Adherence to Antiretroviral Therapy and Associated Factors Among HIV-Infected Children in Public Health Institutions of Adwa, Axum, and Shire Towns of Tigray, Northern Ethiopia: A Cross-Sectional Study.

Background: Antiretroviral therapy (ART) provision was among the major challenge of treatments. Maintaining the optimal level of adherence among children living with HIV/AIDS is a pivotal step towards achieving treatment success. However, there are limited studies on child's ART adherence. Therefore, this study aimed to assess the level of adherence to antiretroviral therapy and associated factors among HIV-infected children in health institutions of Adwa, Axum, and Shire towns, Tigray, Northern Ethiopia. Methods: An institutional-based cross-sectional study was conducted among human immunodeficiency virus (HIV)-infected children in between February and April, 2016. A total of 255 children who were taking antiretroviral therapy in the randomly selected three health facilities from Adwa, Axum and Shire towns were included. Data were collected using pretested and structured questionnaires using a face-to-face interview. The collected data were entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. Bivariate and multivariate binary logistic regression models were used to determine the factors associated with adherence to antiretroviral therapy among HIV-infected children. Results: A total of the 255 study participants were included in the study. The level of ART adherence among HIV-positive children was 212 (84.8%). Knowledge of caregivers about ART treatment (AOR = 2.78, 95% CI: 1.18, 6.53), occupational status (AOR = 4.78, 95% CI: 1.26, 18.91), appointment to ART less than two months (AOR = 3.05, 95% CI: 1.21, 7.70) and use of memory aids (AOR = 4.58, 95% CI: 1.73, 12.13) were independently associated with adherence to ART. Conclusion: The level of adherence to antiretroviral therapy was low. Healthcare providers should reinforce adherence intervention and counseling sessions during follow-up and address the proper use of medication reminders to help children take their drugs appropriately.

Risk factors for mortality among hospitalized COVID-19 patients in Northern Ethiopia: A retrospective analysis.

BACKGROUND: COVID-19 is a deadly pandemic caused by an RNA virus that belongs to the family of CORONA virus. To counter the COVID-19 pandemic in resource limited settings, it is essential to identify the risk factors of COVID-19 mortality. This study was conducted to identify the social and clinical determinants of mortality in COVID-19 patients hospitalized in four treatment centers of Tigray, Northern Ethiopia. METHODS: We reviewed data from 6,637 COVID-19 positive cases that were reported from May 7, 2020 to October 28, 2020. Among these, 925 were admitted to the treatment centers because of their severity and retrospectively analyzed. The data were entered into STATA 16 version for analysis. The descriptive analysis such as median, interquartile range, frequency distribution and percentage were used. Binary logistic regression model was fitted to identify the potential risk factors of mortality of COVID-19 patients. The adjusted odds ratio (AOR) with 95% confidence interval was used to determine the magnitude of the association between the outcome and predictor variables. RESULTS: The median age of the patients was 30 years (IQR, 25-44) and about 70% were male patients. The patients in the non-survivor group were much older than those in the survivor group (median 57.5 years versus 30 years, p-value < 0.001). The overall case fatality rate was 6.1% (95% CI: 4.5% - 7.6%) and was increased to 40.3% (95% CI: 32.2% - 48.4%) among patients with critical and severe illness. The proportions of severe and critical illness in the non-survivor group were significantly higher than those in the survivor group (19.6% versus 5.1% for severe illness and 80.4% versus 4.5% for critical illness, all p-value < 0.001). One or more pre-existing comorbidities were present in 12.5% of the patients: cardiovascular diseases (42.2%), diabetes mellitus (25.0%) and respiratory diseases (16.4%) being the most common comorbidities. The comorbidity rate in the non-survivor group (44.6%) was higher than in the survivor group (10.5%). The results from the multivariable binary regression showed that the odds of mortality was higher for patients who had cardiovascular diseases (AOR = 2.49, 95% CI: 1.03-6.03), shortness of breath (AOR = 9.71, 95% CI: 4.73-19.93) and body weakness (AOR = 3.04, 95% CI: 1.50-6.18). Moreover, the estimated odds of mortality significantly increased with patient's age. CONCLUSIONS: Age, cardiovascular diseases, shortness of breath and body weakness were the predictors for mortality of COVID-19 patients. Knowledge of these could lead to better identification of high risk COVID-19 patients and thus allow prioritization to prevent mortality.

