Patients' and Healthcare Professionals' Perspectives on Preoperative Informed Consent Procedure Obstacles and Potential Solutions, 2021: A Qualitative Study

Background

Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process.

Objective

This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement.

Methods

Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling.

Results

The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas.

Conclusions and Recommendation

Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system.

Magnitude and determinants of improved household latrine utilization in Ethiopia: Multilevel analysis of the mini Ethiopian Demographic Health Survey (EDHS) 2019

INTRODUCTION

Lack of sanitation is a major global problem mainly for the poor and disadvantaged. According to the 2016 Ethiopian Demographic and Health Surveys (EDHS) report, one out of every three households lack a toilet in Ethiopia and about 56% of rural households use unimproved toilet facilities. We aimed to determine the magnitude of improved household latrine utilization and its determinants in Ethiopia using the mini-Ethiopian Demographic Health Survey (EDHS) 2019 data set.

METHOD

A secondary data analysis was conducted based on the mini 2019 EDHS data set. A total weighted sample of 8663 households were involved in analysis. After selecting the relevant variables for the outcome variable, we have fitted four different models. The null (empty) model with no independent variables and the second model contained the effects of the individual-level factors on the outcome variable. The third model included the influence of the community-level factors on the response variable, and the final multilevel multivariable logistic regression model examined the effects of individual-level and community-level variables on the outcome variable. The measure of variation was quantified using Intra-Class Correlation (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV). The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was used to show the strength of association and statistical significance was declared at p value < 0.05.

RESULTS

The magnitude of improved latrine utilization in Ethiopia was 19.5% with 95% CI (18.6%, 20.3%). The factors: educational status (AOR = 1.67; 95% CI: (1.10, 2.55), highest wealth index (AOR = 3.73; 95% CI: (2.73, 5.12), urban residence (AOR = 3.09; 95% CI: (1.68, 5.67), living in Addis Ababa (AOR = 4.08; 95% CI: (1.03, 16.2) and Dire Dawa (AOR = 8.22; 95% CI: (2.46, 27.42) and Somali regions (AOR = 3.11; 95% CI: (1.15, 8.42) were significantly associated to improved latrine utilization in Ethiopia.

CONCLUSION

The magnitude of improved latrine utilization was quite low in Ethiopia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.

Neonatal outcomes of preterm neonates and its predictors in Ethiopian public hospitals: Multicenter prospective follow-up study

Introduction

Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors.

Objective

This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021.

Methods

A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P-value less than 0.05.

Result

The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (β = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (β = 0.85; 95% CI: 0.49, 1.22), body mass index (β = -1.34; 95% CI: -1.87, -0.80), non-union marital status (β = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (β = -0.66; 95% CI: -0.99-0.32), multiparous (β = 0.35; 95% CI: 0.01, 0.69), hypothermia (β = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (β = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (β = -1.23; 95% CI: -1.99,-0.46) were significant predictors.

Conclusion

In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births.

Trends change in teen pregnancy among adolescent women in Ethiopia based on Ethiopian demographic and health surveys: Multivariate decomposition analysis

BACKGROUND

Teenage pregnancy may adversely affect their health, economic, and social life. Evidence shows that no studies in Ethiopia used decomposition analysis to identify factors for the trend change in teen pregnancy. Therefore, this study aimed to examine the trends and identify contributing factors to teen pregnancy in Ethiopia using multivariate decomposition analysis.

METHOD

We obtained the data on adolescent women from three Ethiopian Demographic and Health Surveys. A weighted sample of 3266 in 2005, 4009 in 2011, and 3381 teenagers in 2016 were involved in this study. Statistical analysis was performed using STATA 14. Multivariate decomposition analysis was used to identify contributing factors to the change in teen pregnancy. The coefficient value with a 95% confidence interval was used to identify significant factors associated with teen pregnancy.

RESULTS

The prevalence of teen pregnancy in Ethiopia decreased significantly from 15.9% [95% CI: 14.3, 17.7] in 2005 to 12.5% [95% CI: 10.8, 14.3] in 2016. Multivariate decomposition analysis showed that approximately 83% of the overall change in teen pregnancy over time was due to differences in women's composition. Age, marital status, education status, working status, contraceptive use, and sexual status before age 18 were statistically significant contributing factors to the decline in teen pregnancy over time.

CONCLUSION

The prevalence of teen pregnancy in Ethiopia decreased significantly over time. The overall decline in teenage pregnancy is due to differences in population composition. Public health interventions should focus on changing cultural norms or attitudes regarding early marriage and pregnancy within religious leaders and uneducated communities.

