Epidemiological Characteristics of Cancer Patients Attending at Felege Hiwot Referral Hospital, Northwest Ethiopia.

BACKGROUND: Cancer has become a public health problem and a challenge in developing countries, including Ethiopia. There is scanty local data on cancer epidemiology in Amhara region, Ethiopia. Thus, this study aimed to describe epidemiological characteristics of cancer patients attending Felege Hiwot Referral Hospital. METHODS: This study was based on a patient cancer registry that took place in Bahir Dar Felege Hiwot Referral Hospital, Amhara Regional State, Ethiopia. It is the main referral hospital in the Amhara region, and serves more than 5 million people. The hospital has units including oncology for follow-up health care services. All confirmed cancer patients attending oncology units from July 2017 to June 2019 were included in the study. Global Moran's I statistic was employed to assess spatial heterogeneity of cancer cases across districts. Getis-Ord Gi* statistics was performed to identify hot spot districts with high numbers of cancer cases. RESULTS: In a two-year period, a total of 1888 confirmed cancer patients were registered. There was a significant variation of cancer patients between females (60.8% 95%CI 58.5 to 63.0%) and males (39.3% 95%CI 37.0 to 41.5%). The first three most frequent cancer types seen were breast (19.4%) and cervical cancer (12.9%), and lymphoma (15.7%). Breast and cervical cancer and lymphoma were the first three cancers type among women, whereas lymphoma, sarcoma, and lung cancer were the three most common cancer among men. Spatially, cancer cases were non-random in the study area (global Moran's I = 0.25, z-score = 5.6, p-value < 0.001). Bahir Dar city administration (z = 3.93, p < 0.001), Mecha (z = 3.49, p < 0.001), Adet (z = 3.25, p < 0.01), Achefer (z = 3.29, p < 0.001), Dangila (z = 3.32, p < 0.001), Fogera (z = 2.19, p < 0.05), and Dera (z = 2.97, p < 0.01) were spatially clustered as hotspot with high numbers of cluster cases. CONCLUSIONS: We found that there is a variation in the cancer types with sex. This study provides an insight for further exploration of environmental and occupational exposure related factors for cancer to guide future cancer prevention and control programs. The current study also calls for expansion of cancer registry sites, including in rural areas in the region.

Duration on ART, Alcohol Use and HIV Stage May Predict Risky Sexual Behavior in a Resource-limited Environment: A Cross-sectional Study.

BACKGROUND: The intention of antiretroviral therapy (ART) and regular clinic visits are to engender safe sex attitudes among HIV-infected individuals. However, this may not be the case due to the perceived therapeutic benefits of ART and may result in exposure to drug-resistant HIV strains. OBJECTIVES: We aimed to determine the prevalence and predict the factors associated with risky sexual behaviors among ART users in a resource-limited environment. METHODS: Two hundred and ninety-one sexually active ART-users aged 18-50 years and seeking care at the HIV clinic in Dodoma, Tanzania, participated in this study. The outcome variables modeled in a logistic regression were condom use, multiple sex partners, casual sex partners, and payment for sex. The predictors included in the models were the patients' socio-demographic characteristics. In addition, a new variable, sexual risk scores, was generated by culminating all the outcome variables. Finally, a multiple Poisson regression with the socio-demographic variables of the participants was used to model the sexual risk scores. RESULTS: Patients reported inconsistent/no condom use (44%), payment for sex (4%), casual sex encounters (13%), multiple sex partners (21%), and STD symptoms (15%). While having a casual sexual partner was significantly associated with age group in a Pearson Chi-square (p=0.0147), participants ≤35 years old were less likely to have single-sex partners than older participants (AOR: 0.188, 95 C.I: 0.042-0.849). Meanwhile, the likelihood of condom use was higher among participants with no HIV-infected family members (AOR= 2.409, 95% C.I:1.236,4.697) and among participants who had single-sex partners (AOR= 2.721, 95% C.I.: 1.115,6.640); these participants were less likely to report STD symptoms (AOR=0.265, 95% C.I.: 0.081-0.865). Adjusted analysis showed that estimated mean sexual risk scores significantly increased (mean, λ=1.61, 95% C.I:1.0817-2.4063) for recent ART recipients (within 1-3 years vs. ≥8 years). However, sexual risk scores of participants with HIV stage 3 were 38.8% lower than participants at stage 4 (95% C.I.: 0.3910-0.9558), and non-alcohol drinkers had an adjusted mean sexual risk score of 29% lower than participants who were alcohol drinkers (95% C.I.: 0.5102-0.9879). CONCLUSION: Researchers should prioritize patients at HIV CTC for education concerning safe sexual practices for those characterized by alcohol consumption, younger age (less than 35 years old), HIV stage 4, or commencement of ART within three years.

Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Early initiation of breast feeding has great importance for both mothers and newborns. Despite, recommendations for exclusive and early initiation of breast feeding within one hour of birth, Ethiopia reports that 58% of infants under six months of age are exclusively breastfed. Cesarean deliveries may affect timing of breastfeeding initiation, establishment of milk supply and infant breastfeeding interest compared to vaginal deliveries. The aim of this study was to assess the impact of cesarean delivery on breastfeeding initiation. METHODS: A cross-sectional study was conducted with a total of 7115 study participants from the 2016 Ethiopian Demographic Health Survey (EDHS). Both descriptive and analytical statistical analysis was employed. Univariable and multivariable logistic regression analyses were used to identify anyassociations between variables. Odds ratios with its corresponding 95% confidence intervals (CI) were reported. During multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. RESULTS: The prevalence of late initiation of breast feeding among women with their last live birth was 25.03% (95%CI; 20.5-32.2). Significant factors associated with late initiation of breastfeeding were cesarean delivery [AOR = 4.06 (95%CI, 2.66-6.2)], primipara mother [AOR = 1.45(95%CI, 1.13-1.7)], and having an unplanned pregnancy [AOR = 1.35(95%CI, 1.1-1.65)]. Positively associated with early initiation of breastfeeding was the mother's age, for women between 20-34 years-old. This association, reported as a negative association of late initiation of breast feeding was [AOR = 0.77(95%CI, 0.61-0.98)]. CONCLUSION: Cesarean delivery adversely affects the initiation of breast feeding. Cesarean delivery, unplanned pregnancy, and being primiparous, were associated with late initiation of breastfeeding. Women between the ages of 20-34 years of age had a reduced chance of late initiation of breastfeeding. Providing counseling regarding the strategy and importance of early initiation of breast feeding, could have crucial importance for the mother and her newborn.

Cervical Cancer Screening among Women Receiving Antiretroviral Therapy in a Resource-Limited Environment.

BACKGROUND: Cervical cancer is among the most prevalent cancer among women worldwide and women living with HIV are at increased risk, especially in a resource-limited environment. OBJECTIVE: This study aimed to determine levels of awareness, knowledge, uptake, and willingness to screen for cervical cancer among women receiving care in an HIV clinic at Dodoma Regional Referral Hospital (DRRH), Tanzania. METHODS: Data were collected for a period of three weeks from July 21 to August 11, 2017 using a mobile phone data collection App. A total of 421 Women aged 18-50 years old were included in the study. RESULTS: Majority of the women interviewed (n=306, 73%) were aware of cervical cancer. Among those who were aware, 84% (n=257) did not recall ever being screened for cervical cancer, and majority had a poor knowledge of cervical cancer. Educational level completed (p=0.01), income per month (p=0.02), age group (p<0.0001), and area of residence (p<0.0001) were all significantly associated to awareness of cervical cancer. Most of the women who have never screened (n=231, 91%) expressed willingness to be screened. Prior uptake of cervical cancer screening was associated with number of live births (p=0.001) and area of residence (p=0.04). And Willingness to screen was significantly associated with age groups (p=0.03) and the number of live births (p=0.03). Moreover, we found that younger age and urban residence was positively associated with awareness and uptake of cervical cancer screening. Willingness was found to decrease as age increased. CONCLUSION: The study found that despite older women's higher risk of cervical cancer, those who indicated willingness to screen were younger. Additional education, health promotion, and integration of cervical cancer screening services is needed to improve cervical cancer awareness and screening uptake at the HIV clinic.
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Prevalence and Factors Associated with Current Cigarette Smoking among Ethiopian University Students: A Systematic Review and Meta-Analysis.

BACKGROUND: Although tobacco use is highest in high-income countries, most tobacco-related deaths occur in low- and middle-income countries with the highest number of deaths recorded in East Africa. The aim of this systematic review and meta-analysis is to determine the pooled prevalence and associated factors of current cigarette smoking among Ethiopian university students. METHODS: The authors searched databases from PubMed, PsycINFO, Google Scholar, EMBASE, and Web of Sciences. The publications included in the analysis were inclusive, the literature was searched from January 2011 to December 2018. The JBI-MAStARI critical appraisal tool was applied to 13 publications identified by the database search. I2 statistics were used to indicate heterogeneity. Publication bias was evaluated using the visual funnel plot. A p value < 0.1 was considered as indicative of statistically significant publication bias. A random effect meta-analysis model was computed to estimate the pooled prevalence of cigarette smoking, and the variables associated with cigarette smoking were examined. RESULTS: The meta-analysis of 13 studies showed that the pooled prevalence of current cigarette smoking was found to be 12.55% (95% CI: 10.39-14.72; I2 = 94.0%) with no publication bias according to Egger's test (p = 0.007) for cigarette smoking by 2.05 (95% CI: 1.52-2.75). Factors associated with cigarette smoking were peer influence 2.79 (95% CI: 1.62-4.82; I2 = 35.7), khat chewing (95% CI: 2.81-15.26; I2 = 82.5), and alcohol use 11.16 (95% CI: 7.46-16.71). CONCLUSION: Our findings indicate a high prevalence of cigarette smoking among Ethiopian university students as compared to the general population. Gender, peer influence, khat chewing, and current alcohol use were significantly associated with cigarette smoking. The authors recommend promoting antismoking campaigns, emphasizing health hazard public service announcements about cigarettes, and integrating health education on smoking in youth-friendly services, especially targeting higher educational institutions.