Prevalence and associated factors of anemia among adult human immune deficiency virus positive patients on anti-retroviral therapy at Debre tabor Hospital, Northwest Ethiopia.

OBJECTIVE: Anemia is the most common hematological complication of HIV infection that has a significant impact on the quality of life and clinical outcomes. Therefore, the aim of this study was to assess the prevalence and associated factors of anemia among adult HIV positive patients on Anti-retroviral therapy at Deber Tabor hospital, northwest Ethiopia. An institution based cross-sectional study was conducted on 365 HIV/AIDS patients on ART selected using the systematic random sampling technique. Blood samples were analyzed using the Cell-DYN 1800 automated hematology analyzer to measure hemoglobin. Bivariable and multivariable binary logistic regression analyzes were employed to find the predictors at p-value < 0 .2 and 0.05, respectively. RESULTS: The overall prevalence of anemia was 34.0%[95% CI (29.0, 39.0)]; taking Zidovudine based antiretroviral regimen (AOR: 5.9, 95% CI 1.04, 13.86), CD4 count < 200 cells/mm3 (AOR: 4.8 95%, CI 1.14, 12.42), inability to read and write (AOR: 3.2, 95% CI (1.24,8.40), inadequate dietary diversity (AOR: 2.2, 95% CI 1.15, 4.26), and female sex (AOR: 1.9, 95% CI 1.06, 3.69) were significantly associated with increased odds of anemia. Therefore, routine screening of hemoglobin level, proper treatment of respondents on zidovudine based ART regimen and increasing productivity to improve dietary diversity are essential to prevent anemia.

Mothers treatment seeking intention for neonatal danger signs in northwest Ethiopia: A structural equation modeling.

BACKGROUND: Neonatal mortality contributes to nearly half of under-five mortality in Ethiopia. Treatment seeking for newborn danger signs remains low despite correlations with neonatal mortality. This study tests a theoretical model of factors affecting mothers' treatment seeking intention for neonatal danger signs in northwest Ethiopia. METHOD: A cross sectional study was conducted from March 3-18, 2016 in northwest Ethiopia. A total of 2,158 pregnant women and women who had delivered in the past 6 months were interviewed. Latent variables; knowledge of neonatal danger signs (KDS), household level women empowerment (HLWE) and positive perception toward the behavior of health care providers (PPBHCP) were measured using a Five Point Likert Scale. Socioeconomic status (SES), number of antenatal care attendance, perceived cost of treatment (PCT), average distance to health facilities (ADHF) and treatment seeking intention (TSI) were observed variables in the study. A structural equation modeling was applied to test and estimate the hypothesized model of relationships among latent and observed variables and their direct and indirect effects on TSI. RESULT: KDS, PPBHCP, HLWE, and PCT showed direct, positive and significant association with TSI (ß = 0.41, p<0.001, ß = 0.08, p<0.002, ß = 0.18, p<0.001, and ß = 0.06, p<0.002, respectively). SES was not directly associated with TSI. However, it indirectly influenced TSI through three pathways; KDS, number of ANC attendance and HLWE (ß = 0.05, p<0.05, ß = 0.08, p<0.001 and ß = 0.13, p<0.001, respectively). Number of antenatal care was not directly associated with TSI. But indirectly, it affected TSI through its direct effect on KDS and PPBHCP (ß = 0.05, p<0.05, ß = 0.14, p<0.001, respectively). PPBHCP and HLWE also showed indirect association with TSI through their direct effect on KDS (ß = 0.37, p<0.001, ß = 0.36, p<0.001, respectively). All in all, the model fitted the sample data and explained 31% of the variance in TSI. CONCLUSION: PPBHCP, HLWE, PCT and KDS were associated with mothers' TSI for newborn danger signs.

Why gone too soon? Examining social determinants of neonatal deaths in northwest Ethiopia using the three delay model approach.

