The economic burden of hemodialysis and associated factors of among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia.

INTRODUCTION: The treatment of kidney disease, including hemodialysis, poses challenges in healthcare and finances. Despite limited data on hemodialysis costs and determinants in Ethiopia, existing literature indicates a paucity of evidence regarding the economic burden of hemodialysis. This study aims to evaluate the direct and indirect costs of hemodialysis among end-stage renal disease (ESRD) patients, alongside associated factors, among selected governmental and private institutions in Addis Ababa, Ethiopia. METHODS: An institutional-based cross-sectional study using a simple random sampling technique was conducted from September 10 to November 1, 2021. One hundred twenty-eight patients participated in the study. Data was collected using an interviewer-administered questionnaire. The analysis used proportion and frequency measures of central tendency and linear regression measures. Both simple and multiple linear regression models were used to assess associated factors. The final model used a P value < 0.05 at 95% confidence interval (CI) was used to determine significance. RESULT: The mean cost of hemodialysis in a representative sample of selected hospitals in Addis Ababa was 7,739.17 $ ±2,833.51 $, with direct medical cost contributing 72.9% of the total cost. Furthermore, the institution type (private or public) and duration on hemodialysis were associated with an increased cost of hemodialysis. CONCLUSION: Our findings underline the necessity for policymakers, program administrators, and healthcare institution executives to prioritize this group, recognizing the substantial load they bear and extending these services in government facilities to a broader patient population.

WHAT IS KNOWN?: Chronic kidney disease is the leading cause of sickness and death, affecting an estimated 10% of the population in 2015. Treatment of Kidney disease, including hemodialysis, presents not solely a medical concern but also a financial aspect. Therefore, we tried to assess the direct and indirect cost of hemodialysis among chronic kidney disease patients and associated factors among selected government and private institutions. WHAT DID WE DO?: The study's objective was to evaluate the direct and indirect costs of hemodialysis in patients with chronic kidney disease and examine the associated factors within selected government and private institutions. We selected the institutions after expert consultation due to their high patient flow. An institution-based cross-sectional study was conducted, using an interviewer administered semi structured-questionnaire. WHAT DID WE FIND?: We found the mean cost of hemodialysis in a representative sample of selected hospitals in Addis Ababa to be 7,739.17$ ±2,833.51$, with direct medical cost contributing 72.9% of the total cost. Furthermore, the institution type (Private or Public) and number of years on hemodialysis were predictors of increased cost. Moreover, our findings have highlighted various strategies employed by patients facing challenges covering these expenses. Most patients resort to seeking assistance from family and friends, reducing the frequency of hemodialysis sessions, and cutting back on prescribed medications. It is important to note that several coping mechanisms can adversely affect patients' health, given that they involve skipping crucial life-saving treatments. WHAT DO THE RESULTS MEAN?: We found out that the cost of hemodialysis was relatively high among the study participants. Therefore, policymakers, programmers, health institution leaders should pay closer attention to these patients as they face significant health and financial burdens.

Spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data: Spatial and multilevel analysis.

