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Aemro A, Workneh BS, Mekonen EG, Wassie M, Chekol B. Prevalence of anaemia and its associated factors among HIV-infected adults at the time of ART initiation at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia: a retrospective cross-sectional study. BMJ Open 2022; 12:e057235. [PMID: 35725251 PMCID: PMC9214405 DOI: 10.1136/bmjopen-2021-057235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the prevalence of anaemia and its associated factors at the time of antiretroviral therapy (ART) initiation among HIV-infected adults at Debre Markos Comprehensive Specialized Hospital. METHODS An institution-based retrospective cross-sectional study was conducted among 473 patients' charts enrolled from 2014 to 2018 at Debre Markos Comprehensive Specialized Hospital. Patients' chart numbers were selected from the computer using a simple random sampling technique. Data were entered using Epi Info V.7.2.2.6 and analysed with Stata V.14.0. Anaemia prevalence at the time of ART initiation was computed and described using frequency tables. To identify factors for anaemia, bivariate and multivariate logistic regression models were fitted. Model fitness was checked using the Hosmer-Lemeshow goodness-of-fit test. RESULTS From 473 patients' charts, 468 charts were included in the analysis, and a total of 164 anaemia cases were recorded. The overall prevalence of anaemia among HIV-infected adults at the time of ART initiation was 35.04% (95% CI: 30.84% to 39.49%). After multivariate analysis, an increased risk of anaemia was seen among males (adjusted OR (AOR)=2.45; 95% CI: 1.51 to 3.98); those not attending formal education (AOR=2.38; 95% CI: 1.12 to 5.05); those who had baseline CD4+ T cell count ≤200 cells/mm3 (AOR=4.67; 95% CI: 2.78 to 7.85); had body mass index (BMI) <18.5 kg/m2 (AOR=2.43; 95% CI: 1.42 to 4.16) and had ambulatory/bedridden baseline functional status (AOR=2.69; 95% CI: 1.41 to 5.12). CONCLUSION The current study showed that a significant proportion of HIV-infected adults developed anaemia at the time of ART initiation. Hence, giving special attention to those who have not attended formal education, were males, had decreased baseline CD4+ T cell count, had lower BMI and patients with ambulatory/bedridden baseline functional status is crucial to reduce the health impact of anaemia. The result will provide insight into the development of new anaemia preventive strategies.
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Affiliation(s)
- Agazhe Aemro
- Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Emergency and Critical Care Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Surgical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Basazinew Chekol
- Anesthesiology, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
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Duguma N, Tesfaye Kiya G, Adissu Maleko W, Bimerew LG. Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211020175. [PMID: 34104440 PMCID: PMC8165838 DOI: 10.1177/20503121211020175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives Hematological abnormalities of the major blood cell lines are frequently reported in patients with HIV-1 infection, in patients without antiretroviral therapy, and during the advanced stages of the disease. Chronic immune activation and inflammation results in the progressive depletion of CD4+ T-cells play a significant role in the clinical progression and pathogenesis of this infection. This study was aimed at assessing the prevalence of hematological abnormalities and their associated factors before and after the initiation of antiretroviral therapy in adults with HIV-1 infection in a referral hospital. Methods The study was conducted from 1 April to 30 June 2018, at Goba Referral Hospital. A total of 308 HIV-positive adults on treatment were enrolled during the study period. Socio-demographic and clinical data were collected using a structured questionnaire, with pre-highly active antiretroviral therapy data were extracted from medical records while post-treatment immuno-hematological measurements were done on blood samples collected at the time of enrollment. Results The prevalence of anemia, leukopenia, and thrombocytopenia before initiation of antiretroviral treatment was higher, although anemia and thrombocytopenia decreased correspondingly after initiation of treatment leukopenia increased by 4%. Mean values of immuno-hematological parameters before and after treatment initiation were significant (p < 0.05). CD4+ T-cell count <200 cells/µL was the only independent risk factor for anemia and leukopenia before highly active antiretroviral therapy, while stage IV disease, female sex, zidovudine, lamivudine, and nevirapine treatment, and intestinal parasite infection were predictors of anemia after treatment initiation. Conclusion The study revealed that hematological abnormalities are common in HIV infection, while the occurrence of abnormalities after highly active antiretroviral therapy initiation. Different risk factors are associated with hematological abnormalities at pre- and post-highly active antiretroviral therapy with regular monitoring of risk factors, adherence to the early initiation of highly active antiretroviral therapy, and conduct of further longitudinal studies are recommended.