Survival status and predictors of mortality from severe community-acquired pneumonia among under-five children admitted at Debre Tabor comprehensive specialized hospital: a prospective cohort study

Background

Globally, Pneumonia continues to be the leading cause of mortality among under-five children. Ethiopia ranks fourth out of 15 countries worldwide in terms of the highest death rate of under-five children due to severe community-acquired pneumonia (SCAP). However, to date, there is no recent study that shows survival status and predictors of mortality from SCAP. Therefore, this study aimed to determine survival status and predictors of mortality from this dangerous disease among under-five children.

Methods

A facility-based prospective cohort study was conducted from 1 November 2021 to 31 October 2022 at Debre Tabor comprehensive specialized hospital. All under-five children with SCAP admitted during the study period were included. Participants were selected using a systematic sampling technique. The collected data were coded, edited, and entered into epi-data version 4.2 and then exported to STATA version 17 for further analysis. The Kaplan Meier failure estimate with log-rank test was employed to determine the survival estimates. A cox-proportional hazard regression model was fitted to identify significant variables.

Results

The overall incidence density rate of mortality was 5.7 /1000 children with a median hospital stay of 8.2 days. Heart disease (AHR: 4.37; 95%CI: 1.68-11.32), previous admission of SCAP (AHR: 3.87; 95% CI: 1.31-11.43), WFL < -3Z score (AHR: 3.57; 95% CI: 1.02-12.42), impaired consciousness level at admission 3.41(1.14-10.19), and pleural effusion (AHR: 3.42; 95%CI: 1.18-9.93) were significant predictors of mortality.

Conclusion

In this study, the survival probability of children with SCAP was low. Children with heart disease, previous admission of SCAP, WFL < -3Z score, impaired consciousness level at admission, and pleural effusion had low survival. Therefore, much emphasis is needed on children with SCAP, particularly those with identified predictors.

Survival and predictors of breast cancer mortality in South Ethiopia: A retrospective cohort study

BACKGROUND

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity.

METHODS

A hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit.

RESULTS

The study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7-23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30).

CONCLUSION

Beyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women.

Patients' satisfaction and associated factors towards preoperative informed consent process: A cross-sectional study

Background

Informed consent is a process that needs time and effort to satisfy patients' desires. Patient dissatisfaction on preoperative informed consent process may be caused by multiple factors of clinical practice. This study aimed to assess patients' satisfaction and associated factors of informed consent process among elective surgical patients.

Methods

A cross-sectional study was conducted on 404 postoperative patients who signed the informed consent for elective surgery. A systematic sampling technique was applied to select the study participants. Modified Leiden perioperative patient satisfaction tool was adapted to assess patients' satisfaction with preoperative informed consent process. Data were entered in to Epi-data version 4.20 and exported to SPSS version 20 for analysis. Bivariate and multivariable logistic regression was computed to identify independent variables associated with patient satisfaction towards preoperative informed consent process. A p-value of less than 0.05 was used to declare the statistical significance.

Results

The overall satisfaction of patients with preoperative informed consent process was 70.3%. Multivariable logistic regression analysis revealed that, being male (AOR: 4.75, 95% CI: 2.47-9.16), primary school (AOR: 8.42, 95% CI: 4.74-7.55), secondary school (AOR: 2.17, 95% CI: 5.74-8.62), rural residence (AOR: 1.8, 95% CI: 2.1-3.9) and received general anesthesia (AOR: 2.92, 95% CI: 1.62-5.26) were significantly associated with patients' satisfaction with the informed consent process.

Conclusion

The overall patients' satisfaction on preoperative informed consent process was relatively low. Being male, low level of education, living in rural area, and receiving general anesthesia were significantly associated with patients' satisfaction on informed consent process. Surgeons and anesthesia professionals need to work more to improving the satisfaction of patients with preoperative informed consent process. Researchers are expected to do periodic assessment of patients' level of satisfaction and factors affecting satisfaction.

Knowledge on risk factors and practice of early detection methods of breast cancer among graduating students of Debre Tabor University, Northcentral Ethiopia

Background

Breast cancer is the greatest common cancer in women worldwide, with approximately 1.7 million new cases diagnosed each year in the world which accounts for 12% of all new cancer cases and 25% of all cancers in women. Even though the higher mortality rate of breast cancer in low and middle-income countries, the practice of early detection methods is low and the majority of the patients who appeared at an advanced stage of the disease need palliative care with little survival rates. However, evidence is scarce on the knowledge and practice of breast cancer early detection methods among women of reproductive age in Ethiopia. Therefore we aimed to assess the knowledge on risk factors and practice of early detection methods of breast cancer among female graduating students of Debre Tabor University.

