Survival status and risk factors for mortality among multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia: A retrospective follow-up study.

Background: Tuberculosis continues to be a major health concern around the world. It kills an estimated 1.6 million people each year. The World Health Organization (WHO) removed Ethiopia from its list of thirty countries having a high prevalence of MDR/RR-TB in 2021. As a result, the aim of this study was to assess the current context of survival status and risk factors of multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia, in 2022. Methods: An institutional-based retrospective cohort study with 245 patients was undertaken using multidrug-resistant tuberculosis patients who were recruited from January 1st, 2018 to December 30th, 2021, in St. Peter's specialized hospital. To find independent predictors of survival status, Cox regression analysis was used. An adjusted hazard ratio with a 95% confidence interval and a p-value of < 0.05 was used to establish association and statistical significance. Results: The result of the study revealed that the incidence of mortality in this study was 13.1% (95% CI: 10.3-16.5). Moreover, being male (AOR = 3.7: 95% CI = 1.2, 11.4), old age (AOR = 14: 95% CI = 3.0, 60.4), site of TB (AOR = 0.2: 95% CI = 0.03, 0.6), and presence of comorbidity (AOR = 9.2: 95% CI = 2.4, 35.3), were independent predictors of time to death. Conclusion: Generally, the death rate among research participants was high. Moreover, male gender, old age, site of tuberculosis, and presence of other comorbidity were predictors of mortality among MDR-TB patients.

Mothers' health care seeking behavior for neonatal danger sign in southern Ethiopia: Community based cross-sectional study.

BACKGROUND: Over the previous few decades, significant progress has been made in reducing newborn mortality, but the worldwide scale of the problem remains high. A considerable number of newborn death and difficulties owing to neonatal danger signs could be avoided if mothers sought appropriate health care for common neonatal risk indications, according to a number of studies presently underway in Ethiopia. The aim of this study is to assess health care seeking behavior of mothers' in related to neonatal danger signs. METHOD: A community-based cross-sectional study was conducted among 410 participants in Wolaita Sodo, From October 1 to October 30, 2019. To collect data, structured interviewer administered questionnaire was used. Data was coded, cleaned, recoded and entered in to epi-data version 3.1 and transported to SPSS window version 21 for analysis. Multivariable logistic regression was carried out and p-value of less than or equal to 0.05 was considered statistically significant. RESULT: A total of 410 mothers participated in this study, 110 (47.6%) mothers preferred health intuition for their neonate. Husband educational status (AOR = 2.4, 95% CI = 1.1, 5.5), communication media (AOR = 4.3, 95% CI = 2.4, 7.5), place of residence (AOR = 3.5, 95% C.I = 1.9, 6.7), ANC follow up (AOR = 2.8, 95% CI = 1.4, 5.8), and PNC follow (AOR = 1.7, 95% CI = 1.1, 3.1) were all factors that significantly associated with health care seeking practice neonatal dander signs. CONCLUSION: Overall, there was a low degree of health-seeking practice. The educational status of the mother's husband, communication media, residence, ANC follow-up, and PNC follow-up all predicted the mothers' health-care seeking behavior. The study also identifies the Wolaita Zone and Sodo town health offices, the health development army, one to five local community organizations with and health extension workers as key contributors.

Response to COVID-19 recommended preventive behavioral messages among Guraghe zone communities, South Ethiopia: using constructs of the Extended Parallel Process Model (EPPM).

INTRODUCTION: The World Health Organization declared COVID-19 is a pandemic disease. Countries should take standard measures and responses to battle the effects of the viruses. However, little is known in Ethiopia regarding the recommended preventive behavioral messages responses. Therefore, the study aimed to assess the response to COVID-19 recommended preventive behavioral messages. METHODS: Community-based cross-sectional study design was carried out from 1 to 20, July 2020. We recruited 634 respondents by using a systematic sampling method. Data were analyzed using Statistical Package Software for Social Sciences version 23. Association between variables were explored using a bivariable and multi variable logistic regression model. The strength of the association is presented using odds ratio and regression coefficient with 95% confidence interval. A p-value of less than 0.05 was declared statistically significant. RESULTS: Three hundred thirty-six (53.1%) of respondents had good response to recommended preventive behavioral messages. The general precise rate of the knowledge questionnaire was 92.21%. The study showed that merchant was 1.86 (p ≈ 0.01) times more likely respond to COVID-19 recommended preventive behavioral messages than government-employed. Respondents who scored one unit increase for self-efficacy and response-efficacy, the odds of responding to COVID-19 recommended preventive behavioral messages were increased by 1.22 (p < 0.001), and 1.05 times (p = 0.002) respectively. Respondents who scored one unit increase to cues to action, the odds of responding to COVID-19 recommended preventive behavioral messages were 43% (p < 0.001) less likely. CONCLUSION: Even though respondents were highly knowledgeable about COVID-19, there is a lower level of applying response to recommended preventive behavioral messages. Merchant, self-efficacy, response efficacy, and cues to action were significantly associated with response to recommended preventive behavioral messages. Like merchants, government employer should be applying preventive behavioral messages and also, participants' self and response efficacy should be strengthened to improve the response. In addition, we should be changed or modified the way how-to deliver relevant information, promoting awareness, and also using appropriate reminder systems to preventive behavioral messages.

