Mortality of acute poisoning and its predictors in Ethiopia: A systematic review and meta-analysis.

Introduction: Poison is defined as any chemical that has the potential to affect or harm human physiology due to its chemical activity. Poisoning is becoming a major preventable public health issue in many countries, including Ethiopia. There is a variation in acute poisoning mortality among the existing evidence in Ethiopia. This study aims to determine the pooled mortality rate from acute poisoning and its predictors in Ethiopia. Methods: We searched available evidence of acute poisoning mortality in databases such as PubMed, Hinari, Cochrane, ScienceDirect, and other search engines. Using the Microsoft Excel data extraction form, three authors independently extracted all relevant data. The Higgins I2 test statistics were used to examine heterogeneity among included studies A random-effects model was used to analyze the pooled estimates and predictors in Stata MP version 17. Results: We retrieved 2685 relevant records from different database sources, and after screening, 21 studies (17 published and 4 unpublished) were included. The pooled mortality rate for acute poisoning was 4.69(95 % CI: 3.69, 5.69 I2 = 94.7 %). The most common poisoning agents are organophosphate (29.9 %), household cleansing agents (17.5 %), and pharmaceuticals/medications (9.3 %). The majority of poisoning cases were intentional poisoning committed suicide. Poisoning cases in rural areas [RR: 3.98(95 % CI: 1.41, 11.25)] and delayed arrival times [RR: 2.90(95 % CI: 1.45, 5.84)] were identified predictors of mortality. Conclusions: In this study, the pooled mortality from acute poisoning was 4.69 %. Poisoned cases from rural areas and delayed arrival times to the hospital were predictors of mortality. To prevent mortality, healthcare professionals should give special attention to rural residents and delayed arrival of poison cases. To control this avoidable death, poison control centers should be strengthened, and other preventive measures implemented at the national level.

The cross-cultural validation of the Beach Center Family Quality of Life Scale among persons affected by leprosy or podoconiosis in Northwest Ethiopia.

BACKGROUND: The Beach Center Family Quality of Life Scale has been developed and validated in different languages in different countries. However, this scale has not been validated in the Ethiopian Amharic language context. Therefore, this study aimed to investigate the cross-cultural validity of the Beach Center Family Quality of Life Scale, among Ethiopian families of persons affected by leprosy and podoconiosis. METHODOLOGY: We explored the semantic equivalence, internal consistency, reproducibility, floor and ceiling effects, and interpretability of the Beach Center Family Quality of Life Scale in Amharic. A cross-sectional study was conducted after the translation and back-translation of the instrument. A total of 302 adult persons affected by leprosy or podoconiosis was asked about their level of satisfaction with their family life, using the Beach Center Family Quality of Life Scale. In addition, 50 participants were re-interviewed two weeks after the initial assessment to test the reproducibility of the scale. Participants were recruited in the East Gojjam zone of Northwest Ethiopia. RESULTS: The findings of this study showed that the Beach Center Family Quality of Life Scale had high internal consistency (Cronbach's alpha of 0.913) and reproducibility (intra-class correlation coefficient of 0.857). The standard error of measurement was 3.01, which is 2.4% of the total score range. The smallest detectable change was 8.34. Confirmatory factor analysis showed adequate factor loadings and model fit indices like the original scale. The composite reliability and average variance extracted from the scale were acceptable. No floor and ceiling effects were found. CONCLUSIONS: Our findings indicate that the Amharic version of the Beach Center Family Quality of Life Scale has adequate cultural validity to assess the family quality of life in Ethiopian families of persons affected by leprosy and podoconiosis.

Adherence to option B+ PMTCT program and its predictors among HIV-positive women in Ethiopia. A systematic review and meta-analysis.

