The association of lipid-lowering therapy and blood pressure control among outpatients with hypertension at the Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Background: The lipid-lowering medications known as statins have been shown in controlled clinical trials to have pleiotropic properties, such as lowering blood pressure, in addition to lowering cholesterol levels. The purpose of this study was to see if there was a possible link between blood pressure control and statin therapy in outpatients with hypertension in a real clinical setting. Patients and methods: A retrospective comparative cohort study of 404 patients with hypertension was carried out. A systematic random sampling technique was used. For data entry, Epi-Data version 4.6 was used, and SPSS version 25 was used for further analysis. For group comparisons, chi-square and independent t-tests were computed. To determine the relationship between statin use and blood pressure control, a binary logistic regression model was employed. To declare statistical significance, a 95% confidence interval and a P-value of <0.05 were used. Results: Half of the study participants who were using a prescribed statin were assigned to the statin group, whereas the remaining participants who do not take statins were assigned to the control group. After 3 months of statin treatment, BP control to <130/80 mmHg was significantly greater (P = 0.022) in the statin group (52.5%) than in the control group (41.0%). The use of statins raises the likelihood of having blood pressure under control by 1.58 times when compared to statin non-users. After controlling for possible confounders, statin therapy still increased the odds of having controlled BP by a factor of 5.98 [OR = 5.98; 95% CI: 2.77-12.92]. Conclusion: This study revealed that blood pressure control was higher among statin user hypertensive patients. Favorable effects of statin use were independently observed, even after correction for age, presence of dyslipidemia, and duration of antihypertensive therapy. Therefore, the importance of concomitantly added lipid-lowering drugs such as statins and their role in managing poor blood pressure control should be given due emphasis.

Joint Modeling of Incidence of Unfavorable Outcomes and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospitals of Addis Ababa, Ethiopia.

Background: In Ethiopia, second-line anti-retroviral therapy (ART) for HIV/AIDS patients was started some years ago; however, few studies have reported the unfavorable outcomes of second-line ART. Therefore, this study aimed to assess the incidence and predictors of unfavorable outcomes and their association with change in viral load among adult HIV/AIDS patients on second-line treatment at selected public hospitals in Addis Ababa, Ethiopia. Methods: A retrospective follow-up study was conducted at selected public hospitals in Addis Ababa, Ethiopia, on 421 HIV/AIDS patients on second-line ART from 2016 to 2021. Cox proportional hazard models with a linear mixed effect model were jointly modeled using the JM package of R software with time-dependent lagged parameterizations, and a 95% confidence interval was used to select significant variables. Results: Overall, 89 HIV/AIDS patients developed unfavorable outcomes. The incidence density was 7.48/100 person-years (95% CI: 6.08, 9.2). Secondary and tertiary educational level (AHR=0.47, 95% CI: 0.25, 0.89, and AHR=0.27, 95% CI: 0.1, 0.72), CD4 count less than 100 cells/mm3 (AHR=2.15, 95% CI: 1.21, 3.83), poor adherence (AHR=3.59, 95% CI: 1.73, 7.49), and TB comorbidity (AHR=2.23, 95% CI: 1.21, 4.14) at the start of second-line ART were significant predictors of incidence of unfavorable outcome. Time-dependent lagged value viral load was significantly associated with the risk of unfavorable outcome (AHR=1.28, 95% CI: 1.01, 1.63). Conclusion: In the study area, the incidence of an unfavorable outcome of second-line ART was high. Secondary and tertiary educational level, CD4 count less than 100 cells/mm3, poor adherence, and TB comorbidity at the start of second-line ART were significant predictors of incidence of unfavorable outcomes. Thus, strengthening routine viral load measurement, increase patient adherence, intensive counseling, and strong TB screening are needed in the study setting.

Incidence and Predictors of Virological Failure Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospital of Addis Ababa, Ethiopia: Retrospective Follow-Up Study.

