Magnitude and determinants of undernutrition among tuberculosis patients in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Undernutrition increases the risk of TB infection to be active TB, death and relapse of the disease. Undernutrition also disturbs the management process of tuberculosis. Therefore, this study aimed to estimate the pooled magnitude and determinants of undernutrition among TB patients in Ethiopia. METHODS: From August 20, 2022 to January 6, 2023, the research articles were identified via the search engines Google Scholar, Medline, Pub Med, Cochrane Library, and Web of Science. Stata version 14 was used for analysis, along with a standardized data extraction checklist. The Cochrane Q test statistic and I2 statistics were used to determine heterogeneity. A random-effect model was used to assess the extent of undernutrition among TB patients. OR with a 95% CI was used to report the relationship between undernutrition and independent factors. A funnel plot and Egger's test were used to examine publication bias. RESULTS: A total of 720 research articles were identified via several databases and 21 studies were included in the systematic review and meta-analysis. The pooled magnitude of undernutrition among TB patients was 48.23% (95% CI 42.84, 53.62). The current meta-analysis revealed that patients who had no formal education (OR = 2.11(95%CI: 1.09, 4.06), average monthly income < 1800 ETB (OR = 2.32 (95CI: 1.33, 4.04), unable to work (OR = 2.61(95CI:1.99, 3.43), patients who had eating disorder (OR = 2.73 (95CI: 2.09, 3.56), patients who had intestinal parasite (OR = 3.77 (95CI: 2.39, 5.94), patients of > 5 family size (OR = 3.79 (95CI: 1.06, 14.93), and patients who drank alcohol (OR = 1.47(95CI: 1.06, 2.05) were significantly associated with undernutrition. CONCLUSION: This meta-analysis examined the high magnitude of undernutrition among TB patients in Ethiopia. Strategic and police-oriented intervention to prevent factors contributing to the problem is mandatory.

Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia.

BACKGROUND: Globally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021. METHODS: Facility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association. RESULT: 116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction. CONCLUSION AND RECOMMENDATION: The favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.

Determinants of obstetric fistula in South-western Ethiopia.

INTRODUCTION AND HYPOTHESIS: Obstetric fistula, despite improved obstetric care, remains a real threat to poor women in rural Ethiopia. This study aimed to identify the risk factors that predispose women to obstetric fistula in South-western Ethiopia. METHODS: An unmatched case-control study design was employed in which 48 cases (women with obstetric fistula) and 188 controls (women without obstetric fistula) were included. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Univariate, bivariate, and multivariate analysis was conducted using SPSS version 20.0. Adjusted odds ratio, 95% confidence level, and p-values were used as the main measure of association. RESULTS: The study revealed that age at pregnancy of < 18 years (AOR = 5, 95% CI = 2-13), residing in rural areas (AOR = 4, 95% CI 1.6-11), lack of antenatal care (AOR = 5, 95% CI 2-14), no history of modern contraception utilization (AOR = 5, 95% CI = 2-13), post-term pregnancy (AOR = 8, 95% CI 3-22), and duration of labor > 24 hours (AOR = 4, 95% CI 2-9) were associated with obstetric fistula. CONCLUSIONS: The majority of fistula survivors were teenagers who were living in rural areas. Mothers having no antenatal care, not using modern contraception, having a post-term pregnancy, and having prolonged labor were at increased risk of developing obstetric fistula. Thus, delaying the age of first pregnancy, improving access to basic obstetric care, and advocating the use of modern contraceptive methods are crucial for teenage women residing in rural areas.

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis.

BACKGROUND: In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients. METHODS: Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI). RESULTS: In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level. CONCLUSIONS: Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients' empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.

Prevalence of scabies and associated factors among children aged 5-14 years in Meta Robi District, Ethiopia.

