Effect of empathy training on the empathy level of healthcare providers in Ethiopia: a cluster randomized controlled trial.

Objective: Empathy has deteriorated throughout clinical training and medical practice, and little is known about the effect of empathy training on the empathy level of healthcare providers. To address this gap, we assessed the effect of empathy training on the empathy level of healthcare providers in Ethiopia. Design: A cluster randomized controlled trial study design was conducted from 20 December 2021 to 20 March 2022. The empathy training intervention was conducted for three consecutive days. Setting: The study was conducted in five fistula treatment centers in Ethiopia. Participants: The participants were all randomly selected healthcare providers. Main outcome measures: Total mean score, percentage changes, and Cohen's effect size were computed. A linear mixed effects model and independent t-test were used for data analysis. Results: A majority of the study participants were nurses in the profession, married, and first-degree holders. There was no statistically significant difference in the baseline empathy score of the intervention arm across their socio-demographic features. At the baseline, the mean empathy scores of the control and intervention arms were 102.10 ± 15.38 and 101.13 ± 17.67, respectively. The effect of empathy training on the total mean score changes of empathy of the intervention arm compared to the control arm at each follow-up time had a statistically significant difference. After a week, a month, and three months of post-intervention, the total mean empathy scores between the intervention and control arms were as follows: (intervention 112.65 ± 18.99, control 102.85 ± 15.65, d = 0.55, p = 0.03); (intervention 109.01 ± 17.79, control 100.52 ± 12.57, d = 0.53, p = 0.034); and (intervention 106.28 ± 16.24, control 96.58 ± 14.69, d = 0.60, p = 0.016) with the overall percentage changes of 11, 8, and 5% from the baseline scores, respectively. Conclusion: In this trial, the empathy training intervention was found to have more than a medium effect size. However, over the follow-up intervals, there was a decreasing trend in the total mean empathy scores of healthcare providers; suggesting that there should be continued empathy training and integration of it into educational and training curriculums to enhance and sustain the empathy of healthcare providers.Clinical Trial Registration: Pan African Clinical Trial Registry: http://www.edctp.org/panafrican-clinical-trials-registry or https://pactr.samrc.ac.za, PACTR202112564898934.

Bacterial hazard identification and exposure assessment of raw milk consumption in Jimma zone, South West Ethiopia.

BACKGROUND: Raw milk may contain pathogenic microorganism that can sometimes fatally affect the health of consumers. However, risks related to raw milk consumption in Southwest Ethiopia are not well studied. The aim of this study was to evaluate the presence of five target pathogenic bacteria including Escherichia coli O157:H7, Salmonella enterica Typhimurium, Staphylococcus aureus, Listeria monocytogenes, and Campylobacter jejuni in raw milk and to assess exposure associated with the consumption of raw milk. METHOD: A cross-sectional study was carried out between November 2019 and June 2020 to in Jimma zone, Southwest Ethiopia. Laboratory analysis was conducted on milk samples collected from Seven Woreda towns, including, Agaro, Yebu, Sekoru, Serbo, Shebe, Seka, Sheki and Jimma town administration. Semi-structured interview questions were administered to collect data on the amount and frequency of consumption. Descriptive statistics were used to summarize laboratory results and questionnaire survey data. RESULT: Among 150 total raw milk samples, about 61.3% were found contaminated by one or more types of pathogens along the dairy value chain. The highest and the least bacterial counts recorded were 4.88 log10cfu/ml and 3.45 log10cfu/ml from E. coli and L. monocytogenes respectively. The mean concentrations of pathogens demonstrated significant statistical difference (p < 0.05) using 95% confidence interval where the prevalence percentage of isolates increased as the milk was transported from farms to the retail outlets. Except for C. jejuni; all other pathogens were detected in the range of unsatisfactory level of milk microbiological quality along the chain. The estimated mean annual risk of acquiring intoxication of E. coli across retailer outlets is 100% whereas salmonellosis, S. aureus intoxication, and listeriosis are 84%, 65% and 63% respectively. CONCLUSION: The study highlights the significant health risks associated with the consumption of raw milk due to its unacceptable microbiological quality. The traditional production and consumption patterns of raw milk are the primary reasons for the high annual probability of infection. Therefore, regular monitoring and implementation of hazard identification and critical control point principles are necessary from raw milk production to retail points to ensure the safety of consumers.

Understanding Healthcare-Seeking Pathways and Dilemmas Among Women with Obstetric Fistulas in Ethiopia: A Qualitative Inquiry.

