Modern contraceptive utilization and its associated factors in East Africa: Findings from multi-country demographic and health surveys.

BACKGROUND: The use of modern contraceptives has been low in most Sub-Saharan African countries despite high population growth and a sluggish economy. This study aimed to identify the prevalence and determinants of modern contraceptive use among married reproductive-age women in East Africa. METHODS: For this study, the Demographic and health survey (DHS) data from nine countries in East Africa were analyzed, yielding a weighted sample of 32,925 married women. A multilevel mixed-effect logistic regression model was used to identify characteristics associated with the utilization of modern contraceptives at a p-value less than 0.05. For model comparison, we used the Akaike and Bayesian Information Criteria (AIC and BIC). For assessing variation (random effects), we used community-level variance with standard deviation and intra-cluster correlation coefficient (ICC). RESULTS: The overall prevalence of modern contraceptive use was 45.68%, 95% CI (45.15, 46.21). Women's age, maternal education level, husband education level, media exposure, wealth status, occupation, religion, the total number of children ever born, distance to health facilities, history of termination of pregnancy, couple's desire for children, women's participation in decision making, living country and place of residence were significantly associated with modern contraceptive use in Eastern Africa. CONCLUSIONS: Conferring to this study, utilization of modern contraceptives is low in East Africa. Interventions to improve the use of modern contraceptives should encompass disseminating awareness through mass media, enrolment of males in family planning, giving maternal education, building health facilities in remote areas, and encouraging family planning programs in rural areas.

The Magnitude of Hypertension and Its Contributing Factors Among Patients Receiving Antiretroviral Therapy in Public Hospitals in Harar City, Eastern Ethiopia: A Cross-Sectional Study.

Background: Although people living with HIV (PLHIV) are surviving longer due to the development of highly active antiretroviral therapy (HAART), hypertension continues to be a significant obstacle for human immunodeficiency virus (HIV) positive patients. Purpose: This study aims to determine the prevalence of hypertension and its contributing factors among patients receiving HAART in public hospitals in Harar City, Eastern Ethiopia. Patients and Methods: A hospital-based cross-sectional study was conducted among adult PLHIV who receive HAART in public hospitals in Harar City, Eastern Ethiopia, from 20 March to 14 April 2023. A simple random sampling technique was employed to select a total of 406 clients (382 participated in the study). Data were collected through patient interview and chart review using a questionnaire. The binary logistic regression was used for data analysis. The association was declared statistically significant at a p-value less than 0.05. Results: The magnitude/prevalence of hypertension was 23% (95% CI: 19.1, 27.5) in study settings from a total of 382 adults who participated in this study. Factors significantly associated with hypertension in a multivariable binary logistic regression model include residence (rural residence, AOR = 1.95, 95% CI: 1.04, 3.65); body mass index (obese, AOR = 4.35, 95% CI: 1.08, 16.77); cigarette smoking (past cigarette smoking, AOR = 4.7, 95% CI: 1.10, 21.8); and HAART regimen change (AOR = 0.44, 95% CI: 0.20, 0.97). Conclusion: The prevalence of hypertension observed among adult PLHIV in the study settings was high. Adults from rural areas, with a history of past smoking cigarette, and obesity need close attention during their clinic visits for more health education to reduce risk factors. The changed HAART regimen was associated with a reduced risk of hypertension. Generally, hypertensive PLHIV need consideration for their double burden of communicable and non-communicable diseases during disease management and hospital guideline development.

The prevalence of infertility and factors associated with infertility in Ethiopia: Analysis of Ethiopian Demographic and Health Survey (EDHS).