Methods

Institution-based cross-sectional study was conducted. A stratified random sampling technique was used. Data were collected with a self-administer questionnaire. The collected data were processed and analyzed with the computer using SPSS version 25 software. Descriptive statistics were used to describe the socio-demographic information of participants. Binary and multivariable logistic regression with an adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify factors associated with the outcome variable. Statistical significance was stated at p < 0.05.

Result

A total of 270 female students participated in the study. The median age (± SD) was 24.63 years (± 1.26). All of the students heard about breast cancer and early detection methods. About 206 (76.67%) of the participants had good knowledge of breast self-examination. Mass media, health professionals, and friends in combination were the main source of information 172 (63.77%), only 110 (40.70%) of students performed a breast-self-examination and the rest did not perform it due to forgetting fullness and lack of knowledge. About 208 (77.1%) of the respondents respond family history is a risk factor for breast cancer. Being a health science student (AOR = 2.32; 95% CI: 2.12, 3.52), family history of breast problems (AOR = 3.41; 95% CI: 3.22, 8.33), and having a good level of knowledge (AOR = 1.83; 95% CI: 1.01, 5.68) were the factors associated with the practice of breast self-examination.

Conclusion

Most of the participants were unaware of the benefits, appropriate timing, and techniques of doing a breast self-examination. Health science students had better awareness & practice of breast self-examination than non-health science students. Trained health professionals must give focus on giving health information regarding risk factors of breast cancer and methods of early detection of breast cancer to the public & their clients.

Evaluation of total oxidative stress and antioxidant capacity of brain tumour patients attending referral hospitals in Addis Ababa, 2020: a comparative cross-sectional study

Background

The exact cause of brain tumours is still unknown, but disruptions of redox balance are thought to play a significant role in all stages of brain tumour development. However, the roles of free radical imbalance at different grades of brain tumour and degree of oxidative stress before and after surgery have not been addressed in prior studies.

Aim

A comparative cross-sectional study was conducted to assess the redox imbalance among confirmed brain tumour patients.

Methods and results

An institution-based comparative cross-sectional study was conducted on a total of 100 participants (50 brain tumour patients and 50 controls) at referral hospitals in Addis Ababa, Ethiopia. Descriptive statistics, t-test and analysis of variance (ANOVA) (post-hoc) analysis were used and statistical significance was declared at p ≤ 0.05. The serum oxidised glutathione and total oxidative stress were significantly higher in the serum of brain tumour patients (0.72 ± 0.03 μM/μg and 9.66 ± 1.76 μmol H2O2 Eq/L, respectively) compared to the control group (0.21 ± 0.07 μM/μg and 6.59 ± 0.81 μmol H2O2 Eq/L, respectively) (p ≤ 0.05). The serum total oxidant status gradually increased as the tumour grade increased, being higher in grade four (11.96 ± 0.72) and lower in grade one (8.43 ± 1.56), and the mean differences were statistically significant (p ≤ 0 05). A statistically significantly higher total antioxidant capacity (116.78 ± 5.03 Trolox Eq/L) was obtained in the post-surgery than pre-surgery level (79.65 ± 17.914 Trolox Eq/L) (p ≤ 0 05).

Conclusion

Higher oxidant and lower antioxidant levels were found in the serum of brain tumour patients than in the control group. The post-surgery oxidant level was lower than the pre-surgery state. The findings of this study could suggest that redox imbalance may have a role in the pathophysiology of brain tumours, but further experimental studies are needed.

Survival Time to COVID-19 Severity and Its Predictors in South Gondar Zone, North-West Ethiopia: A Prospective Cohort Study

Background

Methods

Results

Conclusion and Recommendation

Prevalence, intensity of infection and associated risk factors of soil-transmitted helminth infections among school children at Tachgayint woreda, Northcentral Ethiopia

BACKGROUND

Soil-transmitted helminths (STH) are one of the most common infections affecting underprivileged populations in low- and middle-income countries. Ascaris lumbricoides, Trichuris trichiura, and hookworm are the three main species that infect people. School children are the most vulnerable groups for STH infections due to their practice of walking and playing barefoot, poor personal hygiene, and environmental sanitation. However, evidence is limited in the study area. So, this study aimed to assess the current prevalence, infection intensity, and associated risk factors of STHs among school children in Tachgayint woreda, Northcentral Ethiopia.

