Determinants of Six-Month Appointment Spacing Model Utilization Among ART Clients in the Public Health Facilities of Jimma Town, Southwest Ethiopia: Case-Control Study.

BACKGROUND: Ethiopia is currently implementing an Appointment Spacing Model (ASM) for ART. A study conducted in 6 hospitals that piloted ASM showed that 51% of eligible clients declined ASM. Studies conducted on ASM have focused on its benefits, not factors determining its utilization. This study aimed to identify determinants of ASM non-utilization. OBJECTIVE: To identify determinants of ASM non-utilization among stable ART clients. METHODS: An unmatched case-control study was conducted among 194 cases and 194 controls: consecutively selected stable clients on anti-retroviral therapy (ART) at four public health facilities in Jimma town. Data were collected through face-to-face interviews and observation techniques using semi-structured questionnaire and observation checklist. EpiData version 3.1 and SPSS version 23 were respectively used for data entry and analysis. Descriptive statistics, logistic regression, adjusted odds ratio and 95% CI were used to summarize descriptive data, identify determinants of ASM non-utilization, measure the strength of statistical association, and declare the statistical significance respectively. RESULTS: With 100% response rate, predictors of ASM non-utilization were residing in urban areas (AOR=2.61, 95% CI: 1.10-6.18), fear regarding drug safety (AOR=3.19, 95% CI: 1.56-6.54), duration of ART (<5 years) (AOR=2.45, 95% CI: 1.17-5.16), need for frequent checkups (AOR=2.70, 95% CI: 1.29-5.61), poor understanding of ASM (AOR=3.15, 95% CI: 1.54-6.43), high perceived difficulties of engagement in ASM (AOR=10.13, 95% CI: 4.31-23.84), perceived presence of high opportunistic cost (AOR=3.34, 95% CI: 1.64-6.83), low self-efficacy (AOR=7.44, 95% CI: 3.16-17.46), recent history of opportunistic infection (AOR=3.34, 95% CI: 1.64-6.83), absence of competing family activities (AOR=4.39, 95% CI: 2.05-9.44) and stigma (AOR=2.85, 95% CI: 1.39-5.81). CONCLUSION: The majority of factors affecting ASM non-utilization were behavioral and community related, which can be addressed by health education both at client and community level and additionally, by training service providers to address factors connected with the provision of service. Qualitative study and impact assessment on client retention are recommended for further research.

Knowledge, attitude, and practice towards mental illness service provision and associated factors among health extension professionals in Addis Ababa, Ethiopia.

BACKGROUND: Mental, neurological and substance use disorders are highly prevalent in Ethiopia which are known to result in substantial disability. Improving the knowledge, attitude and practice of the primary health care workers is important to reduce this problem. Hence, this study aimed at assessing knowledge, attitude, and practice towards mental illness service provision and associated factors among urban health extension professionals (UHEPs) of Addis Ababa City Administration. METHODS: A cross sectional study design was used. Data was collected from 455 study participants using structured and pre-tested self-administered questionnaire and analyzed using SPSS version 20 software respectively. Multivariate logistic regression analysis was performed to identify variables which have significant association with the outcome variables. The level of significant association was determined by adjusted odds ratio (AOR) with 95% confidence interval. RESULTS: This study showed that 44.0% of urban health extension professionals (UHEPs) had adequate knowledge, 93.4% did not have positive attitude and 75.2% had good practice towards mental illness. Age 30 years and above [adjusted odds ratio (AOR): 95% CI 0.55 (0.34, 0.90)], having diploma educational status [AOR 95% CI 0.49 (0.32, 0.78)], and personal history of mental illness [AOR 95% CI 0.10 (0.01, 0.89)] were found to have a negative association with knowledge. Presence of job aid (AOR 95% CI 4.30 (2.59, 7.15)) and having good knowledge (AOR 95% CI 0.52 (0.32, 0.85) were increased the practice of service provision of UHEPs. CONCLUSION: Less than half of UHEPs had adequate knowledge, most had unfavorable attitude and about three-fourth of them had good practice. Presence of job aid and having good knowledge were increased the UHEPs practice of mental health service provision. Hence, providing refresher training to UHEPs and fully implementing the national mental health strategy as well as proper clinical supervision and support to improve behavioral change is vital.