The uptake of key elements of sexual and reproductive health services and its predictors among rural adolescents in Southern Ethiopia, 2020: application of a Poisson regression analysis.

BACKGROUND: Although 25% of the Ethiopian population is young, Sexual and Reproductive Health (SRH) Services have not been adequately researched and intervened, leaving adolescents with many reproductive health challenges. Assessment of the uptake of each element of SRH service and its determinants among those age groups is essential to improving service uptake and reducing the burden of illness and disability in adolescents. Thus, this study aimed at assessing the uptake of key elements of SRH services and its determinants among adolescents residing in rural districts of Guraghe zone, Southern Ethiopia. METHODS: A community-based cross-sectional study was carried out from May 1 to 30, 2020, and a multi-stage sampling technique was employed to randomly select 1028 adolescents. The data were collected by using a pre-tested interviewer-administered questionnaire. The data were coded and entered into Epi-Data version 3.1 and exported into SPSS version 23 for analysis. Independent t-tests and analysis of variance (ANOVA) were run to determine whether there were statistically significant differences in the mean number of SRH services used across each categorical variable. A multivariable generalized linear regression (GLM) model with a Poisson link was used to determine the effect of each variable on the mean number of SRH services used. Adjusted odds ratios with their corresponding 95% confidence interval were used to declare the statistical significance of the independent variables. RESULTS: The study included 1,009 adolescents, yielding a response rate of 98.1%. The use of the SRH service was assessed using eight elements, and the mean (± SD) score of service uptake was 4.05 (± 1.94), with only 6.8% of adolescents receiving all key elements. Comprehensive sexuality education (55.1%) and voluntary HIV/AIDS counseling and testing (51.0%) were the commonest service items used by adolescents, while the provision of contraceptives was the lowest service item received (25.9%). Educational level (AOR: 1.28, 95% CI: 1.03-1.56), having a parental discussion (AOR: 1.31, 95% CI: 1.13-1.51), lack of youth clubs (AOR: 0.71, 95% CI: 0.66-0.87), and knowledge on SRH issues (AOR: 0.79, 95% CI: 0.73-0.85) were identified as significant predictors of the uptake of key elements of SRH services. CONCLUSION: The overall uptake of SRH services was found to be low in the study area. Schools should be an excellent means of educating adolescents to increase their knowledge of key elements of SRH services. Furthermore, stakeholders must work together to improve the culture of parental discussion with adolescents and establish and strengthen youth clubs, as measures for encouraging the use of SRH services.

Progress towards universal health coverage requires keeping adolescents healthy, as adolescence represents a significant opportunity for successful prevention and health promotion with life-course implications. Sexual and reproductive health (SRH) service is well described as the combination of techniques, procedures, and services that prevent and respond to sexual health snags by ensuring sexual health and well-being. While most adolescent health problems are avertible or fixable, adolescents face many hurdles in accessing health care and information, especially those who are in rural corners. Although 25% of the Ethiopian population is young, Sexual and Reproductive Health (SRH) Services have not been adequately researched and intervened, leaving adolescents with many reproductive health challenges. Assessment of the uptake of each element of SRH service and its determinants among those age groups is essential to improving service uptake and reducing the burden of illness and disability in adolescents. Thus, this study aimed at assessing the uptake of key elements of SRH services and its determinants among adolescents residing in rural districts of Guraghe zone, Southern Ethiopia. A multi-stage method of sampling was employed, and adolescents have been randomly chosen and participated in the study. Pre-tested structured questionnaires were used for data collection. Statistical significance between dependent and independent variables was checked by using bivariate analysis across ANOVA and independent t-tests. To see the weight of each explanatory variable on SRH service utilization, a generalized linear regression model (GLM) with a Poisson link was done. The overall uptake of SRH services was found to be low in the study area. Comprehensive sexuality education (55.1%) and voluntary HIV/AIDS counseling and testing (51.0%) were the commonest service items used by adolescents, while the provision of contraceptives was the lowest service item received (25.9%). Educational level, having a parental discussion, lack of youth clubs, and knowledge of SRH issues were identified as significant predictors of the uptake of key elements of SRH services. Schools should be an excellent means of educating adolescents to increase their knowledge of key elements of SRH services. Furthermore, stakeholders must work together to improve the culture of parental discussion with adolescents and establish and strengthen youth clubs, as measures for encouraging the use of SRH services.

