Predictors of divorce and duration of marriage among first marriage women in Dejne administrative town

Divorce is a common occurrence in the marital lives of spouses. Consequently, numerous divorced spouses and their children face various social, economic, physiological, and health problems after breaking their marriage. This study aimed to identify the predictors of divorce and the duration of marriage. We conducted a community-based cross-sectional study among 423 randomly selected residents of Dejen Township in April 2020, of which only 369 respondents met the study inclusion criteria. We used structured questionnaires to collect data. The predictors of divorce and duration of marriage were analyzed using binary logistic regression and the Gompertz regression model, respectively. A p value less than 0.05 was used to express statistical significance. The prevalence of divorce was 21.14% [95% CI (19.01-23.27%)]. Half of these women broke up their marriage after 11 years. A high age difference (7 or more years) between spouses, an early marriage, infertility among women, the presence of third parties, women without formal education, women in the workforce, sexually dissatisfied women, women who did not live together with their husbands at the same address, partner violence, marital control behaviour of husbands, drug-abused husbands, spouses without children, and women who knew multiple sexual partners were the significant predictors of divorce. Partner violence, sexually dissatisfied women, women who made their own marriage decisions, marital control behaviour of husbands, women who did not live together with their husbands at the same address, drug-abused husbands and spouses without children were significant predictors of shorter marriage durations. In this study, the prevalence of divorce was high. Therefore, a community-based, integrated strategy is needed to minimize the divorce rate.

The effect of possible mediators on the association between chewing khat during pregnancy and fetal growth and newborn size at birth in Eastern Ethiopia

INTRODUCTION

Restriction in the growth of the fetus is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Documented existing scientific evidence have shown the effects of maternal drugs use, alcohol drinking, tobacco smoking, cocaine use and heroin use on fetal growth restriction. However, data is lacking on the effects of khat chewing during pregnancy on fetal growth status and newborn size at birth. Therefore, the aim of the present study was to measure the effect of chewing khat during pregnancy on fetal growth and size at birth in eastern Ethiopia.

METHOD

A cohort study was conducted in selected health institutions in eastern Ethiopia. All pregnant women fulfilled the eligibility criteria in the selected health institutions was the source population. The calculated sample size of exposed and unexposed groups included in the study, in total, was 344. Data collection was performed prospectively by interviewers administered questionnaires, and anthropometric, clinical and ultrasound measurements. Data was analyzed using SPSS version 27 and STATA version 16 software. The survival analysis (cox proportional hazards model) and generalized linear model (GLM) for the binomial family analysis were performed to estimate the crude and adjusted relative risk and attributable risk (AR) with corresponding 95% CI of chewing khat on fetal growth restriction. The mediation effect has been examined through Generalized Structural Equation Modeling (GSEM) analysis using the Stata 'gsem' command. Statistically significant association was declared at p-value less than 5%.

RESULTS

In the present study, the incidence of fetal growth restriction (FGR) among the study cohorts was 95 (29.7%); of this, 81 (85.3%) were among khat chewer cohorts. The relative risk of fetal growth restriction among khat chewer cohort mothers was significantly higher (aRR = 4.32; 95%CI 2.62-7.12). Moreover, the incidence of small for gestational age at birth among the present study cohorts was 100 (31.3%); 84 (84%) were from khat chewer cohorts' deliveries. More importantly, in the present study, 98.95% of the ultrasound-identified fetuses with FGR were found to be SGA at birth. Hence, in the current study, FGR was highly associated with SGA at birth. In additional analysis, the regression coefficient of khat chewing during pregnancy on fetal growth restriction has been decreased in size from path o, β = 0.43, p < 0.001 to path o', β = 0.32, p < 0.001, after adjusting for gestational hypertension and maternal anemia.

CONCLUSION

In sum, the present study showed khat chewing during pregnancy is not simply affected the mothers, but it also affected the unborn fetuses. Therefore, the health workers as well as the local community and religious leaders should give high emphasis on provision of health education regarding the damage of chewing khat by pregnant mothers, with especial focus of the effects on their fetuses.