BACKGROUND: Despite having a high fertility rate, low-resource countries are also home to couples with infertility problems. Although many couples are suffering from the psychological impacts of infertility, its level and determinants are not adequately known. The main objective of this study is to assess the prevalence and factors associated with infertility among couples in Ethiopia using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. METHOD: The study employed a cross-sectional study design extracting variables from the 2016 EDHS. The study included all married or cohabitating women aged 15 to 49 years in the Couples Recode (CR) file data set. Weighted samples of 6141 respondents were analyzed. We used Stata 14 software for analyzing the data. The association of selected independent variables with primary, secondary, and total infertility was analyzed using a logistic regression model. We presented the results using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) and a p-value <0.05 as a cut-off point for declaring statistical significance. RESULTS: The prevalence of infertility in the past 12 months was 24.2% (95% CI: 23.1-25.3%), of which the majority (90.7%) was secondary infertility. Greater than 35 years of age (AOR = 2.45, 95% CI (1.58-3.79)), rural residence (AOR = 1.06, 95% CI (1.01-1.39)), smoking (AOR = 2.29, 95% CI (1.39-3.77)), and <18.5 Body Mass Index (BMI) (AOR = 1.71, 95% CI (1.43-2.04)) were significantly associated with infertility. Conversely, infertility was less likely among women with formal education and better wealth index. Primary infertility was significantly higher among women whose partners drink alcohol (AOR = 1.55; 95% CI 1.06-2.28)) and chew khat (AOR = 1.62; 95% CI (1.12-2.36)). Secondary infertility was significantly higher among women with <18.5 BMI (AOR = 1.59, 95% CI (1.37-1.84)), >30 BMI (AOR = 1.54; 95% CI 1.01-2.35)), and <15 years of age at first birth (AOR = 1.40; 95% CI 1.15-1.69)). CONCLUSION: More than one in five couples in Ethiopia has an infertility problem. Both male and female-related factors are associated with infertility. Primary infertility was significantly higher among women whose partner chews khat and drinks alcohol. Secondary infertility was significantly associated with being underweight, obese, smoking, and young age at first birth. Hence, taking action on preventable factors is the most critical treatment approach and will improve the health status of the couples in other ways.

Inventory Management of Health Commodities in a Tertiary Teaching Hospital in Ethiopia.

Background: Analyzing purchased health commodities based on their budgetary consumption and importance is crucial for efficient utilization of a hospital's budget. However, it is rarely seen when hospitals, mostly in developing countries, conduct such kinds of analyses and make an informed decision, including to utilize their limited budget efficiently. Therefore, the purpose of this study was to analyze a 3-year inventory of health commodities (medicines, medical supplies, and laboratory reagents and chemicals) in Saint Paul Hospital Millennium Medical College (SPHMMC). Methodology: The study was conducted in SPHMMC located in Addis Ababa, Ethiopia. It is one of the largest specialized public hospitals in the country. It is a huge teaching hospital in the country where a large amount of budget is utilized. Three years of data were collected and ABC, VEN, and ABC-VEN matrix techniques were applied for the analysis. The data collection period was from March to April 2017. Results: An average of 296 medicines, 194 laboratory commodities, and 105 medical supplies were purchased over 3 years. Class A medicines, which consume 80% of the total annual pharmaceutical expenditures (APE) account, are 17.8%-20% of the total medicines by quantity. Antibiotics (ceftriaxone 1 gm injection and metronidazole), IV fluids (sodium chloride 0.9% injection and dextrose 40% injection), and antidiabetic medication (insulin zin suspension and metformin) are among the top 10 medications by value that consume significant amounts of the budget of the hospital. On VEN analysis, an average of 24% of the items were vital, 67% were essential, and 4-8-8.9% were nonessential. Nonessential items consumed 0.49%, 9.9%, and 1.1% of Annual Expenditures (AEs) in 2013/14, 2014/15 and 2015/16, respectively. On ABC-VEN matrix analysis, a single expensive and nonessential medicine (valganciclovir HCL 450 mg tablet) consumed 9.4% of expenditure in 2014/15. Class A laboratory commodities, which consume 70%-80% of the total laboratory expenditures represented 8.5%-20% of the total laboratory commodities analyzed for the 3 years. From class A items, antimonoclonal antibodies in 2013/14, hemocue glucose 201 4 × 25 tests in 2014/15, and glucose tests in 2015/16 consumed the highest percentages: 9.2%, 8.2%, and 23.7% of the AEs, respectively. There were laboratory commodities procured out of the VEN list, and these accounted for 6.8%-31.2% of the total laboratory expenditures over the 3 years. Class A medical supplies, which consumed 80% of the total medical supply expenditures, represented only 8.2%-15.8% of the total items over the 3 years studied. Surgical gauze 90 cm × 100 m, surgical gloves sterile latex number 7.5, and examination gloves were the top three based on expenditures in all the studied years. In 2015/16, examination gloves alone consumed 71.9% of the total expenditure. Conclusion: SPHMMC manages large numbers of health commodities (more than 500 excluding program commodities) which necessitate efficient inventory management practice in place. However, the purchase of the commodities particularly those products used for laboratory diagnosis is not strictly based on the hospital's VEN list, indicating the need for better communication of the laboratory unit with the Drug and Therapeutic Committee (DTC) of the hospital. The DTC of the hospital should update the VEN list of the health commodities and strictly enforce the hospital procurement to adhere to the agreed upon list of medicines. In addition, the hospital should prioritize and decide the quantity and frequency of ordering health commodities based on regular ABC-VEN results.

