Self-care practice and associated factors among patients with diabetes on follow-up at Yirgalem General Hospital, Sidama, Ethiopia: a cross-sectional study.

BACKGROUND: Self-care practice is an integral and efficient part of comprehensive diabetes management, which could be influenced by various socio-demographic, clinical, and lifestyle factors. OBJECTIVE: The study aimed to assess the level of diabetes self-care practice and its associated factors among patients with diabetes on follow-up at Yirgalem General Hospital, Yirgalem, Sidama, Ethiopia. METHODOLOGY: An Institution-based cross-sectional study was conducted from February 15 to May 10, 2022, involving 298 patients with diabetes on follow-up at Yirgalem General Hospital. A pre-tested interviewer-administered questionnaire was utilized to collect data from patients. A descriptive analysis was conducted to determine the level of good self-care practice. Bivariate and multivariable binary logistics regression were performed to determine factors associated with good diabetic self-care practice. Associations with a p-value < 0.05 were considered statistically significant. RESULT: The overall good diabetic self-care practice among patients was 59.4%. Regarding the specific domains of care, 15 (5%) participants had good self-glucose monitoring care, 228 (76.5%) had good exercise self-care, 268 (89.9%) had good dietary self-care, 228 (76.5%) had good foot self-care, and 260 (87.2%) had good diabetic medication adherence. Single marital status (AOR = 5.7, 95% CI: (1.418, 22.915), urban residence (AOR = 2.992, 95% CI: (1.251, 7.153)), and having a glucometer (AOR = 2.273, 95% CI: (1.083, 4.772)) were factors that were significantly associated with good diabetic self-care practice. CONCLUSION: Good diabetic self-care practices among participants was low. Marital status, place of residence, and having a glucometer were statistically significant predictors of good diabetic self-care practices. Targeted intervention addressing those patients from rural areas to increase awareness and practice of self-care, as well as the promotion of having a glucometer at home for self-glucose monitoring is recommended.

Growth monitoring and promotion service utilization and its associated factors among mothers of children under two years in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Growth monitoring and promotion (GMP) is a nutritional intervention designed to identify and address growth faltering before a child's nutritional status deteriorates into severe malnutrition. Despite GMP being recognized as a priority in Ethiopia's national nutrition program, there is no national aggregated figure to show the extent of GMP service utilization. Therefore, this systematic review and meta-analysis aimed to assess GMP service utilization and associated factors in Ethiopia. METHODS: A systematic literature search was conducted using PubMed/MEDLINE, CINAHL, Hinari, EMBASE, Scopus, and grey literature sources like Google Scholar, WorldCat, and Institutional repository. The Joanna Briggs Institution (JBI) quality assessment tool was used to appraise the quality of the articles, and articles scoring > 50% were included in the analysis. The pooled prevalence and odds ratio of associated factors with 95%CI was computed using STATA version 16. A random-effect model was employed to estimate the effect size, and I-squared statistics and Egger's test were used to assess heterogeneity and identify potential publication bias, respectively. Subgroup analysis was conducted with publication year, sample size, and region to identify the source of heterogeneity. RESULTS: Nine studies with 4,768 study participants were included in this meta-analysis. The overall pooled utilization of GMP service among children under two years of age in Ethiopia was 23.21% (95% CI: 16.02, 30.41, I2 = 97.27% & P = 0.0001). Mothers who received counselling on GMP service (OR = 3.16 (95%CI: 2.49-4.00), parents who use family health card (FHC) (OR = 3.29 (95%CI: 1.49-7.28), and mother who use postnatal care (OR = 3.93 (95%CI: 2.40-6.42), and Anti natal care (OR = 3.15 (95%CI: 1.29-7.69) were the factors associated with GMP service utilization among children under two years of age. CONCLUSIONS: The utilization of GMP services among children under the age of two in Ethiopia remains inadequate. Therefore, it is crucial to provide health education and counselling focusing on GMP to the mothers/caregivers of the child and encourage utilization of FHC. In addition, integrating GMP with other maternal health services should be promoted.

Time to tuberculosis development and its predictors among HIV-positive patients: A retrospective cohort study.

