Impact of weekly iron-folic acid supplementation on nutritional status and parasitic reinfection among school-age children and adolescents in Sub-Saharan Africa: a systematic review and meta-analysis.

Background: Two significant etiological factors contributing to iron deficiency anemia, and undernutrition posing substantial public health challenges in Sub-Saharan Africa, are soil-transmitted helminths and malaria. This study carried out the effect of weekly iron-folic acid supplementation (WIFAS) on the nutrition and general health of school-age children and adolescents in Sub-Saharan Africa, a systematic review and meta-analysis have been conducted. Methods: To find pertinent publications for this study, a thorough search was carried out on May 20, 2023, across five databases: Pubmed (MEDLINE), Web of Science, Scopus, Cochrane Library, and Google Scholar. In addition, a search was conducted on August 23, 2023, to capture any new records. The inclusion criteria for the studies were based on school-age children and adolescent populations, randomized controlled trials, and investigations into the effects of WIFAS. The outcomes of interest were measured through anthropometric changes, malaria, and helminthic reinfection. Results: A systematic review of 11 articles revealed that WIFAS significantly decreased the risk of schistosomiasis reinfection by 21% among adolescents (risk ratio = 0.79, 95%CI: 0.66, 0.97; heterogeneity I 2 = 0.00%, P = 0.02). However, no significant impact was observed on the risk of malaria reinfection (risk ratio = 1.02, 95%CI: 0.92, 1.13; heterogeneity I 2 = 0.00%, P = 0.67) or A. Lumbricoides reinfection (risk ratio = 0.95, 95%CI: 0.75, 1.19; heterogeneity I 2 = 0.00%, P = 0.65). Moreover, the analysis demonstrated that there is no significant effect of iron-folic acid supplementation in measured height and height for age Z-score (HAZ) of the school-age children (Hedge's g -0.05, 95%CI: -0.3, 0.2; test for heterogeneity I 2 = 0.00%, P = 0.7) and (Hedge's g 0.12, 95%CI: -0.13, 0.37; test for heterogeneity I 2 = 0.00%, P = 0.36) respectively. Conclusion: The effectiveness of WIFAS in reducing the risk of schistosomiasis reinfection in adolescents has been demonstrated to be greater than that of a placebo or no intervention. Additionally, the narrative synthesis of iron-folic acid supplementation has emerged as a potential public health intervention for promoting weight change. However, there was no significant association between WIFAS and Ascariasis, trichuriasis, and hookworm. Moreover, the certainty of the evidence for the effects of WIFAS on height and malaria is low and therefore inconclusive. Whereas, the certainty of the evidence for the effectiveness of WIFAS on Schistosomiasis is moderate. Even though the mechanisms need further research WIFAS may be implemented as part of a comprehensive public health strategy to address schistosomiasis in adolescents. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023397898, PROSPERO (CRD42023397898).

Self-reported side effects of the Oxford AstraZeneca COVID-19 vaccine among healthcare workers in Ethiopia, Africa: A cross-sectional study.

Introduction: Ethiopia is the second most populous country in Africa. Ethiopia received most of its COVID-19 vaccines through donations. The Oxford AstraZeneca vaccine is the first to be donated to Ethiopia by the COVAX facility. Healthcare workers were the priority population that received the Oxford AstraZeneca COVID-19 vaccine. However, there was no nationwide study on the safety of the vaccine in Ethiopia. This study aimed to measure the prevalence and predictors of self-reported side effects of the Oxford AstraZeneca vaccine. Materials and methods: The study employed a cross-sectional design. A sample of healthcare workers who took Oxford AstraZeneca COVID-19 vaccine was drawn from four regions of Ethiopia; namely, Amhara, Oromia, Somali, and Southwest. Data were collected on sociodemographic characteristics, medical anamnesis, COVID-19 related anamnesis, and COVID-19 vaccine anamnesis via telephone interview. Descriptive and inferential analyses were done. The software, IBM SPSS Statistics v21.0, was used for analyses of data. Results: Out of 384 people, 346 responded (response rate: 90.1%). Female accounted for 34.1% of the respondents. The mean age of the respondents was 31.0 years (Standard Deviation (SD) = 7.4). Nurses accounted for 43.7% of the respondents. The prevalence of at least one local- and systemic-side effect was 50.6 and 44.5%, respectively. The most frequent local- and systemic- side effect were injection site pain and headache, respectively. Both types of side effects mostly subsided in the first 3 days. A third of healthcare workers with side effects took at least one medication. Paracetamol followed by diclofenac sodium were taken by healthcare workers to overcome side effects. There was no independent predictor of local side effect. After controlling for age and chronic diseases, the odds of healthcare workers with COVID-19 like symptoms to experience systemic side effects was 1.38 (Confidence Interval (CI): 1.04-1.82) times more than that of healthcare workers without COVID-19 like symptoms. Conclusions: The prevalence of local- and systemic-side effects of the Oxford AstraZeneca COVID-19 vaccine was modest. As the symptoms were mostly common in the first 3 days, it is preferable to monitor healthcare workers at least in the first 3 days following the administration of the vaccine.

