Second Dose Measles Vaccination Utilization and Associated Factors in Jabitehnan District, Northwest Ethiopia.

Background: Herd immunity against measles is essential to interrupt measles transmission, and this can only be attained by reaching at least 95% coverage for each of the 2 doses of measles vaccine provided in infancy and early childhood age group. It is important to provide everyone with 2 doses of the measles vaccine in order to effectively safeguard the population. Despite this, little is known about the second dosage of the measles vaccine utilization status and the factors that affect it. Therefore, this study aimed to assess second dose of measles vaccination utilization and its associated factors among children aged 24-35 months in Jabitehnan district, 2020. Methods: A community-based cross-sectional study design was conducted at Jabitehnan District, Northwest Ethiopia, from September 1st, 2020 to October 1st, 2020. Systematic random sampling technique was used to select 845 mothers/caregivers who had children aged 24-35 months. Both bi-variable and multivariable logistic regression was fitted to identify the determinant factors of second dose measles vaccination utilization. Finally, the statistical significant variables were declared by using 95% CI and P value less than .05 in the multivariable logistic regression analysis. The Hosmer and Lemeshow test was used to check the model's fit to the data, and the variance inflation factor was used to assess multi-collinearity. Results: The overall second dose of measles vaccination utilization was 48.1%, (95% CI: 44.7-51.6). Mothers with primary school education (AOR = 1.91, 95% CI: 1.15-3.17), information about MCV2 (AOR = 6.53, 95% CI: 4.22-10.08), distance from vaccination site (AOR = 3.56, 95% CI: 2.46-5.14), knowledge about immunization (AOR = 1.935, 95% CI: 1.29-2.90), and favorable attitude about immunization (AOR = 5.19, 95% CI: 3.25-8.29) were significantly associated factors with second dose of measles vaccination utilization. Conclusion: Second dose measles vaccination utilization in the district was lower than the national target. Maternal education, distances from vaccination site, information about MCV2, and knowledge about immunization were significantly associated variables with second dose measles vaccination utilization. Therefore, in order to increase the utilization of the second dose of the measles vaccine, improved health education and service expansion to difficult-to-reach areas are required.

Self-Care Practice and Its Associated Factors Among Podoconiosis Patients in East Gojjam Zone, North West Ethiopia.

Introduction: Podoconiosis is endemic non-filarial elephantiasis of the lower legs swelling caused by barefoot exposure to red clay soil. The burden of disability occurs among the poorest populations. Self-care practice is the most cost-effective prevention strategy practiced at home to improve lymphedema, working functionality, and quality of life. Despite this, there is a scarce of knowledge about self-care practices and associated factors among podoconiosis patients in Ethiopia. Objective: To determine self-care practice and its associated factors among podoconiosis patients in East Gojjam zone North West, Ethiopia. Methods: Community-based cross-sectional study design was used among 633 podoconiosis patients. Computer-generated simple random sampling technique was used to recruit participants. All patients who started podoconiosis treatment were the source population. Data were entered using Epidata version 3.1 and exported to SPSS version 25 for cleaning and analysis. Variables with 95% CI corresponding AOR were used to identify statistically significant factors for self-care practice. Results: In this study, the self-care practice of podoconiosis patient was 64%. Females [AOR: 0.38 (95% CI: 0.22, 0.65)], 55-65 years age [AOR: 0.41 (95% CI: 0.22, 0.74)], above 65 years age [AOR: 0.22 (95% CI: 0.11, 0.450)], 4-6 km distance from water source [AOR: 0.06 (95% CI: 0.03, 0.12)], above 6 km distance from water source [AOR: 0.03 (95% CI: 0.01, 0.09)], educational level [AOR: 0.05 (95% CI: 0.01, 0.40)], marital status [AOR: 5.40 (95% CI: 2.30, 12.90)], and distance from health institution [AOR: 0.35 (95% CI: 0.23, 0.54)] were statistically identified associated factors for self-care practice of podoconiosis patient. Conclusion: In this study, the self-care practice of podoconiosis patients was not well practiced. Socio-demographic factors are identified as associated factors for self-care practice. Strengthening health education and behavioral changes are required to improve self-care practice.

Food hygiene practice and its associated factors among food handlers working in food establishments during the COVID-19 pandemic in East Gojjam and West Gojjam Zones, North West Ethiopia.

