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OBJECTIVE: Antibiotic misuse includes using them to treat colds and influenza, obtaining them without a prescription, not finishing the prescribed course and sharing them with others. Although drug providers are well positioned to advise clients on proper stewardship practices, antibiotic misuse continues to rise in Ethiopia. It necessitates an understanding of why drug providers failed to limit such risky behaviours. This study aimed to explore drug providers' perspectives on antibiotic misuse practices in eastern Ethiopia. SETTING: The study was conducted in rural Haramaya district and Harar town, eastern Ethiopia. DESIGN AND PARTICIPANTS: An exploratory qualitative study was undertaken between March and June 2023, among the 15 drug providers. In-depth interviews were conducted using pilot-tested, semistructured questions. The interviews were transcribed verbatim, translated into English and analysed thematically. The analyses considered the entire dataset and field notes. RESULTS: The study identified self-medication pressures, non-prescribed dispensing motives, insufficient regulatory functions and a lack of specific antibiotic use policy as the key contributors to antibiotic misuse. We found previous usage experience, a desire to avoid extra costs and a lack of essential diagnostics and antibiotics in public institutions as the key drivers of non-prescribed antibiotic access from private drug suppliers. Non-prescribed antibiotic dispensing in pharmacies was driven by client satisfaction, financial gain, business survival and market competition from informal sellers. Antibiotic misuse in the setting has also been linked to traditional and ineffective dispensing audits, inadequate regulatory oversights and policy gaps. CONCLUSION: This study highlights profits and oversimplified access to antibiotics as the main motivations for their misuse. It also identifies the traditional antibiotic dispensing audit as an inefficient regulatory operation. Hence, enforcing specific antibiotic usage policy guidance that entails an automated practice audit, a responsible office and insurance coverage for persons with financial limitations can help optimise antibiotic use while reducing resistance consequences.
Subject(s)
Anti-Bacterial Agents , Qualitative Research , Humans , Ethiopia , Anti-Bacterial Agents/therapeutic use , Male , Female , Attitude of Health Personnel , Adult , Drug Misuse , Self Medication/statistics & numerical data , Interviews as TopicABSTRACT
Access to antibiotic medications is critical to achieving the Sustainable Development Goal for good health and well-being. However, non-prescribed and informal sources are implicated as the most common causes of inappropriate antibiotic access practices, resulting in untargeted therapy, which leads to antibiotic resistance. Hence, knowing antibiotic access practices at the community level is essential to target misuse sources. In this study, 2256 household representatives were surveyed between July and September 2023 to examine their antibiotic access practices. Of 1245 household members who received antibiotics, 45.6% did so inappropriately. Non-prescribed antibiotic access was more common among urban residents and individuals not enrolled in health insurance schemes. This means of antibiotic access was also more common among individuals concerned about distance, drug availability, and healthcare convenience at public facilities. In addition, women and rural individuals were more likely to get antibiotics from unauthorized sources. Unrestricted antibiotic dispensing practices in urban areas enabled their non-prescribed access, while unlicensed providers prevailed with this access practice in rural areas. In this regard, personal behaviors and healthcare-related gaps such as the lack of health insurance, inconvenience, and drug unavailability have led community members to seek antibiotics from unofficial and non-prescribed sources. Targeting the identified behavioral and institutional factors can enhance antibiotic access through prescriptions, hence reducing antibiotic resistance.
Subject(s)
Anti-Bacterial Agents , Health Services Accessibility , Humans , Anti-Bacterial Agents/therapeutic use , Ethiopia , Female , Male , Adult , Middle Aged , Rural Population , Adolescent , Young Adult , Surveys and Questionnaires , Urban Population , Inappropriate Prescribing/statistics & numerical dataABSTRACT
BACKGROUND: Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia. METHODS: To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data. RESULT: Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia. CONCLUSION: Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.
Subject(s)
Hyperglycemia , Pregnancy Complications , Pregnancy Outcome , Humans , Pregnancy , Ethiopia/epidemiology , Female , Prevalence , Pregnancy Complications/epidemiology , Hyperglycemia/epidemiology , Risk Factors , Pregnancy Outcome/epidemiology , Diabetes, Gestational/epidemiology , Premature Birth/epidemiologyABSTRACT
BACKGROUND: Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. METHODS: A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. RESULT: Of 510 neonates enrolled, 130(25.5%; 95% CI: 22-29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2-56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4-12.65), primipara (AHR: 2.3; 95% CI: 1.16-4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94-6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28-0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36-19.9) were predictors of preterm neonatal death. CONCLUSION: Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.