Effect of late HIV diagnosis on HIV-related mortality among adults in general hospitals of Central Zone Tigray, northern Ethiopia: a retrospective cohort study.

BACKGROUND: The global incidence of HIV infection is not significantly decreasing, especially in sub-Saharan African countries, including Ethiopia. Though there is availability and accessibility of free HIV services, people are not being diagnosed early for HIV, and hence patients are still dying of HIV-related causes. This research is aimed at verifying the effect of late diagnosis of HIV on HIV-related mortality in Central Zone Tigray, Ethiopia. METHODS: A retrospective cohort study among adult (≥15 years old) HIV patients in three general hospitals of Tigray was conducted. Record reviews were carried out retrospectively from 2010 to 2015. Sample size was determined using stpower Cox in Stata software. Data were entered into EpiData version 3.1 software and transferred to Stata version 12 for analysis. Both bivariable and multivariable analyses were performed using Cox regression model to compare the HIV-related mortality of exposed (cluster of differentiation 4 cells count <350 cells/mm3) and nonexposed (≥350 cells/mm3) patients using adjusted hazard ratio (AHR) at 95% confidence interval (CI). RESULT: In all, 638 HIV patients were analyzed, contributing 2,105.6 person-years. Forty-eight (7.5%) patients died of HIV-related causes with a mortality rate of 2.28 per 100 person-years. In the multivariable Cox regression model, patients with late diagnosis of HIV had a higher risk of mortality (AHR =3.22, 95% CI: 1.17-8.82) than patients with early diagnosis of HIV. Rural residence (AHR =1.96, 95% CI: 1.05-3.68), unemployment (AHR =2.70, 95% CI: 1.03-7.08), bedridden patients (AHR =2.98, 95% CI: 1.45-6.13), ambulatory patients (AHR =2.54, 95% CI: 1.05-6.15), and baseline hemoglobin level of <11 mg/dL (AHR =3.06, 95% CI: 1.51-6.23) were other independent predictors of mortality. CONCLUSION AND RECOMMENDATIONS: Late diagnosis of HIV increased HIV-related mortality. Rural residence, unemployment, bedridden and ambulatory patients, and baseline hemoglobin level <11 mg/dL were also independent predictors of HIV-related mortality.

Risk factors for multidrug-resistant tuberculosis among tuberculosis patients: a case-control study.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) did not receive major attention until recently in sub-Saharan Africa where the tuberculosis incidence and risk factors are highest. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programs. The objective of this study was to identify the risk factors for MDR-TB among tuberculosis patients. METHODS: A case-control study was conducted to assess sociodemographic, behavioral and clinical risk factors using a structured questionnaire and clinical record reviewing. The data were entered and analyzed using SPSS windows version 16. Descriptive analysis was done to generate summary values for the variables and those significant variables in the bivariate analysis at p-value less than 0.25 were entered to multivariable logistic regression to identify independent determinants. Statistical significance was declared at p-value less than or equal to 0.05. RESULTS: A total of 90 cases and 90 controls were included in the study. Age of respondents (adjusted odds ratio [AOR] =7; 95% confidence interval [CI]: 2.6-24.5), living in a household with only one room (AOR=5; 95%CI: 1.68-15.38), history of previous treatment (AOR=21; 95% CI: 17.8-28) and being HIV infected (AOR=3.1; 95%CI: 1.02-9.4) were found to be independent predictors of MDR-TB. CONCLUSION: In light of these findings, the strategies in controlling MDR-TB should emphasize on patients with HIV coinfection, young patients, those who have a history of previous treatment, and those living in crowded places.

Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia.

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1-2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care.

Odontogenic tumors in Ethiopia: eight years retrospective study.

