A qualitative study on reasons for women's loss and resumption of Option B plus care in Ethiopia.

Loss to follow-up (LTFU) from Option B plus, a lifelong antiretroviral therapy (ART) for pregnant women living with human immunodeficiency virus (HIV), irrespective of their clinical stage and CD4 count, threatens the elimination of vertical transmission of the virus from mothers to their infants. However, evidence on reasons for LTFU and resumption after LTFU to Option B plus care among women has been limited in Ethiopia. Therefore, this study explored why women were LTFU from the service and what made them resume or refuse resumption after LTFU in Ethiopia. An exploratory, descriptive qualitative study using 46 in-depth interviews was employed among purposely selected women who were lost from Option B plus care or resumed care after LTFU, health care providers, and mother support group (MSG) members working in the prevention of mother-to-child transmission unit. A thematic analysis using an inductive approach was used to analyze the data and build subthemes and themes. Open Code Version 4.03 software assists in data management, from open coding to developing themes and sub-themes. We found that low socioeconomic status, poor relationship with husband and/or family, lack of support from partners, family members, or government, HIV-related stigma, and discrimination, lack of awareness on HIV treatment and perceived drug side effects, religious belief, shortage of drug supply, inadequate service access, and fear of confidentiality breach by healthcare workers were major reasons for LTFU. Healthcare workers' dedication to tracing lost women, partner encouragement, and feeling sick prompted women to resume care after LTFU. This study highlighted financial burdens, partner violence, and societal and health service-related factors discouraged compliance to retention among women in Option B plus care in Ethiopia. Women's empowerment and partner engagement were of vital importance to retain them in care and eliminate vertical transmission of the virus among infants born to HIV-positive women.

Attrition from care and its predictors among women exposed to dolutegravir- and efavirenz-based first-line antiretroviral therapy in Ethiopia: a before-and-after study.

Background: The effect of dolutegravir (DTG)-based regimens on reducing attrition from care among women enrolled in the prevention of mother-to-child transmission (PMTCT) care program is unknown. Therefore, this study aimed to compare the incidence of attrition among women exposed to DTG-based with those exposed to efavirenz (EFV)-based first-line antiretroviral therapy (ART) in Ethiopia. Methods: An uncontrolled before-and-after study was conducted involving 932 women (with 466 on EFV-based and 466 on DTG-based regimens) who were enrolled in the PMTCT care program from September 2015 to February 2023. The outcome variable was attrition (i.e., maternal death or loss to follow-up before their infants' final HIV status was determined). A Kaplan-Meier estimator was employed to estimate the probability of attrition. The Cox proportional hazards regression model was fitted to identify predictor variables. The adjusted hazard ratio (aHR) with the corresponding 95% confidence interval (CI) was calculated to examine the risk difference in the comparison groups. Results: The cumulative incidence of attrition among women was 5.2% (3.0% for those placed in the DTG-based regimen arm and 7.3% for those placed in the EFV-based regimen arm). Women on DTG-based regimens had a 57% (aHR: 0.43; 95% CI: 0.23-0.80) lower risk of attrition from care compared to those on EFV-based regimens. Women who delivered their infants at home (aHR: 2.35; 95% CI: 1.14-4.85), had poor/fair adherence (aHR: 3.23; 95% CI: 1.62-6.45), had unsuppressed/unknown viral load status (aHR: 2.61; 95% CI: 1.42-4.79), and did not disclose their status to partners (aHR: 2.56; 95% CI: 1.34-4.92) had a higher risk of attrition from PMTCT care compared to their counterparts. Conclusion: The cumulative incidence of attrition among women receiving PMTCT care is optimal. In addition, the risk of attrition among women receiving DTG-based regimens is lower than that among women receiving EFV-based regimens. Thus, DTG-based first-line ART regimen supplementation should be sustained to achieve a national retention target of 95% and above.

Viral load non-suppression status among women exposed to Dolutegravir-based versus Efavirenz-based regimens in Ethiopia: A before-and-after study.

