Predictors of loss to follow up among adults on antiretroviral therapy before and after the start of treat-all strategy in public health facilities of Hawassa city, Ethiopia: A Competing risk regression.

BACKGROUND: Treat-all strategies improved patient outcomes, despite higher rates of loss to follow-up compared to the pre-treat era. Patients in Ethiopia experienced a higher rate of LTFU during the treat-all strategy period; however, studies did not identify contributing factors in comparison with previous strategies. This study aimed to assess the incidence and predictors of loss to follow-up before and after the start of the treat-all strategy among adults on anti-retroviral therapy in public health facilities in Hawassa City, Ethiopia. METHODS: An institution-based retrospective follow-up study was conducted among 1190 randomly selected adults on antiretroviral therapy in public health facilities in Hawassa City. Using the Open Data Kit (ODK), data were collected from medical records and exported to Stata version 16 and R 4.2.1 for analysis. A Grays test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow-up. Bivariable and multivariable competing risk regression were fitted to identify predictors of LTFU and variables with a p-value <0.05 were considered significant. RESULTS: The cumulative incidence of lost-to-follow-up was 4.92(3.84,6.3) and 8.67(7.26,10.3) per 100 person-years (PY) in pre-treat all and treat all cohorts, respectively. The cumulative incidence of mortality was 5.86(4.67,7.35) and 3(2.26,4.12) per 100 PY in pre-treat and treat all cohorts, respectively. Fair/poor adherence (aSHR:5.17; (95% CI 1.97, 13.51), underweight (aSHR:2.13; 95% CI: 1.15-3.93) and WHO stage III/IV (aSHR:2.69; 95% CI: 1.27, 5.71) were predictors of loss up in pre-treat all, whereas fair/poor adherence (aSHR = 2.07; 95% CI: 1.18, 3.68), underweight (aSHR:1.71; 95% CI: 1.13, 2.56), and CD4 cell >350 cell/m3 (aSHR: 1.67; 95% CI: 1.05, 2.65) predicts of loss up in treat all cohorts. CONCLUSION: This study demonstrated that the incidence of loss to follow-up was considerably higher in the treat-all period as compared to the pre-treat-all era. Poor medication compliance, underweight, and a CD4 level >350 cells/m3 contributed to the higher rate of LTFU in the treat-all strategy. Targeted interventions, such as nutritional support and strengthening medication adherence counseling, should be implemented to maintain treatment retention and reduce antiretroviral therapy dropout rates.

Magnitude and factors associated with birth preparedness and complication readiness among pregnant women in Wolaita Zone, Ethiopia.

OBJECTIVE: To assess the magnitude and factors associated with birth preparedness and complication readiness (BPCR) among pregnant women in Humbo district, Wolaita Zone, Ethiopia. METHODS: A community-based cross-sectional study was conducted from August 1 to 30, 2020. A total of 506 pregnant women were randomly selected and interviewed using a questionnaire. Data were entered using EpiData version 4.6.0, and analysis was made using SPSS version 24. An adjusted odds ratio (aOR) with a 95% confidence interval (CI) was calculated. RESULTS: The magnitude of BPCR in the Humbo district was 26.0%. The odds of being prepared for birth and its complications were higher among women who had a history of obstetric complications (aOR 2.77; 95% CI 1.18-6.52), participated in pregnant women's conferences (aOR 3.84; 95% CI 2.13-6.93), received advice on BPCR (aOR 2.39; 95% CI 1.36-4.22), and were knowledgeable on labor and childbirth danger signs (aOR 2.64; 95% CI 1.55-4.49). CONCLUSION: The magnitude of birth preparedness and complication readiness was low in the study area. The healthcare provider should encourage the women to participate in conferences and provide continuous counseling during their prenatal care visits.

Association between iron-folic acid supplementation and pregnancy-induced hypertension among pregnant women in public hospitals, Wolaita Sodo, Ethiopia 2021: a case- control study.