The mediating role of healthy lifestyle behavior in the relationship between religious practice and academic achievement in university students

BACKGROUND

The issues of religious practice, healthy lifestyle behavior and academic achievement are global agendas. Most previous research has focused on either one or two of the variables, not three of them (e.g. just the relationship between religious practice and healthy lifestyle behavior). And addressing these three issues, by and large, demands a systemic approach to re-thinking the current level and improving it.

OBJECTIVE

To examine the causal relationship between religious practice, healthy lifestyle behavior, and academic achievement in the case of Debre Markos University (DMU) and Injibara University (IU), Ethiopia.

METHODS

Four hundred forty students are participated voluntarily using random sampling techniques. To attain this objective, a cross-sectional research method design was used.

RESULTS

The mean scores of students' healthy lifestyle behavior is more than average in all aspects. MANOVA results revealed that batch, ethnicity (region), and the university did not display a statistically significant difference among the composite (or combined) scores of both students' healthy lifestyles and religious practice. However, religious affiliation and gender religious practice and have an effect on religious practice and healthy lifestyle behavior respectively. The correlation output informs that religious practice and healthy lifestyle behavior are positively and significantly correlated with each other. Religious practice also significantly predicted students' healthy lifestyle behavior. Despite this, the academic achievement of students didn't have any relationship with their religious practice and healthy lifestyle behavior.

CONCLUSION

University students' healthy lifestyle behavior doesn't play an intervening variable in the effect of religious practice on academic achievement. Possible practical implications and recommendations have been forwarded.

Problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence: A randomised, controlled feasibility trial in rural Ethiopia

Evidence for the feasibility of brief psychological interventions for pregnant women experiencing intimate partner violence (IPV) in rural, low-income country settings is scarce. In rural Ethiopia, the prevalence of antenatal depressive symptoms and lifetime IPV are 29% and 61%, respectively. We aimed to assess the feasibility and related implementation outcomes of brief problem-solving therapy (PST) adapted for pregnant women experiencing IPV (PST-IPV) in rural Ethiopia, and of a randomised, controlled feasibility study design. We recruited 52 pregnant women experiencing depressive symptoms and past-year IPV from two antenatal care (ANC) services. Consenting women were randomised to PST-IPV (n = 25), 'standard' PST (not adapted for women experiencing IPV; n = 12) or enhanced usual care (information about sources of support; n = 15). Masked data collectors conducted outcome assessments nine weeks post-enrolment. Addis Ababa University (#032/19/CDT) and King's College London (#HR-18/19-9230) approved the study. Fidelity to randomisation was impeded by strong cultural norms about what constituted IPV. However, recruitment was feasible (recruitment rate: 1.5 per day; 37% of women screened were eligible). The intervention and trial were acceptable to women (4% declined initial screening, none declined to participate, and 76% attended all four sessions of either active intervention). PST-IPV was acceptable to ANC providers: none dropped out. Sessions lasting up to a mean 52 minutes raised questions about the appropriateness of the model to this context. Competence assessments recommended supplementary communication skills training. Fidelity assessments indicated high adherence, quality, and responsiveness but assessing risks and social networks, and discussing confidentiality needed improvement. Adjustments to optimise a future, fully powered, randomised controlled trial include staggering recruitment in line with therapist availability, more training on the types of IPV and how to discuss them, automating randomisation, a supervision cascade model, and conducting post-intervention outcome assessments immediately and three months postpartum. Registration: Pan African Clinical Trials Registry #PACTR202002513482084 (13/12/2019): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9601.

Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study

BACKGROUND

Breast cancer is one of the common global health concerns that affects2.1 million women each year and causes the highest number of cancer-related morbidity and mortality among women. The objective of this study was to determine the mortality rate and its predictors among breast cancer patients at the referral hospitals, in northwest Ethiopia.

