Proportion of Attrition and Associated Factors Among Children Receiving Antiretroviral Therapy in Public Health Facilities, Southern Ethiopia.

Purpose: Acquired immunodeficiency syndrome (AIDS) is a major global public health concern. Despite the improved access and utilization of antiretroviral therapy (ART), attrition from care among children continues to be a major obstacle to the effectiveness of ART programs. Hence, this study aimed to assess the proportion of attrition and associated factors among children receiving ART in public health facilities of Gamo and South Omo Zones, Southern Ethiopia. Patients and Methods: A retrospective follow-up study was conducted in public health facilities of Gamo and South Omo Zones in Southern Ethiopia from April 12, 2022, to May 10, 2022. The proportion of attrition was determined by dividing the number of attrition by the total number of participants. Descriptive statistics were calculated. A binary logistic regression model was used to identify factors associated with attrition. Statistical significance was set at p-value <0.05. Results: The median age of the participants was 5.5 (IQR: 2-9) years. The proportion of attrition from ART care was 32.4% (95% confidence interval (CI): 27.57% to 37.69%). Death of either of the parents (adjusted odds ratio (AOR) = 2.19; 95% CI:1.14, 4.18), or both parents (AOR = 3.19; 95% CI: 1.20, 8.52), hemoglobin level <10mg/dL (AOR = 2.39, 95% CI: 1.21, 4.70), a cluster of differentiation (CD)4 count ≤200 cells/mm3 (AOR = 6.78, 95% CI: 3.16, 14.53), CD4 count 200-350 cells/mm3 (AOR = 2.65, 95% CI: 1.16, 6.03), suboptimal adherence (AOR = 6.38; 95% CI: 3.36, 12.19), and unchanged initial regimen (AOR = 6.88; 95% CI: 3.58, 13.19) were factors associated with attrition. Conclusion: Attrition from care is identified to be a substantial public health problem. Therefore, designing interventions to improve the timely tracing of missed follow-up schedules and adherence support is needed, especially for children with either/both parents died, unchanged initial regimen, low CD4, and/or low hemoglobin level.

Prevalence and associated factors of stress and anxiety among female employees of hawassa industrial park in sidama regional state, Ethiopia.

BACKGROUND: Work-related stress and anxiety are emerging global public health problems causing serious social and economic consequences. Working women bear a heavy burden due to high social disparity, gender inequality, and an important responsibility to balance work and family life in undeveloped society. OBJECTIVE: To assess the prevalence and associated factors of work related stress and anxiety among female employees of Hawassa industrial park in Sidama Region, Ethiopia, 2021. METHODS: Institution-based cross-sectional study design was conducted among 417 female employees using structured interviewer-administered questionnaires and depression, Anxiety, and Stress scale (DASS) 21 items. A simple random sampling technique was used through the computer-generated random method. The outcome variables were work related stress and anxiety. Work related stress and anxiety were ascertained using the DASS 21( stress ≥ 15 &anxiety8 - 14). The associated factors assessed included sociodemographic, behavioral factor, job and organization related factors, past illness and social support related factors. Bivariate and multivariable logistic regression analyses were done. The strength of association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval and, the statistical significance of P-value < 0.05. RESULT: The prevalence of work-related stress and anxiety were 59.3% [95% CI: (54.7, 63.9)] and 79.8% [95% CI: 75.5, 83.6)] respectively. Respondents with single marital status [AOR = 5.31, 95% CI: (1.68, 16.86)], having chronic illness [AOR = 4:00, 95% CI: (1.24, 12.9)], and current alcohol drinking [AOR = 12.5, 95% CI: (4.56, 34.2)] were significantly associated with stress. Likewise, being single in marital status [AOR = 1.99, 95% CI: (1.15, 3.46)], poor social support [AOR = 3.78, 95% CI: (1.53, 9.35)], overtime work [AOR = 2.31, 95% CI: (1.12, 4.74)], having work experience (3-4 years) [AOR = 4.71, 95% CI: (1.49, 14.84)], and fear of losing job [AOR = 1.72, 95% CI: (1.01, 2.93)] were significantly associated with anxiety. CONCLUSION: The prevalence of work-related stress and anxiety was high in the study area. Marital status, alcohol drinking, and chronic illnesses were factors associated with work-related stress. In contrast the fear of losing a job, work experience, overtime work, and having poor social support were factors associated with anxiety.. The significant factors identified in this study can be targeted to reduce the occurrence of work related stress and anxiety among women through designing preventive programs and strategies which includes acknowledging the importance of mental health services for the welfare of the public, screening for work related stress and anxiety, counselling, and the provision of support for women as well as lifestyle modification.

Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study.

BACKGROUND: Broad and specific causes of adult mortalities are often neglected indicators of wellbeing in low-income countries like Ethiopia due to lack of strong vital statistics. Thus, this database study aimed to assess the causes of adult mortality using demographic surveillance data. METHODS: An 8-year (12 September 2009-11 September 2017) surveillance data from the Arba Minch Health and Demographic Surveillance Site was used for this study. Verbal autopsy methods and ICD codes were used to identify the causes of the adult deaths. The collected data were entered to the database by data clerks. We used Microsoft Excel and STATA version 16 software for data cleaning and analysis. Chi-squared test was used to see the significances of the trend analyses. RESULT: From the 943 adult deaths from 2009 to 2017 in the Health and Demographic Surveillance Site in southern Ethiopia, more than half of them were females. The specific leading cause of death in the adults were tuberculosis (16.8%), malaria (9.7%), and intestinal infectious diseases (9.6%). Communicable diseases (49.2%, 95% C.I 45.7, 52.7) accounted for about half of the deaths followed by non-communicable diseases (35%, 95% C.I 31.7, 38.4) where both categories showed an increasing trend. CONCLUSION: Although pieces of evidences are showing the shift from communicable diseases to non-communicable diseases as the major causes of adult death in developing countries, this study showed that communicable diseases are still the major causes of adult deaths. Efforts and emphasis should be given to control infectious diseases such as tuberculosis and malaria.

Implementation science to design, test and scale up effective Kangaroo Mother Care in Oromia region, Ethiopia.

AIM: To develop a locally tested and optimised Kangaroo Mother Care (KMC) scale-up model to achieve high population-based effective coverage of KMC in Oromia region. METHOD: We conducted an implementation research study to design and test KMC scale-up models from March 2017 to March 2019 in five hospitals and 39 health centres covering a population of 1.1 million in Oromia region, Ethiopia. We evaluated the models by measuring effective KMC coverage (at least 8 hours of skin-to-skin care plus exclusive breastfeeding) for newborns weighing <2000 g in the 24 hours before discharge from the KMC facility and on the 7th-day post-discharge. RESULTS: After three cycles of iterative model implementation, we developed a KMC scale-up model that resulted in increased population-based effective KMC coverage. We enhanced the existing health system by strengthening the health system, reinforcing the linkages between the health system and communities and improving community engagement. Our final model achieved effective KMC coverage of 54%: 95% CI [49, 60] in the 24 hours before discharge from the facility and 38%: 95% CI [32, 43] on the 7th-day post-discharge. CONCLUSION: Through iterative testing and adaptations, a model to scale up KMC that achieves 54% population-based effective coverage of KMC can be developed.

Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study.

BACKGROUND: Human immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern Ethiopia. METHODS: This retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection. RESULT: One hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART). CONCLUSION: Though the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.

Trend of declining bed net utilization among pregnant women in Ethiopia: new data from the Arba Minch Health and Demographic Surveillance System, 2010-2016.

BACKGROUND: Bed net utilization is one of the important methods of malaria prevention. Malaria during pregnancy is one of the fatal diseases which mostly leads to the death of the mother and the fetus. Some of the complications of malaria during pregnancy are: intrauterine growth restrictions, intrauterine fetal death, and stillbirth. The main challenge of malaria treatment is that most of the anti-malarial drugs are not safe to use during pregnancy. The use of bed net is the most effective method of prevention of malaria during pregnancy. There is a paucity of information on bed net utilization among pregnant women in the study setting. Hence, this study aims to assess the trends of bed net utilization among pregnant women in Arba Minch Health and Demography Surveillance Site (HDSS), Southern Ethiopia. METHODS: The study was conducted in the Arba Minch HDSS. The observation started in 2010 till 2016, using a repeated cross-sectional study design. The data was collected using interviewer administered questionnaire biannually with a total of 14 rounds of data collection from 2010 to 2016. A total of 2657 pregnant women were included in the study. Descriptive statistics such as frequency and proportion were used to present the findings of each variable. RESULTS: Out of 2657 mothers included in the study, more than half, 1521 (63.6%), of the study participants were in the age group between 20 and 29 years. About one-third of the study population 793 (29.8) were having no schooling. The trend of bed net utilization decreased from 83.6% in 2010 to 36.5% in 2016. CONCLUSION: The trends of bed net utilization decreased from 2010 to 2016 in Arba Minch HDSS. Utilization of bed net by pregnant women in the area need to be increased as it is malaria endemic. The government should strengthen the existing bed net distribution strategy. Further research is needed to investigate the cause of decreasing bed net utilization.

