Predictors of loss to follow up among adults on antiretroviral therapy before and after the start of treat-all strategy in public health facilities of Hawassa city, Ethiopia: A Competing risk regression.

BACKGROUND: Treat-all strategies improved patient outcomes, despite higher rates of loss to follow-up compared to the pre-treat era. Patients in Ethiopia experienced a higher rate of LTFU during the treat-all strategy period; however, studies did not identify contributing factors in comparison with previous strategies. This study aimed to assess the incidence and predictors of loss to follow-up before and after the start of the treat-all strategy among adults on anti-retroviral therapy in public health facilities in Hawassa City, Ethiopia. METHODS: An institution-based retrospective follow-up study was conducted among 1190 randomly selected adults on antiretroviral therapy in public health facilities in Hawassa City. Using the Open Data Kit (ODK), data were collected from medical records and exported to Stata version 16 and R 4.2.1 for analysis. A Grays test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow-up. Bivariable and multivariable competing risk regression were fitted to identify predictors of LTFU and variables with a p-value <0.05 were considered significant. RESULTS: The cumulative incidence of lost-to-follow-up was 4.92(3.84,6.3) and 8.67(7.26,10.3) per 100 person-years (PY) in pre-treat all and treat all cohorts, respectively. The cumulative incidence of mortality was 5.86(4.67,7.35) and 3(2.26,4.12) per 100 PY in pre-treat and treat all cohorts, respectively. Fair/poor adherence (aSHR:5.17; (95% CI 1.97, 13.51), underweight (aSHR:2.13; 95% CI: 1.15-3.93) and WHO stage III/IV (aSHR:2.69; 95% CI: 1.27, 5.71) were predictors of loss up in pre-treat all, whereas fair/poor adherence (aSHR = 2.07; 95% CI: 1.18, 3.68), underweight (aSHR:1.71; 95% CI: 1.13, 2.56), and CD4 cell >350 cell/m3 (aSHR: 1.67; 95% CI: 1.05, 2.65) predicts of loss up in treat all cohorts. CONCLUSION: This study demonstrated that the incidence of loss to follow-up was considerably higher in the treat-all period as compared to the pre-treat-all era. Poor medication compliance, underweight, and a CD4 level >350 cells/m3 contributed to the higher rate of LTFU in the treat-all strategy. Targeted interventions, such as nutritional support and strengthening medication adherence counseling, should be implemented to maintain treatment retention and reduce antiretroviral therapy dropout rates.

Bacteriological Contamination of Drinking Water Supply from Protected Water Sources to Point of Use and Water Handling Practices among Beneficiary Households of Boloso Sore Woreda, Wolaita Zone, Ethiopia.

The quality of drinking water is a powerful environmental determinant of health. Water becomes contaminated with faecal material due to inadequate protection of the source, unhygienic practices of the community at the source, and poor household handling practices. The objective of this study was to assess the level of bacteriological contamination of drinking water supply from protected water sources to point of use and water handling practices among beneficiary households of Boloso Sore woreda, Wolaita zone, Ethiopia. A cross-sectional survey and bacteriological analysis of water were conducted in January 2019. The study included 545 households for water handling practices, and 75 samples from stored water from households and eighteen water sources were included for faecal coliform test. Data were analyzed using SPSS v21.0. Descriptive and logistic regression statistical models were used. Sixty percent of shallow wells, 60% of protected hand-dug wells, and 25% of protected on-spot springs were found positive for faecal coliform. In general, 44% of water source samples and 91% of household water samples were positive for faecal coliform. In general, 38% of households were practicing unsafe water handling practices. High school and above level of education (AOR = 3.37, 95% CI: 1.03, 11.57), getting higher monthly income (AOR = 2.37, 95%CI: 1.96, 5.85), households with small family size (AOR = 1.81, 95% CI: 1.15, 2.83), frequency of water collection twice a day (AOR = 2.88, 95% CI:1.56, 5.33), and presence of water payments (AOR = 0.42, 95% CI: 0.24, 0.72) were significantly associated with water handling practice. Unsafe water handling was a common practice in the study area, and water sources and household water storage were not free of faecal coliform, indicating noncompliance with the World Health Organization water quality guideline. Hence, capacity building is mandatory for the protection and management of water sources and safe water handling practices in the household and community.

ACCEPTABILITY OF THE INVOLVEMENT OF HEALTH EXTENSION WORKERS (HEWS) IN MEDICAL ABORTION (MA): THE PERSPECTIVES OF CLIENTS, SERVICE PROVIDERS AND TRAINED HEWS IN EAST SHOA AND ARSI ZONES, OROMIYA REGION, ETHIOPIA.

BACKGROUND: Unsafe abortion remains a significant contributor of maternal morbidity and mortality in Ethiopia and other developing countries. Involvement of community based health workers, health extension workers (HEWs) in Ethiopia, is a vital step in increasing access and utilization of medical abortion and related services. In order to engage HEWs, it is important to understand the attitude of women and service providers. OBJECTIVE: To explore the acceptability of involvement of HEWs in medical abortion by women who seek services, by abortion service providers, and assess willingness and confidence of HEWs. METHODS: An exploratory in-depth interview was conducted at three purposively selected health facilities in Ethiopia; namely Marie Stopes International (MSI) Adama clinic, MSI Asella clinic and Adama Government Health Centre from July-August, 2013. The interviews were transcribed verbatim and analysis was done using Atlas ti software. Themes were abstracted from coded text segments. The findings are presented using quotations, Atlas ti networks and queries. RESULTS: Thirty eight (26 eligibility, 12 follow up) women participated in the study and 9 HEWs and 7 service providers were interviewed. Almost all of the interviewed women, service providers and HEWs accepted HEWs involvement in medical abortion services. The HEWs expressed readiness and confidence. Concerns related to the involvement of HEWs included confidentiality, privacy, over dependence on abortion rather than preventing unwanted pregnancy, quality and poor referral system. CONCLUSIONS: Expansion of medical abortion services by involving HEWs can contribute to the reduction of abortion related morbidity and mortality. Concerns of the study population should be addressed by training HEWs for medical abortion, creating better awareness and advocacy among women and communities, addressing quality and referral issues with proper planning, implementing and monitoring of activities.