Assessment of Smear-Positive Pulmonary Tuberculosis and Associated Factors among Patients Visiting Health Facilities of Gedeo Zone, Southern Ethiopia: A Cross-Sectional Study.

Introduction: Tuberculosis (TB) was one of the top causes of ill health and the leading cause of deaths worldwide until the coronavirus (COVID-19) pandemic. Hence, this study is aimed at assessing the prevalence of sputum smear-positive TB and associated factors among TB-suspected patients attending in Gedeo Zone health facilities, Southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 220 TB-suspected patients in Gedeo Zone health facilities from July 01 to Sep 30, 2021. Patients were grouped as smear positive if one sputum out of two was positive or two sputum smears became positive. Various descriptive statistics were computed using the SPSS-25, and factors to smear positivity were identified by multivariable logistic regression analysis. Odds ratio at 95% CI and p values < 0.05 were considered as indicators of statistical association. Results: The overall prevalence of smear-positive TB in Gedeo Zone health facilities was 18.2%, which is significantly high, and the MTB detection rate of GeneXpert was 29.5%. Contact with a TB patient, cigarette smoking, and previously treatment for TB were factors significantly associated with smear-positive TB. Conclusion: The prevalence rate of smear-positive PTB in the study area was 18.2% and 29.5% by direct sputum AFB and sputum GeneXpert, respectively. As a result, we recommend intervention on the identified associated risk factors and further studies to ascertain risk factors and their magnitude at the community level.

Antenatal Care Dropout and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis.

Background: The prevalence and determinants of antenatal care (ANC) dropout in Ethiopia were studied. However, the results were inconsistent and showed considerable variation. Hence, this meta-analysis aimed at estimating the overall prevalence of ANC dropout and its predictors in Ethiopia. Methods: A comprehensive search of published studies was done using different international databases such as such as PubMed, DOJA, Embase, Cochrane Library, Google Scholar, and the institutional repository of Ethiopian universities were used to search for relevant studies. Data were extracted using Microsoft Excel spreadsheet, and exported to STATA v17 for analysis. A random effect model was used to estimate the overall national prevalence of ANC dropout. Fixed effects model were used to compute the pooled adjusted odd ratios (AOR) with the corresponding 95% confidence intervals (CIs). I 2 test was used to assess heterogeneity of the included studies. Egger's tests was used to check for the presence of publication bias. Results: A total of 7 studies were included in this systematic review and meta-analysis with 11,839 study participants. The overall pooled prevalence of ANC in Ethiopia was found to be 41.37% (95% CI =35.04, 47.70). Distance from the health care facility (AOR = 2.93, 95% CI = 2.75, 3.11), pregnancy complication signs (AOR = 2.97, 95% CI = 2.77, 3.16), place of residence (AOR = 1.79, 95% CI = 1.31, 2.26), educational level (AOR = 1.79, 95%CI = 1.37, 2.21), and age group (30-49) (AOR = 0.61, 95% CI = 0.45, 0.78) were significantly associated with ANC dropout. Conclusion: Based on this review and meta-analysis, 41% of Ethiopian women dropped out of ANC visits before the minimum recommended visit (4 times). Hence, to reduce the number of ANC dropouts, it is important to counsel and educate women during their first prenatal care. Issues of urban-rural disparities and noted hotspot areas for ANC dropout should be given further attention.

Effects of nutrition education and counseling intervention on maternal weight and obstetric outcomes among pregnant women of Gedeo Zone, Southern, Ethiopia: A cluster randomized control trial.