Background: Obstetric fistula is a public health problem with a damaging effect on the health of women around the world. The path to medical care is an integral part of women's experience of illness that may have an impact on their health. Studies have addressed the experiences of patients after fistula repair, but fistula victims' care-seeking pathways and dilemmas are still poorly understood in low-income countries, particularly Ethiopia. Objective: This study aimed to explore the care-seeking pathways and dilemmas among women with fistulas in Ethiopia. Methods: An exploratory phenomenological study was carried out from April 1 to August 1, 2019, through in-depth interviews and supplementary informant interviews. Data were obtained from 21 purposively selected women with fistulas who survived with morbidity for one and more years and 12 supplementary interviewees at fistula treatment centers in Oromia Region and Addis Ababa. Data were analyzed assisted by ATLAS. ti 8.4 software. Results: Respondents gave their testimony that most of the women with fistulas first sought care from traditional care places and finally from fistula treatment centers. The reasons for care-seeking path dilemmas were a wrong perception about fistula, its causes, and treatment; families' pressure and lack of decision-making power on where to seek treatment, and a lack of knowledge on where modern treatments are available for fistula. They received psychological, companionship, and transport support from a family and a community; referral and counseling support from health care providers during their care-seeking pathways. Conclusion: A myriad of reasons inhibits the right care-seeking pathways among women with fistulas. Communities and women with fistula awareness creation on the right places for fistula treatment and psychological support programs are required. Additionally, developing and implementing tactics for community-level screening programs for targeted victims and early admission to treatment centers can minimize the tragic sequela of the fistula.

Magnitude and Associated Factors of Suicidal Ideation and Attempts among High School Adolescents of Jimma Town, Ethiopia.

Background: Studies show that suicidal ideation and attempt are major predictors of suicide. Flourishing technologies such cyber bullying, increased local and global events, like pandemics, wars, and effects of climate change exacerbate vulnerability of adolescents to mental health problems. Thus, timely epidemiological information is important for evidence-based practices. Therefore, the aim of this study was to assess the magnitude and associated factors of suicidal ideation and suicidal attempt among school adolescents. Methods: A school-based cross-sectional study was conducted in June 2022 on randomly selected 1144 school adolescents using multistage sampling technique. Data were collected using a self-administered questionnaire. Then, data were cleaned, entered into Epi-data V.3.1 and analyzed using SPSS version 26. Multivariable logistic regression was done to identify predictors of suicidal ideation and suicidal attempt among adolescents. Adjusted odds ratio and confidence interval (CI) were respectively used to measure statistical associations and their statistical significance. Results: The prevalence of lifetime suicidal ideation and attempt were 22.5%, and 13.3%, respectively, while 12-month suicidal ideation and attempt were found to be 14.6% and 10%, respectively. Being female, disappointment in school results, family history of suicide attempt, current alcohol intake, anxiety, and chronic medical condition were significantly associated with both suicidal ideation and attempt while cyber bullying was significantly associated with suicidal ideation only. Conclusions: Unsupportive home environment plus behavioral and medical conditions predispose school adolescents to suicidal ideation and attempt. The Ministry of Education and school administrations should facilitate favorable environment that enhance mental health awareness and protection of school adolescents. Building better parent-child relationship and parental discretion on the use of mobile phones can mitigate suicidal ideation and attempt.

Household Readiness to Care for Mild and Asymptomatic COVID-19 Cases at Home, Southwest Ethiopia: A Community-based Cross-Sectional Study.

Background: Corona virus disease (COVID-19) continued with its notorious effects overwhelming health institutions. Thus, home-based identification and care for asymptomatic and mild cases of COVID-19 has been recommended. Therefore, the objective of this study was to assess the level of household readiness for caring asymptomatic and mild cases of COVID-19 at home. Methods: A community-based cross-sectional study was conducted from March-June 2021 on randomly selected 778 households. Data entry and analysis were carried out using EpiData and SPSS version 25, respectively. Multivariable logistic regression was modeled to identify independent predictors of community readiness. Results: Overall readiness of the community was very low (43.8%). Factors positively affecting household readiness were male household heads (AOR = 1.6; 95%CI: 1.05, 2.45), primary (AOR=2.0; CI:.62, 1.59) and higher (AOR = 1.90; 95%CI: 1.04, 3.45) educational level of the respondents, number of rooms within household (AOR = 1.22; CI: 1.03, 1.46), having additionally house (AOR = 2.61; CI: 1.35, 5.03), availability of single use eating utensils (AOR = 2.76; 95%CI: 1.66, 4.56), availability of community water supply (AOR = 8.21; 95% CI: 5.02, 13.43), and community participation and engagement (AOR = 2.81; 95% CI: 1.93, 4.08) in accessing transport, water and sanitation. Conclusions: The community was less prepared in terms of housing, infection prevention, water and sanitation. Considering alternative options including universal coverage of vaccine is important; designed behavioral change communications can enhance community participation and engagement in improving access to transport, water and sanitation to reduce risk of infections.