BACKGROUND: Timely vaccination is the practice of administering the vaccine within the first birthday of the child. Not vaccinating the child at the appropriate age is the cause of improper protection of diseases and can be a possible factor in death. The problem of not completing the vaccine in the scheduled period is a globally distributed problem, but especially in sub-Saharan African countries, it is a bottleneck to child health. Even if timely vaccination is crucial for reducing the impact of VPDs, there are no current national-level studies to generate conclusive and tangible evidence in Ethiopia. OBJECTIVE: To assess spatial variations and determinants of timely completion of vaccination in Ethiopia using further analysis of EDHS 2019 data. METHOD: The secondary data analysis of a community-based cross-sectional study design was employed among 3094 participants. Stata-14 software was used for data cleaning, recording, and analysis. Arc GIS version 10.3 and Kuldorff SAT scan version 9.6 software are used for spatial and SAT scan statistics. A multilevel mixed-effect binary logistic regression analysis was used to identify the predictors of timely vaccination. The clustering effect was also evaluated by Moran's I statistics and intra class correlation. RESULTS: The timely completion of vaccination among Ethiopian women who had a child aged 12-35 months was 19.5% (95%CI: 18.2-20.8), and the spatial distribution of timely completion of vaccinations in Ethiopia was non-randomly distributed. A statistically significant high proportion of timely completion areas were clustered in the eastern part of Amhara, the south part of Afar, Addis Ababa, and Oromia. The primary cluster was located at a 13.11 km radius in Diredawa, which was 3.68 times higher than outside the window (RR = 3.68, LLR = 68.76, p-value < 0.001). History of antenatal care follow-up (AOR = 1.63, 95% CI: 1.3-2.04), giving birth at health facilities (AOR = 1.63, 95% CI: 1.25-2.13), age ≥ 35 years (AOR = 186, 95% CI: 1.35-2.63), age 25-34 years (AOR = 1.72, 95% CI: 1.33-2.21), and being richest (AOR = 2.71, 95% CI: 1.86-3.94) were the factors contributing to the timely completion of vaccination. CONCLUSION: The prevalence of timely completion of vaccination was low in Ethiopia, and the spatial distribution of timely completion of vaccination in Ethiopia was non-randomly distributed across the regions. The factors associated with the timely completion of vaccinations were ANC follow-up, place of delivery, age of the participant, and wealth index. We recommend expanding facility delivery, antenatal care services, and empowering women to scale up timely vaccination in Ethiopia.

Utilization of growth monitoring and promotion services among children younger than 2 years in West Armachiho district, Northwest Ethiopia.

Introduction: Inadequate physical growth and poor development of children are prevalent and significant problems worldwide, with 149 million children younger than 5 years stunted and 49 million wasted. Growth monitoring and promotion (GMP) is one of the major activities implemented with the aim of capturing growth faltering before the child reaches the status of undernutrition. In relation to this, the Amhara region, where the study area is found, is a highly burdened area for child malnutrition. Thus, it needs further investigation about the utilization of GMP services and associated factors among children younger than 2 years in the study area. Objective: The aim of this study was to assess the utilization of growth monitoring and promotion services and associated factors among children younger than 2 years. Methods: A community-based cross-sectional study was conducted in the West Armachiho district, including 703 mother-child pairs, with a response rate of 94.7%. A simple random sampling technique was used to select the respondents. Both bivariable and multivariable logistic regression analyzes were performed. An adjusted odds ratio (AOR) with a 95% confidence interval was used to measure the strength of the association. Results: The proportion of utilization of growth monitoring and promotion services in the West Armachiho district was 13.7% (95%Cl; 11.2, 16.4). Factors such as maternal educational status (AOR = 2.17, 95%Cl; 1.05, 4.49), institutional delivery (AOR = 3.16, 95%Cl; 1.62, 6.13), family size (AOR = 2.66, 95%Cl; 1.13, 6.23), access to health facility (AOR = 3.17, 95%Cl; 1.45, 6.95), and maternal knowledge (AOR = 4.53, 95%Cl; 2.71, 7.59) were significantly associated with the utilization of growth monitoring and promotion services. Conclusion: Utilization of growth monitoring and promotion services in children younger than 2 years in the West Armachiho district was low. Thus, giving due attention to the improvement of the knowledge of the mothers/caregivers about child GMP services and counseling them about the importance of facility delivery is vital to improving growth monitoring and promotion services in the area.

Magnitude of early postoperative hypoxemia and its associated factors among adult patients who undergo emergency surgery under general anesthesia at Jimma Medical Center, Jimma, Southwest Ethiopia, 2021: a prospective observational study.

