Determinants of severe acute malnutrition among children aged 6-23 months in bahir dar city public hospitals, Northwest Ethiopia, 2020: a case control study.

BACKGROUND: Severe acute malnutrition is a major problem among developing countries and it is one of the major causes of mortality and morbidity in Ethiopia. The impact is more severe among children aged 6-23 months. Severely malnourished children are nine times more likely to die than healthy children. Identification of the determinants of severe acute malnutrition under the age of two years can significantly reduce the burden of child morbidity and mortality. Therefore, this study was aimed to assess determinants of severe acute malnutrition among children aged 6-23 months at Bahir Dar city public hospitals, Northwest Ethiopia, 2020. METHODS: Institutional-based unmatched case-control study was conducted among a total sample size of 201 children (67 cases and 134 controls) in Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized teaching hospital, from February 2020-March 2020. Children diagnosed with severe acute malnutrition were considered as cases and children with other problems were control groups. The study participants were randomly selected from pediatrics units in the two specialized hospitals. Data were collected using a structured pretested questionnaire through interviews and anthropometric measurements. The data were entered into Epi data version 3.1 and exported to SPSS software version 23 for analysis. Variables with (p < 0.25) in the bivariable analysis were entered into multivariable logistic regression. For multivariable analysis, a backward method was selected with a 95% confidence interval. Statistical significance was declared at P < 0.05. RESULTS: In this study, 67 cases and 134 controls of children with their mothers had participated with an overall response rate of 100%. Family size > 5 [(AOR = 3.89, 95% CI:(1.19, -12.70)], average perceived birth weight [(AOR = 0.048, 95% CI: 0.015, -0.148)] and large perceived birth weight [(AOR = 0.023, 95% CI:(0.002, -0.271)], introduction of complementary feeding before six months [(AOR = 6.21, 95% CI: (1.44, -26.76)] and dietary diversity score < 5 groups [(AOR = 9.20, 95% CI; 3.40, -19.83)were significant factors associated with severe acute malnutrition. CONCLUSION: In this study, dietary diversity, family size, perceived birth weight, and initiation of complementary feeding were significantly associated with severe acute malnutrition. Therefore, emphasis should be given to improving infant and young child feeding practices, especially timely initiation of complementary feeding and dietary diversity.

Incidence and predictors of anemia among adults on HIV care at South Gondar Zone Public General Hospital Northwest Ethiopia, 2020; retrospective cohort study.

BACKGROUND: Anemia is a major public health problem worldwide which accounts 24.8% of the population. Subsequently, anemia is a leading killer of people living with human immunodeficiency virus and many of these deaths occur in developing countries including Ethiopia. Cross sectional studies have done on anemia and human immunodeficiency virus. However, there is limited study on incidence of anemia and its predictors among adults on HIV care, especially no survival study has been conducted in the study area. OBJECTIVE: To assess incidence and predictors of anemia among adults on Human immunodeficiency virus care. METHODS: An institution-based retrospective cohort study was conducted among 434 adults on HIV care from January 1st 2015 to December 30th 2019 at Debre Tabor Referral Hospital. A computer-generated simple random sampling technique was employed to select the study participants. Ethical clearance was obtained from the Institutional Review Board of Bahir Dar University, and also, we got implied consent to review charts from the concerned bodies in the hospital. Data were entered using Epi-data version 3.1 and analyzed by using STATA version 14.0. A Kaplan Meier survival curve was utilized to estimate anemia free survival time. Bivariable and Multivariable Cox proportional hazards model were fitted to identify predictors of anemia. RESULTS: The overall incidence density rate of anemia was 6.27 (95% CI: 0.051, 0.077) per 100 person years. Clinical stage III/IV (AHR = 1.04; 95% CI = 1.02, 1.06), Body Mass Index less than 18.5 kg/m2 (AHR = 3.11; 95% CI = 1.56, 6.22), serum creatinine greater than 1.1 IU/L(AHR = 2.07; 95% CI = 1.12, 3.81) and fair/poor level of adherence(AHR = 1.05; 95% CI = 1.03, 1.07) were statistically significant predictors of anemia while increased anti-retroviral treatment duration (AHR = 0.98; 95% CI = 0.97, 0.99) decrease the risk of anemia at 95% confidence level. CONCLUSION: The overall incidence density rate of anemia was high. Patients with clinical stage III/IV, body mass index < 18.5 kg/m2, serum creatinine greater than 1.1 IU/L and fair/poor level of adherence were significant predictors of anemia while increased antiretroviral treatment duration had decreased the risk of anemia. RECOMMENDATION: Even if the overall incidence rate of anemia was lower as compared to previous studies in Ethiopia, still the incidence of anemia was high. So, prevention measures should be taken beside with HIV care especially within 6-months ART initiation.

Incidence and Predictors of Loss to Follow-Up Among Children Attending ART Clinics in Northeast Ethiopia: A Retrospective Cohort Study.

BACKGROUND: It is known that antiretroviral therapy reduces the transmission of human immunodeficiency virus and AIDS-related morbidity. The coverage of HIV drugs is increasing to control further spread of HIV and children living with HIV are the target groups in using these medications. However, loss to follow-up remains a critical challenge among these groups of the population. The aim of this study was therefore to assess the incidence and predictors of loss to follow-up among children attending antiretroviral therapy clinics. METHODS: A ten-year institution-based retrospective cohort study was employed among 448 children enrolled in antiretroviral therapy. Data were entered and cleaned using EpiData version 3.1 and then exported to STATA version 14 for further statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time and the Log rank test was used to compare the survival time between different categories of the explanatory variables. Multivariable Cox proportional hazards model was fitted to identify predictors of loss to follow-up and p-value < 0.05 was considered statistically significant. RESULTS: The incidence rate of loss to follow-up was 6.3 per 100 children years of observation. Being male (AHR = 2.1, CI = 1.37, 3.34), aged 1-5 years (AHR = 1.6, CI = 1.05, 2.46), poor adherence to antiretroviral therapy (AHR = 6.6; CI = 4.11, 10.66), fair adherence to antiretroviral therapy (AHR = 2.2; CI = 1.13, 4.20), regimen was not changed (AHR = 4.1; CI = 2.59, 6.45), World Health Organization stage III and IV (AHR = 2.2; CI = 1.40, 3.33) and height for age <-2 z score (AHR = 2.2; CI = 1.43, 3.44) were predictors of loss to follow-up. CONCLUSION: Nearly seven out of 100 HIV-infected children were lost to follow-up from their link to ART clinics within a one-year follow-up. Non-modifiable demographic characteristics, clinical stage and nutritional status, and ART-related variables were associated with children's loss to follow-up. Therefore, close monitoring of the "at risk" groups might decrease the rate of loss to follow-up. Improving adherence to antiretroviral therapy and nutritional support are also recommended.