BACKGROUND: Odontogenic tumor (OT) comprises a large heterogeneous group of lesions arising from tooth producing tissues or its remnants. Studies on OTs are scarce in Ethiopia. Thus, the present study aimed to assess the pattern of OTs in Ethiopia. METHODS: An 8 years retrospective study was conducted at the Dental and Maxillofacial Department, St. Paul's referral hospital, Addis Ababa, Ethiopia. Data were collected by reviewing the medical records of patients who visited the Department from September 2008 to August 2015. All the collected data were coded, checked, edited and entered to SPSS windows 18. Lastly, descriptive statistics, and logistic regression were performed for data analysis. RESULTS: A total of 448 patient's socio-demographic, and clinical data were reviewed from the registry book of patients diagnosed with OT. Of these, only 163 patient's records were complete and suitable for the study. 88 (54%) of the study subjects (163) were males, while the remaining 75 (46%) were females. The mean age of patients was 34, ranging between 8 and 80 years. 132 (81.0%) of the OTs were benign, and the rest 31 (19.0%) were malignant type. 126 (77.3%) of OTs occurred in the mandible, and the remaining 37 (22.3%) were located in the maxilla. 135 (82.8%) of the patients had primary surgical treatment. Continuity defect, facial disfigurement and malocclusion were the most frequently encountered complications after surgery. Living in rural areas showed statistically significant association with complication after surgery [Adjusted OR = 2.13, (95% CI: 0.98, 4.6)]. In addition, tumor size had statistically significant association with complication after surgery [Adjusted OR = 4.24, (95% CI: 1.76, 10.21)]. CONCLUSION: OTs were mainly found in males than their females counterpart. Benign OT was predominant over malignant OTs. Regular checkup and/or visit to dentists could help early case detection, and management of OTs.

Health Workforce Acquisition, Retention and Turnover in Southwest Ethiopian Health Institutions.

BACKGROUND: Skill mix of health professionals, staff acquisition and turnover rate are among the major challenges for the delivery of quality health care. This study assessed the health workforce acquisition, retention, turnover rate and their intention to leave. METHODS: A cross-sectional survey with quantitative and qualitative data collection methods was conducted in Jimma Zone health institutions. Five years records (September 2009-August 2014) were reviewed to determine the turnover rate. A total of 367 health professionals were included for the quantitative study. For the qualitaive study, all available and relevant health managers and administrative records in the selected health institutions were included. Descriptive and inferential analyses were done for the quantitative study. Thematic analysis was used for the qualitative component. RESULTS: A total of 367 health workers were incorporated for the quantitative study making a response rate of 87%. The overall health workers' satisfaction was neutral (mean 3.3). In five years period, 45.9% staffs had left for a cause; 59.4% health professionals intended to leave. Being male (AOR =1.6, 95%CI: 1.001-2.5), not knowing their overall satisfaction (AOR=0.5, 95%CI: 0.2-0.8), below mean score of institutional satisfaction (AOR =1.7, 95%CI: 1.06-2.7) and below mean score of organizational satisfaction (AOR=1.8, 95%CI: 1.08-2.8) were independent predictors for intention to leave. CONCLUSION: The overall health workers' satisfaction was marginally neutral. A considerable number of staffs had left, and more than half of the current staffs had an intention to leave. Thus, it is recommended that the responsible authorities should design strategies to improve the situation.

Survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from 2010 to 2012, Jimma, Ethiopia: a retrospective longitudinal study.

BACKGROUND: Although community based treatment of severe acute malnutrition has been advocated for in recent years, facility based treatment of severe acute malnutrition is still required. Therefore, information on the treatment outcomes of malnutrition and potential predictors of mortality among severely malnourished children admitted to hospitals is critical for the improvement of quality care. Thus, the aim of this study was to assess survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from September 11, 2010 to September 10, 2012. METHODS: Retrospective longitudinal study was conducted at Jimma University Specialized Hospital. From September 11, 2010 to September 10, 2012 available data from severely malnourished children admitted to the hospital were reviewed. Data were analyzed using SPSS version 20 for windows. Bivariate and multivariable analyses were performed by Kaplan-Meier and Cox regression to identify clinical characteristics associated with mortality. RESULT: A total of 947 children were enrolled into the study. An improvement, death and abscond rate were 77.8, 9.3 and 12.9% respectively. The median duration from admission to death was 7 days. The average length of stay in the hospital and average weight gain were 17.4 days and 10.4 g/kg/day respectively. The main predictors of earlier hospital deaths were age less than 24 months (AHR = 1.9, 95 % CI [1.2-2.9]), hypothermia (AHR = 3.0, 95% CI [1.4-6.6]), impaired consciousness level (AHR = 2.6, 95% CI [1.5-4.5]), dehydration (AHR = 2.3, 95% CI [1.3-4.0]), palmar pallor (AHR = 2.1, 95% CI [1.3-3.3]) and co-morbidity/complication at admission (AHR = 3.7, 95% CI [1.9-7.2]). CONCLUSION: The treatment outcomes (improvement rate, death rate, average length of stay in the hospital and average weight gain) were better than most reports in the literatures and in agreement with minimum international standard set for management of severe acute malnutrition. Intervention to further reduce earlier deaths should focus on young children with hypothermia, altered mental status, dehydration, anemia and comorbidities.