METHODS

A retrospective follow-up study was conducted on breast cancer patients registered between February 01, 2015 and February 28, 2018. They were selected by simple random sampling using computer-generated method and followed until February 29, 2020, in Amhara region referral hospital. A pre-tested data extraction checklist was used to collect data from the registration book and patient medical records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The mortality rate by person-year observation was computed. The Kaplan-Meier survival curve with the log-rank test was used to estimate the survival probabilities of the patients. Bivariate and multivariate Cox regression model was used to identify predictors of mortality.

RESULTS

The overall mortality rate of breast cancer was 16.9 per 100 person-years observation. The median survival time was 38.3 (IQR: 26.23, 49.4) months. Independent predictors of breast cancer mortality was; Clinical stage IV and stage III (aHR:10.44,95% CI: 8.02,11.93 and aHR: 9.43, 95% CI: 6.29,11.03respectively), number of positive lymph node in the category of 10 and more and number of positive lymph node within the category of 4-9 (aHR:12.58, 95%CI: 5.2, 30.46 and aHR: 4.78, 95% CI: 2.19, 10.43respectively), co-morbidities (aHR:1.5, 95%CI: 1.01,2.21), Postmenopausal (aHR:2.03,95% CI: 1.37, 3), histologic grade III (aHR:2.12, 95% CI: 1.26,3.55) and not received hormonal therapy (aHR: 2.19, 95%CI: 1.52,3.15) were independent predictors of mortality.

CONCLUSION

The overall mortality rate was 16.9 per 100 person-years. The finding was higher compared to high-income countries. Advanced clinical stage, co-morbidities, menopausal status, and hormonal therapy are the significant predictors of mortality. Early detection and treatment of breast cancer is needed to reduce the mortality rate.

A prospective follow-up study on how long newborns are fasting in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020

Background

At birth, continuous flow of nutrients to the fetus in utero interrupted due to cut of the route /umbilical cord/. Instead of the cord, breast-mouth connection will be the next route in the extra uterine life. Nevertheless, limited data in our locality show the duration for how long immediate newborns are fasting.

Objective

This study aimed to assess time to initiation of breastfeeding and its predictors among postnatal mothers within 12 hours of birth in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2020.

Methods

A Facility based prospective follow-up study was conducted among 475 participants who were selected using systematic random sampling techniques. To collect the data, techniques including interview, chart review and observation were used. Data was entered to Epi-data version 3.1 and analyzed by STATA 14 software. A cox proportional hazards regression model was fitted to identify predictors for survival time. Results of the final model were expressed in terms of adjusted hazard ratio (AHR) with 95% confidence interval, statistical significance was declared with P-value is less than 0.05.

Results

Newborns were fasting breast-milk for the median time of 2 hours. In this study, 25% of participants initiated breastfeeding within 1 hour, pre-lacteal while 75% initiated within 3 hours. Gave birth to multiple babies (AHR 0.37, 95% CI (0.19, 0.69)), operative delivery (AHR 0.77, 95% CI (0.62, 0.96)), got advice on timely initiation of breastfeeding immediately after delivery (AHR 0.79, 95% CI (0.63, 0.97)), pre-lacteal feeding initiation (AHR 10.41, 95% CI (2.82, 38.47)) and neonatal sickness (AHR 0.08, 95% CI (0.03–0.19)) were statistically significant predictors for time to initiation of breastfeeding.

Conclusion

Fifty percent of mothers initiated breastfeeding within 2 hours. Most of them didn’t initiate breastfeeding based on world health organization’s recommendation, within one hour after delivery. Multiple birth, operative delivery, getting advice on timely initiation of breastfeeding immediately after delivery, giving pre-lacteal feeding and neonatal sickness were found to be predictors of time to initiation of breastfeeding.