Cost-Effectiveness Analysis of Metronidazole versus Metronidazole with Diloxanide Furoate in the Treatment of Amoebiasis in Ethiopia.

INTRODUCTION: Amoebiasis is one of the world's most prevalent and fatal infectious diseases. Several surveys revealed that amoebiasis is one of the most widely distributed diseases in Ethiopia. The combination of metronidazole with diloxanide furoate represents a new approach for the treatment of the infection. OBJECTIVE: This study aimed to analyze the cost-effectiveness of diloxanide plus metronidazole compared with metronidazole alone in the treatment of amoebiasis in Ethiopia. METHODS: An analytical decision model was used to analyze costs and effectiveness from a societal perspective by taking adult amoebic patients as the study population with a time horizon of two months. The potential impacts of uncertainty in single parameters were explored in one-way sensitivity analyses. RESULTS: Metronidazole with diloxanide had a higher cost and effect compared to metronidazole alone with an incremental cost-effectiveness ratio (ICER) of 8 US$ per amoebic case cured. The result was sensitive to the decrease in the effectiveness of metronidazole with diloxanide. CONCLUSION: This study revealed the addition of diloxanide to standard treatment to be a more effective and more costly treatment strategy. Therefore, a decision for choosing the medication should be based on the ability of patients to pay for the treatment.

Assessment of Knowledge, Attitude, Practice and Associated Factors Towards Post-Exposure Prophylaxis for HIV/AIDS among Health Professionals in Health Centers Found in Harari Region, Eastern Ethiopia.

BACKGROUND: Healthcare workers are at risk of acquiring human immunodeficiency virus (HIV) infections, because of occupational exposure to blood and other body fluids. Post-exposure prophylaxis (PEP) is a short-term antiretroviral treatment used to reduce the likelihood of viral infection after exposure to the blood or body fluids of an infected person. Timely PEP after exposure to high-risk body fluids in the working area can reduce the rate of transmission of HIV significantly. OBJECTIVE: To assess the knowledge, attitude, practice, and associated factors towards PEP for HIV/AIDS among health professionals in health centers in the Harari region, Eastern Ethiopia. METHODOLOGY: A retrospective cross-sectional study was conducted using structured questionnaires from March to April 2019. The collected data were analyzed by using SPSS version 20, and the result was presented in the form of tables and figures. RESULTS: Of 217 participants, 51.6% were male and 75.2% were in the age group of 20-30 years. One hundred thirty (59.9%) respondents had a year of service less than 5 years, and nearly half (45.2%) of the participants had a Diploma. The study revealed that 35.02% of the participants had inadequate knowledge of PEP. About 32.26% had an unfavorable attitude towards PEP. Of 124 (57.1%) exposed respondents, 54 (68.4%) tried to get PEP service and 49 (90.7%) started to use PEP. Twenty-six (48.1%) respondents started to use PEP within 6 to 24 hours after exposure. Sex, qualification, and attitude status were found to have a significant association with knowledge regarding PEP. CONCLUSION: The findings of this study indicated that a significant number of health professionals had poor knowledge and poor attitude towards PEP. Occupational exposures were common among health professionals. However, the practice of using PEP was low among health professionals. As a result, health facilities should strengthen and integrate routine PEP services by providing training to all health professionals.

Epidemiology of Hypertension in Ethiopia: A Systematic Review.