OBJECTIVES: To assess the incidence and predictors of time to Tuberculosis (TB) development among Human Immunodeficiency Virus (HIV) positive patients attending follow-up care in health facilities of Hawassa, Ethiopia. METHODS: We conducted a retrospective cohort study from April 1-30, 2023. A total of 422 participants were selected using a simple random sampling method. Data was collected from the medical records of patients enrolled between January 1, 2018 -December 31, 2022, using the Kobo toolbox. We used Statistical Package for Social Studies (SPSS) version 26.0 for data analysis. To estimate the duration of TB-free survival, we applied the Kaplan-Meier survival function and fitted Cox proportional hazard models to identify the predictors of time to TB development. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated and statistical significance was declared at a P-value of 0.05. RESULTS: The overall incidence rate of TB among HIV-positive patients was 6.26 (95% CI: 4.79-8.17) per 100 person-years (PYs). Patients who did not complete TB Preventive Therapy (TPT) were more likely to have TB than those who did (AHR = 6.2, 95% CI: 2.34-16.34). In comparison to those who began antiretroviral therapy (ART) within a week, those who began after a week of linkage had a lower risk of TB development (AHR = 0.44, 95% CI: 0.21-0.89). Patients who received ART for six to twelve months (AHR = 0.18, 95% CI: 0.05-0.61) and for twelve months or longer (AHR = 0.004, 95% CI: 0.001-0.02) exhibited a decreased risk of TB development in comparison to those who had ART for less than six months. CONCLUSION: The incidence of TB among HIV-positive patients is still high. To alleviate this burden, special attention should be given to regimen optimization and provision of adherence support for better completion of TPT, sufficient patient preparation, thorough clinical evaluation for major (Opportunistic Infections) OIs prior to starting ART, and ensuring retention on ART.

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study.

BACKGROUND: The therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6-59 months admitted to the TFU in Ethiopia. METHODS: Health Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables. RESULTS: The median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62-7.38) compared to F-100 (10 days; 95% CI: 8.94-11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42-0.69), dehydrated (AHR = 1.34, 95% CI: 1.07-1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03-1.61), and anemic (AHR = 2.57, 95% CI: 1.90-3.48) during admission were associated with time to recovery. CONCLUSIONS: Children who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

Third delay and associated factors among women who gave birth at public health facilities of Gurage zone, southern Ethiopia.

BACKGROUND: The third delay is a delay in accessing emergency obstetric care timely and appropriately once a woman reaches a health facility. The third delay plays a crucial role as an indicator to assess the quality of obstetrics services and is often the leading contributing factor to maternal mortality in developing countries. Although considerable research has been conducted on pre-facility delays in healthcare access, there is a lack of focus on delays experienced upon arrival at health facilities, particularly in Ethiopia and the specific study areas of Gurage zone. This study aimed to assess the magnitude of the third delay and associated factors among women who gave birth at Public Health Facilities of Gurage Zone, Southern Ethiopia. METHOD: A facility-based cross-sectional study was conducted with 558 women who gave birth at public health facilities of Gurage Zone from January 01/2020 to March 30/2020. Multi-stage stratified sampling technique was used to select the nine facilities. The data was collected using a structured interviewer administer questionnaire and an observational checklist. Women who waited more than an hour to receive delivery services after arriving at the health facility were classified as experiencing the third delay. The data were entered and analyzed using Epi Data version 3.1 and SPSS version 20.0 software, respectively. Binary logistic regression was employed to identify the determinant factors for the third delay. Variables having a P-value < 0.25 in the binary analysis were a candidate for multivariable analysis. Variables with P < 0.05 were considered statistically significant. RESULT: The magnitude of the third delay was 193 [(34.8%; 95% CI; (30.8%, 38.8%)]. Complication during labor [AOR = 2.0; 95% CI, (1.4, 3.0)], Presence of functional generator in a health facility [AOR = 2.8; 95% CI, (1.3, 6.3)], level of health institution [AOR = 2.8; 95% CI, (1.04, 7.8)] and BEMONC training in the last two years [AOR = 1.6; 95% CI, (2.0, 6.5)] were significantly associated with third delay. CONCLUSION: The magnitude of third delay was high compared to some low income countries, which shows most of mothers were not getting the service timely after they arrived at the health facility. Equipping health facilities with trained manpower and with necessary materials and infrastructure will contribute to hastening the provision of obstetric care.