METHODS

A cross-sectional study was conducted among school children of Tachgayint woreda from February to May 2021. The study participants were chosen via systematic random sampling. Stool samples were collected from 325 children and examined using the Kato-Katz technique. The data was analyzed using SPSS version 23. Binary and multivariable logistic regression analyses were used to identify the potential associated factors for STHs. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the magnitude of the association. A P-value <0.05 was considered statistically significant.

RESULTS

The overall prevalence of STHs in this study was 36.0% (95% CI: 30.5-41.2%). Ascaris lumbricoides are the most prevalent species 89 (27.4%) followed by hookworm 14 (4.3%) and Trichuris trichiura 10 (3.1%). All of the infected school children had light-intensity of infections with the mean of eggs per gram (EPG) being 464.53. Lack of shoe wearing habit (AOR = 4.08, 95% CI: 1.29-12.88) and having untrimmed fingernail (AOR = 1.85, 95% CI: 1.06-3.22) were identified as risk factors for STH infections.

CONCLUSIONS

More than one-third of the school children were infected with at least one STH species and this indicates that STHs are still a health problem among school children in the study area. Therefore, periodic deworming, implementation of different prevention strategies, and health education programs should be regularly applied in the area.

Survival and Predictors of Mortality among Breast Cancer Patients in Northwest Ethiopia: A Retrospective Cohort Study

BACKGROUND

Breast cancer is the most common malignant tumor and the leading cause of cancer death in over 100 countries. Despite the high burden of difficulty, the survival status and the predictors for mortality are not yet determined in Ethiopia. Studies related to this area are scarce. Therefore, we aimed to estimate the survival status and predictors of mortality among breast cancer patients in Northwest Ethiopia.

METHODS

A retrospective cohort study design was carried out from September 2015 to August 2020 among 482 women who had breast cancer in Northwest Ethiopia. A systematic sampling technique was employed to select the required representative sample. The Cox regression model was used to identify the predictors of mortality among breast cancer patients.

RESULTS

For this study, 482 participants had followed for 8824 person-months total analysis time or at-risk time. In our findings, the overall survival of breast cancer patients at the end of two and five years was 54.24% and 25.8%, respectively. In the multivariable Cox regression model, age, stage of BC, menopausal status, and surgical therapy were significant predictors of death.

CONCLUSION

The overall survival after two years was 54.24%, and after five years was 25.8%. This result is lower than the recently published report and indicates that in LMIC, especially in rural cancer centers, the infrastructure and resources for routine screening mammography are often unavailable. Therefore, there is a need to promote early diagnosis of BC at each level of health-care delivery point.

Incidence and associated factors of postdural puncture headache for parturients who underwent cesarean section with spinal anesthesia at Debre Tabor General Hospital, Ethiopia; 2019

Introduction and Objective

Postdural puncture headache is one of the most frequent late complications of spinal anesthesia. There are different factors that might predispose for postdural puncture headache. Therefore, the main aim of this study was to assess the incidence of postdural puncture headache and its associated factors for parturients who gave birth by cesarean section under spinal anesthesia.

Methods

Hospital-based longitudinal study was conducted on mothers who underwent cesarean section with spinal anesthesia. Descriptive analysis and chi-square test were employed. Bivariable and multivariable logistic regression were used to measure the association of factors with the presence of postdural puncture headache. A p-value of ⩽0.05 was used to decide statistical significance for multivariable logistic regression.

Result

A total of 119 parturients were participated in this study. The incidence of postdural puncture headache was 20.2%. According to multivariable logistic regression, having previous spinal anesthesia (adjusted odds ratio = 7.028; 95% confidence interval = 2.377-20.781; p = 0.0001), using 20- and 22-gauge needle (adjusted odds ratio = 4.206; 95% confidence interval = 1.247-14.187; p = 0.021), and repeated attempt (adjusted odds ratio = 4.699; 95% confidence interval = 1.594-13.872; p = 0.05) had statistically significant association with postdural puncture headache.

Conclusion

Larger gauge needle size, repeated attempt, and previous spinal anesthesia might increase the incidence of postdural puncture headache.