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Affiliation(s)
- Negesso Duguma
- Department of Medical Laboratory Sciences, Madda Walabu University, Goba, Ethiopia
| | - Girum Tesfaye Kiya
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu Maleko
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.,Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| | - Lealem Gedefaw Bimerew
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Magnitude of Anemia and Associated Factors among HIV-Infected Children Receiving Antiretroviral Therapy in Pastoral Community, Ethiopia: A Retrospective Cross-Sectional Study. Adv Hematol 2020; 2020:9643901. [PMID: 33061980 PMCID: PMC7545413 DOI: 10.1155/2020/9643901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/25/2020] [Accepted: 09/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background The two major comrbidities (anemia and poor nutrition) are common manifestations of HIV-infected children, which threaten their lives. In Ethiopia, there is limited information on the magnitude and factors associated with anemia among HIV-infected children. Thus, this study was aimed to determine the magnitude and factors associated with anemia among HIV-infected children receiving antiretroviral therapy in the Afar region, Ethiopia. Methods A cross-sectional retrospective record review was conducted on a sample size of 102 HIV-infected children aged 6 months to < 15 years in selected ART sites of the Afar region from May 1 to 25, 2018. Patient cards from 2009 to 2017 with the required information were considered. A paired sample t-test was used to assess whether there is a significant difference in the hemoglobin level before and after the HAART regimen. Multivariable logistic regression was used to determine predictors of anemia. Statistical significance was determined atp value < 0.05. Result At baseline, 53.9% of study participants were anemic, from which 8.7%, 36.3%, and 9.8% were mild, moderate, and severe, respectively. There was a statistically significant improvement of hemoglobin level following the one-year course of ART treatment from 10.67 ± 1.82 to 11.5 ± 1.5 (p value ≤ 0.001): an improvement of 0.83 ± 1.74. Children who were moderately and severely stunted were more than five (AOR = 5.16, 95% CI (1.71, 15.56)) and more than twelve (AOR = 12.45, 95% CI (2.62, 59.21)) times more likely to be anemic than children who were not stunted, respectively. Children whose mothers had not attended ANC follow-up were more than three (AOR = 3.68, 95% CI (1.38, 9.81)) times more likely to be anemic than children whose mothers attended ANC. Children who were in clinical stages 3 and 4 were more than five (AOR = 5.07, 95% CI (1.79, 14.37)) times more likely to be anemic than children who were in clinical stage 1 and 2. Conclusion The magnitude of anemia among HIV-infected children was found to be high, which is 53.9%. Nutritional status (stunting), WHO clinical stage, and history of ANC follow-up were the predictors significantly associated with childhood anemia. Thus, interventions for HIV-infected children should consider those factors.
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Sah SK, Dahal P, Tamang GB, Mandal DK, Shah R, Pun SB. Prevalence and Predictors of Anemia in HIV-Infected Persons in Nepal. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:193-200. [PMID: 32581599 PMCID: PMC7276376 DOI: 10.2147/hiv.s244618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022]
Abstract
Background Anemia is the commonest hematological complications in HIV patients, and has a significant impact on quality of life, morbidity, and mortality. However, little is known about the epidemiology of anemia in this population in a Nepalese setting. Therefore, the present study aimed at assessing the prevalence of anemia in patients living with HIV and further to determine the independent predictors associated with it. Methods This cross-sectional study was conducted in patients diagnosed with HIV at Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu from November 2016 to August 2017. Anemia was considered a core variable, and covariates used for analysis were age, sex, CD4 count, antiretroviral therapy regimen, history of intravenous drug use, marital status, religion, geography, employment status, hypertension, and diabetes mellitus. Prevalence of anemia and its independent predictors were evaluated. Fisher’s exact and χ2 tests were performed to determine the significance of differences among categorical variables and t-tests for continuous variables. Binary logistic regression was modeled to assess predictors associated with anemia. Results Of the total 210 patients analyzed, median age was 37.50±10.57 years, and 110 (52.6%) were male. The estimated prevalence of anemia overall was 66.7% (95% CI 60.64%–73.35%): mild anemia 14.3% (95% CI 8.25%–19.74%), moderate anemia 40.5% (95% CI 31.88%–48.11%), and severe anemia 11.9% (95% CI 6.61%–17.30%). Prevalence of anemia increased significantly with decreasing CD4 count: 5.71%, 12.85%, and 48.09% among patients with CD4 counts >500, 200–499, and <200 cells/mm3, respectively (P=0.019). Severity of anemia was significantly associated with immunostatus (<200, 200–499, and >500; P=0.048). Female sex was significantly associated with increased odds of anemia (OR 2.27, P=0.007). Conclusion The present study demonstrated a high rate of anemia in a substantial number of HIV individuals. Therefore, early detection and timely management of anemia, especially in females and those with decreased immunostatus, are crucial to prevent anemia progression and improve quality of life.