Background: Previously, few studies investigated level of adherence to option B+ lifelong antiretroviral therapy (ART) in Ethiopia. However, their findings were inconsistent. Therefore, this review aimed to determine the pooled magnitude of adherence to option B+ lifelong ART and its predictors among human immune virus (HIV)-positive women in Ethiopia. Methods: A comprehensive web-based search was conducted using PubMed, Cochrane Library, Science Direct, Google scholar, and African Journals Online databases to retrieve relevant articles. STATA 14 statistical software was used to carry out the meta-analysis. We used the random effects model to account for the large heterogeneity across included studies. Egger's regression test in conjunction with funnel plot and I 2 statistics were utilized to assess publication bias and heterogeneity among included studies respectively. Result: Twelve studies with a total of 2927 study participants were involved in this analysis. The pooled magnitude of adherence to option B+ lifelong ART was 80.72% (95% confidence interval [CI]: 77.05-84.39; I 2 = 85.4%). Disclosure of sero-status (OR 2.58 [95% CI: 1.55-4.3]), receiving counseling (OR 4.93 [95% CI: 3.21-7.57]), attending primary school and above (OR 2.45 [95% CI: 1.31-4.57]), partner support (OR 2.24 [95% CI: 1.11, 4.52]), good knowledge about prevention of mother-to-child transmission (PMTCT) (OR 4.22 [95% CI: 2.02-8.84]), taking less time to reach health facility (OR 1.64 [95% CI: 1.13-2.4]), and good relation with care provider (OR 3.24 [95% CI: 1.96-5.34]) were positively associated with adherence. Whereas, fear of stigma and discrimination (OR 0.12 [95% CI: 0.06-0.22]) and advanced disease stage (OR 0.59 [95% CI: 0.37-0.92]) were negatively associated. Conclusion: The level of adherence to option B+ lifelong ART was suboptimal. Strengthened comprehensive counseling and client education on PMTCT, HIV status disclosure, and male partner involvement are important to eliminate mother to child transmission and control the pandemic.

Uptake of appointment spacing model of care and associated factors among stable adult HIV clients on antiretroviral treatment Northwest Ethiopia.

INTRODUCTION: Ethiopia launched an Appointment Spacing Model in 2017, which involved a six-month clinical visit and medication refill cycle. This study aimed to assess the uptake of the Appointment Spacing Model of care and associated factors among stable adult HIV clients on ART in Ethiopia. METHODS: A cross-sectional study was conducted from October 3 to November 30, 2020 among 415 stable adult ART clients. EpiData version 4.2 was used for data entry and SPSS version 25 was used for cleaning and analysis. A multivariable logistic regression model was fitted to identify associated factors, with CI at 95% with AOR being reported to show the strength of association. RESULTS: The uptake of the appointment spacing model was 50.1%. Residence [AOR: 2.33 (95% CI: 1.27, 4.26)], monthly income [AOR: 2.65 (95% CI: 1.13, 6.24)], social support [AOR: 2.21 (95% CI: 1.03, 4.71)], duration on ART [AOR: 2.41 (95% CI: 1.48, 3.92)], baseline regimen change [AOR: 2.20 (95% CI: 1.02, 4.78)], viral load [AOR: 2.80 (95% CI: 1.06, 7.35)], and alcohol abstinence [AOR: 2.02 (95% CI: 1.21, 3.37)] were statistically significant. CONCLUSIONS: The uptake of the ASM was low. Behavioral change communication, engaging income-generating activities, and facility-level service providers' training may improve the uptake.

Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia.