Satisfaction with focused antenatal care service and associated factors among pregnant women attending focused antenatal care at health centers in Jimma town, Jimma zone, South West Ethiopia; a facility based cross-sectional study triangulated with qualitative study.

BACKGROUND: Client satisfaction is essential for further improvement of quality of focused antenatal care and to provide uniform health care services for pregnant women. However, studies on level of client satisfaction with focused antenatal care and associated factors are lacking. So, the purpose of this study is to assess satisfaction with focused antenatal care service and associated factors among pregnant women attending focused antenatal care at health centers in Jimma town. METHODS: A facility based cross-sectional study involving both qualitative and quantitative methods of data collection was used from Feb 1-30/2013. Three hundred eighty nine pregnant women those come to the health centers were included in the study. A semi-structured questionnaire and focus group discussion guide was employed to obtain the necessary information for this study. Quantitative data was analysed using SPSS for windows version 16.0. Logistic regression model was used to compare level of satisfaction by predictors' variables. Qualitative data was analyzed based on thematic frameworks to support the quantitative results. RESULT: More than half of the respondents (60.4%) were satisfied with the service that they received. As to specific components, most of the respondents (80.7%) were satisfied with interpersonal aspects, and 62.2% were satisfied with organization of health care aspect. Meanwhile, 49.9% of the respondents were not satisfied with technical quality aspect and 67.1% were not satisfied with physical environment aspect. Multivariate logistic regression analysis result showed that type of health center, educational status of mother, monthly income of the family, type of pregnancy and history of stillbirth were the predictors of the level of satisfaction. The study found out that dissatisfaction was high in mothers utilizing service at Jimma health center, in mothers with tertiary educational level, in mothers with average monthly family income >1000 birr, in mothers with unplanned pregnancy and in mothers with history of stillbirth. CONCLUSIONS: Even though greater percentages of women (60.4%) were satisfied with the focused antenatal care service, the level of satisfaction was lower compared to other studies. The investigator recommends that patient feedback should be recognized as a legitimate method of evaluating health services in the health center as a whole.

Risky Sexual Behavior and Predisposing Factors among Students of Jimma University, Ethiopia.

BACKGROUND: Students of higher institutions are assumed to be exposed to many risky sexual behaviors. However, little has been explored about the magnitude of risky behavior and predisposing factors in the context of higher education institutions in Ethiopia. Thus, the objective of this study was to assess the pattern of risky sexual behaviors and predisposing factors among Jimma University students. METHODS: This cross-sectional study was conducted in November 2009 involving quantitative and qualitative methods. The quantitative study was conducted on 1010 students selected by multistage cluster sampling technique. The data were collected using self-administered questionnaire and analyzed using SPSS V.16.0. Multi-variate logistic regression was used to see association between variables. The qualitative part involved 10 focus group discussions and 17 key-informant interviews selected purposively. The qualitative data were analyzed by thematic areas. RESULTS: Among the respondents, 267(26.9%) ever had sexual intercourse. The mean age at first sexual intercourse was 17.7±2.7 years. Most, 75.6%, started sexual intercourse during secondary school. Among whoever had sex, 51.0% had sex in the last 12 months and 28.3% had multiple sexual partners. Consistent condom use with non-regular partner in the last 12 months was 69.1%. Lack of parental control, substance use, peer pressure, campus and outside environment were identified as predisposing factors. CONCLUSION: Risky sexual behaviour such as having multiple sexual partner and sexual practice without condom with non-regular partner exists. The university and local health bodies should work together to address the identified risky behaviours with particular focus on Behaviour change communication.

Parents' perception, students' and teachers' attitude towards school sex education.

