Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia

Background

Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Ethiopia. TB prevention and control in low-income countries, such as Ethiopia, face significant challenges, including late detection and treatment initiation. A delay in the initiation of tuberculosis treatment increases the morbidity and mortality of patients and community transmission. Therefore, this study aimed to assess patient delay and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel Zone, Benishangul Gumuz Region, Western Ethiopia.

Methods

An institution-based cross-sectional study was conducted from March to August 2020 among newly diagnosed pulmonary tuberculosis patients. All pulmonary tuberculosis patients (416) who came to all public health facilities of the Metekel zone for treatment during the period were included. Data were collected through face-to-face interviews using a structured and pretested questionnaire. A multivariable logistic regression was fitted to identify independent factors for delay in seeking treatment among PTB patients. Adjusted odds ratios with 95% CIs were determined, and variables with p values <0.05 were considered statistically significant.

Results

Nearly three-fourths 302 (72.6, 95% CI: 68.5, 76.7) of the patients were delayed in seeking medical advice, with a median patient delay of 27 days (IQR: 21-31). Age of the patients [above 54 years (AOR = 2.65, 95% CI: 1.30, 5.40), 36-54 years (AOR = 1.86, 95% CI: 1.14,3.02)], family size of 5 members and above (AOR = 1.62, 95% CI: 1.10-3.14), travel time above 60 min (AOR = 3.65, 95% CI: 1.55, 8.60), history of visits to informal care providers (AOR = 1.74, 95% CI: 1.11, 3.14), and poor knowledge about PTB (AOR = 1.64, 95% CI: 1.04-2.44) were statistically significant factors associated with delays in seeking treatment among PTB patients.

Conclusion

Most pulmonary tuberculosis patients delay seeking medical advice for their illnesses. Delays in seeking treatment were associated with older age, large household size, longer travel time to reach the nearby health facility, visiting informal care providers, and poor knowledge about pulmonary tuberculosis. Hence, it is crucial to consider community screening programs, enhance public awareness, and ensure the accessibility of TB diagnostic and treatment services.

Human papillomavirus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte city, Western Ethiopia, 2020

BACKGROUND

Cervical cancer is the leading cause of cancer death in adult women in the developing world including Ethiopia. To combat cervical cancer, the World Health Organization (WHO) recommends that girls aged 9-14 years have to take the human papillomavirus vaccine. However, there is a lack of information regarding the uptake of human papillomavirus vaccine in the study area. Therefore, this study aimed to assess the Human Papilloma Virus vaccine uptake and associated factors among adolescent girls in high schools of Nekemte City, Western Ethiopia, 2020.

METHODS

A cross-sectional study design was employed among adolescent girls attending grade 9 and age 15 enrolled at schools in Nekemte City from July 15-30, 2020. Six hundred twenty-six (626) randomly selected adolescent girls were interviewed. The data were entered into Epi Info 7 and analyzed by SPSS 25. Multivariable analysis was computed and a P-value < 0.05 was taken as a cut-off point to declare the statistically significant association.

RESULT

The uptake of the HPV vaccine was 61.2%, 95%CI (57.2%, 65%). The Place where adolescents grow up (AOR = 3.46, 95%CI [1.95,6.15]), having a mobile phone(AOR = 1.71, 95%CI [1.05, 2.79]), ever heard about HPV (AOR = 5.69, 95%CI [1.33, 24.27]), ever heard about HPV vaccine(AOR = 1.917, 95%CI [1.002, 3.667]), Ever had sexual intercourse (AOR = 3.04, 95% [1.49,6.20]) and Perceived risk of towards HPV(AOR = 4.63 [2.49, 8.63]) has shown statistically significant association with Uptake of the HPV vaccine.

CONCLUSION

Nearly two-thirds of the study participants had taken at least one dose of the HPV vaccine. It is better if health information on HPV is disseminated considering the available technology like mobile phones and reaching rural girls.

Lippes loop intrauterine device left in the uterus for 40 years as a rare cause of postmenopausal pelvic pain: a case report and review of the literature

BACKGROUND

Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal are crucial. We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. The loop was removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.

CONCLUSION

Different works of the literature showed that retained Lippes loop IUD carries some complications. Our case was also presented with postmenopausal pelvic pain. Therefore, we recommend the removal of IUDs at their expiry date or menopause.

Assessment of the magnitude and contributing factors of expired medicines in the public pharmaceutical supply chains of Western Ethiopia

BACKGROUND

The magnitude of expired medicines in supply chains are increasing globally due to lack of strict control of the supply chain, poor storage management and oversupply of medicines. This situation is very serious in resource-poor countries, including Ethiopia, where the supply of medicines is limited. Therefore, this study aimed to assess the magnitude and the contributing factors of expired medicines in the Public Pharmaceutical Supply Chains of Western Ethiopia.

METHODS

Explanatory sequential study design involving mixed quantitative and qualitative approach were employed among 62 public pharmaceutical supply chains of Western Ethiopia from July1 to August 30, 2021. An observational checklist and the self-administered questionnaire were used to review all records of the expired medicine file and to abstract secondary data on the extent, types of expired medicines and its contributing factors. The collected data was cleared, filtered, and coded using Microsoft Excel® 2010, and exported to SPSS version-23 (Amsterdam, Netherland) for statistical analysis. Bivariate logistic regression was used to check association between the outcome and independent variables. Multivariate logistic regression was analyzed when p-value is less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical at p-value < 0.05. Moreover, audio recordings were transcribed and coded for emergent themes using thematic analysis.

RESULTS

The study revealed 5% expire rate over past two financial (2012 up to 2013) years and the total amount of expired drugs is estimated at 20 million Ethiopian Birr (ETB). Tetanus antitoxin (TAT), in terms of single drug value, had the highest drug expiry (4,110,426.43ETB: 20%), followed by liquid dosage forms (11,614,266.11 ETB: 57%). The Binary logistic regression result indicated that, poor store management were more likely associated with the magnitude of expired medicine than those with good store management (COR: 10.706, 95% CI: 2.148, 53.348). Multivariate logistic regression revealed that poor store management (AOR: 9.718, 95% CI: 1.474, 64.082) was a significant contributor to the expire rate at 5% (P < 0.05). Most facilities did not have a procedure, and programme for disposing of expired medicines. According to key informants, inadequate inventory management, lack of policy and implementation of standards are the main contributing factors of the medicine's expiration.

CONCLUSION AND RECOMMENDATIONS

The current study found that the overall rate of medication expiration is high, at a significant cost to the budget. Inadequate inventory management, lack of policy, and implementation of standards are the main contributing factors to the medicine's expiration, as cited by key informants. Further research is necessary to determine the quality and efficacy of these expired drugs to extend their shelf life to ensure adequate access to drugs in resource-limited settings.

International border malaria transmission in the Ethiopian district of Lare, Gambella region: implications for malaria spread into South Sudan

BACKGROUND

Despite notable progress in the control and prevention of malaria in the Horn of Africa, the disease continues to cause significant morbidity and mortality in various regions of Ethiopia, and elsewhere in the region. The transmission of malaria is affected by genetic, sociocultural, and ecological factors. Lare is an Ethiopian district adjacent to the Ethio-South Sudan border, in Gambella region. The region currently has the highest prevalence of malaria in Ethiopia. This study assesses the burden and spatiotemporal patterns of disease transmission, including the effect of climatic factors on the occurrence of malaria, across an international border crossing. This understanding can assist in crafting informed programmatic and policy decisions for interventions.

METHODS

This study was conducted in Lare district, Southwest Ethiopia, a temperate zone. A retrospective descriptive analysis was conducted using clinical service data collected between 2011 and 2021 from the 9 health facilities of the district. Both clinically diagnosed patients and those identified using microscopy and rapid diagnostic testing (RDT) were included in the study. Additionally, climate data was incorporated into analyses. Examples of analyses include malaria burden, positivity rate, incidence, species frequency, and an ANOVA to assess inter-annual case number and meteorological factor variation.

RESULTS

Between 2011 and 2021, a total of 96,616 suspected malaria cases were tested by microscopy or RDT, and 39,428 (40.8%) of these cases were reported as positive. There were 1276 patients admitted with 22 deaths recorded. There were further more significant fluctuations in positivity rates across years, the highest being 74.5% in 2021. Incidence varied from 18.0% in 2011 to 151.6% in 2016. The malaria parasite species most detected was Plasmodium falciparum, followed by a smaller proportion of Plasmodium vivax. The greatest proportions of P. falciparum cases were observed in 2018 and 2019, at 97.4% and 97.0% prevalence, respectively. There was significant seasonal variation in case number, the highest observed in July through September of each year. Climatic conditions of annual rainfall, temperature and humidity favored the increment of malaria cases from June until October.

CONCLUSION

The study shows that the burden, i.e. morbidity and mortality (with fluctuating patterns) of malaria are still significant public health problems and can pose serious consequences in the district. This has implication for cross-border malaria transmission risk due to considerable border crossings. The predominant cause of the disease is P. falciparum, which causes severe complications in patients. The district has to prepare to deal with such complications for better patient care and outcomes.

Determinants of perinatal mortality at tertiary hospitals in East Wollega, Western Ethiopia: a case-control study

OBJECTIVE

This study was performed to determine predisposing factors of perinatal mortality among deliveries at tertiary hospitals in East Wollega, Western Ethiopia.