Subject(s)
Intensive Care Units, Neonatal , Kangaroo-Mother Care Method , Infant, Newborn , Child , Humans , Female , Pregnancy , Cohort Studies , Retrospective Studies , Ethiopia/epidemiology , Infant Mortality , Hospitals, PublicABSTRACT
BACKGROUND: Tuberculosis is the leading cause of morbidity and mortality among children living with the human immunodeficiency virus (HIV), mainly in sub-Saharan Africa, including Ethiopia. Tuberculosis remains a significant health concern for HIV-positive children in Ethiopia. There is a paucity of data on the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone. Hence, this study aimed to assess the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone between January 2010 to December 2020. METHODS: A retrospective cohort study was conducted among 389 children receiving antiretroviral therapy in Wolaita zone health facilities between January 2010 to December 2020. The checklist was adapted from the standardized antiretroviral treatment (ART) follow-up form currently used by the institutions' ART clinics. The Kaplan-Meier survival function and Log-rank were used to estimate the survival for each categorical variable to compare the survival between different exposure groups. Both bivariable and multivariable parametric survival Gompertz models were fitted to identify predictors of tuberculosis among HIV-positive children. The association was summarized using an adjusted hazard ratio (AHR), and statistical significance was declared at 95% CI and p-value < 0.05. The goodness of the model fit was assessed using a Cox-Snell residual plot. RESULTS: The incidence rate of tuberculosis among children living with HIV was 3.5 (95% CI 2.7-4.5) per 100 child years. World Health Organization clinical stage III or IV (AHR = 2.31, 95% CI [1.26, 4.22]), hemoglobin level <10 g/dL (AHR = 2.87, 95% CI [1.51, 5.45]), fair or poor ART adherence (AHR = 4.4, 95% CI[2.18, 9.05]), underweight (AHR = 2.55, 95% CI [1.45, 4.51]), age >10 years (AHR = 3.62; 95% CI [1.29, 10.0]), and cotrimoxazole preventive therapy (AHR = 0.23; 95% CI [0.08, 0.60]) were among the independent predictors of TB occurrence. CONCLUSION: The incidence of tuberculosis among children on ART was high. HIV-positive children presenting with advanced disease staging (III and IV), anemia, "fair" and "poor" ART adherence, underweight, age above ten years, and not receiving cotrimoxazole preventive therapy were at higher risk of TB. Therefore, counseling on ART adherence, early diagnosis, and prompt treatment of anemia and malnutrition are recommended to avert tuberculosis.
Subject(s)
HIV Seropositivity , Tuberculosis , Humans , Child , Incidence , Retrospective Studies , Thinness , Trimethoprim, Sulfamethoxazole Drug Combination , Tuberculosis/complications , Tuberculosis/epidemiology , Anti-Retroviral Agents/therapeutic use , SeizuresABSTRACT
BACKGROUND: It is well known that the magnitude of undernutrition in Ethiopia is unacceptably high. The burden of co-occurrence of iron, folate, and vitamin A deficiency, on the other hand, has received less attention. Thus, in this study, we looked at the prevalence of iron, folate, and vitamin A deficiency in pregnant women in eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 397 pregnant women in Haramaya district, eastern Ethiopia. An interview-assisted questionnaire and blood serum were collected from pregnant women using standard techniques and shipped to an EPHI for micronutrient analysis. Factors associated with the co-occurrence of iron, folate, and vitamin A deficiency were identified using binary and multiple logistic regressions. RESULTS: According to this study, 81.6% of the participants were deficient in at least one micronutrient, and 53.53.2% were deficient in two or more. Women who did not receive iron-folic acid supplementation (AOR = 2.44; 95% CI = 1.52-3.92), did not attend Antenatal care (ANC) follow up (AOR = 2.88; 95% CI = 1.81-4.61), and reported low consumption of diversified diet (AOR = 2.18 (95% CI = 1.35-3.51) had a higher risk of co-occurrence of iron, folate, and vitamin A deficiency. CONCLUSION: This study found that more than half of pregnant women were in multiple micronutrients, indicating a major public health issue. In addition to the IFA supplementation programs that are already in place, there is a need for multiple micronutrient supplementation.
