Prevalence of depression and associated factors among Somali refugee at Melkadida camp, Southeast Ethiopia: a cross-sectional study.

BACKGROUND: Psychological distress, psychosomatic complaints and clinical mental disorders such as depression and post-traumatic stress disorder are highly prevalent among refugees than other populations. Even though there were several studies done on mental health of refugees globally, there is very few in Ethiopia regarding the mental health of these vulnerable populations. Thus we aimed at determining the prevalence of depression and identifying determinants of depression among refugees. METHODS: A community based cross-sectional multistage survey with 847 adult refugees was conducted in May 2014 at Melkadida camp, Southeast Ethiopia. Data were collected by face to face interviews on socio demographic by using structured questionnaire, level of exposure to trauma by Harvard Trauma Questionnaire and depression symptoms by using Patient Health Questionnaire. Data entry and clearance were carried out by EpInfo version 7 and analysis was carried out by Statistical Package for Social Sciences version-20 software package. Data was examined using descriptive statistics and logistic regression, odds ratios and 95 % confidence intervals. RESULT: Over one third (38.3 %) of respondents met the symptoms criteria for depression. Gender, marital status, displaced previously as refugee, witnessing murderer of family or friend, lack of house or shelter and being exposed to increased number of cumulative traumatic events were significantly associated with depression among Somali refugees in Melkadida camp. CONCLUSION: The study revealed a relatively high prevalence of depression episode among refugees. Being female, divorced, deprived of shelter and witnessing the murder of family are most determinants of depression in refugees. Strengthening the clinical set up and establishing good referral linkage with mental health institutions is strongly recommended.

Building a resilient health system for universal health coverage and health security: a systematic review.

BACKGROUND: Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security. METHODS: A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization's health systems building block framework. RESULTS: A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security. CONCLUSIONS: Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.

Undernutrition and its association with socio-demographic, anemia and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: Under nutrition is a worldwide public health problem affecting the well-being of millions of pregnant women in the developing world. Only limited research has been conducted on the prevalence and determinants of maternal nutritional status in Ethiopia. Particularly, data on the nutritional status of pregnant women are lacking. The aim of this study was to assess the prevalence and determinants of undernutrition among pregnant women attending antenatal care at the University of Gondar Hospital, Northwest Ethiopia. METHODS: An institution based cross-sectional study was conducted in January and February 2016. Randomly selected 409 pregnant women were included in the study. Nutritional status was estimated using mid-upper-arm circumference. Data on potential determinants of undernutrition were gathered using a structured questionnaire. The blood sample was collected to analyze hemoglobin. The stool sample was collected to identify intestinal parasitic infections. Statistical analysis was done using logistic regression. P-value < 0.05 at 95% confidence interval was considered as statistically significant. RESULTS: The prevalence of undernutrition among pregnant women was 16.2% (95% CI: 12.4-20.1%). Using a logistic regression model, factors significantly associated with the undernutrition were living in rural areas (AOR = 2.26), low educational status [no formal education (AOR = 2.91), primary education (AOR = 2.69)], history of too many births (AOR = 2.55), anemia (AOR = 2.01), and intestinal parasitic infection (AOR = 2.73). CONCLUSION: The study findings provide evidence for the public health significance of under nutrition among pregnant women in the study area. The problem must be combated through rural livelihood promotion, socioeconomic empowerment of women, sustained nutrition education and expansion of family-planning services in the area.

Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

BACKGROUND: Household food insecurity remained one of the most crucial challenges to economic development and has been aggravated by household health conditions. Nearly one billion people are undernourished of which 98% in developing countries like Ethiopia. OBJECTIVE: To assess households' food insecurity among podoconiosis patients and non-podoconiosis in East and West Gojjam Zone, Ethiopia, 2016. METHOD: A community based comparative cross sectional study was conducted in East and West Gojjam, 2016. Multi-stage sampling technique was employed to select 208 podoconiosis and 400 non-podoconiosis household heads. Data was collected by using structured and pretested questionnaires. The collected data was cleaned, coded and entered into Epi data then exported to SPSS version 22. Descriptive and inferential statistics was performed. Both bivariate and multivariate logistic regression analyses was employed. The association was measured by adjusted odds ratio (AOR), 95%CI (confidence interval) and P < 0.05 was considered statistically significant. RESULT: A total of 608 study participants were involved in this study. Food insecurity podoconiosis patients and non-podoconiosis household was 83.7%, 53% respectively (p = 0.0001). Podoconiosis and non- podoconiosis whose heads could not read and write AOR = 5.84, (95% CI: 2.14, 15.95) and AOR = 1.70, (95% CI: 1.06, 2.72) were food insecure respectively. Podoconiosis patients without off farm activities AOR = 4.90, (95% CI: 1.60, 14.95), not using fertilizer AOR = 4.38, (95% CI: 1.15, 16.67) and living at > 5 kilo meter distance from market AOR = 4.47, (95% CI: 1.38, 14.48) were food insecure. Non-podoconiosis heads with no perennial plant AOR = 2.11, (95% CI: 1.17, 3.34), not using improved seeds AOR = 2.20, (95% CI: 1.25, 3.87), no access to asset building program AOR = 2.07, (95% CI: 1.27, 3.34), living in medium and low altitude AOR = 8.87, (95% CI: 1.81, 43.40) and AOR = 10.04, (95% CI: 1.90, 52.93) were food insecure. CONCLUSION: Food insecurity was higher among podoconiosis than non-podoconiosis households. Being a female, unable to read and write absence of off farm activities, not using of fertilizers and living in more distance from market were significantly associated with food insecurity among podoconiosis patients. Special emphasis should be given for improvement of food security of podoconiosis and non-podoconiosis households.

Intestinal parasitic infections and its association with undernutrition and CD4 T cell levels among HIV/AIDS patients on HAART in Butajira, Ethiopia.

BACKGROUND: Intestinal parasitic infections and HIV/AIDS have been the major public health problems and remain a vital cause of morbidity and mortality in developing countries. Both problems are linked in a vicious cycle. The magnitude of intestinal parasites was prevalent among people living with HIV/AIDS even in the HAART era. However, the pertinent risk factors associated with intestinal parasites among HIV/AIDS patients were not well investigated in Ethiopia particularly at Butajira town. Therefore, the aim of this study was to determine the prevalence of intestinal parasites and associated risk factors among HIV/AIDS patients on HAART in Butajira, Ethiopia. METHOD: A cross-sectional study was conducted, and a total of 323 study subjects was involved in the study. A systematic random sampling technique was used to select each participant during data collection. Stool specimen was collected and processed using direct wet mount, formol-ether concentration technique, and modified Ziehl-Neelson staining techniques to identify both common and opportunistic intestinal parasites. Structured questionnaire was used to collect socio-demographic, environmental, clinical, and nutritional data. Both bivariate and multivariate logistic regression analyses were used to assess the association of various explanatory factors on intestinal parasites. P value ≤0.05 at 95% CI was considered statistically significant. RESULTS: The overall prevalence of intestinal parasites was 35.9% (95% CI 31.0-40.9%). Protozoa's (Entanmoeba histolytica/dispar trophozoite, E. histolytica/dispar cyst, Giardia lamblia trophozoite, and G. lamblia cyst), helminths (Tanea species, Ascaris lumbricoides, Strongyloid stercoralis, Hookworm species and H. nana), and opportunistic intestinal parasites (Cryptosporidium parvum, Isospora belli) were observed in 57 (17.1%), 46 (14.4%), and 28 (8.7%) study participants respectively. Multivariate logistic regression analysis revealed that the presence of animals (AOR 6. 14; 95% CI 3.13, 12.0); using river water (AOR 4.87; 95% CI 1.14, 20.7); undernutrition (AOR 2.59; 95% CI 1.36-4.95); and level of immunosuppression (AOR 4.02; 95% CI 1.78-9.05 and AOR 2.84; 95% CI 1.37-5.89) were significantly associated with intestinal parasites. CONCLUSIONS: The prevalence of intestinal parasites found to be higher among HIV/AIDS patients receiving HAART at Butajira Hospital, southern Ethiopia. Presence of animals, using river water, lower CD4 T cell count, and undernutrition were significant factors affecting intestinal parasites. Therefore, consistent detection of intestinal parasites and deworming of patients should be performed as well as improving health education on personal hygiene, avoiding contact with pit or domestic animals, and using safe or treated water. Furthermore, improving nutritional support and household food access are recommended.