METHODS

This institutional-based unmatched retrospective case-control study involved 810 samples (270 perinatal deaths and 540 controls) selected from the study hospitals. For each case, two controls were selected. Data were collected using a pretested structured questionnaire. Data were entered into EpiData Version 3.1 and exported to SPSS Version 25 for analysis. Descriptive analysis and logistic regression were performed. The adjusted odds ratio with 95% confidence interval was calculated, and statistical significance was declared at a P-value of <0.05.

RESULTS

The statistical analysis revealed the following independent determinants of perinatal mortality: rural residence, lack of antenatal care, preterm delivery, induction of labor, presence of obstetric complications, breech presentation, shoulder presentation, low birth weight, congenital malformation, and not using a partograph.

CONCLUSION

Given the determinant factors of perinatal mortality in the study area, health facilities are recommended to implement appropriate antenatal care, intrapartum care, and neonatal care to prevent perinatal mortality. They are also advised to use partographs and ensure better access to antenatal care facilities.

Low genetic diversity of Plasmodium falciparum merozoite surface protein 1 and 2 and multiplicity of infections in western Ethiopia following effective malaria interventions

BACKGROUND

Genetic diversity of malaria parasites can inform the intensity of transmission and poses a major threat to malaria control and elimination interventions. Characterization of the genetic diversity would provide essential information about the ongoing control efforts. This study aimed to explore allelic polymorphism of merozoite surface protein 1 (msp1) and merozoite surface protein 2 (msp2) to determine the genetic diversity and multiplicity of Plasmodium falciparum infections circulating in high and low transmission sites in western Ethiopia.

METHODS

Parasite genomic DNA was extracted from a total of 225 dried blood spots collected from confirmed uncomplicated P. falciparum malaria-infected patients in western Ethiopia. Of these, 72.4% (163/225) and 27.6% (62/225) of the samples were collected in high and low transmission areas, respectively. Polymorphic msp1 and msp2 genes were used to explore the genetic diversity and multiplicity of falciparum malaria infections. Genotyping of msp1 was successful in 86.5% (141/163) and 88.7% (55/62) samples collected from high and low transmission areas, respectively. Genotyping of msp2 was carried out among 85.3% (139/163) and 96.8% (60/62) of the samples collected in high and low transmission sites, respectively. Plasmodium falciparum msp1 and msp2 genes were amplified by nested PCR and the PCR products were analysed by QIAxcel ScreenGel Software. A P-value of less or equal to 0.05 was considered significant.

RESULTS

High prevalence of falciparum malaria was identified in children less than 15 years as compared with those  ≥ 15 years old (AOR = 2.438, P = 0.005). The three allelic families of msp1 (K1, MAD20, and RO33) and the two allelic families of msp2 (FC27 and 3D7), were observed in samples collected in high and low transmission areas. However, MAD 20 and FC 27 alleles were the predominant allelic families in both settings. Plasmodium falciparum isolates circulating in western Ethiopia had low genetic diversity and mean MOI. No difference in mean MOI between high transmission sites (mean MOI 1.104) compared with low transmission area (mean MOI 1.08) (p > 0.05). The expected heterozygosity of msp1 was slightly higher in isolates collected from high transmission sites (He = 0.17) than in those isolates from low transmission (He = 0.12). However, the heterozygosity of msp2 was not different in both settings (Pfmsp2: 0.04 in high transmission; pfmsp2: 0.03 in low transmission).

CONCLUSION

Plasmodium falciparum from clinical malaria cases in western Ethiopia has low genetic diversity and multiplicity of infection irrespective of the intensity of transmission at the site of sampling. These may be signaling the effectiveness of malaria control strategies in Ethiopia; although further studies are required to determine how specific intervention strategies and other parameters that drive the pattern.

Mobile phone handover data for measuring and analysing human population mobility in Western Ethiopia: implication for malaria disease epidemiology and elimination efforts

BACKGROUND

Human mobility behaviour modelling plays an essential role in the understanding and control of the spread of contagious diseases by limiting the contact among individuals, predicting the spatio-temporal evolution of an epidemic and inferring migration patterns. It informs programmatic and policy decisions for effective and efficient intervention. The objective of this research is to assess the human mobility pattern and analyse its implication for malaria disease epidemiology.

METHODS

In this study, human mobility patterns in Benishangul-Gumuz and Gambella regions in Western Ethiopia were explored based on a cellular network mobility parameter (e.g., handover rate) via real world data. Anonymized data were retrieved for mobile active users with mobility related information. The data came from anonymous traffic records collected from all the study areas. For each cell, the necessary mobility parameter data per hour, week and month were collected. A scale factor was computed to change the mobility parameter value to the human mobility pattern. Finally, the relative human mobility probability for each scenario was estimated. MapInfo and Matlab softwares were used for visualization and analysis purposes. Hourly travel patterns in the study settings were compared with hourly malaria mosquito vector feeding behaviour.

