Treatment outcome of pediatric tuberculosis in eastern Ethiopia.

Background: Children are more vulnerable to developing active Mycobacterium tuberculosis infection which causes significant morbidity and mortality. However, the contribution of childhood tuberculosis and its treatment outcomes have not been well documented, and no research has been conducted in eastern Ethiopia. Objective: This study aimed to assess the treatment outcome and its predictors of pediatric tuberculosis in eastern Ethiopia from September 1, 2017 to January 30, 2018. Methods: A retrospective study was conducted in eight selected hospitals in eastern Ethiopia. Data on 2002 children with tuberculosis was extracted by using the standard checklist of the national tuberculosis treatment format. Treatment outcomes were determined according to the standard definitions of the National Tuberculosis and Leprosy Control Programme. Data were entered into Epi Data software version 3.1 and exported to Statistical Package for Social Science (SPSS) version 20 for analysis. Bivariable and multivariable regression analyses were carried out to examine the associations between dependent and independent variables. A P-value of <0.05 was considered statistically significant. Result: The overall successful treatment rate was 1,774 (88.6%) [95% confidence interval (CI): (80.59-97.40)]. A total of 125 (6.2%), 1,648 (82.3%), 59 (2.9%), and 19 (0.9%) children with tuberculosis (TB) were cured, completed, defaulted, and died, respectively. A high number of defaulters and deaths were reported in the age group <10 years. More children with smear-positive pulmonary TB (74.4%) were cured, while smear-negative tuberculosis had higher treatment completion rates. Being male in sex (adjusted odds ratio (AOR): 0.71, 95% CI: 0.53, 0.96) and those with human immunodeficiency virus (HIV) positive sero status (AOR: 0.51, 95% CI: 0.29, 0.90) had a lower chance of a successful treatment outcome. Conclusion: In this study, thee treatment success rate was higher than the recent World Health Organization report. Those males and HIV seropositive status were less likely to have a successful treatment outcome. Therefore, efforts should be made by each health institution in eastern Ethiopia by giving emphasis on male and HIV-positive individuals.

Determinants of Undernutrition among Adult Tuberculosis Patients Receiving Treatment in Public Health Institutions in Shashemane Town, Southern Ethiopia.

BACKGROUND: Undernutrition and tuberculosis are the major concerns of underdeveloped regions of the world. Tuberculosis makes undernutrition worse and undernutrition weakens immunity, thereby increasing the likelihood that latent tuberculosis will develop into active disease. Nevertheless, little has been understood about undernutrition among patients with infectious disease like tuberculosis in Ethiopia. This study was conducted to determine the magnitude of undernutrition and its determinants among tuberculosis patients in Shashemane public health institutions, Southern Ethiopia. METHODS: An institution-based cross-sectional study was conducted in two public hospitals and ten health centers of Shashemane Town from March 12, to April 12, 2017, among 368 adult tuberculosis patients on treatment follow-up. Sociodemographic and socioeconomic characteristics and anthropometric data were collected. Data were entered into EpiData version 3.3 computer software and analyzed using SPSS version 20. Bivariable logistic regression analyses were done to assess the association between outcome variable at bivariate analysis, and multivariable logistic regression model was used to assess factors that were independently associated with undernutrition. Odds ratios along with 95% confidence interval (CI) were estimated to measure the strength of the association, and level of statistical significance was declared at P value ≤0.05. RESULT: The overall magnitude of undernutrition among adult tuberculosis patients in this study was 28.8% (95% CI = 0.25-0.34). Patients in the age group of forty-five and above ((AOR = 3.39, 95% CI = (1.6-7.18)), residents in rural area ((AOR = 1.95, 95% CI = (1.07-3.54)), those with problem with eating ((AOR = 2.361, 95% CI = (1.332-4.185)), and those who are not on food supplementation ((AOR = 2.21, 95% CI = (1.06-4.58)) were significantly at higher risk of undernutrition. CONCLUSION: The magnitude of undernutrition in the study setting was found to be significantly higher. Age greater than forty-five, living in rural area, and lack of nutritional care and support were identified as the factors associated with undernutrition. Thus, relevant actors should give attention to fast nutritional intervention together with standard therapeutic regimen in the management of pulmonary tuberculosis patients to curb their nutritional derangement.

Prevalence of Goiter and Associated Factors among Women of Reproductive Age Group in Demba Gofa Woreda, Gamo Gofa Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study.

