Occupational radiation exposure dose and associated factors among radiology personnel in Eastern Amhara, Ethiopia.

BACKGROUND: Ionizing radiation is being used more frequently in medicine, which has been linked to recognized biological effects such as cancer and mortality. Radiology services are becoming more widely available in Ethiopian health facilities but there is no compiled record of worker's radiation dose. So, assessing the magnitude and identifying the associated factors of occupational radiation exposure dose among radiology personnel help to design strategies for radiation protection. OBJECTIVE: The study was designed to assess the occupational radiation exposure dose and associated factors among radiology personnel in eastern Amhara, northeast Ethiopia, 2021. METHODS: Cross-sectional study was conducted from March 25 to April 30, 2021, in 57 health institutions among 198 radiology personnel. The study comprised all eligible radiology personnel. The data were collected using an electronic-based (Google form) self-administered questionnaire, and document review. The data were entered into an excel spread sheet and then, exported to Stata 14 software. Linear regression model was used to analyse the data after checking its assumptions. Variables with a p-value < 0.25 were entered into a multiple linear regression analysis, and those with a p-value < 0.05 were judged significant. VIF was used to check for multi-collinearity. Coefficient of determination was used to check the model fitness. RESULTS: The mean (± SD) annual shallow and deep dose equivalents of radiology personnel were 1.20 (± 0.75) and 1.02 (± 0.70) mSv, respectively. Body mass index (ß = 0.104, 95% CI: 0.07, 0.14), practice of timing (ß = -0.43, 95% CI: -0.73, -0.13), working experience (ß = -0.04, 95% CI: -0.048, -0.032), and practice of distancing (ß = -0.26, 95% CI: -0.49, -0.17) were found to be statistically significant factors of annual deep dose equivalent. In addition, body mass index (ß = 0.113, 95% CI: 0.08, 0.15), practice of timing (ß = -0.62 95% CI: -0.93, -0.31) and, working experience (ß = -0.044, 95% CI: -0.053, -0.036 had statistically significant associations with annual shallow dose equivalent. CONCLUSION: The annual dose equivalents were two times higher than the global average of annual per caput effective dose due to medical exposure. Body mass index, practice of timing, working experience, and practice of distancing were factors of occupational radiation exposure dose. Strategies focusing on increasing the skill, experience, and lifestyle of radiology personnel would be supreme important means to reduce occupational radiation exposure dose.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis.

BACKGROUND: Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD: Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS: Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS: Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.

Spatial distribution of health-risky road traffic noise pollution in Dessie City, North East Ethiopia.

OBJECTIVE: Dessie is the trade center for northeast Ethiopia. High traffic flow plus overacting of promotion made the city noisy. There is a shortage of relevant evidence that enforces policy makers to design intervention plans. Therefore, this study aimed to explore the health-risky road traffic noise pollution in Dessie City, Ethiopia. METHODS: The study was conducted by purposive selection of the study area and sampling sites of the city from May 31, 2021 -June 6, 2021. Noise level recordings were taken by a digital Sound Meter and location data was collected by Global Positioning System. Residential, health facility, commercial, and mixed sites were identified by field observation. A total of 20 noise sampling points were included. The sampling points were selected by considering World Health Organization guideline. The measurements were taken twice a day at peak hours, between 8:00-11:00am and 4:00-7:00pm on all days of the week. The sound level meter was placed at a height of 1.5m and 2m from the curb. A total of 280 sound level records were conducted over one week. RESULTS: Among twenty noise recording sites, more than 50% of them registered as excessive noisy sites for all types of site categories (health facility, residential, commercial, and mixed areas). For the seven days, average noise recordings were in the range of 66-72 dB at 83% of mixed areas; 33% of health facilities; 25% of residential areas, and 86% of commercial areas. The highest levels of noise pollution were seen at the Bus-station, Buanbuawuha Square, Tekuam, Arada, Ethio General Hospital, Ersha-seble, and Menafesha areas. CONCLUSION: This study shows that the average noise level measurement within a week exceeded the permissible limits set by Ethiopia and the World Health Organization. It helps for policy development and timely actions against noise pollution and as baseline information for further investigation.

Factors associated with catastrophic health care expenditure in South Wollo province, Ethiopia: A cross-sectional study.