Metabolic syndrome distributions in dietary diversity score groups and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia: a community based cross- sectional study.

BACKGROUND: Dietary diversity score has long been recognized as a key component of diets quality balances for healthy life status. However, diets with more variety of food items might increase calorie intake and body weight, which, in turn leads to central obesity (waist circumference).Therefore, this study aims to determine the prevalence of metabolic syndrome among dietary diversity score groups, and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia. METHODS: A total of 915 adults aged ≥ 18 years were randomly recruited in this cross-sectional study.The study was undertaken from June 17, 2019, up to July 27, 2019. To this end, the collected data were entered to Epi Data 3.1 and analysed using and SPSS 25 version. What's more, a multivariable logistic regression was used to assess associated factors of the unrecognized metabolic syndrome; adjusted odds ratio (AOR) with its corresponding 95% CI, at P-value ≤ 0.05. RESULTS: The occurrence of metabolic syndrome was 14.4%, and it is more prevalent in females, 11.15% than males, and 3.25%. The most prevalent components of the metabolic syndrome were low level of high-density lipoprotein, elevated level of triacylglycerol, and waist circumferences. Even though metabolic syndrome is not significantly associated with any of the dietary diversity score groups, its prevalence distribution varies among the groups (6.6% in middle, 5.8% in high and 1.9% in low dietary diversity groups). With potential confounders adjusted, by 75% female was significantly associated with the occurrence of metabolic syndrome than male (102 vs. 29, AOR = 0.25 at 95%CI: 0.15-0.40, P = 0.001). Whereas, age ≥ 35 years old (104 vs. 27, AOR = 2.91 at 95%CI:1.78-4.86,P = 0.001), large family size > 5 (65 vs. 10,AOR = 2.43 95% CI: 1.10-5.36, P = 0.03), overweight and obesity (121 vs. 10, AOR = 6.97, 95% CI: 4.50 -10.83, P = 0.005), elevated total cholesterol (103 vs. 28,AOR = 2.46, 95% CI: 1.47-4.11, P = 0.001), and consuming ( spices, condemns and beverages) ≥ 4 days per week (79 vs. 52, AOR = 0.52, 95% CI:0.33 -0.82, P = 0.005) were positively associated with the prevalence of metabolic syndrome as compared to their counterparts. CONCLUSION: Unrecognized metabolic syndrome was relatively high in the study community. The prevalence of metabolic syndrome varied among dietary diversity groups. But any of the dietary diversity scoring categories was not significantly associated with the occurrence of metabolic syndrome. Thus, awareness needs to be made to practice healthy diet and regular physical activity to maintaining normal body weight. Moreover, early screening of metabolic syndrome should be promoted.

Quality of life and its predictive factors among women with obstetric fistula in Ethiopia: A cross-sectional study.

Objective: Living with obstetric fistulas is detrimental to the quality of life of women with fistulas. This study aimed to assess the quality of life and predictive factors among women with obstetric fistula in Ethiopia. Methods: A cross-sectional study was employed on consecutively selected 478 women. Linear regressions were used for data analysis. Results: The mean quality of life in physical, psychological, social, and environmental health domains and the overall quality of life were 40.59 ± 1.58, 38.10 ± 1.78, 29.59 ± 1.97, 34.21 ± 1.65, and 44.61 ± 3.99 respectively. Repair outcome without urinary inconsistence (ß = 5.2; 95% CI = 0.72, 9.64), self-esteem (ß = 1.3; 95% CI = 0.96, 1.57), negative attitude (ß = 5.1; 95% CI = 1.86, 8.33), waiting treatment (ß = -8.4; 95% CI = -15.54, -1.10), and low intention (ß = 4.7; 95% CI = 1.52, 7.93) were predictors of the quality of life in physical domain. Repair outcome without urinary inconsistence (ß = 5.9; 95% CI = 1.73, 9.99), self-esteem (ß = 1.8; 95% CI = 1.47, 2.11), negative attitude (ß = -6.4; 95% CI = -9.60, -3.25), fathers at primary school (ß = 12.5; 95% CI = 0.08, 24.82), living only with parents (ß = 4.9; 95% CI = 0.99, 8.90), time of care-seeking (ß = -0.01, 95% CI = -0.02, -0.002), and duration lived with fistula (ß = -5.4; 95% CI = -9.12, -1.68) were predictors of psychological domain. Dead birth (ß = -5.2; 95% CI = -9.86, -0.51), self-esteem (ß = 1.1; 95% CI = 0.72, 1.43), and living only with parents (ß = 5.5; 95% CI = 0.30, 10.69), and living only with husband (ß = 7.8; 95% CI = 2.01, 13.55) were predictors of social domain. Living in rural (ß = -6; 95% CI = -9.22, -2.79), women at secondary school (ß = 14.1; 95% CI = 3.67, 24.48), self-esteem (ß = 1.3; 95% CI = 0.99, 1.55), negative attitude (ß = -5.1; 95% CI = -7.97, -2.29) were predictors of quality of life in environmental domain. Repair outcome without urinary inconsistence (ß = 8.3; 95% CI = 0.62, 16.02), self-esteem (ß = 2.1; 95% CI = 1.34, 2.79), and living only with parents (ß = 2.9; 95% CI = 1.06, 4.76) were significant predictors of the overall quality of life. Conclusions: The quality of life of women with obstetric fistula was low. Repair outcomes, self-esteem, negative attitudes, rural residence, living with parents, and time of care-seeking were significant predictors of quality of life. Urgent measures should be taken to address these factors to improve the quality of life of women with fistula.

Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study.

INTRODUCTION: Obstetric fistula remains a debilitating complication of childbirth and maternal morbidity in developing countries. Few studies document the challenges and coping mechanisms among women living with obstetric fistula in Ethiopia. Therefore, this study aimed to explore the challenges and coping mechanisms among women with obstetric fistula in Ethiopia. METHODS: A phenomenological study was employed among purposively selected eleven women with obstetric fistula and three key informants at five fistula treatment centers in Ethiopia. An in-depth interview was conducted, audio-recorded, and transcribed into a Microsoft Word document. The transcripts were imported into Atlas. ti version 8.4 for thematic analyses. RESULTS: Painful social life, consequences of fistula, and coping mechanisms with fistula problems were the main themes in this study. Difficult social life, stigma, discrimination, impaired marital status; psychological, physical, sexual, and reproductive health problems were the major challenges for women with obstetric fistulas. Women with fistulas used coping mechanisms such as-going to spiritual sites and drinking alcohol to cope with their fistula disease; separating themselves from community participation and living alone in the forest to cope with a painful social life; restricting the amount of drinking water and wearing many clothes at a time to cope with wetness and odors, and allowing their husband to marry a new wife to cope with the impaired marital responsibilities. CONCLUSION: Women with obstetric fistulas encountered challenges such as a painful social life, impaired marital status, psychological, physical, sexual, and reproductive health problems; and used coping mechanisms with their fistula condition, difficult social life, and impaired marital responsibility that may have an added negative effect on their overall health. Therefore, policymakers need to prioritize the availability and early utilization of obstetric fistula surgery in all settings for all women living with obstetric fistulas to restore their holistic health.

The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study.

Background: Obstetric fistula recurrence predisposes to a decreasing success rate of fistula repair and accounts for the continued incidence of obstetric fistulas in low-income countries. Evidence has revealed that there are women's intent gaps in the prevention of obstetric fistula recurrence. Assessments of predictors of intent to prevent obstetric fistula recurrence among women with fistula are scarce. Objective: This study assessed the intent to prevent obstetric fistula recurrence and its predictive factors among women with obstetric fistula in Ethiopia. Methods: Facility-based cross-sectional study was conducted from April 01, 2019, to August 01, 2019, with consecutively selected 478 women with fistulas in five fistula treatment centers in Addis Ababa and Oromia regions. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS 23 software. Simple and multiple linear regression models were fitted for data analysis. Results: Mean score of intent to prevent obstetric fistula recurrence among women with obstetric fistula was 27.72 ± 5.06. Living in a rural setting (ß =-2.27; 95% CI: -3.62, -0.93), being married (ß =1.71, 95% CI: 0.56, 2.85), having one previous repair (ß =2.14, 95% CI: 0.19, 4.08), high self-esteem (ß =1.42, 95% CI: 0.09, 2.74), psychological health (ß =0.05, 95% CI: 0.26, 3.79), living with fistula ≥5 years (ß =1.82, 95% CI: 0.44, 3.21), high knowledge of risk factors (ß =3.12, 95% CI: 1.99, 4.25), and a positive attitude (ß =2.33, 95% CI: 1.12, 3.54) were significant predictors of the intent to prevent obstetric fistula recurrence. Conclusion: Intent to prevent obstetric fistula recurrence among women with obstetric fistula was low. This indicates an urgent need to create awareness among women with an obstetric fistula on the risk factors of obstetric fistula recurrence, attitudinal changes towards prevention of obstetric fistula recurrence, and the availability of prevention measures.

