Clients' satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method.

BACKGROUND: Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. OBJECTIVE: The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. METHODS: A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). RESULT: The quantitative wing revealed that overall, 65% (95% CI: 60-69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23-11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32-17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12-0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43-12.03, p-value = 0.000) were significantly associated with CSCCSS. QUALITATIVE RESULT: The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). CONCLUSION: According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Person-centered maternity care during childbirth and associated factors among mothers who gave birth at public health institutions of Debre Markos town, Northwest Ethiopia, 2022: A cross-sectional study.

Background: Person-centered maternity care is a crucial scheme for a positive childbirth experience. It enhances facility-based delivery, improves patient-provider communication, and increases women's satisfaction. However, there is limited evidence on the magnitude of person-centered care and certain variables were missed in Ethiopia. Therefore, this study assessed the magnitude of person-centered maternity care during childbirth and associated factors at health institutions of Debre Markos town, Ethiopia. Methods: Institution-based cross-sectional study was conducted at public health institutions of Debre Markos town. Participants were enrolled using systematic random sampling technique. Data were collected through face-to-face exit interviews, cleaned, coded, and entered into Epi-Data version 3.1 then exported to SPSS version 25 for analysis. After generating simple linear regression analysis, variables with p-value ⩽ 0.25 were fitted into multivariable linear regression model and p-value < 0.05 was declared statistically significant with 95% CI for ß. Finally, study findings were presented using texts, tables, and figures. Results: In this study, 380 women participated, with a response rate of 98.19%. The respondent's mean person-centered maternity care score was 56.83 with 95% CI: (55.83, 57.83). Mean score for sub-scale was 15.08 for dignity and respect, 14.42 for communication and autonomy, and 27.33 for supportive care. Commencing antenatal care during third trimester (ß = -4.86, 95% CI: -8.22, -1.49), caesarean delivery (ß = -5.78, 95% CI: -7.68, -3.87), college and above educational level of women (ß = 3.75, 95% CI: 1.11, 6.39), being multiparous (ß = 3.69, 95% CI: 1.85, 5.55), and health center delivery (ß = 6.59, 95% CI: 4.17, 9.02) were factors significantly associated with person-centered maternity care. Conclusion: This study showed person-centered maternity care was low compared with World Health Organization standards. This informs local policymakers, district health offices, institutional healthcare administrators, and healthcare professionals of the discrepancies in achieving international standards of quality care.

Prevalence of sexual violence and associated factors among women attending antenatal care in Debre Markos at public health institutions in north-west Ethiopia, 2021.

Background: Sexual violence refers to being forced to perform any unwanted sexual act. Due to the negative effects on both the mother and the fetus, sexual assault during pregnancy is a public health concern. Knowing the prevalence of sexual violence during pregnancy helps policymakers understand the extent of the problem and can be considered the first step toward implementing interventions for prevention and treatment. This study was done to determine the prevalence of sexual violence and its associated factors during pregnancy in public hospitals in Debre Markos. Methods: An institution-based cross-sectional study was conducted among 306 pregnant women in Debre Markos, north west Ethiopia from May 1 to June 30, 2021, 2021. A systematic random sampling procedure was used to select study participants. Data were collected using a structured and interviewer-administered questionnaire, and a pre-test was done. Both bi-variable and multivariable logistic regression analyses were undertaken to identify significantly associated variables with sexual violence. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of ≤ 0.05 was used to claim statistical association. Results: There were 304 interviewed respondents with a response rate of 99.3%. In this study, the overall prevalence of sexual violence among pregnant mothers during the current pregnancy was 19.4%. A husband who had no formal education {AOR = 3.48; 95% CI: 1.06, 11.39}, pregnant mothers who had no formal education {AOR = 6.1; 95% CI: 1.50-18.11}, pregnant mothers who had secondary education {AOR = 2.80, 95% CI: 1.15, 6.81}, being a housewife {AOR = 3.87, 95 CI:1.21, 12.37}, and being a governmental employee {AOR = 4.49, 95% CI: 1.22, 16.40} were factors associated with sexual violence at the value of p ≤ 0.05. Conclusions and recommendations: In this study, approximately one-fifth of the study participants experienced sexual violence during their current pregnancy. To reduce this, interventions should focus on the education of women as well as their partner about violence against women and on initiatives to economically empower women.

Prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under five diarrheic children attending public health facilities in Debre Markos town, Northwest Ethiopia.

Background: Under five children are at risk of diarrhea-associated morbidity and mortality. Salmonella and Shigella are major causes of diarrhea in under-five children, especially in developing countries. This study aimed to assess the prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under-five diarrheic children in Debre Markos town public health facilities. Methods: A cross-sectional study was conducted at public health facilities in Debre Markos town using a consecutive convenient sampling technique. Data on socio-demographic and associated factors were collected using a structured questionnaire. Salmonella serovars and Shigella species were identified using MacConkey, Xylose Lysine Deoxycholate, Salmonella Shigella agar, and biochemical tests. The antimicrobial resistance pattern was determined by using the modified Kirby-Bauer disk diffusion technique. Results: The overall prevalence of Salmonella and Shigella was 11.7% (26/222; 95% CI = 7.2-17.5%). Isolated Salmonella serovars showed a higher rate of resistance (85.7%, 6/7) for both Ampicillin and Amoxicillin/Clavulanic acid while Shigella isolates showed a higher resistance rate to Amoxicillin/Clavulanic acid (78.9%, 15/19) and Ampicillin (73.7%, 14/19). The overall multidrug resistance (MDR) rate of Salmonella and Shigella isolates was 88.5% (23/26). Parent/guardian educational status ≤ elementary school (AOR = 3.783; 95% CI = 1.28-11.19; P = 0.016), presence of two or more under-five children in the family (AOR = 8.999; 95% CI = 2.93-27.69; P < 0.001), unimproved source of drinking water (AOR = 5.010; 95% CI = 1.56-16.10; P = 0.007), the habit of storing cooked foods for later use (AOR = 3.199; 95% CI = 1.07-9.54; P = 0.037), attendance of the child at social gatherings (AOR = 5.387; 95% CI = 1.78-16.35; P = 0.003), and infrequent child fingernail trimming (every ≥ 2 weeks; AOR = 4.693; 95% CI = 1.47-14.94; P = 0.009) showed statistically significant association with the prevalence of culture-confirmed Salmonella and Shigella isolates. Conclusion: The prevalence of culture-confirmed Salmonella and Shigella isolates was significantly high in the study area. Salmonella and Shigella isolates exhibited a high rate of MDR pattern. Parent/guardian education level below the elementary school, the presence of two or more under-five children in the family, using unimproved water source, a habit of storing cooked food, and infrequent fingernail trimming were independent predictors of culture-confirmed Salmonella and Shigella. Therefore, besides public health measures, regular surveillance of the prevalence and antimicrobial resistance pattern of Salmonella and Shigella should be routinely practiced in the study setting.

Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study.

Background: Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital. Methods: A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis. Results: The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09-11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79-11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08-9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85-12.43)], being referred [AHR: 2.90; 95% CI: (1.10-7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08-10.50)] were statistically significant predictors of puerperal sepsis. Conclusion: The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis.

Preference of birth attendant gender and associated factors among antenatal care attendants at Debre Markos town public health facilities, Northwest Ethiopia: A cross-sectional study design 2021.

Objective: To assess the preference of birth attendant gender and associated factors among antenatal care attendants in Debre Markos town public health facilities, northwest Ethiopia, 2021. Method: A facility-based cross-sectional study was conducted from 8 January 2021 to 28 February 2021 at Debre Markos town public health facilities. A total of 662 study participants were selected by systematic random sampling technique. Pretested interviewer-administered structured questionnaires were used for data collection. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 25. Bivariable and multivariable logistic regression were applied to identify factors associated with birth attendant gender preference. Association was described by the "odd ratio" along with a 95% confidence interval. Finally, a P value < 0.05 in the adjusted analysis was used to declare a significant association. Result: In this study, 644 women participated making a response rate of 97.3%. Of the total study participants, 108 (16.8%; 95% confidence interval: 13.8-19.4) preferred male birth attendants, while 232 (36%; 95% confidence interval: 32.5-39.8) preferred female birth attendants. Age (15-24) (adjusted odds ratio = 4.81, 95% confidence interval: 1.79, 12.94), no formal education (adjusted odds ratio = 2.94, 95% confidence interval: 1.32, 6.52), and primary education (adjusted odds ratio = 2.42, 95% confidence interval: 1.07, 5.47) were significantly associated with female birth attendant preference. A lack of formal education (adjusted odds ratio = 0.08; 95% confidence interval: 0.01, 0.68), secondary education (adjusted odds ratio = 0.34; 95% confidence interval: 0.16, 0.71), and history of assisted vaginal delivery (adjusted odds ratio = 3.72; 95% confidence interval: 1.40, 9.87) were significantly associated with a male birth attendant preference. Conclusion: A female birth attendant is preferred by almost one-third of pregnant mothers, while one-sixth preferred a male. The clients who were younger in age and lower in educational status were more likely to prefer female birth attendants, whereas those who had a history of assisted vaginal delivery were more likely to prefer male birth attendants. To have a mother in the continuum of care, it is crucial to take her preferences into account when providing services.