BACKGROUND: High viral load during pregnancy and breastfeeding period is the risk factor for vertical transmission of human immunodeficiency virus (HIV). Currently, Dolutegravir (DTG)-based regimens are recommended to attain adequate viral load suppression (VLS) among women. However, its effect on VLS has not been investigated among women in PMTCT care in Ethiopia. OBJECTIVE: This study aimed to investigate the rate of viral load non-suppression among women exposed to DTG-based versus Efavirenz (EFV)-based regimens in Ethiopia. METHODS: An uncontrolled before-and-after study design was conducted among 924 women (462 on EFV-based and 462 on DTG-based regimens) enrolled in PMTCT care from September 2015 to February 2023. The outcome variable was the viral load (VL) non-suppression among women on PMTCT care. A modified Poisson regression model was employed, and the proportion was computed to compare the rate of VL non-suppression in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess viral load non-suppression among women on DTG-based and EFV-based regimens by adjusting for other variables. RESULTS: The overall rate of non-suppressed VL was 16.2% (95% CI: 14.0-18.8%). Mothers on DTG-based regimens had approximately a 30% (adjusted risk ratio (aRR): 0.70; 95% CI: 0.52-0.94) lesser risk of developing non-suppressed VL than women on EFV-based regimens. Besides, older women were 1.38 times (aRR: 1.38; 95% CI: 1.04-1.83); mothers who did not disclose their HIV status to their partners were 2.54 times (aRR: 2.54; 95% CI: 1.91-3.38); and mothers who had poor or fair adherence to antiretroviral (ARV) drugs were 2.11 times (aRR: 2.11; 95% CI: 1.45-3.07) at higher risk of non-suppressed VL. CONCLUSION: Women on DTG-based regimens had a significantly suppressed VL compared to those on EFV-based regimens. Thus, administering DTG-based first-line ART regimens should be strengthened to achieve global and national targets on VLS.

Magnitude and risk factors of mother-to-child transmission of HIV among HIV-exposed infants after Option B+ implementation in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a major public health challenge in Ethiopia. The objective of this review was to assess the pooled magnitude of MTCT of HIV and its risk factors among mother-infant pairs who initiated antiretroviral therapy (ART) after Option B+ in Ethiopia. METHODS: A systematic search of literature from PubMed, Hinari, African Journals Online (AJOL), Science Direct, and Google Scholar databases was conducted from June 11, 2013 to August 1, 2023. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to guide the article selection process and reporting. Observational studies that reported the magnitude and/or risk factors on MTCT of HIV among mother-infant pairs who initiated ART after the implementation of Option B+ in Ethiopia were included. We applied a random-effect model meta-analysis to estimate the overall pooled magnitude and risk factors of MTCT of HIV. A funnel plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I2 statistics. The protocol was registered in the PROSPERO database with registration ID number CRD42022325938. RESULT: Eighteen published articles on the magnitude of MTCT and 16 published articles on its risk factors were included in this review. The pooled magnitude of MTCT of HIV after the Option B+ program in Ethiopia was 4.05% (95% CI 3.09, 5.01). Mothers who delivered their infants at home [OR: 9.74; (95% CI: 6.89-13.77)], had not been on ART intervention [OR: 19.39; (95% CI: 3.91-96.18)], had poor adherence to ART [OR: 7.47; (95% CI: 3.40-16.45)], initiated ART during pregnancy [OR: 5.09; (95% CI: 1.73-14.97)], had WHO clinical stage 2 and above [OR: 4.95; (95% CI: 1.65-14.88]], had a CD4 count below 350 at enrolment [OR: 5.78; (95% CI: 1.97-16.98], had no or low male partner involvement [OR: 5.92; (95% CI: 3.61-9.71]] and whose partner was not on ART [OR: 8.08; (95% CI: 3.27-19.93]] had higher odds of transmitting HIV to their infants than their counterparts. CONCLUSION: This review showed that the pooled magnitude of MTCT of HIV among mother-infant pairs who initiated ART after the Option B + program in Ethiopia is at the desired target of the WHO, which is less than 5% in breastfeeding women. Home delivery, lack of male partner involvement, advanced HIV-related disease, lack of PMTCT intervention, and poor ARV adherence were significant risk factors for MTCT of HIV in Ethiopia.

Effect of Dolutegravir-Based First-Line Antiretroviral Therapy on Mother-to-Child Transmission of HIV Among HIV-Exposed Infants in Ethiopia: a Before-and-After Study.

