Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis.

Introduction: Prior primary studies have examined the prevalence and factors associated with glycaemic control among patients with type 2 diabetes mellitus, but studies with evidence-based synthesis of the primary data remained unknown. Hence, we aimed to determine the prevalence of poor glycemic control and identify determinants of poor glycemic control in patients with type 2 diabetes in Ethiopia. Methods: We performed searches in the online databases of PubMed, Google Scholar, Scopus, Science Direct, and the Cochrane Library. Microsoft Excel was used to extract data, and STATA statistical software (v. 16) was used for analysis. Publication bias was explored by forest plots, Begg's rank test, and Egger's regression test. To check for heterogeneity, I2 was computed. Subgroup analysis was conducted based on region and publication year. In addition, the pooled odds ratio for associated factors was calculated. Results: Out of 1,045 studies assessed, 23 studies were included fulfilling our inclusion criteria. In all, 6,643 individuals were enrolled in the study. It was estimated that 61.11% of type 2 diabetes patients had poor glycemic control (95% CI, 57.14-65.19). The subgroup analysis by study region and publication year revealed that the highest prevalence was observed in the Addis Ababa region (68.57%) and studies published before 2019 (61.76%), respectively. Poor glycemic control was associated with older age > 50 years (AOR = 2.12; 95% CI: 1.27-2.97), not attending formal education (AOR = 3.60; 95% CI: 2.75, 4.46), having diabetes for longer duration (10 years; AOR = 2.57; 95% CI: 1.65-3.49), having comorbidity (AOR = 2.43; 95% CI: 2.05-2.80), and low adherence to diabetes management (AOR = 3.67; 95% CI: 2.41-4.92). Conclusion: Our findings indicate a high prevalence of poor glycemic control among people with type 2 diabetes in Ethiopia. Being older, not attending formal education, having a longer duration of diabetes, having comorbidity, and having low adherence to diabetes management were all associated. Therefore, we recommend health organizations implement measures to monitor and control patients' blood glucose levels. Patient education and training of healthcare professionals could serve as a short-term strategy to achieve adequate glycemic control. Systematic review registration: PROSPERO, identifier CRD42022349792, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349792.

Acute malnutrition relapse and associated factors among 6-59 months old children treated in the community-based management of acute malnutrition in Dessie, Kombolcha, and Haik towns, Northeast Ethiopia.

Introduction: Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia. Methods: A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM). The total sample size was 318 children, and data were collected from April 15, 2021, to May 14, 2021. The data were entered into EPI data version 4.4.1 before being exported and analyzed with SPSS version 25 software. A multivariate logistic regression analysis was performed, and a 95% confidence interval and p-value <0.05 were used to identify significantly associated variables. Additionally, the weight-for-height z-score (WHZ) was generated using the WHO Anthro 3.2.2 software. Result: The overall acute malnutrition relapse after discharge from CMAM was 35.2% (6.6% relapsed to severe acute malnutrition and 28.6% relapsed to moderate acute malnutrition). The following variables were significantly associated with the relapse of acute malnutrition: child age (AOR: 3.08, 95% CI; 1.76, 5.39), diarrhea after discharge (AOR: 2.93, 95%CI; 1.51, 5.69), have not immunized (AOR: 3.05, 95% CI; 1.14, 8.23), MUAC at discharge (AOR: 3.16, 95% CI; 1.56, 6.40), and poorest and poor wealth index (AOR: 3.65, 95% CI; 1.45, 9.18) and (AOR: 2.73, 95% CI; 1.13, 6.59), respectively. Conclusion: Over one-third of children treated with the CMAM program reverted to SAM or MAM. The age of the child, diarrhea after discharge, lack of immunization, MUAC at discharge (<13 cm), and poor and poorest wealth index were significantly associated with acute malnutrition relapse. Therefore, adequate health education and counseling services are essential for mothers to improve child immunization coverage and maintain adequate hygiene to prevent diarrhea. In addition, further experimental research is needed to investigate the effect of MUAC at discharge on the risk of acute malnutrition relapse.

Survival status and predictors of mortality among asphyxiated neonates admitted to the NICU of Dessie comprehensive specialized hospital, Amhara region, Northeast Ethiopia.

