Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review.

Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.

Health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy attending Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study.

OBJECTIVE: To determine the mean score of health-related quality of life in epilepsy and its associated factors among adult patients with epilepsy. DESIGN: Institution-based cross-sectional study based on random case selection was conducted. SETTING: The study was carried out at Mizan-Tepi University Teaching Hospital located in Southwest Ethiopia. PARTICIPANTS: A total of 346 patients with epilepsy who visited the psychiatric clinic for follow-up for at least 3 months and who were 18 years or older were included in the study. MAIN OUTCOME MEASURE: Health-related quality of life in epilepsy measured using quality-of-life in epilepsy (QOLIE)-31 health survey evaluated as a dependent variable with simple and multivariable linear regressions. RESULTS: The overall weighted mean score of health-related quality of life was 55.6 (SD=20.9). Only 50.3% of patients scored above a total score of 50. Age (ß=-0.35, 95% CI-0.46 to -0.23), anxiety (ß=-6.79, 95% CI -9.26 to -4.32), depression (ß=-7.36, 95% CI -10.16 to -4.55), low self-esteem (ß=-5.29, 95% CI -8.07 to -2.51), perceived stigma (ß=-3.62, 95% CI -6.30 to -0.94), taking medication two times or more times per day (ß=-2.4, 95% CI -4.58 to -0.27), being illiterate (ß=-4.1, 95% CI -6.87 to -1.31) and having more than two seizures for a year (ß=-4.18, 95% CI -6.97 to -1.39) were negatively affecting health-related quality of life while income of >1000 birr per month (ß=4.5, 95% CI 2.00 to 6.99), social support (ß=0.34, 95% CI 0.27 to 0.40) and being free of seizure for a year (ß=6.5, 95% CI 3.66 to 9.33) were positively affecting health-related quality of life. CONCLUSIONS: Only half of the patients with epilepsy in the study area are leading a better quality of life and the overall mean health-related quality of life score is lower than the global mean score. Health-related quality of life was inversely associated with age, anxiety, depression, low self-esteem, perceived stigma, taking medication two times a day or more, being illiterate and experiencing more than two seizures in a year. Besides controlling seizures, public educational campaigns should be conducted to raise public awareness regarding the need for social support.

Adolescent's and youth's adherence to antiretroviral therapy for better treatment outcome and its determinants: multi-center study in public health facilities.

BACKGROUND: Low-adherence to Anti-retroviral therapy (ART) negatively affects the clinical, immunological, and virologic outcomes of patients. Adherence is the most important factor in determining Antiretroviral Therapy (ART) treatment success and long-term viral suppression which ultimately reduces morbidity and mortality. Thus, this study aimed to identify factors affecting adherence to antiretroviral therapy among adolescents and youth living with HIV. METHODS: Facility-based cross-sectional study was conducted from March 21 to April 30, 2020 among 316 respondents in selected five high-loaded hospitals with adolescent and youth clients using systematic random sampling technique. Patients' adherence was assessed when they had reportedly taken 95% or higher of their prescribed antiretroviral drugs in the five days before the interview. Data were collected, entered into EPI Data and exported to SPSS for analysis. Binary logistic regression was used to see the association between dependent and independent variables. RESULTS: In this study, 316 respondents participated in the study, with a 99.7% response rate. The mean age of respondents were 17.94 years and majority of them (58.5%) were females. The overall ART adherence among adolescents and youths was found to be 70.6%. Being female (AOR = 0.323, 95% CI, 0.164-0.637), presence of opportunistic infection (AOR = 0.483, 95% CI, 0.249-0.936), taking additional medication beside ART (AOR = 0.436, 95% CI, 0.206-0.922) and availability of youth friendly services within the facility (AOR = 2.206, 95% CI, 1.031-4.721) were found to be predictors. CONCLUSION: The adherence rate in this study was low which is below the recommended adherence level. Being female, taking additional medication beside ART and presence of opportunistic infection were determinants of adherence. As a result, significant work must be done on opportunistic infection prevention through health education and promotion for screening and risk reduction. Similarly, adolescents and youths service integration with the ART Clinic is strongly advised.