Background: Currently, Dolutegravir (DTG)-based regimens are administered to women on Option B plus to prevent mother-to-child transmission (MTCT) of the virus. However, its effect on reducing MTCT of human immunodeficiency virus (HIV) among HIV-exposed infants over the previously used Efavirenz (EFV)-based regimen is unknown. Objective: This study aimed to compare the effects of DTG-based and EFV-based regimens on the MTCT of HIV among HIV-exposed infants in Ethiopia. Methods: An uncontrolled before-and-after study design was conducted among 958 mother-infant pairs (479 on EFV-based and 479 on DTG-based regimens) enrolled in the prevention of mother-to-child transmission (PMTCT) care from September 2015 to February 2023. The outcome variable was the HIV infection status among the exposed infants. A log-binomial model was employed, and the proportion was computed to compare the incidence of MTCT of HIV in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess the predictor variables. Results: Mothers on DTG-based regimens were approximately 44% (adjusted risk ratio (aRR): 0.56; 95% CI: 0.44, 0.70) less likely to transmit HIV to their infants than those on EFV-based regimens. In addition, poor or fair adherence to antiretroviral therapy (ART) (aRR: 5.82; 95% CI: 3.41, 9.93), home delivery (aRR: 3.61; 95% CI: 2.32, 5.62), mixed feeding practice (aRR: 1.83; 95% CI: 1.45, 2.3) and not receiving antiretroviral prophylaxis (aRR: 3.26; 95% CI: 1.6, 6.64) were found to increase the risk of MTCT of HIV infection, whereas older maternal age (aRR: 0.93; 95% CI: 0.9, 0.96) was a protective factor. Conclusion: Mother-to-child transmission of HIV was less frequently observed in mother-infant pairs exposed to the DTG-based regimens as compared to those exposed to the EFV-based regimens. Thus, DTG-based first-line ART regimens supplementation should be sustained to achieve global and national targets for zero new infections in HIV-exposed infants.

Health-related quality of life and associated factors among adult patients with epilepsy in public hospitals of Wolaita zone, southern Ethiopia. An embedded mixed method study.

BACKGROUND: The socioeconomic and overall quality of life of patients with epilepsy are significantly impacted by the disease, which is one of the most prevalent chronic noncommunicable brain disorders. Less consideration has, however, been given to research in Ethiopia generally and the study setting in particular. Consequently, the purpose of this study was to assess the health-related quality of life and associated factors among adult patients with epilepsy in public hospitals in the Wolaita zone of southern Ethiopia. METHODS: A facility-based embedded mixed method with cross-sectional and phenomenological study designs was carried out on 423 adult patients with epilepsy from August 1 to August 30, 2022. Systematic and criterion-purposive sampling was employed for the cross-sectional and phenomenological designs, respectively, to select study participants. Quantitative data were entered into Kobo Toolbox and then exported to SPSS Version 25 for analysis. The frequency, percentage, and cross-tabulation of the different variables were then determined. Finally, the magnitude and associated factors were first analyzed using binary logistic regression and then multivariate logistic regression. P < 0.05 was chosen as the level of statistical significance. An inductive thematic approach was used for qualitative data analysis. RESULTS: A total of 423 patients with epilepsy were included in the study, making the response rate 100%. The overall prevalence of poor quality of life among patients with epilepsy in the study area was 53 percent (95% CI: 48.24-57.76). Being single (AOR = 4.457, 95% CI: 1.149, 17.282), having poor social support (AOR = 3.741, 95% CI: 2.107, 6.643), having uncontrolled seizures (AOR = 2.154, 95% CI: 1.234, 3.759), and having a high frequency of seizures (AOR = 5.192, 95% CI: 1.574, 17.126) were significantly associated factors with quality of life. Lack of social support, a fear of drug side effects, and worry about their disease were findings from the qualitative perspective added to the perspective of the quantitative findings. CONCLUSION: One in every two patients with epilepsy in this study had a poor quality of life. Being single, the frequency of seizures, and a lack of social support all have a significant association. Public health initiatives should continue to strive to create positive awareness of epilepsy in society in addition to managing the clinical aspect of the disease.

Modern Health Service Utilization and Associated Factors among Adults in Southern Ethiopia.

