Spatial Variation of Child Stunting and Maternal Malnutrition after Controlling for Known Risk Factors in a Drought-Prone Rural Community in Southern Ethiopia.

Background: Globally, understanding spatial analysis of malnutrition is increasingly recognized. However, our knowledge on spatial clustering of malnutrition after controlling for known risk factors of malnutrition such as wealth status, food insecurity, altitude and maternal characteristics is limited from Ethiopia. Previous studies from southern Ethiopia have shown seasonal patterns of malnutrition, yet they did not evaluate spatial clustering of malnutrition. Objective: The aim of this study was to assess whether child stunting and maternal malnutrition were spatially clustered in drought-prone areas after controlling for previously known risk factors of malnutrition. Methods: We used a community-based cohort study design for a one-year study period. We used SaTScan software to identify high rates of child stunting and maternal malnutrition clustering. The outcome based was the presence or absence of stunting and maternal malnutrition ([BMI] <18.5 kg/m2). We controlled for previously known predictors of child stunting and maternal malnutrition to evaluate the presence of clustering. We did a logistic regression model with declaring data to be time-series using Stata version 15 for further evaluation of the predictors of spatial clustering. Results: The crude analysis of SaTScan showed that there were areas (clusters) with a higher risk of stunting and maternal malnutrition than in the underlying at risk populations. Stunted children within an identified spatial cluster were more likely to be from poor households, had younger and illiterate mothers, and often the mothers were farmers and housewives. Children identified within the most likely clusters were 1.6 times more at risk of stunting in the unadjusted analysis. Similarly, mothers within the clusters were 2.4 times more at risk of malnutrition in the unadjusted analysis. However, after adjusting for known risk factors such as wealth status, household food insecurity, altitude, maternal age, maternal education, and maternal occupation with SaTScan analysis, we show that child stunting and maternal malnutrition were not spatially clustered. Conclusion: The observed spatial clustering of child stunting and maternal malnutrition before controlling for known risk factors for child stunting and maternal malnutrition could be due to non-random distribution of risk factors such as poverty and maternal characteristics. Moreover, our results indicated the need for geographically targeted nutritional interventions in a drought-prone area.

Seasonal Variation of Household Food Insecurity and Household Dietary Diversity on Wasting and Stunting among Young Children in A Drought Prone Area in South Ethiopia: A Cohort Study.

This study was conducted to evaluate seasonal patterns of household food insecurity, dietary diversity, and household characteristics on wasting and stunting among children in households followed for 1 year in the drought-prone areas of Sidama, Ethiopia. A cohort study design was employed. Data were collected on the pre-harvest season (March and June) and post-harvest season (September and December) of 2017. We studied 935 children aged 6 to 47 months. At four seasons over a year, we had 3,449 observations from 897 households and 82% (2,816) (95% CI: 80.3-82.9) were food in-secured households. Severe food insecurity was higher in the pre-harvest (March; food scarcity season) which was 69% as compared to 50% of September (P < .001). From 3,488 observations, 44% (1,533) (95% CI: 42.3-45.6) of children were stunted. Stunting showed seasonal variations with 38% (95% CI: 34.7-41.0) in March and 49% (95% CI: 45.8-52.5) in December. Six percent (95% CI: 5.0-6.6) of children were wasted, with higher prevalence in March (8%) as compared to 3% of September (P < .001). Moreover, household characteristics such as poverty level, education, occupation and the household food insecurity and dietary diversity were associated with subsequent wasting and stunting.

Magnitude and Factors Associated With Post-Cesarean Surgical Site Infection at Hawassa University Teaching and Referral Hospital, Southern Ethiopia: A Cross-sectional Study.