Ethiopia is an underfinanced country when compared to the Sub-Saharan average. Direct payment has a high account in Ethiopia and inhibits access to health services for the poor. We aimed to identify the factors associated with catastrophic health expenditure (CHE) in the South Wollo Zone, Ethiopia. A community-based cross-sectional study was conducted. A two-stage sampling technique was used to get a total of 494 households. The data were entered using Epi data version 4.6 and analysed using STATA version 14.1 software for binary logistic regression analysis. A multivariable logistic regression analysis was done to identify the factors associated with CHE. The total magnitude of CHE was found to be 33.97% at the 10% threshold of total household expenditure and 14.98% at the 40% threshold of non-food expenditure. Insured households (adjusted odds ratio = 0.02, 95% CI: 0.01-0.10) were statistically associated with CHE with total household and non-food measures. Catastrophic health expenditure was found to be decreased among insured households and increased among households had children less than 5 years of age, members with chronic illness, and poor health status. Therefore, encouraging insurance and health promotion activities to improve the health status of the community are important.

Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low-Income Countries of Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

BACKGROUND: Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth. Postpartum contraceptives reduce maternal and infant mortality by preventing unplanned and unwanted pregnancies and by spacing pregnancies at least two years after the previous birth. Thus, it is usually designed as an integral part of reproductive and maternal and child health programs. Therefore, the aim of this systematic review and meta-analysis is to estimate the pooled prevalence of postpartum modern contraceptive use and identify its determinants in low-income countries of sub-Saharan Africa. METHODS: A systematic review and meta-analysis of published and unpublished studies were used. PubMed, HINARI, ScienceDirect, Cochrane Library, Wiley Library, ETH Library, and Google Scholar were used to search all articles. STATA 14 software was used for data analysis. Funnel plots and Egger's test were used to examine the risk of publication bias. Heterogeneity was checked by using Cochran's Q test and I 2 test. A random effect model was computed to estimate the pooled prevalence. RESULTS: A total of 33 articles were included. The pooled prevalence of postpartum contraceptive use in low-income countries of sub-Saharan Africa was 37.41%, 95% CI: (31.35, 43.48%). Secondary and above level of education (AOR 2.09, 95% CI: (1.52, 2.86)), discussion with husband (AOR 3.68, 95% CI: (1.96, 6.89)), resumption of menses (AOR: 3.98, 95% CI: (2.62, 6.03)), ANC follow-up (AOR; 5.10, 95% CI: (3.57, 7.29)), knowledge of modern family planning (AOR: 5.65, 95% CI: 3.58, 8.93)), and family planning counseling during ANC (AOR =5.92, 95% CI: (2.54, 13.79)) were found to be determinants of postpartum contraceptive utilization. CONCLUSION: In this systematic review and meta-analysis, the prevalence of postpartum modern contraceptive use was found to be low compared to the existing global recommendations. Therefore, empowering maternal education, delivering adequate counseling, and strengthening existing integrated maternal and child health services are highly recommended to increase postpartum contraceptive use. This trial is registered with CRD42020160612.

Knowledge and practice of clients on preventive measures of COVID-19 pandemic among governmental health facilities in South Wollo, Ethiopia: A facility-based cross-sectional study.

INTRODUCTION: Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client's knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. METHODS: An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers' knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client's knowledge and preventive practices. RESULTS: Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. CONCLUSION: Our findings revealed that clients' knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices.

Knowledge level and factors influencing prevention of COVID-19 pandemic among residents of Dessie and Kombolcha City administrations, North-East Ethiopia: a population-based cross-sectional study.