Introduction: Virological suppression for persons living with HIV (PLHIV) on antiretroviral therapy (ART) reached 85% at the end of 2018, still falling short of the UNAIDS target of 95%. In Ethiopia, there were studies on treatment failure focusing on viral suppression and immunological failure of ART users, but none of them have addressed virological failure for second-line regimens. Objective: This study was aimed to estimate the incidence and predictors of virological failure among HIV patients who were switched to second-line ART at the selected public hospitals in Addis Ababa. Methods: An institutional-based retrospective follow-up study was conducted from September 2018 to January 2021 at public hospitals in Addis Ababa. The sample size was determined by using the Schoenfeld formula. Data entry were done by Epi Data version-4.6.0.0 and exported to R-software version-4.1.0 for analysis. Kaplan-Meier methods were used to compare the survival estimates. Cox proportional hazard model was used to identify predictors of virological failure and model adequacy was checked by using the Cox-Snell residuals plot. Results: Overall 44 (12.22%) HIV/AIDS patients developed virological failure with incidence density of 3.57/1000 Person-Month (PM) with 95% CI of [2.65-4.79]. Age >45 years (AHR=0.36, 95% CI: 0.12-0.99), CD4 count <100cell/mm3 (AHR=3.02, 95% CI: 1.17-7.78), TB co-infection (AHR=2.48, 95% CI: 1.10-6.33), ATV/r-based second-line regimen (AHR=0.27, 95% CI: 0.11-0.70), and poor adherence at the start of second-line ART (AHR=6.18, 95% CI: 1.93-19.76) were the significant predictors of virological failure. Conclusion: A high incidence of virological failure was noticed. The rate of virological failure was higher for patients who had poor ART adherence, small CD4count, and TB co-infection. Therefore, targeted HIV care interventions shall be provided to young ages and efforts stepped up to improve adherence to ART, which helps to increase immunity and suppress viral replication. In addition, prevention and early detection of TB co-infection are crucial to the patients.

Spatial Distribution and Determinant Factors of Handwashing Practice With Essential Agents Among Households in Ethiopia.

Objectives: This study aimed to assess the spatial distribution and determinant factors of handwashing practice using essential handwashing agents (soap and water) among households in Ethiopia. Methods: A two-stage stratified cluster sampling technique was used. Mixed-effect logistic regression analysis was also used to identify determinants of handwashing practice with essential agents. Results: In Ethiopia, household handwashing practices with essential agents had spatial variation (Moran's Index 0.62, p < 0.001). The Amhara and Somali regions were identified as significant hotspots with low handwashing practice using essential agents. Conclusion: In Ethiopia, handwashing practice with essential agents showed spatial variation across the country with a very low rate. Areas with low handwashing practice with essential agents need high priority in the allocation of resources to ensure communities' access to fixed and portable handwashing facilities, soap, and reliable water supplies. Households with low access to improved sanitation facilities, low wealth status, and low educational status should be targeted for the intervention.

Spatial Distribution and Factors Associated With Risky Health Behavior Among Adult Males Aged 15-59 Years in Ethiopia: Generalized Structural Equation Modeling.

Background: Alcohol drinking and tobacco smoking are the largest preventable causes of death and important risk factors for a number of non-communicable diseases and cause premature death and many socioeconomic consequences. Therefore, the present study is aimed to assess the spatial distribution of risky health behavior and its associated factors among adult males in Ethiopia. Methods: All men (12,688) within the age range of 15-59 years were included in the final analysis. The distribution of risky health behavior across the country was observed by using ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of risky health behavior. Generalized Structural Equation Model (GSEM) was used to determine factors associated with risky health behavior (regular alcohol drinking and tobacco smoking). Results: Risky health behavior had spatial variation across the country. The primary clusters were located in Tigray, Amhara, and north-eastern Benishangul national regional states. Spatial scan statistics identified 118 primary clusters [Log-Likelihood ratio (LLR) = 524.8, p < 0.001]. Residence, frequency of listening to a radio, occupation, and frequency of watching television were significantly associated with drinking alcohol, whereas wealth index was associated with tobacco smoking. Age, region, educational status, marital status, and religion had association with both domains of risky health behavior. Conclusion: Risky health behavior had spatial variation across the country. Bans on advertising and promotion of alcohol and tobacco on national press media should be strengthened. Aggressive health education efforts should be directed toward this high-risk population (Tigray, Amhara, and north-eastern Benishangul regional states). Improving risky health behavior is an important approach to reducing health disparities and promoting a more cost-effective utilization of scarce resources in the public health sector.