Hematological Profiles and Clinical Outcome of COVID-19 Among Patients Admitted at Debre Markos Isolation and Treatment Center, 2020: A Prospective Cohort Study.

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is coronavirus isolated from SARS patients. As far as the researchers' knowledge, there was paucity of studies conducted in Ethiopia, particularly in the study area. As immune protection is arisen from our blood cells, assessing their level will provide a clue for controlling the disease and monitoring the prognosis. This study will also provide additional information for clinical intervention and patient management. Purpose: This study aimed to investigate the hematological profile and clinical outcome of coronavirus disease-19 (COVID-19) among patients admitted to the Debre Markos Isolation and Treatment Center (DMITC). Material and Methods: A prospective cohort study was conducted among 136 COVID-19 adult patients at DMITC from January 1, 2020 to March 30, 2021. Data related to clinical, hematological profiles and socio-demographic factors were collected, entered into Epi data, and analyzed using STATA 14.2 software. Multivariable logistic regression was applied to determine the predictor variable and a p-value <0.05 was considered significant. Results: Of 136 COVID-19 patients, 28.68% had died. The mean age of patients was 47.21±1.29 years. The hematological profile of the patients revealed that 28% had abnormal leukocyte, 23% abnormal lymphocyte, 44.85% abnormal granulocyte, 22.06% abnormal monocyte, 30.15% abnormal RBC and 87% abnormal platelet counts. The prevalence of anemia was 13.24%. Conclusion: Leukocytosis (mainly granulocytosis and monocytosis) and lymphopenia, were the predominant abnormal findings of complete blood cell count (CBC) analysis of the patient's blood. Most of the patients had abnormally low platelet counts. RBC count and hematocrit determination were the only significant predictors of death. The clinician could manage cases according to the hematological findings of the patients. Further experimental studies should be conducted to determine hematological parameter changes and the clinical outcome of the disease.

Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia.

Health-related quality of life (HRQOL) is a multifaceted concept that is strongly impacted by Type II diabetes in developing countries. The majority of studies indicate diabetes mellitus prevalence without looking at people's quality of life. This study was conducted using an Institution-based cross-sectional design in Debre Markos Referral Hospital from March 03 to March 31, 2020. We evaluated HRQOL using the WHO quality of life BREF and data were obtained through face-to-face interviews. We used a systematic random sampling technique to select study participants. Data were entered into Epi data version 3.1 and exported to STATA version 14.0. Candidates for multivariable analysis were variables with a P-value less than 0.25 in the bivariable analysis and P-value less than 0.05 were considered to declare a statistically significant association. The final model was tested for its goodness of fit using Hosmer and Lemeshow's statistics. The analysis included a total of 368 adult individuals with type II diabetes and 206 (56%) had a good HRQOL. Being male (AOR = 4.28, 95%CI:2.36, 7.78), having duration of disease of more than 59 months (AOR = 2.93, 95%CI:1.61, 5.34), doing a physical exercise (AOR = 2.33,95%CI:1.34, 4.05) and got counseling (AOR = 3.33; 95%CI:1.82, 5.94) were directly associated with good HRQOL whereas the presence of diabetic complications (AOR = 0.46, 95%CI:0.26, 0.80), comorbidity (AOR = 0.45; 95%CI:0.25, 0.84) and drinking alcohol (AOR = 0.27, 95%CI:0.16, 0.48) had an inverse relationship with good HRQOL. More than half of type 2 diabetic adult patients had a good HRQOL. Being male, drinking alcohol, getting counseling, doing physical exercise, absence of diabetic complications, and comorbidity and long duration of disease were predictors of good HRQOL. Therefore, avoiding drinking alcohol and promoting physical exercise and counseling should be encouraged.

