Prevalence of syphilis and associated factors among female sex workers in Ethiopia: findings from a multilevel analysis of a national bio-behavioral survey

BACKGROUND

Syphilis is a highly contagious sexually transmitted infection posing a significant public health challenge, especially in developing countries, including sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. However, data on national syphilis prevalence estimates and the associated factors are scarce in Ethiopia. This, as well as our limited knowledge about the extent of clustering among female sex workers in the country, is a critical gap in information we aimed to fill through this analysis.

METHODS

The study was a cross-sectional, bio-behavioral survey conducted among female sex workers in six cities and ten major towns in Ethiopia. Participants were selected using a respondent-driven sampling method. Survey participants provided blood samples for syphilis, HIV, and hepatitis serological testing. Survey data were collected via an interviewer-administered questionnaire. In this analysis, we employed descriptive statistics to summarize data on the study variables. In addition, we used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the dependent variable (syphilis prevalence) while accounting for the clustering effect.

RESULT

A total of 6085 female sex workers participated in the survey. Their median age [Interquartile Range (IQR) was 25 (8)] years, and a majority (96.1%) were in the 20-24-year-old age group. The prevalence of syphilis among female sex workers in Ethiopia's six cities and ten major towns was 6.2%. Being in the age group of 30-34 (AOR = 2.64; 95% CI = 1.40, 4.98) and 35-59 (AOR = 4.7; 95% CI = 2.5, 8.86), being divorced/widowed (AOR = 1.37; 95% CI = 1.03, 1.82), having no formal education (AOR = 3.38; 95% CI = 2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR = 2.77; 95% CI = 1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR = 1.80; 95% CI = 1.21, 2.69) were significantly associated with syphilis among female sex workers.

CONCLUSION

The prevalence of syphilis among female sex workers was high. Being divorced/widowed or in the older age group and having a low level of education were significantly associated with an increased risk of syphilis. The high prevalence and associated factors identified need to be considered in planning comprehensive interventions to control syphilis among female sex workers in Ethiopia.

Intimate partner violence and health system response in Nekemte town, Western Oromia, Ethiopia, 2019: A cross-sectional study

Objectives:

To assess intimate partner violence and health system response among married women.

Methods:

A mixed method of quantitative and qualitative cross-sectional community-based study was conducted from August to September 2019. Later than ethical clearance, the data were collected using a pretested structured questionnaire adapted from the literature. Study participants were selected using systematic random sampling. Data collected is entered into EpiData and then exported to SPSS version 25 for analysis. The odds ratio with their 95% confidence interval was calculated. Variables with p-value < 0.25 in bivariate analysis were entered into multivariate logistic regression. Statistical significance was declared if the p-value was <0.05.

Results:

From all 770 sampled participants in Nekemte town, 730 married women participated in this study, yielding a response rate of 94.8%. The prevalence of intimate partner violence was 55.9%. From this study finding, no intimate partner violence screening was done for 678 (92.9%) respondents who visited health facilities. Educational status of women, partner being illiterate, occupational status being merchant, and daily laborer were associated with intimate partner violence with (adjusted odds ratio = 1.73, 95% confidence interval = (1.05–2.83)), (adjusted odds ratio = 5.94, 95% confidence interval = (1.25–12.23)), (adjusted odds ratio = 4.41, 95% confidence interval = (1.49–13.01)), and (adjusted odds ratio = 3.74, 95% confidence interval = (1.33–10.50)), respectively, were factors found to be associated with intimate partner violence Nekemte town. One of the study participants whose age was 36 years responded that, “our culture approves men’s superiority; we accept intimate partner violence as part of our marital life.” There is an assigned focal person and training was given to them, but screening of intimate partner violence has not started yet and it was not integrated into any maternal service in our health center.

Conclusion:

This study shows that in excess of half of women experience intimate partner violence. Educational status, occupation and violence seen during childhood were the factors that contributed to intimate partner violence. Educating women and partners, integrating, and strengthening a health service are important.

Neonatal near miss and associated factors among neonates admitted to neonatal intensive care unit of hospitals in East Wollega, Western Ethiopia, 2019

Background:

Neonatal near miss is an infant who nearly died but survived from birth to 28 days. Neonatal period is the most vulnerable time for child’s healthiness and continued existence. Globally, about 2.5 million children died in their first month of life and 7000 die/day.

Objective:

To assess neonatal near miss and associated factors among neonates admitted to intensive care unit at hospitals in East Wollega, West Ethiopia, 2019.

Methods:

Quantitative, facility-based cross-sectional study was conducted from 15 July to 30 August 2019 on 403 neonates admitted to neonatal intensive care unit of hospitals. After ethical clearance, five recruited and trained nurses collected the data with pretested structured questionnaire. Neonates sampled were selected using systematic random sampling. Data entered into Epi-info version 7.1 and exported to SPSS Version 24. Binary logistic regression was performed, and adjusted odds ratio with P-value ⩽ 0.05 at 95% confidence interval was used as statistically significant.

Results:

All, 403, study participants were included in this study, yielding 100% response rate. From these, 196 (48.60%) neonates were near miss. In multivariable logistic regression, mother who lived in rural area (adjusted odds ratio = 3.84, 95% confidence interval = (1.78, 8.31)), cesarean section (adjusted odds ratio = 10.68, 95% confidence interval = (2.95, 38.71)), and neonates referred to hospitals (adjusted odds ratio = 3.32, 95% confidence interval = (3.27, 12.01)). Also, female neonates (adjusted odds ratio = 2.99, 95% confidence interval = (1.45, 6.14)) and multiple birth (adjusted odds ratio = 3.07, 95% confidence interval = (1.32, 7.16)) were significantly associated with neonatal near miss.

Conclusion:

Neonatal near miss found to be high compared to previously existing research in Brazil. Health institutions, health professionals, and concerned bodies on plan and implementation of neonatal care need to consider these factors during pregnancy, delivery, and for neonates immediate after birth and in neonatal intensive care unit.