Epidemiological and Clinical Characteristics of COVID-19 Patients in Northern Ethiopia: A Retrospective Cohort Study.

Purpose: COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is an emerging global public health problem. The disease is believed to affect older people and is accompanied by clinical features such as fever, shortness of breath, and coughing. Currently, there is a lack of information regarding the characteristics of COVID-19 patients in Ethiopia. Thus, this paper aims to evaluate the epidemiological and clinical features of COVID-19 patients in Tigray, Northern Ethiopia. Patients and Methods: A total of 6,637 symptomatic and asymptomatic COVID-19 patients collected from six isolation and treatment centers in Tigray between May 7 and October 28, 2020 were retrospectively analyzed. Chi-square test or Fisher's exact test was used to compare the epidemiological and clinical characteristics of COVID-19 patients as appropriate. A p-value <0.05 was considered statistically significant. Results: The mean age of the patients was 31.3±12.8. SARS-CoV-2 infects men more than women with a ratio of 1.85:1. About 16% of the patients were symptomatic, of which 13.3% (95% CI=11.3-15.4%) were admitted to intensive care units and 6.1% (95% CI=4.5-7.6%) were non-survivors. The mortality rate was increased up to 40.3% (95% CI=32.1-48.4%) among patients with severe illness. A higher proportion of deaths were observed in men (73.2%) and 55.4% were in the age group of ≥50 years. About 4.3% (282 of 6,637) had one or more coexisting comorbidities; the most common being cardiovascular diseases (30.1%) and diabetes mellitus (23.8%). The comorbidity rate in the non-survivor group was significantly higher than in the survivor group (p-value <0.001). Conclusion: The proportion of symptomatic patients was low. Non-survival was linked with old age and the existence of comorbidities. The findings of this study can help in the design of appropriate management strategies for COVID-19 patients, such as giving due emphasis to COVID-19 patients who are old and with comorbidities.

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public hospitals in Aksum, Ethiopia.

BACKGROUND: Severe acute malnutrition is defined by <70% weight for length/height, by visible severe wasting, by the presence of pitting edema, and in children 6 to 59 months of age, mid upper arm circumference <110 mm. Severe acute malnutrition remains to be a worldwide problem, claiming lives of millions of children, especially in sub-Saharan Africa and south Asia. Though the Ethiopian national guideline states the total length of stay in therapeutic feeding units should not be more than four weeks, there is huge difference, varying from 8 to 47 days of stay. Therefore, the objective of this study was to assess length of stay to recover from severe acute malnutrition and associated factors among under five children hospitalized to the public hospitals in Aksum Town. METHODS: Sample size was calculated using STATA version 12.0. A retrospective cohort study was conducted using pretested questionnaire in the public hospitals in Aksum on children aged 0-59 months. Cleaned data was entered to Epi info version 7.1.4 and then exported into SPSS version 21 for analysis. Bivariable and multivariable analyses were performed using Kaplan Meier and Cox regression models. During bivariable analysis, variables with p-value < 0.05 were selected for multivariable analysis to identify independent factors associated with length of stay. RESULTS: A total of 564 participants enrolled to the study. The rate of recovery was 56% with median length of stay of 15 days (95% CI: 14.1, 15.9). The independent predictors of length of stay to recovery were presence of diarrhea at admission (AHR = 0.573, 95% CI: 0.415-0.793), being HIV positive (AHR = 0.391, 95% CI: 0.194-0.788), palmar pallor (AHR = 0.575, 95% CI: 0.416-0.794), presence of other co-morbidities at admission (AHR = 0.415, 95% CI: 0.302-0.570) and not being treated with plumpy nut (AHR = 0.368, 95% CI: 0.262-0.518). CONCLUSIONS: Length of stay is in the acceptable range of the international and national set of standards. Nevertheless, the recovery rate was lower compared to the Sphere standard. Presence of diarrhea, palmar pallor, HIV other co-morbidities and not treated with plumpy nut were found independent protective factors for recovery from sever acute malnutrition.