Background: Due to the scarcity of intervention trials, especially in Ethiopia, the effect of nutrition education and counseling intervention on pregnancy outcomes is not well studied. Aim: To assess the effect of nutrition education and counseling on the outcomes of pregnancy among pregnant mothers in public health care institutions of Gedeo Zone, Southern, Ethiopia. Methods: A cluster randomized control trial study design was undertaken. Simple random sampling followed by cluster sampling was used to reach eligible study participants. A total sample of 235 (115 intervention vs.120 control group) pregnant women who followed anti-natal care service in public health facilities of Gedeo Zone was included in the study. Independent t-test was used to analyze the group difference for continuous variable and chi-square test for categorical variables. The post-intervention values between the two groups were compared using analysis of covariance by adjusting to baseline variable. Results: After nutrition education, pregnant women in the control group had less weight gain than in the intervention. The proportion of LBW neonate was 17.8% in the intervention group and 38.2% in the control group (P < 0.001). Multivariable logistic regression analysis showed that the risk of LBW in the control group was 2.43 more likely than in the intervention group (AOR = 2.43; 95% CI: (1.2, 4.92)). Conclusion: Nutrition education delivered to pregnant women during pregnancy could reduce maternal malnutrition and low birth weight. Recommendation: The intervention is easy to implement in the health facilities of Gedeo zone and would be implemented without delay to achieve the sustainable development goals.

Time from symptom onset to severe COVID-19 and risk factors among patients in Southern Ethiopia: a survival analysis.

OBJECTIVE: This study aimed to assess the time to severe coronavirus disease 2019 (COVID-19) and risk factors among confirmed COVID-19 cases in Southern Ethiopia. METHOD: This two-center retrospective cohort study involved patients with confirmed COVID-19 from 1 October 2020 to 30 September 2021. Kaplan-Meier graphs and log-rank tests were used to determine the pattern of COVID-19 severity among categories of variables. Bivariable and multivariable Cox proportional regression models were used to identify the risk factors of severe COVID-19. RESULTS: Four hundred thirteen patients with COVID-19 with a mean age of 41.9 ± 15.3 years were involved in the study. There were 194 severe cases (46.9.1%), including 77 (39.6%) deaths. The median time from symptom onset to severe COVID-19 was 8 days (interquartile range: 7-12 days). The risk factors for severe COVID-19 were age >65 (adjusted hazard ratio [AHR] = 2.65, 95% confidence interval [95%CI]: 1.02, 3.72), cough (AHR = 1.59, 95%CI: 1.39, 2.84), chest pain (AHR = 1.47, 95%CI: 1.34, 2.66), headache (AHR = 2.04, 95%CI: 1.43, 2.88), comorbidity (AHR = 1.3, 95%CI: 1.01, 2.04), asthma (AHR = 1.6. 95%CI: 1.04, 2.24), and symptom onset to admission more than 5 days (AHR = 0.48, 95%CI: 0.34, 0.68). CONCLUSION: Patients with symptoms and comorbidities should be closely monitored.

Under-nutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, southern Ethiopia: A cross-sectional study.

Background: Balanced and adequate nutritious food during pregnancy helps to improve maternal weight and for the healthy growth of the fetus. There has been little progress in reducing pregnant undernutrition in Ethiopia; it has been too slow. Objective: The objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant women in public health care hospitals of Gedeo Zone, Southern Ethiopia. Method: A cross-sectional study design was used in public hospitals of Gedeo Zone, Southern Ethiopia from February 01 to March 01, 2019. Pretested structure questionnaire was used to collect data on the socio-economic and demographic characteristics of the study participants. Epi-data was used to code and enter the data and SPSS-25 was used to analyse and interpret the data. To assess the relationship between the dependent and the independent variables, bi-variable and multivariable logistic regression analysis was done. Results: In this study, the prevalence of undernutrition among pregnant women was 21% (95% CI: 20.8-21.2). After controlling other co-variables, the multivariable logistic regression model revealed that average monthly income, women's educational status, nutrition education and counseling, and parity were found to have a significant association with pregnant women's nutritional status. The odds of under-nutrition among pregnant women whose monthly income is <800 ETB were 2.8 times higher than those whose monthly incomes were >1500 (AOR: 2.89; 95%CI: 1.49-5.6). Conclusion: In this study the magnitude of undernutrition among pregnant women was found to be higher than the previously reported findings. Average household monthly income, family size, mother's educational status, nutrition education and counseling, current health condition of the mother, and parity were factors significantly associated with undernutrition of pregnant mothers. Therefore, Interventions should be initiated in earlier stages of pregnancy to prevent the high level of undernutrition during the second and third trimester in this study area.