Knowledge, Attitudes, and Practice Toward Prevention of COVID-19 Among Jimma Town Residents: A Community-Based Cross-Sectional Study.

Background: Coronavirus disease (COVID-19) was first reported by the World Health Organization on 31 December 2019, and later, it was declared a global pandemic on 12 March 2020. To date, it is a great challenge to the world including Ethiopia. Therefore, to attain effective prevention and control of the COVID-19 pandemic, improving the knowledge, attitude, and practices of the community is necessary. Objective: To assess, knowledge, attitudes, and practice, and associated factors of COVID-19 among Jimma Town residents. Methods: A community-based cross-sectional study was conducted among 1,500 Jimma town residents from May through June 2020. Adults aged ≥18 years were included in the study. Data were collected using a structured questionnaire that was adopted from different literature. A face-to-face interview was implemented to collect data. Analysis was done by using SPSS version 22. p < 0.05 was used to declare statistical significance. Result: A total of 1,500 participants were enrolled in the study. The majority of the respondents were female (59.3%). About 841 (56.1%) of the participants had knowledge about COVID-19. Educational status, household wealth index, and employment showed association with knowledge of COVID-19. Government-owned television (37.3%) was the primary source of information about COVID-19 in the Jimma population. Only 46.6% of respondents had good attitudes toward the COVID-19 pandemic and about 638 (42.5%) of the study participants had good practice toward COVID-19. The mean practice score was 1.98 (± 0.319). Study participants who were residing in the outskirts of the town were 0.37 less likely to apply good practice regarding COVID-19 prevention measures than those around the center of the town. Whereas, households with a family size of four to five individuals were 1.4 times more likely to show good practice against COVID-19 compared to households with ≤3 individuals (AOR: 1.41; CI: 1.05, 1.91). Conclusion: Jimma town community has low knowledge, attitude, and practice regarding COVID-19. Knowledge, attitude, and practice scores regarding COVID-19 are significantly related to educational status, being self-employed, occupation, marital status, residence, family size, and household relative wealth index. Preventive health advisories to upraise knowledge, attitude, and practice are crucial to prevent and control COVID-19.

Determinants of uncontrolled asthma among adult asthmatic patients on follow-up at chest clinic of Jimma medical center: unmatched case-control study.

OBJECTIVE: To identify the determinants of uncontrolled asthma among asthmatic patients on follow-up at Jimma Medical Center. METHODS: Institution-based case-control study was conducted on asthmatic patients who were on follow-up at the chest clinic of Jimma University Medical (JMC) from March to May 2020. A total of 59 cases and 118 controls (1: 2 ratio) were included in the study. Cases and controls were defined based on asthma control test (ACT) scores where those who had scores of ≤19 and above 19 were defined to be cases and controls, respectively. RESULTS: Age of the patients [AOR: 2.78; 95% CI: 1.14, 6.81], age of the cases' residential houses [AOR: 3.65; 95% CI: 1.30, 10.28], presence of pets within the houses [AOR: 2.78; 95% CI: 1.29, 5.96], having rhinitis [AOR: 3.34; 95% CI: 1.17, 9.52], past asthma exacerbation [AOR: 2.38, 95% CI: 1.05, 5.40], non-adherence to treatment [AOR: 2.81; 95% CI: 1.30, 6.08] and smoking [AOR: 7.09; 95% CI: 1.84, 27.33] were found to be determinants of uncontrolled asthma. CONCLUSIONS: Uncontrolled asthma results from multiple sociodemographic, environmental, clinical, and behavioral factors. Therefore, patients should be counseled on avoiding pets, maintenance of houses, adherence to treatment, quitting smoking, and early treatment-seeking for rhinitis and asthma exacerbation to improve asthma control comprehensively.

Intention Toward Dietary Diversity Among Adult People Living With HIV in Public Hospitals in Southwest Ethiopia Using Theory of Planned Behavior. A Mixed Methods Study.

Dietary diversity is a crucial element of an inclusive care for people living with HIV (PLWHIV), particularly in resource-limited countries where undernutrition, poor intention, and poor attitude toward diversified diets are the common challenges. The aim of this study was to assess the Intention toward dietary diversity behavior among adult PLWHIV in Jimma zone public hospitals, South West Ethiopia. A hospital-based survey was carried out in 5 public institutions among sampled 403 adult PLWHIV. Data were entered into EpiData, and exported to SPSS version 20 for analysis. Relationships among variables were assessed using correlation coefficients. The multivariable linear regression model was fitted to assess predictors of behavioral inclination toward dietary diversity at P-value ≤ .05. The quantitative data was supplemented by qualitative data, which was collected through key informant interviews and analyzed thematically. The significant predictors of intention to use dietary diversity were attitude (ß = .196, P < .01) and subjective norm (ß = .390, P < .01) of adult PLWHIV. The constructs of theory of planned behavior (TPB) independently explained the variance in inclination toward dietary diversity by 25.7%. All the intermediate, proximal, and distal components of TPB explained the final model with 32.2% of variance in the intention to use dietary diversity. The qualitative findings indicated that delivery of HIV care requires a drive for livelihood development and economic improvement, creating a sense of responsibility for sustainable HIV care by creating behavioral change at the individual level. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition.

