Utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, North Wollo zone, Ethiopia.

OBJECTIVE: This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, Ethiopia, in 2020. STUDY DESIGN: A community-based cross-sectional study was used. METHODS: Using an interviewer-administered questionnaire, data were collected from 550 randomly selected households. EpiData version 4.6 was used to enter data, and SPSS version 23 was used to analyze it. Multivariable logistic regression analysis was applied to identify the associated factors with health service utilization. RESULTS: The overall health service utilization among fee waiver beneficiaries was 60.98% (95% confidence interval [CI]: 56.4-64.4%). Being an urban resident (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.41-7.28), family size (AOR: 3.17, 95% CI: 1.49-6.75), perceived health status (AOR: 6.26, 95% CI: 3.76-10.41), travel time (AOR: 2.75, 95% CI: 1.25-6.06), perceived distance (AOR: 13.69, 95% CI: 5.22-35.91), and perceived medium (AOR: 3.07, 95% CI: 1.71-5.52) and cheap (AOR: 3.02, 95%CI: 1.43-6.36) transport costs were significantly associated with utilization of health services. CONCLUSIONS: This study revealed that the level of health service utilization among beneficiaries in the Dawunt district was 60.98%. Residence, family size, perceived health status, travel time to the nearest Health Facility (HF), perceived distance, and travel cost to reach the HFs were significantly associated with Health Services Utilization (HSU). Therefore, improving physical accessibility of health services and availability of necessary health services at an affordable cost will possibly result in better utilization of healthcare services.

Advances in HIV self-testing: Systematic review of current developments and the road ahead in high-burden countries of Africa.

Objectives: Although HIV self-testing technologies have created new opportunities for achieving national and global HIV testing goals, current developments have not been compiled to inform policy and practice, especially in high HIV burden countries of Africa. We aimed to compile and synthesize the evidence about HIV self-testing technologies, strategies, and uptake in the top-10 high HIV burden countries of Africa. Methods: We searched CINAHL, PubMed, Web of Science, PsycINFO, Social Science Citation Index, and EMBASE to include eligible articles published in English between January 2012 and November 2022. Results: In total, 865 articles were retrieved and only 16 studies conducted in five African countries were eligible and included in this review. The two types of HIV self-testing modalities presently being used in Africa are: The first is Home Self-Test which is done entirely at home or in another private location by using oral fluid or blood specimen. The second modality is Mail-In Self-Test (self-sampling), where the user collects their own sample and sends this to a laboratory for testing. Perceived opportunities for the uptake of HIV self-testing were autonomy and self-empowerment, privacy, suitability, creating a chance to test, and simplicity of use. The potential barriers to HIV self-testing included fear and worry of a positive test result, concern of the test results is not reliable, low literacy, and potential psychological and social harms. The oral-fluid self-testing is preferred by most users because it is easy to use, less invasive, and painless. The difficulty of instructions on how to use self-test kits, and the presence of different products of HIV self-testing kits, increase rates of user errors. Conclusion: Adopting HIV self-testing by overcoming the challenging potential barriers could enable early detection, care, treatment, and prevention of the disease to achieve the 95-95-95 goal by 2030. Further study is necessary to explore the actual practices related to HIV self-testing among different populations in Africa.

Willingness to Pay for Social Health Insurance Among Public Health Workers in Gedeo Zone, Southern Ethiopia.