Background: The Ethiopian government is striving to improve the health status of its population through the expansion and strengthening of primary health care services in both rural and urban settings of the country. The study aimed to measure modern health service utilization and associated factors in Wolaita Sodo town, Ethiopia. Method: A cross-sectional study design was implemented from May to June 2019 in Wolaita Sodo town, Ethiopia. All 786 study participants were selected by multistage systematic random sampling. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were collected by an open data kit. Stata window version 15.0 was also employed for statistical analysis. Multiple logistic regression was conducted, and a 95% confidence interval was considered for interpretation. Result: Health service utilization was 77.2% with (95% CI of 74.1%, 80.0%). In terms of health facilities in which they visit, first 50.6% were at the public health center and 25.5% of them were at Teaching and Referral Hospital. Respondents with marital status married and widowed have higher odds of utilizing health services compared to single marital status (AOR: 2.96; 95% CI: 1.7-5.2 and 9.0; 95% CI: 1.69-48.0), respectively. Respondents with middle and highest wealth status have higher odds of health service utilization than poor wealth status with AOR (1.75 95% CI 1.03-2.97 and 1.58 95% CI; 1.01, 2.77). Similarly, respondents who had chronic disease and perceived poor health status have higher odds of health service utilization. Conclusion: Modern health services utilization was found to be unsatisfactory. Being married, wealth status being middle and high, having chronic health conditions, and having poor perceived health status were found to have a statistically significant association with health service utilization.

Developing a Prototype Knowledge-Based System for Diagnosis and Treatment of Diabetes Using Data Mining Techniques.

BACKGROUND: Diabetes is a disease that affects the body's ability to produce or use insulin. A total of 425 million people are suffering from diabetes in the world. Of this, more than 16 million people live in the Africa Region, which is estimated to be around 41 million by 2045. The main objective of this study was to design and develop a prototype knowledge-based system using data mining techniques for diagnosis and treatment of diabetes. METHODS: For this study, experimental research design was employed, and the researchers used domain expert knowledge as a supplement of data mining techniques whereby three classification algorithms in WEKA; namely J48, PART and JRip were used, and finally the researchers decided to use the results of J48 classification algorithm. Ultimate Visual basic studio 2013 (Vb.net) was used to store knowledge and as front side of prototype. Common lisp prolog (Clisp) was used for obtained knowledge back end coding. RESULTS: Using a decision tree algorithm; namely J48, 2512 (95.1515%) of the instances were classified correctly, and 128 (4.8485 %) were classified incorrectly. The second most performing model was generated by JRip Classier. This model scored the 94.7348% accuracy on the general data to classify the status of diabetic patient datasets. It classified the 2501 instances of the records correctly. CONCLUSION: The J48 model was the best performing model with the best accuracy of results.

Prevalence of Thinness and Stunting and Associated Factors among Adolescent School Girls in Adwa Town, North Ethiopia.

Introduction. Despite the fact that adolescence is a window of opportunity to break the intergenerational cycle of malnutrition, adolescents are the neglected age groups. Hence information regarding the nutritional status of adolescents is lacking making creating and implementing intervention programs difficult. Objective. To assess the prevalence of thinness, stunting, and associated factors among adolescent school girls in Adwa town, Northern Ethiopia. Methods. Data on 814 adolescent female students were collected from March to April 2015 using interviewer administered pretested semistructured questionnaire and anthropometric measurements. Data were entered using EPI INFO version 3.5.3 and analyzed using SPSS version 20 and WHO Anthroplus software. Results. The prevalence of thinness and stunting was 21.4% and 12.2%, respectively. Age of adolescent [AOR = 2.15 (1.14,4.03)], mother's educational status [AOR = 2.34 (1.14,4.80)], eating less than 3 meals per day [AOR = 1.66 (1.12,2.46)], having family size >5 [AOR = 2.53 (1.66,3.86)] were significantly associated with thinness among the adolescent girls. Family size >5 [AOR = 2.05 (1.31,3.23)] and unimproved source of drinking water [AOR = 3.82 (2.20,6.62)] were significantly associated with stunting. Conclusion and Recommendation. Thinness and stunting are prevalent problems in the study area. Strategies to improve the nutritional status of girls should be given much attention.

Chronic respiratory symptoms and associated factors among cement factory workers in Dejen town, Amhara regional state, Ethiopia, 2015.