BACKGROUND: Scabies is a public health problem that affects children and elders predominantly. Its burden is higher in resource-poor settings, and scabies has a significant impact on the long-term health of children. In Ethiopia, there is limited information about scabies in children. Therefore, the purpose of this study was to determine the prevalence of scabies and its associated factors among children aged 5-14 years in Meta Robi District, Ethiopia. METHODS: A community-based cross-sectional study design using a multistage sampling technique was used to collect data from 457 participants by systematic random sampling. Scabies was diagnosed based on the clinical criteria set by the International Alliance for the Control of Scabies (IACS, 2020). FINDINGS: The prevalence of scabies among children aged 5-14 years old was 19.26% (95%CI: 17.20-22.52). In addition, over half (54.6%) of identified cases of scabies were of moderate severity. Factors like families' low income (aOR = 2.72; 95%CI: 1.32-5.59), being a male child (aOR = 1.96, 95%CI: 1.61-4.01), using only water for hand washing (aOR = 2.01, 95%CI: 1.84-4.79), having a contact history of scabies/skin lesions (aOR = 4.15, 95%CI: 2.02-13.67), and sharing sleeping beds (aOR = 6.33, 95%CI: 2.09-19.13) were significantly associated with scabies. CONCLUSION: The study highlights a high prevalence of scabies among children aged 5-14 years in the district. Provision of adequate health education for the community and children about the scabies and delivering mass drug administration to the district is suggested.

Antenatal depression and associated factors among pregnant women attending antenatal care at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022.

Background: Though antenatal depression (AND) has a risk of maternal and fetal morbidity and mortality, it is a neglected component of pregnancy care in Ethiopia. Research evidence is compulsory in different parts of the country to alleviate this problem. Thus, this study was needed to assess antenatal depression and its associated factors, which can help antenatal care (ANC) providers and program coordinators focus on the mental health of pregnant mothers. Objectives: This study aimed to assess antenatal depression and associated factors among pregnant women attending ANC at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022. Methods: A facility-based cross-sectional study was conducted among 370 pregnant women attending ANC at public health facilities. Systematic random sampling techniques were used to select study participants. A standard (validated) tool, the Edinburgh Postnatal Depression Scale, was also used to assess antenatal depression. The collected data were coded, entered into Epi-data software version 4.6, and analyzed by SPSS version 23. Multivariable logistic regression analyses were used to identify associated factors with a p-value <0.05. Results: In this study, the prevalence of antenatal depression was 62 (16.8%; 95% CI: 13, 20.5). Being single in marital status (AOR = 3, 95% CI: 1.5, 6.2), having an unplanned pregnancy (AOR = 2.7, 95% CI: 1.45, 5.1), and having partner conflict (AOR = 3.49, 95% CI: 1.79, 6.8) were the factors associated with antenatal depression. Conclusion: About one in five pregnant women has antenatal depression. Being single, having an unplanned pregnancy, and having a dissatisfied relationship with a sexual partner were the factors associated with antenatal depression. Therefore, women or partners are expected to plan pregnancy, and the dissemination of health information related to an unplanned pregnancy needs to be intensified by health providers. The partner ought to avoid conflict during the pregnancy, and healthcare providers or families are needed to support the single or widowed pregnant women. Further prospective cohort studies are needed to ascertain the effect of antenatal depression on fetal-maternal outcomes.

Prevalence of homebirth preference and associated factors among pregnant women in Ethiopia: Systematic review and meta-analysis.