INTRODUCTION: Birth asphyxia is one of the leading causes of early neonatal mortality, which causes an estimated 900,000 deaths annually. Therefore, assessing the survival status and predictors of mortality among asphyxiated neonates will be highly helpful to policymakers in designing, implementing, and evaluating programs to achieve the sustainable development goal of reducing neonatal mortality as low as 12/1,000 live births by 2030. METHODS: A facility-based retrospective cohort study was conducted among 378 asphyxiated neonates admitted to the NICU of Dessie Comprehensive Specialized Hospital from January, 2017 -December, 2019. The data were collected from eligible records by using a structured data extraction tool from March 30 -April 21, 2020. The data were cleaned manually and entered into Epi-data version 7.1.2.0, and STATA version 16 was used for the analysis. Bivariate and Multivariate Cox proportional hazard regression analysis were performed, and significant predictors were identified using 95% confidence interval and p-value <0.05. RESULT: A total of 378 neonates were followed for 2298 neonatal days, ranging from 1 to 28 days. The mortality incidence rate was 5.3/100 person-days-of observation (95% CI: 4.41, 6.29), and 32% (95% CI: 27.6%, 36.8%) of the study subjects died. Admission weight (AHR: 1.72; 95% CI: 1.09, 2.72), seizure (AHR: 1.52; 95% CI: 1.02, 2.27), neonates who received resuscitation (AHR: 2.11; 95% CI: 1.18, 3.80), and stage of asphyxia (moderate (AHR: 3.50; 95% CI: 1.55, 8.36), and severe (AHR: 11.55; 95% CI: 4.73, 28.25)) were significant predictors of neonatal mortality among asphyxiated neonates. CONCLUSION: The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Admission weight, seizure, resuscitation, and stage of asphyxia were significant predictors of mortality among neonates with asphyxia. Therefore, special attention should be given to asphyxiated neonates with low admission weight and those who had seizure. Additionally, the timing, quality, and effectiveness of resuscitation might need further assessment and evaluation.

Clinical incident reporting behaviors and associated factors among health professionals in Dessie comprehensive specialized hospital, Amhara Region, Ethiopia: a mixed method study.

BACKGROUND: Understanding the type and causes of errors are necessary for the prevention of occurrence or reoccurrence. Therefore addressing the behavior of health professionals on reporting clinical incidents is crucial to create spontaneous knowledge from mistakes and enhance patient safety. METHOD: A mixed type institution-based cross-sectional study design was conducted from March 1 - 30, 2020 in Dessie comprehensive specialized hospital among 319 and 18 participants for the quantitative and qualitative study, respectively. The professions and participants with their assigned proportions were selected using a simple random sampling technique. For quantitative and qualitative data, semi structured questionnaires and interviewer-guided questions were used to collect data, respectively. Finally, qualitative findings were used to supplement the quantitative result. RESULT: The finding showed that the proportion of clinical incident reporting behavior among health professionals was 12.4%. Having training (AOR=3.6, 95% CI, 1.15-11.45), incident reporting help to minimize errors (AOR=2.8, 95% CI, 1.29-6.02), fear of legal penalty (AOR= 0.3, 95% CI, 0.13-0.82), and lack of feedback (AOR=0.3, 95% CI, 0.11-0.90) were identified as significant factors for clinical incident reporting behavior of the health professionals. CONCLUSIONS: This study showed that the clinical incident reporting behavior of the health professionals was very low. Therefore health professionals should get training on clinical incident reporting and the hospital should have an incident reporting system and guideline.

Acute lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia.