Towards universal health coverage: The level and determinants of enrollment in the Community-Based Health Insurance (CBHI) scheme in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Community-based health insurance (CBHI) is a risk-pooling approach that tries to disperse health expenditures across families with varying health profiles to provide greater access to healthcare services by allowing cross-subsidies from wealthy to poor populations. It is crucial to assess the level of CBHI enrolment and its determinants in Ethiopia, where government health spending is limited to less than 5% of GDP, far below the Alma Ata Declaration's benchmark of 15%. Although various epidemiological studies on CBHI enrolment status and its determinants have been undertaken in Ethiopia, the results have been inconsistent, with significant variability. However, no nationwide study assessing the pooled estimates exists today. Furthermore, the estimated strength of association at the country level varied and was inconsistent across studies. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of CBHI enrolment and its determinants in Ethiopia. METHODS: A comprehensive search of studies was done by using PubMed, EMBASE, Science Direct, HINARI, Scopus, Web of Science, and the Cochrane Library. The database search was complemented by google scholar and some repositories for grey literature. The search was carried out from February 11 to March 12, 2022. The relevant data were extracted using a Microsoft Excel 2013 spreadsheet and analyzed using STATATM Version 16. Studies reporting the level and determinants of CBHI enrolment in Ethiopia were considered. A weighted DerSimonian Laired random effect model was applied to estimate the pooled national prevalence of CBHI enrolment. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. A funnel plot, Begg's and Egger's tests, were used to check for the presence of publication bias. RESULTS: Fifteen studies were eligible for this systematic review and meta-analysis with a total of 8418 study participants. The overall pooled prevalence of CBHI enrolment in Ethiopia was 45.5% (95% CI: 32.19, 58.50). Affordability of premium for the scheme[OR = 2.58, 95% CI 1.68, 3.47], knowledge of respondents on the CBHI scheme[OR = 4.35, 95% CI 2.69, 6.01], perceived quality of service[OR = 3.21, 95% CI 2.04, 4.38], trust in the scheme[OR = 2.32, 95% CI 1.57, 3.07], and the presence of a person with a chronic disease in the household [OR = 3.58, 95% CI 2.37, 4.78] were all found to influence CBHI enrolment. CONCLUSION: Community health workers (CHWs) need to make a high effort to improve knowledge of CBHI in rural communities by providing health education. To deal with the issue of affordability, due emphasis should be placed on building local solidarity groups and strengthening local initiatives to aid poor members. Stakeholders in the health service delivery points need to focus on the dimensions of high service quality. The financial gap created by the adverse selection of households with chronically ill members should be rectified by implementing targeted subsidies with robust plans.

Anemia and associated factors among patients admitted with metabolic syndromes at Worabe Comprehensive Specialized Hospital, Southern Ethiopia: A cross-sectional study.

BACKGROUND: Anemia is a condition in which the number of red blood cells is inadequate to meet the physiologic needs of the human body oxygen and it is highly prevalent among individuals with metabolic syndromes as a complication in turn speed up the progression and the number of adverse outcomes unless the proper measure is undertaken. Determination of anemia may play a major role in the management and early aversion of complications in an admitted patient with metabolic syndromes. Therefore, this study aimed to determine anemia and its associated factors among patients with admitted metabolic syndromes at Worabe Comprehensive Specialized hospital, Southern Ethiopia from March 1 to May 30, 2021. METHODS AND MATERIALS: An institutional-based cross-sectional study design was conducted on 324 adult patients admitted with metabolic syndromes. Structured questionnaires through face-to-face interviews and participants' medical records were used to collect information on determinants related to anemia. A blood sample was collected to determine hematological parameters, biochemical profile, and blood film preparation. Data were analyzed by SPSS version 22. Binary logistic regression analyses were done to identify factors associated with anemia. The p-value was set at <0.05 with a 95% confidence interval of the adjusted odds ratio. RESULTS: A total of 324 admitted adult patients with metabolic syndromes were involved. The overall prevalence of anemia among study participants was 25.3% (95%CI: 20.7, 30.2), of which 52.4% had moderate anemia and 56% had microcytic types of anemia. Being alcoholic (AOR = 6.25, 95% CI: (3.05, 12.82)), obese (AOR = 3.34, 95% CI: (1.02, 11.21)), dyslipidemic (AOR = 2.06, 95% CI: (1.02, 4.17)), and diabetic (AOR = 2.61, 95%CI: (1.31, 5.21)) were significantly associated with anemia. CONCLUSION: The prevalence of anemia among patients admitted with metabolic syndrome observed in this study was a moderate public health problem. Taking alcohol, being dyslipidemic, obese and diabetic was significantly associated with anemia. The finding of this study should be taken into consideration to implement preventive interventions on identified factors in study percipients. Taking fruit and vegetable, and promoting physical exercise, routine determination of fasting blood glucose and hemoglobin level in adult admitted metabolic syndromes patients were recommended to minimize the emergence of anemia.

Nutritional status and associated factors among lactating women in Dire Dawa, Ethiopia.