In Ethiopia, Social Health Insurance (SHI) implementation was delayed repeatedly due to employees' unwillingness to pay 3% of their monthly salary and fear related to the scheme's healthcare coverage. However, provisions of comprehensive training for health workers on health insurance and inclusion of healthcare financing methods in health practitioner education curriculum make their level of willingness to pay for SHI schemes uncertain. Thus, this study aimed to assess willingness to pay for the SHI scheme and its determinant factors among Healthcare providers in the Gedeo zone. From July 1 to 15, 2022, we carried out an institution-based cross-sectional study among 430 healthcare providers recruited using a multistage sampling technique. A multivariable logistic regression model was used to determine the factors associated with willingness to pay for Social Health insurance. Adjusted odds ratio (AOR) and P values of <.05 with 95% confidence intervals (CIs) were used to declare statistical significance. Out of 73.4% (95% CI: 68.8%, 77.6%) healthcare providers willing to join the SHI program, only 47.3% (95% CI: 41.5%, 53.2%) were willing to pay for the proposed 3% premium of their monthly salary. Healthcare providers who had >10, 000 Birr monthly salary (AOR = 2.45, 95% CI: 1.14, 5.26), difficulty in paying for healthcare (AOR = 3.55, 95% CI: 1.22, 10.29), history of chronic conditions (AOR = 4.61, 95% CI: 2.41, 8.82), positive attitude (AOR = 3.16, 95% CI: 1.62, 6.18), and good knowledge of the social health insurance scheme (AOR = 2.35, 95% CI: 1.17, 4.72) were more likely to pay for the social health insurance. More than half of the healthcare providers expressed a lack of willingness to pay for the social health insurance scheme. So, the government should provide an awareness creation program on the concepts and principles of the SHI scheme to improve the willingness to pay for the scheme.

Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial.

Background: In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. Objective: This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. Methods: A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. Discussion: The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.

Clinical presentation, treatment patterns, and outcomes of colorectal cancer patients at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia: A prospective cohort study.

BACKGROUND: Colorectal cancer (CRC) is the third most common cause of cancer death in both genders worldwide. AIMS: This study aimed to evaluate the outcomes and prognostic factors of CRC patients at Tikur Anbessa Specialized Hospital in Ethiopia. METHODS AND RESULTS: A prospective cohort study was conducted on 209 patients from January 2020 to September 2022. Kaplan-Meier curves and bivariate and multivariate Cox regression analyses were used to analyze overall and progression-free survival, with a significance value of P < .05. Results showed an overall mortality rate was 67.46% (95% confidence interval [CI]: 61.0-74.0), while the 1-year overall survival (OS) rate was 63.16% (95% CI: 56.23-69.29), with a median follow-up duration of 20 months. The median OS and progression-free survival times were 17 and 11 months, respectively. Age above 40 years (hazard ratio [HR] = 1.53, 1.02-2.29, p < .040), lower educational level (high school and below) (HR = 2.20, 1.24-3.90, p < .007), poor performance status (HR = 1.60, 1.03-2.48, p < .035), Hgb ≤12.5 g/dL (HR = 1.55, 1.03-2.08, p < .035), T-4 disease (HR = 6.05, 2.28-16.02, p < .000), and metastases at diagnosis (HR = 8.53, 3.77-19.25, p < .000) were all associated with poorer survival. CONCLUSION: These findings suggest that poor survival of CRC patients in Ethiopia is largely due to advanced stage of the disease and lack of timely treatment, and highlight the urgent need for improved access to cancer treatment in the region.

Primary postpartum hemorrhage and associated factors among delivering women in Gedeo Zone, Southern Ethiopia.

Introduction: Primary postpartum hemorrhage is still the main cause of maternal death worldwide, especially in low-resource nations like Ethiopia where there are insufficient healthcare facilities and a shortage of skilled medical personnel. Data on the prevalence of primary postpartum hemorrhage in the study population are scarce or non-existent. Objective: The aim of this study was to assess the prevalence of primary postpartum hemorrhage and its associated factors among delivering women in Gedeo Zone, Southern Ethiopia, in 2021. Methods: A facility-based cross-sectional study was carried out from January 1 to March 30, 2021, in public health facilities in the Gedeo Zone. A randomly selected 577 participants were involved in the study. Data were gathered using an interview-administered, pre-tested, structured questionnaire. The gathered information was imported into Epi Info 3.5.1 and analyzed with SPSS 23. Descriptive data was presented using tables and graphs. A logistic regression model was fitted. A bivariable and multivariable logistic regression model was computed to identify the presence and strength of association. To run multivariable logistic regression analyses, variables with P-values of <0.2 were used. The odds ratio, a 95% confidence interval (CI), and a P-value of <0.05 were used to identify variables that were associated with primary postpartum hemorrhage. Results: The magnitude of primary postpartum hemorrhage was 4.2% (95% CI: 2.4-6.0). Postpartum hemorrhage was significantly associated with current antepartum hemorrhage (AOR = 11.67; 95%CI: 7.17-16.17), twin delivery (AOR = 6.59, 95%CI: 1.48-11.70), uterine atony (AOR = 8.45, 95%CI: 4.35-12.55), and prolonged labor (AOR = 5.6, 95%CI: 2.9-8.50). Conclusions: The prevalence of primary postpartum hemorrhages in the Gedeo Zone, Southern Ethiopia was 4.2%. Current ante partum hemorrhage, twin delivery, uterine atony, and prolonged labor were predictors of primary postpartum hemorrhage. The results back up the necessity for care in the early postpartum period so that clinicians may quickly identify any issues, prevent and start treating excessive blood loss early, and, taking into account the aforementioned factors, possibly reduce the frequency of primary postpartum hemorrhage.