Determinants of underweight among 6-59 months old children in Berahle, Afar, North East Ethiopia: a case control study 2016.

OBJECTIVE: The objective of this study was to identify determinants of underweight among 6-59 months old children in Berahle Woreda, Afar, North East Ethiopia, in 2016. RESULT: The median age (IQR) of cases and controls were 24 (34) and 18 (23) months respectively and 51.6% of the children were not exclusively breast-fed but 64.8% controls were exclusively breastfed. Age group of 48-59 months (AOR = 11.93; 95% CI 3.88-36.67), illiterate mothers (AOR = 2.32; 95% CI 1.19-4.55), low dietary diversity (AOR = 4.57; 95% CI 2.40-8.69), diarrhea in the past of 2 weeks (AOR = 2.93; 95% CI 1.46-5.85), birth interval (AOR = 5.17; 95% CI 2.37-11.26) and unprotected source of water (AOR = 2.62; 95% CI 1.42-4.85) were determinant factors of underweight.

Depression among Adult HIV/AIDS Patients Attending ART Clinics at Aksum Town, Aksum, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Depression is consistently associated with increased risk of Human Immunodeficiency Virus infection and poor antiretroviral treatment adherence. Though many factors have been reported as determinant factors of depression, site-specific evidence is needed to identify factors associated with depression among adults on antiretroviral treatment. METHODS: An institution based cross-sectional study was carried out from March to May 2015 among 411 adults HIV/AIDS patients on ART clinic follow-up. Participants were selected using systematic random sampling techniques. Data were collected using chart review and interviewer- administered techniques. Both bivariable and multivariable logistic regressions were used to compute the statistical test associations by SPSS version-20. Variables with p value < 0.05 were considered as statistically significant. RESULTS: Four hundred eleven patients with a mean age ± Standard Deviation of 36.1±9.2 years and with a total response rate of 97.6% were enrolled in the study. The prevalence of depression was 14.6% (95% CI, 10.90-18.2). Factors independently associated with depression were nonadherence to ART, eating two meals per day or less, having side effect of ART medication, being in the WHO Stage II or above of HIV/AIDS, and living alone with AOR (95% CI) of 3.3 (1.436, 7.759), 2.8 (1.382, 5.794), 4.7 (1.317, 16.514), 2.8 (0.142, 0.786), and 2.4 (1.097, 5.429), respectively. CONCLUSION: Though the magnitude of depression was found relatively low, it was commonly observed as a mental health problem among adult patients with HIV/AIDS on ART. Programs on counseling and close follow-up of adherence to ART, drug side effects, and nutrition should be strengthened. Health facilities should link adult patients with HIV/AIDS who live alone to governmental and nongovernmental social supporter organizations.

Magnitude and factors associated with anemia among pregnant women attending antenatal care in public health centers in central zone of Tigray region, northern Ethiopia: a cross sectional study.