BACKGROUND: Lactating women's nutritional status is critical since it influences the health of their infants. However, there was a scarcity of data on maternal nutrition in low-income countries such as Ethiopia, particularly in the study area. METHODS: Institutional-based cross-sectional study was conducted among 401 lactating women in Dire Dawa town health facilities from February 10, 2019 to March 30, 2019. The sum of the number of food categories consumed by each respondent over the 24-h recall period is the women's diet diversity score. To identify factors linked to undernutrition, all variables with a p-value of less than 0.25 were included into multivariate logistic regression. RESULT: Prevalence of undernutrition was 22%. Women who age 15-25 years were four times more likely undernourished than older (adjusted odd ratio [AOR] = 4.04; confidence interval [CI]: [1.74, 9.40]). Unable to read and write women were almost five times more likely to be undernourished than formal education (AOR = 4.76; CI: [2.31, 9.81]). Women who have family size >7 were six times more likely to be undernourished than family size <3 (AOR = 5.53; CI: [1.15, 26.53]). Women not take additional food during lactating were 4.5 times more likely undernourished than take additional food (AOR = 4.56; CI [1.50, 13.9]). DD score <5 were four times more likely to be undernourished than (≥5) DD (AOR = 4; CI: [2.02, 7.90]). CONCLUSION: Prevalence of undernutrition in the study area was high. Factors associated with undernutrion were: age of lactating women, education status, family size, additional food during lactation and DD score. Thus, multisectoral collaboration targeted at improving women's educational status and increasing food during lactation need to be emphasized.

Disparities in sexual and reproductive health services utilization among urban and rural adolescents in southern Ethiopia, 2020: a comparative cross-sectional study.

BACKGROUND: Although studies on the uptake of Adolescent sexual and reproductive health (ASRH) services in Ethiopia have been conducted they have failed to show the disparity in service uptake among rural and urban settings. Once the extent and determinants of ASRH service uptake in urban and rural contexts are known, it will be crucial to provide evidence-based information and recommendations for potential interventions to reduce the burden of disease and disability among adolescents. This study aimed at determining the level of SRH service utilization among urban and rural adolescents in the Guraghe zone, Southern Ethiopia. METHODS: A community-based comparative cross-sectional study was undertaken from November 1 -30, 2020. A multi-stage sampling technique was employed and a total of 1083 adolescents (361 from the urban and 722 from the rural areas) were selected randomly to take part in the study. Pre-tested, interviewer-administered, structured questionnaires were used to collect the data. The data were encoded and entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. χ2 test was computed to see a significant difference in SRH service utilization among urban and rural adolescents. In a bivariable logistic regression analysis, a variable with a p-value less than 0.25 has been selected for a multivariable logistic regression model. Variables with p-values less than 0.05 were declared statistically significant in multivariate logistic regression. RESULTS: A total of 1,075 adolescents (358 from urban and 717 from rural) took part in the study, yielding a response rate of 99.3%. The overall SRH service utilization among the whole adolescents was 39.5% (95%CI: 36.5, 42.4). There was a significant difference in SRH service utilization between urban 56.9% (95%CI: 51.8, 62.1) and rural 30.8% (95%CI: 27.4, 34.2) adolescents (χ2 = 68.3, p < 0.001). Residence[AOR = 2.62; 95%CI:1.63,3.41], availability of youth clubs [AOR = 4.73; 95%CI:3.43,6.53], taking part in peer education [AOR = 2.06; 95%CI:1.48,3.88], having parental discussion [AOR = 3.29; 95%CI:1.73,3.33], and being knowledgeable on SRH issues [AOR = 2.01; 95%CI: 1.45,3.03] were identified as a significant determinants of SRH service uptake. Having parental discussion, geographical accessibility, and knowledge on SRH were significant predictors of SRH service uptake among rural adolescents. CONCLUSION: Overall, ASRH service utilization in the study area was low, despite urban adolescent service uptake becoming higher than rural adolescents. Since the majority of adolescents were enrolled in schools, schools should be an area of intervention to improve adolescents' knowledge of SRH services through mass media, community networks, and interpersonal/group communication. Furthermore, promoting parent-adolescent discussions, as well as peer-to-peer discussions at the family and school level, should be emphasized. Stakeholders in the education and health sectors need to strengthen their efforts to establish youth clubs in places where they do not yet exist, especially in rural schools.

The applicability of basic preventive measures of the pandemic COVID-19 and associated factors among residents in Guraghe Zone.

INTRODUCTION: Internationally, countries have reacted to the COVID-19 outbreak by introducing key public health non-pharmaceutical interventions to protect vulnerable population groups. In response to COVID-19, the Government of Ethiopia has been taking a series of policy actions beyond public health initiatives alone. Therefore, this study was aimed to assess the applicability of basic preventive measures of the pandemic COVID-19 and associated factors among the residents of Guraghe Zone from 18th to 29th September, 2020. METHODS: Community based cross sectional study was conducted at Guraghe Zone from 18th to 29th September, 2020. Systematic random sampling method was applied among the predetermined 634 samples. Variables which had p-value less than 0.25 in bivariate analysis were considered as candidate for multivariable logistic regression model. P-value <0.05 was used as a cutoff point to determine statistical significance in multiple logistic regressions for the final model. RESULT: In this study, 17.7% (95% CI: 14.7, 20.5) of the respondents apply the basic preventive measures towards the prevention of the pandemic COVID-19. In addition, being rural resident (AOR: 4.78,; 95%CI: 2.50, 8.90), being studied grade 1-8 (AOR: 3.70; 95%CI: 1.70, 7.90), being a farmer (AOR: 4.10; 95%CI: 1.25, 13.35), currently not married (AOR: 2.20, 95%CI: 1.24, 4.06), having family size 1-3(AOR: 6.50; 95%CI: 3.21, 3.35), have no diagnosed medical illness (AOR: 6.40; 95%CI: 3.85, 10.83) and having poor knowledge (AOR: 3.50; 95%CI: 1.60, 7.40) were factors which are statistically significant in multivariable logistic regression model. CONCLUSION: Despite the application of preventive measures and vaccine delivery, the applicability of the pandemic COVID-19 preventive measures was too low, which indicate that the Zone is at risk for the infection. Rural residents, those who have lower educational level, farmers, non-marrieds, those who have lower family size, those who have diagnosed medical illnesses and those who have poor knowledge were prone to the infection with the pandemic COVID-19 due to the lower practice of applying the basic preventive measures. In addition, awareness creation should be in practice at all levels of the community especially lower educational classes and rural residents.