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Background: Tuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms. Methods: We consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth's multivariate-penalized logistic regression model. Results: We enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20-57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25-12.29]) were associated with bacteriologically-confirmed TB cases. Conclusions: We found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.
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Introduction: Premature rupture of membrane is a disruption of fetal membrane followed by passage of watery fluid gush before the onset of labor any time beyond 28 weeks of gestation. It is a significant cause of perinatal morbidity and mortality. Many studies were conducted on the pre-labor rupture of membrane, yet limited evidence is available on its determinants. This study aimed to identify determinants of premature rupture of membrane among pregnant women in Harar Town, Eastern Ethiopia. Method: ology; Hospital-based unmatched case control study was conducted on 115 cases and 230 controls from 15th May to 15th July 2021. The study was conducted on two public hospitals in Harar town. All cases admitted at the time of data collection were included until the required sample size was obtained and controls were selected by using simple random sampling among all non -cases. Data were collected using interviewer-guided semi-structured questionnaires. The data were entered into Epi-data version 3.1 and exported to SPSS version 22.0 for analysis. Binary logistic regression was used to identify determinants of the outcome and statistical significance declared at a p-value less than 0.05. Multicollinearity was checked and model fitness was assessed by Hosmer Lemeshow test. Results: Abnormal vaginal discharge [AOR 2.15 (2.53, 22.46), history of cesarean delivery [AOR 2.06 (1.11, 6.78)], history of premature rupture of membrane [AOR 4.62 (2.06, 11.52)] and history of abortion [AOR 2.81 (1.04, 6.23)] increase the odds of the outcome. Conclusion: Bad obstetric histories in the current and previous pregnancies are related to premature rupture of membrane. Therefore, it is recommended that health care providers should take attention to women with past and current pregnancy complications.
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Background: Health workforces across all levels of the healthcare system are the main modulators in the effective implementation of disease surveillance system. However, their level of integrated disease surveillance response (IDSR) practice and determinant factors was hardly investigated in Ethiopia. This study determined the level of IDSR practice and associated factors among health professionals in the west Hararghe zone, eastern Oromia, Ethiopia. Methodology: A multicenter facility-based cross-sectional study design was conducted between December 20, 2021, and January 10, 2022, among 297 systematically selected health professionals. Trained data collectors collected data using structured pretested self-administered questionnaires. The level of IDSR practice was assessed using six questions where each acceptable practice was given "1" and unacceptable "0", with a total score of 0 to 6. Hence, a score above or equal to the median was categorized as good practice. Epi-data and STATA were used for data entry and analysis. A binary logistic regression analysis model with an adjusted odds ratio was used to determine the effects of independent variables on the outcome variable. Results: The magnitude of good practice of IDSR was 50.17% (95% CI: 45.17, 55.17). Being married (AOR = 1.76; 95% CI: 1.01, 3.06), perceived organizational support (AOR = 2.14, 95% CI: 1.16, 3.94), good knowledge (AOR = 2.77, 95% CI: 1.61, 4.78), positive attitude (AOR = 3.30, 95% CI: 1.82, 5.98) and working in an emergency (AOR = 0.37, 95% CI: 0.14, 0.98) were significantly associated with the level of practice. Conclusion: Only half of the health professionals had a good level of practice in integrated disease surveillance response. Marital status, working department, perceived organizational support, knowledge level, and attitude toward integrated disease surveillance were significantly associated with health professionals' practice of disease surveillance. Thus, organizational and provider-targeted interventions should be considered to improve the knowledge and attitude of health professionals that improve integrated disease surveillance response practice.
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BACKGROUND: The novel coronavirus disease has emerged as the most pressing global health issue. In women with COVID-19 disease, pregnancy confers a substantial additional risk of morbidity and mortality. OBJECTIVE: This study aimed to assess WHO-recommended COVID-19 prevention practices and determinant factors among pregnant women attending antenatal care during the third wave of COVID-19 in eastern Ethiopia. METHODS: An Institutional-based cross-sectional study was conducted among 422 pregnant women attending antenatal care in Harar, from October 10 to November 10, 2021. The sample size was proportionally allocated to all healthcare facilities, then the study participants were selected using systematic random sampling. Descriptive summary statistics were done. Logistic regression analyses were computed to identify associations between dependent and independent variables. Variables with a p-value < 0.05 were declared statistically significant. RESULT: Out of 422 pregnant women, 61.6% of them had good WHO Recommended COVID-19 Prevention Practices. Those with age 25-34 years (AOR: 9.7, 95%CI: 4.8, 19.3), age 35-44 years (AOR:4.8, 95%CI: 2.6, 9.03), monthly income > 10,000 ETB (AOR: 9.4, 95%CI: 2.1, 42.1), being a student (AOR: 10, 95%CI: 2.3, 47.1), having a good level of knowledge (AOR: 2.3, 95%CI:1.4, 3.8), and having ≥10 family members (AOR: 0.24, 95%CI: 0.06, 0.9) were found to have a significant association with WHO recommended prevention practice among pregnant women. CONCLUSION: Overall, the WHO-recommended COVID-19 prevention practice among pregnant women attending antenatal care was good, but it needs improvement. In order to improve prevention practices among pregnant women, Harari Regional Health Bureau and other stakeholders should provide repeated, targeted, and tailored information to pregnant women and the community at large through different media.