Quality of adolescent and youth-friendly sexual and reproductive health services and associated factors in Ethiopia: a systematic review and meta-analysis.

Background: Low-quality health care services are linked to a variety of health problems, which can have negative effects on adolescent and youth health. As a result, national data is crucial to providing high-quality healthcare to adolescents and youths in order to promote their health, wellness, and growth. Objective: To examine the quality of young people's sexual and reproductive health care services and factors associated with service satisfaction in Ethiopia. Methods: This review was carried out in accordance with the PRISMA guideline. We reviewed published data related to the quality of adolescent and youth-friendly sexual and reproductive health services (AYSRHS) in Ethiopia from January 02, 2002 to December 30, 2022. Relevant studies were identified through Google Scholar, PubMed, Cochrane Library, Science Direct, and HINARI. The extracted data was imported into STATA version 14.0 software for analysis. Heterogeneity among the reported prevalence of studies was checked using χ2 and I2 tests. The publication bias was examined by Egger's correlation and Begg's regression intercept tests at a 5% significance level. Results: The national pooled magnitude of structural, process, and output dimensions of quality of AYSRHS is 54.22% (95% CI: 33.21, 75.24%), 35.44% (95% CI: 24.95, 45.93%), and 57.01% (95% CI: 50.32, 63.7%), respectively. Being female (AOR: 1.61, 95% CI: 1.14-2.27), employed (AOR: 1.82, 95% CI: 1.06-3.14), waiting <30 min to get services (AOR: 2.7, 95% CI: 1.69-4.31), and getting information on the availability of services (AOR: 1.56, 95% CI: 1.15-2.11) were significantly associated with client satisfaction with AYSRHS. Conclusion: The overall magnitude of quality of AYSRHS in the three dimensions is far below WHO quality standards, which are 75 percent for good quality. Sex, employment status, waiting time to get services, and information on the availability of services were significantly associated with client satisfaction with AYSRHS. Therefore, different stakeholders on different levels should work together to strengthen the quality of AYSRHS concidering the above factors. Systematic review registration: Identifier [CRD42023422667].

Risky sexual practice and associated factors among street children of Wonago town, Gedeo zone, Southern Ethiopia.

Introduction: A "risky sexual practice" is any sexual act that might put an individual's social, physical, and psychological health at risk and increase the likelihood of adverse sexual and reproductive health consequences. Street children have risky sexual practices, which place them at all kinds of health risks. Therefore, the aim of this study is to assess risky sexual practices and associated factors among street children in Wonago Town, southern Ethiopia. Methods: A community-based cross-sectional study design was employed. About 214 street children, aged 10-18, residing in Wonago Town from September 1-30, 2021, participated in the study. Data was gathered from all of the street children in Wonago town. A pre-tested and structured interviewer-administered questionnaire was used to collect data. Epi data software was used to enter the collected data, which was then exported to SPSS for analysis. A logistic regression model was applied to identify the associated factors. A p value <0.05 was used to declare the significant variables. Results: A total of 214 street children were involved in the study. Overall, the magnitude of risky sexual practices was 43.46 percent (95% CI: 38.3-48.62). About 52.7% of participants had ever had sexual intercourse in the last year, and of them, around 43.5% had more than one sexual partner. Among sexually active street children, 40.9% never used a condom during sexual intercourse. Age (Adjusted Odd Ratio (AOR): 1.42, 95%CI: 1.03-2.37), educational status (AOR: 5.73, 95%CI: 1.49-10.51), substance use (AOR: 1.24, 95%CI: 1.03-2.07), duration on the street (AOR: 2.14, 95%CI: 1.03-4.12), and daily income (AOR: 0.68, 95%CI: 0.32-0.98) were found to be significantly associated with risky sexual practices. Conclusion: Risky sexual practices among street children were more prevalent in Wonago Town, Southern Ethiopia. Children's age, educational status, daily income, duration on the street, and status of substance use were the factors that contributed to risky sexual practices. As a result, conducting information and education campaigns, developing income-generating activities for children, increasing children's school enrollment and attendance, improving access to sexual and reproductive health services, and providing capacity-building training for health care providers may all help to reduce risky sexual practices.