Factors associated with uptake of human papillomavirus vaccination among adolescent girls in Mettu town, southwest Ethiopia: a school-based cross-sectional study.

OBJECTIVE: This study was designed to assess the level of uptake of human papillomavirus (HPV) vaccination and its associated factors among school-age adolescent girls. DESIGN: School-based cross-sectional study. SETTING: High schools in Mettu town, southwest Ethiopia, from 5 February to 10 March 2022. PARTICIPANTS: Data were collected using a pretested and structured questionnaire through face-to-face interviews with 667 adolescent girls selected via multistage random sampling. Data were entered into EpiData V.3.1 and exported to SPSS V.26 for analysis. Simple binary logistic regression was done, and variables with a p value less than 0.25 were entered into a multivariable logistic regression model; variables with a p value <0.05 were considered significant. RESULTS: About half (48.6%) of adolescent girls aged 14-18 years had received the HPV vaccine. Being in the 16-18 years age group (adjusted OR 2.7, 95% CI 1.50 to 4.80), having good knowledge (2.14, 95% CI 1.29 to 3.52), having a positive attitude (5.86, 95% CI 3.51 to 9.76), and getting encouragement from healthcare workers (3.04, 95% CI 1.36 to 6.79), teachers (2.14, 95% CI 1.05 to 4.34) and parents (2.39, 95% CI 1.02 to 5.64) were significantly associated with vaccine uptake. CONCLUSION: The uptake of HPV vaccination was low. Having good knowledge and positive attitude as well as encouragement from parents, healthcare workers and teachers were identified as factors associated with HPV vaccine uptake. Improving knowledge about HPV and involving teachers and parents in the immunisation campaign might help promote HPV vaccine uptake.

A systematic review and meta-analysis of adolescent nutrition in Ethiopia: Transforming adolescent lives through nutrition (TALENT) initiative.

BACKGROUND: Ethiopia has undergone rapid economic growth over the last two decades that could influence the diets and nutrition of young people. This work systematically reviewed primary studies on adolescent nutrition from Ethiopia, to inform future interventions to guide policies and programs for this age group. METHOD: A systematic search of electronic databases for published studies on the prevalence of and interventions for adolescent malnutrition in Ethiopia in the English language since the year 2000 was performed using a three-step search strategy. The results were checked for quality using the Joanna Bridge Institute (JBI) checklist, and synthesized and presented as a narrative description. RESULTS: Seventy six articles and two national surveys were reviewed. These documented nutritional status in terms of anthropometry, micronutrient status, dietary diversity, food-insecurity, and eating habits. In the meta-analysis the pooled prevalence of stunting, thinness and overweight/obesity was 22.4% (95% CI: 18.9, 25.9), 17.7% (95% CI: 14.6, 20.8) and 10.6% (7.9, 13.3), respectively. The prevalence of undernutrition ranged from 4% to 54% for stunting and from 5% to 29% for thinness. Overweight/obesity ranged from 1% to 17%. Prevalence of stunting and thinness were higher in boys and rural adolescents, whereas overweight/obesity was higher in girls and urban adolescents. The prevalence of anemia ranged from 9% to 33%. Approximately 40%-52% of adolescents have iodine deficiency and associated risk of goiter. Frequent micronutrient deficiencies are vitamin D (42%), zinc (38%), folate (15%), and vitamin A (6.3%). CONCLUSIONS: The adolescent population in Ethiopia is facing multiple micronutrient deficiencies and a double-burden of malnutrition, although undernutrition is predominant. The magnitude of nutritional problems varies by gender and setting. Context-relevant interventions are required to effectively improve the nutrition and health of adolescents in Ethiopia.

Determinants of diabetic retinopathy in Southwest Ethiopia: a facility-based case-control study.