Determinants of Postnatal Care and Timing of the First Postnatal Care for Newborns in Ethiopia: Further Analysis of 2019 Ethiopian Demographic and Health Survey.

Background: Neonatal mortality remains a persisting public health challenge in Ethiopia. Most of the factors that lead to neonatal deaths could be prevented through postnatal checkups. However, in Ethiopia, the provision of postnatal care (PNC) continues to be low. This study aims to assess the socioeconomic and demographic factors associated with PNC visits and the timing of PNC among newborns in Ethiopia. Methods: Using the Ethiopia Mini Demographic and Health Survey (EMDHS) 2019, a total weighted sample of 2,105 women aged 15-49 giving birth in the 2 years preceding the survey were included in the study. The generalized linear mixed models were separately fitted to identify factors associated with any PNC for newborns delivered at home and health facilities. Multinomial logistic regression was used to assess the timing of PNC with their associated factors. Results: Overall, only 13% (95% CI: 11.2, 14.0) of the newborns received PNC in Ethiopia. Among newborns delivered at home, utilization of any PNC was determined by region, maternal educational status, and birth order. On the other hand, among newborns delivered in a health facility, region, number of antenatal care (ANC) visits, and religion were determinants of any PNC. Furthermore, utilization of the first PNC within 48 h after the delivery was determined by region and religion. On the other hand, utilization of the first PNC after 48 h after the delivery was determined by region number of ANC visits, maternal educational status, and religion. Conclusion: The finding of the current study revealed low coverage of PNC among newborns regardless of the place of delivery in Ethiopia. The study makes the following recommendation: increase community health education on PNC, encourage delivery at health facilities, and link community home birth with PNC. It will be more valuable if there is sharing good practice.

Magnitude and determinants of intimate partner violence against women in East Africa: multilevel analysis of recent demographic and health survey.

BACKGROUND: Violence against women is a significant public health problem, and human rights abuse, and is associated with multiple adverse physical, mental, sexual, and reproductive health effects. The current study aimed to determine the magnitude of intimate partner violence (IPV) and its determinant factors in East African countries. METHODS: We utilized the most recent demographic and health survey data from 11 East African countries, which was comprised of a weighted sample of 55,501 ever-married women. A multilevel multivariable logistic regression analysis was applied. We used an adjusted odds ratio with a 95% CI and a p value ≤ 0.05 in the multilevel logistic model to declare significant factors associated with IPV. RESULTS: The overall prevalence of all forms of IPV in East African countries was 32.66% [95% CI 32.27, 33.05], with the highest IPV occurring in Uganda (14.93%) and the lowest IPV recorded in Comoros (0.87%). In the multivariable multilevel logistic regression model, women's education, residence, sex of household head, current pregnancy, husband drinking alcohol, attitude towards wife-beating husband controlling behavior, and women's decision-making autonomy were significantly associated with IPV. CONCLUSION: The risk factors noted above increase the likelihood of a woman experiencing IPV. Therefore, we recommend establishing effective health and legal response services for IPV, raising awareness of the existing legislation service and improving its application, strengthening legislations on purchasing and selling of alcohol, strengthening joint (both husband and wife) decision-making power by empowering women, improving the educational level of women, and establishing measures to break the culture of societal tolerance towards IPV.

Spatial distribution and determinant factors of intimate partner violence among reproductive age group women in Ethiopia: Using generalized structural equation modeling.