OBJECTIVES: This study was aimed to assess the food hygiene practice and associated factors among food handlers working in food establishments during the COVID-19 pandemic in East Gojjam and West Gojjam Zones, North West Ethiopia. METHODS: A facility-based cross-sectional study was conducted among 845 food handlers working in 423 selected food establishments of East and West Gojjam Zones from 22 September to 2 November 2020. The food handlers were categorized as a cooker and a waiter based on their responsibility. A data collection tool was adapted from the literature and validated by conducting a pre-test prior to the study. Binary logistic regression was done to identify the factors associated with food hygiene practice among food handlers. RESULTS: The prevalence of poor food hygiene practices among food handlers working in food establishments was 51.2% (95% confidence interval = 47.8, 54.6%). Being both a cooker and waiter (adjusted odds ratio = 2.98; 95% confidence interval = 1.02, 8.66), availability of personal protective equipment (adjusted odds ratio = 2.67; 95% confidence interval = 1.75, 4.08), presence of pipe water in the kitchen (adjusted odds ratio = 2.73; 95% confidence interval = 1.84, 4.06), presence of a supervisor (adjusted odds ratio = 2.26; 95% confidence interval = 1.41, 3.62), and separate dressing room (adjusted odds ratio = 2.69; 95% confidence interval = 1.84, 3.93) were significantly associated with food hygiene practice among food handlers. CONCLUSION: The prevalence of poor food hygiene practices among food handlers working in food establishments during the COVID-19 pandemic was high. Therefore, improving food hygiene practice focusing on availing personal protective equipment, pipe water in the kitchen, and ensuring the presence of a supervisor as well as a separate dressing room in the food establishment is recommended.

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.

Predictors of tuberculosis infection among adults visiting anti-retroviral treatment center at east and west Gojjam, northwest, Ethiopia, 2017.

BACKGROUND: Tuberculosis is a serious health risk, for people living with human immune deficiency virus worldwide, and the burden of TB/HIV infection is still high in Ethiopia in particular. Therefore, the aim of this study was to determine the predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in East and West Gojjam, northwest, Ethiopia. METHODS: Institution based unmatched case-control study was employed to determine the predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in east and west Gojjam, Northwest, Ethiopia from March 7-April 15, 2017. Just about 552 participants were participated in the study (139 Cases and 413 controls). Cases were confirmed with active TB and infected with HIV, and controls were HIV positive adults with non-TB. All cases in each health facility who confirmed by acid-fast bacilli, culture and gene expert were considered as TB positive. However, controls were selected by using simple random sampling technique through the above diagnostic criteria and the data were collected with Face to face interview as well as patient medical record were utilized, and the quality of the data were assured, checked, coded, cleaned and entered in EPI-Data version 3.1 and exported to SPSS version 20 for the analysis. RESULT: Of the total sample (556), just about 552(99.2%) were participated in the study. 47.5% were females and 58.9% were rural dweller. Behavioral and modifiable biological risk factors: alcohol users (AOR = 2.33; 95%CI:1.34,4.07), BMI < 18.5 kg/m2 (AOR = 3.03;95%CI:1.79,5.14), CD4 count ≤200 cells/µl (AOR = 2.34;95%CI:1.89,2.79) and between 201 and 499 cells/µl (AOR = 2.63; 95%CI: 1.01,6.84), bedridden and ambulatory (AOR = 3.3;95%CI:1.70,6.29 and AOR = 8.2;95%CI:4.34,15.64), respectively. TB history in the family (AOR = 3.00; 95%CI: 1.57, 5.74) were predictors for TB infection. Taking CPT (AOR = 0.36; 95%CI: 0.21, 0.62) and having early WHO clinical stage I or II (AOR = 0.34; 95%CI: 0.20, 0.56) had protective effect against TB infection. CONCLUSION: From this study, it has been concluded that alcohol users, BMI < 18.5 kg/m2, CD4 count < 499 cells/µl, bedridden and ambulatory and TB history were predictors for TB-HIV co-infected adults. Strengthen screening more frequently, CPT Prophlaxysis and treated promptly important to reduce TB co-morbidity.

Prevalence and Associated Factors of Intestinal Parasitic Infections among Food Handlers at Prison, East and West Gojjam, Ethiopia.

INTRODUCTION: One of the top ten major public health problems in developing countries including Ethiopia is the intestinal parasitic infection. Most of the time, intestinal parasitic infections do not show clinical signs and symptoms and also have a number of potential carriers, such as food handlers, which makes it too difficult to eradicate and control. OBJECTIVE: The aim of this study is to assess the prevalence and associated factors of intestinal parasitic infection among food handlers at prison, East and West Gojjam, Ethiopia, 2017. METHODS: An institution-based cross-sectional study design was conducted at East and West Gojjam prison. A total of 416 study participants, with a response rate of 82.7%, were included in the study for both stool exam and questioner. Data were collected using a structured questionnaire, and the sample was collected and examined based on the standard parasitological procedure. Epi data Version 3.1 was used to enter data, and SPSS version 20 was used to analyze the data. RESULTS: The overall prevalence of intestinal parasitic infections in the present study was 61.9%. The most prevalent parasite was A. lumbricoides (157 (45.6%)). Protozoan infection was higher than helminth infection. Multiple intestinal infections were identified; among study participants, 34.6% had double infection. The most significant associated factors of intestinal parasitic infections were fingernail status, residence, information about food contamination related to intestinal parasitic infection, income, and handwashing before having contact with food and after toilet with water only. CONCLUSIONS: A high proportion of intestinal parasitic infection was detected among food handlers working at East and West Gojjam prison. Training must be given to the food handlers on personal hygienic conditions (finger trimming, handwashing after toilet and before having contact with food with water and soap, etc.).

