The status of immunization program and challenges in Ethiopia: A mixed method study.

Introduction: Immunization helps reduce morbidity and mortality attributable to severe vaccine-preventable childhood illnesses. However, vaccination coverage and the quality of immunization data remain challenging in Ethiopia. This has led to poor planning, suboptimal vaccination coverage, and the resurgence of vaccine-preventable disease outbreaks in under-immunized pocket areas. The problem is further compounded by the occurrence of the COVID-19 pandemic and the disruption of the health information system due to recurrent conflict. This study assessed the current status of the immunization service and its challenges in Ethiopia. Methods: A mixed-methods study was conducted in three regions of Ethiopia from 21 to 31 May, 2023. A survey of administrative reports was done in a total of 69 health facilities in 14 woredas (districts). Nine KIIs were conducted at a district level among immunization coordinators selected from three regions to explore the challenges of the immunization program. Linear regression and descriptive statistics were used to analyze the quantitative data. Thematic analysis was applied to analyze the qualitative data. The findings from the qualitative data were triangulated to supplement the quantitative results. Result: Two-thirds (66.4%) of the children were fully vaccinated, having received all vaccines, including the first dose of the MCV1, by 12 months of age, as reported through administrative reports collected from health facility records. Catchment area population size and region were significantly associated with the number of fully immunized children (p < 0.001 and p = 0.005, respectively). The vaccination dropout rates of the first to third dose of pentavalent vaccine and the first dose of pentavalent vaccine to the first dose of MCV1 were 8.6% and 7.4%, respectively. A considerable proportion of health facilities lack accurate data to calculate vaccination coverage, while most of them lack accurate data for dropout rates. Longer waiting time, interruptions in vaccine supply or shortage, inaccessibility of health facilities, internal conflict and displacement, power interruption and refrigerator breakdown, poor counseling practice, and caretakers' lack of awareness, fear of side effects, and forgetfulness were the reasons for the dropout rate and low coverage. The result also showed that internal conflict and displacement have significantly affected immunization coverage, with the worst effects seen on the most marginalized populations. Conclusion: The study revealed low vaccination coverage, a high dropout rate, and poor quality of immunization data. Access and vaccination coverage among marginalized community groups (e.g., orphans and street children) were also low. Hence, interventions to address organizational, behavioral, technical, and contextual (conflict and the resulting internal displacement) bottlenecks affecting the immunization program should be addressed.

The Effect of Expert Patient Simulation on Clinical Judgment: A Quasi-Experimental Study.

Background: Worldwide, quality education is one of the important tools to improve healthcare quality. Healthcare practitioners must be competent in their clinical judgement to meet clients' need. However, poor clinical judgment skill accounts for almost one-third of all patient problems in health care. Expert patient simulation has been used as a training method for clinical judgement skill. However, according to empirical studies, using expert patients to develop clinical judgement skill is unclear. The method is effective in one situation but not in another. Objective: To examine the effect of expert patient simulation on the clinical judgment skill of health science students of Mizan-Tepi University. Methods: A pre-test/post-test quasi-experimental design was used on 92 randomly selected samples from the graduating cohort of midwifery students. The research subjects who took part in the experiment were picked at random. Tools included the Creighton Competency Evaluation Instrument (C-CEI®), the Learning Satisfaction and Self-Confidence Questionnaire, and the Kolb Learning Style Inventory (LSI). The Wilcoxon-signed rank test was utilized to compare the self-confidence scores among intervention and control group of students, and the paired sample test was used to compare clinical judgment scores. Cohen's d was used to assess the effect size, and Spearman correlation was used to explore the association. Results: Clinical decision-making ability and self-confidence measures revealed statistical and practical differences between before and after simulation. There was a mean difference of 2.28 (95% CI, 1.78, 2.79), t (45)=9.13, p 0.001, and an effect size of 1.3, p 0.001. A pre-and post-simulation self-confidence measure showed statistically significant improvement after simulation (W = 1, Z = -3.57, P 0.001). A moderately significant positive connection (r = 0.419, p 0.004) was also discovered. Conclusion: The study found that human expert patient simulation is a tremendous clinical training technique for improving students' clinical decision-making skill competency and self-confidence.