Predictors of mortality among newborns admitted with perinatal asphyxia at public hospitals in Ethiopia: a prospective cohort study.

INTRODUCTION: Perinatal asphyxia is a complicated newborn health problem and applies a high contribution to the increased proportion of newborn mortality. It occurs in newborns due to altered breathing or inadequate inhalation and exhalation resulting in reduced oxygen perfusion to certain body tissues and organs. Irrespective of the increased progress in health care towards newborns and implementations in reductions in under-five, infant, and neonatal mortality in the past 10 years, perinatal asphyxia remained as the most common severe newborn health challenge that causes a high number of morbidity and mortality. METHODS: A prospective cohort longitudinal study was implemented among 573 newborns admitted with perinatal asphyxia at public hospitals in Southern Ethiopia from 1st March 2018 to 28th February 2020. The perinatal survival time was determined using Kaplan Meier survival curve together with a log-rank test. The dependent variable was time to death and the independent variables were classified as socio-demographic factors, obstetrics related factors, newborn related factors and maternal medical related factors. The study subjects were entered in to the cohort during admission with perinatal asphyxia in the hospital and followed until 7 days of life. RESULTS: The cumulative proportion of survival among the newborns admitted with perinatal asphyxia was 95.21% (95%CI:91.00,97.48), 92.82% (95%CI:87.95,95.77), 92.02%(95%CI:86.84,95.22) and 90.78%(95%CI:84.82,94.48) at the end of first, second, third and fourth follow-up days respectively. The mean survival date was 6.55(95%CI: 6.33, 6.77) and cord prolapse (AHR:6.5;95%CI:1.18,36.01), pregnancy induced hypertension (AHR:25.4;95%CI:3.68,175.0), maternal iron deficiency anemia (AHR:5.9;95%CI:1.19,29.5) and having convulsion of the newborn (AHR:10.23;95%CI:2.24,46.54) were statistically significant in multivariable cox proportional hazard model. CONCLUSION: The survival status among newborns with perinatal asphyxia was low during the early follow-up periods after admission to the hospital and the survival status increased after fourth follow up days. In addition, cord prolapse, history of PIH, maternal iron deficiency anemia and newborns history of convulsion were the independent predictors of mortality.

Determinants of Premature Rupture of Membranes Among Pregnant Women Admitted to Public Hospitals in Southern Ethiopia, 2020: A Hospital-Based Case-Control Study.

BACKGROUND: A gush of amniotic fluid any time before the onset of labor is known as premature rupture of the membranes (PROM). Its consequences vary from maternal and neonatal mortality and morbidity to country-wide economic loss. At the national level in general, and in the study area in particular, little is known about PROM and its determinants. Hence, this study aimed at identifying determinants of PROM among pregnant women admitted to public hospitals in Southern Ethiopia, 2020. METHODS AND MATERIALS: A hospital-based unmatched case-control study was conducted on 279 pregnant women (93 cases and 186 controls) admitted to public hospitals from October 1 to 30, 2020. Pregnant women admitted to maternity wards of selected hospitals with a painless gush of fluid spilling out from the vaginal canal were considered as cases. Interviewer-administered questionnaires and data abstraction tools were used to collect data. The data were coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The determinants of PROM were identified by applying a multivariable logistic regression analysis at a p-value <0.05. RESULTS: Term PROM accounted for the majority, 55 (59.2%) of cases. Previous history of abortion (AOR: 4.14, 95% CI: 2.21-9.07), lack of ANC (AOR: 3.51; 95% CI: 1.33-8.27), previous history of PROM (AOR: 4.91; 95% CI: 2.23-9.82), caesarean delivery (AOR: 3.02, 95% CI: 1.24-6,40), using of a maternal waiting room (MWR) (AOR: 0.33, 95% CI: 0.15-0.74), and mid-upper arm Circumference (MAUC) <23cm (AOR: 3.69, 95% CI: 1.58-8.64) were identified as significant determinants of PROM. CONCLUSION: Health-care providers should work on providing adequate ANC by tracing mothers who have not received it and advising pregnant women to use MWR in the final weeks of their pregnancy. Furthermore, maternal and child health care units must place a strong focus on screening and managing the nutritional status of pregnant women. Furthermore, women with a history of abortion, caesarean section, and PROM need due attention from health care providers to mitigate the occurrence of PROM.