Perception and Experience of Health Extension Workers on Facilitators and Barriers to Maternal and Newborn Health Service Utilization in Ethiopia: A Qualitative Study.

Background: Health extension workers (HEWs) have substantial inputs to reduce maternal and newborn morbidity and mortality in Ethiopia. However, their perceptions and experiences were not well understood. Therefore, this study aimed to explore their perceptions and experiences on facilitators and barriers to maternal and newborn health services in Ethiopia. Methods: A descriptive qualitative study was conducted from 8-28 April 2021 in Oromia, Amhara and Southern Nation, Nationality, and People's Regional State of Ethiopia. Focused group discussions were made with purposively selected 60 HEWs. The data were transcribed verbatim and translated into English. An inductive thematic analysis was carried out using Atlas ti.7.1. The findings were presented in major themes, categories, and sub-categories with supporting quote(s). Results: The findings were categorized into two major themes (i.e., facilitators and barriers) and seven sub-themes. Community-related facilitators encompass awareness and behavior at the individual, family, and community. Significant others such as traditional birth attendants, religious leaders, women developmental armies, and kebele chairman substantially contributed to service utilization. Availability/access to infrastructures such as telephone, transportation services, and solar energy systems facilitated the service utilization. Furthermore, health facility-related facilitators include the availability of HEWs; free services; supervision and monitoring; maternity waiting rooms; and access to ambulance services. Maternal and newborn health services were affected by community-related barriers (i.e., distance, topography, religious and socio-cultural beliefs/practices, unpleasant rumors, etc.), health facility-related barriers (i.e., health worker's behaviors; lack of logistics; lack of adequate ambulance service, and placement and quality of health post), and infrastructure (i.e., lack or poor quality of road and lack of water). Conclusions: The HEWs perceived and experienced a wide range of facilitators and barriers that affected maternal and newborn health services. The study findings warrant that there was a disparity in behavioral factors (awareness, beliefs, and behaviors) among community members, including pregnant women. This underscores the need to design health education programs and conduct social and behavioral change communication interventions to address individuals, families, and the broader community to enhance maternal and newborn health service utilization. On the other hand, the health sector should put into practice the available strategies, and health workers provide services with empathy, compassion, and respect.

Burden of Undiagnosed Hypertension among Adults in Urban Communities of Southwest Ethiopia.

BACKGROUND: Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia. METHODS: A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors. P-value <0.05 and 95% CI were used on multivariable logistic regression analysis as threshold for significant statistical association. RESULTS: Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02-1.05), BMI with overweight (AOR=2.52, 95% CI=1.35-4.71), triglyceride (AOR=1.83, 95% CI=1.29-2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03-2.54) were factors significantly associated with HTN. CONCLUSION: As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population.

Effect of Microbial Quality of Washing Water on Hand Hygiene Status of Food Handlers in Jimma Town: Implication for Food Hygiene and Safety.

BACKGROUND: In most cases, people pay more attention to the microbial quality of drinking water than the quality of water they used to wash hands. This may lead to the occurrence of various foodborne illnesses through the introduction of pathogenic microbes during preparation and serving of food. OBJECTIVE: To determine the effect of microbial quality of washing water on the hand hygiene status of food handlers in Jimma town. METHODS: Laboratory-based cross-sectional study design was used. A total of 150 food handlers were selected randomly for hand hygiene examination, and 150 water samples were collected aseptically from water storage tanks, food handlers used to wash their hands. The samples were subjected for microbiological analysis using standardized protocol. Descriptive statistics and Pearson correlation coefficient were used to summarize the data and to determine the effect of microbial quality of water on hand hygiene of food handlers, respectively. RESULTS: Among 150 food handlers included in the study, 104 (69.0%) of them were males and 64 (43.0%) of them aged between 35 and 50 years. On the other hand, 64 (42.7%) of the study participants had not attended formal education. About three-fourth of them used stored water to wash their hands, and almost similar proportion of them were waiters. The mean coliform bacteria of water and hand rinsate samples were 4.2 ± 0.8 and 4.1 ± 0.8 log CFU/mL, respectively. CONCLUSION: The study revealed that the microbial quality of water used to wash hands significantly affects the hand hygiene status of the food handlers. Hence, improving the microbial quality of washing water is important to improve the hand hygiene status of food handlers and consequently to prevent the occurrence of food-borne illness in the town.