BACKGROUND: Lower respiratory infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than 5 years. Even if the burden of lower respiratory infections in children under 5 years old had decreased dramatically in the last 10 years, it is still the main cause of morbidity and mortality in children under-5 years old in developing countries, so the aim of this study was to assess the magnitude of lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital. METHOD: A cross-sectional study was conducted from 1st to 30th April 2019, among under-five child/mother or caretaker pairs visiting Wolaita Sodo University Teaching and Referral Hospital. Child/mother or caretaker pairs who visits outpatient department for curative care service or follow up were recruited for the study. Data were collected using a semi-structured pre-tested interviewer-guided questionnaire. Epi-info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratios with their 95 % confidence intervals was computed. Finally, a p-value ≤ 0.05 was used to identify variables that had a significant association with acute lower respiratory infection. RESULT: A total of 414 child/mother or caretaker pairs were recruited for the study. The magnitude of acute lower respiratory infections among under-five children was 40.3 % (95 % CI: 35.7- 44.9 %). Unvaccinated children (AOR: 2, 95 % CI, (1.27-3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95 % CI, (1.18-2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95 % CI, (1.07-4.19)), absence of separate kitchen (AOR: 1.7, 95 % CI, (1.09-2.65)), and absence of window in the kitchen room (AOR: 1.69, 95 % CI, (1.07-2.68)) showed significant association with acute lower respiratory infection. CONCLUSIONS: The magnitude of acute lower respiratory tract infections among under-five children visiting outpatient department was 40.3 %. Unvaccinated children, non-exclusive/replacement feeding, using unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen showed significant association with acute lower respiratory infection. Therefore, special attention should be given to the environmental sanitation and family health components of health extension packages.

Knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan District Health Centers, North Wollo, Ethiopia.

BACKGROUND: The majority of neonatal deaths in developing countries occurred at home due to late recognition of the signs of serious illness by parents or caregivers. In Ethiopia, besides the attempts made to scale-up the maternal and child health services, maternal knowledge of neonatal danger signs is low. Therefore, this study aimed to assess the knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan district health centers, North Wollo, Ethiopia. METHOD: An institution-based cross-sectional study was conducted from September 1-30, 2020, among 399 mothers attending pediatric immunization clinics in Gidan district health centers. The data were collected using a pretested, structured, and interviewer-administered questionnaire. Epidata version 4.4.2.0 was used for data entry, and Statistical Package for Social Sciences version 22 was used for analysis. Descriptive statistics, bivariate and multivariate logistic regression were computed. Finally, an adjusted odds ratio along with 95% CI was calculated, and variables that had a P-value <0.05 were declared statistically significant. RESULT: The level of good maternal knowledge of neonatal danger signs in the study area was 48.1% (95% CI, 43.6%-52.9%). Maternal education level (AOR: 3.58, 95% CI, 1.22-10.55), parity (AOR: 2.10, 95% CI 1.18-3.71), having postnatal care follow-up (AOR: 2.05, 95% CI, 1.21-3.49), receiving health education about neonatal danger signs (AOR: 4.87, 95% CI, 2.73-8.68), and previous experience of neonatal danger signs (AOR: 2.35, 95% CI, 1.33-4.15) were significantly associated variables with the maternal knowledge of neonatal danger signs. CONCLUSION: This study revealed that maternal knowledge of neonatal danger signs was low. Maternal educational level, parity, postnatal care follow-up, health education about neonatal danger signs, and previous experience of neonatal danger signs were significantly associated variables. Therefore, maternal knowledge of neonatal danger signs needs to be enhanced through improving postnatal care services utilization and providing adequate health education about newborn health problems.

Health Communication, Knowledge, Perception and Behavioral Responses to COVID-19 Outbreak in Dessie, Kombolcha and Kemissie Towns, Amhara Region, Northeast Ethiopia: A Mixed-Method Study.