PURPOSE: Emergency surgical procedures involve considerable risks. Among these, early postoperative hypoxemia (EPH) is a frequent anesthetic complication in the post-anesthetic care unit (PACU). There is a great concern for EPH among health professionals, specifically, those providing emergency surgery during the nighttime. This raised anesthesia-ended time-related risk of EPH question. Thus, this study aimed to determine the magnitude of EPH and its associated factors among adult patients who undergo emergency surgery under general anesthesia. METHODS: A prospective observational study through a consecutive sampling technique was conducted. Binary logistic regression analysis was used to identify associated risk factors. All variables that were found statistically significant on bivariable analysis were entered into a multivariable logistic regression analysis. RESULT: Of 352 patients who had undergone emergency surgery, 149 (42.3%) patients developed EPH. Factors significantly associated with EPH were anesthesia ended during nighttime (AOR = 1.76, 95%CI [1.01, 3.05], p = 0.045), ASA III (AOR = 12.35, 95%CI: [4.5, 34.02], p ≤ 0.001), age greater than 55 (AOR = 3.2, 95%CI: [1.7, 5.91], p ≤ 0.001), surgery duration greater than 2 h (AOR = 2.012, 95%CI: [1.2, 3.51], p = 0.014), hypotension (AOR = 10.3, 95%CI: [2.4, 44.16], p = 0.002), muscular strength score zero (AOR = 2.944, 95%CI: [1.8, 4.82], p ≤ 0.001), and preoperative oxygen saturation less than 95% (AOR = 2.371, 95%CI: [1.35,4.16], p = 0.003). CONCLUSION: The magnitude of EPH among patients who have undergone emergency surgery was high and thus recommended that oxygen should be provided timely to decrease it. Identified risk factors were night-time ended anesthesia, ASA III, age greater than 55, surgery duration greater than 2 h, hypotension, muscular strength score zero, and preoperative oxygen saturation less than 95%. This study found anesthesia ended during early morning favors early morning early postoperative hypoxemia (EMEPH). To avert EMEPH, the anesthetist should avoid factors that favor the circadian rhythm of the lung-based early morning anesthesia augmented EPH.

Magnitude and predictors of pre-diabetes among adults in health facilities of Gondar city, Ethiopia: a cross-sectional study.

Introduction: Impaired glucose tolerance currently affects 374 million (7.5%) people worldwide, and by 2030, this number is predicted to affect 454 million (8%). Urban inhabitants have an increased risk of developing pre-diabetes. Thus, the study aimed to assess the magnitude of pre-diabetes and associated factors among adults attending outpatient departments of the health facilities of Gondar, Ethiopia. Method: From 3 March to 18 April 2020, an institution-based cross-sectional study was conducted. A systematic random sampling technique was used to select 992 participants. Data were gathered using an interviewer-administered questionnaire, and fasting blood glucose was assessed using capillary blood. Bivariable and multivariable binary logistic regression analyses were fitted to check the association between independent variables and pre-diabetes. Statistical significance was declared at a level of P of <0.05. Results: The prevalence of pre-diabetes was 16.6% (95% CIs: 14.3-18.8%). Age [AOR = 3.66, 95% CIs (2.05, 6.52)], a family history of diabetes mellitus [AOR = 3.46, 95% CIs (2.16, 5.52)], waist circumference [AOR = 3.6, 95% CIs (2.26, 5.88)], physical activity [AOR: 5.02, 95% CIs (2.87, 8.77)], dietary diversity [AOR = 3.07, 95% CIs (1.95, 4.84)], and smoking [AOR = 2.9, 95% CI (1.42, 6.05)] were factors associated with pre-diabetes. Conclusion: From our study, we can conclude that one in six adults in the health facilities have pre-diabetes. Age, family history of diabetes, waist circumference, physical activity, dietary diversity, and smoking were the factors associated with pre-diabetes. Therefore, it is recommended that adults should be educated on modifying their lifestyle, including their diet, and substantial care should be provided for older adults.

Practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in South Gondar Zone, Amhara Region, Ethiopia, 2020.