The shadow challenges to improve the state essential newborn care practices in healthcare providers: evidence from a multicentre cross-sectional study in Ethiopia

Background

Neonatal mortality can be reduced by providing essential newborn care. However, it is overlooked by most healthcare providers in Ethiopia. Hence, this study aims to examine immediate essential newborn care practices and associated factors among healthcare providers in Ethiopia.

Methods

Institution-based cross-sectional study was conducted among 214 healthcare providers from November 11 to December 19, 2020, at a selected South Gondar health facility. Data were entered into Epi-data 4.2 and then exported to STATA14.0 for analysis. Both bivariable and multivariable logistic regression with a 95% confidence interval were computed. The variable that had a p-value less than 0.25 in bivariable logistic regression was entered into the multivariable logistic regression. In multivariable logistic regression, variables having a p-value < 0.05 were considered a statistically significant association with the poor practice of essential newborn care practice.

Results

The overall essential newborn care practice among healthcare providers was found to be 74.8% (95% CI: 68.4, 80.2). Diploma educational status (AOR = 7.8, 95% CI:2.80–21.9), presence of workload (AOR = 9.7, 95% CI: 2.76–23.9), unavailability of drugs and vaccines (AOR = 9.8, 95% CI: 6.95–17.7), and having no training (AOR = 3.9, 95% CI: 1.73–8.92) were found to be predictors for poor essential newborn care practices.

Conclusion

Essential newborn care practice among healthcare providers at South Gondar health institutions was found to be low. Being diploma educational status, presence of workload, unavailability of drugs and vaccines, and having no training were found to be independent predictors for poor practice of essential newborn care. Hence, periodic evaluation and strategies are needed for those predictor variables to address the gaps.

Level of knowledge and practice of female healthcare providers about early detection methods of breast cancer at Debre Tabor Comprehensive Specialised Hospital: a cross-sectional study

Background

Despite the higher mortality rate of breast cancer in low and middle-income countries, the practice of early detection methods is low and the majority of the patients presenting at an advanced stage of the disease need palliative care with low survival rates. Although healthcare providers are the key for practicing early detection methods of breast cancer for themselves and their clients, little is known about their knowledge and practice of early detection methods of breast cancer in Northcentral Ethiopia.

Methods

An institution-based cross-sectional study was conducted among female healthcare providers at Debre Tabor Comprehensive Specialised Hospital. Data were collected using a structured self-administered questionnaire. The data were analysed using SPSS version 23. Descriptive statistics were used to describe the socio-demographic information of participants. Binary and multivariable logistic regression with adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify factors associated with the outcome variable. Statistical significance was declared at p < 0.05.

Result

The mean (±SD) age of the participants was 31.4 (±7.8) years. About 106 (79.7%) participants had good knowledge about breast cancer early detection methods and only 56 (42.1%) of them practiced breast self-examination regularly. Work experience of >2 years (AOR = 3.2; 95% CI: 1.72, 5.29), history of any breast problem (AOR = 1.4; 95% CI: 1.02, 2.37), family history of breast cancer (AOR = 4.0; 95% CI: 2.58, 15.84), having good knowledge (AOR = 2.9; 95% CI: 1.3, 6.52) and history of comorbidities (AOR = 1.09; 95% CI: 1.09, 3.59) were the factors associated with the practice of breast self-examination.

Conclusion

Our study found that the knowledge and practice of breast cancer early detection methods was low in the study setting. Only less than half of female healthcare providers practiced regular breast self-examination, which suggests the need to provide training for healthcare providers to fill the gap and to promote early detection of breast cancer cases.

Community risk perception and barriers for the practice of COVID-19 prevention measures in Northwest Ethiopia: A qualitative study

Background

According to the World Health Organization, viral diseases continue to emerge and represent a serious issue for public health. The elderly and those with underlying chronic diseases are more likely to become severe cases. Our study sets out to present in-depth exploration and analyses of the community’s risk perception and barriers to the practice of COVID-19 prevention measures in South Gondar Zone, Northwest Ethiopia.

Methods

A qualitative study was done in three districts of South Gondar Zone. Community key informants and health extension workers were selected purposely for in-depth interviews and focus group discussion. The interviews were conducted by maintaining WHO recommendations for social distancing and use of appropriate personal protective equipment. The sample size for the study depended on the theoretical saturation of the data at the time of data collection. The qualitative data generated from in-depth interviews and focus group discussions was transcribed verbatim and translated into English language and thematically analyzed using open code software version 4.02.