Incidence and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at public hospitals in Southern Ethiopia.

BACKGROUND: Tuberculosis and human immune deficiency virus co-infections remained the most common cause of child mortality for the last ten years. Globally, 1.2 million cases of tuberculosis occurred in patients living with HIV/AIDS, of which 1.0 million cases occurred in children. The public health impact of tuberculosis and human immune deficiency virus co-infection among children is high in developing countries and Sub-Saharan Africa accompanied three fourth of the global burden. However, there are limited studies that assess the incidence and predictors of mortality among tuberculosis and human immune deficiency virus co-infected children in Ethiopia. METHODS: A facility-based retrospective cohort study was conducted at Public hospitals in Southern Ethiopia with a total of 286 randomly selected records of ART enrolled children from 1st January 2009 to 31stDecember 2018. Data were entered into Epi Data version 3.1 and exported to STATA version 14 for analysis. Bivariate and multivariable Cox proportional hazards model was fitted to identify the predictors of mortality. Variables that had a p-value<0.05 at 95%CI in the multivariable cox proportional hazard model were considered as statistically significant. RESULTS: A total of 274 tuberculosis and human immunodeficiency virus co-infected children's records were reviewed. The incidence of mortality among tuberculosis and human immunodeficiency virus co-infected children was 17.15 per 100 children. The overall incidence density rate of mortality was 2.97(95%CI: 2.2, 3.9) per 100 child year of observation and being anemic (AHR: 2.6; 95%CI: 1.28, 5.21), not initiating isoniazid prophylaxis therapy (AHR: 2.8; 95%CI: 1.44, 5.48), developing extrapulmonary tuberculosis (AHR: 5.7; 95%CI: 2.67, 12.56) and non-adherence (AHR: 5.2; 95%CI: 2.19, 12.39) were independent predictors of mortality. CONCLUSION: Mortality rate was high among TB/HIV co-infected children at the public hospitals in Southern Ethiopia. Extra-pulmonary tuberculosis, anemia, non-adherence, and isoniazid preventive therapy use were statistically significant predictors of mortality among TB/HIV co-infected children. Therefore, extra pulmonary tuberculosis, and anemia should be closely monitored to increase their adherence as well as they should be provided with isoniazid preventive therapy.

Survival Time to Development of Hypertension and Its Predictors among a Cohort of Diabetic Patients in Health Facilities of Gurage Zone: A Retrospective Follow-Up Study.

BACKGROUND: It is expected that around 50% of individuals with diabetes mellitus will develop hypertension in the course of medical follow-up. However, with strict medical follow-up and adherence to medical advice the incidence of hypertension can be highly reduced and the time to occurrence can be delayed. Therefore, this paper aimed to measure the time to development of hypertension and identify its predictors among a 10-year cohort of diabetic patients who have medical follow-up in health facilities of Gurage Zone. METHODS: An institution-based retrospective cohort study was conducted in diabetic follow-up clinics of Gurage Zone by reviewing 540 consecutively selected records among the records enrolled from January 1, 2010 to December 31, 2019. The outcome variable was incidence rate and survival time to the occurrences of hypertension (a systolic blood pressure at or above 140 mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known hypertensive cases taken from adults' age ≥18 years) among admitted diabetic patients (fasting blood sugar ≥126 mg/dL or random blood sugar ≥200 mg/dL). Data were collected using a standardized checklist by trained professionals by reviewing records of all clients ever enrolled. Data were cleaned and entered by Epi info version 7 and analyzed by STATA. A Cox-proportional hazard regression model was built to identify predictors of development of hypertension. RESULTS: A total of 540 clients were followed for different periods with a median follow-up period of 2.3 years which gives 3,200 person-years of observation. Two hundred and seventy-six (51.1%) participants were males and the mean age of was 52.2 (+11.7) years. Three hundred (55.6%) participants were urban dwellers. The overall incidence density rate (IDR) of hypertension in the cohort was 48.6 cases per 1,000 persons-year. Older ages adjusted hazard ratio (AHR)=4.0 (95% CI=2.26-7.82), body mass index (BMI) >25 kg/m2 AHR=2.3 (95% CI=1.06-3.68), Type II diabetes mellitus (DM) AHR=2.0 (95% CI=1.16-3.04), presence of comorbidity AHR=2.9 (95% CI=1.74-4.58), and poor drug adherence AHR=2.5 (95% CI=1.45-4.65) predicted the development of hypertension. CONCLUSION: The risk of occurrences of hypertension among diabetic patients was high at the early periods and the risk was less at the late diabetic periods and the incidence density rate of hypertension among diabetic patients was high. In addition, age, BMI, type of DM, comorbidity, and drug adherence were independent predictors of occurrences of hypertension. Therefore, intervention to further reduce its occurrence has to focus on drug adherence and prevention of infection.

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis.

BACKGROUND: Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. METHODS: A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. RESULTS: Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. CONCLUSION: The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study.

