Prevalence and determinants of overweight/obesity among under-five children in sub-Saharan Africa: a multilevel analysis.

INTRODUCTION: Childhood obesity has become a major public health problem for both developed and developing nations. It is uncommon to find under-nutrition in many low and middle-income countries; as well, obesity is a double burden in these settings. This study aimed to investigate the pooled prevalence of overweight /obesity among under-five (under-5) children in sub-Saharan Africa (SSA). METHODS: Data were accessed from the recent nationally representative demographic and health survey datasets from 33 SSA Countries. A total of 192,132 under-five children were recruited for this study. The pooled prevalence of overweight /obesity among under-5 was done using random-effects meta-analysis command. Multivariable multi-level mixed-effects logistic regression analysis was used to identify determinants for the prevalence of under-5 overweight and/or obesity. A P-value less than 0.05 was used to declare statistical significance. RESULTS: The pooled prevalence of overweight /obesity among under-5 was 5.10% (9% CI: 4.45 - 5.76) in SSA. South Africa region (8.80%, 95% CI: 4.18 - 13.42) had a higher prevalence of under-5 overweight and/or obesity followed by the East Africa region. Male under-5 children (adjusted odds ratio (AOR) = 1.09, 95 confidence interval (CI): 1.02 - 1.25), Larger birth weight under-5 children (AOR = 1.39, 95% CI: 1.26 - 1.54), under-5 children aged older two to three years (AOR = 0.85, 95% CI: 0.76 - 0.94), under-5 children born from educated mothers (secondary and above) (AOR = 1.12, 95% CI: 1.01 - 1.25), and under-5 children living in the West Africa (AOR = 0.67, 95% CI: 0.56 - 0.81) and South Africa (AOR = 1.87, 95% CI: 1.09 - 3.21) were significant determinants for under-5 overweight and/or obesity. CONCLUSION: Childhood obesity is becoming a great challenge and double burden in developing nations. In SSA Africa 1 in 20 under 5 children were overweight and/or obese. Male under-5 children, older aged, under-5 children born from educated mothers, and under-5 children living in the South Africa region were at higher risk for developing overweight and/or obesity. Thus, SSA countries should implement early to pause these consequences preventing the double burden of undernutrition.

Spatial distribution of iron rich foods consumption and its associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2016 Ethiopian demographic and health survey.

BACKGROUND: Micronutrient deficiencies are the most prevalent nutritional deficiencies that cause serious developmental problems in the globe. The aim of this study was to assess the spatial distribution of iron rich foods consumption and its associated factors among children aged 6-23 months in Ethiopia. METHODS: The data retrieved from the standard Ethiopian Demographic and Health Survey 2016 dataset with a total sample size of 3055 children aged 6-23 months. Spatial scan statistics done using Kuldorff's SaTScan version 9.6 software. ArcGIS version 10.7 software used to visualize spatial distribution for poor consumption of iron rich foods. Multilevel mixed-effects logistic regression analysis employed to identify the associated factors for good consumption of iron-rich foods. Level of statistical significance was declared at a two-sided P-value < 0.05. RESULTS: Overall, 21.41% (95% CI: 19.9-22.9) of children aged 6-23 months had good consumption of iron rich foods in Ethiopia. Poor consumption of iron rich foods highly clustered at Southern Afar, Southeastern Amhara and Tigray, and the Northern part of Somali Regional States of Ethiopia. In spatial scan statistics, children aged 6-23 months living in the most likely cluster were 21% more likely vulnerable to poor consumption of iron rich foods than those living outside the window (RR = 1.21, P-value < 0.001). Child aged 12-17 months (AOR = 1.90, 95% CI: 1.45-2.49) and 18-23 months (AOR = 2.05, 95% CI: 1.55-2.73), primary (AOR = 1.42, 95% CI:1.06-1.87) and secondary and above (AOR = 2.26, 95% CI: 1.47-3.46) mother's education level, rich (AOR = 1.49, 95% CI: 1.04-2.13) and middle (AOR = 1.83, 95% CI: 1.31-2.57) household wealth status, Amhara (AOR = 0.24, 95% CI: 0.09-0.60), Afar (AOR = 0.38, 95% CI: 0.17-0.84), and Harari (AOR = 2.11, 95% CI: 1.02-4.39) regional states of Ethiopia were statistically significant factors for good consumption of iron rich foods. CONCLUSION: Overall, the consumption of iron rich foods was low and spatially non-random in Ethiopia. Federal Ministry of Health and other stakeholders should give prior attention to the identified hot spot areas to enhance the consumption of iron rich foods among children aged 6-23 months.