BACKGROUND: Homebirth preference is the intention/plan to give birth outside health facilities with the help of unskilled birth attendants. The preference to give birth at home without a skilled birth attendant leads to care-seeking delays, intrapartum mortality, multiple stillbirths, and postpartum morbidities and mortality. Therefore, this study aimed to estimate the pooled prevalence of homebirth preference and associated factors among pregnant women in Ethiopia. METHODS: Search of Google Scholar, Medline, PubMed, Cochrane Library and Web of Science were done for this study from 20th August 2022 to 6th November 2022. For data extraction and analysis, the standardized data extraction checklist and Stata version 14 were used respectively. Sentence as "Cochrane Q test statistics and I2 statistics were used to check heterogeneity of the studies. The pooled prevalence of homebirth preference was estimated using a random-effects model. The association between homebirth preference and independent variables was determined using an odd ratio with a 95% confidence interval. A funnel plot and Egger's test were used to assess publication bias. RESULTS: A total of 976 research articles were identified. Seven studies that fulfilled eligibility criteria were included in this systematic review and meta-analysis. The pooled prevalence of homebirth preference in Ethiopia was 39.62% (95% CI 27.98, 51.26). The current meta-analysis revealed that average monthly income <1800 ETB (OR = 2.66, 95% CI 1.44, 4.90) lack of ANC follow-up (OR = 2.57, 95%CI 1.32, 5.01), being multipara (OR = 1.77, 95%CI 1.39, 2.25), poor knowledge about obstetric danger sign (OR = 5.75, 95%CI 1.o2, 32.42), and not discussing the place of delivery with a partner (OR = 5.89 (95%CI 1.1, 31.63) were significantly associated with homebirth preference. CONCLUSION: This systematic review and meta-analysis examined the substantial prevalence of homebirth preference in Ethiopia which may contribute maternal and child health crisis. The homebirth preference was associated with low average monthly income (<1800 ETB), lack of ANC follow-up, multipara, poor knowledge about obstetric danger signs, and not discussing with their partner the place of delivery. Improving knowledge of pregnant women about the benefit of health facility delivery and obstetric danger signs is necessary to decrease the prevalence of homebirth preference; for these can reduce negative outcomes occurred during delivery.

Magnitude and associated factors of depression among prisoners in Wollega zones, Oromia region, Ethiopia: A cross-sectional study.

BACKGROUND: Mental health is for everybody, but the individuals in prisons require more focus. Depression is a contributor to the global burden of disease and affects people in prisons in particular. There were limited studies on depression among prisoners. Therefore, the study aimed to assess the magnitude of depression and factors associated with it among prisoners in Wollega Zones Prisons, western Ethiopia. METHODS: Institutional based cross-sectional study was conducted on randomly selected 368 prisoners from June 1, 2019, up to August 1, 2019, in Wollega zones prisons. Data were collected by trained data collectors through interviewer-administered questionnaires. Data were entered into EpiData version 3.1 and analyzed using SPSS version 20. Bivariable and Multivariable logistic regression model was computed to identify factors associated with depressive symptoms. In the final model, the strength of the association between independent variables and depression was measured using the Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI). Then, in the final model, variables having a p-value of less than 0.05 were considered factors significantly associated with depression. RESULTS: Of the total study respondents, 166/368 (45.1%) had symptoms of depression. Lack of job opportunity in prison (AOR = 6.64, 95%CI: 3.65, 12.06), not attending religious place at all (AOR = 3.51, 95%CI: 1.30,10.00), and Unsentenced for suspected crime (AOR = 7.36, 95%CI: 2.08, 26.04) were associated with depression. CONCLUSION AND RECOMMENDATION: This finding showed that the magnitude of depression in prisons was high. Prisoners in the young age group, attending religious places, being married, prisoners who were sentenced for suspected crime on timely and prisoners performing work in prison were less likely to have depression. The prison institution needs to facilitate income-generating activities in prison, promoting prisoners to attend their religious places and promoting timely sentencing.

Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study.

Background: Index case HIV/AIDS testing (ICHT) is a good approach for addressing and improving the efficiency and yield of testing among high-risk populations. Partners and families of people living with HIV/AIDS are among the high-risk populations for contracting HIV/AIDS. However, there is limited study on index case HIV testing among HIV patients attending Anti-Retroviral Therapy (ART). Hence, this study was aimed at assessing the magnitude and factors associated with ICHT among HIV patients attending ART in Nekemte town public health facilities. Methods: An institution-based cross-sectional study was conducted at Nekemte town public health facilities from May 20 to July 21, 2020. A systematic random sampling method was used to select the study participants. Multivariable logistic regression analysis was used to determine the predictors of acceptance of ICHT among HIV patients. Results: The ICHT acceptance was 85.2% (95% CI=84.9-91.1%). Disclosure of their HIV status (AOR=9.74, 95% CI=4.11-23.06), having good knowledge of ICHT (AOR=4.70, 95% CI=1.92-11.61), believing HIV index case testing has benefits (AOR=3.43, 95% CI=1.27-9.29), and being on ART for more than 1 year (AOR=4.78, 95% CI=2.13-10.76) were significantly associated with index case HIV test acceptance. Conclusion and Recommendation: This study revealed a significant proportion of index case HIV testing acceptance. HIV status disclosure of index cases, knowledge of ICHT, the perceived benefit of ICHT, and long duration on ART were found to be significantly associated with acceptance of ICHT. Hence, it is essential to give attention to counseling on the importance of ICHT, enhance people living with HIV (PLWHIV) to have positive belief on the advantage of ICHT, strengthen disclosure counseling, and assist HIV status disclosure in health facilities.