Statistical Joint Modeling for Predicting the Association of CD4 Measurement and Time to Death of People Living with HIV Who Enrolled in ART, Southwest Ethiopia.

BACKGROUND: In much epidemiological HIV research, patients are often followed over a period of time to predict their survival on the basis of repeatedly measured CD4 status. To predict survival, statistical models of the association between mortality and longitudinal CD4 measurement have been conducted widely using time-varying Cox models. However, in the presence of repeated measure, this approach leads to biased estimates. In view of the limitation of time-varying Cox models, in the present study, we considered joint modeling to predict the association of longitudinal CD4 measurement and time to death among patients initiated on ART. METHODS: A retrospective cohort study was employed for five years from 2009 to 2014 on a randomly selected 358 samples. Data were collected from patients' ART and pre-ART follow-up registration book, database and other clinical records. Data were analyzed using joint latent class modeling of repeated CD4 measurement and time-to-event (HIV death). RESULTS: We have studied a total of 358 HIV-positive patients. The median and interquartile ranges of the age of patients were 30.31 years and 13.82, respectively. Males constitute the larger proportion, 51.68%. The square root of CD4 count has declined on average over time. This has been indicated with the negative sign of the coefficient for the time effect. The deterioration of health of individuals is severe in class 1, it has been observed with a worse decline in CD4 cell counts over time in this class than other classes (ß= -0.488). Women had a larger risk rate than men (ß=-2.475, p-value=0.013). Besides, the CD4 counts measurement of patients has been revealed to decrease as age increases (ß= -0.016, p=0.008). CONCLUSION: The finding indicated that the square root CD4 cell measurement dropped over time in the three classes. This clearly suggested deterioration in the health of individuals. Women were found to have a higher hazard rate than men.

Effect of highly active antiretroviral treatment on TB incidence among HIV infected children and their clinical profile, retrospective cohort study, South West Ethiopia.

Globally, 1.8 million HIV infected children live with HIV; nearly 53% of them were receiving HIV treatment. People who are infected with HIV are 18 times more likely to develop active TB. Despite antiretroviral treatment has shown marked reduction in TB incidence, TB continues to occur in Sub-Saharan countries including Ethiopia among HIV infected people. The effect of highly active antiretroviral treatment is quite successful in developed countries. However, in developing country TB/HIV co-infection remains perplexing among children on the treatment. The aim of this study was to investigate the impact of ART on the incidence of TB among Children infected with HIV in Southwest Ethiopia. A retrospective cohort study was conducted on randomly selected 800 samples from ART clinic between 2009 and 2014. We used chi-square test, and Mann-Whitney U test to compare HAART naïve and HAART cohort. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. A total of 800 children were followed for 2942.99 child-years. The children were observed for a median of 51 months with IQR 31 and for a total of 2942.99 child-years. From 506 OIs that occurred, the most common reported OIs were Pneumonia (22%) and TB (23.6%). The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933-9.002). Whereas among HAART (7.667 per 100-years (95% CI, 6.318-9.217) and 8.1686 per 100 person-years (95% CI 6.772-9.767) for HAART naïve. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.642 (95% CI 0.442-0.931, p < 0.02). HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than expected.

Incidence-Proportion of Maternal Near-Misses and Associated Factors in Southwest Ethiopia: A Prospective Cross-Sectional Study.