BACKGROUND: Sex education is described as education about human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, family planning, body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods. This study was conducted to explore perception of parents about school sex education and assess the attitude of teachers and students towards school sex education. METHODS: A cross-sectional quantitative and qualitative study was conducted on randomly selected 386 students, total census of 94 teachers and 10 parents in Merawi Town from March 13-27, 2011. Data were collected using self-administered structured questionnaire and in-depth interview guideline. Multiple linear regression analysis was performed using total score to determine the effect of the independent variables on the outcome variable and thematic analysis was used to analyze the qualitative data. RESULTS: All study participants have favourable attitude towards the importance of school sex education. They also agreed that the content of school sex education should include abstinence-only and abstinence-plus based on mental maturity of the students. That means at early age (Primary school) the content of school sex education should be abstinence-only and at later age (secondary school) the content of school sex education should be added abstinence-plus. The students and the teachers said that the minimum and maximum introduction time for school sex education is 5 year and 25 year with mean of 10.97(SD±4.3) and 12.36(SD±3.7) respectively. Teacher teaching experiences and field of studies have supportive idea about the starting of school sex education. Watching romantic movies, reading romantic materials and listening romantic radio programs appear to have a contribution on the predictor of students' attitude towards the starting time of school sex education. CONCLUSION: All study participants have a need to start sex education at school. All study participants said that at early age (Primary school) the content of school sex education is abstinence-only and at later age (secondary school) is added abstinence-plus. School Sex education should be under considers the need of students, teachers and parents.

Population based survey of chronic non-communicable diseases at gilgel gibe field research center, southwest ethiopia.

BACKGROUND: Chronic Non-communicable Diseases are increasingly becoming more prevalent and burden to the health care system in developing countries including Ethiopia. However, evidences showing the magnitude of the problem in those countries are scarce particularly in a community setting. The objective of this study was to determine the magnitude of chronic non communicable diseases in a community. METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center from late September 2008 to end of January 2009. A random sample of 4,469 individuals aged 15-64 years was studied. Data on characteristics and chronic symptom inventories were collected by interviewing study participants. Blood pressure was taken three times from each individual and blood sugar and lipid levels were determined after an overnight fasting. Data were analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The overall prevalence of CNCD was 8.9% (7.8% men and 9.8% women). The specific observed prevalence were 0.5% for diabetes mellitus (DM), 2.6% for hypertension, 3.0% for cardiovascular diseases, 1.5% for asthma and 2.7% for mental illness. In addition 3.1% and 9.3% of the study population had been informed to have DM and hypertension respectively. CONCLUSION: There is a high prevalence of CNCD among the study population indicating an immediate need for preventive action and also warrant further nationally representative study.

Risk factors for chronic non-communicable diseases at gilgel gibe field research center, southwest ethiopia: population based study.

BACKGROUND: The burden of chronic non-communicable diseases is on the rise in middle and low income countries on top of the existing infectious diseases. Moreover, the distributions of the specific risk factors are not systematically identified in those countries hampering the designing of appropriate preventive and control strategies. The objective of this component of the study was to describe the distribution of risk factors for chronic non-communicable diseases. METHODS: The cross sectional study was conducted from September 2008 to January 2009 at Gilgel Gibe Field Research Center of Jimma University. Data were collected using WHO steps instruments translated into the local languages. Individuals for the study were selected by stratified random sampling for interviewing, physical examination and biochemical tests from the study base. Data were analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The distribution of the various categories of risk factors is identified. Among the behavioral risk factors, the prevalence of smoking is 9.3%, alcohol consumption 7.3%, consumption of fruits and vegetables below adequate level 27.0%, low level physical activity (16.9%) and khat chewing (38.6%). The prevalence of physical risk factors is 9.3% for hypertension, 2.6% for overweight and 33.3% central obesity. The prevalence of metabolic disorders is 10.7% for high total cholesterol and 7.7% for raised triglyceride. Overall, 80.0% of the population had at least one of the risk factors. CONCLUSION: The magnitude of risk factors for chronic non-communicable diseases is considerably high in the study population. Appropriate preventive measure and should be designed to prevent and control these risk factors.

Physical measurement profile at gilgel gibe field research center, southwest ethiopia.

