Depression and Associated Factors among People Living with Human Immunodeficiency Virus Attending Antiretroviral Therapy in Public Health Facilities, Hosanna Town, Southern Ethiopia.

Background: Among those infected with the human immunodeficiency virus, depression is one of the most prevalent mental health issues. Despite its high incidence, depression goes undiagnosed and untreated in the majority of HIV/AIDS patients, which has a negative impact on how well they adhere to their antiretroviral regimen. Objective: To assess the magnitude of depression and associated factors among people attending antiretroviral therapy in public health facilities of Hosanna town, Hadiya Zone, Southern Ethiopia, 2019. Methods: Institution-based cross-sectional study was conducted at public health facilities of Hosanna town from June 6 to July 6, 2019, among people living with HIV/AIDS aged 18 years and older who were on ART. A systematic sampling technique was used to select 392 participants. Data were collected using a pretested and standardized structured interviewer-administered questionnaire. Variables having a p value less than 0.2 in bivariate analysis were entered into the multiple logistic regression model. Odds ratio with 95% CI was computed, and variables with p value < 0.05 were considered as statistically significantly associated with depression. Result: The prevalence of depression among HIV patients was 37.8%. Being female (AOR = 2.15, 95% CI (1.21, 3.84)), not disclosing their HIV status (AOR = 2.77, 95% CI (1.57, 4.89)), rural dwellers (AOR = 2.69, 95% CI (1.58, 4.57)), poor ART adherence (AOR = 1.89, 95% CI (1.10, 3.24)), having HIV-perceived stigma (AOR = 1.71, 95% CI (1.01, 2.88)), and poor social support (AOR = 1.85, 95% CI (1.11, 3.09)) were significantly associated with depression. Conclusion: The magnitude of depression was high among PLWHIVs. Being female, rural dwellers, not disclosing HIV status, poor ART adherence, HIV-perceived stigma, and poor social support were significantly associated with depression. Enhancing adherence, counseling, and linking those patients who had poor social support to the concerned relatives for care and support is recommended. Providing health education both at the facility level and at the community level may reduce stigma and subsequently depression. Encouraging disclosing HIV status may help to prevent depression.

Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis.

BACKGROUND: Cervical cancer (CC) is the 4th most prevalent cancer among females globally. In Ethiopia, around 7,095 new CC cases are diagnosed every year and it is the second common cause of cancer deaths in women. There is limited evidence on survival status as well as about predictors of time to death among CC patients in Ethiopia. Thus, this study investigated the five-year survival status and predictors of time to death among CC patients who had been admitted at Tikur Anbesa specialized Hospital (TASH) from 2014-2019. METHODS: Facility-based, retrospective-cohort study was conducted at Tikur Anbesa specialized Hospital among 348 patients from June 2014 to June 2019. A systematic random sampling method was employed to select the study participants. Data were extracted from the patient card, and through phone calls. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Kaplan and Meier's method was used to estimate survival functions and Cox-proportional hazard regression analysis was carried out in order to identify the independent predictors of time to death. RESULTS: The overall incidence of death was 31 per 100 person-years of follow up. The median (IQR) follow-up time of the entire cohorts was 18.55 (8.96-49.65) months. The independent predictors for time to death included; age older than 50 years [AHR: 1.4; 95% CI: 1.1-1.9], late stage of CC at diagnosis [AHR: 2.2; 95% CI: 1.7-2.9], No CC treatment [AHR: 2.1; 95% CI: 1.5-3.1] and HIV positive [AHR: 2.3; 95% CI: 1.4-3.8]. CONCLUSION AND RECOMMENDATION: The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient's survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia.

The status of serum cortisol before and after treatment of schizophrenia and its correlation to disease severity and improvement: A longitudinal study.

