condom use and sex under the influence of alcohol. Risky sexual practice was defined based on a 'yes' response to any of the four items. RESULTS: Of the adult PLHIV who were sexually active in the 6 months preceding the survey, 75.7% (95% CI: 70.5% to 80.2%) engaged in at least one risky sexual practice, with 3.3% (95% CI: 1.8% to 6.1%) engaged in three or more. A positive attitude towards condom use and being on antiretroviral therapy for over 10 years were correlated with low odds of risky sexual practices. There was a higher likelihood of risky sexual behaviour among those who kept their HIV status secret and did not bring up using a condom before sexual contact. Whereas, those with a positive attitude towards condom use had a reduced risk of engaging in risky sexual practices. CONCLUSION: A considerable proportion of adult PLHIV engage in risky sexual practices. Efforts directed at removing barriers to disclosing HIV status to partners and promoting condom use discussion among sexual partners could reduce the burden of risky sexual practices and the onward transmission of HIV.

The association between HIV diagnosis disclosure and adherence to anti-retroviral therapy among adolescents living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis.

INTRODUCTION: Nine in ten of the world's 1.74 million adolescents living with human immunodeficiency virus (ALHIV) live in Sub-Saharan Africa. Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are important problems among adolescents. To guide intervention efforts in this regard, this review presented pooled estimates on the prevalence of adherence and how it is affected by disclosure of HIV status among ALHIV in Sub-Saharan Africa. METHODS: A comprehensive search in major databases (Excerpta Medica database (EMBASE), PubMed, Ovid/MEDLINE, HINARI, and Google Scholar) with additional hand searches for grey literature was conducted to locate observational epidemiologic studies published in English up to November 12, 2022 with the following inclusion criteria: primary studies that reported disclosure of HIV status as an exposure variable, had positive adherence to ART as an outcome, and conducted among adolescents and children. The COVIDENCE software was used for a title/abstract screening, full-text screening, the JBI quality assessment checklist, and data extraction. Random effects model was used to pool estimates. Furthermore, sensitivity analysis and subgroup analysis were also conducted by age groups and type of adherence measures used. RESULTS: This meta-analysis combines the effect estimates from 12 primary studies with 4422 participants. The prevalence of good adherence to ART was 73% (95% CI (confidence interval): 56 to 87; I2 = 98.63%, P = <0.001), and it was higher among adolescents who were aware of their HIV status, 77% (95% CI: 56 to 92; I2 = 98.34%, P = <0.001). Overall, knowledge of HIV status was associated with increased odds of adherence (odds ratio (OR) = 1.88, 95% CI: 1.21 to 2.94; I2 = 79.8%, P = <0.001). This was further supported in a subgroup analysis by age (seven studies, pooled OR = 1.89, 95% CI: 1.06 to 3.37; I2 = 81.3%, P = <0.0001) and whether primary studies controlled for confounding factors (six studies provided adjusted estimates, pooled OR = 2.61, 95% CI: 1.22 to 5.57; I2 = 88.1%, P = <0.001) confirmed this further. CONCLUSIONS: Our meta-analysis and systematic review revealed that knowledge of one's HIV status was associated with adherence to ART, particularly among adolescents. The findings underscored the importance of encouraging disclosure in order to enhance adherence among adolescents.

Prevalence of hepatitis B infection and its associated factors among pregnant mothers attending antenatal care at public hospitals at Hararghe, Eastern Ethiopia.