A cross-sectional study design to assess the sexual experiences and contraceptive use of adolescents and youths attending high school and college in Jimma town.

BACKGROUND: Adolescents and youths in Ethiopia have limited access to reproductive health services designed to address their needs. Therefore, the study aims to assess adolescents' and youth's sexual practice, contraceptive use, and behavioral patterns towards safe sexual exercise. METHODS: A quantitative cross-sectional study design was used on 374 students selected from high school and vocational colleges to assess their sexual experience and contraceptive use and related perceptions using pre-tested self-administered semi-structured questionnaires. We used descriptive analyses to report their sexual and reproductive health status and logistic regression to examine the association between contraceptive use and other variables. RESULTS: The results show that 52.7% of the respondents (students) migrated or moved from rural to urban to continue their high school and college education at urban. 41.7% of the respondents were with less than 18 years, of which 75.9% of them already initiated sexual intercourse. Of all the students who started sexual intercourse (51.1%), only 30.9% used contraceptives, but condom use accounts for 49.2%. Overall, 84.8% of those who practiced sexual intercourse were at risk of acquiring sexually transmitted diseases due to not using a condom. About 3% of the respondents reported unwanted pregnancy experiences, of which 64% of these pregnancies were reported to be aborted. CONCLUSION: Adolescents and youths attending high schools and College are at increased risk of acquiring HIV and unwanted pregnancy due to low levels of contraceptive use. Specifically, a designed youths-friendly reproductive health service is needed to avert related problems and contribute to sustainable development goals.

Differential effect of prenatal exposure to the Great Ethiopian Famine (1983-85) on the risk of adulthood hypertension based on sex: a historical cohort study.

BACKGROUND: The consequence of the Great Ethiopian Famine (1983-1985) on mortality had been well documented. However, the long term assaults of the famine on adulthood health, particularly on the risk of hypertension, has never been documented. The aim of this study was twofold: to examine the association of prenatal-exposure to the Great Ethiopian Famine and hypertension in adulthood and investigate if there existed sex difference in the risk estimate. METHODS: Participants were recruited using multistage stratified random sampling and grouped as prenatal famine exposed and non-exposed cohorts based on their reported date of birth and current age. Independent sample T test was employed to compare continuous outcomes between the groups. A multivariable logistic regression was used to examine the association between prenatal famine exposure and risk of hypertension in adults. RESULTS: Compared to the non-exposed groups, prenatal famine exposed cohorts had higher systolic blood pressure by 1.05 mmHg, (95% CI 0.29, 4.42) and diastolic by 2.47 mmHg (95% CI 1.01, 3.95). In multivariable logistic regression analysis, both unadjusted (COR = 2.50; 1.575, 3.989) and adjusted model for covariates (OR: 2.306 95% CI (1.426, 3.72) indicated a positive association between prenatal famine exposure and the risk of adult hypertension. However, in sex disaggregated analysis, the positive association was only significant in females (AOR = 3.95 95% CI 1.76, 8.85) indicating nearly four folds of odds of hypertension among females, while the corresponding figure for males was not significant (AOR = 1.201 (0.69, 2.07). CONCLUSIONS: Famine exposure during prenatal period could have differential impact on the development of hypertension based on sex, where adult exposed females had higher risk of hypertension as compared to males. Contextualized primary prevention programs with special focus on gender is critical undertaking in hunger spots and regions with historical famine.

Impact of prenatal famine exposure on adulthood fasting blood glucose level.