OBJECTIVE: In Ethiopia, community-level knowledge about the current COVID-19 pandemic has not been well studied. This study is aimed to assess knowledge level and factors influencing the prevention of the COVID-19 pandemic among residents of Dessie and Kombolcha city administrations, Ethiopia. DESIGN: Community-based cross-sectional study. SETTINGS: Dessie and Kombolcha city administrations. PARTICIPANTS: Participants were household heads or members (n=828, >18 years) who have lived in the study area for at least 2 months preceding the survey. METHODS: Binary logistic regression was used for a single outcome and multiple response variables. In the multivariable regression model, a value of p<0.05 and adjusted OR (AOR) with 95% CI were used to identify factors associated with knowledge level of the community. Epi Info V.7.2 and SPSS V.20 software were used for data entry and analysis, respectively. OUTCOME: Knowledge level. RESULTS: A total of 828 participants was involved with a response rate of 98%. Women were 61.7%. Participants' mean (±SD) age was 39 (±14) years. Of the total participants 54.11% (95% CI 50.6% to 57.6%) had inadequate knowledge about COVID-19 prevention. Significant associations were reported among women (AOR=1.41; 95% CI 1.03 to 1.92); age ≥65 years (AOR=2.72; 95% CI 1.45 to 5.11); rural residence (AOR=2.69; 95% CI 1.78 to 4.07); unable to read and write (AOR=1.60; 95% CI 1.02 to 2.51); information not heard from healthcare workers, mass media and social media (AOR=1.95; 95% CI 1.35 to 2.82), (AOR=2.5; 95% CI 1.58 to 4.19) and (AOR=2.13; 95% CI 1.33 to 3.42), respectively, with inadequate knowledge. CONCLUSION: These findings revealed that more than 50% of participants had inadequate knowledge about COVID-19. It highlights the need for widespread awareness campaigns about COVID-19 through mass media, healthcare professionals and social media as sources of information. House-to-house awareness creation is recommended to address older adults who are more vulnerable to the pandemic.

Academic Achievements in National Competence Assessment Among Health Extension Students in Regional Health Science Colleges, Amhara Region, Ethiopia.

BACKGROUND: The national competency assessment (NCA) is a strategy with the objective of creating a competent, motivated, adaptable and innovative workforce in Ethiopia. However, of all the students that had taken the NCA, below average students had passed the assessment in the study settings. Therefore, this study aimed to assess the level of academic achievements of health extension students (HESs) and identify the influencing factors that contribute to the failure of HESs on NCA in the study settings. METHODS: An institution-based cross-sectional study complemented with qualitative methods was conducted from 18th to 27th January 2019 of a sample of 186 level III health extension students in Regional Health Science Colleges. A self-administered structured questionnaire and focus group discussion guiding tool were used to collect the data. The data were checked for completeness, coded and entered into EPI info version 7.1.0 and exported to SPSS version 20 for analysis. Bivariate logistic regression analysis was done to assess the association between each independent variable and the outcome variable with p<0.25. Multivariable analysis was done to control the influence of potential confounding variables and to identify influencing factors. The significant level was declared at p<0.05. RESULTS: A total of 186 study subjects were involved in the study with a response rate of 100%. Of the total participants, only 31.7% of students passed the national competency assessment. After adjusting for covariates, fathers' education level, fathers' occupation, and students' English language understanding were significantly associated with the passing of the NCA. CONCLUSION: Students' competency in the NCA is below average. Therefore, the health science colleges should give due attention to the inclusion of the English language as a unit of competency. The regional government and stakeholders should give priority to paternal awareness about the health extension program. Follow-up studies are recommended exploring other influencing factors related to the NCA.

Spatial heterogeneity and factors influencing stunting and severe stunting among under-5 children in Ethiopia: spatial and multilevel analysis.

Stunting remains a major public health concern in Ethiopia. Government needs to reshape and redesign new interventions to reduce stunting among under-five children. Hence, this study identified the problem according to location and risk factor. This study is a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey. A total of 9588 children aged 0-59 months were included in the study. The spatial and multilevel logistic regression analyses were used to explore spatial heterogeneity and identify individual- and household-level factors associated with stunting and severe stunting. Spatial heterogeneity of stunting and severe stunting was seen across the study setting. Male children (AOR = 1.51, CI 1.16, 1.96); multiple births (AOR = 27.6, CI 10.73, 71.18); older children (AOR = 1.04, CI 1.01, 1.05) and anemic children (AOR = 3.21, CI 2.3, 4.49) were severely stunted at individual-level factors. Children from educated and malnourished mothers (respectively, AOR = 0.18, CI 0.05, 0.71; AOR = 5.35, CI 3.45, 8.32), and from less wealthier mothers (AOR = 5.95, CI 2.58, 13.69) were severely stunted at household-level factors. Giving priority to the hotspot areas of stunting and older and anemic children, multiple births, and maternal undernutrition is important to reduce stunting. Studies are recommended to fill the gaps of this study.