Predictors of homebirth amidst COVID-19 pandemic among women attending health facilities in Wondo Genet, Sidama Region, Ethiopia: A case control study.

BACKGROUND: In developing countries, home delivery increases the risk of maternal and perinatal mortality. Despite this, home deliveries account for a considerable share of deliveries in developing nations such as Ethiopia. Evidence on factors that affect homebirth is required for the measures needed to overcome these conditions. OBJECTIVE: To identify predictors of homebirth among women attending health facilities in Wondo Genet, Sidama Region. METHODS: Unmatched case-control study was conducted from May to June 2021 among 308 mothers (102 cases and 206 controls) who recently delivered and visited either postnatal care or sought immunization service at public health facilities of Wondo Genet. A structured interviewer-administered questionnaire was used to collect data. Epi-Data version 3.1 was used for data entry, and the Statistical Package for the Social Sciences (SPSS) version 20 was used for data analysis. Bivariate and multivariate logistic regression analyses were used to identify the determinants of homebirth. The association between the outcome variable and independent variables was declared statistically significant at a P-value < 0.05 with a 95% Confidence Interval (CI) in a multivariable model. RESULTS: Rural residence [AOR: 3.41; 95%CI: 1.58-7.39], lifetime physical IPV [AOR: 2.35; 95%CI: 1.06-5.17], grand-multiparity [AOR: 5.36; 95%CI: 1.68-17.08], non-use of contraception before recent pregnancy [AOR: 5.82; 95%CI: 2.49-13.60], >30 min to reach health facility [AOR: 2.14; 95%CI: 1.02-4.51], and lack of facemask [AOR: 2.69; 95%CI: 1.25-5.77] were statistically significant predictors of homebirth. CONCLUSION AND RECOMMENDATION: The access gap to maternity services should be narrowed between rural and urban women. Healthcare programs concerning women's empowerment could help reduce persistent intimate partner violence. Family planning needs to be promoted, and multiparous women should be counseled on the adverse obstetric consequences of homebirth. The devastating effect of the coronavirus disease 2019 pandemic on maternity services should be prevented.

Suicidality and homelessness: prevalence and associated factors of suicidal behaviour among homeless young adults in Southern Ethiopia.

BACKGROUND: Research indicates that homelessness is associated with an increased risk of suicide. While street homelessness is a global problem, it is a disproportionately serious concern in low- and middle-income countries such as Ethiopia. Despite their high risk of suicidal thoughts and attempts, there has been limited research on this subject among homeless young people in Ethiopia. Therefore, we assessed the prevalence and factors contributing to suicidal behaviour among homeless young people in the southern region of this country. METHODS: We conducted a community-based cross-sectional study from 15 June to 15 August 2020 involving 798 homeless young adults in four southern Ethiopian towns and cities. The Suicide Behaviour Questionnaire-Revised (SBQ-R) was used to assess suicidal behaviour. Data were coded and entered into Epi-Data version 7 and analysed using SPSS version 20. We conducted a multivariable logistic regression analysis to identify factors associated with suicidal behaviour. Variables with a p-value of < 0.05 were considered statistically significant. An adjusted odds ratio with a 95% confidence interval was determined to indicate the association's strength. RESULTS: The overall prevalence of suicidal behaviour among young homeless individuals was 38.2% (95% CI: 34.8%, 41.5%). The lifetime prevalence of suicidal ideation, planning and attempt was 10.7% (95% CI: 8.6-12.9%), 5.1% (95% CI: 3.6-6.6%) and 3% (95% CI: 1.9-4.3%), respectively. A longer duration of homelessness (1-2 years) (AOR = 2.244, 95% CI: 1.447-3.481), stressful life events (AOR = 1.655, 95% CI: 1.132-2.418) and the stigma associated with homelessness (AOR = 1.629, 95% CI: 1.149-1.505) were significantly associated with suicidal behaviour. CONCLUSION: The results of our study indicate that suicide is a serious public health problem among homeless young people in southern Ethiopia. We have found associations between suicidal behaviour and stressful events, homelessness lasting for one to two years and stigma. Our study suggests that policymakers and programme planners need to develop a strategy for preventing, detecting and managing suicidal behaviour among street-dwelling homeless young adults, a vulnerable and understudied population. A community-based suicide prevention campaign is also essential for street-dwelling homeless young people in Ethiopia.