Microbial quality of raw cow milk and its predictors along the dairy value chain in Southwest Ethiopia.

Raw milk may contain pathogenic microorganism that can seriously affect the health of consumers. In Southwest Ethiopia, raw cow milk is consumed more than the processed products, but its microbiological quality and its predictors are not studied well. The aim of this study was to determine the microbial quality of raw cow milk and its predictors along the dairy value chain in Southwest Ethiopia. A total of 150 milk and 300 environmental samples were collected randomly from dairy farms, milk distribution centers, and retailer outlets for microbiological analysis using standard protocols. One milk handler from each milk production or distribution stage was also interviewed to assess the knowledge, attitude, and practices regarding milk handling. Descriptive statistics and multiple linear regression models were used to summarize the data and to identify predictors of milk microbial quality, respectively. As the milk transported from dairy farm to milk retailer outlet, the mean total bacterial count has increased from 5.0 ±â€¯0.3 to 7.2 ±â€¯0.1 log CFU/ml respectively. The mean coliform count of the milk sample was 4.4 ±â€¯0.4 log CFU/ml at the dairy farm and 7.0 ±â€¯0.2 log CFU/ml at milk selling points, indicating the deterioration of milk quality along the dairy value chain. All of the analyzed water samples were positive for fecal coliform bacteria. The highest coliform bacteria were reported from milk storage equipment found at milk retailer outlet with the count of 4.8 ±â€¯0.5 log CFU/ml. Educational status and attitude of milk handlers and the quality of water used to wash milk equipment and hands of milk handlers were the major factors affecting the microbial quality of raw cow milk. The findings of this study revealed that the microbial quality of raw milk in the study area was poor. Hence, improving the attitude and educational status of milk handlers, and the quality of water is an important step to enhance milk quality and consequently to prevent milk borne diseases.

Predictors of Mortality among Adult People Living with HIV and Its Implications for Appointment Spacing Model Approach Care.

BACKGROUND: Ethiopia has been motivated to achieve a goal of "appointment spacing model approach care." However, little has been documented on the predictor of mortality and challenges of sustainable HIV care. Therefore, the aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS: A retrospective cohort study was conducted on 676 adult people living with HIV who enrolled to ART clinic from September 01, 2012 - August 30, 2016. Multivariable Cox Regression analysis was done where adjusted hazard ratio (AHR)with corresponding 95% confidence interval (CI) at P value ≤ 0.05 cut of point was used to identify predictors of mortality. RESULTS: The total person-time contributed was 28,209 person-months with an overall mortality incidence rate of 11 per 1000 person-months observation. The cumulative mortality incidence among females over the study period was 16.8% (64/382). Severe undernourishment and moderate malnutrition at baseline, younger age, female sex, single, divorced, illiterate, lack of disclosure, advanced WHO clinical stage, seeking treatment outside catchment area, rural residence and immunological failure were found to be independent predictors of mortality. CONCLUSIONS: Poor nutritional status at baseline, advanced stage of HIV disease, occurrence of treatment failure, female sex, substance abuse, lack of social support, immunological failure, clinical failure, and younger age, low level of education and poor physical access to healthcare facility were found to be important predictors of mortality. Intervening, those factors as routine and part of the appointment spacing model care can improve survival of PLWHA.

Predictors of Under Nutrition and Its Implication toward HIV Continuum Care among Adult People Living with HIV in Jimma Zone Public Hospitals, Southwest Ethiopia: A Mixed Method Study.

OBJECTIVES: The study aimed to see predictors of undernourished and its implication towards HIV continuum care. STUDY DESIGN: unmatched case-control study was conducted among 678 individuals in Jimma zone, southwest Ethiopia. METHODS: Randomly selected data of 339 PLWHA who had poor nutritional outcomes (cases) and 339 without undernourished (controls) were analyzed. Logistic regression was used to identify forecasters of undernutrition. The quantitative results were supplemented from key informants who work closely on HIV care, then data were coded and analyzed thematically. RESULTS: Rural residence (AOR:1.8; 95% CI: 1.2, 6.4), female (AOR: 2.9; 95% CI: 1.1, 4.3), unstable livelihood (AOR: 5.1; 95% CI: 4.2, 19.6), low meal frequency (AOR: 6.6; 95% CI: 5.2, 21.1), less diversified foods (AOR: 3.5; 95% CI: 1.2, 14.3), and advanced WHO clinical stage (AOR: 4.3; 95% CI: 3.6, 13.7) and were found to be independent predictors of undernourishment. No social support advanced clinical stage, and unstable livelihood adversely affect nutritional status of PLWHA from the qualitative data. CONCLUSIONS: The socio-cultural, economic, and health-system factors inhibit ideal patient nutritional status. Better tracking, enhanced livelihood and social support along with drug therapy, food aid needs to consider for PLWHA.