Health-related quality of life (HRQOL) is a multifaceted concept that is strongly impacted by Type II diabetes in developing countries. The majority of studies indicate diabetes mellitus prevalence without looking at people's quality of life. This study was conducted using an Institution-based cross-sectional design in Debre Markos Referral Hospital from March 03 to March 31, 2020. We evaluated HRQOL using the WHO quality of life BREF and data were obtained through face-to-face interviews. We used a systematic random sampling technique to select study participants. Data were entered into Epi data version 3.1 and exported to STATA version 14.0. Candidates for multivariable analysis were variables with a P-value less than 0.25 in the bivariable analysis and P-value less than 0.05 were considered to declare a statistically significant association. The final model was tested for its goodness of fit using Hosmer and Lemeshow's statistics. The analysis included a total of 368 adult individuals with type II diabetes and 206 (56%) had a good HRQOL. Being male (AOR = 4.28, 95%CI:2.36, 7.78), having duration of disease of more than 59 months (AOR = 2.93, 95%CI:1.61, 5.34), doing a physical exercise (AOR = 2.33,95%CI:1.34, 4.05) and got counseling (AOR = 3.33; 95%CI:1.82, 5.94) were directly associated with good HRQOL whereas the presence of diabetic complications (AOR = 0.46, 95%CI:0.26, 0.80), comorbidity (AOR = 0.45; 95%CI:0.25, 0.84) and drinking alcohol (AOR = 0.27, 95%CI:0.16, 0.48) had an inverse relationship with good HRQOL. More than half of type 2 diabetic adult patients had a good HRQOL. Being male, drinking alcohol, getting counseling, doing physical exercise, absence of diabetic complications, and comorbidity and long duration of disease were predictors of good HRQOL. Therefore, avoiding drinking alcohol and promoting physical exercise and counseling should be encouraged.

Time to death from cervical cancer and predictors among cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital, North West Ethiopia: Facility-based retrospective follow-up study.

INTRODUCTION: A sexually transmitted virus called the Human Papillomavirus is responsible for more than 99% of cervical cancer cases and its precursors. In 2019, the median survival time of cervical cancer patients at 5 years was 37 months. The survival time and predictors of death from cervical cancer vary in different study settings. This study was aimed to assess the time to death and to identify the major predictors of death of cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital. METHODS: A facility-based retrospective follow-up study was conducted among 422 randomly selected cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital from 25th June 2017 to 31st March 2021. Data were extracted from the sampled patient charts by using a structured checklist which was prepared in an English version. Data were coded and then entered, edited, and cleaned using EPI-data 3.1 and exported to STATA14.2 statistical software for analysis. Frequencies and proportions were used to describe the study population with relevant variables and were presented using tables, pie charts, and graphs. Kaplan Meier and life table were used to describe the restricted mean survival time and the overall survival rates. Differences in survival among different variables were compared using the log-rank test. The assumption of proportional hazard was checked using Schoenfeld residual test. Variables having a P-value > 0.05 were considered as fulfilling the assumption. Variables with a significance level below 0.2 in the bivariable Cox regression model were included in a multivariable Cox regression model analysis, where Variables with a p-value < 0.05 were considered to be statistically significant at a 95% confidence interval. Model fitness was checked by Cox-Snell residual. RESULTS: The mean follow up time of this cohort was 27.66 (CI: 26.96, 28.36) months, and the restricted mean survival time of cervical cancer patients in this study was 40.21 (95% CI: 38.95, 41.47) months. Being FIGO stage IV [AHR = 6.10, 95% CI: 2.18, 16.90)], having adenocarcinoma [AHR = 3.12, 95% CI: 1.34, 7.28)], having co-morbidity [AHR = 2.57, 95% CI: 1.29, 5.11)], and being initiated with radiotherapy [AHR = 4.57, 95% CI: 1.60, 13.06)] were a significant predictors of death from cervical cancer. CONCLUSION: The restricted mean survival time of cervical cancer patients in this study was 40.21 months. Marital status, type of tumor histology, stage of disease, type of treatment initiated, and presence of co-morbidity were significant predictors of death for cervical cancer. Treatment of comorbidities in the early stage of cervical cancer plays a key role in maximizing the survival time of cervical cancer patients.

Family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis versus usual care in Ethiopia: study protocol for a cluster-randomised controlled trial.