BACKGROUND: Hypertension is one of the leading causes of disease in the world. This study is a systematic review paper, intended to provide compressive evidence on the prevalence, distribution, determinants, and burden of hypertension in Ethiopia. METHODS: A quantitative epidemiological literature review was conducted by searching different articles in different databases, including PubMed, Cochrane, and Google scholar. The search involved population-based, hospital-based, and institution-based studies on hypertension conducted in Ethiopia. All data were extracted independently by two reviewers using data collection formats. Finally, this review included 22 studies. RESULTS: Different studies reported varied prevalence of hypertension because of the differences in participant's mean ages, source population, and study settings. Population-based studies revealed the prevalence of hypertension to be 9.3-30.3%, institution-based studies revealed 7-37%, whereas hospital-based studies revealed 13.2-18.8%. In studies included in this review, about 37-78% of hypertensive patients were not aware of their blood pressure condition. There was a high prevalence of hypertension in urban residents, and different factors were associated with hypertension, including being overweight, family history of hypertension, age, sex, diabetes mellitus, alcohol intake, physical inactivity, and obesity. CONCLUSION AND RECOMMENDATION: Hypertension was substantially prevalent in Ethiopia, which calls for the implementation of timely and appropriate strategies for the prevention and control of the disease.

Treatment Outcome of Tuberculosis and Associated Factors among TB-HIV Co-Infected Patients at Public Hospitals of Harar Town, Eastern Ethiopia. A five-year retrospective study.

BACKGROUND: The bidirectional relationship between the twin epidemics of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) causes major global health challenges in the twenty-first century. TB-HIV co-infected people are facing multifaceted problems like high lost to follow up rates, poor treatment adherence, high TB recurrence rate, and high mortality risk. Our objective was to assess the outcomes of TB treatment and associated factors among TB-HIV co-infected patients in Harar town, Eastern part of Ethiopia, 2018. METHODS: A retrospective study was conducted among systematically selected 349 TB/HIV co-infected patients who registered from 2012 to 2017 in two public hospitals in Harar town. The data were collected through document review by using a pre-tested structured data extraction checklist. The data were analyzed using SPSS Version 21. Bivariate and multivariate logistic regression were determined at 95% confidence intervals. RESULTS: Among the 349 TB/HIV co-infected patients included in the study, 30.1% were cured, 56.7% had completed their treatment, 7.7% died, 1.7% were lost to follow up, and 3.7% were treatment failure. Overall, 86.8% of the TB-HIV co-infected patients had successful TB treatment outcomes. The patients who were on re-treatment category (AOR = 2.91, 95% CI: 1.17-7.28), who had a history of opportunistic infection (AOR = 3.68, 95% CI: 1.62-8.33), and who did not take co-trimoxazole prophylaxis (AOR = 3.54, 95% CI: 1.59-7.89) had 2.91, 3.68, and 3.54 times higher odds of having unsuccessful TB treatment outcome than their counterparties, respectively. The chance of unsuccessful TB treatment outcome was 4.46 (95% CI: 1.24-16.02), 5.94 (95% CI: 1.87-18.85), and 3.01 (95% CI: 1.15-7.91) times higher among TB/HIV patients in stage 2, 3 and 4 than those in stage 1, respectively. CONCLUSIONS: The overall rate of the success of the TB treatment among TB-HIV co-infected patients in this study was higher compared with many previous studies. TB/HIV patients with a history of previous TB treatment, smear-positive pulmonary TB, late HIV stage, history of opportunistic infection and not being on co-trimoxazole prophylaxis therapy were at a high risk of getting poor treatment outcomes.

Assessment of drug-related problems among type 2 diabetic patients on follow up at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia.

OBJECTIVES: To assess the drug-related problem among patients with type 2 diabetes at Hiwot Fana Specialized University Hospital. RESULTS: In this study, a total of 148 patient medication records were included. More than half, 83 (57.4%) were men and the rest 65 (42.6%) were women. The mean age of the study participants was 51.26 ± 7.08. Around one-third (74.3%) of the participants had urban residency. A total of 127 drug-related problems were identified, of which dosage too low was the most common type of DRP encountered, 46 (36.2%), followed by unnecessary drug therapy, 25 (19.7%) and ineffective drug therapy, 25 (19.7%). 95 (64.2%) of the patients had at least one drug-related problem. Among patients with DRP, more than half of them, 59 (62.1%) had a single DRP. Out of the total participants, 85 (57.4%) of them were taking one anti-diabetic medication and 63 (42.6%) of them dual anti-diabetic medications. Only half of the patients have attained the desired FBG level. There was no patient who had experienced more than two types of drug-related problems at a time. Less than 10% of patients were taking five or more drugs at a time.