Plant diversity and community analysis of Sele-Nono forest, Southwest Ethiopia: implication for conservation planning

BACKGROUND

Studying the floristic diversity of a certain forest is a basic aspect of the design and management of forest vegetation; and consequently this study focused on the plant diversity and community analysis of the Sele-Nono forest. For the current study, plants were sampled from 90 plots using a stratified random sampling technique along the established strata of the study forest. In all the plots, both floristic and environmental data that were relevant to the study were collected following the state of the art. Based on the collected data, the community types, ordination, floristic diversity, and threats to the forest were analyzed using R-package and SPSS software.

RESULTS

Cluster analysis produced seven distinct community types which significantly differed among themselves (Cophentic correlation coefficient = 0.785, P < 0.001) of which community types 2 and 6 were relatively poor; whereas communities 1 and 4 were rich in terms of their species richness and diversity. In addition, Canonical Correspondence Analysis (CCA) suggests that a number of environmental factors such as altitude and slope (topographic factor), OM and N (edaphic factors) and disturbance were the main drivers for the current distribution of plant species and disparity in plant community composition in Sele-Nono forest. Moreover, the study revealed high beta diversity ([Formula: see text] >12) of plant species at the landscape level (i.e., throughout the study forest). Deforestation for agricultural land expansion and degradation through selective logging are the main threats to the Sele-Nono forest.

CONCLUSIONS

The present study revealed that the Sele-Nono forest is a large and heterogenous forest at the landscape level (150, 325.27 ha; [Formula: see text] >12). Moreover, it is one of the richest and diverse forest ecosystems in terms of plant biodiversity, and it could qualify to be labeled as a keystone ecosystem. However, currently it is exposed to a variety of threats. We recommend the forest to be developed into a biosphere reserve. We also recommend the prioritization of areas belonging to community types 2 and 6 of the forest for any possible conservation actions so as to maximize species richness and diversity of the native plants of the area.

Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia

BACKGROUND

Microvascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes.

METHODS

A retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients.

RESULTS

The prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004).

CONCLUSION

The progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.

Off-label medication use in pediatrics and associated factors at public hospitals in east Gojjam zone, Ethiopia

Objective

Due to a lack of appropriate pediatric preparations, health providers frequently use adult formulations in an off-label manner. This study aimed to assess pediatric off-label medication use patterns and associated factors in East Gojjam, Ethiopia.

Methods

Institutional-based cross-sectional study was conducted from December 2020 to June 2021 at three randomly selected hospitals. Data were collected by using self-structured questionnaires and a data abstraction checklist from health care workers and prescriptions, respectively. The collected data were analyzed using SPSS version 25. Logistic regression analysis was used to assess the association between independent and dependent variables.

Results

A total of 285 eligible health professionals from the pediatric unit and pharmacies, and 1,800 eligible prescriptions were involved in the study. The response rate of healthcare workers was 94.37%. Around 74.4% of professionals had good knowledge about off-label medication. Only 8% of participants had taken training on pediatric off-label medications. Of all prescriptions, 27.6% of them have contained at least one off-label medication. Phenobarbitone (16.1%) and phenytoin (12.7%) were the most frequently prescribed off-label medication. In all, 496 (27.6%) prescriptions contained off-label drugs in the form of overdose, cutting adult tablets into small portions, and formulating tablets/capsules into solution. Lack of information on off-label prescribing, shortage of pediatric drugs, and suitable dosage forms showed significant association with off-label prescribing with p-value < 0.001.

Conclusion

Almost one-third of pediatric prescriptions contained off-label medication. Only a small number of healthcare workers had taken training on pediatric off-label medications. Lack of sufficient information on risks of off-label medication, shortage of pediatric medication, and suitable pediatric dosage forms were associated with the use of off-label medication compared to non-use. Further research should be done on the long-term effects associated with off-label prescribing in pediatrics to assess whether the potential risks are balanced with the therapeutical benefit.