BACKGROUND: Despite the efforts made to mitigate the spread of COVID-19 in Ethiopia, new cases continue to rise. Therefore, to overcome the devastating effects of the outbreak, health communication and the community's knowledge, perception, and behavioral responses towards COVID-19 should be assessed. METHODS: A community-based cross-sectional study design was conducted from June 15 to July 30, 2020, with 827 and 18 participants for the quantitative and qualitative study, respectively. The data were collected using ODK collect and exported to SPSS version 25 for analysis. Multivariate logistic regression was computed, and variables that had a significant association were interpreted at p <0.05 with a 95% CI. Additionally, the qualitative data were collected using in-depth interview and then transcribed, translated, and analyzed using thematic content analysis. RESULTS: The majority (97.8%) of respondents obtained information about COVID-19 through broadcast media, and 58.5% of the participants had good knowledge of COVID-19. Likewise, 51.3%, 60.9%, 73.8%, 35.1%, and 74.2% of participants had high perceived susceptibility, severity, benefit, barrier, and self-efficacy to COVID-19, respectively. Additionally, 54.3% of respondents had good behavioral responses to COVID-19. Kombolcha town residents (AOR: 4.32, 95% CI, 2.02-9.2), aged from 25 to 34, and 35 to 44 years old (AOR: 2.62, 95% CI, 1.37-5.0), and (AOR: 2.23, 95% CI, 1.11-4.46), respectively, secondary or above education (AOR: 2.38, 95% CI, 1.17-4.86), good knowledge of COVID-19 (AOR: 2.07, 95% CI, 1.42-3.02), high perceived self-efficacy (AOR: 4.90, 95% CI, 3.10-7.75), and low perceived barriers (AOR: 3.17, 95% CI, 2.12-4.74) to COVID-19 preventive measures were significantly associated with the behavioral responses to COVID-19. CONCLUSION: In this study, the behavioral responses to COVID-19 were relatively low. Therefore, continuous awareness creation is needed to scale up the community's knowledge and perceived self-efficacy. Furthermore, the general public, especially young people, should follow the government's COVID-19 prevention and control rules and regulations.

Low Birth Weight and Associated Factors Among Newborn Babies in Health Institutions in Dessie, Amhara, Ethiopia.

BACKGROUND: Globally, more than 20.5 million infants are born with low birth weight, and the majorities were from Asia and Africa. Even though efforts were made to reduce low birth weight worldwide, it remains a global public health problem, especially in sub-Saharan Africa. OBJECTIVE: To assess low birth weight and associated factors among newborn babies in health institutions in Dessie, Amhara, Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 358 newborn/mother pairs from March 1 to April 15, 2017, in Dessie town health institutions. The data were collected using a semi-structured interviewer-guided questionnaire. The numbers of newborn/mother pairs surveyed from each health institution were allocated proportionally, and systematic random sampling was used to select the respondents. Epi-info version 7.0 was used for data entry, and Statistical Package for Social Sciences version 20 was used for the analysis. Multivariate logistic regression with adjusted odds ratios and 95% confidence intervals were used to identify significantly associated variables with low birth weight. RESULTS: In this study, the prevalence of low birth weight was 15.6%. Maternal age <20 years (AOR: 3.78, 95% CI, 1.02-13.97), rural residence (AOR: 3.49, 95% CI, 1.48-8.24), having antenatal care follow-up (AOR: 3.79, 95% CI, 1.08-13.23), gestational age <37 weeks (AOR: 3.82, 95% CI, 1.55-9.42), and females (AOR: 3.37, 95% CI, 1.17-9.72) were significantly associated with low birth weight. CONCLUSION: The proportion of LBW in this study is comparable to the estimated global prevalence. Maternal age, residence, antenatal care, gestational age, and sex were significantly associated variables with low birth weight. Therefore, special attention should be given to antenatal care services and preventive strategies for preterm delivery.

Neonatal Hypothermia and Associated Factors among Newborns Admitted in the Neonatal Intensive Care Unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia.

INTRODUCTION: Neonatal hypothermia is the reduction in the body temperature of the newborn (less than 36.5°C). It is a global problem in neonates born both at hospitals and homes, but it showed a higher prevalence in developing countries (>90%). Although hypothermia is rarely a direct cause of death, it contributes to a substantial proportion of neonatal mortality globally. OBJECTIVE: To assess neonatal hypothermia and associated factors among newborns admitted in the NICU of Dessie Referral Hospital. METHODS AND MATERIALS: An institution-based cross-sectional study was conducted from March 15 to May 30, 2018. The data was collected from the mother and the chart of the newborn using a semistructured questionnaire. Data were cleaned, coded, and entered in EPI-info version 7.1.2.0 then exported to Statistical Package for Social Sciences (SPSS) version 20 software for analysis. Descriptive statistics were used to summarize the data. Bivariate and multivariate logistic regression and crude and adjusted odds ratio with their 95% confidence interval were computed. Finally, p value < 0.05 was used to identify variables that had a significant association with neonatal hypothermia. RESULT: The proportion of neonatal hypothermia in the study area was 66.8%. Preterm delivery (AOR = 2.6, 95% CI: 1.1, 6.2), no skin-to-skin contact within 1 hour of delivery (AOR = 3.0, 95% CI: 1.3, 7.8), delivered at night time (AOR = 2.0, 95% CI: 1.02, 4.0), and neonates who had resuscitation (AOR = 2.9, 95% CI: 1.1, 7.2) showed significant association with neonatal hypothermia. CONCLUSION: In this study, the proportion of hypothermia was high. Preterm delivery, no skin-to-skin contact within 1 hour, night-time delivery, and having resuscitation were significantly associated with neonatal hypothermia. Therefore, special attention is needed for the thermal care of preterm neonates and neonates delivered at night time. Furthermore, there should be strict adherence to cost-effective thermal care recommendations like warm resuscitation and skin-to-skin contact.