Results

Three main themes and five categories emerged from the narrations of the participants regarding the perceived barriers for the practice of COVID-19 prevention measures. A total of 9 community key informants (5 women development armies (HDA), 2 health extension workers (HEW), and 2 religious leaders participated in the in-depth interview, while two focus group discussions (7 participants in each round) were conducted among purposely selected community members. The age of the participants ranged from 24 to 70 years with the median age of 48 years. The major identified barriers for practicing COVID-19 prevention measures were the presence of strong cultural and religious practices, perceiving that the disease does not affect the young, misinformation about the disease, and lack of trust in the prevention measures.

Conclusions

Socio-cultural, religious, and economic related barriers were identified from the participant’s narratives for the practice of COVID-19 prevention measures in south Gondar Zone. Our findings suggest the need to strengthen community awareness and education programs about the prevention measures of COVID-19 and increase diagnostic facilities with strong community-based surveillance to control the transmission of the pandemic.

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BACKGROUND

Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers.

METHODS

A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance.

RESULTS

Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition.

CONCLUSION

The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

Time to detection of anemia and its predictors among children living with HIV at Debre Tabor and University of Gondar Compressive Specialized Hospitals, 2020: a multicentre retrospective follow-up study

BACKGROUND

Even though antiretroviral therapy access for HIV infected children increased dramatically, anemia have been continued as a challenge regardless of a cluster of differentiation (CD4) count and viral load. Hence, this study aimed to assess the time to detection of anemia and its predictors among children living with HIV at Debre Tabor and university of Gondar compressive specialized hospital, 2020.

METHODS

A retrospective follow-up study was conducted from January 2010 to December 2018. A total of 372 children under the age of 15 who had received ART were included in the study. Data were collected from children's medical charts and ART registration logbook using a standard checklist. Besides, the data were entered into Epi data 4.2.2 and then exported to Stata 14.0 for further analysis. The Cox regression model, the variables having P-value ≤.05 with 95% CIs in multivariable analysis were declared as statistically significant for anemia.

RESULT

The mean (±SD) of follow-up periods were 56.6 ± 1.7 SD months. The overall median survival time free from anemia was 137 months, and the incidence rate of anemia was 6.9 per 100 PYO (95% CI: 5.3, 7.8). Moreover, WHO clinical staging of III/IV [AHR: 4.2, 95% CI: 1.80, 11.1], low CD4 count below threshold [AHR: 1.9, 95% CI: 1.09, 3.37], cotrimoxazole preventive therapy non-users, and poor level of adherence [(AHR: 2.4, 95% CI: 1.20, 4.85] were the main predictors of the time to detection of anemia.

CONCLUSION

The incidence rate of anemia in our retrospective cohort was high. The risk of anemia is present in children living with HIV infection but the risk for anemia is increased based on (WHO clinical staging III and IV, CD4 count below the threshold level, CPT non-users, and poor level of adherence). Since many of these risk factors are present routinely, even within one single patient, our clinical monitoring for anemia quarterly was fully justified as was our routine switch from standard therapies such as AZT to another regimen upon lab confirmation of anemia. Additional methods to improve cotrimoxazole preventative therapy and level of adherence are also needed.

Factors associated with advanced-stage diagnosis of breast cancer in north-west Ethiopia: a cross-sectional study

Background

Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia.

Methods

An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p-value < 0.05 was used as the cut-off point to select the determinants of the advanced stage.

Result

About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer.

Conclusion

Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation.

Knowledge and attitude towards blood donation among college students in Southwest Ethiopia

Introduction

blood donation (BD) is affected by several factors, among which people's knowledge and attitude are the key determinants. However, the level of knowledge and attitude towards BD in Ethiopia is not yet well studied. Therefore, this study aimed to assess the level and factors associated with knowledge and attitude towards blood donation among health science college students in Southwest Ethiopia.

Methods

a cross-sectional study was conducted among 394 health science students from June 1^st to 15^th 2019. The data were collected using a structured self-administered questionnaire. The data were entered using EPI-data version 4.2.0.0 and analyzed using SPSS version 20. The correlation analysis was done to determine the association between the knowledge sum score and the attitude sum score. A binary logistic regression analysis was done to determine the association between the dependent and independent variables.