Postnatal care service utilization and its determinants in East Gojjam Zone, Northwest Ethiopia: A mixed-method study

BACKGROUND

The days and weeks after childbirth are crucial for both the mother and her newborn child leading for the majority of maternal and perinatal mortalities. The World Health Organization recommends at least three postnatal visits within 42 days after birth. However, postnatal care utilization remains low worldwide. Quantitative findings revealed low utilization of postnatal care in Ethiopia, however, no study explored the barriers for postnatal care. This study aimed to assess the barriers to postnatal care service utilization in East Gojjam Zone, Northwest Ethiopia.

METHODS

A community-based, mixed type cross-sectional study was conducted from December 15, 2018, to February 15, 2019. The quantitative data was gathered using the interviewer-administered interviewing technique from 751 women who gave birth within one year prior to the study selected by multistage sampling. The qualitative data were collected from purposively sampled women, facility leaders, and health extension workers using in-depth interviews and focused group discussions. The quantitative and qualitative data were analyzed using logistic regression and by the thematic content analysis method, respectively.

RESULTS

The study revealed that postnatal care service utilization was 34.6%. The odds of using PNC services were greater in women aged 25-34 years and used maternity waiting home. In contrast, women who were muslim religion followers, had normal or instrumental birth, not aware of the PNC services and whose partners were not supportive of the use of MCH services were less likely to use PNC services. According to the qualitative findings, lack of awareness, traditional beliefs and religious practices, distance and transportation, environmental exposure, and waiting time were identified as barriers to PNC service utilization.

CONCLUSION AND RECOMMENDATION

The study showed low utilization of PNC services in East Gojjam zone, northwest Ethiopia. Improvements in personal health education, in construction of relevant infrastructure, and to transport, are needed to remove or reduce barriers to PNC service use in East Gojjam Zone, Northwest Ethiopia.

Effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia: Institution based prospective cohort study

BACKGROUND

Intestinal parasitosis is a common disease that causes misery and disability in poor populations. The number of individuals affected is staggering. From two billion peoples who harbor parasites worldwide, 300 million suffer severe morbidity and more than 25% of pregnant women are infected with hookworm, which causes intestinal bleeding and blood loss, and has been most commonly associated with anemia. Intestinal parasite infection during pregnancy has been associated with iron deficiency, maternal anemia, and impaired nutritional status, as well as decreased infant birth weight.

OBJECTIVE

This study aimed to assess the effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care in Debre Markos Referral Hospital from December 2017 to February 2019.

METHOD

A prospective cohort study design was conducted among 94 intestinal parasite-infected pregnant women as an exposed group and 187 pregnant women free from intestinal parasite were used as a control group. The effect of intestinal parasites on hematological profiles of pregnant women was assessed at Debre Markos Referral Hospital antenatal care ward. Socio-demographic data and nutrition status were assessed by using structured questionnaires and mid-upper arm circumference (MUAC), respectively. Two ml of venous blood and 2 gm of stool samples were collected to analyze the hematological profiles and detect intestinal parasites, respectively. Wet mount and formol-ether concentration (FEC) techniques were used to detect intestinal parasites. Hematological profile was analyzed using Mind ray BC-3000 plus instrument. Data were double entered into EpiData version 3.1 software and exported to SPSS version 24 software for analysis. Results were presented using tables and graphs. Associations of hemoglobin levels with intestinal parasitic infections were determined using binary logistic regression models. P≤0.05 was considered statistically significant. The mean hematological profile difference between parasite-infected and parasite-free pregnant women was computed using independent t-test.