BACKGROUND: Without improving the survival of newborns, meaningful reduction in under-five mortality is difficult. Most neonatal deaths are preventable when appropriate and timely care is sought. In Ethiopia, there is lack of evidence on the type and contribution of delays in treatment seeking to neonatal deaths. METHODS: A community based social autopsy (SA) of 39 neonatal deaths was conducted from March 16 to 24, 2016 in Dabat Health and Demographic Surveillance System (HDSS) in northwest Ethiopia. The result was linked with verbal autopsy (VA) information completed for each of the deaths as part of the ongoing HDSS. The SA tool was adapted from INDEPTH Network. Three delay model approach was used to classify the delay types that contributed for the deaths investigated. Descriptive statistics was used to analyze the data. RESULTS: SA was completed for 37 (94.9%) of the 39 neonatal deaths. Of all the deaths, 51.3% (19/37) of them occurred within the first 24 h, 75.6% (28/37) within the first 6 days and the remaining in 7-28 days. Birth asphyxia was the leading cause of death (34%) followed by bacterial sepsis (31%) and prematurity (16%). The median time from recognition of illness to initiation of modern treatment was 1 day (IQR 1-2.5 days). Delay in treatment seeking outside home (delay one) was associated with 81% of the deaths. Delay in receiving care at a health facility (delay three) and delay in transport (delay two) were associated with 16 and 3% of the deaths, respectively. The major contributors of death for delay one were bacterial sepsis (33.3%), birth asphyxia (30%), unspecified illness (20%) and acute lower respiratory tract illnesses (6.7%). For delay three, the major causes of death included birth asphyxia (50%), prematurity (33.3%) and bacterial sepsis (16.7%). CONCLUSIONS: Delays created at home and at health facility were the major delays contributing to the death of newborns. More focus has to be given in improving delays at home and at health facility.

Child wasting is a severe public health problem in the predominantly rural population of Ethiopia: A community based cross-sectional study.

BACKGROUND: In Ethiopia, child wasting has remained a public health problem for a decade's, suggesting the need to further monitoring of the problem. Hence, this study aimed at assessing the prevalence of wasting and associated factors among children aged 6-59 months at Dabat District, northwest Ethiopia. METHODS: A Community based cross-sectional study was undertaken from May to June, 2015, in Dabat District, northwest Ethiopia. A total of 1184 children aged under five years and their mothers/caretakers were included in the study. An interviewer-administered, pre-tested, and structured questionnaire was used to collect data. Standardized anthropometric body measurements were employed to assess the height and weight of the participants. Anthropometric body measurements were analyzed by the WHO Anthro Plus software version 1.0.4. Wasting was defined as having a weight-for-height of Z-score lower than two standard deviations (WHZ < -2 SD) compared to the WHO reference population of the same age and sex group. In the binary logistic regression, both bivariate and multivariate analyses were done to list out factors associated with wasting. All variables with P-values of < 0.2 in the bivariate analysis were earmarked for the multivariate analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) at 95% Confidence Interval (CI) were computed to determine the strength of association. In the multivariate analysis, variables at P-values of < 0.05 were identified as determinants of wasting. RESULTS: The overall prevalence of wasting was 18.2%; 10.3% and 7.9% of the children were moderately and severely wasted, respectively. Poor dietary diversity [AOR = 2.08, 95% CI: 1.53, 4.46], late initiation of breastfeeding [AOR = 1.43, 95% CI: 1.04, 1.95], no postnatal vitamin-A supplementation [AOR = 1.55, 95% CI: 1.04, 2.30], and maternal occupational status [AOR = 2.31, 95% CI: 1.56, 3.42] were independently associated with wasting in the study area. CONCLUSION: Wasting is a severe public health problem in Dabat District. Therefore, there is a need to strengthen the implementation of optimal breastfeeding practice and dietary diversity. In addition, improving the coverage of mothers' postnatal vitamin-A supplementation is essential to address the burden of child wasting.