Prevalence of Medication Non-Adherence and Associated Factors among Diabetic Patients in A Tertiary Hospital at Debre Markos, Northwest Ethiopia.

Background: Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital. Methods: A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05. Results: A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications. Conclusion: The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients.

COVID-19 vaccine acceptability and determinants among pregnant mothers attending antenatal care services at Debre Markos town public health institutions, Debre Markos Northwest Ethiopia: mixed study.

Introduction: coronavirus is a communicable disease that produces severe morbidity and mortality in the globe and more than three million people died due to COVID-19. Pregnant mothers are at higher risk of COVID-19 viral infection, with great morbidity and mortality. Thus, the purpose of this research is to assess the level of COVID-19 vaccine acceptability, determinants, and hesitancy among pregnant mothers attending antenatal care at Debre Markos town, public health institutions, Debre Markos, Northwest Ethiopia. Methods: a mixed study was conducted among 350 pregnant mothers attending antenatal care at Debre Markos town health institutions and the participants were selected by consecutive sampling techniques. The collected data were entered into EPI Info version 7 and then exported to SPSS version 25 for data cleaning and analysis. The level of COVID-19 vaccine acceptability was determined through descriptive statistics, whereas its determinants were identified by binary logistic regression analyses. Variables with p-value < 0.05 in multivariable were considered as significantly associated factors. The qualitative data were collected by an unstructured interviewer guide using in-depth interview data collection methods. Study participants were selected purposively until the required data was saturated. The data was analysed under selected themes based on the guide and summarized manually. Results: sixty-five (18.5%) of the respondents accept the COVID-19 vaccine [95% CI: 13, 23]. Maternal age [AOR: 3.281 (95% CI: 1.184, 9.092)], chronic medical illness [AOR: 0.170 (95% CI: 0.051, .562)], information about COVID-19 vaccine [AOR: 4.063 (95% CI: 1.462, 11.293)], pregnancy-induced medical conditions [AOR: 4.131 (95% CI: 1.055, 16.183) were identified as significant determinants of COVID-19 vaccine acceptability. From the quantitative wing. The qualitative finding implied that misconception, fear of medical complications, lack of trust in its effectiveness, and religious constraints were the common reasons for vaccine hesitancy. Conclusion: COVID-19 vaccine acceptability by pregnant mothers attending ANC at Debre Markos town public health institutions is very low. The health care providers and health extension workers shall create information about the COVID-19 vaccine on its importance and side effects.

Depressive symptoms and associated factors among adults attending antiretroviral therapy clinic in Debre Markos comprehensive specialized hospital, Amhara, Ethiopia.

Objective: This study aimed to assess the prevalence and associated factors of depressive symptoms among adults attending anti-retroviral therapy follow up at Debre Markos Comprehensive Specialized Hospital. Methods: Institution-based cross-sectional study was conducted, and a systematic sampling technique was used to select the 266 participants. Depressive symptoms were assessed by using patient health questionnaire 9. A binary logistic regression analysis with an odds ratio and a 95% confidence interval was used to assess the strength of associations in SPSS version 20 and a p-value < 0.05 was considered as statistically significant. Results: In this study, the prevalence of depressive symptoms among HIV-positive individuals was 39.1% with 95% confidence interval (33.7%-45.3%). Multivariable analysis showed that participants who had age group > 40 (adjusted odds ratio = 5.26, 95% confidence interval (2.24-12.35)), presence of perceived stigma and discrimination (adjusted odds ratio = 7.5, 95% confidence interval = (3.77-14.9)), poor medication adherence (adjusted odds ratio = 6.05, 95% confidence interval = (2.86-12.80)), and poor social support (adjusted odds ratio = 2.53, 95% confidence interval = (1.25-5.12)) were significantly associated with depression. Conclusion: The prevalence of depressive symptoms in this study was found to be significantly high. Age > 40 years old, the presence of perceived stigma and discrimination, poor medication adherence, and a lack of social support were found to be associated factors of depressive symptoms. It would be better for clinicians to give special emphasis to those patients who were stigmatized, who had compliance problems, and poor social support.