INTRODUCTION: Intimate Partner Violence (IPV) is the most serious and pervasive yet under-recognized human rights violation in the world, particularly in Ethiopia. Hence, the objective of this study was to find the spatial distribution of IPV and its determinant factors in Ethiopia. METHODS: Secondary data analysis was conducted among 2,687 reproductive age group women (15-49 years). The distribution of IPV across the country was observed by ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of IPV. Besides, Generalized Structural Equation Model (GSEM) was used to determine factors associated with each domain of IPV (physical, emotional & sexual violence). RESULT: The spatial distribution of IPV was found to be clustered in Ethiopia with Global Moran's I 0.09 (p < 0.001), and the highest IPV cluster was observed in Oromia (p < 0.001), Somali (p < 0.001) and SNNP (p<0.001) regions. Watching television and not having attitudes toward wife beating were negatively associated with physical violence. Being rich and nonsmoker were inversely associated with emotional violence. The odds of experiencing sexual violence were high among pregnant women and wives of uneducated husbands/partners. In addition, women's decision-making autonomy and husband/partner drinking alcohol have positive and negative associations with all domains of IPV respectively. CONCLUSION: There was a significant clustering of IPV in Ethiopia and the highest IPV cluster was observed in Oromia, Somali and SNNP regions. Being rich, watching television, not having attitudes toward wife beating, women's decision-making autonomy, and husband's/partner's high education and non-alcohol drinker status were negatively associated with IPV. The likelihood of experiencing IPV was also high among smokers and pregnant women. Thus, we recommend that improving the economic status of the household through social protection and empowerment of women in decision-making autonomy by education and employment and increasing community awareness about the consequences of IPV with particular emphasis on Oromia, Somali and SNNP regions is essential.

Joint modeling of time to diabetic retinopathy and change in fasting blood sugar among type 2 diabetic patients, Northwest Ethiopia.

This study aimed to assess changes in fasting blood sugar (FBS) levels, time to diabetic retinopathy (DR) and its predictors among type 2 diabetes patients in Ethiopia. An institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Hospital. The linear mixed effect model and Cox proportional hazard models were fitted separately, and later, the two models were fitted jointly using R software. Variables with a p value < 0.05 were considered significant predictors in the adjusted analysis. The incidence rate of DR was 2 per 100-person year of observation with a median follow-up time of 90.8 months (IQR 63.4). The current value and rate of change in FBS level were significant predictors of time to DR (AHR = 1.35; 95% CI 1.12-1.63) and (AHR = 1.70; 95% CI 1.21-2.39), respectively. Hypertension (AHR = 2.49; 95% CI 1.32-4.66), taking > 1 antidiabetic oral agent (AHR = 4.90; 95% CI 1.07-20.0) and more than 10 years duration (AHR = 0.17, 95% CI 0.06-0.46) were predictors of time to DR. This study revealed that the current value of FBS and the rate of FBS change were significantly associated with the time to DR.

Spatial distribution, prevalence, and determinants of unintended pregnancy among youth (15-24) in Ethiopia: Further analysis of Ethiopia Demographic and Health Survey.

OBJECTIVES: This study aimed to determine the spatial distribution, prevalence, and determinant factors of unintended pregnancy among youth in Ethiopia. METHODS: Using the Ethiopian Demographic and Health Survey 2016, a total of 2446 pregnant women aged 15-24 in the last 5 years, including current pregnancy, were included in the study. The unintended pregnancy data were spatially visualized using coordinates for each respondent in the survey using ArcGIS 10.3. The Bernoulli model was used to identify the presence of purely spatial unintended pregnancy cluster using SaTScan software. Logistic regression analysis was fitted to determine factors associated with unintended pregnancy among youth. RESULTS: Unintended pregnancy among youth had spatial variation across the country. Among youth, 20.5% (confidence interval: (19.0, 22.2)) of pregnancies were estimated to be unintended. Spatial scan statistics identified 72 primary clusters (log-likelihood ratio of 37.6, at p < 0.001) which were located in Addis Ababa, southern part of Amhara, northwest of Oromia and northeast of Southern Nations, Nationalities and Peoples Region. Age, region, marital status, occupation, sex of household head, and number of household members were the determinant factors of unintended pregnancy among youth in Ethiopia. CONCLUSION: The distribution of unintended pregnancy among youth in Ethiopia was nonrandom. Unintended pregnancy prevention strategies among youth need to be targeted on the identified factors. Hence, we recommend creating awareness on sexual and reproductive health rights with special priority to the identified hotspot areas (Amhara, Addis Ababa, Gambella, Northern part of Southern Nations, Nationalities and Peoples Region, and northwest of Oromia region) to reduce unintended pregnancy.

