Time to develop severe acute malnutrition and its predictors among children living with HIV in the era of test and treat strategies at South Gondar hospitals, northwest, Ethiopia, 2021: a multicentre retrospective cohort study.

BACKGROUND: Although severe acute malnutrition is a major public issue among HIV infected children, there is no prior evidence in Ethiopia. Hence, this study aims to assess the time to develop severe acute malnutrition and its predictors among children living with human immunodeficiency virus in Ethiopia, 2012. METHODS: An institution based retrospective cohort study was conducted in South Gondar hospitals among 363 HIV infected children from February 10, 2014, to January 7, 2021. Epi-data version 3.1 was used to enter data, which was then exported to STATA version 14 for analysis. Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. A standardized data extraction tool was used to collect the data. The Kaplan Meier survival curve was used to estimate the median survival time. The Cox-proportional hazard model assumption was checked via the Schoenfeld residual ph test and a stph plot. Bivariable and multivariable Cox proportional hazard models were employed at 95% confidence intervals (CI). A variable having a p-value < 0.05 was considered a statistically significant predictor of severe acute malnutrition. RESULTS: A total of 363 children living with HIV, 97 (26.72%) developed severe acute malnutrition during the follow-up period. The overall incidence rate was 5.4 (95% CI: 4.7-5.9) person per year with a total of 21, 492 months or 1791 years of observation. Moreover, the median survival time was 126 months. Treatment failure [AHR =3.4 (95% CI: 2.05-5.75)], CD4 count below threshold [AHR =2.5 (95% CI: 1.64-3.95)], and WHO stage III & IV [AHR =2.9 (95% CI: 1.74-4.73)] were all significant predictors of severe acute malnutrition. CONCLUSION: The time to develop severe acute malnutrition was found to be very low. Treatment failure, CD4 count below threshold, and WHO stage III were all significant predictors of severe acute malnutrition. Hence, emphasizing those predictor variables is essential for preventing and controlling the occurrence of severe acute malnutrition among HIV infected children.

Postpartum haemorrhage and associated factors among mothers who gave birth in South Gondar Zone public health facilities, Ethiopia: a cross-sectional study.

BACKGROUND: Postpartum haemorrhage is one of the direct and the leading causes of maternal morbidity and mortality. There are many risk factors of postpartum haemorrhage, which vary in different settings. Therefore, the purpose of this study was to assess postpartum haemorrhage and associated factors among mothers who gave birth in public health facilities. METHODS: A cross-sectional study was employed from 17 November 2019 to 15 February 2020. The study participants were selected using a systematic sampling technique. The data were entered and cleaned using EpiData V.3.1 then exported to SPSS V.20 for analysis. Factors associated with postpartum haemorrhage were selected for multiple logistic regression at the probability value (p value) of less than 0.2 in the χ2 analysis. Statistically significant associated factors were identified at probability value (p value) less than 0.05 and adjusted OR (AOR) with a 95% CI. RESULTS: The mean age of participants was 31.3 (SD ±5.7) years. This study found that the prevalence of postpartum haemorrhage was 13.6% (67). Age of participants (AOR 12.5, 95% CI 4.0 to 38.6), disrespectful maternity care (AOR 8.4, 95% CI 3.2 to 22.0), labour induction and augmentation (AOR 6.97, 95% CI 2.34 to 20.8), the prolonged second stage of labour (AOR 9.9, 95% CI 2.6 to 37.1) and no antenatal care visit (AOR 10.1, 95% CI 3.4 to 29.7) were statistically significant associated factors of postpartum haemorrhage. CONCLUSIONS: The prevalence of postpartum haemorrhage is high. The age of the participants, disrespectful maternity care, labour induction and augmentation, the prolonged second stage of labour and no antenatal care visit were independent predictors of postpartum haemorrhage.

Undernutrition and associated factors among pregnant women in Ethiopia. A systematic review and meta-analysis.