Background: Hepatitis B infection is one of the world's most serious public health problems, causing significant morbidity and mortality. More than 2 billion individuals around the world have been infected with the hepatitis B virus (HBV), and approximately 400 million people are chronically infected with the virus, with more than a million dying each year from hepatitis B virus-related liver disease. A newborn infant whose mother is positive for both HBsAg and HBeAg has a 90% chance of developing chronic infection by the age of 6. Its infectivity is a 100 times that of the human immunodeficiency virus, but it receives little attention in public health. Therefore, this study was conducted to assess the prevalence of hepatitis B infection and its associated factors among pregnant mothers attending antenatal care at public hospitals in west Hararghe, eastern Ethiopia 2020. Method: This institution-based cross-sectional study was conducted on 300 pregnant mothers selected by systematic random sampling from September to December 2020. Data were collected by face-to-face interview using a pretested structured questionnaire. A blood sample was collected and tested for hepatitis B surface antigen using the enzyme-linked immunosorbent assay test method. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Science version 22 for analysis. Bivariate and multivariable logistic regressions were used to assess the association between outcome and predictor variables. P-value <0.05 was considered to be statistically significant. Results: The overall seroprevalence of hepatitis B virus infection was 8% [95% confidence interval (CI): 5.3-11.0] among pregnant mothers. History of tonsillectomy [adjusted odd ratio (AOR) = 5.7; 95% CI: 1.3-23.9], tattoo (AOR = 4.3; 95% CI: 1.1, 17.0), having multiple sexual partners (AOR = 10.8; 95% CI: 2.5, 45.9), and history of contact with jaundiced patients (AOR = 5.6; 95% CI: 1.2, 25.7) were factors associated with the seroprevalence of hepatitis B virus infection among pregnant mothers. Conclusion: The hepatitis B virus was highly prevalent. A history of tonsillectomy, tattooing, having multiple partners, and contact with jaundiced patients were factors associated with hepatitis B virus infection. To reduce HBV transmissions, the government should increase HBV vaccination coverage. All newborns should receive the hepatitis B vaccine as soon as possible after birth. It is also recommended that all pregnant women have HBsAg testing and antiviral prophylaxis to reduce the risk of transmission from mother to child. Hospitals, districts, regional health bureaus, and medical professionals should also educate pregnant women about hepatitis B virus transmission and prevention, both in the hospital and in the community, with a focus on modifiable risk factors.

Antiretroviral therapy non-adherence among children living with HIV in Dire Dawa, Eastern Ethiopia: a case-control study.

BACKGROUND: In 2018, nearly 90% of the global children living with human immunodeficiency virus (HIV) were in sub-Saharan Africa (SSA). Compared to the adult population, antiretroviral therapy (ART) coverage among children was limited. However, adherence remained a problem among children though they had limited access to ART. This study was conducted to identify the risk factors of non-adherence to ART among children aged 6 to 17 years. METHODS: This case-control study was conducted in 2020 using data obtained from clinical record reviews and self-reported data from 272 caregivers of HIV-infected children aged 6-17 years. Cases and controls represented children with poor versus children with good adherence to ART, respectively. Good adherence was defined based on a past 30-day physician adherence evaluation of taking ≥ 95% of the prescribed doses. Binary logistic regression was used to identify factors associated with non-adherence to ART. All statistical tests are defined as statistically significant at P-values < 0.05. RESULTS: Of the 272 children, for whom data were obtained, 78 were cases and 194 were controls; females accounted for 56.3%, 32% attended secondary school, and for 83.1%, the reporting caregivers were biological parents. Non-adherent children had higher odds of association with the following risk factors: a caregiver who is a current substance user (aOR = 2.87, 95% CI: 1.44, 5.71), using AZT-and ABC-based regimen compared to the TDF-regimen (AZT-based, aOR = 4.12, 95% CI: 1.43, 11.86; ABC-based, aOR = 5.58, 95% CI: 1.70, 18.30), and had an increase in viral load from baseline compared to those remained undetectable (remained at or decreased to < 1000, aOR = 4.87, 95% CI: 1.65, 14.33; remained at ≥ 1000, aOR = 9.30, 95% CI: 3.69, 23.46). In contrast, non-adherent children had 66% lower odds of being at early adolescent age compared to 6-9 years old (10-14 years, aOR = 0.34, 95% CI: 0.12, 0.99) and had 70% lower odds of being aware of their HIV status (aOR = 0.30, 95% CI: 0.13, 0.73). CONCLUSION: Technical support to caregivers to build disclosure self-efficacy, identifying the appropriate regimen for children, counseling on viral load suppression on subsequent visits, and helping caregivers avoid or reduce substance use may help improve the problem of children's non-adherence to ART.

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia.