Subject(s)
COVID-19 , Pregnant Women , Female , Pregnancy , Humans , Adult , Prenatal Care , Ethiopia/epidemiology , Cross-Sectional Studies , COVID-19/epidemiology , COVID-19/prevention & control , World Health OrganizationABSTRACT
INTRODUCTION: Although undernutrition in pregnancy has continued to get global attention as pregnancy is considered a critical period in the life cycle owed to increase the metabolic and physiological demands, evidence is scarce on undernutrition and associated factors among pregnant women in eastern Ethiopia. Therefore, this study assessed the undernutrition and associated factors among pregnant women in Haramaya district, Eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. Data were collected through face-to-face interviews, anthropometric measurement, and hemoglobin analysis by trained research assistants. An adjusted Prevalence ratio (aPR), and a 95% confidence interval (CI), were used to report associations. Poisson regression analysis model with a robust variance estimate identified variables associated with undernutrition. Data were double entered using Epi-data 3.1 and cleaned, coded, checked for missing and outliers, and analyzed using Stata 14 (College Station, Texas 77845 USA. Finally, the p-value <0.05 was the cut-off point for the significant association. RESULTS: A total of 448 pregnant women with a mean age of 25.68 (± 5.16) were included in the study. The prevalence of undernutrition among pregnant women was 47.9% (95% CI: 43%-53%). From the analysis, the undernutrition was more likely higher among respondents who had five or more family members (APR = 1.19; 95% CI = 1.02-1.40), lower dietary diversity (APR = 1.58; 95% CI = 1.13-2.21) and those who were anemic (APR = 4.27; 95% CI = 3.17-5.76). CONCLUSION: Nearly half of the pregnant women in study area were undernourished. High prevalence was found among women who had large family sizes, low dietary diversity and anemia during pregnancy. Improving dietary diversity, strengthening family planning services and giving special attention to pregnant women, supplementation of iron and folic acid, and early detection and treatment of anemia is essential to improve the high burden of undernutrition and the adverse effect on pregnant women and the fetus.
Subject(s)
Anemia , Malnutrition , Female , Pregnancy , Humans , Adult , Pregnant Women , Prenatal Care , Ethiopia/epidemiology , Cross-Sectional Studies , Anemia/epidemiology , Malnutrition/epidemiology , PrevalenceABSTRACT
Background: The age of children up to 59 months is a critical period for children's growth and development and the age when optimal complementary feeding is crucial. Aim: To assess optimal complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia. Methods: A community-based cross-sectional study was conducted. Statistical Package for Social Science (SPSS) version 24 was used for the analyses. Bivariable and multivariable logistic regression analysis were conducted at p-value < 0.05 and an Adjusted Odd Ratio (AOR) with a 95% Confidence Interval (CI). Results: The percentage of mothers that practiced optimal complementary feeding practices was 53.5% (95% CI: 49.2%, 57.6%). Average monthly income of the family, $37.5 to $75 (AOR = 0.52, 95% CI: 0.28, 0.98), institutional delivery (AOR = 1.61, 95% CI: 1.06, 2.46), postnatal care follow-up (AOR = 2.53, 95% CI: 1.67, 3.82), having an awareness about IYCF (AOR = 3.05, 95% CI: 1.85, 5.02), less than 30â min foot-walking to reach health facility (AOR = 2.61,95% CI: 1.65, 4.09), separate child's feeding plate (AOR = 1.75, 95% CI: 1.16, 2.64), and attendance of Infant and Young Child Feeding demonstration (AOR = 2.02, 95% CI: 1.33, 3.07) were significantly associated with optimal complementary feeding practices. Conclusion: The magnitude of optimal complementary feeding practices was below the minimum recommended level for the growth and development of children in the study area. Lack of access to and underutilization of maternal and child healthcare services were significant risk factors for suboptimal complementary feeding practices. Maternal and child health services would be essential to mitigate suboptimal feeding practices for children aged 6-23 months.
