Adherence to preventive behaviours and associated factors towards COVID-19 among adults in Gurage zone, Ethiopia, 2020: a community-based cross-sectional study.

OBJECTIVES: People's adherence to preventive practices for COVID-19 is fundamental to controlling the transmission of the virus. Therefore, this study is aimed at assessing adherence to preventive practices for COVID-19 and associated factors among the general population in Gurage zone, Ethiopia. METHODS: A community-based cross-sectional study was conducted to assess preventive practices and associated factors for COVID-19 among adults in the Gurage zone. The study is based on health belief model constructs. The study involved 398 participants. A multistage sampling technique was employed to recruit study participants. An interviewer-administered, close-ended, structured questionnaire was used to collect data. Binary and multivariable logistic regressions were used to identify independent predictors of the outcome variable. RESULTS: The overall adherence to all recommended preventive behaviours of COVID-19 was 17.7%. The majority of respondents (73.1%) practice at least one of the recommended preventive behaviours for COVID-19. Among adults' COVID-19 preventive behaviours score, wearing a face mask was the highest (82.3%) and social distancing was the lowest (35.4%). Residence adjusted OR (AOR)) 3.42 (95% CI 1.6 to 7.31), marital status AOR 0.33 (95% CI (0.15 to 0.71)), knowledge of the absence/presence of the COVID-19 vaccine AOR 0.45 (95% CI (0.21 to 0.95)) and self-rated level of knowledge as poor AOR 0.052 (95% CI 0.036 to 0.18) and self-rated level of knowledge as not bad AOR 0.14 (95% CI 0.09 to 0.82) were significantly associated with social distancing practice. Factors affecting other COVID-19 preventive behaviours are described in the 'Results' section. CONCLUSION: Prevalence of good adherence to recommended preventive behaviours for COVID-19 was very low. Residence, marital status, knowledge of vaccine presence, knowledge of curative drug presence, knowledge of the incubation period, the self-rated level of knowledge and perceived risk to be infected with COVID-19 are significantly associated factors with adherence to preventive behaviours.

The applicability of basic preventive measures of the pandemic COVID-19 and associated factors among residents in Guraghe Zone.

INTRODUCTION: Internationally, countries have reacted to the COVID-19 outbreak by introducing key public health non-pharmaceutical interventions to protect vulnerable population groups. In response to COVID-19, the Government of Ethiopia has been taking a series of policy actions beyond public health initiatives alone. Therefore, this study was aimed to assess the applicability of basic preventive measures of the pandemic COVID-19 and associated factors among the residents of Guraghe Zone from 18th to 29th September, 2020. METHODS: Community based cross sectional study was conducted at Guraghe Zone from 18th to 29th September, 2020. Systematic random sampling method was applied among the predetermined 634 samples. Variables which had p-value less than 0.25 in bivariate analysis were considered as candidate for multivariable logistic regression model. P-value <0.05 was used as a cutoff point to determine statistical significance in multiple logistic regressions for the final model. RESULT: In this study, 17.7% (95% CI: 14.7, 20.5) of the respondents apply the basic preventive measures towards the prevention of the pandemic COVID-19. In addition, being rural resident (AOR: 4.78,; 95%CI: 2.50, 8.90), being studied grade 1-8 (AOR: 3.70; 95%CI: 1.70, 7.90), being a farmer (AOR: 4.10; 95%CI: 1.25, 13.35), currently not married (AOR: 2.20, 95%CI: 1.24, 4.06), having family size 1-3(AOR: 6.50; 95%CI: 3.21, 3.35), have no diagnosed medical illness (AOR: 6.40; 95%CI: 3.85, 10.83) and having poor knowledge (AOR: 3.50; 95%CI: 1.60, 7.40) were factors which are statistically significant in multivariable logistic regression model. CONCLUSION: Despite the application of preventive measures and vaccine delivery, the applicability of the pandemic COVID-19 preventive measures was too low, which indicate that the Zone is at risk for the infection. Rural residents, those who have lower educational level, farmers, non-marrieds, those who have lower family size, those who have diagnosed medical illnesses and those who have poor knowledge were prone to the infection with the pandemic COVID-19 due to the lower practice of applying the basic preventive measures. In addition, awareness creation should be in practice at all levels of the community especially lower educational classes and rural residents.

"Universal test and treat" program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia.

BACKGROUND: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the "UTT" and "differed treatment" programs, we aim to measure the effect of the UTT program on TB incidence. OBJECTIVE: To measure the effect of "UTT" program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia. METHODS: A retrospective cohort study was conducted through record review over 5 years (2014-2019) in public health facilities in Gurage Zone. Three hundred eighty-four records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi Info™ Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs. RESULTS: During the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR = 2.10/100 PY) in comparison to the differed program cohort (IR = 6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI = 0.08-0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR = 0.35 (95% CI = 0.22-0.48)), WHO Stage I and II (AIRR = 0.70 (95% CI = 0.61-0.94)) and higher base line CD4 count (AIRR = 0.96 (95% CI = .94-0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR = 5.8 (95% CI = 1.93-8.46)). CONCLUSION: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

The effect of "universal test and treat" program on HIV treatment outcomes and patient survival among a cohort of adults taking antiretroviral treatment (ART) in low income settings of Gurage zone, South Ethiopia.

BACKGROUND: Through universal "test and treat approach" (UTT) it is believed that HIV new infection and AIDS related death will be reduced at community level and through time HIV can be eliminated. With this assumption the UTT program was implemented since 2016. However, the effect of this program in terms of individual patient survival and treatment outcome was not assessed in relation to the pre-existing defer treatment approach. OBJECTIVE: To assess the effects of UTT program on HIV treatment outcomes and patient survival among a cohort of adult HIV infected patients taking antiretroviral treatment in Gurage zone health facilities. METHODS: Institution based retrospective cohort study was conducted in facilities providing HIV care and treatment. Eight years (2012-2019) HIV/AIDS treatment records were included in the study. Five hundred HIV/AIDS treatment records were randomly selected and reviewed. Data were abstracted using standardized checklist by trained health professionals; then it was cleaned, edited and entered by Epi info version 7 and analyzed by STATA. Cox model was built to estimate survival differences across different study variables. RESULTS: A total of 500 patients were followed for 1632.6 person-year (PY) of observation. The overall incidence density rate (IDR) of death in the cohort was 3 per-100-PY. It was significantly higher for differed treatment program, which is 3.8 per-100-PY compared to 2.4 per-100-PY in UTT program with a p value of 0.001. The relative risk of death among differed cases was 1.58 times higher than the UTT cases. The cumulative probability of survival at the end of 1st, 2nd, 3rd, and 4th years was 98%, 90.2%, 89.2% and 88% respectively with difference between groups. The log rank test and Kaplan-Meier survival curve indicated patients enrolled in the UTT program survived longer than patients enrolled in the differed treatment program (log rank X2 test = 4.1, p value = 0.04). Age, residence, base line CD4 count, program of enrolment, development of new OIS and treatment failure were predicted mortality from HIV infection. CONCLUSION: Mortality was significantly reduced after UTT. Therefore, intervention to further reduce deaths has to focus on early initiation of treatment and strengthening UTT programs.