BACKGROUND: Diabetic Retinopathy is one of the serious complications patients' diabetic patients suffer from. Little is known about which risk factors are associated with this complication. The aim of this study was therefore to identify determinants of Diabetic Retinopathy in Jimma University Medical Center. METHODS: A facility-based case-control study was conducted. Cases were Diabetic patients with diabetic retinopathy and who were on follow up at the Jimma University Medical Center while controls were Diabetic patients but free of diabetic retinopathy and who were on follow up at the Jimma University Medical Center. Cases and controls were identified and 311 of them were recruited using systematic random sampling. Data were entered into the Epi-Data version 4.1 and analyzed using SPSS Version 20. Binary Logistic regression analysis was conducted to identify determinants of diabetic retinopathy. RESULT: A total of 106 cases and 205 controls diabetic participated in the study. Being ≥60 years of age (AOR = 5.04,95%CI: 1.83,13.87),being illiterate (AOR = 7.17, 95% CI: 2.61,19.7), poor adherence to medication (AOR =3: 95% CI: 1.29,6.95),having high systolic blood pressure (AOR = 3.38:95% CI: 1.26,9.05), having family history of Diabetes Mellitus (AOR = 3.95: 95% CI: 1.64,9.54), having other micro vascular complications (AOR = 3.76,95% CI: 1.33,10.66), poor glycemic control (AOR = 9.08, 95%CI: 3.7,22.29), poor cholesterol control (AOR = 0.21, 95%CI: 0.08,0.51) and being anaemic (AOR = 2.8, 95%CI: 1.05,7.47) were the independent determinants of diabetic retinopathy. CONCLUSION: This study found that poor adherence to medication, being at the age of 60 years and above, being illiterate patients, having high systolic blood pressure, having a family history of Diabetes Mellitus, having other micro vascular complication, poor glycemic control, poor cholesterol control and being anemic patient were the independent determinants of diabetic retinopathy. Therefore, more attention should be given to older age and illiterate patients. Giving more emphasis for patients poorly adhered to anti-diabetic medications and giving advice for diabetic patients with high systolic blood pressure to follow their blood pressure regularly are also vital. Diabetic patients should also control their Blood sugar and blood cholesterol levels to prevent diabetic retinopathy or reduce its further complications.

Prevalence of Visual Impairment and Associated Factors Among Primary Schoolchildren in Addis Ababa, Central Ethiopia.

BACKGROUND: Visual impairment (VI) refers to reduction of vision resulting in a lower than normal visual acuity (VA). Although school programs are recommended for early detection and timely interventions of VI, available information with regard to prevalence of VI and associated factors among primary schoolchildren near to the main city, Addis Ababa is inadequate. Thus, we assessed the prevalence of VI and the associated factors among children attending government primary schools of Lideta sub-city, Addis Ababa, Ethiopia. METHODS: This was a school-based cross-sectional study conducted from April to May 2019, using a two-stage cluster sampling method in Lideta sub-city, Addis Ababa, Ethiopia. From the total 18 government primary schools in Lideta sub-city, six were selected using probability proportionate to size (PPS) method. The study population was primary schoolchildren aged 7 to 17 years in the selected six primary schools. A total of 816 eligible primary schoolchildren were identified to be included in the study. The selected children were examined for the presence of VI. Children's parents/guardians were interviewed using structured pre-tested questionnaires. In this study, myopia and hyperopia were defined as difficulty in viewing distant and near objects, respectively. Similarly, astigmatism was a refractive error which results from an uneven cornea surface, which results in distorted images. Epi-data 3.1 and SPSS version 20 were used for data entry and analysis, respectively. Binary logistic regression was performed to check association between dependent and independent variables. Significance was set at p-value <0.05. RESULTS: From a total of 816 eligible primary schoolchildren, 773 children were examined for VI, making the response rate 94.7%. Out of the 773 children, 370 (47.9%) were male and 403 (52.1%) were female. The mean age of the participants was 11.69 years (SD 2.64 years). The prevalence of VI among schoolchildren was 4.4%. The causes of VI included myopia (43%), astigmatism with or without amblyopia (31%), hyperopia with or without amblyopia (20%), and others. The parents/guardians not being aware of their children's eye problem (AOR=2.2, 95% CI: 1.2-4.4) was the only significantly associated factor with VI. CONCLUSION: In this study, the prevalence of VI among schoolchildren was high. The students being unaware about their eye problem was significantly associated with VI. Thus, close monitoring and regular screening for VI in schoolchildren are highly recommended to allow timely intervention.