In the past decade, in low-income countries, there have been a rapid rise in prevalence of diabetes among adult population. Hence, understanding the context specific drivers of this change including the impacts of childhood nutrition adversaries on adult metabolic conditions is critical undertaking. This study investigates the potential effects of prenatal famine exposure to the Ethiopian great famine (1983-1985) on adulthood blood glucose level of survivors. A total of 441 adults (222 exposed and 219 controls) were included in the study. Self-reported place of birth and, date of birth and/or age were used to identify participants. A multivariable linear regression analysis was used to analyze the impact of prenatal famine exposure on the level of fasting blood glucose. In linear regression, unadjusted model (Model 1), fasting blood glucose level was increased by 4.13 (ß = 4.13; 95% CI .41, 7.42) points in prenatal famine exposed groups, compared with non-exposed. Similarly, the positive association of prenatal famine exposure and fasting blood glucose level was maintained after adjusted for sex (Model 2) (ß = . 4.08 95% CI .056, 7.50). Further adjusted for age, residence, educational status, wealth index and family size (Model 3) resulted in 4.10 (ß = . 4.10 95% CI .45, 7.56) points increases in fasting blood glucose level. In model 4 adjusting for dietary pattern, physical activity level and family history of diabetes, alcohol and cigarette smoking resulted in 3.90 (ß = 3.90, 95% CI 039, 7.52) points increase in fasting glucose level. In the he full adjusted model (Model 5) prenatal exposure to famine was resulted in 3.78 (ß = 3.78, 95% CI .22, 7.34) increases in fasting blood glucose level after adjusted for BMI and waist to height ratio. There existed a positive association of prenatal famine exposure and adulthood blood glucose levels. In this population, establishing effective overweight/obesity prevention programs to minimize the co-impact of early famine exposure on blood glucose control are important.

Prevalence of Low Self-esteem and Mental Distress among Undergraduate Medical Students in Jimma University: A Cross-Sectional Study.

BACKGROUND: Medical students often experience chronic stress. Self-esteem is one of the most important factors in the process of psychosocial growth and has remarkable effect on thoughts, feelings, values, and goals. The aim of this study was to assess the prevalence and associated factors of low self-esteem (LSE) and mental distress among Medical Students of Jimma University. METHOD: This cross-sectional study was conducted in Jimma University from June to July, 2018. Self-esteem was measured with Rosenberg self-esteem scale. Self-administered Short form with General Health Questionnaire was used to assess presence of mental distress. RESULT: Out of 422 students enrolled to the study, 279 (66.1%) were male, and 413 (97.9 %) were 18 to 25 years of age. The prevalence of LSE and mental distress were 19.0%, and 19.7 %, respectively. Students who had LSE had 5 times higher risk of having mental distress, AOR= 5.1 (95% CI, 2.9-8.9). Moreover, female students had higher risk of developing mental distress (AOR=1.9, 95% CI, 1.1-3.3). Students who had poor social support were 4.3 times at higher risk of developing LSE, AOR=4.3 (95% CI, 1.9-9.8). Those who reported to have poor academic performance were also more likely to have LSE AOR= 3.7 (95% CI, 1.3-10.0). CONCLUSION: One in five medical students had LSE and it is strongly associated with metal distress. Female students were at higher risk of mental distress. Preventive, curative and rehabilitative mental health services should be available for medical students with particular attention to those with poor social support.

Risk perceptions and attitudinal responses to COVID-19 pandemic: an online survey in Ethiopia.

BACKGROUND: Effective risk communication is one of the critical strategies in the response to COVID-19. This study examined risk perceptions and attitudinal responses to COVID-19 among the educated section of the society in Ethiopia. METHODS: An internet-based survey was conducted from April 22 to May 04, 2020, in Ethiopia. A questionnaire addressing the perception of health threat-combination of perceived vulnerability (PV) and perceived seriousness (PS), and perceived efficacy-combinations of perceived response efficacy (PRE), perceived self-efficacy (PSE), and perceived collective efficacy (PCE). The data were analyzed using SPSS 21.0. Descriptive statistics were computed after the standardization of the scores. The scores for overall efficacy and threat were split by median value and response classifications were generated through threat by efficacy interactions. For statistical significance, 95% CI and p-value < 0.05 were used. RESULTS: A total of 929 respondents submitted their responses. Eight hundred and twenty-eight (89.1%) of the respondents were male and 753 (81.1%) were Christian. The perceived threat to COVID-19 was generally low (median = 58.3). The median score for overall efficacy, PRE, and PSE were 79.8, 87.5, and 80.0, respectively. However, the median value (66.7) for PCE was relatively low. Perceived threat significantly varied by age, education, occupation, and place of residence (p < 0.05). Perceived efficacy significantly differed by gender, residence, and use of some sources of information (p < 0.05). In terms of response to COVID-19, 290 (31.2%), 239 (25.7%), 175 (18.8%) and 225 (24.2%) of the respondents were in the responsive, pro-active, avoidant, and indifferent attitudinal categories, respectively. The avoidant and indifferent groups constituted a fear control response (mal-adaptive motivation towards COVID-19 protective behavior) whereas responsive and pro-active categories formed a danger control response (self-protective motivation). These responses varied significantly by residence, region, religion, and sources of information (p < 0.05). CONCLUSIONS: Understanding people's perceived health threat and efficacy is a critical step toward creating risk communication campaigns. Hence, this study provided an insight that has the potential to inform the COVID-19 risk communication campaigns targeting the educated section of the society, by ensuring a balanced combination of threat appeals and efficacy messages for improved self-protective responses.