INTRODUCTION: Leprosy, podoconiosis and lymphatic filariasis (LF) are three skin-related neglected tropical diseases. All three conditions can lead to temporary and permanent impairments. These impairments progressively worsen and are major determinants of stigma, discrimination and participation restrictions. Self-care is essential to prevent disabilities and chronic disease complications. Many persons with leprosy-related, LF-related and podoconiosis-related disabilities need to practice self-management routines their entire life. This is difficult without support and encouragement of others. The objective of this study was to assess the effectiveness of a family-based intervention in terms of physical outcomes related to prevention and self-management of disabilities due to leprosy, podoconiosis and LF and family quality of life and well-being compared with usual practice and care. METHODS AND ANALYSIS: The study will use a cluster-randomised controlled trial design with two study arms. The project will be carried out in endemic districts in East and West Gojjam zones in the Amhara region in Ethiopia. Clusters consist of kebeles (lower administrative structures in the district) that have been merged, based on their geographical proximity and the number of cases in each kebele. A total of 630 participants will be included in the study. The intervention group will consist of 105 persons affected by leprosy, 105 persons affected by LF or podoconiosis, and 210 family members. The control group will consist of 105 persons affected by leprosy and 105 persons affected by LF or podoconiosis. The family-based intervention comprises an essential care package that consists of the following three main components: (1) self-management of disabilities, (2) economic empowerment and (3) psychosocial support. Participants in the control areas will receive usual practice and care. Data analysis includes, but is not limited to, calculating the percentage of change and corresponding 95% CI of physical impairment outcomes in each group, before and after the intervention is implemented, effect sizes, intention to treat and difference in difference analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Debre Markos University Health Sciences Institutional Research Ethics Review Committee. Results will be disseminated through peer-reviewed publications, conference presentations and workshops. TRIAL REGISTRATION NUMBER: PACTR202108907851342.

Incidence and Predictors of Viral Load Suppression After Enhanced Adherence Counseling Among HIV-Positive Adults in West Gojjam Zone, Amhara Region, Ethiopia.

BACKGROUND: Viral load suppression among people living with HIV is the main goal of antiretroviral therapy (ART). The most cause for high viral load is poor adherence to ART. World Health Organization (WHO) recommends intensive enhanced adherence counseling for people with a high viral load, which is greater or equal to 1000 RNA copies per mL and at least on treatment for six months. However, little is known about the outcome of enhanced adherence counseling. The study aimed to assess the incidence of viral load suppression after enhanced adherence counseling and its predictors among HIV-positive adults in high caseload health facilities in the Amhara region, Ethiopia. METHODS: An institution-based retrospective follow-up study was employed among 346 HIV-positive adults enrolled in enhanced adherence counseling in a high caseload health facility in the West Gojjam zone from June 2016 to June 2020. The data on relevant variables were collected from the patient's medical cards by trained data collectors. The collected data were entered into EpiData version 3.1 and then exported to Stata version 14 for analysis. Descriptive analysis was performed to describe the variables. Cox proportional regression model was used to identify independent predictors of viral load suppression after enhanced adherence counseling. RESULTS: Overall, 51.73% of the study participants achieved viral load suppression after enhanced adherence counseling. The incidence of viral load suppression rate was 11.17 per 100-person month. During the multivariate analysis, it was observed that being female (AHR = 1.50, 95% CI: 1.05-2.15), CD4 count of greater than or equal to 350 cells/mm3 (AHR = 1.98, 95% CI: 1.12-3.51) and no recurrent OI (AHR = 1.85, 95% CI: 1.06-3.24) were an independent predictor of viral load suppression after enhanced adherence counseling. CONCLUSION: Incidence of viral load suppression rate was still far from the WHO target (70%). Therefore, higher priority should be given to patients with low CD4 counts with improved enhanced management of opportunistic infections.

Determinants of Virological Failure Among HIV-Infected Children on First-Line Antiretroviral Therapy in West Gojjam Zone, Amhara Region, Ethiopia.