BACKGROUND: Physical measurement reference values are helpful to manage patients, conduct surveillances and monitor and evaluate interventional activities. Such valuable data at a community level however, are almost non-existent in Ethiopia. The objective of this study was to determine anthropometrics and blood pressure in "apparently healthy individuals" in community settings. METHODS: A population-based cross-sectional survey was conducted from September 2008 to January 2009 at Gilgel Gibe Field Research Center, Southwest Ethiopia. Blood pressure, height and weight were measured using Automatic Blood Pressure monitor, stadiometers and digital weight scales respectively. Waist and hip circumferences were measured using measuring tapes. BMI was computed as weight in kg divided by square of height in meter of individual (kg/m(2)). Waist to hip circumference ratio (WHR) was calculated by dividing the waist circumference to hip in centimeter. Data were entered into Epidata and analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The mean systolic/diastolic blood pressures for men and women were 115.8/73.4 and 112.6/72.9 mmHg respectively. The mean BP values showed increasing trend with age for both sexes. The mean heart rate for men and women were 78.6 and 84.7 beats per minute, respectively. The mean weight and height values in all age groups, waist circumference value in 35 years and above were significantly higher (p < 0.001) for men, while the mean values for hip circumference in under 35 years and body mass index in under 45 year age groups were significantly higher (p < 0.025) for women. The mean body mass index for age group 15-24 (18.1 kg/m(2)) was significantly lower (p < 0.001) than the other age groups in men; whereas in women those 55+ years had significantly (p < 0.001) lower mean body mass index compared to the other age groups. The Waist to Hip circumference (WHC) ratio increased from 0.87 for age 15-24 years to 0.92 for those age 55 years and above. Comparison with findings in other parts of the world showed that Ethiopians (both sex) had low mean weight, waist and hip circumferences, but high body mass index. CONCLUSION: The study showed that the physical measurement values are different from the other regions of the world. The use of other reference values in evidence based practices may result in under detection of risk groups.

Hematoimmunological profile at gilgel gibe field research center, southwest ethiopia.

BACKGROUND: Health and disease can only be distinguished by accurate and reliable reference values of a particular laboratory test. In interpreting laboratory test results, usually the reported values are compared with established reference values from developed countries. Now it is a fact that there is considerable variation in hematology reference intervals by several variables. However, such data at a population level are scanty in the Ethiopian situation. Therefore, this study was conducted to determine the hematological and immunological values in a community setting. METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center (GGFRC) from late September 2008 to end of January 2009. A tsample of 1,965 individuals was included in the study. Blood sample was collected by vacutainer tube and transported to Jimma University Specialized Hospital laboratory. Data were entered in to EpiData and analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: A total of 1965 (955 men and 1010 women) individuals were studied. The mean red blood cell count for men and women was 4.55 × 10(12)/L and 4.34 × 10(12)/L (95 percentile range between 2.9 and 5.7 × 10(12)/L) and 4.34 ×10(12)/L (95 percentile range between 2.8 and 5.2 × 10(12)/L), respectively. On the other hand, the red blood cell count of 95% of the men and women lied between 2.9-5.7 × 10(12) cells/L and 2.8-5.2 × 10(12) cells /L, respectively. The mean hemoglobin value for men was 13.6 gm/dl and for women 12.7 gm/dl. The mean corpuscular volume for men and women was 90.2 fl and 90.8 fl, respectively. The mean platelet value for men was 229.1 ×10(9) cells/L and for women 241.3 ×10(9) cells/L. The mean white blood cells count for men and women was 6.08 ×10(9) cells/L and 6.12 ×10(9) cells/L, respectively. The mean CD4 value was 809 cell/µl for men and 868 cell /µl for women. Forty two percent of the study participants had O blood group. CONCLUSION: The hematologic and immunologic profile of the studied population in Southwest Ethiopia is different from the reports from other countries and the standards described in western literature. We recommend conducting similar nationwide study to determine the immunological and hematological reference values of the Ethiopian population as a whole.

Biochemical profile at gilgel gibe field research center, southwest ethiopia.