RESULTS

Heterogeneous human movement patterns were observed in the two regions with some areas showing typically high human mobility. Furthermore, the number of people entering into the two study regions was high during the highest malaria transmission season. Two peaks of hourly human movement, 8:00 to 9:00 and 16:00 to 18:00, emerged in Benishangul-Gumuz region while 8:00 to 10:00 and 16:00 to 18:00 were the peak hourly human mobility time periods in Gambella region. The high human movement in the night especially before midnight in the two regions may increase the risk of getting mosquito bite particularly by early biters depending on malaria linked human behaviour of the population.

CONCLUSIONS

High human mobility was observed both within and outside the two regions. The population influx and efflux in these two regions is considerably high. This may specifically challenge the transition from malaria control to elimination. The daily mobility pattern is worth considering in the context of malaria transmission. In line with this malaria related behavioural patterns of humans need to be properly addressed.

Sexual assault cases managed at a referral hospital in Western Ethiopia: A retrospective cross-sectional study

Objectives:

Sexual assault is the most prevalent and hidden global problem. The condition is worse in developing countries like Ethiopia. Therefore, this study described the survivors’ characteristics, clinical profiles, and management of cases of sexual assault at the One-Stop Service Center for survivors of sexual assault at a referral hospital in Western Ethiopia.

Methods:

A facility-based retrospective cross-sectional descriptive study was conducted to assess 203 cases of sexual assault managed at the One-Stop Service Center for survivors of sexual assault in Wollega University Referral Hospital from January 2019 to March 2022. Data were collected using a pre-tested structured checklist. Data were organized using Epidata version 3.1, cleaned, and exported to SPSS version 25 for analysis. The results were presented in tables.

Results:

Of 203 cases of alleged sexual assaults during the study period, 142 (70%) and 61 (30%) of survivors were raped and attempted rape, respectively. The age of survivors ranges from 3 to 28 years with a mean age of 15.7 ± 4.7 years. One hundred ninety-four (95.6%) were females. Seventy percent of them were students. Most of the survivors, 173 (85.2%), were assaulted by a person known to them. Only 74 (36.5%) present to the hospital within 72 h. Genital injuries were documented in 153 (75.4%). More than half, 112 (55.2%), were brought to the hospital by the police officers. In this study, 34 (16.7%) of survivors were admitted and 10 (4.9%) needed surgical procedures. Serology for syphilis, hepatitis B virus and HIV were reactive in 5 (7.1%), 1 (0.5%), and 1 (0.5%) respectively. The pregnancy test was positive in 12 (7.1%) of survivors. One (0.5%) study participant died in the intensive care unit.

Conclusion:

In this study, children and adolescents were the most vulnerable group, and survivors’ presentation to the hospital was delayed. They presented to the hospital with variable complications, including minor genital and/or extra-genital injuries, sexually transmitted infections, unwanted pregnancy, fractures, and multiple organ failures leading to death. Therefore, it is recommended that all concerned stakeholders work on the prevention of sexual assault in the study area. Legal protection for these survivors and students should also be strengthened. It is also recommended to evaluate the execution of existing national and international policies and programs toward sexual assault to develop contextual policies and guidelines.

Pattern of semen analysis in male partners of infertile couples in Western Ethiopia: Retrospective cross-sectional study

Objectives:

This study assesses the pattern of semen analysis results in male partners of infertile couples at Gimbie Adventist Hospital, Western Ethiopia, 2021.

Methods:

A retrospective cross-sectional study on 131 semen samples of male partners of infertile couples was conducted at Gimbie Adventist Hospital from 5 September 2021 to 5 October 2021. All semen samples were processed and analyzed according to methods and standards outlined by the World Health Organization laboratory manual for the examination and processing of human semen 2010. The data were coded and entered into EpiData version 3.1, and then cleaned and exported to Statistical Package for Social Sciences (SPSS for Windows version 25) for analysis. The results were presented in tables, figures, and charts.

Results:

The age of study participants ranges from 20 to 65 years with a mean age of 30.2 ± 8.1 years. Sperm cell count, morphology, total motility, and vitality below the World Health Organization reference level were found in 48.9%, 27.5%, 43.5%, and 67.2% of the analyzed samples, respectively. Low power of hydrogen and high viscosity were observed in 31.3% and 16.8% of the semen samples, respectively. The majority, 84%, had one or more abnormal semen analysis parameters. Asthenozoospermia (43.5%), necrozoospermia (25.2%), oligozoospermia (24%), azoospermia (24%), and oligoasthenoteratozoospermia (25.2%) were the severe forms of abnormal semen analysis findings detected in this study. The decline in sperm cell morphology and motility were noticed after the age of 31–34 years.