Spatial patterns and associated factors of HIV Seropositivity among adults in Ethiopia from EDHS 2016: a spatial and multilevel analysis.

BACKGROUND: HIV is a major public health issue, especially in developing countries. It is important to track and design successful intervention programs to explore the spatial pattern, distribution, and associated factors of HIV Seropositivity. This study therefore showed the spatial variation of HIV Seropositivity and related factors in Ethiopia. METHODS: A total sample of 25,774 individual data collected from the 2016 EDHS data were primarily HIV biomarkers, IR, MR, and GPS. Spatial heterogeneity analysis was used with methods such as Morans I, Interpolation, and Kulldorff 's scan statistic. Spatial analysis was conducted using open source tools (QGIS, GeoDa, SaTScan). Multilevel logistic regression analysis was performed using Stata14 to identify HIV-associated factors. Finally, the AOR with a 95% confidence interval was used to report the mixed-effect logistic regression result in the full model. RESULT: The prevalence of HIV / AIDS at national level was 0.93%. The highest prevalence regions were Gambela, Addis Abeba, Harari and Diredawa, accounting for 4.79, 3.36, 2.65 and 2.6%, respectively. Higher HIV seropositive spatial clusters have been established in the Gambela and Addis Ababa regions. Multilevel analysis at the individual level being married [AOR = 2.19 95% CI: (1.11-4.31)] and previously married [AOR = 6.45, 95% CI: (3.06-13.59)], female [AOR = 1.8, 95% CI: (1.19-2.72)], first-sex at age ≤15 [AOR = 4.39, 95% CI: (1.70-11.34)], 18-19 [AOR = 2.67 95% CI: (1.05-6.8)], middle age group (25-34) [AOR = 6.53, 95% CI: (3.67-11.75)], older age group (>34) [AOR = 2.67 95% CI: (1.05-6.8)], primary school [AOR = 3.03, 95% CI: (1.92-4.79)], secondary school [AOR = 3.37, 95% CI: (1.92-5.92) were significantly associated with serropositivity. Regarding household level, place of residence [urban: AOR = 6.13 CI: (3.12, 12.06)], female-headed households (AOR = 2.24 95% CI: (1.57-3.73), media exposure [low exposure (AOR = 0.53 95% CI: (0.33-0.86), no exposure AOR = 0.39 95% CI: (0.23-0.65)] and increased household size [AOR = 0.72 95% CI: (0.65-0.8)] were associated with HIV Seropositivity. CONCLUSION: High cluster HIV cases were found in Gambela, Addis Abeba, Harari, and Diredawa. Having a history of married, start sex at a younger age, female-headed household, urban residence, and lower household size is more affected by HIV/AIDS. So any concerned body work around this risk group and area can be effective in the reduction of transmission.

Hotspots of unimproved sources of drinking water in Ethiopia: mapping and spatial analysis of Ethiopia demographic and health survey Data 2016.

BACKGROUND: More than 35% of the Ethiopian population are using drinking water from unimproved sources. As per the United Nations' Sustainable Development Goals, Ethiopia is aspiring to achieve universal and equitable access to safe and affordable drinking water for all by 2030. For these goals to be accomplished, it is important to map the country's hotspot areas of unimproved source of drinking-water so that resource allocation and disease control can be optimized there. Therefore, the objective of this study is to map and identify hotspot areas of unimproved sources of drinking water in Ethiopia. METHODS: A population based cross-sectional study was conducted in Ethiopia from January 18 to June 27, 2016. Data were collected from 10,064 households using a pretested and structured questionnaire. A stratified two-stage cluster sampling was employed where the enumeration areas were primary sampling units and households were secondary sampling units. Systematic sampling with probability proportional to size was employed to select samples. Datasets were cleaned and entered into SaTScan and ArcGIS software for mapping and analysis. The Global Moran's I and spatial scan statistical tests (Bernoulli model) were done to explore the presence of clustering in the study area and local spatial clusters (hotspots) of unimproved sources of drinking water using ArcGIS version 10.3 and Kuldorff's SaTScan version 9.4 software, respectively. RESULTS: Unimproved sources of drinking water were spatially clustered in the study area (Moran's I: 0.35, p < 0.05). A total of 143 significant clusters was identified. Of which, eight were most likely (primary) clusters and the other 135 were secondary clusters. The first spatial window which contains primary clusters was located in Amhara and Afar regions (LLR: 78.89, at p < 0.001). The other 33 spatial windows which contain secondary clusters were found in all regions, except Gambela region and Addis Abeba city administration (with a range of LLR: 10.09-78.89, p < 0.001). CONCLUSIONS: This study allowed the identification of important non-random clusters and hotspots of unimproved sources of drinking water. Therefore, these results will be determinant to help decision makers in their geographical interventions to combat problems related to drinking water quality.