Pediatric Oculo-orbital Tumor Characteristics, Imaging and Histopathology Agreement in a Tertiary Level Teaching Hospital, Ethiopia.

Background: Oculo-orbital tumors are frequently encountered pathologies and late diagnosis results in high morbidity and mortality in developing countries. This study aims to assess the computed tomography and magnetic resonance imaging patterns of pediatric oculo-orbital tumors with particular emphasis on retinoblastoma and compare agreement between imaging and histopathology diagnosis. Methods: A retrospective analysis of 101 pediatric patients with oculo-orbital lesions from February 2017 to January 2020 at Tikur Anbessa Specialized Hospital oncology center. Medical records were reviewed for clinical data, history, physical examination, pretreatment eye exam under anesthesia (EUA), computed tomography (CT) magnetic resonance imaging (MRI) and histopathology reports. The agreement between imaging and histopathology diagnosis was analyzed. Results: Malignant oculo-orbital tumors represented 97 (96.1%) cases. Age group 2-5 years had 56 (55.4%) cases of oculo-orbital tumors. Retinoblastoma accounted for 78 (77.2%) followed by rhabdomyosarcoma in 8 (7.9%) patients. The primary patient complaint was proptosis in 78 (77.2%) followed by leukocoria in 16 (15.8%). In 88 (89.7%) cases, there was agreement between imaging and histologic findings with 72 out of the 75 histopathology confirmed cases of retinoblastoma showing an agreement. Retinoblastoma patients presented at an advanced stage with orbital and intracranial extension. Conclusions: In conclusion, patients with oculo-orbital tumors presented with advanced stage of disease. Excellent imaging and histopathology agreement was demonstrated.

Brain Magnetic Resonance Imaging Findings in Patients with Developmental Delay in Addis Ababa, Ethiopia.

Background: Developmental delay is a major health problem throughout the world causing significant individual disability. Even though physical examination and patient history are the most important and basic evaluations of patients with developmental delay, additional investigations are usually required in supporting or reaching a diagnosis among which is neuroimaging. This study aims to assess brain Magnetic resonance imaging (MRI) patterns in patients presented with developmental delay. Method: A retrospective analysis of 164 patients who had undergone brain Magnetic Resonance Imaging (MRI) evaluation for the developmental delay was done. The study was conducted between March to November 2021 G.C at Tikur Anbessa Specialized Hospital (TASH). The patients' clinical history and magnetic resonance imaging reports were reviewed from their medical records. All patients with developmental delay who had brain MRI evaluation at TASH and at one private diagnostic center in Addis Ababa were included in the study. Results: A total of 164 patients were included in this study of which 95(57.9%) were male and 69(42.1%) female patients were seen. A total of 120 patients (73.2%) showed abnormal brain MRI studies. Previous neurovascular insults were the most common abnormalities seen in 75(45.7%) patients followed by imaging findings of congenital and developmental abnormalities seen in 20(12.2%) patients. Conclusion: Brain MRI is an important input in the evaluation of patients with developmental delay. It can give evidence for the cause of developmental delay, especially in the diagnosis of perinatal/hypoxic-ischemic insults, and congenital and developmental malformations.