The Burden of Malnutrition among Adults Residing in Arba Minch Health and Demographic Surveillance Site (HDSS): A WHO STEPS Survey.

BACKGROUND: Malnutrition is one of the main underlying risk factors for the deaths due to different diseases. The aim of this study was to assess the prevalence and factors associated with underweight and overweight among adults residing in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia. METHODS: A community-based cross-sectional survey was conducted from April to June 2017. The data collection procedures and 3,368 calculated sample size were based on the World Health Organization (WHO) STEPwise approach to Surveillance guideline. Using the surveillance data of Arba Minch HDSS, simple random sampling technique was implemented to identify individuals for the study. To assess the presence of association, the multinomial logistic regression model was used. RESULTS: The mean (SD) body mass index of the participants was 21.5 4.90 kg/m2. From 3,346 participants, 23.3% of the study participants were affected by malnutrition (10.8% and 12.5% were overweight and underweight, respectively). The prevalence of underweight was increased significantly among individuals aged 45-54 years and 55-64 years (adjusted odds ratio (AOR) 1.70 and 1.93, respectively) compared with those who were 25-34 years old. Belonging to households with higher wealth index quintile (2nd quintile AOR is 0.58 and 4th quintile AOR is 0.66) has decreased the chance of adult individual to be underweight compared with the poorest households. On the other hand, the prevalence of overweight was significantly higher among females (AOR 1.60), urban residents (AOR 1.72), those with formal education (primary AOR 1.89 and secondary and above AOR 1.94), and higher wealth index (5th quintile AOR 1.87). CONCLUSION: One in five adult individuals was malnourished in the study area. The double burden of malnutrition at the population level is becoming a challenge for this community, as both underweight and overweight are becoming prevalent. Sex, age, residency, educational status, current tobacco use, occupation, and wealth index were identified as important determinates of under- and overweight.

Determinants of Implant Utilization among Married Women of Childbearing Age in Chencha Town, Southern Ethiopia, 2017: A Case-Control Study.

Globally, 53% of women in reproductive age group use modern methods of contraception, with less than one percent of which using implants. In Ethiopia and other parts of sub-Saharan Africa, short-term contraceptive methods have been more utilized than long-acting methods like implants. Despite their effectiveness, implants have been underutilized due to various reasons. There is a dearth of stronger evidences on those factors in the country in general and the study area in particular. Therefore, this study aimed to identify determinants of implant utilization among married women of reproductive age at Chencha town, Gamo Gofa Zone, Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. A community-based case-control study design was conducted among 324 women of reproductive age, 90 cases (users of implants) and 234 controls (users of short-acting contraceptives) from July to August 2017. Data were collected using a pretested, structured questionnaire through face-to-face interview. The data were entered and coded using Epi info 3.5.1 and then exported to Statistical Package for Social Sciences (SPSS) version 20 for cleaning and analysis. Descriptive analysis was done to quantify proportions, means, and standard deviations of variables. Bivariate and multivariable logistic regressions were done to identify the determinants of implant utilization. A total of 324 married women of reproductive age group were interviewed with response rate of 98%. In this study, the major determinants for implant utilization were desire to have 3-4 children {AOR = 0.104, 95% CI (0.03, 0.4)}, husband disproval {AOR = 0.11, 95% CI (0.038, 0.314)}, joint decision {AOR = 3.11, 95% CI (1.02, 9.48)}, and decision by other persons {AOR = 0.065, 95% CI (0.012, 0.352)}. This study found out that desire to have more children, husband disapproval, joint decision making, and decision by other persons were determinants of implant utilization among the target women. Implant utilization would improve through strengthening existing interventions targeting women with high fertility desire, transformation of gender norms in household decisions, and counseling for informed decisions.

Undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in the Arba Minch area, southern Ethiopia.