BACKGROUND: Surgical site infection (SSI) after cesarean section (CS) increases maternal morbidity, hospital stay and medical cost. However, in Ethiopia, limited evidence exists regarding the magnitude and risk factors of post-CS wound infection. The purpose of this study was to determine the prevalence of - and factors associated with the problem among mothers who gave birth in Hawassa University Teaching and Referral Hospital, Southern Ethiopia. METHODS: Hospital based cross-sectional study was conducted based on the medical records of 592 women who underwent CS from June 2012 to May 2013. Data on the occurrence and factors associated with SSIs were extracted. Factors associated with SSI were identified using multivariate logistic regression analysis. The output of the analysis is presented using adjusted odds ratio (OR) with the corresponding 95% confidence interval (CI). RESULTS: The prevalence of SSI was 11.0% (95% CI: 8.6-13.8%). Mothers with prolonged labor (6.78, 95% CI: 2.54-18.00) and prolonged rupture of membrane (5.83, 95% CI: 2.14-15.89) had significantly increased odds of SSI. Compared to mothers who had no digital vaginal examination, those who had 1-4 and 5 or more examinations were at higher risk with OR of 2.91 (95% CI: 1.21-6.99) and 8.59 (95% CI: 1.74-42.23), respectively. Prolonged duration of surgery (12.32, 95% CI: 5.46-27.77), wound contamination class III (9.61, 95% CI: 1.84-50.06) and postoperative anemia (2.62, 95% CI: 1.21-5.69) were also significant predictors. CS conducted by junior practitioners is likely to be followed by infection. CONCLUSION: Post-CS SSI is relatively common in the hospital. Thus, it should be averted by implementing infection prevention techniques.

Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study.

BACKGROUND: Decentralization and task shifting has significantly improved access to antiretroviral therapy (ART). Many studies conducted to determine the attrition rate in Ethiopia have not compared attrition rates between hospitals and health centers in a relatively recent cohort of patients. This study compared death and loss to follow-up (LTFU) rates among ART patients in hospitals and health centers in south Ethiopia. METHODS: Data routinely collected from patients aged older than 15 years who started ART between July 2011 and August 2012 in 20 selected health facilities (12 being hospitals) were analyzed. The outcomes of interest were LTFU and death. The data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences version 20.0 and Stata version 12.0. Competing-risk regression models were used. RESULTS: The service years of the facilities were similar (median 8 and 7.5 for hospitals and health centers, respectively). The mean patient age was 33.7±9.6 years. The median baseline CD4 count was 179 (interquartile range 93-263) cells/mm(3). A total of 2,356 person-years of observation were made with a median follow-up duration of 28 (interquartile range 22-31) months; 24.6% were either dead or LTFU, resulting in a retention rate of 75.4%. The death rates were 3.0 and 1.5 and the LTFU rate were 9.0 and 10.9 per 100 person-years of observation in health centers and hospitals, respectively. The competing-risk regression model showed that the gap between testing and initiation of ART, body mass index, World Health Organization clinical stage, isoniazid prophylaxis, age, facility type, and educational status were independently associated with LTFU. Moreover, baseline tuberculous disease, poor functional status, and follow-up at a health center were associated with an elevated probability of death. CONCLUSION: We observed a higher death rate and a lower LTFU rate in health centers than in hospitals. Most of the associated variables were also previously documented. Higher LTFU was noticed for patients with a smaller gap between testing and initiation of treatment.

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia

Background: Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus. Objectives: To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia. Methodology: Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome. Results: Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR = 3.2, CI = 1.58-6.82, p-value = 0.001), age greater than 45 years (AOR = 6.08, CI = 2.28-16.23) and baseline CD4 count less than 200 cells/L (AOR = 6.19, CI = 2.28-16.89, p-value = 0.001). Conclusion: The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases. .

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia.

BACKGROUND: Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus. OBJECTIVES: To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia. METHODOLOGY: Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome. RESULTS: Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR=3.2, CI=1.58-6.82, p-value=0.001), age greater than 45 years (AOR=6.08, CI=2.28-16.23) and baseline CD4 count less than 200cells/µL (AOR=6.19, CI=2.28-16.89, p-value=0.001). CONCLUSION: The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases.