Sequela of female genital mutilation on birth outcomes in Jijiga town, Ethiopian Somali region: a prospective cohort study.

BACKGROUND: In Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth. METHODS: Facility based cohort study, involving 142 parturients with FGM and 139 parturients without FGM, was conducted in Jijiga town from October to December, 2014. The study participants were recruited by consecutive sampling technique. Data were collected using a structured interviewer administered questionnaire and observational checklists. Data were analyzed using SPSS version 16 and STATA version 11. RESULTS: The existence of FGM was significantly associated with perinealtear [RR = 2.52 (95% CI 1.26-5.02)], postpartum blood loss [RR = 3.14 (95% CI 1.27-7.78)], outlet obstruction [RR = 1.83 (95% CI 1.19-2.79)] and emergency caesarean section [RR = 1.52 (95% CI 1.04-2.22)]. FGM type I and FGM type II did not demonstrate any association with prolonged 2nd stage of labour, emergency caesarean section, postpartum blood loss, and APGAR score < 7. FGM type III however was significantly associated with prolonged 2nd stage of labour [RR = 2.47 (95% CI 1.06-5.76)], emergency caesarean section [RR = 3.60 (95% CI 1.65-7.86)], postpartum blood loss [RR = 6.37 (95% CI 2.11-19.20] and APGAR score < 7 [RR = 4.41 (95% CI, 1.84-10.60)]. FGM type II and type III were significantly associated with perinealtear [RR = 2.45(95% CI 1.03-5.83)], [RR = 4.91(95% CI 2.46-9.77)] and outlet obstruction [RR = 2.38(95% CI 1.39-4.08)], [RR = 2.94(95% CI 1.84-4.71)] respectively. CONCLUSION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive form of FGM. Adverse obstetric outcomes can therefore be added to the known harmful immediate and long-term effects of FGM.

Provider-initiated HIV testing and counseling among tuberculosis patients in a hospital in the Oromia region of Ethiopia.

BACKGROUND: Routine testing for human immunodeficiency virus (HIV) in settings with generalized HIV epidemics affords the benefit of diagnosing the infection early and thereby preventing morbidity, mortality and sustained transmission; early detection hastens the initiation of cotrimoxazole prophylaxis and anti-retroviral treatment (ART). Therefore, the objective of this study was to assess HIV counseling and testing among tuberculosis patients under routine care conditions in the Bishoftu hospital within the Oromia region of Ethiopia. METHODS: A retrospective study was conducted from a tuberculosis (TB) registry, which included data from all adult patients who were diagnosed and treated at Bishoftu Hospital in Oromia from 2009 through 2011. The data were reviewed, coded and entered into the computer software, SPSS version 16.0, for analysis. We used a descriptive and multi-variable logistic regression model to predict HIV-positive status. RESULTS: Among the 682 patients recorded on the TB registry, the required variables for this study were completed for 681 adult tuberculosis patients. Out of all the TB patients for whom the variables were collected, 98% (669/681) were offered HIV counseling and testing, and nearly all of them (668/669) accepted and were tested for HIV. Among those patients who accepted for testing and were tested for HIV, 32.2% (215/668) tested positive. Pulmonary TB, among all types of all forms of TB, urban residence and the 25-64 age group were more generally associated with an HIV-positive status; however, male sex and pulmonary-positive types of TB were less likely to be HIV-positive. CONCLUSION: The acceptance rate for HIV counseling and testing services among TB patients was very high. However, there were missed cases in which the test was not offered. The prevalence of HIV was very high, and the infection was more prevalent among urban residents, females, young people and pulmonary-negative TB patients; thus, these patients need attention from all concerned parties.

Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia.

BACKGROUND: In resource limited settings, many People Living with HIV/AIDS (PLWHA) lack access to sufficient quantities of nutritious foods, which poses additional challenges to the success of antiretroviral therapy (ART). Maintaining adequate food consumption and nutrient intake levels and meeting the special nutritional needs to cope up with the disease and the ART are critical for PLWHA to achieve the full benefit of such a treatment. OBJECTIVE: To determine the prevalence and correlates of food insecurity among HIV-infected individuals receiving highly active antiretroviral therapy in resource-limited settings. METHODS: A cross sectional study was carried out from January 1, 2009 to March 3, 2009 at ART clinic at Jimma University specialized hospital (JUSH) in Ethiopia. We used multivariable logistic regression model to compare independent risk factors by food insecurity status among 319 adult PLWHA (≥ 18 years) attending ART Clinic. RESULTS: A total of 319 adult PLWHA participated in the study giving a response rate of 100%. Out of 319 PLWHA the largest numbers of participants, 46.4% were in the age group of 25-34 years. The overall 201(63.0%) PLWHA were food insecure. Educational status of elementary or lower [OR = 3.10 (95%CI; (1.68-5.71)], average family monthly income <100 USD [OR = 13.1 (95% CI; (4.29-40.0)] and lower food diversity [OR = 2.18 (95%CI; (1.21-3.99)] were significantly and independently associated with food insecurity. CONCLUSION: Food insecurity is a significant problem among PLWHA on HAART. Lower educational status and low family income were the predictors of food insecurity. Food security interventions should be an integral component of HIV/AIDS care and support programs. Special attention need to be given to patients who have lower educational status and are members of households with low income.

Predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in resource-limited setting of southwest ethiopia.

BACKGROUND: Good adherence to antiretroviral therapy is necessary to achieve the best virological response, lower the risk that drug resistance will develop, and reduce morbidity and mortality. Little is known about the rate and predictors of adherence in Ethiopia. Therefore this study determines the magnitude and predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in Southwest Ethiopia. METHODS: A cross sectional study was carried out from January 1, 2009 to March 3, 2009 among 319 adult PLWHA (≥ 18 years) attending ART clinic at Jimma university Specialized Hospital (JUSH). Multiple Logistic regression models were constructed with adherence and independent variables to identify the predictors. RESULTS: About 303(95%) of the study subjects were adherent based on self report of missed doses (dose adherence) in a one-week recall before the actual interview. The rate of self reported adherence in the study based on the combined indicator of the dose, time and food adherence measurement was 72.4%. Patients who got family support were 2 times [2.12(1.25-3.59)] more likely to adhere than those who didn't get family support as an independent predictor of overall adherence (dose, time and food). The reasons given for missing drugs were 9(27.3%) running out of medication/drug, 7(21.2%) being away from home and 7(21.2%) being busy with other things. CONCLUSION: The adherence rate found in this study is similar to other resource limited setting and higher than the developed country. This study highlights emphasis should be given for income generating activities and social supports that helps to remember the patients for medication taking and management of opportunistic infections during the course of treatment.