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.

Predictors of neonatal mortality in Assosa zone, Western Ethiopia: a matched case control study.

BACKGROUND: Benshangul Gumuze region is one of the regional states in Ethiopia, with highest rate of neonatal mortality rate. The trend increased at alarming rate from 42/1000 live birth in 2005 to 62/ 1000 live birth in 2011. Hence, identifying predictors of neonatal death and implement evidence based interventions at community level is crucial to reduce the mortality. Therefore, the purpose of this study was to identify predictors of neonatal mortality in Assosa zone, Western Ethiopia. METHODS: A community based matched case control study was conducted from February 1, until December 30, 2013. The study included 114 cases who died during the first 28 completed days after birth from September 1, 2010 till September 1, 2013. For each case, one alive control matched approximately by the same date of birth (-/+ 2 days) was identified from the preliminary data collected. Finally, multivariate conditional logistic regression analysis was performed; and goodness of fit of the final model was tested using likely hood ratio test. All analysis was done using EPI Info version 7 and SPSS version 16 statistical softwares. RESULTS: Model households in health extension packages [AmOR = 0.32; 95%CI:0.12-0.86], age at first pregnancy < 20 years old [AmOR = 4.3;95%CI: 1.13-16.27],pregnancy complication [AmOR = 4.59; 95%CI: 1.53-13.78], delivery complication [AmOR = 2.80; 95%CI: 1.06-7.39], antenatal care visit [AmOR = 0.34;95%CI: 0.12-0.94], primipara mothers [AmOR = 3.37; 95%CI:1.05-10.78], small size neonate at birth [AmOR = 3.40: 95%CI: 1.05-11.55], gestational age < 37 weeks [AmOR = 4.35;95%CI:1.16-16.28], and home delivery [AmOR = 2.84; 95%CI:1.07-7.55] were found statistically significantly associated with neonatal mortality. CONCLUSIONS: Model households in health extension package and antenatal care visit were associated with reducing risk of neonatal mortality. However, age at first pregnancy < 20 years old, primipara mothers, pregnancy complication, delivery complication, small size neonates, gestational age < 37 weeks, and home delivery were associated with increasing risk of neonatal death. Therefore, promotion of model household in health extension package, anti natal care visit, institutional delivery, family planning to prevent early age pregnancy; and improve access to basic emergency obstetric care and intensive newborn care centers are effective interventions to reduce risk of neonatal mortality at community level.

Predictors of Clinical and Immunological Failure Among Patients on First-Line Antiretroviral Therapy (ART) in Southwest Ethiopia.

BACKGROUND: Global expanded access to antiretroviral therapy has led to a rapid fall in the number of people dying from HIV-related causes. However, the remarkable achievement recorded in reducing morbidity and mortality has been affected due to the occurrence of first-line ART failure. The study was intended to identify predictors of clinical and immunologic failure of first-line ART in southwest Ethiopia. METHODS: A retrospective cohort study was conducted among 737 randomly selected ART patients from 1st January 2010 to 30th June 2016. Trained data collectors collected the data from the patients' follow-up charts and electronic databases. The Kaplan Meier (KM) curve was used to describe the probability of survival time to antiretroviral treatment failure. Variables with a p-value of ≤ 0.05 in a multivariable cox-proportional hazard model were statistically significant predictors of first-line ART failure. RESULTS: Among 737 HIV patients on ART followed retrospectively, 445 (60.4%) were females. During the follow-up period, the incidence rate of treatment failure was 7.3 per 100 person-year observations, and the highest rate was observed during the first 6 to 12 months of ART initiation. Not disclosing HIV status (AHR꞊ 2.04, 95% CI: 1.32-3.16), being bedridden (AHR꞊ 2.01, 95% CI: 1.02-3.98) and low hemoglobin at ART initiation (AHR꞊ 2.02, 95% CI: 1.29-3.13) were associated with an increased hazard rate for first-line ART failure. CONCLUSION: The study showed that predictors of first-line ART treatment failure are modifiable. Therefore, these factors should be addressed during routine care of HIV patients by health care providers to preserve the rapid exhaustion of  first-line medications, improve the quality of life of the patients and reduce HIV/AIDS related deaths.

