Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey.

BACKGROUND: Stunting or chronic undernutrition is a significant public health problem in Ethiopia. In 2019, 37% of Ethiopian children under-5 were stunted. Stunting results from a complex interaction of individual, household and social (environmental) factors. Improving the mother's overall care is the most important determinant in reducing the stunting levels in developing countries. We aimed to determine the most important maternal factors associated with stunting and quantify their effects. METHODS: This study used data from the nationally representative 2016 Ethiopian Demographic Health Survey (EDHS). Common maternal factors were first selected and analyzed using Pearson's chi-square of association followed by multiple logistic regression. To quantify the effect of a unit change of a predictor variable a model for the continuous maternal factors was developed. All analyses were carried out using IBM SPSS© Version 23. RESULTS: Higher maternal educational level, better maternal autonomy, average or above maternal height and weight, having at least 4 antenatal care (ANC) clinic visits, and delivering in a health facility were significantly associated with lower severe stunting levels. Unemployed mothers were 23% less likely (p = 0.003) to have a stunted child compared with employed mothers. Mothers delivering at home had 32% higher odds of stunting (p = 0.002). We found that short mothers (< 150 cm) were 2.5 more likely to have stunted children when compared with mothers above 160 cm. Every visit to the ANC clinic reduces stunting odds by 6.8% (p <  0.0001). The odds of stunting were reduced by 7% (p = 0.028) for every grade a girl spent in school. A unit increase in Body Mass Index (BMI) reduced the odds of stunting by 4% (p = 0.014) and every centimeter increase in maternal height reduced the odds of stunting by 0.5% (p = 0.01). CONCLUSION: Maternal education, number of antenatal care visits, and place of delivery appear to be the most important predictors of child stunting in Ethiopia.. Therefore, educating and empowering women, improving access to family planning and ANC services, and addressing maternal malnutrition are important factors that should be included in policies aiming to reduce childhood stunting in Ethiopia.

Ethiopian progress towards achieving the global nutrition targets of 2025: analysis of sub-national trends and progress inequalities.

OBJECTIVES: The World Health Assembly (WHA) developed six global nutrition targets that focus on child and maternal nutrition. The progress made by individual countries is available as a yearly global nutrition report. However, reporting the national progress might mask important sub-national differences. This study aimed to measure the progress of the 11 regions of Ethiopia towards achieving the 2025 WHA targets using average annual reduction rates (AARR). RESULTS: Ethiopia is off-track in meeting the five global nutrition targets studied. The national AARR of stunting is 2.3 against a target of 5.3, for wasting the current AARR is 3.1 against a target of 5.3. The AARR of non-exclusive breastfeeding was 2.1 close to the target of 2.7. Anemia in women of reproductive age increased across all the regions of Ethiopia. The majority of Ethiopian regions were on track to achieving the overweight and exclusive breastfeeding targets by 2025. There is an urgent need to address anemia in Ethiopian women of reproductive age because its prevalence has been increasing. Secondly, the progress to reduce wasting and stunting in children under-5 has not been enough and more work needs to be done if Ethiopia is to achieve the 2025 targets.

What factors are associated with the increase of anemia in Ethiopian children aged 6 to 59 months between 2011 and 2016?