BACKGROUND: Chronic respiratory diseases represent a public health challenge in both industrialized and developing countries. Chronic respiratory symptoms are more prevalent in cement factories of developing countries, where occupational health and safety issues are less emphasized. This study was conducted to determine the prevalence and factors affecting chronic respiratory symptoms among workers in Dejen cement factory, 2015. METHODS: Institution based cross sectional study was conducted among 404 randomly selected study participants. Data were collected through interviewer administered structured questions derived from British Medical Research Council (BMRC) adult respiratory symptom assessment questions and observational check lists for the assessment of dust exposure, hygienic practices and use of personal protective equipments. Multivariable logistic regression model was used to identify predictor variables which have association with chronic respiratory symptoms and finally the variables which had significant association were identified on the basis of Adjusted Odds Ratio (AOR) with 95 % Confidence Interval (CI) and p < 0.05. RESULTS: The prevalence of chronic respiratory symptoms among Dejen cement factory workers was 62.9 %, with prevalence of chronic cough 24.5 %, chronic wheezing 36.9 %, chronic phlegm 24.5 %, chronic shortness of breath 38.6 %, and chest pain 21.0 %. Chronic respiratory symptoms were associated with sex (AOR = 2.07, 95 % CI = 1.18, 3.63), age (AOR = 4.20, 95 % CI = 1.94, 9.12), education level (AOR = 4.07,95 % CI = 1.86, 8.92), cement mill (AOR = 3.72, 95 % CI = 1.92, 7.21), burner and clinker (AOR = 2.28, 95 % CI = 1.18, 4.43), work experience (AOR = 5.44, 95 % CI = 3.09, 9.59), training on occupational safety and health (AOR = 2.73, 95 % CI = 1.41, 5.29), smoking (AOR = 5.38, 95 % CI = 1.42, 20.39) and chronic respiratory diseases (AOR = 7.79, 95 % CI = 2.02, 30.04). CONCLUSION: Chronic respiratory symptoms were highly prevalent among Dejen cement factory workers. Age, sex, education level, working department, smoking, work experience, and training were identified factors. Pre employment and on service training, smoking cessation programs, improving hygienic practices are important tasks in order to maintain the health and safety of workers.

Environmental and host-related determinants of tuberculosis in Metema district, north-west Ethiopia.

BACKGROUND: Each year, one third of the world's population is estimated to be infected with tuberculosis (TB). Globally in 2011, there were an estimated 8.7 million TB cases that resulted in 1.4 million deaths. In Ethiopia, TB is the leading cause of morbidity and the third most common cause of hospital admission. The aim of this study is to assess environmental and host-related determinants of TB in Metema district, north-west Ethiopia. METHODS: A community-based unmatched case-control study was conducted from March 12 to April 5, 2013. The study population included 655 subjects (218 cases and 437 controls in a ratio of 1:2). Cases were TB patients selected from a total of 475 cases registered and treated from March 2012 to February 2013 at the Metema District Hospital DOTS (direct observation therapy, short-course) clinic and selected randomly using a lottery method. Controls were people who had had no productive cough for at least 2 weeks previously and were selected from the community. RESULTS: A total of 655 respondents (218 cases and 437 controls) participated in the study. In multivariate analysis, being illiterate (adjusted odds ratio [AOR] 3.65, 95% confidence interval [CI] 2.31-5.76), households containing more than four family members (AOR 3.09, 95% CI 2.07-4.61), living space <4 m(2) per person (AOR 3.11, 95% CI 2.09-4.63), a nonseparated kitchen (AOR 3.27, 95% CI 1.99-5.35), history of contact with a TB patient (AOR 2.05, 95% CI 1.35-3.12), a house with no ceiling (AOR 1.46, 95% CI 1.07-2.21), and absence of windows (AOR 4.42, 95% CI 2.46-7.95) were independently associated with the development of TB. CONCLUSION: This study identified that the number of family members in the household, educational status, room space per person, history of contact with a TB patient, availability and number of windows, location of kitchen facilities within the house, and whether or not the house had a ceiling were independently associated with contracting TB. Every community should construct houses with the kitchen separated from the main living room, and include a ceiling and more than one window. Cigarette smoking should be avoided since this also contributed to the risk of transmission of TB. Further research focusing on coinfection with human immunodeficiency virus, helminth burden, and malnutrition is important for the control and prevention of TB.

Hypertension and associated factors among university students in Gondar, Ethiopia: a cross-sectional study.