Validity of Anthropometric Cut-Offs for Early Diagnosis of Dyslipidemia Among Ethiopian Adults.

INTRODUCTION: Lack of regional- and local-based cut-off points of lipid profile and/or anthropometric measurements remains one of the challenges in prevention, early detection and control of non-communicable diseases. This study aimed to validate anthropometric-based screening of lipid profiles to develop locally appropriate optimal cut-off points for metabolic syndrome screening. METHODS: A community-based cross-sectional study was conducted among randomly selected 977 adults in Jimma Town, Ethiopia. Data were collected using structured questionnaire, anthropometric and biochemical measurements. Data were analyzed using SPSS windows version 21 and Kappa statistic was used to validate the agreement between anthropometric measurement and lipid profile. A p-value of <0.05 was considered statistically significant. RESULTS: Body mass index (BMI) at ≥24.5 was used as screening of dyslipidemia (TG≥150mg/dl) with slight Kappa coefficient of 0.138 (P<0.001) among females while it was ≥22.2 among males with fair (0.275) Kappa coefficient (P<0.001). Waist circumference-based screening of dyslipidemia (TG≥150mg/dl) at ≥78.0cm had negative (-0.005) Kappa coefficient (Pp<0.001) among females (sensitivity: 72.6% and specificity: 26.7%). Yet, waist circumference at ≥83.7cm had slight Kappa coefficient of 0.13 (P<0.005) among males (sensitivity: 38% and specificity: 74.9%). Waist hip ratio-based screening of dyslipidemia (TG≥150mg/dl) at ≥0.82 among females had negative (-0.001) Kappa coefficient (p=0.763), whereas among males at ≥0.88, there was a slight (0.105) Kappa coefficient of (p=0.002) (sensitivity:77.5% and specificity:36.8%). This study showed that anthropometric-based high-density lipoprotein measurement was not applicable. CONCLUSION: This study indicated that BMI-based screening of triglyceride was more applicable for both sexes than other anthropometric measurements. Waist circumference and waist-to-hip ratio-based screening of triglyceride were slightly applicable only for males. However, anthropometric-based screening of high-density lipoprotein measurement was not applicable for both sexes. In conclusion, researchers and policy makers need to consider locally validated cut-off points to be used for screening metabolic syndrome in the community.

Determinants of Fertility Desire among Women Living with HIV in the Childbearing Age Attending Antiretroviral Therapy Clinic at Jimma University Medical Center, Southwest Ethiopia: A Facility-Based Case-Control Study.

BACKGROUND: High fertility and aspiration to have more children are a normal phenomenon in many developing countries including Ethiopia. The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Despite the growing number of women living with HIV/AIDS, the issues of fertility and childbearing intention have not been widely studied in Ethiopia. OBJECTIVE: To identify determinants of fertility desire among women living with HIV in the childbearing age attending antiretroviral therapy clinic at Jimma University Medical Center, Southwest Ethiopia. METHODS: A facility-based case-control study was conducted in March 2019. Cases were women living with HIV who had fertility desire, and controls were those who had not. Data was collected using a face-to-face interview using a pretested questionnaire. The data was entered into EpiData 3.1 and exported to SPSS Version 24 for analysis. Bivariate and multivariable logistic regression analyses were used to identify candidate and independent determinants of fertility desire, respectively. Independent determinants associated with fertility desire were assessed using AORs with their corresponding 95% CIs at P value < 0.05 cutoff point. Results. Three hundred forty-four (115 cases and 229 controls) were included into the study with a 100% response rate. Age categories 15-24 (AOR: 4.1; 95% CI: 2.0, 8.4) and 25-34 (AOR: 2.3; 95% CI: 1.3, 4.2) years, not using family planning (AOR: 2.3; 95% CI: 1.4, 4.0), and having a sexual partner (AOR: 1.9; 95% CI: 1.1, 3.2) were independent predictors of fertility desire. CONCLUSIONS: Age of women, family planning, and sexual partner were found to be the independent predictors of fertility desire among women living with HIV/AIDS. Policymakers and health care providers who are working on an ART clinic should try to consider the effects of these factors for women living with HIV while developing HIV/AIDS interventions and discussing on sexual and reproductive health issues with their clients, respectively.