Determinants of under-five mortality in Ethiopia using the recent 2019 Ethiopian demographic and health survey data: nested shared frailty survival analysis.

BACKGROUND: Worldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia. METHODS: Nationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value < 0.05. RESULTS: The weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 - 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR = 7.03, 95% CI: 4.40-11.24), breastfed within one hour after birth (AHR = 0.41, 95% CI: 0.28-0.61), preceding birth interval 18-23 months (AHR = 1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR = 2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR = 1.70, 95% CI: 1.01-2.87) were statistically significant factors for time to under-five death. CONCLUSION: Even though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality.

Magnitude of Stunting and Associated Factors among Adolescent Students in Legehida District, Northeast Ethiopia.

BACKGROUND: Undernutrition including stunting particularly at an adolescent stage was not emphasized by various intervention strategies in the Ethiopian context. Assessing the magnitude and potential risk factors of undernutrition is thus helpful for policymakers to design appropriate intervention strategies. Hence, this study was aimed at assessing the magnitude of stunting and associated factors among adolescent students in Legehida district, Northeast Ethiopia. METHODS: A school-based cross-sectional study was conducted among 424 adolescent students from February 15th to March 15th, 2018. A stratified sampling followed by a simple random sampling technique was used to select the study participants. A pretested, structured, and self-administered questionnaire was used to collect the required data. Height was measured by using a portable stadiometer and the height-for-age (HFA) z-score was calculated as an indicator of stunting. SPSS version 25 and WHO AnthroPlus software were applied to analyze the data. A multivariable logistic regression analysis was performed to identify factors associated with adolescent stunting. Statistical significance was determined at a p value of <0.05 and association was described by using an odds ratio at a 95% confidence interval. RESULTS: A total of 406 adolescent students (with a response rate of 95.7%) participated in the study. The magnitude of stunting among adolescent students in this study was 24.9% (95% CI: 24.6%-35.3%). CONCLUSIONS: Stunting among adolescent students was significantly associated with being male [AOR = 2.1; 95% CI: 1.73-5.90], meal frequency (<3/day) [AOR = 4.6; 95% CI: 2.61-8.24], infrequent handwashing practice [AOR = 3.6; 95% CI: 1.30-9.40], absence of latrine facility (AOR = 5.51; 95% CI: 3.03-9.9), and consumption of unsafe water [AOR = 2.8; 95% CI: 1.35-6.19]. Hence, conducting routine nutrition screenings and assessments, promotion of proper food intake, and emphasis on nutrition education and counseling are needed to be strengthened.

Level of glycemic control and its associated factors among type II diabetic patients in debre tabor general hospital, northwest Ethiopia.