BACKGROUND: Hypertension causes considerable morbidity and mortality worldwide. However, evidences on the burden of hypertension and associated factors are lacking among college students in resource-poor settings. This study measured the prevalence of hypertension and associated factors among university students in Gondar, Ethiopia. METHODS: Institution-based cross-sectional study was conducted among randomly selected college students in Gondar, Ethiopia. Trained data collectors administered a pre-tested and structured WHO STEPS questionnaire for data collection. Data were entered using the EPI INFO version 2002 a statistical soft ware. Stata version 11.0 was also employed for descriptive and logistics regression analysis. RESULTS: A total of 610 college students were screened for hypertension of which 453 (74.4%) were male and 157(25.6%) female with the male to female sex ratio of 2.9:1. The prevalence of hypertension was 7.7%. Higher rates of hypertension were observed among male [AOR: 3.12, 95% CI (1.16- 8.36)], overweight [AOR: 6.92, 95% CI; (2.65-18.07)] and participants who had sleep duration of ≤ 5 hours [AOR: 3.48, 95% CI (1.69-7.15)]. CONCLUSIONS: A high burden of hypertension was observed among college students in Gondar, Ethiopia. Male sex, overweight and sleep duration of ≤ 5 hours were identified as independent risk factors for the disease. Preventive measures, such as increasing awareness and early screening for the disease in young adults warranted.

Children who received PCV-10 vaccine from a two-dose vial without preservative are not more likely to develop injection site abscess compared with those who received pentavalent (DPT-HepB-Hib) vaccine: a longitudinal multi-site study.

BACKGROUND: The single dose pneumonia ten-valent vaccine has been widely used and is highly efficacious against selected strains Streptococcus pneumonia. A two-dose vial without preservative is being introduced in developing countries to reduce the cost of the vaccine. In routine settings improper immunization practice could result in microbial contamination leading to adverse events following immunization. OBJECTIVE: To monitor adverse events following immunization recommended for routine administration during infancy by comparing the rate of injection-site abscess between children who received PCV-10 vaccine and children who received the Pentavalent (DPT-HepB-Hib) vaccine. METHODS: A longitudinal population-based multi-site observational study was conducted between September 2011 and October 2012. The study was conducted in four existing Health and Demographic Surveillance sites run by public universities of Abraminch, Haramaya, Gondar and Mekelle. Adverse events following Immunization were monitored by trained data collectors. Children were identified at the time of vaccination and followed at home at 48 hour and 7 day following immunization. Incidence of abscess and relative risk with the corresponding 95% Confidence Intervals were calculated to examine the risk difference in the comparison groups. RESULTS: A total of 55, 268 PCV and 37, 480 Pentavalent (DPT-HepB-Hib) vaccinations were observed. A total of 19 adverse events following immunization, 10 abscesses and 9 deaths, were observed during the one year study period. The risk of developing abscess was not statistically different between children who received PCV-10 vaccine and those received Pentavalent (RR = 2.7, 95% CI 0.576-12.770), and between children who received the first aliquot of PCV and those received the second aliquot of PCV (RR = 1.72, 95% CI 0.485-6.091). CONCLUSION: No significant increase in the risk of injection site abscess was observed between the injection sites of PCV-10 vaccine from a two-dose vial without preservative and pentavalent (DPT-HepB-Hib) vaccine in the first 7 days following vaccination.

Prevalence of malnutrition and associated risk factors among adult visceral leishmaniasis patients in Northwest Ethiopia: a cross sectional study.

BACKGROUND: Visceral leishmaniasis (VL) causes considerable morbidity and mortality in Ethiopia. Data on the prevalence and associated risk factors on malnutrition among VL patients in Ethiopia are scarce. This study aimed to assess the prevalence of malnutrition and its associated risk factor among VL patients in Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from June to September 2012 at four leishmaniasis treatment sites in Northwest Ethiopia. Four hundred and three adult VL patients were enrolled in the study. Malnutrition was defined as a body mass index (BMI) ≤ 18.5 kg/m2. The data collected from the VL patients included sex, age, residence, occupation, weight, height, laboratory results (HIV, hemoglobin, intestinal parasites). Multivariate logistic regression model was used to determine the strength of association between malnutrition and associated risk factors. RESULTS: Among 403 adult VL patients 385 (95.5%) were malnourished. Twenty eight percent (n = 113), 30.3% (n = 122), and 37.2% (n = 150) were mildly, moderately and severely malnourished, respectively. The prevalence of intestinal parasitic infection was 47.6% (n = 192) and it was associated with malnutrition (P = 0.01). The prevalence of VL-HIV co-infection was 10.4% (n = 42). Hook worm, Giardia intestinalis and Ascaris lumbircoides were the leading prevalent intestinal parasites. Factors such as age, sex, residence, occupation, HIV status and anemia were not associated with severe malnutrition. CONCLUSIONS: The prevalence of malnutrition in VL patients was very high and it was associated with intestinal parasitic infections. Therefore, screening of severely malnourished VL patients for intestinal parasitic infections during admission is recommended.