BACKGROUND: In Ethiopia more than half of the children under 5 years are anemic and between 2011 and 2016 anemia in children under-5 increased by 28.7%. This study aimed to analyze this increase in anemia by socio-demographic characteristics. METHOD: This study was a secondary analysis of the data from the Ethiopian Demographic Health Surveys (EDHS) for 2011 and 2016. The increase of anemia was calculated using percentage change. The chi-square test was used to determine the association between anemia and six predictor variables of age, sex, mother's educational level, residence, wealth quintile and region. The strength of association was measured using Cramer's V. RESULTS: Anemia increased in all age groups, both sexes, urban and rural residencies, across all wealth quintiles, all maternal education levels and all regions of Ethiopia except Benishangul Gumuz. The highest increase of anemia was seen among children born to mothers with above secondary education (65.8%), living in urban areas (40.1%), in the lowest wealth quintile (41.5%), and children from Tigray region (42.9%). Severe anemia increased in all age categories except in infants aged 9-11 months. Children of mothers with above secondary educational level had the highest increase of mild and moderate anemia. Severe anemia decreased in the second and middle wealth quintiles whereas it increased in the rest quintiles. Benishangul Gumuz is the only region where mild, moderate, and severe anemia decreased. Pearson's chi-square (χ2) test showed that all the predictor variables except sex were significantly associated with anemia. Although highly significant (p < 0.001) using the chi-square test, Cramer's V showed that residence (V = 0.052-0.066) and maternal education (V = 0.041-0.044) were only weakly associated with anemia. CONCLUSION: Anemia in children under-5 continues to be a severe public health problem in Ethiopia. Benishangul Gumuz region is the only region that was able to reduce the prevalence of all forms of anemia under-5 between 2011 and 2016, consequently other regions of Ethiopia could learn from this experience. The high increase of anemia in children born to mothers with above secondary education and highest wealth quintiles points to poor dietary practices, therefore, community based nutrition education for mothers needs to be strengthened.

Antibiotic consumption study in two hospitals in Asmara from 2014 to 2018 using WHO's defined daily dose (DDD) methodology.

This study compares the antibiotic consumption rates over a period of five years in two hospitals in Eritrea, Orotta National Referral and Teaching Hospital (ONRTH) and Hazhaz Zonal Referral Hospital (HZRH). Antibiotic consumption is an important parameter in the study of antibiotic use. However, no published data on consumption rates exist for these two hospitals, thus the aim of the study is to measure and compare a five year antibiotic consumption trends of the two hospitals' medical wards using Defined Daily Dose per 100 bed-days (DDD/100-BD). Antibiotics dispensed from January 2014 to December 2018 were considered. Non-parametric Pearson's correlation coefficient was used for comparison of consumption, while non-parametric Friedman's test measured annual rates. The total antibiotic consumption in the HZRH was almost double that of ONRTH. The analysis showed that antibiotic consumption in ONRTH was significantly decreased from 2014 to 2018 while there was no significant difference in consumption in HZRH. Benzyl penicillin was the most consumed antibiotic in HZRH and ONRTH throughout the study period at 87.8DDD/100-BD and 35.4 DDD/100-BD respectively. Ceftriaxone and ciprofloxacin were among the most commonly consumed antibiotics in both hospitals. Establishment of Antibiotic stewardship program would benefit both hospitals greatly, and further studies need to be done to establish the national antibiotic consumption baseline.

Assessment of completeness and legibility of handwritten prescriptions in six community chain pharmacies of Asmara, Eritrea: a cross-sectional study.

BACKGROUND: Incompleteness and illegibility of prescriptions are prescription errors that account for a high proportion of medication errors that could potentially result in serious adverse effects. Thus, the objective of this study was to assess the completeness and legibility of prescriptions filled in the community chain pharmacies. METHODS: An analytical and cross-sectional study was conducted in the six government owned community chain pharmacies of Asmara, Eritrea from June 3rd to 10th, 2019 using a stratified random sampling technique. A total of 385 prescriptions were analyzed for completeness and legibility by three pharmacists (two experienced and one intern pharmacist). Descriptive statistics and multinomial logistic regression were employed using IBM SPSS® (Version 22). RESULTS: A total of 710 drugs were prescribed from the 385 prescriptions assessed. On average, a prescription was found to have 78.63% overall completeness. In the majority of the prescriptions, patient's information such as name, age, sex, and prescriber's identity were present. Prescribed drugs' information such as dose, frequency and quantity and/or duration were present in 83.7, 87.7, and 95.1% respectively. Moreover, generic names were used in 83.3% of the drugs prescribed. About half (54.3%) of the prescriptions' legibility were classified in grade four (clearly legible) and 30.6% in grade three (moderately legible). It was observed that legibility significantly increased with an increase in percentage completeness (rs = 0.14, p = 0.006). However, as the number of drugs written in brand name increased, legibility decreased (rs = - 0.193, p < 0.001). Similarly, as the number of drugs prescribed increased, legibility decreased (rs = - 0.226, p < 0.006). CONCLUSION: Majority of the handwritten prescriptions received in the community pharmacies of Asmara are complete and clearly legible.

Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study.

Background: Antibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines. Methods: A prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22). Results: The average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71-5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10-2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35-3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62-2.52). Conclusions: This study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20-26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4-24.0%. Patients' age, gender and number of medicines were significantly associated with antibiotic prescribing.

Evaluation of ceftriaxone use in the medical ward of Halibet National Referral and teaching hospital in 2017 in Asmara, Eritrea: a cross sectional retrospective study.

BACKGROUND: Antibiotic resistance due to overuse of antimicrobials is an issue that has been of concern to many health institutions and society in general. Resistant infections have high impact in low income countries since they can't afford more recent and expensive antibiotics. Studies that evaluate antibiotic use in hospitals are scarce in Eritrea. Ceftriaxone is commonly available in Halibet National Referral and teaching hospital (HNRTH). Resistance to this antibiotic would have a great impact on the hospital since there is no other available third generation cephalosporin or higher classes of antibiotics. METHOD: A retrospective cross sectional design was used to evaluate the use of ceftriaxone in patients admitted to the medical ward in 2017. Clinical card number of inpatients who took ceftriaxone was extracted from the database of the Satellite Pharmacy Department of HNRTH and collected using a standardized data collection form. A descriptive analysis was employed and the Statistical package for social sciences (SPSS), version 20 was used for analysis. RESULTS: A total of 120 patients were taking ceftriaxone for various indications. There were 55 (50.5%) males and 54 (49.5%) females. 59.8% of the patients were treated in the range of 0-7 days. The mean age was 56 (SD: 20.7). On average patients were under treatment for 6 days. The proportion of patients taking ceftriaxone was 11.43% out of all admissions in the medical ward. One, two or three antibiotics were co-prescribed with ceftriaxone in 39.4%. The most commonly co-prescribed antibiotic was gentamycin, accounting for 16.4% of the co-administered antibiotics. The most common indications for ceftriaxone were pneumonia, sepsis, TB, and CHF. Ceftriaxone therapy was appropriate in 30 (27.5%) cases and 68 (62.4%) cases were inappropriate in any of the four parameters of assessment used. CONCLUSION: Inappropriate use of ceftriaxone was found to be high in the hospital. This calls for establishment of hospital and national guidelines of antimicrobial treatment. Moreover drug restriction and antibiotic stewardship implementation in the hospital should be sought to prolong the lives of important drugs like ceftriaxone.

Assessment of inpatient antibiotic use in Halibet National Referral Hospital using WHO indicators: a retrospective study.

OBJECTIVE: Inappropriate use of antibiotics in primary care and hospital settings is a major contributing factor to the spread of antibiotic resistance. Many microorganisms were tested in Eritrea and have proven resistant to ampicillin. The aim of this study was to investigate the prescription pattern, hospital indicator and patient care indicator of antibiotics among hospitalized patients in Halibet National Referral Hospital, Asmara, Eritrea. RESULTS: The data on prescription patterns showed 79% of hospitalizations had at least one antibiotic prescribed and on average 1.29 antibiotics were prescribed per hospitalization; prescribing using generic name was at 97%; all (100%) of the antibiotics were prescribed from the Eritrean National List of Medicines. On average an antibiotic was prescribed for 6.36 days (SD = 6.06). Ampicillin was the most commonly prescribed antibiotic (42.1%) and parenteral was the most common route prescribed (81.4%). The data on hospital indicators showed key antibiotics were out of stock on average for 78.18 days; 87.5% of key antibiotics were available on the day of the study. The data on patient care indicator showed patients taking antibiotics stayed in the hospital for 9.97 days (± 7.33 days).