Infection Prevention Practices and Associated Factors among Healthcare Workers in Governmental Healthcare Facilities in Addis Ababa.

BACKGROUND: Failure to follow proper infection prevention practices puts healthcare workers, patients and communities at risk. Despite the increases of highly contagious infections, infection prevention practices among healthcare workers is unknown in many developing countries. The need to understand infection prevention practices is important for prevention and control of nosocomial infections. Therefore, the objective of this study was to assess infection prevention practices and associated factors among healthcare workers in governmental healthcare facilities in Addis Ababa, Ethiopia. METHODS: A facility based cross-sectional study design was conducted from February to March 2016, in Addis Ababa among 629 healthcare workers who were selected by multistage sampling technique from 30 governmental healthcare facilities. Data were collected using pre-tested interviewer administered structured questionnaire. Data were entered into Epi -data 3.1 and exported to SPSS version 20 for analysis. Multivariable logistic regression model was used to identify factors associated with infection prevention practices.. Findings were presented using odds ratios with their 95% confidence intervals., A p-value less than 0.05 were used to declare statistical significance. RESULTS: Six hundred five (96.2%) healthcare workers participated in the study. Four hundred (66.1%, (95%CI: 62.1%-70.1%)) health care workers had good infection prevention practices. Having good knowledge on infection prevention meausures (AOR =1.53, 95%CI: 1.05-2.22), having positive attitude towards infection prevention practices (AOR=2.03, 95%CI: 1.26-3.26), having awareness on availability of standard operating procedures (AOR=1.97, 95%CI: 1.34-2.93) and presence of continuous water supply (AOR=1.68, 95%CI: 1.11-2.56) were predictors of good infection prevention practices. CONCLUSION: Two-third of the healthcare workers had good infection prevention practices. Having good knowledge on infection prevention measures, having positive attitude towards infection prevention practices, having awareness on availability of standard operating procedures and presence of continuous water supply were predictors of good infection prevention practices. To sustain good practices, adequate pre-service and in-service training should be in place to equip and update health care workers about infection prevention precautions. The need for continuous supervision should be implemented to strengthen adherence for infection prevention practices among workers along with sustainable and reliable water supply is crucial.

Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia.

BACKGROUND: In Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. This study aims to determine prevalence, causes and management outcome of intestinal obstruction in Adama Hospital in Oromia region, Ethiopia. METHOD: A hospital based cross-sectional study design was used. Data covering the past three years were collected from hospital medical records of sampled patients. The collected data were checked for any inconsistency, coded and entered into SPSS version 16.0 for data processing and analysis. Descriptive and logistic regression analyses were used. Statistical significance was based on confidence interval (CI) of 95 % at a p-value of < 0.05. RESULT: 262 patients were admitted with intestinal obstruction. The prevalence of intestinal obstruction was 21.8 % and 4.8 % among patients admitted for acute abdomen surgery and total surgical admissions, respectively. The mortality rate was 2.5 % (6 of 262). The most common cause of small bowel obstruction was intussusceptions in 48 patients (30.9 %), followed by small bowel volvulus in 47 patients (30.3 %). Large bowel obstruction was caused by sigmoid volvulus in 60 patients (69.0 %) followed by colonic tumor in 12 patients (13.8 %). After controlling for possible confounding factors, the major predictors of management outcome of intestinal obstruction were: duration of illness before surgical intervention (adjusted odds ratio (AOR) = 0.49, 95 % CI: 0.25-0.97); intra-operative findings [Viable small bowel volvulus (SBV) (AOR = 0.08, 95 % CI: 0.01-0.95) and viable (AOR = 0.17, 95 % CI: 0.03-0.88)]; completion of intra-operative procedures (bowel resection & anastomosis (AOR = 3.05, 95 % CI: 1.04-8.94); and length of hospital stay (AOR = 0.05, 95 % CI: 0.01-0.16). CONCLUSION: Small bowel obstruction was more prevalent than large bowel obstruction. Intussusceptions and sigmoid volvulus were the leading causes of small and large bowel obstruction. Laparotomy was the most common methods of intestinal obstruction management. Bowel resection and anastomosis was the commonest intra-operative procedure done and is associated with postoperative complications. Wound infection in the affected area should be improved because it is the most common postoperative complication. This can be decreased by appropriate surgical technique and wound care with sterile techniques.