Predictors of time to recovery from postpartum hemorrhage in Debre Markos comprehensive specialized hospital, Northwest, Ethiopia, 2020/21.

BACKGROUND: Postpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Early recovery is a performance indicator and better health outcome of patients with postpartum hemorrhage. Therefore, this study aimed to assess time to recovery from postpartum hemorrhage and its predictors in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020. METHODS: A retrospective follow-up study was conducted among 302 women who were diagnosed with postpartum hemorrhage from January 1, 2016 to December 31, 2020 at Debre Markos Comprehensive Specialized Hospital. Consecutive sampling technique was employed. To show the statistical significant difference between each group of variables, log rank test was used. Kaplan Meier analysis to estimate time to recovery and cox proportional-hazard regression analysis to determine independent predictors were carried out cautiously. Adjusted hazard ratio used to determine the strength of association. RESULT: The median recovery time from postpartum hemorrhage was 13 h with range of (10 to 17 h). Blood transfusion (AHR: 1.8, 95% CI (1.39, 2.57)), NASG utilization (AHR: 6.5, 95% CI (4.58, 9.42)) fluid resuscitation (AHR 2.9, 95% CI (1.48, 5.54)), active management of third stage of labor (AHR: 1.7, 95% CI (1.18, 2.45)) and history of antenatal care follow-up (AHR: 2.6, 95% CI (1.91, 3.56)) were the predictors, which shorten the recovery time. Comorbidities like anemia at the time of admission (AHR: 0.62 95% CI (0.44, 0.89)), retroviral infection (AHR: 0.33, 95% CI (0.16, 0.67)) and Hepatitis B-Virus infection (AHR: 0.52, 95% CI (0.32, 0.82)) delay the recovery rate from postpartum hemorrhage. CONCLUSION: Mothers in North-West Ethiopia stays morbid from postpartum hemorrhage for more than half a day. Their recovery time was affected by Non-Pneumatic Anti-Shock Garment utilization, implementation of emergency management components like blood transfusion and fluid resuscitation, history of antenatal care follow up, and being comorbid with viral infections. Non-pneumatic anti-shock garment application to every mother with postpartum hemorrhage and implementation of proper emergency management approach are vital for rapid recovery from postpartum hemorrhage.

Parent-adolescent discussion about reproductive health issues and associated factors among parents in Debre Markos town, Northwest, Ethiopia: a cross-sectional study.

Introduction: adolescence is a transition phase from being a child to an adult. Open positive parent-adolescent communication on reproductive health issues has many positive effects on adolescents, families, and society. Methods: a community-based cross-sectional study design was employed, and a multistage sampling technique was used. Data were collected through face-to-face interviews with pre-tested structured questionnaires. After data collection, data were coded and entered using Epi data version 3.1 and analysed using SPSS version 25 statistical software. Binary logistic regression analysis was used to ascertain the association between explanatory variables and the outcome variable. Variables with a P value less than 0.25 in the bivariable analysis and P-value < 0.05 in the multivariable analysis and corresponding 95% CI of odds ratio were considered to declare a result as statistically significant. Results: this study has revealed parent-adolescent discussion on reproductive health issues was 55.2%. Age 45-54 (AOR=2.37, 95% CI: 1.28-4.39) and 55-64 (AOR=2.54, 95% CI: 1.15-5.56) years, male parents (AOR= 0.51, 95% CI: 0.29-0.89) and monthly income above 158 USD (AOR=3.31, 95% CI: 1.79-6.12) were statistically significant. Conclusion: more than half of the parents discuss reproductive health issues with adolescents. Age 45-54 and 55-64 years, male parents, and higher incomes were the factors that allowed parent-adolescent discussion on reproductive health issues.

Incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia; A retrospective cohort study, 2021.