BACKGROUND: Hypothalamic-pituitary-adrenal axis functioning, with cortisol as its major output hormone, has been presumed to play a key role in the development of psychopathology of schizophrenia. OBJECTIVE: We examined the association of serum cortisol with disease severity and improvement in schizophrenia patients in Jimma, Ethiopia. METHOD: A total of 34 newly diagnosed schizophrenics were included in this study. Data on demographic, behavioral, clinical state, serum cholesterol level, and antipsychotic usage were obtained at baseline and after 8 weeks. The Positive and Negative Syndrome Scale was used to assess psychotic symptoms severity. A paired sample t-test was used to compare baseline and post-treatment values. Linear regression was used to assess associations. RESULT: Post-treatment serum cortisol level was significantly lower than its baseline value (p = 0.001). There was also a significant positive and negative psychotic symptoms decrease after treatment (baseline positive psychotic vs post-treatment positive psychotic symptoms: t(33) = 6.24 (95% confidence interval = 7.03,13.84, p = 0.000) and (baseline negative psychotic vs post-treatment negative psychotic symptoms: t(33) = 4.21 (95% confidence interval = 3.82, 10.99, p = 0.000).At baseline, neither positive nor negative subscore on the Positive and Negative Syndrome Scale showed an association with serum cortisol level (B = -0.016, p = 0.794 and B = -0.032, p = 0.594). However, serum cortisol level showed strong associations with post-treatment positive sub scores and negative sub scores (B = 0.167, p = 0.007) and (B = 0.144, p = 0.010) on the Positive and Negative Syndrome Scale. CONCLUSION: We found a significant decrease in serum cortisol level after antipsychotics treatment and that was associated with improvement in psychotic symptoms in schizophrenics in Jimma, Ethiopia.

Association of serum cortisol level with severity of depression and improvement in newly diagnosed patients with major depressive disorder in Jimma medical center, Southwest Ethiopia.

BACKGROUND: Major Depressive Disorder (MDD) is the leading psychiatric disorder in low- and middle-income countries, and is to be the second leading cause of burden of disease by 2020. Cortisol plays a significant role in pathophysiology of MDD. Depression can alter serum cortisol level. However, the change in serum cortisol level and its association with depressive symptom severity and improvement among patients with MDD is not well studied. OBJECTIVE: To outline change in serum cortisol levels and its association with severity and improvement of depressive symptoms in newly diagnosed patients with MDD. METHOD: Hospital based longitudinal study was conducted among 34 newly diagnosed patients who met DSM-V criteria of MDD. Venous blood sample was performed twice; pre- and post- 8 weeks of treatment. Serum cortisol concentration was measured using an extracted radioimmunoassay. The 17-item Hamilton Depression Scale (HAM-D) was used to rate depression at baseline and after 8 weeks of treatment. Paired t-test was done to look the mean difference of serum cortisol level and HAM-D, before and after treatment. Pearson correlation was done to look the association between serum cortisol levels, HAM-D scores and, sociodemographic and clinical factors. Statistical significance was set at p<0.05. RESULTS: There is no significant difference in cortisol concentrations at baseline and end line (t (33) = 2.02, p = 0.052). However, there is significant difference in HAM-D total score (t (33) = 5.67, p<0.001). Baseline and end line serum cortisol levels were significantly correlated (r = .561, p = .001). Monthly family income is correlated with baseline HAM-D total score (r = -0.373, p = .030). There is no significant relationship between baseline serum cortisol level and HAM-D score. There is also no significant relationship between end line serum cortisol level and HAM-D score. CONCLUSIONS: The symptoms of MDD were reduced following treatment but there is no significant difference in serum cortisol levels. Baseline and end line serum cortisol levels were significantly correlated. We recommend further research based on large sample.

Does time to loss to follow-up differ among adult tuberculosis patients initiated on tuberculosis treatment and care between general hospital and health centers? A retrospective cohort study.

BACKGROUND: Patients' loss to follow-up (LTFU) from tuberculosis treatment and care is a growing worry in Ethiopia. But, available information is inadequate in assessing the time to tuberculosis patient loss to follow-up difference between health centers and a general hospital in Ethiopia. We aimed to assess time to LTFU difference between health centers and a general hospital in rural Ethiopia. METHODS: We conducted a retrospective cohort study from September 2008 to August 2015 and collected data from September 1 to October 02, 2016. A total of 1341 TB patients with known treatment outcomes were included into the study. Log rank test was used to compare the difference in time to TB patient loss to follow-up between health centers and a general hospital, whereas Cox proportional hazard model was used to assess factors associated with time to loss to follow-up in both settings. RESULTS: We reviewed a total of 1341 patient records, and the overall follow-up time was 3074.7 and 3974 person months of observation (PMOs) for TB patients followed at health centers and a general hospital, respectively. The incidence of loss to follow-up rate was 27.3 per 1000 PMOs and 9.6 per 1000 PMOs, at health centers and a general hospital, respectively. From the overall loss to follow-ups that occurred, 55 (65.5%) and 33 (86.8%) of LTFUs occurred during the intensive phase and grew to 78 (92.9%) and 38 (100%) at health center and a general hospital, respectively, at the end of 6-month observation period. Older age (AOR = 1.7, 95%CI, 1.2-2.5, P < 0.001), being a rural resident (AHR = 2.7, 95%CI, 1.6-4.6), HIV reactive (AHR = 2.2, 95%CI, 1.5-3.2), following treatment and care in health center (AHR = 3.38, 95%CI, 2.06-5.53), and living at more than 10 km away from the health facility (AHR = 3.4, 95%CI, 2.1-5.7) were predictors for time to loss to follow-up among TB patients on treatment and care. CONCLUSION: Time to TB patient loss to follow-up between health centers and a general hospital was significant. Loss to follow-up was high in patients with older age, rural residence, sero positive for HIV, living further from the health facilities, and following treatment and care at health centers. Strengthening the DOTs program with special emphasis on health centers is highly recommended.