Conclusion:

In this study, both sperm quantity and quality were more affected when compared to similar studies. Only 16% of analyzed samples had normal semen parameters. Given this finding, identifying risk factors and introducing advanced diagnostic modalities for the workup of male infertility in the study area are highly recommended.

Determinants of adverse birth outcomes among women delivered in public hospitals of Ethiopia, 2020

Background

Adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. Factors such as the age of the mother, antepartum hemorrhage, history of abortion, gestational age, anemia, and maternal undernutrition have predisposed the mother to adverse birth outcome. For appropriate prevention of the adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. Therefore, this study was aimed to assess the determinants of adverse birth outcomes among women who give birth in public hospitals of western Ethiopia.

Methods

An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. From mothers who gave birth in public hospitals of Wollega zones, 165 cases and 330 controls were selected. Mothers with adverse birth outcomes were cases and mothers without adverse birth were controls. Data was collected by structured interviewer-administered questionnaires. In addition to the interview, the data collectors abstracted clinical data by reviewing the mother and the babies’ medical records. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Finally, multivariable logistic regression was used to identify determinants of adverse birth outcomes at P-value < 0.05.

Results

A total of 495 mothers (165 cases and 330 controls) were included in the study with a mean age of 28.48 + 5.908. Low ANC visit (AOR = 3.92: 95% CI; 1.86, 8.2), premature rupture of membrane (AOR = 2.83: 95% CI; 1.72,4.64), being Anemic (AOR = 2: 95% CI; 1.16,3.44), pregnancy induced-hypertension (AOR = 2.3:95% CI; 1.4,3.85), not getting dietary supplementation (AOR = 2.47:95% CI; 1.6,3.82), and physical abuse (AOR = 2.13: 95% CI; 1.05,4.32) were significantly associated with the development of the adverse birth outcome.

Conclusion

Low antenatal care visit, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve antenatal care follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00776-0.

The adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Birth outcomes are measures of health at birth and their magnitude is dramatically decreased in the past 40 years. However; there is still a large gap between developing and developed countries. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. For appropriate prevention of adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. In this study, low Antenatal care (ANC) visits, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve ANC follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.

Co-infections and Comorbidities of Multiple Parasites and Hepatitis B Virus Infections in the Lowland Area of Western Ethiopia: Implications for Integrated Approaches

Background

In the current study area, the burden of morbidities associated with S. mansoni, soil-transmitted helminths (STHs), asymptomatic malaria, and hepatitis B virus (HBV) infections and co-infection has not been known for the last 20 years. This necessitated a systematic investigation of the status of these infections and their associated morbidities in the lowland areas of the Abbey and Didessa Valleys in Western Ethiopia.

Methods

We used a cross-sectional study design in three schistosomiasis endemic areas. Systematic random sampling and simple random sampling techniques were used to select households and one study participant from each household. Each selected and consented participants were give stool sample for S. mansoni and soil-transmitted helminths screening using duplicate kato-Katz technique; blood sample for screen of asymptomatic malaria using malaria rapid diagnostic test and microscopy and hepatitis B virus using hepatitis B surface antigen kit and anthropometric measurement to assess nutritional status and digital hemoglobin meter to measure hemoglobin and interviewed using structured questionnaire to assess factors associated with infections. A descriptive statistic to summarize the data and a chi-square test, Fisher's exact test, and binary logistic regression models were used to see the associations.

Results

The overall prevalence of studied infections was 74.5%. It was highest for Schistosoma mansoni (53.9%), followed by asymptomatic Plasmodium falciparum infection (23.6%). The prevalence of Schistosoma mansoni co-infection with asymptomatic malaria was 8.6%, Schistosoma mansoni and soil-transmitted helminths co-infection was 6.2%, and the seroprevalence of hepatitis B virus was 2.9%. About half (49.9%) of the study participants were undernourished and about a quarter (24.4%) were anemic. Age group, the younger age group and infection status, those with multiple infections were more anemic and commonly undernourished.

Conclusion

There was a high prevalence of infections in the study area. Morbidities such as undernutrition and anemia were still prominent public health problems. There was a significant association between infection status and undernutrition and anemia.

Patterns of road traffic accident, nature of related injuries, and post-crash outcome determinants in western Ethiopia - a hospital based study

Introduction

Ethiopia is one of the countries with the worst road traffic accident records in the world and it ranks second among east African countries. There have not been sufficient studies that mainly reflect the post-crash determinants of deaths and this study was therefore done to assess the overall nature of injuries and the post-crash outcome determinants of road the traffic accident in western part of Ethiopia.