Misconceptions About COVID-19 and Associated Factors Among Residents of Dilla Town, Southern Ethiopia.

BACKGROUND: Despite the implementation of various coronavirus disease 2019 (COVID-19) prevention and control strategies, the rate of COVID-19 is alarmingly increasing in Ethiopia as well as worldwide. The success of COVID-19 prevention measures is highly influenced by a lack of knowledge and misconceptions. This study aimed to assess misconceptions about COVID-19 and associated factors among residents of Dilla Town, southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from December 1 to 30, 2020. Data were collected from 415 individuals using structured interviewer-based questionnaires. Logistic regression analyses were used to identify the relationship between the dependent and independent variables. RESULTS: The proportion of respondents who have a high misconception about COVID-19 was 41.1%. Study participants who had poor knowledge were 2.1 (95% confidence interval [CI]: 1.1-3.8) times more likely to have a misconception about COVID-19 than their counterparts. Respondents who had access to information from more than 2 sources were 3.29 (with 95% CI: 1.2-9.2) times less likely to have a misconception about COVID-19 when compared with those who had access to 2 or fewer information sources. CONCLUSIONS: A significant proportion of people have misconceptions about COVID-19 in the study area. To resolve these misconceptions, health sectors and stakeholders need to improve the residents' knowledge by delivering COVID-19-related information from credible sources on a routine basis.

Level of Mothers'/Caregivers' Healthcare-Seeking Behavior for Child's Diarrhea, Fever, and Respiratory Tract Infections and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis.

Objective: To assess the pooled prevalence of mothers' or caregivers' healthcare-seeking behavior for childhood diarrhea, fever, and respiratory tract infections and associated factors in Ethiopia. Study Design. Systematic review and meta-analysis. Methods: Literature searches were conducted through databases (Google Scholar, PubMed, CINHAL, ScienceDirect, HINARI, and gray literatures) from September 1 to 30, 2021, using key terms in accordance with the PRISMA guidelines. The characteristics of the original articles were described using text and tables. Heterogeneity among the reported prevalence of studies was checked by using a heterogeneity χ 2 test and I2 test. Publication bias was examined by performing Egger's correlation and Begg's regression intercept tests at a 5% significant level. A random-effect model was employed to estimate the pooled prevalence of the outcome variable and its determinants in Ethiopia. Results: Of the total identified studies, 25 studies were included in the review, with a total of 29,993 study participants. The overall pooled prevalence of mothers' or caregivers' health-seeking behavior for childhood diarrhea, fever, and respiratory tract infections was 60.33% (95% CI: 50.14-70.52). The significant factors were residence (AOR = 3.06, 95% CI: 1.11-8.39), wealth index (AOR = 2.18, 95% CI: 1.92-2.48), perceived severity of illness (AOR = 2.7, 95% CI: 1.12-6.51), and knowledge of the illness (AOR = 1.95, 95% CI: 1.37-2.75). Conclusion: This review suggests that the overall pooled prevalence of mothers' or caregivers' HSB for childhood diarrhea, fever, and respiratory tract infections was 60.33%. Residence, wealth index, perceived severity of illness, and knowledge of the illness by mothers were the significant factors. Therefore, providing interventions by considering the above factors will improve the overall seeking behavior.

The epidemiology of road traffic accidents and associated factors among drivers in Dilla Town, Southern Ethiopia.