Background: Penetrating abdominal injury (PAI) is a public health problem and accounts for significant mortality and disability in both developing and developed countries. It often causes damage to internal organs, resulting in shock and infection. In this study, we assessed the outcomes of PAI and factors associated with post-surgical outcomes including surgical site infection (SSI) and in-hospital death. Methods: An institution-based cross-sectional study was conducted from 15 January to January 30, 2020, using a standard checklist to review the clinical charts of patients who presented to Hiwot Fana Specialized University Hospital (HFSUH) with PAI and underwent laparotomy between January 2015 and September 2019. Descriptive statistics were used to describe the characteristics of patients, and odds ratios (ORs) with a 95% confidence interval (CI) were reported for factors included in binary logistic regression. The statistical significance was declared at a P-value <0.05. Results: A total of 352 charts of patients with PAI were reviewed. A majority of them (84.9%) were males and the mean age was 26.5 years. The anterior abdomen was the most common site of injury, accounting for 285 patients (81%), 329 patients (93.5%) suffered organ injury, 204 (62%) had a single organ injury, and 125 (38%) had more than one organ injury. The leading injured organs were small intestines 194 (55.1%), followed by the colon 88 (25%) and liver 40 (11.4%). The magnitude of SSI and hospital death was 84 (23.9%) and 12 (3.4%), respectively. Patients above 45 years of age (AOR = 2.9, 95% CI: 1.2, 9.2), with fluid collection (AOR = 2.7, 95% CI: 1.2, 5.9), colostomy (AOR = 3.9, 95% CI: 1.9, 7.8), body temperature >37.5 °C (AOR = 3.8,95% CI:1.9,7.6), and Hgb < 10 mg/dl (AOR = 7.4, 95% CI: 3.4,16.1) had a higher likelihood of SSI. Those patients admitted to the intensive care unit (AOR = 21.3, 95% CI: 1.1, 412.3) and who underwent damage control surgery (AOR = 9.6, 95% CI: 1.3, 73.3) had a higher likelihood of mortality. Conclusions: SSI and death among patients with PAI were high. Age, fluid collection, colostomy, body temperature, and hemoglobin level were statistically associated with SSI, and intensive care unit and damage control surgery were statistically associated with death. Therefore, health professionals working in surgical wards should consider these factors to alleviate SSI and prevent death. Broadly speaking, the guidelines of the World Society of Emergency Surgery (WSES) should consider these factors in their recommendations.

Prevalence of overweight/obesity and associated factors among under-five children in Ethiopia: A multilevel analysis of nationally representative sample.

Background: Childhood overweight and obesity are emerging public health challenges of the twety-first century. There was a 24% increase in the number of overweight children under the age of 5 years in low-income countries. Despite the significant risk of childhood overweight/obesity for non-communicable diseases, premature death, disability, and reproductive disorders in their adult life, little attention has been given. Therefore, we aimed to assess the prevalence of overweight/obesity and associated factors among under-five children. Methods: This study was conducted using data from a nationally representative sample of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). The Mini EDHS was a community-based cross-sectional study that covered all the administrative regions of Ethiopia. The data collection was conducted between March 21, 2019 and June 28, 2019. Both descriptive and analytic findings were produced. The overweight/obesity was measured by the weight-for-height (WFH) index, more than two standard deviations (+2 SD) above the median of the reference population based on the BMI Z-score. To identify significantly asso. Results: A total of 5,164 under-five children were included in this study cited factors of overweight/obesity, a multilevel binary logistic regression model was fitted to account for the hierarchical nature of the data. Adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI) was reported to show the strength of association and statistical significance. The overall prevalence of overweight/obesity was 2.14% (95% CI: 1.74-2.53). The odds of overweight/obesity was higher among children aged <6 months (aOR = 5.19; 95% CI: 2.98-9.04), 6-24 months (aOR = 1.97; 95% CI: 1.18-3.29), delivered by cesarean section (aOR = 1.75; 95% CI: 1.84-3.65), living in Addis Ababa city (aOR = 2.16; 95% CI: 1.59-7.81), Oromia region (aOR = 1.93; 95% CI: 1.71-5.24), having mothers with the age 40-49 years (aOR = 3.91; 95% CI: 1.90-16.92), uses traditional contraceptive methods (aOR = 2.63; 95% CI: 1.66-10.47) and households headed by male (aOR = 1.71; 95% CI: 1.84-3.48). Conclusion: This study showed that the prevalence of overweight/obesity among under-five was low in Ethiopia. There were several factors that affect childhood overweight/obesity including child age, maternal age, mode of delivery, sex of head of household, contraception use, and geography of residence. Therefore, strategies to reduce childhood overweight and obesity should consider an identified multitude of contributing factors.