BACKGROUND: The biochemical reference ranges currently used in developing countries are derived from data collected from populations living in developed countries. However, it is a fact that there is considerable variation in biochemical reference intervals by several variables. Moreover, reference ranges provided by different laboratory manuals and books do not also solve this problem. Biochemical profile at population level is scanty in the Ethiopian situation. Therefore, this study was conducted to determine the biochemical profiles for general population in community settings. METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center (GGFRC) from late September 2008 to end of January 2009. The study setting included both rural (majority) and urban dwellers. A total of 1,965 (955 men and 1010 women) individuals aged 15-64 years were included. Fasting blood glucose was determined immediately at field. Blood sample was collected by vacutainer tube without anticoagulant and transported to Jimma University Specialized Hospital laboratory for determination of total cholesterol, triglycerides, total serum protein, blood urea nitrogen, creatnine, uric acid, alanine aminotransferase and aspartate aminotransferase. Data were entered into EpiData and analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The mean total cholesterol value for both sexes was 141.0 mg/dl with higher values for women at different age strata. The mean FBS level of the study population was 96 mg/dl. The mean values for blood urea nitrogen, creatinine and uric acid were 14.1 mg/dl, 0.86 mg/dl and 4.4 mg/dl. The mean level of alanine aminotransferase and aspartate aminotransferase of the study population were 27.2 U/L and 31.2 U/L, respectively. CONCLUSION: All biochemical values in this study except for blood urea nitrogen were not different from values in other reports. Even though our finding showed similar ranges with reported values, there might be a variation in values across the country. Therefore, we recommend conducting similar nationally representative study to validate the current finding.

Prevalence of lipodystrophy and metabolic syndrome among HIV positive individuals on Highly Active Anti-Retroviral treatment in Jimma, South West Ethiopia.

INTRODUCTION: Use of highly active antiretroviral therapy has led to significant reductions in morbidity and mortality rates. However, these agents had also given rise to the metabolic and morphologic abnormalities which are modifiable risk factors for cardiovascular diseases. Evidences elsewhere indicate growing in prevalence of these problems but studies are lacking in Ethiopia. This study was conducted to determine the prevalence of HIV-associated lipodystrophy and metabolic syndrome in patients taking highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted in 2010 on a sample of 313 patients taking highly active antiretroviral therapy in Jimma University specialized hospital. Structured questionnaire was used to assess patients' sociodemographic characteristics and clinical manifestations of metabolic abnormalities. Checklists were used for reviewing charts about clinical manifestations of metabolic abnormalities and immunologic profile of patients. Data was cleaned, entered in and analyzed using SPSS for windows version 16.0. RESULTS: Metabolic syndrome was detected in 21.1% and HIV-lipodystrophy was detected 12.1% of patients. The factors found to be independently associated with metabolic syndrome were taking the antiretroviral therapy for more than 12 months (AOR=4.2; 95% CI=1.24-14.23) and female sex (AOR=2.30; 95% CI=1.0-5.27) and the factor found to be independently associated with HIV-lipodystrophy was taking the antiretroviral therapy (AOR=3.59; 95% CI=1.03-12.54) for more than 12 months. CONCLUSION: Metabolic abnormalities were relatively common in the study population. The problems were higher among those who took anti-retroviral treatment for longer duration. Therefore, regular screening for and taking action against the metabolic abnormalities is mandatory.

Knowledge about Obstetric Danger Signs among Pregnant Women in Aleta Wondo District, Sidama Zone, Southern Ethiopia.

BACKGROUND: Raising awareness of women on danger signs of pregnancy, childbirth and the postpartum period is crucial for safe motherhood. In Ethiopia, a country where maternal morbidity and mortality is high little is known about knowledge level of pregnant women on obstetric danger signs. The objective of this study was to assess pregnant women's knowledge about obstetric danger signs in Aleta Wondo district, Sidama Zone, South Ethiopia. METHODS: A community based cross-sectional study was conducted from January 18 - February 20, 2007, on a sample of 812 pregnant women selected from, 8 rural and 2 urban Kebeles. A structured pre-tested questionnaire was used to collect quantitative data on socio-demographic characteristics, obstetric history, and knowledge about danger signs of pregnancy, childbirth and post partum period. Qualitative data was collected through focus group discussion with pregnant women and in-depth interview with traditional birth attendants. The collected data were analyzed using SPSS for Windows version 12.0.1. RESULTS: Seven hundred forty three pregnant women participated in the study making a response rate of 92%. Out of the 743 pregnant women who participated in this study 226 (30.4%), 305(41.3%) and 279(37.7%) knew at least two danger signs during pregnancy, childbirth and postpartum period, respectively. Being urban resident was consistently found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4). CONCLUSION: This study indicated that the knowledge level of pregnant women about obstetric danger signs (during pregnancy, childbirth and postpartum period) was low and affected by residential area. Therefore, the identified deficiencies in awareness should be addressed through maternal and child health services by designing an appropriate strategies including provision of targeted information, education and communication.