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Affiliation(s)
- Shiv Kumar Sah
- Purbanchal University, Little Buddha College of Health Science, Kathmandu, Nepal
| | - Prastuti Dahal
- Purbanchal University, Little Buddha College of Health Science, Kathmandu, Nepal
| | - Gyan Bahadur Tamang
- Purbanchal University, Little Buddha College of Health Science, Kathmandu, Nepal
| | | | - Rajesh Shah
- Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal
| | - Sher Bahadur Pun
- Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal
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Prevalence of Anemia and Its Associated Factors in Antiretroviral-Treated HIV/AIDS-Positive Adults from 2013 to 2018 at Debre Berhan Referral Hospital, Ethiopia. Adv Hematol 2020; 2020:2513578. [PMID: 32231702 PMCID: PMC7086413 DOI: 10.1155/2020/2513578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction. Anemia was defined as a hemoglobin level of less than or equal to 13.9 g/dl for male and less than or equal to 12.2 g/dl for female adults. It is one of the most common hematological abnormalities in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and is a determining factor for disease progression and death. Among the countries in sub-Saharan Africa, Ethiopia is one of the most affected nations by HIV. Therefore, this study aimed to assess the prevalence of anemia and its associated factors among HIV-positive adults that had received antiretroviral treatment (ART) at Debre Berhan Referral Hospital. Methods An institution-based, descriptive, cross-sectional study was conducted involving 263 adults with HIV/AIDS that had undergone ART at Debre Berhan Referral Hospital, Ethiopia. Data were collected from patient charts using systematic sampling with a pretested data extraction tool and entered using EpiData 3.1. Variables having a p value ≤0.25 in the bivariate were fitted to a multivariable regression model with a 95% confidence interval. p value ≤0.25 in the bivariate were fitted to a multivariable regression model with a 95% confidence interval. Results Among the 263 HIV-positive patients, 237 (90.11%) were included in the final analysis. The overall prevalence of anemia was 26.2%. Factors that were significantly associated with anemia were past opportunistic infections, patients being in WHO clinical stage III and IV, and a BMI <18.5. Conversely, those patients who took anti-TB medication were less likely to have anemia. Conclusion Our study shows that the severity of anemia among HIV/AIDS patients that had undergone ART is lower than most studies conducted in Ethiopia. We also found that opportunistic infection, WHO clinical staging, anti-TB treatment, and low BMI were significantly associated with anemia. Therefore, routine screening of patient nutritional status and opportunistic infections may be useful in predicting and controlling anemia in HIV/AIDS patients.