Sexual and reproductive health services utilization and associated factors among adolescents attending secondary schools.

BACKGROUND: Sexual and reproductive health (SRH) is referring to physical and emotional wellbeing and includes the ability to be free from unwanted pregnancy, unsafe abortion, sexually transmitted infections including HIV/AIDS, and all forms of sexual violence and coercion. SRH is the main services packages that prevent and reduce adolescent reproductive health risks and problems. While the government of Ethiopia has undertaken several measures to improve SRH services, there was limited data on utilization among adolescents and associated factors. OBJECTIVE: To assess utilization of SRH services and associated factors among adolescents attending secondary schools in Haramaya District, Eastern Ethiopia. METHODS: A school-based cross-sectional study was conducted among adolescent students aged 15-19 years. A total of 692 adolescents were selected using a multi-stage sampling from two randomly selected secondary schools, each from rural and urban settings, in Haramaya district where 642 provided complete data and included in the analysis. A structured, pretested, and self-administered questionnaire was used to collect data. Data entry was conducted using Epi Data version 3.1 and exported to STATA version 16 for analysis. Bivariable and multivariable binary logistic regression were used to identify factors associated with school adolescents' utilization of SRH. Statistically significant associations are declared at P-value < 0.05. RESULT: A total of 642 completed the survey questionnaire, constituting a response rate of 92.7% (642/692). Male adolescents accounted 63.7% and the mean age of respondents was 17.71 years. Among those who completed the survey, 23.5% (95% CI: 20-26.8) utilized SRH services. Adolescents who were exposed to SRH information (adjusted odds ratio (AOR) = 2.11, 95% CI: 1.22-3.6), aware of SRH service providing facility (AOR = 1.83, 95% CI: 1.12-3.0) and SRH service components (AOR = 2.76, 95%, CI: 1.53-4.97), and distance from SRH facilities (AOR = 2.28, 95%, CI: 1.13-4.62) were significantly associated with the utilization of SRH services. CONCLUSION: Nearly one-in-four secondary school adolescents (23.5%) utilized SRH services. Targeted promotion of SRH providing facilities and SRH service components aimed at awareness creation could improve adolescents' utilization of SRH services. Improved SRH services utilization among adolescents who were far from SRH services providing facilities needs further investigation.

BACKGROUND: Sexual and reproductive health (SRH) refers to physical and emotional wellbeing and includes the ability to be free from unwanted pregnancy, unsafe abortion, sexually transmitted infections including HIV/AIDS, and all forms of sexual violence and coercion. Components of the SRH services are important to reduce adolescent reproductive health risks and problems. This paper reports on the frequency of in-school adolescents who utilized SRH services and the factors that determined it. METHODS: we collected data from 642 in-school secondary school adolescents, aged 15­19 years, in Haramaya district, East Ethiopia. The data were collected from two schools, one from rural and the other from urban areas, using lottery method from the available schools in the district. A face-to-face interview was conducted to obtain data from the adolescents in the selected secondary schools. RESULT: Out of 642 in-school adolescents, 23.5% utilized SRH services in Haramaya District. Adolescents who previously received SRH information, who knew SRH services providing facility, aware of SRH service components, and those who live not close to the SRH facilities were utilized the SRH services more often compared to their friends. CONCLUSION: Nearly one-in-four secondary school adolescents (23.5%) utilized SRH services. Targeted promotion of SRH providing facilities and SRH service components aimed at awareness creation could improve adolescents' utilization of SRH services.

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study.

BACKGROUND: Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility. METHODS: A total of 402 patient cards of TB patients who received care were reviewed from March 1-30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05. RESULTS: A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15-15.53). The incidence rate ratio was 12.19 (95% CI: 5.01-35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care. CONCLUSIONS: LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment.

Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study.