BACKGROUND: Viral load monitoring is a golden indicator for diagnosing treatment failure in patients with HIV. HIV-infected children are considered a priority group for routine viral load monitoring. Globally, the World Health Organization recommends 95% of HIV patients have viral suppression. Factors leading to virological failure are not well understood and studied. This study aimed to determine virological failure among HIV-infected children on first-line antiretroviral therapy in the West Gojjam Zone, Amhara region. Ethiopia. METHODS: An institutional-based unmatched case-control study was carried out from October 1 to October 15, 2020, among HIV-infected children on first-line antiretroviral therapy. The study included 94 cases and 276 controls, with a total sample size of 370 out of 378 HIV-infected children. A structured English version checklist was used to collect data through chart review. The data were entered using Epi-data 4.2 and exported into SPSS version 20 for analysis. Descriptive statistics were conducted to summarize the sample characteristics. Bivariate and multivariate analyses were used to describe each explanatory variable's association with the outcome variable. A bivariate analysis with a p-value < 0.25 was selected for multivariate analysis. Adjusted odds ratio with 95% confidence intervals was conducted, and p-value < 0.05 was considered statistically significant. RESULTS: Non-disclosure (AOR = 4.26; 95% CI: 2.09, 8.70), baseline viral load >1000 copies/mL (AOR = 10.82; 95% CI: 5.4, 21.67), recent poor adherence (AOR, 6.05, 95% CI, 1.70, 21.55) and missed clinical appointments (AOR = 8.03; 95% CI: 3.88, 16.65) were factors independently associated with virological failure. CONCLUSION: Disclosure of HIV status of patients early, according to their age and adherence to counseling, should be emphasized. Efforts should be strengthened to trace back for missed clinical appointments and strictly follow-up with antiretroviral (ARV) medication for a baseline viral load >1000 copies/mL that helps to boost immunity and suppress viral replication.

Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran's I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization. RESULTS: A spatial heterogeneity of defaulting from immunization was observed (Global Moran's I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level. CONCLUSIONS: A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.

Psychological Distress and Its Correlates among Newly Diagnosed People Living with HIV in Northwest Ethiopia: Ordinal Logistic Regression Analyses.

BACKGROUND: Although there is a high burden of HIV in sub-Saharan Africa (SSA), studies on mental health issues among people living with HIV are scarce. The study addressed the transition to "test and treat" guidelines for HIV, which makes it unique regarding its evaluation of psychological distress amongst newly initiated people living with HIV in the test and treat era. METHODS: We conducted a cross-sectional survey of 689 people newly diagnosed with HIV. Symptoms of psychological distress were measured using the Kessler-10 psychological distress assessment scale. Factors associated with psychological distress were captured using interviewer-administered questionnaires. Ordinal logistic regression analyses were employed to identify predictors of psychological distress. RESULTS: The magnitude of psychological distress was 58.63% (95% CI = 55.2%-62.3%). The severity of the psychological distress of which, 17.42% had severe distress. Psychological distress was observed more among female patients (ß = 0.47, AOR = 1.59, 95% CI = 1.12, 2.27), patients presented with opportunistic infections (ß = 0.50, AOR = 1.65, 95% CI = 1.03, 2.66) and being non-working functional status (ß = 0.99, AOR = 2.70, 95% CI = 1.64, 4.45). Moreover, patients who were malnourished (ß = 0.46, AOR = 1.58, 95% CI = 1.09, 2.26), having good level of knowledge on HIV prevention (ß = 0.59, 95% CI = 0.55, 0.39, 0.78), presented with sexually transmitted infection (ß = 0.48, AOR = 1.61, 95% CI = 1.01, 2.58), history of alcohol use (ß = 0.44, AOR = 1.55, 95% CI = 1.09, 2.21), perceived stigma (ß = 0.08, AOR = 1.09 95% CI = 1.04, 1.15) and treated in health centers (ß = 0.55, AOR = 1.74, 95% CI = 1.25, 2.41) had higher odds of psychological distress. CONCLUSION: The large majority of newly diagnosed HIV patients suffered from psychological distress. An increased vulnerability was observed among females, those with opportunistic and sexually transmitted infections, those having poor functional status and malnourished. Furthermore, HIV patients treated in health centers, those who had history of alcohol use and patients with high level of HIV related stigma are more negatively affected by the HIV diagnosis. Hence, all intervention strategies should target all the identified predictors.