Sero-prevalence of hepatitis B virus and associated factors among pregnant women in Gambella hospital, South Western Ethiopia: facility based cross-sectional study.

BACKGROUND: Hepatitis B virus (HBV) is a hepatotropic deoxyribonucleic acid (DNA) virus which causes death. More than 300 million people have chronic liver infections globally and about 600,000 people die annually from acute or chronic complications of hepatitis B infection. Recent studies conducted in Ethiopia showed moderate endemicity (3-7.8%) of HBV among pregnant women. However, there is paucity of information on sero- prevalence of HBV and associated factors among pregnant women at Gambella town. The aim of this study is to assess sero-prevalence of hepatitis surface antigen (HBsAg) and associated factors among pregnant women in Gambella Hospital. METHODS: Hospital based cross-sectional study was conducted in a total of 253 pregnant women from March 10-April 15, 2017. Socio-demographic characteristics and risk factors were collected through face to face interview using structured questionnaire. HBV infection was determined using Eugene strip test. Logistic regression analysis was used to determine association between HBsAg sero-positivity and various factors. Findings were presented using 95% CI of Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR). RESULT: The overall sero- prevalence of HBV infection was 7.9% (95% CI, 4.7-11.9), which indicates intermediate endemicity. History of abortion (AOR = 3.56:1: 95% CI, 1.24-10.22), occupation (AOR = 8.36:95% CI, 1.67-41.96) and multiple sexual partner (AOR = 17.38: 95% CI, 4.48-67.49) had statistical significant association with HBsAg sero-positivity. CONCLUSION: HBV sero-prevalence in pregnant women shows intermediate endemicity. Hence health education on having single sexual partner and risk factors of abortion should be given. In addition, routine screening and immunization of pregnant women for HBV infection should be strengthen.

Proximate Determinants of Under-Five Mortality in Ethiopia: Using 2016 Nationwide Survey Data.

INTRODUCTION: Although there has been a remarkable decline in under-five mortality through the decades, it is still highest in socio-economically disadvantaged countries, including Ethiopia. The benefits of reducing under-five mortality have been highly emphasized in the ambitious target of Sustainable Development Goals. The risk factors of under-five mortality have not been exhaustively researched in Ethiopia using recent nationwide survey data. OBJECTIVE: This study aimed to determine the risk factors of under-five mortality using the recent nationwide survey data. METHOD: The data source for this study was the 2016 Ethiopian Demographic and Health Survey. Bivariate and multivariable logistic regression analysis was conducted and statistical significance was declared at p value < 0.05. RESULTS: The data for a total of 10,641 under-five children were analyzed and the under-five mortality rate was 67 per 1000 live births in this study. In the final model, rural residence (AOR=2.0, [1.20, 3.30], P=0.008), mothers who gave birth with preceding birth intervals of shorter than 24 months (AOR=2.12, CI=[1.72, 2.61], P<0.000), multiple births (AOR=4.74, CI=[3.34, 6.69], P<0.000), very small size of child at birth (AOR=1.43, CI= [1.10, 1.85], P=0.007), and being male (AOR=1.30, CI=[1.07, 1.57], P<0.008) showed significant association with under-five mortality compared to their counterparts. CONCLUSION: Under-five mortality was significantly associated with place of residence, preceding birth interval, plurality, size of child at birth, and sex of the child. Thus, special emphasis should be placed on children with rural residence, preceding birth interval of shorter than 24 months, very small size of the child at birth, and male children.