Background: Currently, coronavirus disease 2019 (COVID-19) is the leading cause of death and the rate of mortality is rapidly increasing over time. There is a paucity of information regarding the incidence and predictors of mortality among COVID-19 patients from low-income countries, particularly in Ethiopia. Objective: To assess incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia. Methods: An institution-based retrospective cohort study was conducted among 552 laboratory-confirmed COVID-19 cases at Debre Markos University and Tibebe Ghion Hospital COVID-19 treatment centers in North West Ethiopia from March 2020 to March 2021. Data were collected from patients' medical records using a structured data extraction tool. Cox-proportional hazards regression models was fitted to identify significant predictors of mortality. Result: The overall mortality rate of COVID-19 was 4.7, (95 % CI: 3.3-6.8) per 1000 person day observations. Older age (AHR: 4.9; 95% CI: 1.8, 13.5), rural residence (AHR: 0.18; 95% CI: 0.05, 0.64), presence of hypertension (AHR: 3.04; 95% CI: 1.18, 7.8), presence of diabetes mellitus (AHR: 8.1; 95% CI: 2.9, 22.4) and cardiovascular disease (AHR: 5.2; 95% CI: (1.69, 16.2) were significantly associated with mortality. Conclusions: The rate of mortality among hospitalized COVID-19 patients in this study was low. COVID-19 patients from urban residences, older patients, and patients with comorbidity have a high risk of death. These high risk groups should be prioritized for COVID-19 vaccinations, and early screening and appropriate intervention should be established on presentation to health facility.

Immediate Postnatal Care Satisfaction and Associated Factors Among Postnatal Women in Public Health Facilities at Debre Markos Town, Northwest Ethiopia, 2021.

BACKGROUND: Immediate postnatal care (PNC) satisfaction is considered as the desired outcome of the health care system and determines the use of subsequent health care services. There is a paucity of evidence on the level of immediate PNC satisfaction in the study setting. Therefore, the aim of this study was to assess the level of immediate PNC satisfaction and associated factors among women who gave birth in Debre Markos town public health institutions, northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from January 1 to February 28, 2021, and a systematic sampling technique was used to select the postnatal women. An interviewer-administered pretested structured tool was used. The level of immediate PNC satisfaction was measured by Jipi's postnatal satisfaction with the nursing care questionnaire (JPSNQ). The collected data were entered into EpiData version 4.6.0 and exported to SPSS version 23 for management and analysis. Both bivariable and multivariable binary logistic regression analysis were applied. Adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were calculated and statistical significance was declared at P-value <0.05. RESULTS: A total of 389 postnatal mothers participated in this study with a response rate of 98.73%. Immediate PNC satisfaction was 60.90% (95%CI: 56.50-65.60). Postnatal women having multiparity (AOR=7.31, 95%CI: 4.40-12.17), four and more antenatal care (ANC) visits (AOR=1.90, 95%CI: 1.08-3.36), satisfied by delivery care (AOR=2.05, 95%CI: 1.24-3.40), received friendly care (AOR=7.72, 95%CI: 2.42-13.52) and having companion (AOR=2.48, 95%CI: 1.37-4.50) had higher likelihood of immediate PNC satisfaction. CONCLUSION: Women's satisfaction with immediate PNC was higher than the national achievements of targets for the client satisfaction. Therefore, health-care providers should encourage frequent ANC visits, friendly care, and companionship to increase the level of immediate PNC satisfaction.

Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Risk Factors Among Patients With Wound Infections at Debre Markos Referral Hospital, Northwest, Ethiopia.

Wound infections are associated with morbidity and mortality in developing countries. Thus, this study aimed to assess bacterial profile, antimicrobial susceptibility pattern and risk factors among wound infection suspected patients. A hospital-based cross-sectional study was conducted on 201 participants at Debre Markos referral hospital from January to May 2019. Sociodemographic data were collected using pre-designed questionnaire and swabs from different types of wounds were collected, and inoculated onto mannitol salt agar, blood and MacConkey agar plate for isolation and identification. Antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique. Out of 201 swabs analyzed, 72.6% were culture positive and 10.9% of them had co-infections, and 162 bacterial isolates obtained from 146 swab samples. Staphylococcus aureus was the most frequently isolated which accounted for 32.1% of isolates followed by Pseudomonas aeruginosa, 15.4%. The susceptibility patterns of ciprofloxacin, gentamycin and ceftriaxone were 77.8%, 69.1%, and 68.5%, respectively. The MDR rate of gram positive and gram negative isolates were 69.7% and 82.3%, respectively. Anatomically located wounds near a site of potential contamination, inadequate management of moisture, exudate or edema, mechanism of wound production, presence of predisposing condition and being urban in residence significantly associated with wound infections. S. aureus and P. aeruginosa were the predominant causes of wound infections. Ciprofloxacin, gentamycin and ceftriaxone were the most effective antimicrobials. Periodic surveillance of isolates involved in wound infection and their antimicrobial susceptibility is recommended for effective management of patients.