INTRODUCTION: Anemia is defined as a low blood hemoglobin concentration (< 11 mg/dl). It is a global public health problem especially in pregnant women and is associated with higher risk for both maternal and perinatal mortality and morbidity. In developing countries, like Ethiopia where anemia is common, determining the magnitude and identifying factors that are associated with anemia is necessary to control it. METHODS: Facility based cross sectional study design were conducted among 638 pregnant women attending antenatal care in public health centers in central zone of Tigray region, Northern Ethiopia from November 1/2017 to January 30/2018 using stratified multi stage sampling method. The data was collected through interviewing the pregnant women face to face after getting informed consent using structured and pre-tested questionnaire. The data was coded and entered in to Epi-info 7 then exported to Stata 14 for cleaning and further analysis. Both Bivariable and multi variable logistic regression model was used in the data analysis. RESULTS: The overall magnitude of anemia (hemoglobin level < 11 mg/dl) were found that 16.88% (95% CI: 13.95%, 19.8%). Factors which were significantly associated with anemia in the multivariable analysis were: history of malaria attack 1 year prior to study period (AOR = 4.73, 95% CI: 2.64, 8.46), women who had history of excessive menstrual bleeding (AOR = 3.94, 95% CI: 2.11, 7.35), unplanned pregnancy (AOR = 2.5, 95% CI: 1.4, 4.42) and three times or less meal frequency (AOR = 1.89, 95% CI: 1.02, 3.5). CONCLUSION: The magnitude of anemia among pregnant were found that 16.88%. Malaria attack, excessive menstrual bleeding, pregnancy planning and meal frequency were found that significantly associated with anemia in the multivariable analysis. Pregnant women are recommended to increase meal frequency. Health providers should give attention to pregnant women who had history of malaria attack, excessive menstrual bleeding and women whose pregnancy were not planned.

Dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia: a case control study.

OBJECTIVE: Preeclampsia or eclampsia, which is one of the direct obstetric complication, results in maternal and child morbidity and mortality. The factors associated with it remains unclear. So, the aim of the study was to assess the dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia. RESULTS: Factors which were investigated as protective for preeclampsia or eclampsia were: Fruit intake during pregnancy (AOR: 0.94, 95% CI 0.20, 4.32), vegetable intake during pregnancy (AOR: 0.95, 95% CI 0.01, 0.71) and receiving nutritional counseling during antenatal care (AOR: 0.17, 95% CI 0.05, 0.6). In the other side being nulliparous women was a risk factor for preeclampsia or eclampsia (AOR: 2.02, 95% CI 1.15, 3.55).

Assessment of patients' satisfaction and associated factors among outpatients received mental health services at public hospitals of Mekelle Town, northern Ethiopia.

BACKGROUND: Satisfaction is the psychological state that results from confirmation or disconfirmation of expectations with reality. Patients' satisfaction is a healthcare recipient's reaction to salient aspect of the contexts, process and result of their service experience. The aim of this study was to assess patient satisfaction and associated factors among outpatients receiving mental health services at public hospitals in Mekelle town. OBJECTIVES: To assess patient satisfaction and associated factors among outpatients receiving mental health services at public hospitals in Mekelle town, northern Ethiopia. METHODS: An institution based cross-sectional study was conducted among 415 outpatients receiving mental health services at public hospitals in Mekelle town from September 2013 to August 2014. The data were collected using standardized, structured pre-tested questionnaire. Participants were selected by systematic random sampling technique. Satisfaction rate was examined with the client satisfaction questionnaire (CSQ-8), having four responses ranging from poor to very good. Descriptive summary using percentages, frequency and graph were used to present study results. Multivariate logistic regressions with 95% confidence interval (CI) were used to assess the strength and p-value < 0.05 was used to indicate the significance of the association. RESULTS: A total of 415 respondents were enrolled, with a response rate of 100% and magnitude of satisfaction of 72%. The predictors associated with patient satisfaction were higher education (AOR = 0.34; 95% CI 0.24, 0.97), longer waiting time (AOR = 0.01; 95% CI 0.002, 0.07), having a diagnosis of psychosis (AOR = 2.36; 95% CI 1.41, 5.72) were significantly associated with satisfaction. CONCLUSION AND RECOMMENDATION: More than one-four of patients receiving mental health services were dissatisfied with the service they received. Improvement in accessibility and availability of drugs, minimizing consultation time (< 45 min) or increasing number of OPD units are important to improve satisfaction.

Effect of late HIV diagnosis on HIV-related mortality among adults in general hospitals of Central Zone Tigray, northern Ethiopia: a retrospective cohort study.