Tuberculosis (TB) remains a major medical and public health problem throughout the world, especially in developing countries including Ethiopia. Its control program is currently being challenged by the spread of drug-resistant TB, which is the result of poor treatment outcomes. Hence, this study assessed poor adult TB treatment outcomes and associated factors in Gibe Woreda, Southern Ethiopia. An institution-based cross-sectional study was conducted from March 1, 2020 to March 30, 2020, using a standard checklist to review clinical charts of TB patients who enrolled on first-line TB treatment under DOTS between June 2016 and June 2019. Poor treatment outcomes constituted death during treatment, treatment failure, and loss to follow-up (LTFU). Descriptive statistics were used to describe the characteristics of study participants. A binary logistic regression model was fitted to identify factors influencing treatment outcome and adjusted odds ratios with a 95% confidence interval were reported. The statistical significance of all tests in this study was declared at P-value <5%. A total of 400 adult TB patients were participated. The mean age of study participants was 39.2±16.7 years, 55.5% were males and 79.8% were pulmonary tuberculosis cases. Regarding the treatment outcomes, 58% completed treatment, 27.5% cured, 9.3% were LTFU, 3.2% died, and 2.0% failed. The overall poor treatment outcome was 14.5% (95% CI: 11.1-17.9). Age (aOR = 1.02; 95%CI: 1.01-1.04), male gender (aOR = 1.82; 95% CI: 0.99-3.73), travel ≥ 10 kilometres to receive TB treatment (aOR = 6.55; 95% CI: 3.02-14.19), and lack of family support during the course of treatment (aOR = 3.03; 95% CI: 1.37-6.70), and bedridden baseline functional status (aOR = 4.40; 95% CI: 0.96-20.06) were factors associated with poor treatment outcome. Successful TB treatment outcome in this study area was below the national TB treatment success rate. To improve positive treatment outcomes, remote areas should be prioritized for TB interventions, and stakeholders in TB treatment and care should give special emphasis to adults over the age of 45 years, males, those who travel more than 10 kilometres to receive TB care, having bedridden baseline functional status and those who had no family support.

Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study.

BACKGROUND: Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. METHODS: We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. RESULTS: We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio (aHR = 1.96; 95% CI: 1.92-4.00)), rural residence (aHR = 1.98; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms (aHR = 2.19; 95% CI: 1.11-4.37), a fair level of adherence (aHR = 11.5; 95% CI: 2.10-61.10), and a poor level of adherence (aHR = 12.03; 95% CI: 5.4-26.7). CONCLUSIONS: In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.

Post cesarean section surgical site infection and associated factors among women who delivered in public hospitals in Harar city, Eastern Ethiopia: A hospital-based analytic cross-sectional study.

BACKGROUND: Cesarean section (CS) is often complicated by surgical site infection (SSI) that may happen to a woman within 30 days after the operation. This study was conducted to estimate the prevalence of SSI and identify the factors associated with SSI. METHODS: A hospital-based analytic cross-sectional study was conducted based on the review of medical records of 1069 women who underwent CS in two public hospitals in Harar city. The post-CS SSI is defined when it occurred within 30 days after the CS procedure. Factors associated with SSI were identified using a multivariable binary logistic regression analysis. The analysis outputs are presented using an adjusted odds ratio (aOR) with a corresponding 95% confidence interval (CI). All statistical tests are defined as statistically significant at P-values<0.05. RESULTS: The prevalence of SSI was 12.3% (95% confidence interval (CI): 10.4, 14.4). Emergency-CS was conducted for 75.9% (95% CI: 73.2, 78.3) of the women and 13.2% (95% CI: 11.3, 15.4) had at least one co-morbid condition. On presentation, 21.7% (95% CI: 19.3, 24.3) of women had rupture of membrane (ROM). Factors significantly and positively associated with post-CS SSI include general anesthesia (aOR = 2.0, 95%CI: 1.10, 2.90), ROM (aOR = 2.27, 95%CI: 1.02, 3.52), hospital stay for over 7 days after operation (aOR = 3.57, 95%CI: 1.91, 5.21), and blood transfusion (aOR = 4.2, 95%CI: 2.35, 6.08). CONCLUSION: The prevalence of post-CS SSI was relatively high in the study settings. Screening for preoperative anemia and appropriate correction before surgery, selection of the type of anesthesia, close follow-up to avoid unnecessary prolonged hospitalization, and careful assessment of membrane status should be considered to avoid preventable SSI and maternal morbidity.

Gender Differences in Perceived Stigma and Coping Strategies Among People Living with HIV/AIDS at Jugal Hospital, Harar, Ethiopia.