Nasal colonization and antimicrobial susceptibility pattern of Staphylococcus aureus among pre-school children in Ethiopia.

BACKGROUND: Staphylococcus aureus is one of the bacterium that can asymptomatically colonize the human upper respiratory tract (i.e. nose and throat). Carriage of S. aureus, including methicillin resistant S. aureus, is common to children. The aim at this study was to determine the nasal colonization, associated factors and antimicrobial susceptibility patterns of S. aureus isolates among pre-school children in Debre Markos town. METHODS: Institutional-based cross sectional study was conducted. A total of 400 nasal swabs were collected from pre-school children from April to June, 2015 following standard microbiological methods. MRSA was detected using both Cefoxitin (30 µg) and Oxacillin (6 µg) (Oxoid Ltd. England) discs in combination and associated factors were assessed using self-administered pretested questionnaires, which were delivered to the children's parents/guardians. Statistical analysis of the data (logistic regression) was done using SPSS V-22. RESULTS: A total of 52 S. aureus isolate was recovered from 400 nasal swap samples. The prevalence of S. aureus among pre-School children was 13% (52/400). The susceptibility patterns of the isolates to commonly used antibiotics were: 84.62% to Chloramphenicol, 69.2% to Doxycycline and Tetracycline, 92.3% to Kanamycin, 7.7% to Ampicillin and Penicillin, 86.6% to Ceftriaxone, and 76.9% to Augmentin. All the isolates were sensitive to Oxacillin and Cefoxitin, mean there was no methicillin resistant S. aureus isolate, and also sensitive to Gentamycin, Erythromycin and Clindamycin. The main associated factors of nasal colonization of S. aureus in the study area was, having recurrent acute otitis media (AOM) [AOR = 2.37 (1.11, 5.06)], Children admission in hospital [AOR = 1.96 (1.03, 3.73)] and cough [AOR = 2.09 (1.08, 4.09)]. CONCLUSIONS: The prevalence of S. aureus nasal colonization among pre-school children was relatively low in absence of MRSA. Factors like; recurrent AOM, hospital admission and cough were significantly associated with S. aureus nasal colonization. Most of the isolates were resistant to ß-lactam drugs and sensitive to drugs like Gentamycin, Erythromycin, Clindamycin, Chloramphenicol, Doxycycline, Tetracycline, Kanamycin and Augmentin.

Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis.

BACKGROUND: While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. METHODS: A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. RESULTS: Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). CONCLUSION: Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care.

Using Qualitative Methods to Explore Lay Explanatory Models, Health-Seeking Behaviours and Self-Care Practices of Podoconiosis Patients in North-West Ethiopia.

BACKGROUND: Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients' care: explanatory models, health-seeking behaviours and self-care. METHODS: In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia. RESULTS: Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue. CONCLUSION: A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and "signpost" patients to clinics. Change in behaviour and improving water access is key to self-care.

Barriers to access and re-attendance for treatment of podoconiosis: a qualitative study in northern Ethiopia.

BACKGROUND: Podoconiosis is a chronic non-infectious lymphoedema affecting individuals exposed to red clay soil in endemic areas. Evidence from International Orthodox Christian Charities (IOCC) treatment centers' registers suggests that a significant proportion of registered patients with podoconiosis fail to re-attend for treatment, putting them at risk of worsening disability associated with the lymphoedema and attacks of acute adenolymphangitis. The aim of this study was to explore barriers to access and re-attendance of patients with podoconiosis in northern Ethiopia. METHODS: A cross-sectional qualitative study was conducted at three IOCC treatment sites from February to April 2013. Twenty-eight patients and three project leaders took part in in-depth interviews. Three focus group discussions were undertaken with 22 patients, patient association leaders and project staff members. RESULTS: Barriers to access and to continued attendance at treatment centers were recognized by all participant groups. The following reasons were reported: lay beliefs about the disease's causation and presentation, occupational, geographic and financial barriers, stigma and conflicting expectations of treatment services. CONCLUSIONS: This study illustrates the multiple, step-wise barriers to accessing treatment faced by podoconiosis patients. These factors are dynamic, frequently interact and result from competing social and economic priorities.

Podoconiosis patients' willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery.

BACKGROUND: Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient's willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. METHODS: A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n=393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. RESULTS: The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. CONCLUSIONS: The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government's primary health care system.