Methods

This was a hospital-based prospective study conducted from 1 January 2019 to 31 December 2019 using an area sampling technique. Five administrative zones in west Ethiopia were initially selected as a geographical cluster; out of which, four zones were randomly selected. Then, a total of four hospitals were conveniently selected. Finally, 327 people injured in road traffic accidents and brought to the selected hospitals were consecutively included.

Results

Overall, 189 (66.1%) of the casualties have sustained multiple injuries and 65 (24.0%) of them have got severe injuries. About 38.8% and 13.6% have respectively died and discharged with permanent disabilities. A longer distance from receiving hospital (AOR: 1.4, 95% CI [0.48–4.08]), singleness in the number of injury (AOR: 4.3, 95% CI [2.08–9.8]), and lack of receiving pre-hospital care (AOR: 4.072, 95% CI [1.197–13.85]) had statistical associations with increased number of death. On the other hand, injured people who were taken to the hospitals by police officers (AOR: 0.371, 95% CI [0.160–0.860]) than emergency medical technicians and those who were transported by other vehicles (AOR: 2. 58, 95% CI [1.21–5.52]) than ambulance have ironically survived more.

Conclusion

This study concludes that the road traffic accidents related deaths occur largely due to the seriousness of injuries and are exacerbated by lack of adequate pre-hospital emergency care services, costing the lives of many Ethiopians.

Investigation of Moral Hazard Deportments in Community-Based Health Insurance in Guto Gida District, Western Ethiopia: A Qualitative Study

INTRODUCTION

Ethiopia introduced CBHI in 2011 as part of the health sector finance improvement. This study was accompanied to identify moral hazard behaviors in community-based health insurance in Guto Gida District of Oromia regional state.

METHODS

The qualitative study used data generated from focus group discussions and in-depth interviews. Three health service centers were purposively selected for the study. Thematic analysis was accomplished using the NVivo-12 software package as it operates better in qualitative data analysis.

RESULTS

The study found that member's frequent visit to health service centers, tendency to collect more drugs, sense of feeling cheated by the insurance, tendency to use their cards redundantly, giving their cards to nonmembers, and seeking for most often expensive drugs were the demand side moral hazard behaviors explored by the study. From the supply side, inflating the price of drugs, increasing the price of services, alleging for services not provided, overstating the number of customers obtained insurance package and insulting users are found as moral hazard problems.

CONCLUSION

The study concluded that moral hazard behavior is discouraging from both the demand and supply sides. The presence of moral hazard discourages members of CBHI and creates reluctances in the scheme officials and workers. The policy implication is that tremendous attention should be given to reducing the level of moral hazard behaviors from the sides of both users and providers.

Prevalence and Factors Associated with Delayed Initiation of Antiretroviral Therapy Among People Living with HIV in Nekemte Referral Hospital, Western Ethiopia

Background

Ethiopia has adopted the “Universal Test and Treat” strategy to its national policy in 2016 to put all people living with HIV/AIDS (PLHIV) on antiretroviral therapy (ART) regardless of their World Health Organization (WHO) clinical stage or CD4 cell count level. A significant percentage of PLHIV start therapy has been delayed despite the availability of ART, which results in poor treatment outcomes including HIV-related morbidity and mortality, and continued HIV transmission.

Methods

This cross-sectional study was conducted to determine the magnitude and associated factors of delayed ART initiation among PLHIV at ART Clinic, Nekemte Referral hospital, Western Ethiopia between January 1, 2020 and March 31, 2020 for the time period of January 1, 2016 to December 31, 2019. A consecutive sampling method was used to recruit 417 study subjects. The collected data were entered into Epi data version 3.1 and exported to STATA version 14 for statistical analysis. Logistic regression analysis was used to identify associated factors with delayed ART initiation among PLHIV. P-values<0.05 were used to declare significant association.

Results

A total of 417 PLHIV were included in the study. The mean age of study subjects was 33.49 (SD±9.81) years. The majority of participants attended formal education (77%) and were urban dwellers (82%). One-third (34%) of them initiated ART delayed, beyond 7 days of confirmed HIV diagnosis. Subjects with normal nutritional status (BMI=18.5–24.9kg/m²) (AOR=3.12, 95% CI=1.29–7.57; P=0.012), CD4 count ≥351cells/mm³ (AOR=2.89, 95% CI=1.27–6.58; P=0.011), tuberculosis (TBC) co-infection (AOR=2.76, 95% CI=1.13–6.70; P=0.025), use of traditional treatment (AOR=4.03, 95% CI=2.03–8.00; P<0.001) and did not know other ART user(s) (AOR=2.86, 95% CI=1.52–5.37; P=0.001) were significantly associated with delayed ART initiation.

Conclusion

Early HIV testing mechanisms and timely linkage to HIV care by advocating “Test-and-Treat” should be strengthened.