BACKGROUND: HIV/AIDS is among the most devastating diseases, having multiple effects on the health and well-being of people living with HIV/AIDS (PLWHA). There is a paucity of studies that examined the gender differences in perceived stigma among PLWHA and the different coping strategies that they use in Ethiopia. OBJECTIVE: To assess the gender differences in perceived stigma and coping strategies among PLWHA. METHODS: A comparative cross-sectional study was conducted at Jugal Hospital, Harar, eastern Ethiopia from May 01 to July 30, 2018. A total of 412 (206 females and 206 males) PLWHA were included. Face-to-face interviewer-administered data were collected. Perceived HIV stigma was assessed using the Berger HIV stigma scale. Similarly, the coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (Brief COPE) scale. The data were analyzed using STATA version 13. RESULTS: The mean Berger stigma scale score was 65.3±11.3. The overall perceived stigma mean score was not statistically different between males and females (64.8±10.8 vs 65.8±11.7, p=0.407). Among the four subscales, women reported a higher level of disclosure stigma than men (21.1±5.5 vs 20.3±5.5; p=0.006). Regarding maladaptive coping strategies, men often used substances compared to women (2.8±1.5 vs 2.1±0.4; p<0.001). However, women use behavioral disengagement (4.6±1.1 vs 4.2±1.1; p=0.002) and self-distraction (5.9±1.5 vs 5.5±1.7; p=0.019) more often than men. Females used a higher level of adaptive coping strategies compared to males (42.5±4.9 vs 40.9±6.3, p=0.005). Furthermore, females were found to use more emotional-focused coping than males (27.6±3.2 vs 26.4±4.0; p<0.001). CONCLUSION: Women reported a higher level of disclosure stigma than men and the types of coping strategies used vary between male and female. Thus, interventions to support PLWHA must take into account the gender differences in terms of perceived stigma.

Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study.

OBJECTIVE: Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia. METHODS: Data from a total of 872 randomly sampled adults aged 25-64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05. RESULTS: 14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25-64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus. CONCLUSION: The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient's adherence to medications and promote diabetes self-care management.

The association between diagnosis disclosure and adherence to antiretroviral therapy among adolescents living with HIV in sub-Saharan Africa: a protocol for systematic review and meta-analysis.

INTRODUCTION: More than eight in ten of the world's 1.65 million adolescents living with human immunodeficiency virus (ALHIV) live in sub-Saharan Africa (SSA). Suboptimal adherence to antiretroviral therapy (ART) and poor viral suppression are reported among ALHIV which may in turn compromise the gains achieved so far. The evidence on whether knowing one's own human immunodeficiency virus (HIV) status and self-disclosure to others benefit adherence to ART or not is inconclusive. This review aims to estimate the association between knowing one's HIV status and self-disclosure on adherence to ART among ALHIV in SSA. METHODS: Comprehensive search strings will be used to identify relevant observational studies published in English up to May 2020 in major databases: Excerpta Medica database (EMBASE), PubMed, and Ovid/MEDLINE. To access African studies and also to freely access subscription-based articles, the African Index Medicus (AIM) and the WHO HINARI databases will be searched. The AfroLib database will be searched to access the gray literature of African studies. We will use the COVIDENCE software for title/abstract screening, full-text screening, quality assessment, and data extraction. Two authors will independently screen retrieved articles, and a third author authorized to resolve conflicts will handle disagreements. The Joanna Briggs Institute's (JBI) critical appraisal tools will be used to assess study quality. Appropriate statistical tests will be conducted to quantify the between studies heterogeneity and for the assessment of publication bias. We will check individual study influence analysis and also do subgroup analysis. The STATA version 14.2 will be used for statistical analysis. DISCUSSION: A high-level adherence to ART is required to achieve adequate viral suppression and improve quality of life. Consequently, the evidence on how adherence to ART differs with knowledge of one's own HIV status and self-disclosure may help guide interventions aimed at improving adherence to ART.

Clustering of Elevated Blood Pressure, Elevated Blood Glucose, and Abdominal Obesity Among Adults in Dire Dawa: A Community-Based Cross-Sectional Study.