BACKGROUND: Iodine deficiency disorder is a major public health problem in Ethiopia that is more common in women of reproductive age. However, it is not well addressed and there is a lack of information on its prevalence and associated factors in women of reproductive age group. Therefore, the objective of this study was to assess goiter prevalence and associated factors among women of reproductive age in the Demba Gofa woreda, Gamo Gofa Zone, Southwest Ethiopia. METHODS: A community-based cross-sectional study was used among 584 randomly selected women in the reproductive age group from February 05 to April 20, 2016. A simple random sampling technique was used to select the study kebeles, and a systematic random sampling technique was used to select the study samples. Data were collected through a pretested questionnaire, and the goiter examination was done clinically for each participant. The collected data were coded and entered into a computer for statistical analysis using EpiData version 3.2 and analyzed using SPSS version 20. Variables with a P value ≤0.25 in bivariate logistic regression analysis were entered into multivariate logistic regression analysis, and finally, variables with a P value <0.05 in multivariate logistic regression were considered significantly associated with the dependent variable. RESULTS: The total goiter rate was 43%, 95% CI = 39.2-46.9. Cassava consumption (AOR: 2.02, 95% CI: 1.03-4), salt wash before use (AOR: 3.14, 95% CI: 1.1-11.3), salt use after >2 months of purchase (AOR: 11, 95% CI: 5-26), family history of goiter (AOR: 4.6, 95% CI: 1.4-15.8), and poor knowledge of iodized salt (AOR: 2.7, 95% CI: 1.4-5.5) were significant factors associated with goiter. CONCLUSION: Iodine deficiency was found to be severe in women of reproductive age in the study area. This showed that women of reproductive age, especially during pregnancy, are exposed to iodine deficiency and its adverse effects at delivery. Thus, they need urgent supplementation with iodine, improved access to foods rich in iodine, and intake of iodized salt. Additionally, health education should focus on the importance of iodized salt, the proper method of use, and the prevention of iodine deficiency, which are highly recommended to minimize the problem.

Evidence-based medicine among physicians working in selected public hospitals in eastern Ethiopia: a cross-sectional study.

BACKGROUND: Evidence-Based Medicine (EBM) is the process of systematically locating, searching, evaluating, and using contemporaneous research findings as the basis for clinical decision making. The systematic review showed that there is a considerable gap between what is known in the systematic research evidence and what happens in practice. Thus, the purpose of this study is to assess knowledge, attitude, practice and perceived barriers to EBM among physicians working in public hospitals in eastern Ethiopia. METHODS: An institutional-based cross-sectional survey was conducted from April 1-June 8, 2017. Simple random sampling with proportional allocation was used. A total of 137 physicians was included in the survey. The data were collected by interview. Data were coded and entered to EpiData 3.1 then exported to and analyzed by using IBM SPSS statistics 21.0. RESULTS: Physicians were aware of and used HINARI (22.6%), Cochrane (29.8%) and PubMed/Medline (37.9%) EBM electronic databases. The majority, (88.7%) physicians have a good attitude to EBM but only (32.3%) integrate it into clinical practice. Ability to retrieving evidence, evaluating the outcomes of the EBM practice implemented and difficulty in understanding research reports were significantly associated factors. CONCLUSIONS: The attitude of the physicians towards EBM was virtuous, but knowledge of EBM and practice of integrating new evidence in healthcare service were really insufficient. Relatively, the EBM implementation is low when compared with many studies. To obviate this, the stakeholders need to have a strong commitment to design a strategy for promoting physicians in implementing EBM to their day to day clinical decision-making process.

Prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia.

BACKGROUND: Depression among tuberculosis patients, especially in settings with low economic status is common. Screening for depression in all levels of health facilities can identify patients who need support and treatment for depression. OBJECTIVE: The aim of this study was to assess the prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia. METHODS: An institutional based cross-sectional study was conducted among 403 tuberculosis patients attending in eleven tuberculosis treatment centers in eastern Ethiopia from February to July 2017. Depression was measured using the Patient Health Questionnaire. Data was collected consecutively until the required sample size was obtained. Tuberclusis  patients who were under anti tuberculosis treatments for more than one month were included. Data were analyzed with Statistical Package for Social Sciences (SPSS) version 20. Bivariate and multivariate logistic regression models were applied to identify independent factors for dependent variable depression and P-values < 0.05 considered statistically significant. RESULTS: A total of 403 tuberculosis patients were included in the study. The prevalence of depression among tuberculosis patients was 51.9% (95%CI = 42.7, 62.2%) with 34.2% were mild cases. In our logistic regression analysis, odds of developing depression among tuberculosis patients with age less than 25 years were 0.5(50% protective effect) [AOR = 0.5, 95% CI 0.26-0.99] where as patients with a monthly income within the 25thpercentile were four times higher odds to have depression [AOR = 3.98, 95% CI: 2.15-7.39]. CONCLUSION: The prevalence of depression was high in this study. Age, low monthly income, the category of patients as "new tuberculosis treatment" and the first 3 months of treatment was associated with depression among tuberculosis patients. Health facilities should integrating mental health services with tuberculosis clinics, especially assessing and treating TB patients for depression, is vital.

Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia.