INTRODUCTION: Traditional uvulectomy is widely practiced in Africa especially in sub-Saharan countries including Ethiopia. Studies conducted in different times and areas of the world have shown that the level of practice of uvulectomy and its associated factors were varied from country to country. Therefore, this study was carried out to assess the practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in the South Gondar Zone. OBJECTIVE: This study aimed to assess practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in South Gondar Zone, Amhara Region, Ethiopia, 2020. METHOD: A community-based cross-sectional study was conducted on 634 participants who were selected using a multistage with a simple random sampling method. Data were collected using a structured interviewer-administered Amharic version questionnaire; it was entered into Epi Data and analyzed using SPSS. Descriptive statistics were calculated and logistic regressions were fitted to declare statistical significance at p-value < 0.05 and 95% CI. RESULT: The prevalence of traditional uvulectomy in this study was 52.5% (95% CI, 48.6-56.3%). Moreover, lack of information [AOR = 2.975 (1.677-5.277)], perceived as uvula causes illness [AOR = 4.888 (2.954-8.086)], future intention or will perform [AOR = 4.188 (2.584-6.788)], perceived as traditional uvulectomy should not be eradicated [AOR = 1.893 (1.172-3.057)]), saw the previous good result [AOR = 9.396 (5.512-16.016)], health personnel hospitality problem [AOR = 5.922 (2.392-14.664)] and did not get cured by pharmacologic treatment [AOR = 3.918 (2.073, 7.405)] were significantly associated with traditional uvulectomy. CONCLUSION AND RECOMMENDATION: The prevalence of traditional uvulectomy was high. Lack of information, perceived as uvula causes illness, future intention to uvulectomy, perceived as traditional uvulectomy should not be eradicated, saw the previous good result, health personnel hospitality problem and did not get cured by pharmacologic treatment were the factors significantly associated with traditional uvula cutting. Therefore, special attention will be given to creating further awareness to the community at large and setting controlling mechanisms for the health care delivery system.

Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study.

BACKGROUND: Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children. METHODS: A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association. RESULTS: A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years' follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure. CONCLUSION: In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.

Malnutrition and its determinants among older adults people in Addis Ababa, Ethiopia.

BACKGROUND: In Ethiopia, malnutrition among older adults is under detected and, neglected area because the entire problem related with aging considered as fate of aging. Also, older adults are often omitted from public health research. Literatures are scarce in Ethiopia; there is limited information in the current study area among older adults using Min Nutritional Assessment (MNA). Therefore, this paper investigated the prevalence of malnutrition and its predictors among older adults people aged 65 years or above in Addis Ababa, Ethiopia. METHODS: A community-based cross-sectional study was employed from January 1 to march 30, 2020 in Addis Ababa. Nutritional status of the older adults was measured by using Min nutritional assessment (MNA). Data from 662 older adults were collected through face to face interviews using a structured questionnaire. Bivariable and multivariable logistic regression analysis was done to identify factors associated with malnutrition. RESULT: The prevalence of malnutrition among older adults was found to be 26.6%[95% Confidence interval (CI):22.8, 30.1]. Depression [Adjusted Odds Ratio (AOR) = 7.57 95%CI: 5.01, 11.45], being poor [AOR = 1.95 95% CI: 1.166, 3.25], occupation; daily laborer and guard [AOR = 2.78 95% CI: 1.12, 7.17] and being old old [AOR = 2.62 95% CI: 1.62, 4.25] were significantly associated with the higher odds of malnutrition. CONCLUSION: This study illustrated that considerably high proportion of older adults were malnourished in Addis Ababa. Socio-economic characteristics and depression were significantly associated with malnutrition. Therefore, nutritional and social support activities are essential for older adults, particularly of those who are socio-economically disadvantaged and advanced age. In addition, regular nutritional screening and management as well as behavioral interventions should be strengthened as a pillar component of therapeutic interventions. Specific nutritional requirements, at later stages of life is changing, and with the population aged over 65 years increasing in low-income countries like Ethiopia, the research in this field is likely to increase further.

Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia.

BACKGROUND: Delay in the diagnosis and treatment of tuberculosis exacerbates the disease and clinical outcomes. It further enhances transmission of the infection in the society as well as increased the severity of the illness and raised rate of mortality. OBJECTIVES: The major goal of this study is to determine the magnitude of delays in tuberculosis treatment and factors affecting tuberculosis treatment among adult tuberculosis patients at Debremarkos town, North West Ethiopia, 2018. METHODS: Institution-based cross-sectional study design was employed. Systematically selected 300 adult TB patients were recruited to the study. The study was conducted at Debremarkos town public health facilities from March 1 to April 30, 2018. Logistic regression models were fitted to identify the predicting variables and control confounder's of the outcome variables. P value ≤ 0.05 with 95% CI was considered as an indicator for the presence of statistically significant association. The result revealed that the median total delay was 23 days (IQR: 19-28 days). The median patient and health system delays were 20 days (IQR: 15-20 days) and 4 days (IQR: 3-5 days), respectively. Tuberculosis patients living in a rural area were 1.14 times more likely to delay for the TB treatment (AOR: 1.141, 95% CI (1.106, 2.608)). Patients who were unable to read and write have almost two times a chance of being delayed (AOR: 2.350, 95% CI (1.630, 2.608)). Monthly income of patients has found another predictor for delay; patients with low monthly income were about six times more likely to delay for TB treatment (AOR: 6.375, 95% CI: (1.733, 23.440)). Those TB patients who had visiting traditional healers before arrival to health facilities were about 2.7 times more likely to delay for TB treatment(AOR: 2.795, 95% CI (1.898, 8.693)). Conclusion and Recommendation. The significant proportion of delays in tuberculosis treatment was found in this study. Living in the rural area, unable to read and write, lower monthly income, and visiting traditional healers were found independent predictors of TB treatment delay. The regional and zonal health administrator shall design various awareness creation mechanisms to educate the public about timely initiation of tuberculosis treatment.

Reformulating and testing Temesgen-Melesse's temperature-based evapotranspiration estimation method.

The use of FAO-56 Penman-Monteith (PM) equation is the recommended equation to estimate potential evapotranspiration. However, when data that satisfy the PM equation is not available or incomplete, the use of PM equation is not an option. In this study, one such method known as Temesgen-Melesse's (TM) method was assessed in relation to the PM equation using data of eight class-I meteorological stations in Ethiopia. In the study, first the problems with this method were identified and the TM equation was modified. The modifications made were replacement of the average maximum temperature at the denominator of the equation varying with time with the average of Tmax for each location (which is a constant for a given location). The Second consideration was calibrating the power of the maximum temperature at the numerator using PM data instead of taking it as a constant 2.5 suggested by the authors in their original equation. Then the three (the original TM, the modified TM with constant power of 2.5 and the modified TM with the power calibrated) methods were fitted against PM equation. Thereafter tests using statistical parameters, model tendency parameters and model performances were carried out. The results indicate the modified TM equation to be better than the original TM equation in terms of percent slope (0.8-12.3 against 1.3-15.1) and the correlation coefficient (R2) and the slope (100% good or satisfactory against 25%). The modified and calibrated equation gave best results in terms of percent error by slope (0.5-2.3), by coefficient of efficiency (100% good or satisfactory), by R2 and slope (100% good or satisfactory) and by mean percent error (5.7-13.6%). Therefore, whenever data that satisfy PM equation are available (even if for limited years), it is better to calibrate the power of the maximum temperature and to consider more decimal places rather than taking 2.5 as suggested by the authors. When data is not available it is better to use the modified TM equation rather than using the original TM equation. The study would benefit those who want to study long-term climate changes and drought patterns, which involve the use of evapotranspiration with limited data that satisfy the PM equation, but have long-term data of temperature.