Determinants of Birth Asphyxia Among Newborns in Referral Hospitals of Amhara National Regional State, Ethiopia.

BACKGROUND: Globally, every year, 2.5 million infants die within their first month of life. Birth asphyxia is one of the leading causes in all low- and middle-income countries and the leading single cause of neonatal mortality in Ethiopia. Therefore, the aim of this study was to identify the determinants of birth asphyxia among newborns admitted to neonatal intensive care units (NICU) in Amhara region referral hospitals, Ethiopia. METHODS: Facility-based unmatched case-control study was employed from March 1 to April 30, 2018. Cases were newborn babies admitted to neonatal intensive care units with an admission criteria of birth asphyxia with APGAR score of <7 at five min of birth and controls were newborn babies admitted to NICU with an admission criteria of other complications (such as jaundice, congenital anomalies, sepsis, hemorrhagic diseases) with APGAR score of ≥7 at five min of birth. Using SPSS version 20, bivariate logistic regression model was fitted to check the relation of each independent variable to the outcome variable. Variables with p<0.2 in bivariate analysis were transferred to multivariable logistic regression model for final analysis. Variables with an adjusted odds ratio (AOR) of 95%CI and p<0.05 were reported as determinants of birth asphyxia. RESULTS: Data were collected from 193 cases and 193 controls with a response rate of 100%. Low birth weight (AOR: 8.94, 95%CI: 4.08, 19.56), born at health centers (AOR: 7.36, 95%CI: 2.44, 22.13), instrumental delivery (AOR: 3.03, 95%CI: 1.41, 6.49), and prolonged labor (AOR: 2.00, 95%CI: 1.20, 3.36) were significant determinants of birth asphyxia. CONCLUSION: Even though most of the identified variables are the common and familiar causes of birth asphyxia, neonates born at health centers were more exposed to birth asphyxia than neonates born in hospitals. This might be due to delay of referral process and lack of skilled professionals in health centers. Further research might be needed to identify the root causes of delays and follow-up issues by adding qualitative component.

Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia.

BACKGROUND: Under nutrition is one of the leading causes of morbidity and mortality in under-five children in developing countries including Ethiopia. In Ethiopia, many children with severe acute malnutrition (SAM) are treated at inpatient therapeutic feeding centers. However, the survival status and its determinants are not well understood. Therefore, the aim of this study was to estimate the survival status and its determinants among under-five children with severe acute malnutrition admitted to inpatient therapeutic feeding centers (ITFCs). METHODS: A record review was conducted on 414 under-five children who were admitted with severe acute malnutrition to ITFCs in South Wollo Zone, northeast Ethiopia, between September 11, 2014, and January 9, 2016. Data were entered into Epi-Info version 7.2 and analyzed using SPSS version 20. Life table analysis was used to estimate cumulative proportion of survival. The relationship between time to recovery and covariates was determined using Cox-proportional hazards regression model. p < 0.05 was used to declare presence of significant association between recovery time and covariates. RESULTS: Of the total children recorded, 75.4% of children were recovered and discharged, 10.3% were defaulters, 3.4% died, 7.4% were nonresponders, and 3.4% were unknown. The mean (±standard deviation) time to recovery was 12 (±5.26) days, whereas the median time to recovery was 11 (interquartile range of 8-15) days. Children's breastfeeding status at admission (AHR: 1.42, 95% CI: 1.10, 1.83) and children without comorbidities at admission (AHR: 1.44, 95% CI: 1.03, 2.00) had statistically significant effect on time to recovery from SAM. CONCLUSION: All treatment responses in this study were within the recommended and acceptable range of global standards. Policy makers, health facilities, and care providers may need to focus on the importance of breastfeeding especially for those under two years of age and give emphasis for cases with comorbidities.