Management, survival, and predictors of mortality among hospitalized heart failure patients at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: Prospective cohort study.

INTRODUCTION: Heart failure is a major public health problem worldwide. Since heart failure with reduced ejection fraction and preserved ejection fraction are different clinical entities, in-hospital mortality may occur at different rates. This study aimed to assess the management, survival, and predictors of mortality among hospitalized heart failure patients at Debre Markos comprehensive specialized medical ward. METHODS: A prospective cohort study was conducted on 228 heart failure patients at Debre Markos Comprehensive Specialized Hospital medical wards. A structured data collection tool was used to collect data. Data were analyzed using SPSS version 21.0. The Kaplan-Meier survival curve was used to investigate if there was a difference in the in-hospital survival between heart failure with a reduced ejection fraction and heart failure with a preserved ejection fraction. Those variables having p-value < 0.05 were considered statistically significant. RESULTS: From the 228 participants, 126 (55.3%) were females with a mean age of 53.32 ± 15.68 years. One hundred thirty-three (58.3%) patients were presented with preserved (⩾50%) level of ejection fraction. The all-cause in-hospital death rate was 12.7%, and the risk of in-hospital mortality was higher in heart failure patients with reduced ejection fraction (7.4% vs 5.3%; p = 0.005). Current occupation (p = 0.041), elevated serum creatinine (p = 0.010), reduced ejection fraction (p = 0.017), and asthma/chronic obstructive pulmonary disease comorbidity (p = 0.002) were the independent predictors of high hospital mortality. CONCLUSION: The rate of in-hospital mortality among heart failure patients was high. Healthcare providers should provide effective education activities and define disease management strategies for patients with reduced ejection fractions.

Methicillin and Vancomycin Resistant Staphylococcus aureus and Associated Factors from Surgical Ward Inpatients at Debre Markos Referral Hospital, Northwest Ethiopia.

INTRODUCTION: Staphylococcus aureus is a well-known superbug and leading causes of wound infections. The clinical epidemiology of methicillin resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) is not well documented in Ethiopia. The aim of this study was to determine the proportion of MRSA, VRSA and associated factors from surgical inpatients in Debre Markos Referral Hospital (DMRH), Northwest Ethiopia. METHODS: A facility-based cross-sectional study was conducted from February to April 2020 at DMRH. A structured questionnaire was used to gather demographic and clinical data. Wound swab was collected from inpatients and then inoculated on blood agar and mannitol salt agar. The presence of MRSA and VRSA was determined using the cefoxitin (30 µg) antibiotic disk diffusion and vancomycin E-test methods, respectively. The data were analyzed using SPSS 20. Data were analyzed using bivariate and multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 242 wound cases were enrolled and the majority of them were males 172 (71.1%). Among the total enrolled cases, S. aureus was identified from 71 (29.3%) of the admitted patients. The proportion of MRSA was 32 (13.22%) and that of VRSA was 4.1%. The proportion of vancomycin intermediate S. aureus (VISA) was gauged at 4.5%. Hospital stay over 72 hrs, wound depth, current antibiotic use, and previous history of wound infection showed statistically significant association with MRSA. On the contrary, VRSA did not showed any significant association against the analyzed variables. CONCLUSION: High proportions of S. aureus isolates became MRSA; resistant to all ß-lactam antimicrobial agents excluding newer cephalosporin. In addition, the proportion of VRSA/VISA was also high. Multiple variables demonstrated significant associations with MRSA. Hence, intervention measures for MRSA risk groups must be in place. Furthermore, hospital infection control and an antibiotic stewardship program should be strengthened.

Magnitude of anemia and associated factors among children aged 6-59 months at Debre Markos referral hospital, Northwest Ethiopia: a hospital-based cross-sectional study.