INTRODUCTION: Pulmonary tuberculosis (TB) impairs respiratory physiology and functional ability, resulting in economic and social dependence upon others. Patients with tuberculosis especially multi drug resistant (MDR-TB) suffer from social isolation, stigma, lack of support and economic constraints. In Ethiopia, the trend of MDR TB is increasing and becoming a serious public health problem. However, little is known about patients except treatment outcomes, financial burden and psychological distress with serious deficiency of data on Health Related Quality of Life (HRQOL). Hence, the aim of this study was to assess HRQOL of MDR TB patients in comparison with drug sensitive pulmonary TB (DSTB) patients. METHODS: We included 100 cases of MDR and 300 controls with DSTB who were matched by sex. Data were collected using SF- 36v2 TM questionnaire and analysed with SPSS version 20. Independent t-test and conditional logistic regression analysis was done considering P-values of less than 0.05 statistically significant. Eight in-depth interviews were also conducted with both groups and represented with verbatim quotations and narrative texts. RESULTS: There were no statistically significant differences in mean scores for health related quality of life between cases and controls (57.61±16.42 and 59.13±22.10) nor were there significant differences in physical functioning, role disruption due to physical problems, vitality, social functioning, role disruption due to emotional distress, or overall mental health. Individuals with MDR-TB were significantly more likely to be single, a current student, and with lower education and families with more than 5 people than individuals with Drug sensitive TB, all of which were significantly associated with poorer HRQOL (p<0.05). There was good internal consistency of the scale scores, with a Cronbach's alpha value of 0.73. CONCLUSION: Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with Drug sensitive TB. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households and students about pulmonary tuberculosis, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB.

Dietary diversity and associated factors among HIV positive adults attending antiretroviral therapy clinics at Hiwot Fana and Dilchora Hospitals, eastern Ethiopia.

BACKGROUND: Nutritional care is considered a crucial component of comprehensive care for people living with HIV/AIDS (PLWHA), particularly in resource-limited settings where malnutrition and food insecurity are endemic problems, and low quality monotonous diets are the norm. The findings of this study provide baseline information on dietary diversity and related factors for health care providers so that they will be able to improve nutritional care and support activity. Therefore, the aim of this study was to assess dietary diversity and associated factors among HIV positive adults (18-65 years old) attending antiretroviral therapy (ART) clinics at Hiwot Fana and Dilchora Hospitals, eastern Ethiopia. PATIENTS AND METHODS: An institution-based cross-sectional study was conducted from November 2015 to February 2016 at the ART clinics of Hiwot Fana and Dilchora Hospitals. Using a systematic random sampling technique, a total of 303 patients were selected from all adults attending the ART clinics. The data were collected with a 95% CI used to show association between dietary diversity and independent factors. RESULTS: A total of 303 adult HIV positive individuals on ART participated in the study and 62.4% were females. The largest numbers of participants (49.5%) were 30-40 years of age. Eighty-seven (28.7%) participants had low dietary diversity (≤4 food groups). Duration of anti-retroviral treatment was the factor significantly associated with dietary diversity: respondents with a duration of antiretroviral treatment of more than 2 years were almost two times more likely to have high dietary diversity compared with those with less than a year of antiretroviral treatment (adjusted odds ratio =0.490; 95% CI: 0.091, 0.978). CONCLUSION: Low dietary diversity was found to be a nutritional problem among HIV positive adults. Duration of antiretroviral treatment was the predictor of low dietary diversity. Therefore, appropriate dietary management of side effects of ART is important.

Determinants of active pulmonary tuberculosis in Ambo Hospital, West Ethiopia.

OBJECTIVES: The aim of this study was to determine factors associated with active pulmonary tuberculosis seen in cases in Ambo Hospital, Ethiopia. DESIGN: A facility-based prospective case-control study. SETTING: Patients attending Ambo Hospital from 01 December 2011 to 29 March 2012. PARTICIPANTS: The sample included 312 adult patients attending Ambo Hospital. The main outcome measure was presence of active pulmonary tuberculosis (TB). EXPLANATORY MEASURES: Age, gender, occupation, educational status, marital status, place of residence, patient history of TB, family history of TB, human immunodeficiency virus (HIV) infection, smoking, alcohol intake, khat chewing, body mass index (BMI), employment, diabetes, history of asthma, previous history of worm infestation, history of hospitalisation, number of adults living in the household (HH), person per room, housing condition. RESULTS: A total of 312 study participants, including 104 active pulmonary tuberculosis (PTB) cases (cases) and 208 non-active PTB cases (controls), were recruited for the present study. Having one or more family member with a history of TB (OR = 4.4; 95% CI: 1.50­12.90), marital status (OR = 7.6; 95% CI: 2.2­12.6), male gender (OR = 3.2; 95% CI: 1.4­7), rural residence (OR = 3.3; P = 0.012), being a current or past smoker (OR = 2.8; 95% CI: 1.1­7.2), BMI < 18.5 (OR = 2.1; 95% CI: 1.03­4.2), HIV infection (OR = 8.8; 95% CI: 2.4­23.8) and a history of worm infestation (OR = 6.4; 95% CI: 2.6­15.4) remained significant independent host-related factors for active PTB. CONCLUSION: Patients who came from a compound with more than two HHs were more likely to develop active PTB than those who came from a compound with only one HH. Those who lived in houses with no windows were more likely to develop active PTB than those who lived in houses with one or more windows, had a family history of TB, lived in rural areas. Sex of the patient was a predicting factor. Not being the owner of the house was significantly more associated with active PTB. Measures taken to reduce the prevalence and burden of active PTB should consider these determinant factors.