Seroepidemiology of Peste des Petits ruminants in sheep and goats in the selected district of Horu Guduru Zone, Western Ethiopia

Peste des Petits Ruminants (PPR) is an acute, highly contagious, economically important transboundary viral disease of small ruminants. The objectives of this cross-sectional study were to estimate the seroprevalence and associated risk factors of PPR in small ruminants in selected districts of Horo Guduru Zone, Western Ethiopia. A total of 806 blood samples, corresponding to 124 flocks comprised of 387 sheep and 419 goats, were collected using multi-stage sampling. The sera were tested using competitive Enzyme-Linked Immunosorbent Assay (c-ELISA). A pre-tested questionnaire was used to collect data on potential risk factors for PPRV infection. Pearson's Chi-Square and logistic regression analyses were used to see the association of the seroprevalence with potential risk factors. The flock-level overall seroprevalence of PPR was 27.42% (95% confidence interval [CI]: 19.79-36.15%). An overall animal level seroprevalence of 5.71% (95% CI: 4.21-7.54%) was recorded with 6.98% (95% CI: 4.65-10.00%) seroprevalence in sheep and 4.53% (95% CI: 2.75-6.99%) in goats. There was a significant association between the seroprevalence and risk factors that were sharing common grazing land (P = 0.032), the introduction of newly purchased animals into the flock (P = 0.011), and uncontrolled animal movements in goats (P = 0.018). Sharing common grazing land with other flocks in goats (P = 0.026) and midland altitude in sheep (P = 0.029) were the other predictors of PPR. The seropositivity in unvaccinated small ruminants suggests the circulation of the virus. Therefore, awareness creation, vaccination, strengthening the disease surveillance system and large-scale epidemiological and molecular studies are suggested.

Under nutrition as a predictor of poor academic performance; the case of Nekemte primary schools students, Western Ethiopia

OBJECTIVE

Though gradual improvements are exist; Ethiopia's learning outcomes are still low in primary schools. Academic achievement of school age children can be affected by several factors such as nutritional status, socio-economic and demographic factors. The aim of this study was to assess predictors of poor academic performance in Nekemte Primary school students, Western Ethiopia.

RESULTS

A total of 362 schoolchildren and their parents were involved in the study. The study involved interviewing the participants and their parents, anthropometric measurement of participants and their document review. The prevalence of stunting and underweight was 30.2% and 45.9% respectively. Of the total study participants, 32.2% of them were poor in academic achievement. Variables like Being underweight (Adjusted odds ratio (AOR): 0.57; 95% Confidence interval (CI) 0.23-0.82), Skipping breakfast (AOR: 2.1; 95% CI 1.42-5.76), stunting (AOR: 0.66; 95% CI 0.12-0.93), being male (AOR: 2.8; 95% CI 1.79-4.52), participants whom mothers didn't attend formal education (AOR: 0.62; 95% CI 0.37-0.92) were significantly associated with academic performance. Thus, Modifiable factors like under nutrition should be a great concern to improve the overall achievement of children in schooling.

Primary school teachers' misconceptions about Attention Deficit/Hyperactivity Disorder in Nekemte town, Oromia region, Western Ethiopia

Objective

Teachers’ misconception on Attention Deficit/Hyperactivity Disorder (ADHD) in general and the implementation of effective educational strategies for children with this problem in particular is one obstacle that largely impacts the academic and overall success of school children with this problem. In Ethiopia, despite there are thousands of school children with this ADHD, no studies have been conducted to examine school teachers’ understanding about problem. This research was therefore aimed to investigate primary school teachers’ misconceptions about ADHD in Western Ethiopia.

Result

In this study, 76.2% of respondents had misconception on general awareness of ADHD. More than half (62.7%) of them had misconceptions on the diagnosis and on 81% had misconceptions regarding treatment of the problem. Concerning teachers’ misconception on the contemporarily recommended educational placement of students with ADHD, 141 (68.3%) have said that such students should be placed in part time special education. The findings of this research have clearly indicated that primary school teachers have a wide range of misconceptions about the ADHD. It also reflects the need of equipping teachers with basic knowledge of ADHD which also enables them provide effective support for students with this exceptionality.

Assessment of focused antenatal care utilization and associated factors in Western Oromia, Nekemte, Ethiopia

Objective

Despite the fact that quality antenatal care is one of the essential aspects in maternal and child health care, the current perceived quality and associated factors of this service is not well acknowledged in Ethiopia. This study was therefore undertaken to assess focused antenatal care service utilization and associated factors in western Ethiopia.