Sexual and reproductive health service utilization of young girls in rural Ethiopia: What are the roles of health extension workers? Community-based cross-sectional study.

OBJECTIVE: Little is known about the extent to which Health Extension Programme (HEP) has played its role to increase service uptake among young girls. This study aims to estimate the status of young girls' sexual and reproductive health (SRH) services utilisation in rural Ethiopia and to examine the role of health extension workers (HEWs) in this regard. DESIGN: A cross-sectional study. SETTING: A community-based study among all nine regions of Ethiopia. PARTICIPANTS: Nine hundred and two young girls aged 15-24 years were included in this study. METHOD: We used data from the national HEP assessment, collected from March to May 2019. Multilevel binary logistic regression was used to investigate the association between exposure to HEP and SRH services utilisation of young girls and we reported an adjusted OR with a corresponding 95% CI as measure of the degree of associations. RESULT: Only 19.18% (95% CI 16.74% to 21.89%) of young girls used SRH services with significant regional variability (intraclass correlation coefficien=17.16%; 95% CI 6.30% to 39.99%). Exposure to HEP (adjusted OR, aOR 3.13, 95% CI 2.03 to 4.85), knowing about the availability of HEP services (aOR 3.06, 95% CI 1.75 to 5.33) and having good trust in HEWs (aOR 1.82, 95% CI 1.07 to 3.10) and other sociodemographic factors were significantly associated with increased SRH services utilisation. OUTCOME: SRH service utilisation. CONCLUSION: Although the overall SRH service utilization of young girls in rural Ethiopia was very low, HEWs have a great contribution to improving service utilization of young girls through strong health education provided during home visits, school visits and at health posts. More investment along this line has the potential to improve service uptake among young girls. Encouraging HEWs to build trust among this segment of the population and creating awareness of SRH-related services is crucial to improv service uptake.

Knowledge, practice, and impact of COVID-19 on mental health among patients with chronic health conditions at selected hospitals of Sidama regional state, Ethiopia.

BACKGROUND: COVID-19 causes worse outcomes and a higher mortality rate in adults with chronic medical conditions. In addition, the pandemic is influencing mental health and causing psychological distress in people with chronic medical illnesses. OBJECTIVE: To assess the knowledge, practice, and impact of COVID-19 on mental health among chronic disease patients at selected hospitals in Sidama regional state. METHOD: A facility-based cross-sectional study was conducted. A total of 422 study subjects were enrolled in the study using a two-stage sampling technique. Data were coded and entered using Epi Data version 3.1 and exported to SPSS-20 for analysis. Descriptive analysis was used to present the data using tables and figures. Bivariate and multivariate logistic analyses were used to identify factors associated with the initiation of preventive behavior of COVID-19. Variables with a P-value of less than 0.25 in bivariate analysis were considered as candidate variables for multivariable analysis. The statistical significance was declared at a P-value less than 0.05. RESULT: More than half 237 (56.2%, 95% CI: 50.7-60.9) of the study participants had good knowledge of COVID-19. The practice of preventive measures toward COVID-19 was found to be low (42.4%, 95% CI: 37.9-47.2). Being widowed (AOR = 0.31, 95% CI (0.10, 0.92)), secondary and above educational status (AOR = 2.21, 95% CI (1.01, 4.84)), urban residence (AOR = 2.33, 95% CI (1.30, 4.19)) and good knowledge (AOR = 4.87, 95% CI (2.96, 8.00)) were significantly associated with good practice. In addition, more than one-third of the study participants 37% (95% CI 32.7, 41.5) were experiencing anxiety. While more than a quarter of respondents 26.8% (95% CI 22.5, 31.5) had depression. CONCLUSION AND RECOMMENDATION: Despite more than half of the participants had good knowledge, the prevention practice was low. Hence, multiple information dissemination strategies should be implemented continuously among chronic disease patients. In addition, the magnitude of concurrent depression and anxiety in the current study was high.