Results

the proportions of good knowledge and positive attitude towards BD were 69.3%, 95% CI (64.8%-73.4%) and 58.1%, 95% CI (52.3%-63.0%) respectively. The study also found that age ≥23 years (adjusted odds ratio (AOR)=1.67, 95% CI (1.04-2.67)), having a father with primary and secondary school and above (AOR=2.24, 95% CI (1.20-4.17) and AOR=2.26, 95% CI (1.26-4.06) respectively) and ever donated blood (AOR=3.64, 95%CI (2.26-5.85)) were factors associated with good knowledge of blood donation. Being a rural resident (AOR=1.59, 95% CI (1.01-2.40)) and graduating class student (AOR=0.56, 95% CI (0.34-0.96)) were factors associated with a positive attitude towards blood donation. The knowledge-related questions´ sum score value was positively correlated with the attitude-related questions’ sum score value (r=0.30, P<0.001).

Conclusion

the knowledge and attitude towards BD among the study population are a substantial deficiency. Therefore, more effort is needed to increase the level of knowledge and attitude towards BD by inculcating short training courses for these groups of population in the existing curriculum.

Why women with breast cancer presented late to health care facility in North-west Ethiopia? A qualitative study

BACKGROUND

Although early diagnosis is a key determinant factor for breast cancer survival, delay in presentation and advanced stage diagnosis are common challenges in low and middle income countries including Ethiopia. Long patient delays in presentation to health facility and advanced stage diagnosis are common features in breast cancer care in Ethiopia but the reasons for patient delays are not well explored in the country. Therefore we aimed to explore the reasons for patient delay in seeking early medical care for breast cancer in North-west Ethiopia.

METHODS

A qualitative study was conducted from November to December 2019 using in-depth interviews from newly diagnosed breast cancer patients in the two comprehensive specialized hospitals in North West Ethiopia. Verbal informed consent was taken from each participant before interviews. A thematic content analysis was performed using Open Code software version 4.02.

RESULTS

Lack of knowledge and awareness about breast cancer, cultural and religious beliefs, economic hardships, lack of health care and transportation access, fear of surgical procedures and lack of trusts on medical care were the major reasons for late presentation of breast cancer identified from the patient's narratives.

CONCLUSIONS

The reasons for late presentation of patients to seek early medical care for breast cancer had multidimensional nature in Northwest Ethiopia. Health education and promotion programs about breast cancer should be designed to increase public awareness to facilitate early detection of cases before advancement on the existing health care delivery system.

Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study

Background

Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce.

Methods

Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay.

Results

A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay.

Conclusion

Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.

Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia

BACKGROUND

More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies.

METHODS

Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI.

RESULTS

The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI.

CONCLUSIONS

The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.

Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study

BACKGROUND

Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia.

PATIENTS AND METHODS

A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant.

RESULTS

Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91).

CONCLUSION

The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.

Abstract 2315: Perceived barriers to early diagnosis of breast cancer in south and southwestern Ethiopia: Qualitative study

Background: Early diagnosis is a key determinant of breast cancer prognosis and survival. However, advanced stage presentation and delays in diagnosis are common problems in Ethiopia. More than half of the cases are diagnosed at advanced stages and the barriers to early diagnosis are not well studied in the country. Hence, this study aims to explore perceived barriers to early diagnosis of breast cancer in South and Southwestern Ethiopia.

Methods: A qualitative study was conducted from March to April 2018 in six selected public hospitals located both in urban and rural settings. Twenty five purposefully selected breast cancer patients and health care providers from these public hospitals were interviewed. An in-depth interview was conducted using a topic guide by qualitative research experts. A thematic analysis was performed using Open Code software version 4.02.

Results: Patient and health system related barriers are two main themes identified for barriers to early diagnosis of breast cancer. Patient related barriers included lack of awareness and knowledge of the disease, beliefs in traditional and religious means of treatments, lack of social and financial support to seek medical care. Health system related barriers included misdiagnosis of cases, long distance referrals due to service inaccessibility, high diagnostic costs, long waiting time, unavailability of screening and diagnostic tests.

Conclusion: Early diagnosis of breast cancer is affected by a multitude of barriers in South and Southwestern Ethiopia. Hence, to increase early diagnosis of breast cancer, awareness campaigns and education about the disease, its prevention, and early detection are needed. Opportunities exist to improve early diagnosis and timely treatment by strengthening referral linkages of health care facilities in rural areas. Efforts are needed to decentralize the tertiary level oncology care and improve capacity in local health facilities.

Citation Format: Sefonias Getachew, Adamu Addissie, Aragaw Tesfaw, Lesley Taylor, Eva Kantelhardt. Perceived barriers to early diagnosis of breast cancer in south and southwestern Ethiopia: Qualitative study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2315.