Subject(s)
Health Knowledge, Attitudes, Practice , Mothers , Female , Infant , Humans , Child , Cross-Sectional Studies , Ethiopia , Infant Nutritional Physiological PhenomenaABSTRACT
Background: Children share 12% of the global 10 million people infected with tuberculosis (TB) each year. Closing case detection gap in children remains difficult, with 56% of all children and 65% under-five with TB missed each year. We aimed to assess the patterns of childhood TB diagnosis and underlying determinants in Ethiopia when different TB diagnostic platforms are applied. Methods: A multi-site, cross-sectional study was carried out in Ethiopia as part of the larger EXIT-TB study - evidence-based multiple focused integrated intensified TB screening package. Outpatient children aged ≤ 15 with cough of any duration seeking care at four healthcare facilities in Ethiopia were enrolled consecutively. Participants underwent sputum Xpert MTB/RIF and/or smear microscopy and posteroanterior chest X-ray (CXR), and their clinical and sociodemographic data were captured using a structured questionnaire. Data were analyzed using Stata version 23. Multiple regression model was computed to determine the factors that influence TB case detection, with a 95% confidence interval (CI) and p < 0.05 taken as statistically significant. Results: A total of 438 children were enrolled. Of these, 399 had CXR examination of which 55 (13.8%) were suggestive of TB, 270 had Xpert MTB/RIF testing of which 32 (11.9%) were positive, and AFB smear microscopy was done for 51 children of which 2 (3.9%) were positive. Febrile children were more likely to be diagnosed with pulmonary TB than those without fever [aPR = 1.3, 95% CI (1.1-1.4)], and those with a TB contact history were more likely to be diagnosed with pulmonary TB than those with no such contacts [aPR = 1.2, 95% CI (1.1-1.3)]. Children from rural residences were more likely to be diagnosed with TB than those from urban residences [aPR = 1.3, 95% CI (1.1-1.5)]. Conclusion: The findings showed that clinical diagnosis remains an important method of TB diagnosis in children and the preferred choice to avert underdiagnosis. A more sensitive TB diagnostic method for children was symptom screening, followed by CXR and Xpert MTB/RIF assay or smear microscopy. Hence, an algorithm that combines clinical, CXR, and microbiological confirmatory tests can improve the rate of pulmonary TB diagnosis in children till more accurate and cost-effective diagnostic tools are accessible. Fever, weight loss, and TB contact history are highly associated with TB positivity rates in children.
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BACKGROUND: Globally, Human Immunodeficiency Virus (HIV) is the leading cause of death in women of reproductive age and accountable for a quarter of deaths during pregnancy in sub-Saharan Africa including Ethiopia. Introduction of antiretroviral therapy to women living with HIV highly improves lifestyle and the desire to have children. A comprehensive understanding of baseline predictors of pregnancy among women receiving ART essential to reduces unintended pregnancies, appropriate care, and preventing transmission from mother to child. OBJECTIVE: To determine the effect of baseline predictors on incidence rate of pregnancy among reproductive age women on antiretroviral therapy at public hospitals of Jigjiga and Harar town, Eastern Ethiopia from February 15 to march 15, 2020. METHODS: Retrospective cohort study was conducted on randomly selected 420 HIV-infected women using data recorded from September 11, 2014, to September 10, 2019 in Jigjiga and Harar town in Eastern Ethiopia. Simple random sampling was used to select study subjects from each hospital. Data were entered to Epi data version 3.2 and exported to Stata version 14.2 for analysis. Kaplan-Meier failure, and Cox proportional hazards model were used to estimate the incidence, and to identify predictors of pregnancy respectively. Variables which were significant (P value < 0.05) in the multivariate analysis were considered independent predictors of pregnancy. RESULTS: The overall incidence rate of pregnancy was 9.1 per 100 person-years (95% CI 7.19, 11.76). Being unadvanced HIV disease stage (AHR: 2.50; 95% CI 1.46, 4.19), having less than two children (AHR: 2.93; 95% CI 1.59, 5.40), and disclosed HIV status (AHR: 2.25; 95% CI 1.34, 3.79) were independent predictors of pregnancy. CONCLUSION: The incidence rate of pregnancy among reproductive age women on ART was found to be considerable. Being unadvanced HIV disease stage, having less than two children, and disclosed HIV status were independent predictors of pregnancy. Thus, tailoring counseling have to be designed to enhance better pregnancy planning and consecutive health outcomes.