BACKGROUND: Evidence shows that the presence of a single component of the metabolic syndrome (MetS) increases the risk of developing the MetS later in life. This study estimated the prevalence and associated factors of abdominal obesity, elevated blood pressure, elevated blood glucose, and the 3-factor MetS components among urban adults in Dire Dawa, East Ethiopia. METHODS: Community-based cross-sectional data were collected from 872 adults aged 25-64 years. The joint interim statement (JIS) was used to define the MetS components. The dependent outcome variables were both the individual and the 3-factor MetS components. A robust variance Poisson regression model was used to directly estimate the prevalence ratio (PR) of risk factors. RESULTS: The prevalence of the 3-factor MetS components (abdominal obesity, elevated blood pressure, and elevated blood glucose) was 9.5% (95% CI: 7.7, 11.7). Women had two times higher prevalence of the 3-factor MetS components compared with men, 11.6% (95% CI: 9.2, 14.5) vs 5.2% (95% CI: 3.2, 8.5). A higher prevalence of abdominal obesity, 46.4% (95% CI: 43.1, 49.8), followed by a raised blood pressure, 42.7% (95% CI: 39.4, 46.0), was observed among study subjects. The presence of a single MetS component had an associated cluster of other components: 33.7% of subjects with elevated blood glucose, 22.3% with elevated blood pressure, and 20.5% with abdominal obesity had also the 3-factor MetS components. Age, sex, body mass index, waist circumference, and physical activity were significantly associated with the individual components or the 3-factor MetS components. CONCLUSION: A higher prevalence of the individual components and the presence of clustering with a single factor identified call for the need of community screening. Interventions targeting both abdominal and general obesity through physical activity and lifestyle modification can contribute towards reducing cardiometabolic risk factors with due attention given to women and older adults.

Socio-demographic correlates of availability of adequate iodine in household salt: a community-based cross-sectional study.

OBJECTIVE: This study aimed to assess the availability of adequately iodized salt at a household level and associated factors in Arba Minch town, South Ethiopia using the gold standard technique, the iodometric titration. RESULTS: 41.8% (95% CI (confidence interval) 38.6 to 45.1) of households had inadequately iodized salt, and 9.3% (95% CI 7.5 to 11.4) had an iodine content below 10 ppm (parts per million). Compared to households with a monthly income of greater than 2000 ETB (Ethiopian Birr), households with a monthly income between 1000 ETB to 2000 ETB (adjusted odds ratio (AOR) = 0.52, 95% CI 0.390.36 to 00.77) and main food handlers aged 30 years or above compared to those aged less than 20 years of age (aOR = 0.55, 95% CI 0.34 to 0.91) had higher odds of having adequately iodized salt. Food handler's knowledge and practice were not found to be correlated with the availability of adequately iodized salt in household salt.

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017.

BACKGROUND: The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years. METHODS: We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury. RESULTS: Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change. CONCLUSIONS: While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.

Predictors of self-care activities of outpatient diabetic residents in Harar and Dire Dawa: A hospital-based cross-sectional study.

OBJECTIVES: Diabetes mellitus is a metabolic disorder of major public health importance due to its prevalence and potential health complication. The success of long-term maintenance therapy of diabetes patients depends largely on their ability to adherence to self-care practices. Africa's most populous country, Ethiopia, has the highest burden of diabetes mellitus. However, studies on self-care activities of diabetic patients are limited. Therefore, this study measures the level of self-care activities of diabetic patients in a follow-up clinic of public hospitals in Harar and Dire Dawa, Eastern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted on 320 randomly selected diabetic patients in Harar and Dire Dawa. A standard diabetic self-care activity interview tool was used to collect the data. Data were entered into Epi-data v 3.1 and STATA v 14.2 was used for analysis. Our outcome variable, self-care activities, has three ordered categories and a robust Ordinal logistic regression was used to identify predictors. All statistical tests with p-value <0.05 were considered as statistically significant. RESULTS: The self-care activities of study participants were rated good for 38.1% (95% confidence interval: 32.94, 43.60). Being rural residents (adjusted odds ratio = 0.38, 95% confidence interval: 0.17, 0.82), attended secondary education (adjusted odds ratio = 2.96, 95% confidence interval: 1.51, 5.78), uncontrolled blood glucose (adjusted odds ratio = 1.68, 95% confidence interval: 1.02, 2.79), and had diabetic complications (one, adjusted odds ratio = 1.91, 95% confidence interval: 1.08, 3.38; two or more, adjusted odds ratio = 4.71, 95% confidence interval: 1.81, 12.25) were significantly associated with the better diabetes mellitus self-care activities. CONCLUSION: Significant number of diabetes mellitus patients living in rural areas did not adhere to diabetic self-care activities. This is more evident among participants who have limited or no formal education and patients with controlled blood glucose level. Therefore, individualized diabetic lifestyle education programs in follow-up clinics should target these population groups to improve self-care.