Background: Maternal undernutrition is a major public health concern due to its association with mortality and overall disease burden for mothers and their children. Maternal nutrition determines pregnancy outcomes since reduced intake of nutrients influences gestational age length, placental function, and fetal growth during pregnancy. The complexity of the intergenerational aspects of maternal nutrition may also confound the design of interventions. Therefore, this research aimed to assess the prevalence of undernutrition and associated factors among pregnant women in Ethiopia. Methods: We identified the literature from PubMed, EMBASE, Scopus, and CINAHL databases. Data were entered into Microsoft Excel and then exported to Stata version 17 statistical software for analysis. The I2 and Q-statistic values detect the level of heterogeneity, and meta regression was performed to investigate between-study heterogeneity using more than one moderator. JBI quality assessment tools were used to include relevant articles. Evidence of publication bias was indicated using the funnel plot and Egger's linear regression test. The effect size was expressed in the form of point estimates and an odds ratio of 95% CI in the fixed-effect model. Result: In total, 19 studies fulfill the inclusion criteria. The pooled prevalence of undernutrition among pregnant women was 32% (95% CI 31.3-33.2 I2 = 97.5%, P < 0.0). Illiteracy (AOR = 3.6 95% CI; 2.3-5.6), rural residence (AOR = 2.6 95% CI; 1.2-3.5), a lack of prenatal dietary advice (AOR = 2.6 95% CI; 1.8-3.7), household food insecurity (AOR = 2.5 95% CI; 1.9-3.2), and low dietary diversity score (AOR = 3.7 95% CI; 2.2-5.9) appear to be significantly associated with undernutrition among pregnant women. Conclusion: The review showed that the prevalence of undernutrition is still high among pregnant women. Illiteracy, rural residence, a lack of prenatal dietary advice, household food insecurity, and low dietary diversity score were significantly associated with undernutrition during pregnancy. Interventions should focus on educating the public and helping families access food or supplements they need through local markets, health systems, and community-based support, as undernutrition is caused by numerous interconnected causes. Systematic review registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42023417028.

Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study.

OBJECTIVES: This study aims to identify levels of adherence to antiretroviral therapy (ART) drugs and factors associated with them in Northwest Ethiopia. We hypothesise that in the era of COVID-19, there would be suboptimal adherence to ART drugs. DESIGN: An observational cross-sectional study was conducted. Factors associated with the level of adherence were selected for multiple logistic regressions at a p value of less than 0.2 in the analysis. Statistically significant associated factors were identified at a p value less than 0.05 and adjusted OR with a 95% CI. SETTING: The study was conducted in one specialised hospital and three district hospitals found in the South Gondar zone, Northwest Ethiopia. PARTICIPANTS: About 432 people living with HIV/AIDS receiving highly active ART in South Gondar zone public hospitals and who have been on treatment for more than a 3-month period participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Levels of adherence to ART drugs and their associated factors. RESULTS: Among 432 study participants, 81.5% (95% CI: 78% to 85.2%) of participants were optimally adherent to ART drugs. Determinants of a low level of adherence: stigma or discrimination (OR=0.4, p=0.016), missed scheduled clinical visit (OR=0.45, p=0.034), being on tuberculosis treatment (OR=0.45, p=0.01), recent CD4 cell count less than 500 cells/mm3 (OR=0.3, p=0.023) and patients who had been on WHO clinical stage III at the time of ART initiation (OR=0.24, p=0.027) were factors significantly associated with adherence to ART drugs. CONCLUSIONS: Level of adherence was relatively low compared with some local studies. The intervention targeted to reduce discrimination, counselling before initiation of treatment and awareness regarding compliance is advised to improve adherence to antiretroviral regimens.

Appropriate Complementary Feeding Practice and Its Associated Factors among Mothers Who Have Children Aged between 6 and 24 Months in Ethiopia: Systematic Review and Meta-Analysis.