Subject(s)
HIV Infections , Infectious Disease Transmission, Vertical , Child , Pregnancy , Humans , Female , Incidence , Retrospective Studies , Ethiopia/epidemiology , Cities , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV , Hospitals, PublicABSTRACT
OBJECTIVES: This study examined the association between sexual and reproductive health (SRH) education in peer-group discussion and comprehensive knowledge of HIV among young adolescent girls in rural eastern Ethiopia. DESIGN: The study analysed data from a large quasi-experimental study involving 3290 young adolescent girls aged 13-17 years. The intervention targeted adolescent girls aged 10-14 years. Data were collected using a comprehensive HIV knowledge tool adopted from the demographic and health survey questionnaire. Multi-level mixed-effect logistic regression analysis was employed to examine associations using STATA/SE V.14 statistical software. SETTING: West Hararghe, rural Ethiopia. PARTICIPANTS: 3290 adolescent girls. RESULTS: Magnitude of comprehensive knowledge of HIV among those who received SRH education and those who did not receive SRH education was 16.78% (95% CI 14.41% to 19.45%) and 14.01% (95% CI 12.38% to 15.81%), respectively. Overall, 14.84% (95% CI 13.4.% to 16.39%) of the adolescent girls aged 13-17 years had comprehensive knowledge of HIV. The odds of having comprehensive HIV knowledge were higher (1.36 times) among adolescent girls who received SRH education compared with those who did not receive SRH education (adjusted OR 1.36, 95% CI 1.01 to 1.84) after controlling for selected potential confounders. Odds of having comprehensive HIV knowledge were also higher (1.73 times) among older adolescent girls (adjusted OR 1.733 95% CI 1.098 to 2.735) and (3.89 times) among those who attended secondary school (adjusted OR=3.889 95% CI 1.836 to 8.235) compared with young adolescent girls and the uneducated, respectively. CONCLUSIONS: Comprehensive knowledge of HIV among young adolescent girls was very low. Providing SRH education for young adolescent girls improved their comprehensive knowledge of HIV in rural eastern Ethiopia. Initiating sexual education at an early age would benefit HIV prevention efforts.
Subject(s)
Acquired Immunodeficiency Syndrome , Reproductive Health , Adolescent , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Peer Group , Sexual BehaviorABSTRACT
Background: Postabortion family planning is a part of comprehensive package of postabortion care. However, it did not receive due attention to break the cycle of repeated abortion, unintended pregnancies, and abortion-related maternal morbidity and mortality. Therefore, this study aimed to determine the utilization of postabortion family planning and associated factors among women attending abortion service in Dire Dawa health facilities, Eastern Ethiopia. Methods: A facility-based cross-sectional study design was employed among 483 clients who sought abortion service in Dire Dawa from 15 May to 30 June 2020. A structured interviewer-administered questionnaire was used for data collection. The collected data were entered into EpiData version 3.2 and exported to SPSS version 22 for analysis. The multivariate logistic regression models were fitted to identify factors associated with utilization of postabortion family planning. Adjusted odds ratios (AORs) along with 95% CI were estimated to measure the strength of the association and statistical association was declared statistical at a p-value < 0.05. Results: More than three-fourths (77.8%) [95% CI: (73.4-81.6%)] of respondents were utilized postabortion family planning methods. Respondents with age 15-24 years [AOR: 5.59, (95% CI: (1.5, 19.7)], attended postsecondary [AOR: 7.6, (95% CI: (2.7, 21.2)], single marital status [AOR: 11.1, (95% CI: (4.6, 26.5)], a monthly income 500-1,000 birr [AOR: 7.9, (95% CI: (3.2, 19.4)], parity ≥ 5 [AOR: 0.41, (95% CI: (0.18, 0.92)], desire of current pregnancy [AOR: 4.2, (95% CI: (1.9, 9.3)], and ever used family planning [AOR: 4.4, (95% CI: (2.2, 8.9)] were major factors significantly associated with postabortion family planning utilization. Conclusion: In this study, more than three-fourths of respondents utilize postabortion family planning. Most of the factors associated with postabortion family planning were modifiable. Therefore, policymakers and health planners need to integrate with comprehensive abortion care to improve the utilization of postabortion family planning.