INTRODUCTION: Post cesarean section surgical site infection increases both the duration of a patient's hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities. METHOD: Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers' who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model. RESULT: Age 20-34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection. CONCLUSION: Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Acceptability and Factors Associated with Immediate Postpartum Intrauterine Contraceptive Device Use Among Women Who Gave Birth at Government Hospitals of Gamo Zone, Southern Ethiopia, 2019.

BACKGROUND: An intrauterine contraceptive device is suitable for women of all reproductive age groups for preventing unwanted pregnancies. Immediate postpartum family planning (PPFP) services need to be emphasized when the woman leaves the hospital. Despite the accepted demand for PPFP, many women do not access the services. Therefore, this study aimed to assess acceptability and factors associated with immediate postpartum intrauterine contraceptive device use among women who gave birth at government hospitals of Gamo Zone, Southern Ethiopia. METHODS: A cross-sectional study was conducted from March 1 to 30, 2019 with 452 participants studied using systematic random sampling technique. Data was collected using a pretested interviewer-administered questionnaire from March 1 to 30, 2019. The data were coded, cleaned and entered into Epi-data manager version 4.2.2.1 and exported to SPSS version 23 for advanced analysis. Binary logistic regression was performed to identify associated factors of immediate PPIUCD acceptability. RESULTS: This study revealed that about 161 (35.6%) in 95% CI (31.0, 39.6) of the study participants accepted immediate PPIUCD. Multiparty (AOR = 2.33, 95% CI, (1.29, 4.20)), completed antenatal follow up (AOR = 3.65, 95% CI, (2.22, 5.99)), counselling (AOR= 8.38, 95% CI, (4.85, 14.48)) and prior discussion (AOR=2.57, 95% CI, (1.51, 4.36)) were statistically significant. CONCLUSION AND RECOMMENDATION: Even though 58% of the mothers were counselled about PPIUCD during the important cascade of pregnancy and 53% of the mothers completed antenatal service, efforts need to improve antenatal care services and integrate counselling services through the whole cascade of pregnancy.

Determinants of Frequency and Contents of Postnatal Care Among Women in Ezha District, Southern Ethiopia, 2020: Based on WHO Recommendation.

BACKGROUND: Postnatal care is a constellation of preventive care, practices, and assessments intended to detect and treat complications for both the mother and the newborn in the first six following birth. Monitoring of the content and frequency of the PNC is required to make the service provision more successful. However, several studies centered on the general PNC visits, and pieces of evidence were limited at the country level on the core content of the PNC, including the current study area. Therefore, this study aimed to identify determinants of the frequency and content of PNC visits among women who gave birth in the last 12 months in Ezha district, Southern Ethiopia. METHODS AND MATERIALS: A community-based cross-sectional survey was conducted in the Ezha district to collect data from 568 respondents by using pre-tested, interviewer-administered questionnaires. Data were entered into EpiData3.1 and exported to SPSS version 23 for analysis. To determine the wealth status of the respondents, the Principal Component Analysis was undertaken. To evaluate the determinants of frequency and the content of PNC, both binary logistic regression and generalized linear regression with Poisson type were applied respectively. RESULTS: Nearly a quarter (23.9%) of respondents received three or more postnatal visits, and only 81 (14.6%) respondents received all the PNC service contents suggested by WHO. Identified predictors of the core content of PNC were, frequencies of ANC (AOR: 1.25, 95% CI: 1.15-1.35), enrollment in community-based health insurance scheme (AOR: 0.69 (95% CI: 0.64-0.75), and PNC frequency (AOR: 0.64, (95% CI (0.57-0.73). CONCLUSION: A low level of WHO-recommended frequency and content of the PNC were identified in the study area. To achieve better utilization, strengthening efforts to improve adequate ANC uptake, enrollment in the CBHI scheme, and working on a model household creation were, therefore, should be crucial measures.

Time Until Loss to Follow-Up, Incidence, and Predictors Among Adults Taking ART at Public Hospitals in Southern Ethiopia.

INTRODUCTION: According to the World Health Organization, more than seventeen million people were accessing ART in 2015 globally. Adherence to effective ART reduced the risk of transmitting the virus to uninfected persons. The government and other stakeholders' focus was high to reduce the rate of loss to follow-up in HIV programs among patients who are already on ART follow-up, but its incidence rate increases from time to time. METHODS: A retrospective cohort study was conducted among the records enrolled from 1 January 2013 to 30 December 2017 at Public hospitals in Southern Ethiopia. Data were entered into Epi info V 7 and exported to STATA V 14 for analysis. The Kaplan-Meier survival curve together with a log rank test was used to estimate the survival time of the ART attending patients. Variables which had p-value <0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant. RESULTS: The incidence rate of loss to follow-up from ART services among adults attending ART was 6.48 (95% CI:5.67,7.29) per 1000 person months. The cumulative survival probability at the end of the 10th, 20th, 40th and 60th follow-up month was 0.89 (95% CI:0.87,0.91), 0.82 (95% CI:0.79,0.85), 0.78 (95% CI:0.75,0.81) and 0.74 (95% CI:0.70,0.77), respectively. Distance >5 kilometers (AHR:3.71; 95% CI:2.32,5.95), not having registered phone number (AHR:2.52; 95% CI:1.76,3.60), not initiating Isoniazid (AHR:2.15; 95% CI:1.50,3.08), body mass index <18.50kg/m2 (AHR:1.87; 95% CI: 1.18; 2.97) and not having primary caregiver (AHR: 2.59; 95% CI: 1.84, 3.66) were statistically significant predictors of loss to follow-up. CONCLUSION: The time until loss to follow-up was high in the first 20 months of the initiation of the ART and it declines after 20 months; longer distance between home and hospital, not having registered phone number, not initiating INH, lower body mass index and not having primary caregiver were the independent predictors of loss to follow-up from ART services.