BACKGROUND: Pregnancy-induced hypertension is the new onset of high blood pressure after 20 weeks of gestation in women with previously normal blood pressure. To the best of our knowledge, no study has been conducted in our country to investigate the association between this pregnancy problem and iron-folic acid supplementation. The aim of this study was to determine the association between iron-folic acid supplementation and pregnancy-induced hypertension (PIH) in pregnant women at public hospitals in the Wolaita Sodo zone. METHODS: An institution-based case-control study was conducted among pregnant women who visited public hospitals in the Wolaita Sodo zone from March 3, 2022, to August 30, 2022. A consecutive sampling method was used to select the study participants. The total sample size was 492, of which 164 were cases and 328 were controls. The data were collected by conducting face-to-face interviews and measurements. The data were entered into EpiData version 4.6 and exported to STATA 14 for analysis. Those variables with a p-value less than 0.05 were considered statistically significant. Descriptive statistics and odds ratios were presented using texts, tables, and figures. RESULTS: A total of 471 women participated in this study, yielding a response rate of 96%. The cases had a mean age of 25 ± 4.43, while the controls had a mean age of 25 ± 3.99. The mean age at first pregnancy among cases was 20 ± 2.82 and among controls was 20 ± 2.97. The average number of deliveries for cases and controls was 1.97 ± 1.41 and 1.95 ± 1.38, respectively. There is no significant association between iron-folic acid supplementation and PIH. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it (AOR = 3.65; 95% CI: 1.0-12.9). Eating kocho (AOR = 14.4; 95% CI: 1.2-16.7) was positively associated with PIH. CONCLUSIONS: There is no association between iron-folic acid supplementation during pregnancy and pregnancy-induced hypertension. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it. There is an association between kocho consumption and PIH. More research should be done using stronger designs.

Determinants of puerperal sepsis among postpartum women at public hospitals of Hawassa city, Southern Ethiopia: Institution-based unmatched case-control study.

Background: World health organization reported that from 358,000 maternal deaths occurring during labor and childbirth about 15% were attributed to puerperal sepsis. In Ethiopia, puerperal sepsis is the fourth leading direct cause of maternal death next to hemorrhage, obstructed labor, and pregnancy-induced hypertension. Early recognition and management of the contributing factors would help to modify the problem. Therefore, this study was aimed to identify the determinants of puerperal sepsis among postpartum women at Hawassa city public hospitals in South Ethiopia. Methods: & materials: Institution-based unmatched case-control study was conducted among 305 postpartum women (61 cases & 242 controls; with a ratio of 1:4) at Hawassa city public hospitals from June 17 to August 20/2021. Cases were all postpartum women admitted with puerperal sepsis and controls were randomly selected postpartum women admitted with other cases. A pre-tested interviewer-administered questionnaire was used to collect the data. Data were entered into Epi data version 4.6 and then exported to STATA version 14 for analysis. Bivariable analysis was performed and variables having a p-value <0.25 made candidates for the multivariable logistic regression model. Adjusted Odds ratio (AOR) with 95% confidence interval was computed to identify the presence and strength of association and statistical significance was declared at p-value <0.05. Result: In this study, a total of 61 cases & 242 controls were included. Cesarean section delivery (AOR = 2.85; 95% CI; 1.36-5.98), manual removal of placenta (AOR = 6.0; 95% CI = ; 0.39-26.26), ≥5 times Per-vaginal Examination during labor (AOR = 4.53; 95% CI; 2.10-9.80), presence Gestational Diabetes Mellitus (AOR = 8.50; 95% CI; 1.99-36.33) & prolonged labor (AOR = 3.43; 95% CI; 1.20-9.76) were identified as determinants of puerperal sepsis. Conclusion: In this study, cesarean delivery, Per-vaginal Examination ≥5 times during labor, manual removal of placenta, Gestational Diabetes Mellitus & prolonged labor were factors that significantly increased the odds of developing puerperal sepsis among postpartum women. So, labor & delivery procedures should be conducted as per labor & delivery management protocols.

Determinants of Preeclampsia Among Pregnant Women in Public Hospitals of Wolaita and Dawuro Zones, Southern Ethiopia: A Case-Control Study.