Barriers and Facilitators of Same-Day Antiretroviral Therapy Initiation Among People Newly Diagnosed with HIV in Ethiopia: Qualitative Study Using the Transtheoretical Model of Behavioral Change.

PURPOSE: HIV test and treat approach is currently a strategy used as a part of the prevention and control program in Ethiopia. The strategy adopts initiating antiretroviral therapy (ART) on the same-day as HIV diagnosis or in the next visit. However, there is little evidence on barriers and facilitators of same-day (ART) initiation in Ethiopia. Therefore, this study aimed to investigate barriers and facilitators of same-day (ART) initiation in the northwest Ethiopia. PATIENTS AND METHODS: A qualitative study was conducted in East Gojjam Zone in northwest Ethiopia. Purposively selected HIV patients, healthcare workers, and treatment assistants participated in the qualitative study. Data were collected through in-depth interviews and focus group discussions (FGDs). Coding was done via ATLAS.ti software thematically. The interviews and FGDs were conducted in Amharic (local language) and then transcribed verbatim and translated into English. Coding was done via ATLAS.ti software. The thematic analysis approach was employed using the constructs of the transtheoretical behavioral model (TTM) to show stages of change that newly HIV diagnosed experienced in the course of preparation for treatment initiation. RESULTS: A total of 19 patients, 12 treatment supporters, and 9 healthcare workers participated in the qualitative study. Shocking due to the test result, having no symptoms, mistrust of the test result, and seeking spiritual healing from holy water were the major barriers to start ART in the same-day of diagnosis or within the next visit. CONCLUSION: During HIV diagnosis, more barriers were observed in the early stages, while treatment facilitators emerged in the later stages of TTM. The TTM model can be applied to characterize where participants were in the stages of change.

Risky Sexual Practice, Sexually Transmitted Infection and Associated Factors Among Newly Diagnosed HIV-positive People in Northwest Ethiopia.

PURPOSE: Risky sexual practice expose for the acquisition of sexually transmitted infection (STI) including human immunodeficiency virus (HIV). This study was conducted to fill the knowledge gap on the prevalence of risky sexual practice, STIs and associated factors among newly diagnosed HIV-positive people in northwest Ethiopia. PATIENTS AND METHODS: This study was a cross-sectional study design which was conducted on 745 newly diagnosed HIV patients. An interviewer-administered questionnaire was used to interview patients within seven days of HIV diagnosis using client exit interview approach. Data were entered to EpiData and exported to SPSS version 24 for analysis. Binary logistic regression analysis was employed to select factors for multivariate logistic regression at p-value of less than 0.25. Two separate logistic regression models were used for risky sexual practice and STI as dependent variables. The strength of statistical association was quantified using an adjusted odds ratio (AOR) with a 95% confidence level. RESULTS: The prevalence of risky sexual practices and STIs among newly diagnosed HIV-positive people were 15.8% (95%CI: 13.1-18.4) and 6.6% (95%CI: 4.8-8.5), respectively. Although there were no statistically significant factors associated with STI, having two or more lifetime sexual partners (AOR=3.19; 95%CI: 1.57-6.49) and frequent use of alcohol (AOR=3.10; 95%CI: 1.34-7.19) were the factors associated with risky sexual practice. CONCLUSION: Risky sexual practice and STI were found to be low among newly identified HIV patients. Factors associated with risky sexual practice failed to explain STI diagnosis using the syndromic approach. Therefore, revisiting the definition of risky sexual practice is necessary for the universal test and treat approach since sustained viral suppression may leave the need for consistent use of condoms among HIV patients who are on ART especially with regular sexual partners. Further study is also recommended to measure changes in sexual practice after initiating antiretroviral therapy.