Abstract C105: Late-stage diagnosis of breast cancer and associated factors at rural hospitals in Ethiopia: A mixed-method study

Background: A key factor for beneficial breast cancer (BC) outcome is detection at early stage; however, late-stage diagnosis of BC is a common problem in Africa. In Ethiopia the causes for late-stage presentation are not well studied, particularly in rural settings. Thus, the main aim of this study was to assess the magnitude of late-stage diagnosis of BC and its associated factors at six selected public hospitals in south and southwestern Ethiopia, where 80.6% of the population inhabits rural areas.

Methods: A hospital-based retrospective cross-sectional study was conducted from January 2013 to December 2017. A total of 426 BC patients' records were reviewed. Qualitative data were collected by in-depth interview from purposely selected health care providers and patients. Multiple logistic regression was used to identify factors associated with late-stage diagnosis of BC. P-value &lt;0.05 was used to determine level of significance.

Result: Of the 426 BC patients, 72.5% presented with late-stage disease (stage III and IV). The median age was 42.8 years (+/- 13.4 years). 93.4% of the cases were female. 73% (331/426) patients had longer than 3 months' delay to treatment. 89.9 % of the patients presented with a palpable mass and 42.3% presented with an active wound. Among all, 34.3% were referred to the regional centers by private and public health facilities, thus indicating a previous point of contact with a heath care provider. Almost one third (33.8 percent) were diagnosed with Grade III disease. Independent risk factors for late stage of presentation and diagnosis were the patient's own delay to care (AOR=1.87, 95% CI; 1.04, 3.38); living in a rural area (AOR=2.97, 95%CI; 1.66, 5.34); and delays within the health care system to refer (AOR=2.03, 95%CI; 1.09, 3.78). Females were at more risk than males (AOR=3.75 95%CI; 1.33, 10.54). Patients with breast masses (AOR=4.09, 95%CI; 1.66, 10.11), wounds (AOR=0.41, 95%CI 0.24, 0.72), and Grade III tumor (AOR=2.45, 95%CI; 1.27, 4.73) were also associated to late stage at presentation. The In-depth interview revealed that lack of awareness and knowledge to BC, use of traditional therapy, considering symptoms as “not serious,” and long waiting times to receive care at referred health facilities were the main reasons for late-stage presentation and diagnosis.

Conclusion: The study found that patient delay, rural residence, breast lump and wound, tumor grade, sex and a referral history were factors related to the high proportion of late stage at diagnosis. Hence, there is a need to increase patients' awareness to prevent delays in diagnosis and to strengthen the capacity of early detection, diagnosis and referrals within the health care system.

Citation Format: Aragaw Tesfaw, Sefonias Getachew, Lesley Taylor, Eva Johanna Kantelhardt, Adamu Addissie. Late-stage diagnosis of breast cancer and associated factors at rural hospitals in Ethiopia: A mixed-method study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C105.

Perceived barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative study

Background

Early diagnosis is a key determinant of breast cancer prognosis and survival. More than half of breast cancer cases are diagnosed at an advanced stage in Ethiopia, and the barriers to early diagnosis in this country are not well understood. We aimed to identify the perceived barriers to early diagnosis of breast cancer from the perspective of patients and health care providers in south and southwestern Ethiopia.

Methods

A qualitative study was conducted from March to April 2018 using in-depth interviews of breast cancer patients and breast cancer health care providers from six public hospitals located in urban and rural areas of south and southwestern Ethiopia. All participants provided verbal consent before participating. A thematic analysis was performed using Open Code 4.02.

Results

Twelve breast cancer patients and thirteen health care providers were included in the study. Patient and health-system related barriers to early diagnosis of breast cancer were identified. Patient-related barriers were lack of knowledge and awareness of breast cancer, belief in traditional medicine and religious practices for treatment, and lack of social and financial support to seek care at a medical facility. Health-system related barriers were misdiagnosis of breast cancer, long distance to referral facilities, high cost of diagnostic services, long waiting time for diagnostic tests, and lack of screening and diagnostic tests in local facilities.

Conclusions

Early diagnosis of breast cancer is affected by multiple barriers in south and southwestern Ethiopia. Awareness campaigns and education about the disease, prevention, and early detection are needed to increase early diagnosis of breast cancer. Opportunities exist to improve early diagnosis and timely treatment in rural areas.