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Factors Associated with Anemia among People Living with HIV/AIDS Taking ART in Ethiopia. Adv Hematol 2019; 2019:9614205. [PMID: 30941180 PMCID: PMC6421011 DOI: 10.1155/2019/9614205] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/14/2019] [Accepted: 02/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background Globally, anemia, among people living with HIV/AIDS, is a major public health problem. It has a significant effect on the progression of HIV/AIDS to advanced stages and there are a number of factors that often affect anemia. However, there is little insight regarding factors affecting anemia among HIV/AIDS patients in developing countries, including Ethiopia. Objective This study aimed at investigating factors affecting anemia among people living with HIV/AIDS taking ART drug at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods A hospital based cross-sectional study design was used to assess factors affecting anemia among people living with HIV/AIDS. Structured checklist was used to gather information from charts of patients selected by simple random sampling method. We analyzed the data to identify factors associated with anemia among people with HIV/AIDS using logistic regression models. Results A total of 301 selected charts were reviewed. The median age was 38 ± 10.38. The majority (62.5%) of the patients were taking ZDV-containing ART drug (ZDV/3TC/NVP). The overall anemia prevalence was 34.6%, while about 5%, 15.6%, and 14% of the patients had severe, moderate, and mild prevalence of anemia, respectively. Factors that were found to affect anemia among these patients include gender (OR = 2.26 [95% CI: 1.22, 4.16]), occupation (OR: 0.57 [95%CI: 0.35, 0.92]), WBC count (OR = 2.30 [95% CI: 1.29, 4.09]), platelet count (OR = 2.89 [95% CI: 0.99, 8.41]), nutritional status (OR = 2.05 [95% CI: 0.69, 6.02]), and WHO clinical stage of HIV/AIDS (OR = 3.69 [95% CI: 1.86, 7.31]). Conclusions About one in three patients was found to be anemic. Intervention aimed at diagnosing and treating anemia among people living with HIV/AIDS should be considered.
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Negesse A, Getaneh T, Temesgen H, Taddege T, Jara D, Abebaw Z. Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis. BMC HEMATOLOGY 2018; 18:32. [PMID: 30459953 PMCID: PMC6233542 DOI: 10.1186/s12878-018-0127-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023]
Abstract
Background Anemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level. Methods Studies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively. Result A total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M2 with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors. Conclusion This review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.
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Affiliation(s)
- Ayenew Negesse
- 1Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- 2Department of Midwifery, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- 1Department of Human Nutrition and Food Sciences, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Tesfahun Taddege
- 3Ethiopia Field Epidemiology and Laboratory Training Program (EFELTP) Resident, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Dube Jara
- 4Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.,5School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zeleke Abebaw
- 6Department of Health Informatics, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Woldeamanuel GG, Wondimu DH. Prevalence of anemia before and after initiation of antiretroviral therapy among HIV infected patients at Black Lion Specialized Hospital, Addis Ababa, Ethiopia: a cross sectional study. BMC HEMATOLOGY 2018; 18:7. [PMID: 29568529 PMCID: PMC5856395 DOI: 10.1186/s12878-018-0099-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/23/2018] [Indexed: 01/03/2023]
Abstract
Background Anemia is the most common hematological abnormality in Human immunodeficiency virus (HIV) positive patients and a significant predictor of its progression to AIDS or death. This study was aimed to assess the prevalence of anemia before and after initiation of antiretroviral therapy (ART) among HIV positive patients attending Black Lion Specialized Hospital, Addis Ababa, Ethiopia. Methods A cross sectional study was conducted from January to April, 2017 in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. A total of 255 patients on ART were selected using simple random sampling techniques. Socio-demographic and clinical characteristics of the study subjects were collected using structured questionnaire. Measurements of complete blood cell counts and CD4 + T cell counts were made using Sysmex XT 2000i hematology analyzer and BD FACS Count CD4 analyzer, respectively. Statistical analysis of the data (Chi-square, paired T-test, logistic regression) was done using SPSS version 20. A p-value < 0.05 was considered as significant. Results Prevalence of anemia before and after ART initiation was 41.9 and 11.4% respectively. There are a significance differences in CD4 + T cell count, RBC count, hemoglobin values and RBC indices in HIV patients before and after ART initiation (p-value < 0.05). WHO clinical stages and CD4+ T cell counts were found to be associated with the prevalence of anemia before ART initiation. Among the total number of anemic cases, normocytic normochromic anemia was present in 71% of the cases before ART and in 58.6% of the cases after ART. The prevalence of macrocytic normochromic anemia before and after ART initiation was 4.7 and 27.6% respectively. Conclusions It is evident from this study that there is a remarkable reduction in the prevalence of anemia after ART initiation. However, a significant proportion of HIV patients remained anemic after 6 months of ART initiation suggesting the need for routine screening and proper treatment of anemia to mitigate its adverse effects.
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Affiliation(s)
- Gashaw Garedew Woldeamanuel
- 1Department of Medicine, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
| | - Diresibachew Haile Wondimu
- 2Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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