Appropriate health-seeking behavior and associated factors among people who had cough for at least two weeks in northwest Ethiopia: a population-based cross-sectional study.

BACKGROUND: Tuberculosis remains the major debilitating public health problem in Ethiopia. However, studies to understand the patients' perspectives on the illness and their health-seeking behavior have been few in the country. In this study, we seek to investigate the magnitude of appropriate health-seeking behavior and factors associated with tuberculosis among people who had cough for at least two weeks. METHODS: A population-based cross-sectional study was conducted from July to October 2012 in Dabat, northwest Ethiopia. All people aged ≥ 15 years and had cough for at least two weeks were included in the study. Data collected by using a pre-tested and structured questionnaire were entered and cleaned using the Epi Info version 2002 statistical software. The statistical Package for the Social Sciences Version 16.0 was also employed for descriptive and logistics regression analysis. RESULTS: Out of the 25,701 people aged ≥ 15 years surveyed, the proportion of people who had cough for at least two weeks was reported to be 843(3.3%). Appropriate health-seeking behavior towards tuberculosis was reported by 674(80.0%) of them. Factors significantly associated with health-seeking behavior for tuberculosis were being female [AOR: 0.56, 95%CI: (0.39-0.79)], high monthly real per capita income [AOR: 1.66, 95%CI: (1.15-2.38)], large family size [AOR: 0.50, 95%CI: (0.35-0.72)], and use of traditional-healing practices [AOR: 13.27, 95%CI: (9.10-25.41)]. CONCLUSION: This study showed that the magnitude of appropriate health-seeking behavior during the event of chronic cough was high. However, this doesn't mean that there will be no need for further strengthening of the intervention activities as significant proportions of the study communities still demonstrate inappropriate health-seeking behavior. So tuberculosis control programs need to emphasize factors, such as sex, family size, socioeconomic inequalities, and traditional-healing practices in resource-poor settings.

The clustering of smear-positive tuberculosis in Dabat, Ethiopia: a population based cross sectional study.

BACKGROUND: In Ethiopia where tuberculosis epidemic remains high, studies that describe hotspots of the disease are unavailable. This study tried to detect the spatial distribution and clustering of smear-positive tuberculosis cases in Dabat, Ethiopia. METHODS AND FINDINGS: A population-based cross sectional study conducted in the Dabat Health and Demographic Surveillance System site from October 2010 to September 2011 identified smear-positive tuberculosis cases. Trained field workers collected demographic and location data from each study participant through house-to-house visits. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. Two significant (p<0.001) spatial and space-time clusters were identified in the study district. CONCLUSION: Tuberculosis is concentrated in certain geographic locations in Dabat, Ethiopia. This kind of clustering can be common in the country, so the National Tuberculosis Control Program can be more effective by identifying such clusters and targeting interventions.

Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study.

BACKGROUND: Timely tuberculosis treatment initiation and compliance are the two key factors for a successful tuberculosis control program. However, studies to understand patents' perspective on tuberculosis treatment initiation and compliance have been limited in Ethiopia. The aim of this study is to attempt to do that in rural Ethiopia. METHODS: This qualitative, phenomenological study conducted 26 in-depth interviews with tuberculosis patients. A thematic content analysis of the interviews was performed using the Open Code software version 3.1. RESULTS: We found that lack of geographic access to health facilities, financial burdens, use of traditional healing systems and delay in diagnosis by health care providers were the main reasons for not initiating tuberculosis treatment timely. Lack of geographic access to health facilities, financial burdens, quality of health services provided and social support were also identified as the main reasons for failing to fully comply with tuberculosis treatments. CONCLUSIONS: This study highlighted complexities surrounding tuberculosis control efforts in Dabat District. Challenges of geographic access to health care facilities and financial burdens were factors that most influenced timely tuberculosis treatment initiation and compliance. Decentralization of tuberculosis diagnosis and treatment services to peripheral health facilities, including health posts is of vital importance to make progress toward achieving tuberculosis control targets in Ethiopia.