Prevalence and Associated Factors of Poststroke Depression among Outpatient Stroke Patients Who Have a Follow-Up at the Outpatient Neurology Clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

Background: Poststroke depression is the most common and burdensome poststroke psychiatric complication. Studies showed discrepancies in reporting frequencies and risk factors for poststroke depression. Updated local data are relevant for efficient strategies of poststroke depression screening and prevention. Objectives: To determine the prevalence and associated factors of poststroke depression among outpatient stroke patients from the outpatient neurology clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Methods: An institution-based cross-sectional study was conducted on 249 stroke patients. Data was collected through structured questionnaire using interviews and a review of medical charts. PHQ-9 depression questionnaire was used to diagnose poststroke depression. Descriptive analysis was used to see the nature of the characteristics of interests. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using an odds ratio with 95% CI and p value < 0.05. Results: Point prevalence for poststroke depression was 27.5 percent. Female gender, unemployment, low social support level, diabetes mellitus, and poststroke period under 2 years were statistically significant and independent predictors for poststroke depression. Conclusions: The point prevalence estimate of poststroke depression was comparable with other studies. Low social support levels increased the odds for poststroke depression by more than eight folds. It appeared that external factors are more important in the pathogenesis of poststroke depression in the African population. Detection and prevention programs should consider disparities of poststroke depression incidence and risk factors.

Reproductive health education: a qualitative study of health seeking behaviour of in-school female adolescents

Introduction: adolescents in developing countries are often vulnerable to sexually transmitted diseases (STDs) and unplanned pregnancies. It is estimated that about 13 million adolescent girls have unplanned births each year in developing countries. This study examined the scope of the School Health Education Programme (SHEP) and health-seeking behaviours of female adolescents in Junior High School (JHS). Methods: this qualitative research used the narrative approach. Group discussions were conducted among 100 female adolescents aged 12-19 years. Interviews were conducted among five community health workers in five health centres that provide reproductive health services. The in-depth interviews and group discussions were documented, transcribed and analyzed using NVivo 11, whilst thematic analysis was used in analyzing data. Results: the mean age of adolescents was 15.5 years, with 74% reporting having knowledge of STDs. It was observed that the SHEP offers various information on health issues such as menstrual hygiene, STDs, personal hygiene, contraceptives, personal development and unsafe abortion practices. Adolescent reproductive health services were also available in the health centres but patronage was low as a result of perceived negative attitude of health workers and trust. Knowledge on issues of reproductive health is insufficient among JHS female adolescents, with many of them relying on the media and peers for reproductive health support. Conclusion: in this study, female adolescents are generally involved in risky sexual behaviour due to their low level of knowledge on reproductive issues and their unwillingness to patronize available reproductive health services because of the health system and cultural barriers.

Case Report: Kanamycin Ototoxicity and MDR-TB Treatment Regimen.

INTRODUCTION: Aminoglycosides are ototoxic drugs because they have the ability to destroy the inner ear structures irreversibly. They are used to treat Gram-negative bacterial infections that are aerobic and as a second-line treatment for tuberculosis. CASE PRESENTATION: A 40-year-old male from Dilla presented with right side chest pain and cough which is productive of whitish sputum of one-year duration, after investigation the diagnosis of multiple-drug resistant tuberculosis (MDR-TB) was made and the patient was started with a short-term MDR-TB treatment regimen (4-6 KM-Mf-Pto-Cfz-Z-HH-E/5Mfx-Cfz-Z-E). Two and half months after the initiation of treatment, he developed decreased bilateral hearing ability and he had also vertigo, but this patient has no hearing impairment before the initiation of the anti-TB treatment. Then the diagnosis of sensor neural hearing loss secondary to drug toxicity (kanamycin) was made. Then the treatment was discontinued for four days as a result of ototoxicity and the patient was referred to Yirgalem Hospital for further workup and management. CONCLUSION: Injectable-containing MDR-TB regimens can cause permanent hearing loss. Hearing loss during treatment for MDR-TB with kanamycin can occur at any time. Systematic monitoring of AEs during and after the end of treatment needs to be strengthened in most TB programs. It is important to monitor for hearing loss and kidney function.

Novel Coronavirus (COVID-19)-Associated Guillain-Barre' Syndrome: Case Report.