Background: Undernutrition constitutes an important threat to the success of HIV programs in sub-Saharan Africa, and failure to effectively address it may jeopardize the benefits gained so far in the fight against HIV. The aim of the study was to assess undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in Arba Minch area, south Ethiopia. Methods: A facility-based cross-sectional study was conducted in 2017. There were 351 adult individual study participants who were enrolled in ART clinics in Arba Minch area public health facilities. Variables with P-value less than 0.25 on binary logistic regression analysis were entered into a multivariate logistic regression model to outline the independent predictors of undernutrition. CI of 95% was used to assess precision of the study. Results: Out of all the participants, 18.23% (95% CI: 14.52-22.65) were undernourished. The prevalence of undernutrition was significantly lower among those consuming food from five or more food groups per day (AOR: 0.33; 95% CI: 0.16-0.71) and undergoing ART for more than a year (AOR: 0.24; 95% CI: 0.08-0.73). On the contrary, the prevalence was significantly higher among those who were currently smoking tobacco (AOR: 6.67; 95% CI: 1.45-30.76). In addition, those with WHO clinical stage 3 had a significantly higher prevalence of undernutrition compared to those with WHO clinical stage 1 (AOR: 311; 95% CI: 1.47-6.60). Conclusion: The prevalence of undernutrition was high among adults with HIV/AIDS enrolled in ART clinics in the study area. The prevalence of undernutrition was lower among those who consumed diverse food groups and had been receiving ART for longer (more than a year). On the contrary, the prevalence of undernutrition was higher among those who consumed tobacco and with higher WHO clinical stage. Therefore, efforts should be made to enhance the dietary diversity of these individuals.

Predictors of Neonatal mortality among Neonates who admitted in Neonatal intensive Care Unit at Arba Minch General Hospital

Introduction: The neonatal period refers to the first 28 days of life. Newborns are particularly vulnerable to death. The predictors associated with neonatal mortality need to be addressed, as identifying the predictors will contribute to reducing the rates of neonatal morbidity and mortality. Method: A facility-based retrospective cohort study was conducted of 332 records of neonates who were admitted to the neonatal intensive care unit at Arba Minch General Hospital. Data were collected from randomly selected neonate records using computer-generated random numbers. Data were entered into Epi-info version 3.5.1 and exported to SPSS v.23 for analysis. Crude hazard ratios, adjusted hazard ratios and 95% confidence intervals were used to assess the strength of association and statistical significance. The incidence density rate of death with respect to 'person time at risk' was calculated. Variables which had a p-value of ≤ 0.25 in bivariate analysis were considered as candidates for multivariate regression analysis; variables that had a p-value of ≤0.05 in the multivariate analysis were considered as independent predictors of neonatal mortality in the final Cox regression analysis. Result: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days. The neonatal mortality predictors were 5th-minute APGAR score ≤5 (AHR: 1.9; 95%CI: 1.02,3.54); 2nd to 4th birth order (AHR:13; 95%CI: 5.1,33.4); 5th birth order (AHR:24; 95%CI: 10.5,55.2); history of two to four live births(AHR: 0.16; 95%CI: 1.07,3.63); history of ≥5 live births (AHR: 0.18; 95%CI: 0.06,0.51); and not initiating exclusive breastfeeding within the first hour of delivery (AHR: 1.8: 95%CI: 1.03,3.18). Conclusion: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days, and maternal age, APGAR score, birth order, parity, and exclusive breastfeeding initiation were independent predictors of neonatal mortality

Determinants of Anemia among Pregnant Women Attending Antenatal Clinic in Public Health Facilities at Durame Town: Unmatched Case Control Study.

BACKGROUND: Anemia among pregnant women is one of the most common public health problems in developing country. World health organization (WHO) estimate shows nearly half of pregnant women were affected by anemia. High burden of anemia is observed in Africa particularly in Ethiopia. However, the factors that contribute to the occurrence of anemia were not exhaustively studied. Therefore, the aim of this study was to identify determinant factors of anemia among pregnant women in Durame Town, southern Ethiopia. METHOD: An institutional based unmatched case control study was conducted among 111 cases and 222 controls in Durame Town from 16th February to 8th May 2017 using interviewer administered questionnaires. Controls were pregnant women whose hemoglobin level was 11 g/dl and above at their first antenatal care clinics and cases were pregnant women whose hemoglobin level was less than 11 g/dl. Bivariate and multivariate logistic regression model was used to see the determinants of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value were used to identify the significant association. RESULT: A total of 333 women (111 cases and 222 controls) participated in the study. The major determinant factors were parasitic infection (AOR: 3.67, 95% CI: 1.72-7.86), not taking additional diet during pregnancy (AOR: 2.49, 95% CI: 1.22-5.08), consuming tea/coffee immediately after food (AOR: 3.58, 95% CI: 1.72-7.42), not eating meat (AOR: 2.07, 95% CI: 1.03-4.15), previous heavy menstrual blood flow (AOR: 2.62, 95% CI: 1.18-5.84), and being housewife (AOR: 2.38, 95% CI: 1.02-5.57). CONCLUSION: Parasitic infection, additional diet during pregnancy, consuming tea/coffee immediately after food, meat consumption, previous heavy menstrual blood flow, and occupational status of women were significant factors associated with anemia among pregnant women. Therefore, anemia prevention strategy should include promotion of counseling on additional diet during pregnancy, preventing parasitic infection, and increasing employment opportunities for women.