Family and Social Support Among Patients on Anti-Retroviral Therapy in West Wollega Zone Public Hospitals, Western Ethiopia: A Facility-Based Cross-Sectional Study.

Background: Poor family and social support is a problem for patients taking antiretroviral therapy (ART), but it protects them against the negative consequences of stress, reducing morbidity and mortality among peoples living with human immunodeficiency virus (PLWHIV). Objective: This study aimed to assess family and social support and the associated factors among patients on antiretroviral therapy in West Wollega Public Hospitals. Methods: A facility-based cross-sectional study design was conducted among 329 respondents attending antiretroviral therapy (ARV) clinics in West Wollega Public Hospitals from September 1-30, 2020. Data were collected by simple random sampling methods using an interviewer-administered questionnaire. Bivariate and multivariate logistic regression analysis was used. The strength and presence of statistical association were assessed using adjusted odds ratio with a 95% confidence interval. Results: About 266 (66.4%) of the respondents had low family and social support. Being female sex [AOR (95% CI)=0.066 (0.013-0.338)], failing to discuss with family or society [AOR (95% CI)=0.275 (0.100-0.753)], lack of information on support [AOR (95% CI)=0.314 (0.104-0.951)], and non-disclosure of HIV status to family [AOR (95% CI)=0.227 (0.084-0.916)] were associated with family and social support. Conclusion: In this study, family and social support to people living with HIV/AIDS is low. Being female sex, feelings of negative treatment, lack of discussion on support, lack of information about support, and failure to disclose HIV status were associated with low family and social support. Information, education, and communication should be intensified to increase the awareness of the community, family, and people living with HIV related to support for people living with HIV.

Quality of antenatal care in selected public health facilities of West Ethiopia.

BACKGROUND: Ante natal care (ANC) is a key entry point for a pregnant woman to receive abroad range of promotion and preventive health services. Quality of ANC has paramount role to ensure better maternal and neonatal outcome. OBJECTIVE: To assess the quality of antenatal care services at public health facilities of western Ethiopia. METHODS: Facility-based cross-sectional study was conducted from May 30th to June 30th, 2016. All public health facilities in the Kellem Wollega Zone of West Ethiopia were audited, 316 medical records were reviewed, and 316 pregnant women were interviewed. The data was entered using EPI Data version 3.1 and analyzed using SPSS version 20.0. Descriptive statistics, binary, and multiple logistic regressions were conducted. Variables with a P-value of <0.05 were considered as statistically significant associated factors. RESULTS: A total of 316 pregnant women were enrolled in the study. All facilities were categorized as "good" by the possession of necessary equipment, 3/4 by basic amenities and 87.34% by general and gynecologic examination. The information was provided for 222(86.21%), which is categorized as poor. About 252 (79.7%) of the women were satisfied with ANC. A urine sample taken during ANC visit [(AOR= 3.36 (95 % CI= 1.70, 6.61)], and counseling on nutrition during pregnancy [(AOR= 2.27 (95 % CI=1.16, 4.45)] were predictors of client satisfaction on ANC. CONCLUSIONS: In this study quality of ANC was labeled good for structural aspects and poor for process aspects of quality. In terms of outcome aspects, the majority of pregnant women were satisfied with the ANC they received. A urine sample taken during the ANC visits and being counseled on nutrition during pregnancy were predictors for client satisfaction on ANC. Concerned bodies need to improve laboratory tests and information provision.

HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission.

Background: Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa. Objectives: To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa. Methods: HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses. Result: The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure. Conclusion: The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.