Same-day antiretroviral treatment (ART) initiation and associated factors among HIV positive people in Northwest Ethiopia: baseline characteristics of prospective cohort.

BACKGROUND: Despite a well-established fact that same-day or rapid ART initiation after a positive HIV test result is vital for faster viral suppression and for prevention of further sexual transmissions of HIV, there is a paucity of evidence on the uptake of same-day ART initiation among newly HIV diagnosed people in Northwest, Ethiopia. METHODS: A cross-sectional study was conducted between December 1st, 2018 and July 30, 2019. About 759 newly HIV diagnosed adults were recruited from 24 health facilities. Data were collected using interviewer-administered questionnaire. Data were entered using EPI-Data and exported to SPSS and STATA software for further analysis. Bivariate logistic regression was used to select candidate variables at p-value less than 0.25 for multivariate logistic regression. Then adjusted odds ratio with 95% Confidence Interval (CI) at p-value of less than 0.05 was used to declare the statistical associations between the dependent and independent variables. RESULT: Magnitude of same-day ART initiation was 318 (41.90%) [(95% CI, 38.2-45.20%)]. Factors associated with same-day ART initiation were: Patients resided in West Gojjam Zone were 2.04 times more likely to initiate same-day ART compared to those in Bahir Dar city administration [AOR = 2.04 (1.04-3.97)], patients in the health centers were 3.06 times more likely to initiate same-day ART initiation compared to those in the hospitals [AOR = 3.06 (1.90-4.92)] and Patients who were diagnosed their HIV status at the same health facility where they linked for ART were 2.16 times more likely to initiate ART at the same-day of diagnosis [AOR = 2.16 (91.24-3.74)]. Moreover, patients with no opportunistic infection [AOR = 2.08 (1.04-4.19)] and pregnant women [AOR = 3.97 (1.78-8.87)] were more likely to initiate ART same-day of diagnosis. CONCLUSIONS: Same-day ART initiation was low among HIV patients in Ethiopia. Patients attending their treatment at hospitals and those from big city (Bahir Dar) were less likely to initiate same-day ART. Clinical factors such as having opportunistic infections and non-pregnancy status affected the immediate initiation of treatment. HIV positive people who seek care in hospitals and those tested HIV positive from another health facilities in which they did not intend to continue their ART follow-up care need special attention.

Undernutrition among Ethiopian adults living with HIV: a meta-analysis.

BACKGROUND: Malnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia. METHODS: We searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I 2 test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults. RESULTS: After reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%). CONCLUSION: This study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm3, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement.

Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study.

BACKGROUND: Neonatal mortality remains a serious global public health problem, but Sub-Saharan Africa (SSA), in particular, is largely affected. Current evidence on neonatal mortality is essential to inform programs and policies, yet there is a scarcity of information concerning neonatal mortality in our study area. Therefore, we conducted this prospective cohort study to determine the incidence and predictors of neonatal mortality at Debre Markos Referral Hospital, Northwest Ethiopia. METHODS: This institutionally-based prospective cohort study was undertaken among 513 neonates admitted to the neonatal intensive care unit of Debre Markos Referral Hospital between December 1st, 2017 and May 30th, 2018. All newborns consecutively admitted to the neonatal intensive care unit during the study period were included. An interviewer administered a questionnaire with the respective mothers. Data were entered using Epi-data™ Version 3.1 and analyzed using STATA™ Version 14. The neonatal survival time was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables were compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of neonatal mortality. RESULTS: Among a cohort of 513 neonates at Debre Markos Referral Hospital, 109 (21.3%) died during the follow-up time. The overall neonatal mortality rate was 25.8 deaths per 1, 000 neonate-days (95% CI: 21.4, 31.1). In this study, most (83.5%) of the neonatal deaths occurred in the early phase of neonatal period (< 7 days post-partum). Using the multivariable Cox-regression analysis, being unemployed (AHR: 1.6, 95% CI: 1.01, 2.6), not attending ANC (AHR: 1.9, 95% CI: 1.01, 3.5), not initiating exclusive breastfeeding (AHR: 1.7, 95% CI: 1.02, 2.7), neonatal admission due to respiratory distress syndrome (AHR: 2.0, 95% CI: 1.3, 3.1), and first minute Apgar score classification of severe (AHR: 2.1, 95% CI: 1.1, 3.9) significantly increased the risk of neonatal mortality. CONCLUSION: In this study, we found a high rate of early neonatal mortality. Factors significantly linked with increased risk of neonatal mortality included: unemployed mothers, not attending ANC, not initiating exclusive breastfeeding, neonates admitted due to respiratory distress syndrome, and first minute Apgar score classified as severe.