Uptake of complete postnatal care services and its determinants among rural women in Southern Ethiopia: Community-based cross-sectional study based on the current WHO recommendation.

BACKGROUND: Postnatal care services are a constellation of preventive care, practices, and assessments designed to identify and manage maternal and newborn complications during the first six weeks after birth. Recognizing the role of the appropriate PNC at this critical time, the World Health Organization recommended four visits as a complete PNC for all post-partum mothers and newborns to ensure their survival. Although there have been numerous studies on the factors affecting the general PNC service in Ethiopia, there is a shortage of evidence on the use of complete postnatal care services and its determinants. Therefore, the objective of this study was to assess the uptake of full postnatal care service and its determinants among women who recently gave birth in the Ezha district of southern Ethiopia. METHODS: A community-based cross-sectional study was conducted in Ezha district. A two-stage sampling technique was applied. A total of 568 mothers who stayed for at least 6 weeks after childbirth from selected Kebeles were included in the study using computer-generated random numbers. Data collected through pre-established, structured, and interviewer-administered questionnaires were entered into EpiData3.1 and exported to SPPS version 23 for analysis. The Principal Components Analysis (PCA) was carried out to assess the wealth status of participants. The Multivariable logistic regression model has been fitted to identify the determinants of complete post-natal care service uptake. RESULTS: The overall uptake of complete postnatal care services in the study area was 23.9% [95% CI: (19.9, 27.5)]. The factors namely; maternal education of secondary and above [AOR: 4.31, 95%CI: 2.15, 8.05], having four and more antenatal visits [AOR: 4.03, 95%CI: 1.83, 8.85], Caesarean delivery [AOR: 3.75, 95%CI: 1.78, 7.92], having good knowledge on PNC [AOR: 4.31, 95%CI: 2.34, 9.04], and being a model household [AOR: 3.61, 95%CI: 1.97, 6.64] were recognized as determinants complete postnatal care uptake. CONCLUSION AND RECOMMENDATION: Complete post-natal care services uptake in the study area was low. Thus, a due emphasis should be given to behavioral change communication activities to improve maternal knowledge on PNC and enhancing adequate ANC uptake by health workers in the district. Besides, health extension workers in the district need to work on creating a model household through continuing education, support, and follow-up.

HIV-Positive Status Disclosure and Associated Factors among HIV-Positive Adult Patients Attending Art Clinics at Public Health Facilities of Butajira Town, Southern Ethiopia.

BACKGROUND: Human immunodeficiency virus-positive status disclosure is the process of informing one's HIV-positive status to others. It is the base for accessing care and treatment programs, attaining psychosocial support, reducing stigma, adhering to treatment, and promoting safer health. Even though different strategies were done in Ethiopia to increase the magnitude of HIV status disclosure among HIV-positive patients, the magnitude is still low. The magnitude of HIV-positive status disclosure was not assessed yet after initiation of the new strategy (test and treat strategy). The aim of this study is to assess the magnitude and factors associated with HIV-positive status disclosure among HIV-positive adults attending antiretroviral therapy clinic at the public health facilities of Butajira town. METHODS: Institution-based cross-sectional study was conducted at public health facilities of Butajira town. A total of 414 study participants were selected by systematic random sampling technique. Data were collected by using pretested interviewer-administered semistructured questionnaire. The collected data were entered into EpiData3.1 and exported to SPSS version 23. Bivariate and multivariable logistic regression analysis was used to identify factors associated with HIV-positive status disclosure. The strength of association was assessed by crude odds ratio and adjusted odds ratio for bivariate and multivariable logistic regression analysis, respectively. Statistically significance was declared at p value <0.05 and 95% CI. RESULTS: The magnitude of HIV-positive status disclosure was 90%. Discussing about safer sex (AOR: 3.5; 95% CI: 1.3, 9.4), viral load suppression (AOR: 4; 95% CI: 1.5, 10.1), having good ART adherence (AOR: 6; 95% CI: 2.4, 14.0), receiving counseling (AOR: 2.5; 95% CI: 1.01, 6.3), and perceiving stigma (AOR: 0.25; 95% CI: 0.09, 0.60) were the independent factors associated with HIV-positive status disclosure. CONCLUSION: Although the majority of the participants (90%) of them disclosed their HIV-positive status, lack of disclosure by few people can tackle HIV prevention and control programs. Health programs could improve disclosure of HIV-positive status by providing counseling service, strengthening adherence of antiretroviral therapy, suppressing viral load, and avoiding (reducing) stigma on HIV-positive patients by their community.