Incidence of Diabetic Nephropathy and Its Predictors among Type 2 Diabetes Mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: Although the rate of diabetic nephropathy which is the leading cause of end-stage renal disease (ESRD) continues to rise, there is limited information about the problem. This study aimed to assess the incidence and predictors of diabetic nephropathy among type 2 DM patients. METHODS: Institution-based retrospective follow-up study was conducted at UGCSH with 462 newly diagnosed type 2 DM patients from January 2001 to February 2016, and the data were collected by reviewing their records. The Schoenfeld residuals test was used to check proportional hazard assumption. The best model was selected by using Akaike information criteria (AIC). Hazard ratios (HR) with its respective 95% confidence interval were reported to show significance and strength of association. RESULTS: The incidence rate of diabetic nephropathy was 14 (95% CI 10.8-17.7) cases per 10,000 patient-month observation. In addition, 63 (13.6%) DM patients developed diabetic nephropathy. The median time to develop diabetic nephropathy was 94.9 months with interquartile range (IOR) of (64.1-127.4) months. Type 2 DM patients who had coronary heart disease (AHR = 2.69, 95% CI 1.42-5.13) and anemia (AHR = 1.94, 95% CI 0.97-3.87) were at higher hazard for developing diabetic nephropathy. Besides this, having a long duration (>10 years) (AHR = 0.24, 95% CI 0.11-0.56) and being female (AHR = 0.44, 95% CI 0.26-0.73) was found to be protective against diabetic nephropathy. CONCLUSION: The incidence of diabetic nephropathy among type 2 diabetes patients remains a significant public health problem. Duration of diabetes >10 years and female sex reduced the risk of diabetic nephropathy. Coronary heart disease and anemia increased the risk of diabetic nephropathy among type 2 DM patients. In light of these findings, early screening for diabetes complication is needed, and health professionals should give targeted intervention for type 2 DM patients with coronary heart disease comorbidity and anemia.

Health Insurance Coverage and Its Associated Factors Among Reproductive-Age Women in East Africa: A Multilevel Mixed-Effects Generalized Linear Model.

BACKGROUND: Despite improvement in access to modern healthcare services in East African countries, health-service delivery and health status of the population remained poor mainly due to the weak health-sector financing system. Therefore, the current study aimed to assess the health insurance coverage and its associated factors among reproductive-age group (RAG) women in East Africa. METHODS: The most recent (between 2010 and 2018) Demographic and Health Surveys (DHS) data of the ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe) were included. STATA version 16.0 statistical software was used for data processing and analysis. In the multilevel mixed-effects generalized linear model, variables with a p-value ≤0.05 were declared as significant associated factors of health insurance coverage. RESULTS: The overall health insurance coverage in East Africa was 7.56% (95% CI: 7.42%, 7.77%). The odds of health insurance coverage were high among educated, currently working, and rich RAG women whereas it was low among rural residents. Besides, RAG women who have media exposure, visited by field workers, and visited health facilities have a higher chance of health insurance coverage. CONCLUSION: Health insurance coverage in East Africa among RAG women was below ten percent. Educational status, working status, place of residence, wealth index, media exposure, visiting health facility within 12 months and being visited by field worker were significantly associated with health insurance coverage among RAG women in East Africa. Improving women's access to health facilities, promoting field workers' visit, and media exposure targeting uneducated, unemployed, and rural resident women of RAG will be a gateway to promote health insurance coverage.

Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis.

BACKGROUND: Maternal anemia continues as a global public health concern particularly in developing countries including Ethiopia. It is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. Even though maternal anemia is the commonest problem in Ethiopia, there is limited evidence on the spatial distribution and determinants of iron supplementation. Therefore, this study aimed to investigate the spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia. METHOD: A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 7589 women was included for analysis. For the spatial analysis; ArcGIS version 10.6, and SaT Scan version 9.6 statistical software were employed to explore the spatial distribution, and to identify significant hotspot areas of iron supplementation in Ethiopia. For the determinant factors, multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Deviance, Median Odds Ratio (MOR), and Intra-class Correlation Coefficient (ICC) were used for model comparison and for assessing model fitness. Variables with a p-value of less than 0.2 in the bivariable analysis were considered in the multivariable multilevel analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare significant determinants of iron supplementation. RESULTS: The spatial distribution of iron supplementation was significantly varied across the country with Global Moran's index value of 0.3 (p < 0.001). The SaTScan analysis identified a total of 271 significant clusters, of these 89 clusters were primary clusters located in the Southwest Somali and Central Oromia regions (LLR = 66.69, P < 0.001, RR = 1.35). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were statistically significant determinant factors of iron supplementation. CONCLUSION: Iron supplementation among pregnant women were significantly varied across the country. Therefore, the finding of this study could help to design effective public health interventions targeting areas with low iron supplementation and maternal health services should be delivered in all areas of our country. Besides, public health programs should enhance iron supplementation through promoting ANC visits, media exposure, and giving special emphasis to marginalized and remote areas.