BACKGROUND: Pregnancy-related morbidity and mortality continue to have a serious impact on the lives of women all over the world. Women in sub-Saharan Africa accounted for nearly two-thirds of global maternal deaths. The World Health Organization recommends monitoring maternal near-miss provides better information regarding the quality of maternal health care, on which to base action to prevent further death. Accordingly, this study sought to assess the incidence-proportion of maternal near-miss and its risk factors. We have also seen the near-miss-to-mortality ratio and overall maternal mortality index. METHODS: An institution-based prospective cross-sectional study was carried out from February 6, 2017 to March 6, 2017, using the WHO criteria for maternal near-misses at the three randomly selected public hospitals. About 845 participants were enrolled in the study with systematic random sampling techniques. WHO multi-country survey on maternal and neonatal health tool was used. Descriptive statistics and bivariate logistic regression analysis were done. Variables with p-value <0.2 in the bivariate analysis were transferred to multivariable analysis, and during multivariate logistic regression analysis, variables with P-value <0.05 were considered as statistically significant with 95% CI. RESULTS: There were 5530 live births, 210 maternal near-misses, 17 maternal deaths, and 364 maternal near-miss events. The overall proportion of maternal near-miss is 24.85%. Besides, the ratio of maternal near-misses to maternal mortality was 12.35:1, and the overall mortality index was 7.48%. Parity, residence, a distance of maternal home from the hospital, ANC follow-up, duration of labor, and administration-related problems were found to have statistically significant associations. CONCLUSION: The incidence-proportion of maternal near-misses is relatively high when compared against the national target and to other regional studies. Besides, with all its limitations, the outcome indicators and outcome measures in this study seem to suggest optimum care is being given to mothers who suffered from life-threatening complications.

Clinical Profile of Covid-19 in Children, Review of Existing Literatures.

WHO has confirmed that COVID-19 disease is a pandemic on March 11, 2020. The disease is caused by a new virus called SARS-CoV-2. Since, the pandemic was announced around 18,854,287 cases and 708,639 deaths were reported as of August 7, 2020. This review aimed to explore the etiology, pathogenesis, manifestation and complication. The phylogenetic study showed that SARS-CoV-2 is a single-stranded RNA virus. The virus is very contagious and has rapidly spread globally. Its unique structure called S glycoproteins help the virus enters in and cause infection in the body. Children's body reacts against SARS-CoV-2 infections through the involvement of innate and adaptive immune system. The clinical manifestation in children is not specific and not determined. However, fever and cough have mostly been profiled. Though the severe condition is rarely reported in children compared with adults, life-threatening complications, and death associated with COVID-19 disease have been documented. Underlying chronic pulmonary disease, cardiovascular disease, immunosuppression, and obesity significantly contribute to the complications.

How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis, Southwest Ethiopia.

BACKGROUND: Children younger than 15 years, carry almost 80% of the global burden of HIV/AIDS. HIV worsens the progression of latent TB to active TB disease. Although antiretroviral treatment has shown marked reduction in Tuberculosis incidence, TB continues to occur in Sub-Saharan countries including Ethiopia. The aim of this study was to investigate the impact of HAART on the incidence of tuberculosis among children infected with HIV in Southwest Ethiopia. METHODS: A retrospective cohort study was conducted between 2009 to 2014. We used chi-square test, and Mann-Whitney U test to compare non-HAART and HAART cohort. We estimated the effect of HAART on TB incidence using marginal structural model after adjusting for time-dependent confounders affected by exposure. RESULT: A total of 844 children were followed. We observed them for a median of 51 months (IQR 31) and a total of 2942.99 child-years. The overall TB incidence rate was 7.917 per 100 child years (95% CI, 6.933-9.002). TB incidence for specific HAART and non-HAART cohort were 7.67 per 100 child-years (95% CI, 6.318-9.217) and 8.17 per 100 child-years (95% CI, 6.772-9.767) respectively. From marginal structural modeling, children on HAART were 36% (HR=0.642, 95% CI 0.442-0.931, p<0.02) less likely to develop TB compared to those who were not. CONCLUSION: HAART reduced the hazard of TB in HIV-infected children by 36%. This is by far less than what is expected.