Level of physical activity among urban adults and the socio-demographic correlates: a population-based cross-sectional study using the global physical activity questionnaire.

BACKGROUND: Globally, in 2016, 23.3% of adult populations were physically inactive, and it accounts for 9% of the global premature mortality. However, evidence on the level of physical activity was limited in resource-poor settings. This study, therefore, assessed the adult's level of physical activity and its correlates among the urban population in Dire Dawa, eastern Ethiopia. METHODS: A total of 872 randomly selected adults of age 25-64 years in Dire Dawa city, eastern Ethiopia, are included in this analysis. The Global Physical Activity Questionnaire (GPAQ) is used to measure physical activity. Individuals are considered physically active when they achieved metabolic equivalent tasks (MET) minutes of 600 or more per week, and otherwise inactive. A binary logistic regression is used to identify the correlates of physical activity. RESULTS: 54.9% (95% confidence interval (CI) 51.6 to 58.2) of adults were physically active, with a higher proportion of men being physically active than women, 63.9% (95% CI 58.1 to 69.3) versus 50.6% (95% CI 46.5 to 54.6). Among the adults who reported doing physical activity, the highest domain-specific contribution to the total physical activity was from activities at workplaces, and leisure-time activities contributed the least. The proportion of adults who engaged in a high-level physical activity was 37.0% (95% CI 33.9 to 40.3). Male adults were 1.45 times (aOR (adjusted odds ratio) =1.45; 95% CI 1.05 to 1.99) more likely to achieve the recommended level of physical activity. In contrary, unemployed adults (aOR = 0.51; 95% CI 0.35 to 0.75) were less likely to perform the recommended level of physical activity to accrue health benefits. CONCLUSION: Interventions aimed at promoting physical activity should target unemployed and female adults. We recommend further study to explore the contextual factors that hinder physical activity in the study setting.

Prevalence of Hypertension and Associated Factors in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Hypertension is a major cardiovascular risk factor that is linked with fatal complications and is an overwhelming global challenge. Primary prevention is a key to control hypertension with identification of major risk factors. This study was aimed at assessing the prevalence and factors associated with hypertension. METHODS: Community-based cross-sectional study was conducted among 903 adults aged 25 to 64 years in Dire Dawa City, East Ethiopia. Data were collected using World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) for non-communicable disease (NCD) standard survey tool. Multivariate logistic regression models were used to identify relative effects of distal, proximal, and immediate risk factors of hypertension, and all statistical tests were declared significantly at P-value<0.05. RESULTS: The average SBP and DBP were 124.98±17.18 mmHg and 78.92±10.13 mmHg, respectively. The prevalence of hypertension was 24.43% (95% CI: 21.57, 27.28). Majority (51.64%) of adults were not aware of their elevated blood pressure status. hypertension was significantly associated with the age group 30-44 (aOR 3.61, 95% CI: 2.0, 6.55), 45-54 (aOR 5.36, 95% CI: 2.62, 10.91), and 55-64 (aOR 9.38, 95% CI: 4.73, 18.59), being unemployed (aOR 1.68, 95%CI: 1.03, 2.77), ever smoking (aOR 1.89, 95% CI: 1.04, 2.23), having abdominal obesity (aOR 1.72, 95% CI: 1.13, 2.64), and BMI≥25 kg/m2 (aOR 1.48, 95%CI: 1.01, 2.15). CONCLUSION: Moderately high prevalence of hypertension was observed among adults in study setting demonstrating a major public health problem. Majority of adults with hypertension in study setting were not aware of their elevated BP status highlighting the burden of the hidden morbidity and subsequent complications. Community level intervention and routine assessment of sociodemographic, behavioral, and biophysiological risk factors, screening, and diagnosis of NCDs should be institutionalized to address the occult burden.