Spatial distribution of traditional male circumcision and associated factors in Ethiopia; using multilevel generalized linear mixed effects model.

BACKGROUND: Traditional male circumcision (TMC) is primarily associated with a religious or cultural purpose and may lead to complications. To reduce risks of complication and long-term disabilities that may happen from circumcisions that are undertaken in non-clinical settings, information concerning TMC is very important. Therefore, this study is aimed at identifying spatial distribution of TMC and the factors associated with TMC in Ethiopia. METHODS: A secondary data analysis was conducted among 11,209 circumcised males using data from 2016 Ethiopian Demographic and Health Survey (EDHS). Global Moran's I statistic was observed to check whether there was a significant clustering of TMC. Primary and secondary clusters of TMC were identified by fitting Bernoulli model in Kulldorff's SaTScan software. Multilevel Generalized Linear Mixed effects Model (GLMM) was fitted to identify factors associated with TMC. RESULT: The spatial distribution of TMC was nonrandom across the country with Global Moran's I = 0.27 (p-value < 0.0001). The primary clusters of TMC were identified in the southern part of Oromia and Tigray, northern part of SNNPR, Amhara, Gambella and Benishangul regions. Current age, age at circumcision, ethnicity, religion, place of residence, wealth index, media exposure, sex of household head and age of household head were factors associated with TMC in Ethiopia. CONCLUSIONS: The spatial distribution of TMC was varied across the country. This variation might be due to the diversity of culture, ethnicity and religion across the regions. Thus, there is a need to rearrange the regulations on standards of TMC practice, conduct training to familiarize operation technique and general hygiene procedures, and launch cross-referral systems between traditional circumcisers and health workers. While undertaking these public health interventions, due attention should be given to the identified clusters and significant factors.

Spatial distribution and determinant factors of anemia among adults aged 15-59 in Ethiopia; using mixed-effects ordinal logistic regression model.

BACKGROUND: Anemia is a global public health problem, particularly in developing countries. Assessing the geographic distributions and determinant factors is a key and crucial step in designing targeted prevention and intervention programmes to address anemia. Thus, the current study is aimed to assess the spatial distribution and determinant factors of anemia in Ethiopia among adults aged 15-59. METHODS: A secondary data analysis was done based on 2016 Ethiopian Demographic and Health Surveys (EDHS). Total weighted samples of 29,140 adults were included. Data processing and analysis were performed using STATA 14; ArcGIS 10.1 and SaTScan 9.6 software. Spatial autocorrelation was checked using Global Moran's index (Moran's I). Hotspot analysis was made using Gettis-OrdGi*statistics. Additionally, spatial scan statistics were applied to identify significant primary and secondary cluster of anemia. Mixed effect ordinal logistics were fitted to determine factors associated with the level of anemia. RESULT: The spatial distribution of anemia in Ethiopia among adults age 15-59 was found to be clustered (Global Moran's I = 0.81, p value <  0.0001). In the multivariable mixed-effectordinal regression analysis; Females [AOR = 1.53; 95% CI: 1.42, 1.66], Never married [AOR = 0.86; 95% CI: 0.77, 0.96], highly educated [AOR = 0.71; 95% CI: 0.60, 0.84], rural residents [AOR = 1.53; 95% CI: 1.23, 1.81], rich wealth status [AOR = 0.77; 95% CI: 0.69, 0.86] and underweight [AOR = 1.15; 1.06, 1.24] were significant predictors of anemia among adults. CONCLUSIONS: A significant clustering of anemia among adults aged 15-59 were found in Ethiopia and the significant hotspot areas with high cluster anemia were identified in Somalia, Afar, Gambella, Dire Dewa and Harari regions. Besides, sex, marital status, educational level, place of residence, region, wealth index and BMI were significant predictors of anemia. Therefore, effective public health intervention and nutritional education should be designed for the identified hotspot areas and risk groups in order to decrease the incidence of anemia.