The pattern of cardiac diseases at the cardiac clinic of jimma university specialised hospital, South west ethiopia.

BACKGROUND: Rheumatic heart disease is the commonest cardiac disease in most sub-Saharan African countries, followed by hypertensive heart disease which is rising along with the other non-communicable diseases. However the pattern in our setting is not known. This study aimed to determine the pattern of cardiac diseases among adult patients on follow-up at the cardiac follow-up clinic of Jimma University Specialized Hospital. METHODS: A cross-sectional study was conducted on cardiac patients who are newly enrolled to the cardiac follow up clinic of Jimma university specialized hospital during a five year period from 2003 to 2008. Out of the total 837 cases that were newly enrolled to the clinic in the five year period, 781 patients who had complete record about etiologic diagnosis were included in the study. The data were collected using structured record review checklist. The collected data were then analyzed using SPSS for windows version 12.0. RESULTS: Rheumatic heart disease was the diagnosis in 256 (32.8%) of the cardiac cases on follow-up followed by hypertensive heart disease and cardiomyopathy accounting for 189 (24.2%) and 158 (20.2%) of cases, respectively. Among Rheumatic heart disease patients; male to female ratio was 0.86:1 and the mean age was 31.4 years. One hundred ninety three (75.4%) of the cases with rheumatic heart disease had echocardiographic report that showed valve(s) involvements of pure MS in 99 (51.3%) and combined MS, MR in 49 (25.4%). Overall, hypertension contributed for a total of 241 (30.9%) of cardiac patients that included 189 (24.2%) hypertensive heart disease and 52 (6.7%) as one major risk factor for ischemic heart disease. CONCLUSION: Rheumatic, hypertensive and cardiomyopathic heart diseases accounted for more than three-quarters of cardiac diseases in the study population. This study highlighted the need for further study to determine the burden at community setting.

Risk Factors for Cardiovascular Diseases among Diabetic Patients In Southwest Ethiopia.

BACKGROUND: Studies on cardiovascular risk factors among diabetic persons in Ethiopia are lacking. The objective of this study was to determine the prevalence of the cardiovascular risk factors (hypertension, obesity, physical inactivity, dyslipidemia and smoking) among diabetic patients at the diabetic clinic of Jimma University Specialized Hospital. METHODS: A cross-sectional study was conducted from October to December 2007. Three hundred one individuals were randomly selected from 950 patients on follow-up. Data were collected using a structured format and appropriate equipments and reagents. Laboratory data were recorded in a separate checklist. The data were entered into SPSS for Windows version 12. Multivariate regression analysis was carried out to identify predictors of hypertension, obesity and dyslipidemia. RESULTS: Two hundred and fifty six (85.1%) of the sample participated in the study. The prevalence of hypertension, obesity, dyslipidemia, physical inactivity and current smoking was 46.5%, 23.4%, 63.5%, 55.1% and 5.5% respectively. Age ≥ 45 years, type 2 diabetes and obesity were predictors of hypertension. Females were less likely to be hypertensive (OR =2.26, 3.37, 3.79 and 0.48 respectively). Type 2 diabetics and females were more while rural diabetics were less likely to be obese. (OR =6.08, 4.17 and 0.37 respectively). Female gender, hypertension and fasting blood glucose ≥ 180mg/dl were predictors of dyslipidemia. Alcohol users were less likely to be dyslipidemic. (OR =4.25, 3.5, 3.56 and 0.39, respectively) CONCLUSION: Hypertension, obesity, dyslipidemia and physical inactivity were common while smoking was uncommon among diabetic patients in Jimma University Specialized Hospital. Type 2 DM was a predictor of hypertension and obesity. Diabetic women were more likely to be obese and dyslipidemic. We recommend screening and management of these risk factors.