RESULTS

In the present study, the predominant parasites identified were Entamoeba histolytica, hookworm, Giardia lamblia, Schistosoma mansoni, and Ascaris lumbricoides. About 8.2% of intestinal parasite-infected pregnant women had mild anemia while 4% had moderate anemia. Only 1.2% of intestinal parasite-free pregnant women developed moderate anemia. The mean HGB, HCT, MCV, MCH, and MCHC values of intestinal parasite-infected pregnant women were 12.8g/dl, 38.2%, 94.7fl, 33.1pg and 34.7g/dl, respectively. But the mean HGB, HCT, MCV, MCH and MCHC values of pregnant women who were free from intestinal parasites were 14.4 g/dl, 39.8%, 94.9fl, 33.9pg and 35.5g/dl, respectively. Anemia was strongly associated with hookworm (AOR = 21.29, 95%CI: 8.28-54.75, P<0.001), S.mansoni (AOR = 63.73, 95% CI: 19.15-212, P<0.001) and A.lumbricoide (AOR = 14.12, 95% CI 3.28-60.65, P<0.001).

CONCLUSION

Intestinal parasitic infection in pregnant women caused adverse impact on hematological profiles and was an independent predictor of anemia. Intestinal parasitic infection significantly decreased pregnant the level of HGB, HCT, MCV, MCH, and MCHC values. To minimize maternal anemia deworming could be good before pregnancy.

Medication Administration Errors and Associated Factors Among Nurses

INTRODUCTION

Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients' hospitalization, produces extra costs and even death. This study aimed to assess medication administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia.

METHODS

Institutional-based, cross-sectional study design was used, and 422 study participants were selected using a simple random sampling method. Data were collected using a semi-structured and pre-tested self-administered questionnaire and observational checklist. The collected data were analyzed using descriptive and analytical statistics and binary logistic regression was done to identify factors associated with medication administration errors. P-value ≤ 0.05 was considered statistically significant.

RESULTS

Four hundred fourteen participants with a response rate of 98.1% were involved and 54.3% were females. The median age was 30 with IQR (28-34) years and the majority of them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was 57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated medication administration errors. Significant association between medication administration errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline [AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31; 95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed.

CONCLUSION

MAE was high in the study area as compared to studies from Jimma University Specialized Hospital, Adigrat and Mekelle University Hospital, and the University of Gondar Referral Hospital and hence developing guidelines, providing training, and develop strategies to minimize distracters are better to be undertaken.

Perceived learning difficulty associates with depressive symptoms and substance use among students of higher educational institutions in North Western Ethiopia: A cross sectional study

Background

The potential role of perceived learning difficulty on depressive symptoms and substance use in the context of student population was seldom studied. This study aimed to investigate the association of perceived learning difficulty with depressive symptoms and substance use among university students in northwest Ethiopia.

Methods

A cross sectional study was conducted on 710 pre-engineering students. A locally validated version of Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms at a cut off 5–9 indicating mild depressive symptoms and at a cut off 10 for major depressive symptoms. Perceived difficulty in school work was assessed by items dealing about difficulties in areas of course work. The response alternatives of these items were 0 = not at all, 1 = not so much, 2 = quite much, 3 = very much. The types of substances that students had used in their life and in the last three months were assessed. Negative binomial regression and multinomial regressions were employed to investigate the predictors of number of substance use and depressive symptoms respectively.

Results

The prevalence of depressive symptoms was 71.4% (Mild: 30% and Major 41.4%). About 24.6% of participants had the experience of using at least one substance. Increment in perceived difficulties in learning score was associated with more use of substances (aRRR = 1.03, 95% CI: 1.01–1.06), mild level depressive symptoms (aOR = 1.10, 95% CI: 1.04, 1.56 and major depressive symptoms (aOR = 1.19, 95% CI: 1.13, 1.26). Every increment in anxiety score was associated with increased risk of mild level of depressive symptoms (aOR = 1.09, 95% CI: 1.01, 1.17) and major depressive symptoms (aOR = 1.28, 95% CI: 1.18, 1.37). Being male (aRRR = 5.54, 95% CI: 3.28, 9.36), urban residence (aRRR = 2.46, 95% CI: 1.62, 3.72) and increment in number of life threatening events (aRRR = 1.143, 95% CI: 1.08, 1.22) were associated with increased risk of substance use.

Conclusion

Perceived difficulties in learning independently predicted increased depressive symptoms as well as substance use among participants.