Prevalence of erectile dysfunction and its associated factors among patients with diabetes in Ethiopia: a systematic review and meta-analysis.

OBJECTIVES: We aimed to estimate the pooled prevalence of erectile dysfunction (ED) among patients with diabetes mellitus (DM) in Ethiopia and to identify its associated factors. METHODS: We performed a systematic search of scientific databases (PubMed, ScienceDirect); the grey literature was also searched (Google, Google Scholar). Data were extracted from primary studies using a data extraction format and exported for statistical analysis. I2 tests were used to assess the heterogeneity of studies. Owing to heterogeneity among the included studies, we used a random-effects model to determine pooled estimates of ED. Publication bias was assessed using Egger's and Begg's tests. RESULTS: The pooled prevalence of ED among patients with DM in Ethiopia was 54.3% (95% confidence interval [CI]: 28.2-80.5). Older age (OR: 4.42, 95% CI: 2.83-6.00) and duration of DM (OR: 3.2, 95% CI: 1.74-4.66) had statistically significant associations with ED. CONCLUSION: One in two individuals with DM in Ethiopia also had ED. This finding highlights the need to integrate assessment and management of ED into routine medical care in diabetes follow-up visits. Special attention is recommended for patients with older age and a longer duration of DM.

Prevalence of Anaemia and Its Associated Factors among Type 2 Diabetes Mellitus Patients in University of Gondar Comprehensive Specialized Hospital.

BACKGROUND: Anaemia is one of the commonest blood disorders seen in patients with diabetes. In Ethiopia, chronic illnesses are tremendously raising with their complications. But very little research has been conducted, particularly on anaemia among diabetes mellitus (DM) patients. Therefore, this study aimed at assessing the prevalence of anaemia and associated factors among type 2 diabetes mellitus patients in Northwest Ethiopia. METHODS: A cross-sectional study design was employed at University of Gondar Comprehensive Specialized Hospital from March 1 to April 15, 2019, among 372 type 2 diabetes mellitus patients (T2DM). Multivariable logistic regression analysis was fitted, and the corresponding adjusted odds ratio (AOR) and 95% CI were used to identify factors associated with anaemia. Level of significance was declared at the p value less than 0.05. RESULTS: The study revealed 8.06% (95% CI: 5.68-11.31%) of the participants were anaemic. Being male (AOR = 2.74, CI: 1.02, 7.38), combined type of treatment (AOR = 8.38, CI: 1.66, 42.25), having diabetes-related microvascular complications (AOR = 3.24, CI: 1.14, 9.26), and hypertension (AOR = 0.01, CI: 0.002, 0.06) were the significant factors associated with anaemia. CONCLUSIONS: The finding of the current study revealed low prevalence of anaemia among T2DM patients. Sex, type of treatment, diabetes-related microvascular complications, and hypertension were factors associated with anaemia. Assessment of haemoglobin levels among T2DM patients may help to prevent ensuing microvascular complications. Incorporate anaemia screening into the routine assessment of diabetic complication particularly for those who are hypertensive and took combined treatment to allow early appreciation and treatment of anaemia and later improve the overall care of patients with diabetes.

Spatial distribution and associated factors of underweight in Ethiopia: An analysis of Ethiopian demographic and health survey, 2016.