Though the novel corona virus (COVID-19) mostly affects the respiratory system, it can also result in several neurological complications. One of these is Guillain-Barré Syndrome (GBS) and which is rare and only reported from some parts of the world during this pandemic. Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy. Patients can present with limb or cranial-nerves weakness, loss of deep tendon reflexes, sensory and dysautonomic symptoms. The main pathophysiology for the clinical presentation is demyelination and/or axonal damage to peripheral nerves or roots. Neurological manifestations are more commonly associated with severe COVID-19 infection. Here, we present a case of Guillain-Barré syndrome associated with COVID-19 in Ethiopia.

Rehabilitation in Africa.

In Africa, rehabilitation services are insufficient and marred with inadequate political commitments and collaborations of stakeholders. Infrastructures and expertise for rehabilitation are scarce and poorly coordinated. Community-based rehabilitation programs are fragmented and fractured and lack working partnership with rehabilitation services in health care systems. Locally responsive policy frameworks, service delivery models, and health governance practices are prerequisites for meeting rehabilitation needs of the ever-increasing number of persons with chronic disabling conditions. Concerted global efforts are required for equitable and accessible coordinated continuum of rehabilitation care at various levels of health services and the community in most Sub-Saharan African countries.

Patient satisfaction with outpatient neurology services: a momentum for improvement.

BACKGROUND: Outcome measures of patient satisfaction are increasingly accepted as an integral component of the overall healthcare quality assessment. AIMS OF STUDY: A survey of the outpatient neurology services in Addis Ababa, Ethiopia was performed to determine the overall patient satisfaction, provide an assessment of current services and form the foundation for improved expansion of neurological care. METHODS: 233 patients were recruited from the Addis Ababa University Teaching Hospital outpatient general neurology clinic by a cross-sectional sample survey design. Data from structured interview and abstraction of medical records were analyzed by SPSS for Windows version 15.0 computer software. Visual analysis of mean satisfaction scores and Spearman's rho correlation coefficients generated priority indices serving to guide expansion of neurology services. RESULTS: 212 patients with mean age of 40.1 and a 1:1M: F ratio completed the survey. The variation of overall patient satisfaction (mean, 70.4; SD, 12.4) was independently predicted by patient clinical outcome expectations and satisfaction on waiting area, overall service of doctor and card room [R(2)=0.305; F (8,195)=10.685, p=0.000]. Mean satisfaction scores for specific dimensions of the outpatient general neurology clinic ranged from 57.2 for waiting time at the clinic to 74.0 for overall service of the guards. Waiting time at the clinic stood first among the top five priority indices. CONCLUSION: This survey demonstrates predictors of overall patient satisfaction with the outpatient neurology services, and delineates priority areas warranting further improvement. It is the first African study on patient satisfaction with neurology services, and provides a guide for neurological or other specialty clinics seeking to improve and expand medical services.

Bilaterally symmetric cervical spondylotic amyotrophy: a novel presentation and review of the literature.

BACKGROUND: Cervical spondylotic amyotrophy (CSA) is considered a syndrome of (1) unilateral upper extremity weakness and atrophy, (2) affecting either the proximal or distal musculature, (3) without sensory impairment or lower extremity dysfunction. AIMS OF STUDY: The authors report a novel case of bilaterally symmetric CSA with blurring of the proximal-distal distinction, discuss the pathophysiology, and review the literature. METHODS: A 45 year old man presented with a several year history of insidiously progressive bilaterally symmetric upper extremity weakness and wasting, profound in the proximal musculature and moderate to severe in the distal muscle groups. RESULTS: Based on the clinical, neuroimaging and electrodiagnostic features, this patient harbors a more severe phenotype of the classical syndrome. CONCLUSION: The authors propose expanding the generally accepted definition of CSA to include this bilaterally symmetric form of disease, thereby minimizing diagnostic error or delay. Additionally, based on this case and a review of the literature, adherence to the proximal-distal distinction should be avoided since it is commonly blurred. Accurate diagnosis is crucial since this presentation mimics the motor neuron disease variant Vulpian-Bernhardt syndrome. The importance of early diagnosis is underscored by reports of significant improvement with timely surgical decompression.