Patient Experience in Nursing Care and Associated Factors Among Adult Admitted Patients in Debre Markos and Dessie Referral Hospitals, Amhara Region, Ethiopia, 2019.

Patient experience of nursing care is the perception of the patient about the real existing nursing service. Addressing patient experience of nursing care is very important to improve nursing service quality because it identifies the factors that affect the nursing care quality better than patient satisfaction. Therefore, this study aimed to assess patient experience in nursing care and associated factors among adult admitted patients in Debre Markos and Dessie referral hospitals. An institution-based cross-sectional study was conducted from March 1, 2019, to March 30, 2019, among 528 consecutively selected adult admitted patients. Data were cleaned, coded, and entered in Epi-data version 3.1 then exported to Statistical Package for Social Sciences version 25 for analysis. Multivariate logistic regression, with a 95% CI was used to identify variables that had a significant association. The overall good patient experience in nursing care was 64%. Duration of admission ≥22 days (adjusted odds ratio [AOR] = 2.67, 95% CI = 1.013-7.025) and free service (AOR = 3.69, 95% CI = 2.381-5.730) showed a positive association with patient experience in nursing care. However, admission in gynecology ward (AOR = 0.43, 95%CI = 0.257-0.707), secondary education (AOR = 0.53, 95% CI: 0.308-0.907), and college or above education (AOR = 0.55, 95%CI = 0.320-0.957) showed a negative association with patient experience in nursing care.

Mother to Child Transmission of HIV and Associated Factors Among HIV Exposed Infants at Public Health Facilities, Dessie Town, Ethiopia.

BACKGROUND: Vertical transmission of Human Immunodeficiency Virus (HIV) is the primary route of infection among children. Ethiopia is among the top ten countries in the world with the highest burden of HIV infections among children. Therefore we aimed to assess mother to child transmission (MTCT) of HIV and associated factors among HIV exposed infants (HEIs). METHODS: A cross-sectional study was conducted using retrospective data collected from HEIs paired with their mothers who had received the services in prevention of mother to child transmission (PMTCT) programs from January 2014 to December 2017 in public health facilities in Dessie town. Data of a total of 313 HEIs paired with their mothers were obtained by using semi-structured data extraction proforma from their medical records. The data were processed in Epi-info version 7.1.2.0 and analyzed using SPSS version 22. Crude and adjusted odds ratios with their 95% confidence intervals and p-value were used to identify significant factors. RESULTS: The prevalence of HIV among exposed infants was 3.8%. Absence of maternal antenatal care visit (AOR = 4.6, 95% CI: 1.17-17.99), home delivery (AOR = 4.2, 95% CI: 1.04 -16.76), absence of antiretroviral intervention to the mother (AOR= 5.7, 95% CI: 1.10-29.36), and failure to initiate nevirapine prophylaxis for the infant (AOR = 5.3, 95% CI: 1.11 -25.44) were significant factors of MTCT of HIV. CONCLUSION: Prevalence of MTCT of HIV was low (3.8%) in Dessie town public health facilities. Having ANC visit, delivery at health facility, maternal ARV drug intake, and infant ARV prophylaxis were the significant protective factors against MTCT of HIV. Promoting ANC service utilization among pregnant women and providing counseling as well as setting up linkage with PMTCT and giving ARV intervention to all HIV positive pregnant women and timely initiation of NVP prophylaxis to all HEIs should be recommended by the minister of health and health facilities.