Result

This study has measured the utilization of focused antenatal care services in terms of regularity of frequency of attendance, initiation time and completeness of the components. In about 19.8% of mothers attendance was irregular. While than three-fourths 330 (78.6%) started in the second trimester, and 42 (10%) of them commenced in the third trimester. The essential components of the services like counseling on nutrition, family planning, and HIV/AIDS were respectively missing in 1.9%, 8.3% and 7.4% of clients. Providing and receiving quality ANC was found to have emanated from different factors which were related to mothers, providers and facilities. Although the overall ANC utilization noticed deceivingly seems satisfactory, it was not fully comprehensive, focused and not to its current standard. Further efforts in terms of effective planning, monitoring and evaluation activities on the service are therefore strongly recommended.

Susceptibility to cigarette smoking and associated factors among high school students in western Ethiopia

OBJECTIVE

Tobacco smoking is one of the leading causes of preventable premature death worldwide. Adolescence is a common period at which most of the established smokers start experimenting and smoking. The aim of the study was to determine the prevalence of susceptibility to cigarette smoking and associated factors among high school students in western Ethiopia.

RESULT

The prevalence of susceptibility to cigarette smoking among the study participants was 16.9%. Two-third (65.9%, 95% CI; 62.77, 68.87) of the students reported that they are exposed to second hand smoking in public areas. Students, whose father smoked (OR 2.76, 95% CI [1.26, 6.09]), whose friends smoked (OR 3.73 95% CI [1.57, 8.90]). Adolescents who have the perception that boys who smoke are attractive (OR 2.26, 95% CI [1.24, 4.09]) and smoking cigarettes makes young people look cool (OR 1.47, 95% CI; [1.01, 2.17]) were more likely to be susceptible to smoking. Having the knowledge that tobacco smoking is harmful (OR .43, CI 95% [.28, .67]) to health was found to be a protective factor against susceptibility to smoking cigarette.

Knowledge, Attitude, and Practice of Complementary and Alternative Medicine Among Residents of Wayu Town, Western Ethiopia

Complementary and alternative medicine covers a wide variety of therapies and practices, which vary from country to country and region to region. The study was conducted to assess the knowledge, attitude, and practice of complementary and alternative medicine among the residents of Wayu town, Western Ethiopia. A descriptive cross-sectional study was carried out on 302 residents. A systematic sampling was used to select households. Data were entered in SPSS (version 20; IBM Corp) and descriptive statistics was carried out. Of 302 participants, 51.65% have a good knowledge, 78.6% were aware of complementary and alternative medicine, and 74.22% used it in the past 2 years. A total of 23.83% believe that complementary and alternative medicine is more effective than modern medicine and 28.8% preferred complementary and alternative medicine to modern medicine. This study revealed that in Wayu town, there is relatively high public interest in complementary and alternative medicine practices and a significant number has a good knowledge but generally the attitude toward complementary and alternative medicine is relatively low.

Bovine trypanosomosis: changes in parasitemia and packed cell volume in dry and wet seasons at Gidami District, Oromia Regional State, western Ethiopia

BACKGROUND

Animal trypanosomosis is one of the major disease problems affecting agricultural productivity in Ethiopia. The impact of the disease is believed to vary with season and agro-ecologies in line with fly vector distribution. A cross-sectional study on bovine trypanosomosis was conducted from November 2015 to June 2016, in seven selected villages of Gidami district, Oromia Regional State, western Ethiopia. A total of 930 blood samples were collected and subjected to parasitological and hematological analysis.

RESULT

The overall prevalence of bovine trypanosomosis was 14.1%. The seasonal prevalence shows 9.06% in early dry and 18.4% in early rainy seasons. Three trypanosome species, Trypanosoma congolense, Trypanosoma vivax and Trypanosoma brucei were identified in the examined animals. T. congolense followed by T. vivax were the predominant species (respectively 59.0 and 35.9% in early dry season and 62.0 and 22.8% in early rainy season). The prevalence of T. vivax remained similar in both early dry and early rainy seasons in both lowland and midland agroecologies whereas T. congolense was more dominant in the lowland area in both seasons compared to mid land study sites. The disease was more prevalent in lowland (23.9%) compared to midland (11.1%) during early rainy season (P < 0.001) whereas no significant difference was observed between the two agroecologies during early dry season (P = 0.165). Packed cell volume (PCV) was much lower in parasitemic animals than in aparasitemic cattle whereas the mean PCV value for parasitemic animals (20.36%; 95% CI 19.56 to 21.16) in early dry season was similar to values in early rainy season (20.46%, 95% CI 18.84 to 21.08%). A similar situation was noticed for animals in both low land and mid land study sites.

CONCLUSION

Overall, the detection of trypanosomes in blood was significantly affected by agro-ecology, season and body condition of the animals. Special emphasis should be given to integrated trypanosomosis management in early rainy months where fly population is believed to start increasing.