BACKGROUND: Underweight is one form of indicators of under-nutrition, which results from the poor nutrient intake and underlying health problems. Its impact is beyond an individual and extends to a country level. It has been known from the literature that underweight has a negative effect on income and development of a country. In the context of Ethiopia, factors predicting underweight remain unknown and there is a paucity of evidence on geographical distribution of underweight among individuals aged 15-49 years. Therefore, the aim of this study was to examine the geographic distribution of underweight and its associated factors among individuals aged 15-49 years in Ethiopia. METHODS: Secondary data analysis was done on a data set consisting of 28,450 individuals and obtained from the Ethiopian Demography and Health Survey (EDHS) 2016. The spatial distribution of underweight across the country was identified by ArcGIS software. Hotspots analysis was done using Getis-Ord Gi* statistic within ArcGIS. In SaTScan software, the Bernoulli model was fitted by Kulldorff's methods to identify the purely spatial clusters of underweight. A binary logistic regression was applied to determine factors associated with being underweight. RESULT: In Ethiopia, the spatial distribution of underweight was clustered with Global Moran's I = 0.79 at p-value < 0.0001. The highest underweight clusters were observed in Tigray, Gambella, eastern part of Amhara, and western and central part of Afar regions. Male individuals [AOR = 1.21; 95% CI: (1.15 1.28)], never married [AOR = 1.14; 95% CI: (1.05, 1.24)], rural residents [AOR = 1.32; 95% CI: (1.18, 1.47)], rich [AOR = 0.85; 95% CI: (0.76, 0.94)], cigarette smoking [AOR = 1.25; 95% CI: (1.07, 1.46)], drinking treated water [AOR = 0.91; 95% CI: (0.83, 0.99)] and open filed defecation [AOR = 1.17; 95% CI: (1.08, 1.26)] were found to have a significant association with being underweight. CONCLUSIONS: There was a significant clustering of underweight among individuals aged 15-49 years. Gender, age, marital status, place of residence, wealth index, cigarette smoking, using untreated water and types of toilet were the significant factors of being underweight. Therefore, effective public health interventions like building safe and supportive environments for nutrition, providing socio-economic protection and nutrition-related education for poor and rural resident would be better to mitigate these situations and associated risk factors in hot spot areas. In addition, policymakers should strengthen and promote nutrition sensitive policies and activities in order to alleviate the underlying and basic causes of underweight.

Prevalence of Depression and Associated Factors among Diabetes Patients in East Shewa, Ethiopia: Bayesian Approach.

BACKGROUND: Depression is one of the most pressing public health problems and also highly prevalent comorbid condition among diabetes mellitus (DM) patients. Depression may impact lifestyle decisions and ability to poorly perform tasks which are risk factors for DM. For reducing the impact of depression among DM patients in developing countries, it is crucial to identify and assess associated risk factors of depression among DM patients, thereby designing effective management techniques. In line with this, the current study applies the Bayesian framework, which pools prior information and current data, to find factors associated with depression among DM patients. METHODS: A hospital-based cross-sectional study was conducted at Adama Hospital and Medical College (AHMC) from March to April 2019. Data was entered into the Epi-data 3.1 then exported to the R software 3.4.4. Bayesian logistic regression models were fitted to the data using the Markov chain Monte Carlo (MCMC) algorithm. Estimates of model parameters including adjusted odds ratio (AOR) with 95% credible intervals (CI) were calculated. RESULTS: A total of 359 adults with DM were included in the analysis. The prevalence of depression among diabetic patients was 9.22% (95% CI: 6.4% to 12.7%). Higher fasting blood sugar level (AOR = -1.012; HPD CI: (1.0020, 1.025)), having diabetic complication (AOR = 0.1876; HPD CI: (0.0214, 0.671)), history of hospital admission (AOR = 0.2865; HPD CI: (0.0711, 0.7318)), low medication adherence (AOR = 29.29; HPD CI: (3.383, 92.26)), and taking both insulin and oral antidiabetic medication (AOR = 24.46; HPD CI: (15.20, 49.37) were significantly and strongly associated with depression among DM patients. CONCLUSIONS: Prevalence of depression among diabetes patients in the catchment area of Adama Hospital, Ethiopia, was found to be very low. Higher fasting blood sugar level, diabetic complication, history of hospital admission, low medication adherence, and taking both insulin and oral antidiabetic medication were found to be strong predictors of prevalence of depression among DM patients. Based on the findings, we recommend that integrating screening and treating of depression, early detection and management of diabetic complication, and giving counseling to improve medication adherence is an effective approach for lowering the impact of depression on DM patients.