Feasibility of diabetes self-management coaching program for individuals with type 2 diabetes in the Ethiopian primary care setting: a protocol for a feasibility mixed-methods parallel-group randomized controlled trial.

BACKGROUND: Diabetes mellitus is the third most prevalent chronic metabolic disorder and a significant contributor to disability and impaired quality of life globally. Diabetes self-management coaching is an emerging empowerment strategy for individuals with type 2 diabetes, enabling them to achieve their health and wellness goals. The current study aims to determine the feasibility of a diabetes self-management coaching program and its preliminary effectiveness on the clinical and psychosocial outcomes in the Ethiopian primary healthcare context. METHODS: The study will employ a mixed-method feasibility randomized controlled trial design. Forty individuals with type 2 diabetes will be randomly allocated to treatment and control groups using block randomization. The primary feasibility outcomes include acceptability, eligibility, recruitment, and participant retention rates, which will be computed using descriptive analysis. The secondary outcomes are self-efficacy, self-care activity, quality of life, and glycated hemoglobin A1c. For normally distributed continuous variables, the mean difference within and between the groups will be determined by paired sample Student t-test and independent sample Student t-test, respectively. Non-parametric tests such as the Mann-Whitney U test, the Wilcoxon signed rank test, and the Friedman analysis of variance test will determine the median difference for variables that violated the normality assumption. A repeated measure analysis of variance will be considered to estimate the variance between the baseline, post-intervention, and post-follow-up measurements. A sample of 10 volunteers in the treatment group will participate in the qualitative interview to explore their experience with the diabetes self-management coaching program and overall feasibility. The study will follow a qualitative content analysis approach to analyze the qualitative data. Qualitative and quantitative findings will be integrated using a joint display technique. DISCUSSION: Evidence reveals diabetes self-management coaching programs effectively improve HbA1c, self-efficacy, self-care activity, and quality of life. This study will determine the feasibility of a future large-scale randomized controlled trial on diabetes self-management coaching. The study will also provide evidence on the preliminary outcomes and contribute to improving the diabetes self-management experience and quality of life of individuals with type 2 diabetes. TRIAL REGISTRATION: The trial was registered online at ClinicalTrials.gov on 12/04/2022 and received a unique registration number, NCT05336019, and the URL of the registry is https://beta. CLINICALTRIALS: gov/study/NCT05336019 .

Pediatrics HIV-positive status disclosure and its predictors in Ethiopia: a systematic review and meta-analysis.

Introduction: HIV-positive status disclosure for children is challenging for family members, guardians, and healthcare professionals. Disclosure is very challenging, particularly for children, yet no systematic synthesis of evidence accurately measures HIV-positive status disclosure in children. This systematic review and meta-analysis study aimed to quantify the national prevalence of pediatric HIV-positive status disclosure in Ethiopia and identify factors associated with HIV-positive status disclosure. Method: We systematically searched PubMed, EMBASE, Web of Science databases, and google scholar for relevant published studies. Studies published in the English language and conducted with cohort, case-control, and cross-sectional designs were eligible for the review. The primary and secondary outcomes of the study were HIV-positive status disclosure and factors associated with HIV-positive status disclosure, respectively. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. A random effect- model was used to estimate the pooled prevalence of HIV-positive status disclosure. Heterogeneity and publication bias of included studies was determined using I2 and Egger's test, respectively. Result: From 601 records screened, nine relevant studies consisting of 2,442 HIV-positive children were included in the analysis. The overall pooled prevalence of HIV-positive status disclosure among children living with HIV/AIDS in Ethiopia was 31.2% (95% CI [23.9-38.5]). HIV-negative status of caregivers (AOR: 2.01; 95% CI [1.28-3.18]), long duration on ART (greater than 5 years) (AOR: 3.2; 95% CI [1.77-5.78]) and older age of the child (>10 years) (AOR: 7.2; 95% CI [4.37-11.88]) were significantly associated with HIV-positive status disclosure. Conclusion: Low prevalence of pediatric HIV-positive status disclosure was observed in Ethiopia. The longer duration of ART, the HIV-negative status of the caregiver, and older age greater than 10 years were the predictors of pediatric HIV-positive status disclosure. Health system leaders and policymakers shall design training and counseling programs for healthcare professionals and caregivers to enhance their awareness about HIV-positive status disclosure. Trial registration: This review was registered under PROSPERO and received a unique registration number, CRD42019119049.

Do adult patients with diabetes mellitus living in rural part of Ethiopia and having poor social support have disproportionately poor self-care practice? A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis is aimed at determining the pooled national percentage of diabetic self-care practice and its determinants among adult diabetic patients in Ethiopian. METHODS: Different electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I2 test. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2 > 50%). The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI. RESULTS: A total of 3861 studies were identified, of which only 19 studies have reached the final qualitative synthesis and quantitative analysis. Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07-61.01, I2 = 97.3, P < 0.001). Subgroup analysis by region showed that the highest pooled estimate was observed in Southern Nations Nationalities and Peoples 81.96% (71.85-92.04), I2 = 89.1, p < 0.002), whereas the lowest was from the Harari region 44.53% (32.16-56.89%) I2 = 94%, p < 0.001). Being knowledgeable about diabetes Mellitus 2.69 (1.62, 4.46; I2 = 99%, p < 0.001), having good social support 2.25 (1.49-3.39; I2 = 99%, p = 0.00), owning private glucometer 3.04(1.64, 5.65; I2 = 97.4, P < 0.001), and being urban residents 3.26 (2.24, 4.74; I2 = 96.3%, P < 0.001) promote diabetic victims to apply self-care practice. CONCLUSIONS: Despite the life-threatening complications of diabetes Mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short-term sequelae of diabetes Mellitus. Therefore, improving the client's awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat complications to attain sustainable development goal 3.4 Aims to reduce premature death. REGISTRATION: The protocol has been registered under the prospective Register of Systematic Review and Meta-analysis (PROSPERO) and received a unique registration number CRD42020151014.