Psychological distress during the COVID-19 pandemic in Ethiopia: an online cross-sectional study to identify the need for equal attention of intervention.

BACKGROUND: The COVID-19 pandemic led individuals to suffer from different levels of mental health problems such as psychological distress, anxiety, depression, denial, panic, and fear. This study aimed at determining the prevalence of psychological distress and associated factors among the Ethiopian population during the COVID-19 pandemic. METHODS: A cross-sectional study was performed through an online survey using different online platforms. The questionnaire was created through Google Form and the survey link was administered by e-mail, LinkedIn, Telegram, and Facebook. Educated Ethiopian population who have access to the internet were invited to participate through an online survey and addressed to 929 respondents. The study participants completed the survey anonymously without any personal identifier. The psychological distress was assessed using the Kessler 10-item tool to measure psychological distress. Data were analyzed using SPSS and logistic regression to examine mutually adjusted associations, expressed as adjusted odds ratios. A generalized additive model was also employed to identify additional predictors using R. RESULTS: The prevalence of high psychological distress among the study population was 236 (25.5%). Of all respondents, 421 (45.1%) had low psychological distress, 274 (29.4%) had moderate psychological distress, 164 (17.6%) had high psychological distress, and 72 (7.3%) had very high psychological distress. Psychological distress increased with being at young and middle-aged adults, getting information from social media, and not correctly practicing infection prevention and control measures to prevent COVID-19 infection. Respondents with high perceived severity had increased psychological distress. On the contrary, those with the highest score of perceived response efficacy had low distress. CONCLUSION: Prevalence of psychological distress was substantial. The need for intervention of psychological distress inline with the prevention of COVID-19 is critically essential. The intervention target groups are those whose information sources are from social media, young and middle-aged adults, and those who do not correctly practice infection prevention and control measures against COVID-19 infection.

Myths, beliefs, and perceptions about COVID-19 in Ethiopia: A need to address information gaps and enable combating efforts.

BACKGROUND: The endeavor to tackle the spread of COVID-19 effectively remains futile without the right grasp of perceptions and beliefs presiding in the community. Therefore, this study aimed to assess myths, beliefs, perceptions, and information gaps about COVID-19 in Ethiopia. METHODS: An internet-based survey was conducted in Ethiopia from April 22 to May 04, 2020. The survey link was promoted through emails, social media, and the Jimma University website. Perceptions about COVID-19 have considered the World Health Organization (WHO) resources and local beliefs. The data were analyzed using Statistical Package for Social Science (SPSS) software version 20.0. Classifications and lists of factors for each thematic perception of facilitators, inhibitors, and information needs were generated. Explanatory factor analysis (EFA) was executed to assist categorizations. Standardized mean scores of the categories were compared using analysis of variance (ANOVA) and t-tests. A significant difference was claimed at p-value <0.05. RESULTS: A total of 929 responses were gathered during the study period. The EFA generated two main categories of perceived facilitators of COVID-19 spread: behavioral non-adherence (55.9%) and lack of enablers (86.5%). Behavioral non-adherence was illustrated by fear of stigma (62.9%), not seeking care (59.3%), and hugging and shaking (44.8%). Perceived lack of enablers of precautionary measures includes staying home impossible due to economic challenges (92.4%), overcrowding (87.6%), and inaccessible face masks (81.6%) and hand sanitizers (79.1%). Perceived inhibitors were categorized into three factors: two misperceived, myths (31.6%) and false assurances (32.9%), and one correctly identified; engagement in standard precautions (17.1%). Myths about protection from the virus involve perceived religiosity and effectiveness of selected food items, hot weather, traditional medicine, and alcohol drinking, ranging from 15.1% to 54.7%. False assurances include people's perception that they were living far away from areas where COVID-19 was rampant (36.9%), and no locally reported cases were present (29.5%). There were tremendous information needs reported about COVID-19 concerning protection methods (62.6%), illness behavior and treatment (59.5%), and quality information, including responses to key unanswered questions such as the origin of the virus (2.4%). Health workers were perceived as the most at-risk group (83.3%). The children, adolescents, youths were marked at low to moderate (45.1%-62.2%) risk of COVID-19. Regional, township, and access to communication showed significant variations in myths, false assurances, and information needs (p <0.05). CONCLUSIONS: Considering young population as being at low risk of COVID-19 would be challenging to the control efforts, and needs special attention. Risk communication and community engagement efforts should consider regional and township variations of myths and false assurances. It should also need to satisfy information needs, design local initiatives that enhance community ownership of the control of the virus, and thereby support engagement in standard precautionary measures. All forms of media should be properly used and regulated to disseminate credible information while filtering out myths and falsehoods.