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BACKGROUND: In resource-limited countries such as Ethiopia, tuberculosis is the major cause of morbidity and mortality among people living with the human immunodeficiency virus. In the era of antiretroviral therapy, the effect of tuberculosis on the survival of patients who are living with human immunodeficiency virus has been poorly understood in Ethiopia. Therefore, this study aimed to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy in public hospitals in Eastern Ethiopia. METHODS: An institution-based retrospective cohort study was conducted among 566 participants from January 1, 2014, to June 30, 2018. The collected data were entered into EpiData version 3.1 before being exported to Stata version 14 for analysis. A Cox proportional hazard model was used to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy, and a p-value less than 0.05 and a 95% confidence level were used to declare statistical significance. RESULT: Of the 566 patients included in the study, 76 died. The mortality rate was 11.04 per 100 person-years in tuberculosis co-infected patients, while it was 2.52 per 100 person-years in non-tuberculosis co-infected patients. The patients with tuberculosis co-infection had a 2.19 times higher hazard of death (AHR: 2.19; 95% CI: 1.17, 4.12) compared to those without tuberculosis. Advanced clinical stage, low CD4+ cell count, and previous episodes of an opportunistic infection other than tuberculosis were found to be independent predictors of mortality. CONCLUSION: Co-infection with tuberculosis at antiretroviral therapy initiation increases the hazard of death approximately two-fold. Hence, we recommend key organizations to enhance the region's collaborative interventional and preventative strategies for TB and HIV.
Subject(s)
Coinfection , HIV Infections , Tuberculosis , Adult , Humans , Coinfection/drug therapy , Coinfection/epidemiology , Retrospective Studies , Ethiopia/epidemiology , Incidence , Tuberculosis/complications , Tuberculosis/drug therapy , Tuberculosis/epidemiology , HIV Infections/complications , HIV Infections/drug therapy , Hospitals, PublicABSTRACT
BACKGROUND: Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. METHODS: A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. RESULTS: In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40-50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49-62%) than those studies with community surveys (40%; 95% CI: 34-46%) (P = 0.001). It was also varied by the recall period of antibiotics use-56% (95% CI: 50-62%) for instantly observed practice, 36% (95% CI: 22-50%) for within two week recall, 35% (95% CI: 26-45%) for 1-6 months recall, and 46% (95% CI: 37-54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. CONCLUSIONS: We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. TRIAL REGISTRATION NUMBER: CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971 .
ABSTRACT
Background: Acute malnutrition is a major global public health problem, particularly in low and middle-income countries. A targeted supplementary feeding program is an approach recommended to address moderate acute malnutrition in food insecure settings. Preventing and treating moderate acute malnutrition requires identifying factors shown to affect the treatment outcome and duration of stay on treatment. This study aimed to determine the treatment outcome and predictors of recovery time from moderate acute malnutrition among children 6-59 months of age in Darolebu district, Eastern Ethiopia. Methods: A retrospective cohort study design was conducted on 540 children with moderate acute malnutrition. A Kaplan-Meier survival analysis was used to estimate the recovery time. Cox proportional hazard regression model was used to determine the association between the independent and the outcome variables. The proportional hazard assumption of the model was checked graphically and statistically. Any violation of the proportional hazard assumption of the model was also considered and adjusted in the analysis. Finally, a variable with a P-value <0.05 in the multivariate cox regression model was considered statistically significant. Results: The overall recovery rate was 73% (95% CI 69.4-76.4%) with the median time to recovery of 16 weeks. Being between the ages of 24 and 59 months (AHR = 1.24, 95% CI: 1.01-1.54), having a mid-upper arm circumference (MUAC) at admission between 11.5 and 11.9 cm (AHR = 1.27, 95% CI: 1.34-2.61), walking for an hour or less to receive services (AHR = 1.2, 95% CI: 1.02-1.89), using ready-to-use supplementary food (AHR= 1.8, 95%CI: 1.38-2.39) were significant predictors of recovery time. Conclusion: The recovery rate was slightly below the accepted minimum international standard, suggesting that further work is needed to improve the treatment outcomes and mortality and morbidity associated with moderate acute malnutrition.