INTRODUCTION: Poor glycemic control is the major risk factor for the development of acute and chronic diabetes complications. There are limited studies on the level of glycemic control and its associated factors among diabetic patients. So, this study aimed to assess the level of glycemic control and its associated factors among type II DM patients in Debre Tabor General Hospital. METHODS: An institution based cross sectional study was conducted from November 1-30, 2017. Totally, 413 diabetic patients selected by systematic random sampling. The three months average fasting blood glucose was used to determine glycemic control. Regressions were fitted to identify associated factors. A p-value <0.05 was used to declare statistical significance. RESULT: A total of 398 study participants were participated in the study with a response rate of 96.4%. Among 398 type II DM patients, 284 (71.4%) had poor glycemic control. Patient's educational status (able to read and write; AOR = 3.0, 95%CI (1.5, 5.7), (primary education; AOR = 4.5, 95%CI (1.8, 10.9), and (secondary education; AOR = 5.7, 95% CI (2.9, 11.2)))), family history of DM (AOR = 2.3, 95%CI (1.4, 3.9)), duration of DM since diagnosis (AOR = 0.3, 95% CI (0.1, 0.9)), and dietary adherence (AOR = 2.4, 95% CI (1.4, 4.1)) were associated factors to had good glycemic control. CONCLUSION: Poor glycemic control was high. Educational status, family history of DM, duration of DM, and dietary adherence were the associated factors of glycemic control. Appropriate attention shall be given for glycemic control especially for patients with a longer duration. Health promotion related to medical recommendations is a cross-cutting intervention for diabetic patients and should be provided for all type II diabetic patients.

Magnitude of Obesity/Overweight and Its Associated Factors Among HIV/AIDS Patients on Antiretroviral Therapy in Jimma Zone Hospitals, South West Ethiopia: Hospital-Based Cross-Sectional Study.

PURPOSE: Obesity is on the rise worldwide, not only in the general population but also in PLWHA. Being overweight and obese are themselves risk factors for cardiovascular and other diseases. Despite this, few studies have been conducted to determine the magnitude of obesity/overweight and its associated factors among HIV/AIDS patients in Ethiopia, which necessitates this study. METHODS: Hospital-based cross-sectional study was conducted from December to January 2019 at selected Jimma zone hospitals. WHO STEP-wise approach to chronic disease risk factor surveillance (STEPS) questionnaire and document review for HIV-related clinical factors was applied. Weight, height and waist circumference and hip circumference were measured. Data were analyzed using SPSS version 20. RESULTS: A total of 252 participants with a response rate of 95.8% were included. The prevalence of obesity/overweight was 21%. After adjusting for these variables, age category of greater than 50 years [AOR = 0.4, 95% CI (0.2, 0.9), p = 0.03], WHO clinical stage III and above [AOR = 0.04, 95% CI (0.002, 0.6), p = 0.02], presence of mild to moderate physical activity [AOR = 1.3, 95% CI (5.5, 33.3), p ≤ 0.001)], plasma CD4 count between 351 and 500 copies/mL [AOR=0.15, 95% CI (0.04, 0.6) p=0.024], and female sex [AOR = 2.6, 95% CI (1.25, 10) p=0.03)] were significantly associated with obesity/overweight. CONCLUSION: There was a high prevalence of obesity/overweight among HIV/AIDS patients. It was found that older age, female sex, early stage of the disease, lower CD4 count and presence of mild to moderate physical activity were significant predictors of obesity/overweight. Clinicians should be aware of the health consequence of obesity and consider instituting targeted weight management programs as a part of routine HIV care.

Prevalence of Syphilis among Pregnant Women Attending Antenatal Care Clinic, Sede Muja District, South Gondar, Northwest Ethiopia.