Background: Data on the magnitude of road traffic accidents (RTAs) were mostly obtained through police records and hospital registration data. However, insufficient data reporting masked the gravity of the problem, and little attention was paid to the magnitude and correlation of road traffic accidents from the driver's perspective. Therefore, this study aimed to assess the prevalence of RTA and related factors among drivers. Methods: A community-based cross-sectional study involving 316 drivers was conducted in Southern Ethiopia. The participants were chosen using a systematic random sample technique, and the data were obtained using an interview-administered structured questionnaire. To analyze the data, SPSS software (version 20) was employed. In addition to descriptive statistics, binary logistic regression analysis was also employed to find factors connected to traffic accidents. RTA factors were considered statistically significant if they had a P-value of 0.05 or below in the multivariate analysis. Result: The RTA among drivers was 126 (39.9%) (95% confidence interval (CI): 34.2-45.6%) in the previous year. The following factors were associated with RTA: vehicle maintenance (AOR = 0.11, 95% CI: 0.09, 0.96), media utilization (AOR = 0.38, 95% CI: 0.18, 0.65), participation in driving-related training (AOR = 0.73, 95% CI: 0.28, 0.91), punishment for prior traffic violations (AOR = 0.56, 95% CI: 0.47, 0.83), and risky driving behavior (AOR = 7.89, 95% CI: 3.22, 12.38). Conclusion: Two-fifths of the drivers were involved in a traffic accident. Risky driving behaviors, vehicle maintenance, media usage, attending driving-related training in the previous 2 years, and prior experience with traffic police punishment or warning were all strongly linked to road traffic accidents. In light of these statistics, the Federal Ministry of Transport of Ethiopia and other stakeholders should support making it mandatory for drivers to check their vehicles' safety, provide them with safety training, raise awareness about vehicle maintenance and risky driving behaviors, and enforce strict penalties for traffic violations.

Kinetics of the QuantiFERON-TB Gold In-Tube test during treatment of patients with sputum smear-positive tuberculosis in relation to initial TST result and severity of disease.

The QuantiFERON-TB Gold In-Tube test (QFN) measures interferon-gamma production in response to Mycobacterium tuberculosis antigens. Our aim was to assess the kinetics of the QFN and initial tuberculin skin test (TST) result in relation to severity of disease in a tuberculosis (TB) endemic area. Smear-positive TB patients (n = 71) were recruited at Gondar University Hospital, Ethiopia. The TST, QFN, CD4+ cell count and clinical symptoms (TB score) were assessed and followed up during treatment. From baseline to 7 months after treatment, there was a significant decrease in QFN reactivity (93.8% to 62.5% in HIV-negative/TB; 70.3% to 33.3% in HIV-positive/TB patients) down to a level comparable to a control group of blood donors (51.2%). The agreement between TST and QFN was poor in TB patients compared to healthy controls. A negative TST correlated to more advanced TB in contrast to a negative QFN test. We conclude that the QFN reactivity is significantly reduced at the end of treatment against active TB to the background level of healthy blood donors, and that the agreement between TST and QFN is poor including correlation to the severity of disease.

Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross-sectional study.

BACKGROUND: Adequate antiretroviral drug potency is essential for obtaining therapeutic benefit, however, the behavioral aspects of proper adherence and readiness to medication, often determine therapeutic outcome. Therefore, this study aimed to assess the level and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy (HAART) among people living with HIV/AIDS (PLWHA) at Gondar University Teaching Hospital and Felege Hiwot Hospital in Northwest Ethiopia. METHODS: A cross-sectional study was conducted between July and September 2008 using structured interviewer-administered questionnaire. All consecutive adult outpatients who were receiving antiretroviral treatment for at least three months, seen at both hospitals during the study period and able to give informed consent were included in the study. Multivariate logistic regression was used to determine factors associated with nonadherence and nonreadiness. RESULTS: A total of 504 study subjects were included in this study. The prevalence rates of nonadherence and nonreadiness to HAART were 87 (17.3%) and 70 (13.9%) respectively. Multivariate logistic regression analysis revealed that medication adverse effects, nonreadiness to HAART, contact with psychiatric care service and having no goal had statistically significant association with nonadherence. Moreover, unwillingness to disclose HIV status was significantly associated with nonreadiness to HAART. CONCLUSIONS: In this study the level of nonadherence and nonreadiness to HAART seems to be encouraging. Several factors associated with nonadherance and nonreadiness to HAART were identified. Efforts to minimize nonadherence and nonreadiness to HAART should be integrated in to regular clinical follow up of patients.

Prevalence and Associated Factors of Thyroid Incidentaloma among Adult People Attending Gondar University Hospital, Northwest Ethiopia.