Dried Blood Spot Test for HIV Exposed Infants and Children and Their Anti-Retro Viral Treatment Status in Selected Hospitals in Ethiopia.

BACKGROUND: Infants and children living with HIV receive antiretroviral treatment often late, are exposed to opportunistic infection and quickly develop AIDS. Few hospitals are providing ART service after Dried Blood Spot (DBS)test.The objective of this study is to assess the status of infants and children linked to ART. METHODS: Descriptive cross-sectional study was conducted in hospitals. Data of 138 infants and children exposed to HIV were collected from registration books and data bases from 2009 to 2011. Data were analyzed using SPSS version 16. Chi-squared test and p-value were computed. In-depth interviews were conducted with key informants. RESULT: Ninety-eight (71%) infants and children exposed to HIV were diagnosed for HIV infection of which 68(69.4%) initiated ART. Twenty four (35.3%) initiated ART one month after HIV screening results. Thirty-three (50.0%) and 23(35.3%) infants and children dropped from and adhered to ART respectively. Eleven (16.2%) of them who initiated ART died within the study period. HIV infection status (p-value=0.003), dropping from ART (p-value=0.002) and death after ART initiation (p-value=0.010) showed significance with mothers' PMTCT service status. CONCLUSION: Seven in ten HIV-exposed infants and children were diagnosed with HIV, and almost all of them initiated ART. The overall turnaround time was 10 days. Based up on mothers' PMTCT service status, there was a significant difference among HIV-exposed infants and children in acquiring HIV infection from mothers during pregnancy (p-value=0.003) and dropping from ART (p-value=0.010). There were challenges in sample collection and transportation. Early HIV screening during pregnancy and PMTCT service should be strengthened.

Health service utilization and reported satisfaction among adolescents in Dejen District, Ethiopia: a cross-sectional study.

BACKGROUND: There is no adequate health service or counseling specifically suitable for adolescents in Ethiopia. Adolescents' satisfaction on the health service provided is important to increase utilization and quality of care. The objective of this study was to assess health service utilization, reported satisfaction and predictors of satisfaction among adolescents of 15-19 years in Dejen District. METHODS: A community based cross-sectional study was done from February 05 to 17, 2012. Interview method was used to collect data from 690 adolescents. Following stratification into urban and rural, six kebeles were selected by lottery method. Study participants allocated proportionally to households' size of kebele. Households were selected randomly, and one from each household was used. Descriptive measures and binary logistic regression were used to identify independent predictors for health service satisfaction. RESULT: Among 690 adolescents, 313(45%) used health service. Of these, 190 (60.7%) were satisfied. Physical proximity (AOR=3.6, 95% CI: 1.8, 7.3), drug availability (AOR=2.7, 95% CI: 1.3, 5.8), health services availability (AOR=2.5, 95% CI: 1.1, 6.0), treatment in separate room (AOR=2.9, 95% CI: 1.4, 5.6), checked all adolescents problem (AOR=4.0, 95% CI: 2.0, 8.5), treated with respect (AOR=3.0, 95% CI: 1.4, 5.7) and opportunity to explain feeling (AOR=3.3, 95% CI: 1.7, 6.6) were predictors of satisfaction. CONCLUSION: Adolescents' health service utilization and satisfaction were low. Adolescents' perception of accessibility, acceptability and interaction with health workers' had significant influence on health services satisfaction. Therefore, health professionals and administrators should work on availing services with close proximity and acceptable behavior in order to increase adolescents' satisfaction.