Background: Appropriate complementary feeding practices prevent malnutrition among children. The proportion and determinant factors of appropriate complementary feeding practices identified by different studies were inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to assess the pooled proportion and determinants of appropriate complementary feeding practices among mothers. Methods: Databases (PubMed, HINARI, Google Scholar, Cochrane Library, and Web of Science) and university repositories were used to search for important articles. A critical appraisal of the studies was conducted. Data analysis was conducted using STATA version 11. Cochran (Q test) and I2 test were used to test the heterogeneity of the studies. Publication bias was checked using the funnel plot for asymmetry and Egger's regression test. Results: Seventeen primary studies with a total sample size of 9166 mothers were involved in this study. The pooled proportion of appropriate complementary feeding practices among mothers who had infants and young children aged between 6 and 24 months was 21.77 (with a 95% CI: 14.07-29.48). Mothers' educational status of secondary school and above (OR = 3.36 with a 95% CI: 3.03-3.69), having repeated antenatal care visits (OR = 4.77 with a 95% CI: 3.49-6.05), child's age between 12 and 24 months (OR = 3.7 with a 95% CI: 2.75-4.65), having repeated postnatal care visits (OR = 3.17 with a 95% CI: 1.96-4.38), health education (OR = 4.88 with a 95% CI: 3.86-5.9), knowledge of mothers (OR = 4.85 with a 95% CI: 3.77-5.93), maternal age between 18 and 35 years (AOR = 2.67 with a 95% CI: 1.64-3.72), institutional delivery (OR = 2.23 with a 95% CI: 1.79-2.68), and higher household wealth (OR = 2.65 with a 95% CI: 1.46-3.84) were found to be statistically significant associated factors of appropriate complementary feeding practices among mothers. Conclusions: The pooled proportion of appropriate complementary feeding practices was low in Ethiopia. Knowledge of mothers and maternal health service uptake such as antenatal care, postnatal care, and institutional delivery increase appropriate complementary feeding practices. More focus is required for mothers who have children aged less than 12 months, mothers aged above 35 years and less than 18 years, lower mothers' educational status, and lower household wealth. Therefore, integrated interventions are still required to improve appropriate complementary feeding practices.

Importance of male partner's involvement in prevention of mother to child transmission of HIV/AIDS in Ethiopia: a systematic review and meta analysis until June 2021.

BACKGROUND: To promote the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS male partners play a significant role, especially in developing country were men's are a decision maker in domestic activity. When men are involved in PMTCT it would boost the service utilization and uptake of ART drugs. Thus this systematic review and Meta analysis aims to assess importance of male partner involvement in prevention of mother to child transmission of HIV/AIDS in Ethiopia. METHODS: Studies were accessed through an electronic web-based search mechanism from PubMed, Advanced Google Scholar, WHO databases and journals (African Health Monitor, Pan African Journal of Public Health), using independent and combinations of key terms together with a reference list of included studies. Two reviewers independently screened and assessed the quality of studies based on pre-specified criteria. When a disagreement between the two reviewers happened; the third reviewer was invited and resolve it based on the stated objectives and inclusion criteria. Measures of effects were pooled and random effect meta analysis was conducted. RESULTS: Ten studies met the inclusion criteria. The pooled prevalence of male involvement in PMTCT was 31.8% (95% CI; 22.3-41.3 I2 = 98.4%, p = 0.00). being urban residence(AOR = 2.43 95%CI;1.42-4.18), partner knowledge (AOR = 2.84 95%CI;1.90-4.22), knowledge on Antenatal care(AOR = 3.5 95%CI;1.80-6.76), partners who had no negative perception towards for PMTCT (AOR = 3.21 95%CI;2.18-4.72), government employee(AOR = 2.57 95%CI;1.76-3.75), partners informed of need to go for PMTCT(AOR = 3.83 95%CI;1.88-7.79), health institution related barriers(AOR = 2.6 95%CI;1.882-3.622), primary (AOR = 2.21 95%CI;1.29-3.80), and secondary education(AOR = 2.67 95%CI;1.69-4.19) were significant factors related with male partner involvement in prevention of mother to child transmission of HIV/AIDS. CONCLUSION: The proportion of male involvement in the Prevention of mother-to-child transmission of HIV in Ethiopia was low. Interventions aimed at improving male participation in the Prevention of mother-to-child transmission should consider the factors related to it. Healthcare services may need to be inclusive and could help men active engagement in PMTCT programs.