BACKGROUND: Incidentally discovered thyroid lesions have become highly common in the development and more frequent utilization of highly sensitive imaging modalities, like ultrasound. However, little is known about its prevalence and associated factors in Ethiopia. The aim of this study was to determine the prevalence of thyroid incidentalomas and associated factors through ultrasound (US) among adults attending Gondar University Hospital. METHODS: A hospital-based cross-sectional study was carried out on 290 adults aged 15 years and above. Out of the adults who visited the hospital during the study, those who neither had history of thyroid disease, thyroid surgery, nor clinically palpable thyroid nodules were involved in the investigation. The participants were examined using a high frequency linear-array transducer (7 MHz). For comparing men and women, the unpaired t-test was used. Binary logistic analysis was used to identify the associated factors, and a P-value < 0.05 was considered statistically significant. RESULT: The frequency of thyroid incidentaloma was found to be 33.4% (95% CI: 27.9, 38.9). Thyroid incidentaloma was detected in 42.4% of the females and 22.7% of the males (P<0.001). About 63% had single and 37% multiple thyroid nodules. About 25.8% had thyroid nodules greater than 1cm. In the multivariable logistic regression analysis, increasing age (AOR=5.96; 2.34, 15.15) and female sex (AOR=3.01; 1.73, 5.26) were significantly associated with thyroid incidentalomas. CONCLUSION: The frequency of thyroid incidentaloma (TI) was found to be high in this study and much higher among older women. Solitary and small sized thyroid nodules were commonly seen in the study.

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.

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.

Establishing a Multicenter Longitudinal Clinical Cohort Study in Ethiopia: Advanced Clinical Monitoring of Antiretroviral Treatment Project.

BACKGROUND: The purpose of this paper is to describe the establishment of the Advanced Clinical Monitoring of ART Project in Ethiopia for monitoring and evaluation of the longitudinal effectiveness of the ART program and to show the opportunities it presents. This cohort was established in response to the 2005 call by WHO for establishing additional mechanisms for stronger monitoring of ART and the need for creating the platform to generate evidence to guide the care given for the ever increasing number of patients on ART in Ethiopia. METHOD: A participatory and multi-stage process which started from a consensus building workshop and steered by a mother protocol as well as guiding documents which dictated the degree of engagement and expectations was followed. The primary and secondary aims of the study were agreed upon. A multi-site longitudinal observational clinical cohort was established by a consortium of stakeholders including seven Ethiopian medical schools and their affiliated referral hospitals, John Hopkins University, Ethiopian Public Health Institute, Ministry of Science and Technology, US Centers for Disease Prevention and Control - CDC-Ethiopia, and the Federal Ministry of Health. Adult and adolescent cohorts covering the age range of 14+ years) and pediatric cohorts covering those below age 14 years were the two main cohorts. During the initial recruitment of these cohorts information was extracted from existing documents for a total of 2,100 adult participants. In parallel, a prospective cohort of 1,400 adult and adolescent patients were enrolled for ART initiation and follow-up. Using similar recruitment procedures, a total of 120 children were enrolled in each of retrospective and prospective cohorts. Replacement of participants were made in subsequent years based on lost follow up and death rates to maintain adequacy of the sample to be followed-up. ACHIEVEMENTS: Between January 2005 and August 2013 a total of 4,339 patients were followed for a median of 41.6 months and data on demographic characteristics, baseline and ongoing clinical features, hospitalization history, medication and laboratory information were collected. 39,762 aliquots and 25,515 specimens of plasma and dryblood-spots respectively were obtained and stored longitudinally from October 2009 to August 2013. The project created a research platform for researchers, policy and decision makers. Moreover, it encouraged local and international investigators to identify and answer clinically and programmatically relevant research questions using the available data and specimens. Calls for concept notes paired with multiple trainings to stimulate investigators to conduct analyses further boosted the potential for doing research. CONCLUSIONS: A comprehensive and resourceful mechanism for scientific inquiry was established to support the national HIV/ART program. With meaningful involvement and defined roles, establishment of a study, which involved multiple institutions and investigators, was possible. Since ACM is the largest multi-site clinical cohort of patients on antiretroviral treatment in Ethiopia-which can be used for research and for improving clinical management-considering options to sustain the project is crucial.