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study.

BACKGROUND: Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia. METHODS: An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients' charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery. RESULT: From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9-17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22-31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27-0.85), no formal education (ARR = 0.24, 95% CI: 0.13-0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08-0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17-0.59) decrease the probability of nutritional recovery. CONCLUSION: Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.

Corrigendum to "Prevalence of Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care at Dubti Hospital: A Case of Pastoralist Region in Northeast Ethiopia".

[This corrects the article DOI: 10.1155/2018/1659089.].

Sexual Behavior of Perinatally Infected Youth in Northwest Ethiopia: Implication for HIV Prevention Strategy.

BACKGROUND: The major mode of HIV transmission in many resource-limited settings is via heterosexual intercourse, but the primary risk factor for youth is primarily through perinatal infection. With the maturing of the HIV epidemic, youth who acquired the virus perinatally are now reaching adolescence and becoming young adults. There is a paucity of data on the sexual practices of perinatally infected youth in Ethiopia. METHODS: This a cross-sectional study among 343 HIV positive youths receiving HIV care and treatment in the two hospitals in northwest Ethiopia. A self-administered questionnaire was administered among those who were able to read and write, and the questionnaire was administered by a trained study team member for those who were illiterate. Data were entered using Epi data version 3.5 and analyzed using SPSS. Sexual behaviors of the two groups were compared using bivariate logistic regression and the significant ones were further analyzed using multivariate logistic regression. Statistical significance was declared at 95% confidence interval and P-value less than 0.05. RESULT: About (63.3%) were females, and 177 (51.6%) were between 20 and 24 years of age. The modes of HIV acquisition were 133 (35%) through perinatal HIV infection, 120 (35%) through sexual contact, 27 (7.9%) through exposure to HIV infected sharp materials, and 63 (18.4%) unsure how they acquired HIV. More than half 155 (59.3%) had multiple sexual partners, and 50 (63.3%) of their sexual partners were HIV negative. Among those who were sexually active, only 77 (56.2%) use a condom consistently. CONCLUSIONS: More children who acquired HIV from their mothers are joining the youth population. Their sexual behavior is similar to those youth with behaviorally acquired HIV. There is significant risky sexual behavior among both groups. There is great urgency to effectively address the HIV the prevention strategy to break the cycle of "transgenerational" infection.

Magnitude of malnutrition and associated factors among HIV infected children attending HIV-care in three public hospitals in East and West Gojjam Zones, Amhara, Northwest, Ethiopia, 2017: a cross-sectional study.

OBJECTIVE: The main aim of this study was to assess the magnitude of malnutrition and associated factors among HIV infected children in Amhara Regional State, and Northwest Ethiopia. This study is a result of single observation. RESULTS: A total of 372 study participant were interviewed, of which 60.2%, 95% CI (55.90-65.60) were malnourished. Children who had good individual dietary diversity were 53% times less likely malnourished as compared to children who had fair/poor dietary diversity (AOR = 0.474, 95% CI (0.26, 0.86)). Sex of child, Age of the child, undiversified diet, comorbidity disease, oral ulcer, diarrhea and history of hospital admission were found statically significant associated with malnutrition. Magnitudes of malnutrition among HIV infected children were very high. The early detection and control progression of HIV, closely follow up to intervene this situation is highly recommended.