BACKGROUND: Syphilis is a disease caused by bacteria called Treponema pallidum. Major rout of transmission of this bacterium was through sexual and contact with mucocutaneous lesion. Untreated syphilis during pregnancy can greatly affect pregnancy outcome, resulting in spontaneous abortion and stillbirth. OBJECTIVE: The objective of the study was to determine the seroprevalence of syphilis and associated factors among pregnant women attending antenatal care unit at Sede Muja district, Northern Ethiopia. METHODS AND MATERIALS: Facility based cross-sectional study was conducted from November 2018 to January 2019 in two health centers from Sede Muja district, Northwest Ethiopia. The study included a total of 210 participants. The entire participants were recruited by systematic random sampling method after proportional allocation of the sample size in the two health centers. Sociodemographic and clinical data were collected by semistructured questioner. Two milliliter of blood was collected to determine seroprevalence of syphilis using VDRL test method. The data was analyzed by using SPSS version 21. The association between independent and dependent variables was determined using chi-square. P-value less than 0.05 was considered as statistically significant. RESULT: Seroprevalence of syphilis was found to be 1.9% (95 CI, 0.5-3.5%). Women with multiple sexual partners and late trimester of pregnancy during first ANC visit were found to be significantly associated with seropositive syphilis. CONCLUSION: Syphilis remains a major problem in the study area. Seroprevalence of syphilis was significantly associated with women who have multiple sexual partners and late first ANC visit attendees in the study area. Therefore it is recommended to give health education about syphilis etiology and transmission as well as creating awareness about the importance of early ANC visit and follow-up regarding syphilis prevention.

Factors influencing diabetes self-care practice among type 2 diabetes patients attending diabetic care follow up at an Ethiopian General Hospital, 2018.

INTRODUCTION: Diabetes mellitus is a global public health emergency in the twenty-first century. Diabetes patients who had to adhere to good self-care recommendation can prevent the complication associated with diabetes mellitus. Self-care management of diabetes mellitus in Sub-Saharan Africa was poor including Ethiopia. The aim of this study was to assess factors influencing diabetes self-care practice among type 2 diabetes patients at Debre Tabor General Hospital, Northwest Ethiopia diabetes clinic follow up unit. METHODS: An institutional based cross-sectional survey was conducted on systematically sampled 405 type 2 diabetes patients at Debre Tabor General Hospital diabetes clinic from June 02/2018 to June 30/2018. Bivariate and multivariable logistic regression was fitted to identify independent predictors of diabetes self-care practice. A p value of less than 0.05 was used to declare statistical significance. RESULTS: A total of 385 type 2 diabetes patients participated with a response rate of 95%, of which 243 (63.1%) study participants had good self-care practice. The mean ± SD age of the respondents and the duration of diagnosed for diabetes mellitus was 52.28 ± 12.45 and 5.09 ± 3.80 years respectively. Type 2 diabetes patients who had a glucometer at home (AOR = 7.82 CI (3.24, 18.87)), getting a diabetes education (AOR = 2.65 CI (1.44, 4.89)), and having social support (AOR = 2.72 CI (1.66, 4.47)) were statistically associated with good self-care practice. CONCLUSION: Despite, the importance of diabetes self-care practice for the management of diabetes and preventing its complications, a significant number of type 2 diabetes patients had poor diabetes self-care practice. So, to enhance this poor practice of diabetes self-care, provision of diabetes self-care education and counseling on self-monitoring blood glucose should be promote by health care providers during their follow up.

Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection.

BACKGROUND: Nitric oxide (NO) is essential for host defense in rodents, but the role of NO during tuberculosis (TB) in man remains controversial. However, earlier observations that arginine supplementation facilitates anti-TB treatment, supports the hypothesis that NO is important in the host defense against TB. Local production of NO measured in fractional exhaled air (FeNO) in TB patients with and without HIV co-infection has not been reported previously. Thus, our aim was to investigate levels of FeNO in relation to clinical symptoms and urinary NO metabolites (uNO). METHODS: In a cross sectional study, FeNO and uNO were measured and clinical symptoms, chest x-ray, together with serum levels of arginine, tumor necrosis factor alpha (TNF-alpha) and interleukin 12 (IL-12) were evaluated in sputum smear positive TB patients (HIV+/TB, n = 36, HIV-/TB, n = 59), their household contacts (n = 17) and blood donors (n = 46) from Gondar University Hospital, Ethiopia. RESULTS: The proportion of HIV-/TB patients with an increased FeNO level (> 25 ppb) was significantly higher as compared to HIV+/TB patients, but HIV+/TB patients had significantly higher uNO than HIV-/TB patients. HIV+ and HIV-/TB patients both had lower levels of FeNO compared to blood donors and household contacts. The highest levels of both uNO and FeNO were found in household contacts. Less advanced findings on chest x-ray, as well as higher sedimentation rate were observed in HIV+/TB patients as compared to HIV-/TB patients. However, no significant correlation was found between FeNO and uNO, chest x-ray grading, clinical symptoms, TNF-alpha, IL-12, arginine levels or sedimentation rate. CONCLUSION: In both HIV negative and HIV co infected TB patients, low levels of exhaled NO compared to blood donors and household were observed. Future studies are needed to confirm whether low levels of exhaled NO could be a risk factor in acquiring TB and the relative importance of NO in human TB.

Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital.

BACKGROUND: Limited data are available regarding the level of adherence and barriers to dietary recommendations in individuals with type 2 diabetes in Africa including Ethiopia. Therefore, this study aimed at assessing the level of dietary adherence and its barriers among patients with type 2 diabetes in northwest Ethiopia. METHODS: A prospective hospital-based cross-sectional study was conducted from August to October 2017 at Debre Tabor General Hospital, Northwest Ethiopia. The Perceived Dietary Adherence Questionnaire (PDAQ) was used for dietary adherence measurement. Multivariate logistic regression was done to identify the barriers influencing dietary adherence. RESULT: A significant percentage (74.3%) of the study participants had poor adherence to dietary recommendations. The highest mean score was obtained for the question regarding consuming foods high in sugar with a mean 5.49 ± 1.20 times a week. On the other hand, our participants had a low consumption of fruits and vegetables and foods high in omega-3 fats with a mean of 1.84 ± 1.96 and 0.1 ± 0.62 times a week respectively. According to the survey of participants, lack of knowledge, lack of diet education, inability to afford the cost of healthy diet and poor awareness about the benefit of dietary recommendations were the most cited reasons for poor dietary adherence. In multivariate logistics regression, low level of educational status, the presence of co-morbidities, lack of previous exposure to dietary education and low monthly income were statistically significant factors associated with non-adherence. CONCLUSION: The rate of non-adherence to dietary recommendation among patients with T2DM was found to be high in northwest Ethiopia. Hence, providing customized health education about the potential benefit of proper dietary recommendations in controlling blood glucose is recommended. Health care providers should be proactive in promoting adherence to dietary recommendations in patients with T2DM.

Coinfection and clinical manifestations of tuberculosis in human immunodeficiency virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia.

BACKGROUND AND PURPOSE: The pattern of clinical presentations of tuberculosis (TB) is reflected in the microbiological, radiological, and histological characteristics of the disease. However, coinfection with human immunodeficiency virus (HIV) poses special diagnostic and therapeutic challenges. This study was aimed at assessing the clinical manifestations of TB in patients with or without HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia. METHODS: TB was diagnosed following standard clinical, bacteriological, radiological, and histological procedures. HIV serostatus was checked by enzyme-linked immunosorbent assay. RESULTS: This study included 257 TB patients, of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were diagnosed in 64.2% and 35.8% of the patients, respectively. No significant association was found between sputum smear positivity and HIV serostatus. One-fifth of the patients reported hemoptysis. More than one-third had chest pain, and >90% reported fever and weight loss. Night sweats and cough were reported by 86% and 82.5%, respectively. Coarse crepitations were the most frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%. Cavitation was significantly associated with sputum smear positivity (odds ratio = 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough of

HIV and intestinal parasites in adult TB patients in a teaching hospital in Northwest Ethiopia.

The level of HIV infection and intestinal parasitoses among TB patients was assessed in a hospital-based cross-sectional study involving 257 patients in Gondar, Ethiopia. In TB patients, our study reported co-infection with HIV (52.1%) and intestinal parasites (40.9%) The high prevalence of HIV and intestinal parasites indicates an increased morbidity inTB patients and emphasized the importance of continued HIV sero-surveillance, stool analysis and treatment.