BACKGROUND: The global incidence of HIV infection is not significantly decreasing, especially in sub-Saharan African countries, including Ethiopia. Though there is availability and accessibility of free HIV services, people are not being diagnosed early for HIV, and hence patients are still dying of HIV-related causes. This research is aimed at verifying the effect of late diagnosis of HIV on HIV-related mortality in Central Zone Tigray, Ethiopia. METHODS: A retrospective cohort study among adult (≥15 years old) HIV patients in three general hospitals of Tigray was conducted. Record reviews were carried out retrospectively from 2010 to 2015. Sample size was determined using stpower Cox in Stata software. Data were entered into EpiData version 3.1 software and transferred to Stata version 12 for analysis. Both bivariable and multivariable analyses were performed using Cox regression model to compare the HIV-related mortality of exposed (cluster of differentiation 4 cells count <350 cells/mm3) and nonexposed (≥350 cells/mm3) patients using adjusted hazard ratio (AHR) at 95% confidence interval (CI). RESULT: In all, 638 HIV patients were analyzed, contributing 2,105.6 person-years. Forty-eight (7.5%) patients died of HIV-related causes with a mortality rate of 2.28 per 100 person-years. In the multivariable Cox regression model, patients with late diagnosis of HIV had a higher risk of mortality (AHR =3.22, 95% CI: 1.17-8.82) than patients with early diagnosis of HIV. Rural residence (AHR =1.96, 95% CI: 1.05-3.68), unemployment (AHR =2.70, 95% CI: 1.03-7.08), bedridden patients (AHR =2.98, 95% CI: 1.45-6.13), ambulatory patients (AHR =2.54, 95% CI: 1.05-6.15), and baseline hemoglobin level of <11 mg/dL (AHR =3.06, 95% CI: 1.51-6.23) were other independent predictors of mortality. CONCLUSION AND RECOMMENDATIONS: Late diagnosis of HIV increased HIV-related mortality. Rural residence, unemployment, bedridden and ambulatory patients, and baseline hemoglobin level <11 mg/dL were also independent predictors of HIV-related mortality.

Determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia: A case-control study.

BACKGROUND: Diabetic nephropathy is the most serious complication of diabetes which leads to end-stage renal failure and other complication of diabetes mellitus. Determinants of Diabetic nephropathy are not consistent in different studies and associated factors to chronic complications of diabetes are not specific and there are limited studies specific to diabetic nephropathy. Thus, the aim of this study is to identify determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia. METHODS: A case-control study was conducted from February 14 to May 8 2016. Diabetic patients who developed nephropathy in the last two years were the cases and diabetic patients free of nephropathy were controls. Cases and controls were identified detailed review of the chronic care follow up chart. Then simple random sampling was used to select sample of 420 (with control to case ratio of 4:1) resulting in 84 cases and 336 controls. Record review and interviewer administered questionnaire were used to collect data. Data was coded and entered in to Epi-Data version 3.1 and then exported to STATA 12 for analysis. Variables with P-values< 0.25 in Bivariate logistic regression were selected for multiple logistic regressions to determine independent determinants of diabetic nephropathy. OR was calculated with 95% CI to show strength of association. RESULT: The mean age (±Standard deviation) for the cases and the controls were 52(SD: ±1.34) and 42.4(SD: ±0.8) respectively. In multiple logistic regressions age of patient (AOR: 1.037 95%CI: 1.01-1.064), duration of diabetes after diagnosis (AOR for one year increase: 1.09 95%CI: 1.036-1.15), not-adhered to blood glucose measurement at home (AOR: 6.81 95%CI: 1.15-40.24), having Systolic Hypertension (AOR;2.13 (1.002-4.51), poor glycemic control (AOR;2.71 95%CI: (1.49-4.95), being overweight(AOR;2.7(1.47-4.96) were the independent predictors of diabetic nephropathy. CONCLUSION: In the light of these findings, targeted interventions should be designed at the follow up clinic to address the risk of developing diabetic nephropathy among the risk groups.