Injury-related gaining momentum as external causes of deaths in Ethiopian health and demographic surveillance sites: evidence from verbal autopsy study.

BACKGROUND: In Ethiopia, though all kinds of mortality due to external causes are an important component of overall mortality often not counted or documented on an individual basis. OBJECTIVE: The aim of this study was to describe the patterns of mortality from external causes using verbal autopsy (VA) method at the Ethiopian HDSS Network sites. METHODS: All deaths at Ethiopian HDSS sites were routinely registered and followed up with VA interviews. The VA forms comprised deaths up to 28 days, between four weeks and 14 years and 15 years and above. The cause of a death was ascertained based on an interview with next of families or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history and circumstances preceding death after 45 days mourning period. Two physician assigned probable causes of death as underlying, immediate and contributing factors independently using information in VA forms based on the WHO ICD-10 and VA code system. Disagreed cases sent to third physician for independent review and diagnosis. The final cause of death considered when two of the three physicians assigned underlying cause of death; otherwise, labeled as undetermined. RESULTS: In the period from 2009 to 2013, a total of 9719 deaths were registered. Of the total deaths, 623 (6.4%) were from external causes. Of these, accidental drowning and submersion, 136 (21.8%), accidental fall, 113 (18.1%) and transport-related accidents, 112 (18.0%) were the topmost three leading external causes of deaths. About 436 (70.0%) of deaths were from the age group above 15 years old. Drowning and submersion and transport-related accidents were high in age group between 5 and 14 years old. CONCLUSION: In this study, external causes of death are significant public health problems and require attention as one of prior health agenda.

Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study.

Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell's concordance, and fitness was checked by Cox-Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101-7.329), altered pulse rate (AHR =3.926, 95% CI =1.579-9.763), altered temperature (AHR =7.173, 95% CI =3.05-16.867), shock (AHR =3.805, 95% CI =1.829-7.919), anemia (AHR =2.618, 95% CI =1.148-5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18-8.575), hypoglycemia (AHR =2.74, 95% CI =1.279-5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638-13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.

Validation of Health Extension Workers Job Motivation Scale in Gamo-Gofa Zone, Southern Ethiopia: A Cross-Sectional Study.

Introduction. Well-trained and highly motivated community health workers are critical for delivery of community-based health care services. Understanding what motivates especially community health care providers for better community health requires the use of psychometrically reliable and valid scale. This study was conducted to validate job motivation scale in Gamo Gofa Zone, Southern Ethiopia. Methods. A cross-sectional study was conducted in 150 health care posts in Gamo Gofa Zone, from February 01, 2013, to March 01, 2013. A total of 301 participants responded to questionnaires asking about sociodemographic characteristics and job motivation. Exploratory factor analysis with principal component extraction and varimax with Kaiser Normalization rotation were employed to develop scales for job motivation. Eigenvalues greater than 1 were used as criterion of extraction. Items with item factor loadings less than 0.4 and double loaded items were dropped. Alpha and exploratory factor analyses were examined to test reliability and validity of the scale. Results. During exploratory factor analysis eight factors emerged from the three dimensions of job motivation scale, namely, educational career, workload, financial incentive, supervisor encouragement, community recognition, access to infrastructure, living condition, and better achievement in work. The factor loadings of the items in each dimension ranged from 0.58 to 0.83. Crobach's alpha of the scales ranged from 0.79 to 0.90. To check validities of the scales developed in this study, the previous studies conducted to develop job motivation scale were used. Conclusion. Although the present scale has the potential to measure the job motivation of health extension workers and it is low in cost and easy to administer and analyze, it should be field-tested at different settings.