Lost to Follow-up and Predictors Among HIV-Exposed Infants in Northwest Ethiopia.

INTRODUCTION: Even though advancement in mother-to-child HIV transmission prevention services is observed, many infants are lost to follow-up and could not access the full package of mother-to-child HIV transmission prevention services as a result. This is one of the obstacles to the effectiveness of the program. Therefore, determining the magnitude of lost to follow-up and its predictors is important among HIV-exposed infants. METHOD: This institution-based retrospective cohort study was conducted from August 2013 to June 2018 at the University of Gondar Comprehensive Specialized Hospital. We retrieved charts of 423 child-mother pairs through a simple random sampling technique. Data collectors extracted data by using a data extraction tool adapted from the Ethiopian Federal Ministry of Health HIV-exposed infant follow-up form. Bivariable and multivariable Cox regression models were fitted to identify predictors of lost to follow-up. RESULT: A total of 402 child-mother pairs were included in the study. Of the study participants, 6.0% were lost to follow-up for more than 3 months before the declaration of their HIV status. Born from rural residence mother (AHR = 3.5; 95% CI 1.549-7.894), infants whose mothers have three and more children (AHR = 3; 95% CI 1.284-6.963), and low birth weight infants (AHR = 3.2; 95% CI 1.055-9.450) were independent predictors of lost to follow-up among HIV-exposed infants. CONCLUSION: Significant numbers of infants were unable to access full HIV diagnosis and care services as a result of loss to follow-up. Special consideration for mothers having large numbers of children, rural residence, and low birth weight infants could be an important intervention to decrease lost to follow-up.

Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia.

BACKGROUND: Delay in the diagnosis and treatment of tuberculosis exacerbates the disease and clinical outcomes. It further enhances transmission of the infection in the society as well as increased the severity of the illness and raised rate of mortality. OBJECTIVES: The major goal of this study is to determine the magnitude of delays in tuberculosis treatment and factors affecting tuberculosis treatment among adult tuberculosis patients at Debremarkos town, North West Ethiopia, 2018. METHODS: Institution-based cross-sectional study design was employed. Systematically selected 300 adult TB patients were recruited to the study. The study was conducted at Debremarkos town public health facilities from March 1 to April 30, 2018. Logistic regression models were fitted to identify the predicting variables and control confounder's of the outcome variables. P value ≤ 0.05 with 95% CI was considered as an indicator for the presence of statistically significant association. The result revealed that the median total delay was 23 days (IQR: 19-28 days). The median patient and health system delays were 20 days (IQR: 15-20 days) and 4 days (IQR: 3-5 days), respectively. Tuberculosis patients living in a rural area were 1.14 times more likely to delay for the TB treatment (AOR: 1.141, 95% CI (1.106, 2.608)). Patients who were unable to read and write have almost two times a chance of being delayed (AOR: 2.350, 95% CI (1.630, 2.608)). Monthly income of patients has found another predictor for delay; patients with low monthly income were about six times more likely to delay for TB treatment (AOR: 6.375, 95% CI: (1.733, 23.440)). Those TB patients who had visiting traditional healers before arrival to health facilities were about 2.7 times more likely to delay for TB treatment(AOR: 2.795, 95% CI (1.898, 8.693)). Conclusion and Recommendation. The significant proportion of delays in tuberculosis treatment was found in this study. Living in the rural area, unable to read and write, lower monthly income, and visiting traditional healers were found independent predictors of TB treatment delay. The regional and zonal health administrator shall design various awareness creation mechanisms to educate the public about timely initiation of tuberculosis treatment.

HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis.

BACKGROUND: The national burden of human immunodeficiency virus treatment failure and associated factors in the Ethiopian context is required to provide evidence towards a renewed ambitious future goal. METHODS: We accessed Ethiopian Universities' online repository library, Google Scholar, PubMed, Web of Science, and Scopus to get the research articles. We run I-squared statistics to see heterogeneity. Publication bias was checked by using Egger's regression test. The pooled prevalence was estimated using the DerSimonian-Laird random-effects model. We employed the sensitivity analysis to see the presence of outlier result in the included studies. RESULTS: The overall human immunodeficiency treatment failure was 15.9% (95% confidence interval: 11.6-20.1%). Using immunological, virological, and clinical definition, human immunodeficiency treatment failure was 10.2% (95% confidence interval: 6.9-13.6%), 5.6% (95% confidence interval: 2.9-8.3%), and 6.3% (95% confidence interval: 4.6-8.0%), respectively. The pooled effects of World Health Organization clinical stage III/IV (Adjusted Odd Ratio = 1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (Adjusted Odd Ratio = 1.8; 95% CI: 1.2-2.4), and poor adherence to highly active antiretroviral therapy (Adjusted Odd Ratio = 8.1; 95% CI: 4.3-11.8) on HIV treatment failure were estimated. CONCLUSIONS: Human immunodeficiency virus treatment failure in Ethiopia found to be high. Being on advanced clinical stage, presence of opportunistic infections, and poor adherence to highly active antiretroviral therapy were the contributing factors of human immunodeficiency virus treatment failure. Human immunodeficiency virus intervention programs need to address the specified contributing factors of human immunodeficiency virus treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain human immunodeficiency virus treatment adherence. PROTOCOL REGISTRATION: It has been registered in the PROSPERO database with a registration number of CRD42018100254.