Evaluating the performance of interpreting Verbal Autopsy 3.2 model for establishing pulmonary tuberculosis as a cause of death in Ethiopia: a population-based cross-sectional study.

BACKGROUND: In resource- poor settings, verbal autopsy data are often reviewed by physicians in order to assign the probable cause of death. But in addition to being time and energy consuming, the method is liable to produce inconsistent results. The aim of this study is to evaluate the performance of the InterVA 3.2 model for establishing pulmonary tuberculosis as a cause of death in comparison with physician review of verbal autopsy data. METHODS: A population-based cross-sectional study was conducted from March to April, 2012. All adults aged ≥14 years and died between 01 January 2010 and 15 February 2012 were included in the study. Data were collected by using a pre-tested and modified WHO designed verbal autopsy questionnaire. The verbal autopsy interviews were reviewed by the InterVA model and the physicians. Cohen's kappa statistic, receiver operating characteristic curves, sensitivity, and specificity values were applied to compare the agreement between the InterVA model and the physician review. RESULTS: A total of 408 adult deaths were studied. The proportion of tuberculosis-specific mortality was established to be 36.0% and 23.0% by the InterVA model and the physicians, respectively. The InterVA model predicted pulmonary tuberculosis as a cause of death with the probability of 0.80 (95% CI: 0.75-0.85). In classifying all deaths as tuberculosis and non-tuberculosis, the sensitivity and specificity values were 0.82 and 0.78, respectively. A moderate agreement was found between the model and physicians in assigning pulmonary tuberculosis as a cause of deaths [kappa= 0.5; 95% CI: (0.4-0.6)]. CONCLUSIONS: This study has revealed that the InterVA model showed a more promising result as a community-level tool for generating pulmonary tuberculosis-specific mortality data from verbal autopsy. The conclusion is believed to provide policymakers with a highly needed piece of information for allocating resources for health intervention.

Alcohol and khat use as risk factors for HIV infection among visitors to voluntary counselling and testing centres in Northwest Ethiopia.

Alcohol and khat are commonly used substances in Ethiopia and are believed to be risk factors for HIV infection. We assessed alcohol and khat use as risk factors for HIV infection among visitors to voluntary counselling and testing centres. In this institution-based unmatched case control study, a total of 495 respondents aged ≥ 15 years participated. Data were collected using a pretested and structured questionnaire by voluntary counselling and testing service providers. Of the 495 visitors recruited for the study, 155 were cases and 316 were controls. Adjusted for confounding variables, the chewers of khat and alcohol drinkers among the cases were adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.31-5.47 and AOR, 1.84; 95% CI, 1.10-3.07, respectively. This study revealed that alcohol and khat uses were significantly associated with those infected with HIV.

Determinants of Occupational Injury: A Case Control Study among Textile Factory Workers in Amhara Regional State, Ethiopia.

Background. Occupational injuries pose major public health and socioeconomic developmental problems. However, efforts towards investigation of determinants among factory workers are very minimal in developing countries. Thus, this study aimed at to identify determinants of occupational injury among textile factory workers in Amahara regional state in Ethiopia. Methods. A case control study was done among 456 textile factory workers (152 cases and 304 controls). Self-reported data from workers and document review from factories clinics were used to ascertain occupational injury status within one-year period. Data was collected using pretested and structured questionnaire by trained data collectors. Odds ratio with 95% confidence interval was used to assess level significance. Results. Young age (<30 years) (AOR 1.90, 95% CI (1.22, 2.94)), male gender (AOR 2.54, 95% CI (1.58, 4.07)), health and safety training (AOR 1.85, 95% CI (1.17, 2.91)), sleeping disturbance (AOR 1.99, 95% CI (1.30, 3.04)), and job stress (AOR 2.25, 95% CI (1.15, 4.41)) were significant predictors of occupation injury. Conclusion. Lack of training, sleeping disturbance, and job stress increased the risk of occupational injury. So, providing basic health and safety training with special emphasis on younger and male workers, reducing stressors, and providing sleep health education were recommended.