BACKGROUND: Anemia, the most common micro-nutrient deficiency disorder, is the world's second leading cause of morbidity and morbidity, affecting 24.8% of the population, of which 47.4% are under-five children. The prevalence of anemia ranges from 44 to 56% in Ethiopia. Although its magnitude has shown decreases across regions; it continues to be a significant public health problem, particularly in developing countries including Ethiopia. Despite this evidence, the magnitude and associated factors of anemia was not systematically explored and there is a limited information or limited evidences in the study area. Hence, the aim of this study was to assess the magnitude and associated factors of anemia among children aged 6-59 months attending at Debre Markos Referral Hospital, Northwest Ethiopia. METHODS: A hospital-based cross-sectional study was conducted at Debre Markos referral hospital Northwest Ethiopia from September 30 to December 30, 2019. Data on socio-demographic and socio-economic factors, health and nutritional features of children and their mothers were obtained using pre-tested structured questionnaires in a face-to-face interview with child care providers. Blood samples and stool examination for intestinal parasites were performed. Hemoglobin level was analyzed using the HemoCue device (HemoCueHb 301). The collected data were coded, cleared and entered into Epi-Data version 3.1, and analyzed using Stata version 14 software. To identify candidates and predictor variables, bivariate and multivariate logistic regressions were applied respectively. The significance level was determined at a confidence interval of 95% at p-value < 0.05. RESULTS: Of the total of 341 participants planned to be participated, about 310 mother-child pairs participated in the study, giving a response rate of 91%; and data were collected from children as well as their parents or guardians. In this study, the magnitude of anemia was 11.9% (95% CI, 8.5, 16.2%). Poor dietary diversity (AOR = 2.3; 95% CI: 1.12, 5.14), food-insecure households (AOR = 3.24; 95% CI: 1.85, 4.52), complementary feeding initiation time (AOR = 3.20; 95% CI:1.23, 6.61), intestinal parasites infection (AOR = 3.20; 95% CI:1.23, 6.61) and family income (AOR = 2.87; 95% CI:1.57, 5.0) were found to be factors significantly associated with anemia. CONCLUSION: Overall, anemia is considered a public health problem among children aged 6-59 months attending at Debre Markos referral hospital, based on the cut-off point of the World Health Organization. Poor dietary diversity, complementary feeding initiation time, household food insecurity, intestinal parasite infection and family income were significantly associated with childhood anemia. Thus, it needs for proven interventions in public health such as food diversification, anti-helmintic drug provision and household food security. In addition, educating women about nutrition and diet diversification, as well as involving them in alternative sources of income-generating activity, can be vital in the study area.

Virological Suppression and Its Associated Factors of Dolutegravir Based Regimen in a Resource-Limited Setting: An Observational Retrospective Study in Ethiopia.

BACKGROUND: Toxicity, treatment failure, and resistance to existing HIV treatment regimens have become a challenge in resource-limited settings. As a result, a dolutegravir based regimen has recently been utilized. However, there is a paucity of evidence in sub-Saharan countries regarding its virological suppression. Thus, this study aimed to assess virological suppression and associated factors of dolutegravir based regimen. METHODS: A retrospective follow-up study was conducted on 349 individuals. They were selected using a systematic random sampling technique among all treatment-experienced adult HIV patients who were on a dolutegravir based regimen. From this, 81.4% of them were virologically suppressed before the initiation of dolutegravir based regimen. The study was carried out at twelve months of therapy after shifting to dolutegravir based regimen (TDF-3TC-DTG) during the period May 2018-August 2020 at Debre Markos referral hospital. Retrospective data before and after dolutegravir based regimen initiation were collected from their medical records. The time on dolutegravir based regimen was one year. Bivariable and multivariable logistic regression was used to identify factors. Variables with p <0.05 were considered statistically significant. RESULTS: From a total of 359, 349 participated (97.2%) in the study, and the mean age of the participants was 40.28 ±11.6 years. Totally, 192 (55.0%) of them were female. The proportion of virological suppression was 92%. Good adherence (participants who reported an intake of ≥95% of the prescribed medication) (AOR=6.2, 95% CI: 1.93, 20.11) and overall duration of ART (AOR=1.02, 95% CI: 1.01, 1.04) were associated with virological suppression. CONCLUSION: Dolutegravir based regimen maintains high virological suppression. Adherence and duration of ART were associated with virological suppression. Therefore, designing effective mechanisms to maintain virological suppression is important.