Sexual assault: pattern and related complications among cases managed in Jimma University Specialized Hospital.

BACKGROUND: Sexual assault affects one out of every five women, and it is a substantial public health and human rights problem in developing countries including Ethiopia. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to assess the pattern of sexual assault and related complications in cases which were treated at Jimma University Specialized Hospital from November 1, 2011 - October 31, 2012. METHODS: A hospital based cross-sectional descriptive study was conducted with the aim of assessing sexual assault patterns and related complications on 99 sexual assault cases which were managed at the Gynecology Out-patient Department of the Hospital. Data on circumstances of sexual assault, survivor specific demographic characteristics and information on complications and interventions provided were collected by trained third year residents in obstetrics and gynecology using pretested questionnaire after respondent consent was taken. The collected data was cleaned, edited, fed into computer and analyzed using SPSS for windows version 16.0. RESULTS: The mean (±SD) of the survivors' age was 14 (±5) years; 57.5% of the survivors were children and 68.7% were from rural areas. Three percent of the clients visited the Gynecology Outpatient Department for sexual assault where rape accounted for 78.8%. The majority (76.8%) of the assailants was known to the survivors, 91% were assaulted by one assailant and 5.1% of the rape cases were gang rape. The mean time of presentation after sexual assault to the hospital was 15 days. Survivors had pregnancy test, HIV test and screening for sexually transmitted infections in 76.8%, 99%, 93% respectively of which 17.1%, 5.1%, 14.1% tested positive for pregnancy, HIV, and some STIs respectively. All HIV positive survivors were children under fifteen years of age. Forty percent of the survivors were provided with emergency contraception. In addition, 60.5%, 63%, and 91.9% of them were provided with post-exposure prophylaxis for HIV, STIs prophylaxis and were given counseling respectively. CONCLUSION: It has been revealed that sexual assault is a major problem of women and children of less than fifteen years. There were gaps in providing and receiving packages of care and justice system to protect survivors indicating the needs for community intervention and providing quality of care by health care staff.

Diabetic Patients' Knowledge of Their Disease, Therapeutic Goals, and Self-management: Association With Goal Attainment at Dessie Referral Hospital, Ethiopia.

PURPOSE: This study aims to assess diabetic patients' knowledge of their disease, therapeutic goals, self-management, and its association with goal attainment at a hospital in Ethiopia. METHODS: A prospective cross-sectional study was conducted from February to March 2012 at the diabetic follow-up clinic of Dessie Referral Hospital. Diabetic patients who came for their diabetic follow-up were included consecutively until a calculated sample size of 303 was obtained. Data were collected by face-to-face interview through a pretested structured questionnaire and by medical record review. Binary logistic regression analysis was used to determine predictors of fasting glycemic control. RESULTS: Ninety-nine patients (32.7%) had poor knowledge about their disease. The average fasting blood glucose was 226.57 ± 85.86 mg/dL, and only 61 patients (20.1%) achieved the recommended fasting glycemic goal (70-130 mg/dL). Diabetic patients who had poor knowledge were 5.53 times (95% confidence interval [CI]: 1.85, 16.49) more likely to not attain fasting glycemic goal compared to those who had good knowledge. Patients who did not practice self-monitoring of blood glucose were 3.09 times (95% CI: 1.33, 7.21) more likely to not attain fasting glycemic goal than those who practiced. Failure to achieve fasting glycemic goal was 2.43 times (95% CI: 1.15, 5.13) more common among patients who did not regularly exercise as compared to those who did. Patients who did not adhere to their medication were 3.72 times (95% CI: 1.69, 8.20) more likely to fail to achieve fasting glycemic goal compared to those who adhered to their medication. CONCLUSIONS: Fasting glycemic control was below the recommended standard among the study participants. Glycemic control was poor among patients who had poor knowledge, did not practice self-monitoring of blood glucose, did not participate in regular exercise, and were nonadherent to their medication. This study population had poor knowledge about their disease.