Determinants for not utilizing trachomatous trichiasis surgery among trachomatous trichiasis patients in Mehalsayint District, North-East Ethiopia.

BACKGROUND: Globally, trachoma is the leading cause of infectious blindness. In Ethiopia, the overall Trachomatous Trichiasis (TT) surgical coverage is 41%. Identifying determinants for not utilizing TT surgery among TT patients is important to design and monitor effective intervention programs. Therefore, this study aimed to identify determinants for not utilizing TT surgery among TT patients in Mehalsayint District, North East Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS: A community based unmatched case control study was employed from March 30, 2017 to April 13, 2017. A total of 482 study participants (241 cases and 241 controls) with age of ≥15 years were included in the study. The data were entered with Epi info version 7.2 software and exported to SPSS version 20 for analysis. Bivariate analysis was fitted to screen candidate variables with p<0.2 for the final model. Finally, multivariable logistic regression analysis was employed to identify significant factors (p<0.05) for not utilizing TT surgery. Respondents' age of 16-30 years (AOR: 10.11; 95% CI: 2.72, 37.59) and widowed respondents (AOR: 0.40; 95% CI: 0.21, 0.77), time to reach the service (AOR: 0.46; 95% CI: 0.24, 0.87), unavailability of TT surgeon (AOR: 5.00; 95% CI: 1.16, 21.38), symptoms of trichiasis (AOR: 7.49; 95% CI: 2.41, 23.26), duration of the problem (AOR: 2.56; 95% CI: 1.44, 4.54), the affected eye (AOR: 2.16; 95% CI: 1.23, 3.80), epilation practice (AOR: 3.22; 95% CI: 1.84, 5.64), and place of TT surgery given (AOR: 4.21; 95% CI: 2.48, 7.14) were significant determinants for not utilizing TT surgical services. CONCLUSIONS/SIGNIFICANCE: In this study, TT surgery against trachoma is very low and TT remains public health problem in the district. Being younger age and widowed, time taken to reach the service, absence of TT surgeon, symptoms of trichiasis, duration of problem, the affected eye, epilation practice, and service place were determinants for the inability of TT surgical services. The findings of this study would help in designing effective interventions to reduce trachoma in that district.

Spatial patterns of childhood diarrhea in Ethiopia: data from Ethiopian demographic and health surveys (2000, 2005, and 2011).

BACKGROUND: Childhood diarrhea is a major public health problem, especially in developing countries, including Ethiopia. Exploring the spatial pattern of childhood diarrhea is important to monitor and design effective intervention programs. Therefore, this study aimed to explore the spatial patterns of childhood diarrhea in Ethiopia over the past one decade. METHODS: A total of 29,358 under-five children were retrieved from three consecutive Ethiopian demographic and health surveys (2000, 2005, and 2011) and included into the study. Spatial cluster and autocorrelation analysis was done to explore the patterns of childhood diarrhea. RESULTS: Childhood diarrhea clustered spatially at a national level in all survey periods (Moran's I: 0.3830-1.3296, p < 0.05). Significant spatial clusters were found in different survey periods across the regions. The most likely spatial clusters were found in Southern Nations Nationalities and people, West Oromia, Gambella, Benshangul-Gumuz, and Somali regions. Childhood diarrhea also clustered at the border areas of Southern Nations Nationalities and People and Tigray, Central Somali and Western Oromia, Gambella and Amhara (West Gojam, Awi, Oromia, and Wag Himra) regions. In 2000, the most likely clusters were found in Southern Nations Nationalities and People, West Oromia, and Gambella regions (LLR = 55.37, p < 0.001); in 2005, at Southern Nations Nationalities and People (LLR: 45.69, p < 0.001); and in 2011, at Gambella, West Southern Nations Nationalities and People and Oromia, and Benshangul-Gumuz regions (LLR: 51.09, p < 0.001). CONCLUSION: In this study, childhood diarrhea remains public health problem and had a spatial variation across the regions. Identifying the risk areas would help in designing effective interventions to reduce childhood diarrhea in these areas.