Introduction: Preeclampsia is a leading cause of maternal and fetal morbidity and mortality in Ethiopia. It is defined by the onset of new hypertension (HTN) and proteinuria in the second trimester of pregnancy. There is a research gap in the study area and there is an inconsistency of findings in previous studies. Therefore, this study aimed to determine the factors of preeclampsia among pregnant women in public hospitals. Methods and Materials: An institution-based unmatched case-control study was conducted in public hospitals in Wolaita and Dawuro Zones from February 1 to June 26, 2021. Women who were diagnosed with preeclampsia were cases, while those who did not have it were controls. They were selected using a consecutive sampling method. Descriptive statistics and logistic regression were done by STATA. Results: A total of 349 cases and 698 controls participated in this study. The average age of the cases and controls was 26.1 ± 4.6 standard deviation (SD) and 24.6 ± 4.8 SD years, respectively. The determinants of preeclampsia in this study were a family history of HTN (adjusted odds ratio [AOR = 11.5; 95% confidence interval, CI: 6.46-20.41], family history of diabetes mellitus [AOR = 2.1; 95% CI: 1.10-3.90], having two or multiple pregnancies [AOR = 6.33; 95% CI: 2.28-17.51], primigravida [AOR = 1.49; 95% CI: 1.01-2.21], and being gravida 5-9 [AOR = 2.47; 95% CI: 1.34-4.58]). Conclusion: In this study, family history of HTN, family history of diabetes mellitus, history of preeclampsia, primigravida, and multiple gestation pregnancies were the determinants of preeclampsia. As a result, health care providers should pay special attention to pregnant women with a family history of HTN, primigravida, and two or multiple gestation pregnancies during antenatal care follow-up.

Effect of hospital attributes on patient preference among outpatient attendants in Wolaita Zone, Southern Ethiopia: discrete choice experiment study.

BACKGROUND: Patient preference has preceded the use of health care services, and it has been affected by different hospital attributes. Meanwhile, the number of patients receiving vital health intervention is particularly low in Ethiopia. Therefore, this study aimed to determine the effect of hospital attributes on patient preference for outpatients in the Wolaita area in September 2020. METHODS: A discrete choice experimental study was applied to determine the effect of hospital attributes on patient preference with a sample size of 1077. The experimental survey was conducted among outpatient attendants selected through a systematic random sampling approach. Six key attributes (competence of healthcare providers; availability of medical equipment and supplies; cost of service; wait time; distance; and hospital reputation) deduced from various hospital attributes were used to elicit the patient preferences. The data was collected from participants through the Open Data Kit application. A random effect probit model with marginal willingness to pay measure and partially log-likelihood analysis was applied to extract important attributes. We used STATA version 15 software for analysis, and the fitness of the model was verified by the calculated p-value for the Wald chi-square with a cut-point value of 0.05. RESULT: One thousand forty-five patients who received outpatient care participated in the study. The random effect probit results have shown that all hospital attributes included in the study were significantly valued by patients while choosing the hospital (p-value < 0.001). Meanwhile, based on marginal willingness to pay and partial log-likelihood analysis, the competence of health care providers was identified as the most important attribute followed by the availability of medical equipment and supplies in hospitals. CONCLUSION AND RECOMMENDATION: The results suggested that the quality of health care providers and availability of medical equipment and supply in hospitals would be primary interventional points for improving the patient preference of hospitals. Assessment, education, and training are recommended for enhancing the quality of health care providers. And stock balance checks, inspections, and accreditation are believed to be valuable for improving the availability of equipment and supply in hospitals.

Nutritional status and associated factors among lactating women in Dire Dawa, Ethiopia.

BACKGROUND: Lactating women's nutritional status is critical since it influences the health of their infants. However, there was a scarcity of data on maternal nutrition in low-income countries such as Ethiopia, particularly in the study area. METHODS: Institutional-based cross-sectional study was conducted among 401 lactating women in Dire Dawa town health facilities from February 10, 2019 to March 30, 2019. The sum of the number of food categories consumed by each respondent over the 24-h recall period is the women's diet diversity score. To identify factors linked to undernutrition, all variables with a p-value of less than 0.25 were included into multivariate logistic regression. RESULT: Prevalence of undernutrition was 22%. Women who age 15-25 years were four times more likely undernourished than older (adjusted odd ratio [AOR] = 4.04; confidence interval [CI]: [1.74, 9.40]). Unable to read and write women were almost five times more likely to be undernourished than formal education (AOR = 4.76; CI: [2.31, 9.81]). Women who have family size >7 were six times more likely to be undernourished than family size <3 (AOR = 5.53; CI: [1.15, 26.53]). Women not take additional food during lactating were 4.5 times more likely undernourished than take additional food (AOR = 4.56; CI [1.50, 13.9]). DD score <5 were four times more likely to be undernourished than (≥5) DD (AOR = 4; CI: [2.02, 7.90]). CONCLUSION: Prevalence of undernutrition in the study area was high. Factors associated with undernutrion were: age of lactating women, education status, family size, additional food during lactation and DD score. Thus, multisectoral collaboration targeted at improving women's educational status and increasing food during lactation need to be emphasized.

Utilization of youth friendly reproductive health services and associated factors among secondary school students in Southern Ethiopia, 2019: school-based cross-sectional study.

Introduction: youth-friendly services are services that are accessible, acceptable, and appropriate for them. Youths are suffering by unwanted pregnancy, unsafe abortion and its complications and Sexually transmitted diseases (STIs) including HIV. However, a little study was done in Ethiopia previously. Hence, the purpose of this study is to assess the utilization of youth-friendly reproductive health services and associated factors among secondary school students in Areka Town, Sothern Ethiopia. Methods: school-based cross-sectional study design was conducted among 600 secondary school students at the Areka Town. A simple random sampling method was used to select the study participants. A structured and pre-tested self-administered questionnaire was used to collect data. Data was entered using Epi data version 3.1 and exported to the SPSS version 20 for further analysis. Adjusted odds ratio at 95% confidence interval with p-value < 0.05 was estimated to identify the associated factors on multivariable logistic regression. Results: the magnitude of youth-friendly reproductive health service utilization was 44.2%, with 95% CI: (40.0-48.4). Having sexual experience (AOR: 14.72, 95%CI (2.41-89.79)), parental monitoring (AOR = 7.65, 95% CI (1.19-49.07)) and having good knowledge (AOR: 14.02 95% CI (9.34-21.53)) were factors independently associated with youth-friendly reproductive health service utilization. Conclusion: the study shows the utilization of youth-friendly reproductive health service were low. Having sexual intercourse experience, parental monitoring, and having good knowledge were predictors of youth-friendly reproductive health service utilization. Areka Town educational office in collaboration with multimedia should provide information and create awareness on youth-friendly service.

Determinants of post cesarean section surgical site infection at public hospitals in Dire Dawa administration, Eastern Ethiopia: Case control study.

INTRODUCTION: Post cesarean section surgical site infection increases both the duration of a patient's hospital stay and unplanned hospital costs. It can delays recovery, prolongs hospitalization, necessitates readmission, and adds to hospital bills and other morbidities as well as mortalities. METHOD: Facility-based case-control study was conducted from 1st March to 20th April, 2019 among all the mother records enrolled from 1st January to 31st December, 2018 at Public hospitals in Dire Dawa administration. The records of the mothers' who had post-cesarean section surgical site infection (119) was extracted by a census and every three consecutive controls (357) for each case were collected by trained data collectors using a structured data extraction tool. Variables which had p-value <0.25 in bivariate analysis were considered as candidates for multivariable analysis. Statistical significance was declared at P-value ≤0.05 with adjusted odd ratio and 95% confidence interval in the multivariable logistic regression model. RESULT: Age 20-34 years (AOR:5.4; 95%CI:2.35,12.7), age >35 years (AOR:8.9; 95%CI:1.8,43.9), ≥4 per vaginal examinations (AOR: 4.2; 95%CI:2.16,8.22), current history of Chorioamnionitis (AOR:5; 95%CI:1.05,23.9), previous history of cesarean section (AOR:6.2; 95%CI: 2.72,14.36), provision of antibiotics prophylaxis (AOR:3.2; 95%CI:1.81,5.62), perioperative HCT level <30% (AOR:6.9; 95%CI:3.45,14.1) and duration of rupture of membrane >12 hours (AOR:5.4; 95%CI:1.84,15.87) were the independent determinants of post-cesarean section surgical site infection. CONCLUSION: Increased in age of the mother, higher number of per vaginal examination, having a history of chorioamnionitis, having previous history of cesarean section, not receiving antibiotics prophylaxis, lower perioperative hematocrit level and longer duration of rupture of membrane were statistically significant in multivariable analysis. Therefore; emphasis should be given for mothers who have higher age category, previous cesarean scar and history of choriamnionitis. In addition; provision of antibiotics should be comprehensive for all mothers undergoing cesarean section.

Utilization of Integrated Community Case Management Service and Associated Factors Among Mothers/Caregivers Who Have Sick Eligible Children in Southern Ethiopia.

BACKGROUND: Proper utilization of integrated community case management service has a significant contribution in reducing the under-five children mortality. However, the utilization of integrated community case management service is low especially in developing countries like Ethiopia. Therefore, this study was planned to assess the utilization of integrated community case management service and associated factors among mother/caregivers who have sick children aged 2-59 months in Boloso Sore Woreda, Southern Ethiopia. METHODS: Community-based cross-sectional study design was done from January 15-February 15, 2018. Face to face interview was conducted using pre-tested structured questionnaire. Bivariable and multivariable logistic regression analysis were carried out to assess the association between independent and outcome variables. Odds ratio along with 95% confidence interval and p-value <0.05 were estimated to measure the strength of the association and statistical significance. RESULTS: The magnitude of the utilization of integrated community case management service was 25.3%. Mothers/caregiver's education of secondary and above (AOR=4.15, 95% CI: 1.94-8.90), mothers/caregivers having good knowledge about childhood illness (AOR=2.00, 95% CI: 1.08-3.69), the previous visit of mothers/caregivers to health post (AOR=2.92, 95% CI: 1.01-8.54), short distance to health post (AOR=2.42, 95% CI: 1.02-5.76), the child with cough (AOR=2.52, 95% CI: 1.13-5.63) and mother's/caregiver's perception of high severity of illness (AOR=2.51, 95% CI: 1.19-5.27) were significantly associated with utilization of integrated community case management service. CONCLUSION: The magnitude of the utilization of integrated community case management was low in the study area. Mother/caregiver's education of secondary and above, having good knowledge of childhood illness, history of mother's/caretaker's visit to the health post, short distance to the health post, and perceived high severity of disease and presence of cough were factors significantly determining service utilization. Therefore, health education should be provided to mothers by Health Extension Workers, community leaders, and organizations.

Full-dose hepatitis B virus vaccination coverage and associated factors among health care workers in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: The hepatitis B vaccine is the backbone of hepatitis B prevention. All health care workers must receive a full-dose (3-dose vaccine series) to achieve >90% protection against hepatitis B virus. There is limited evidence available on vaccination coverage of HBV among health care workers in Ethiopia. Therefore, the objective of this study was to estimate the national full-dose hepatitis B vaccination coverage and the associated factors among health care workers in Ethiopia. METHODS: Studies were retrieved from PubMed, EMBASE, Web of Science, SCOPUS, CINAHL, and Google Scholar by using a combination of search terms with Boolean operators. The quality of each study was evaluated independently by three authors using the modified Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Statistical analyses were performed using STATA™ Version 14 software. Meta-analysis was carried out using a random-effects (DerSimonian and Laird) method. The heterogeneity test was conducted by using I-squared (I2) statistics. Leave-one-out sensitivity analysis was performed. RESULTS: A total of 15 articles with 5734 participants were included in this systematic review and meta-analysis. The pooled prevalence of full-dose hepatitis B virus vaccination coverage among health care workers in Ethiopia was 20.04% (95% CI: 13.83, 26.26); I2 = 98.9%). Being male sex (p = 0.002), having work experience of less than 5 years (p < 0.001), educational level of diploma and below (p = 0.003), health care providers who received training on infection prevention (p < 0.001), and those who had a history of exposure to blood and body fluids (p = 0.001), were factors significantly associated with full-dose hepatitis B virus vaccination. CONCLUSION: The national full-dose hepatitis B vaccination coverage among health care workers was low. Training of health care workers in infection prevention, particularly in hepatitis B and testing and providing hepatitis B vaccination for newly recruited staff and every 5 years for those long-term workers were recommended to increase the uptake of the vaccine.