Prevalence and associated factors of birth injury among neonates admitted at neonatal intensive care unit (NICU) in governmental hospitals of Southwest Ethiopian people regional state, Ethiopia: A multicenteric cross-sectional study

INTRODUCTION

Neonatal birth injury is the functional or structural damage of the new-born during child birth. Fetal related factors such as macrosomia, fetal height, fetal weight, and prematurity; maternal related factors such as overly young and old maternal age, parity, poor maternal health, and pelvic anomalies contribute to neonatal birth injury. Labor and delivery related factors including prolonged labor, fetal mal-presentation and mal-position, cesarean and instrumental deliveries also predispose the neonate to birth injury. This study was conducted to assess the prevalence and associated factors of birth injury among neonates admitted to the neonatal intensive care unit (NICU) in Governmental Hospitals of Southwest Ethiopia.

OBJECTIVE

To assess the prevalence and associated factors of birth injury among neonates admitted to the neonatal intensive care unit (NICU) in governmental hospitals in Southwest Ethiopia.

METHOD

Hospital-based cross-sectional study design was implemented at Mizan-Tepi University Teaching Hospital, Bonga Gebretsadik Shawo General Hospital, and Tepi General Hospital. A total of 1,315 neonates were included in the study using systematic random sampling techniques. Data was entered using Epi-Data version 4.2 and exported to SPSS version 21 for analysis. Logistic regression analysis was conducted to see the association between the dependent and independent variable.

RESULTS

The prevalence of neonatal birth injury was 16.7%. Predictors such as primipara, no formal education, mothers with no antenatal care, and mothers whose occupational status were unemployed were 12.27, 2.52, 2.40, and 4.26 times more likely to develop neonatal birth injuries than their counterparts, respectively. Whereas, maternal age within the age range of 25-34 years, and neonates delivered via instrumental delivery were 6.68, and 2.81 times more likely to develop neonatal birth injury compared to those whose age was greater than 34 years and neonates delivered through Cesarean section, respectively.

CONCLUSION

The magnitude of birth injury in the current study was significantly high. Primiparity, mothers with no history of antenatal care follow up, uneducated women, unemployed women, mode of delivery, and maternal age between 25 and 34 years were strong predictors associated with neonatal birth injury. Therefore, comprehensive maternal health care such as antenatal care follow up and health institution delivery should be promoted and well addressed to all reproductive age women and special attention should be given particularly to pregnant women in order to mitigate problems related to childbirth.

Factors associated with immunological and virological discordant responses to highly active antiretroviral therapy among adult HIV positive individuals in Ethiopia: A cross-sectional study

In clinical practice, not all human immune deficiency virus (HIV) positive individuals who received highly active antiretroviral therapy (HAART) achieve the desired concordant response characterized by a sustained viral suppression or immune recovery. The expected success of HAART doesn't occur in all treated patients and a discordant response between CD4 count and the viral load (VL) has been a major concern in the treatment of HIV patients. Thus, this study is designed to describe the factors associated with immunological and virological discordant responses to HAART among adult HIV positive individuals.A hospital-based cross-sectional study with secondary data review was conducted on 423 HIV positive individuals on HAART from February 1 to April 30, 2017. Socio-demographic characteristics, clinical data and about 10 mL of blood specimen for HIV VL, and CD4 count measurement were collected. The data was entered into SPSS version 20 and descriptive, bivariate, and multivariate logistic regression analysis was employed.The mean age of the patients at study time was 39 (±9.8). The average follow-up duration of patients on antiretroviral therapy (ART) was 7 (±3) years. The prevalence of immunological discordance and virological discordance to HAART were 13.2% and 47%, respectively. With multivariate logistic regression analysis duration of follow-up on ART ≤ 6 years (adjusted odds ratio [AOR] = 3.29 (1.80-6.03), P ≤ .001) and VL ≥20 copies/mm3 (AOR = 3.08 [1.70-5.61], P ≤ .001) were significant factors for immunological discordance conversely the patients who switched drug as a result of TB (AOR = 3.33 [1.10-10.08], P = .03) was significant factors for virological discordance.The prevalence of immunological discordance and virological discordance to HAART among HIV patients is high. Patients with the duration of follow-up on ART ≤ 6 years, VL ≥ 20 copies/mm3 and patients who switched drugs as a result of TB were significant factors for discordance. Hence, intensive adherence support and counseling should be provided to achieve the UNAIDS 90 target. HIV positive individuals co-infected with TB, who have had VL ≥ 20 copies/mm3 and who are ≤6 years duration of follow-up on ART need to be carefully monitored. In addition, national based study of discordant groups is recommended.

Predictors of Current CD4+ T-Cell Count Among Women of Reproductive Age on Antiretroviral Therapy in Public Hospitals, Southwest Ethiopia

Background

HIV/AIDS is one of the major global public health problems. CD4 is a glycoprotein found on the surface of different immune cells. CD4 cell counts determine the need for screening and prophylactic interventions against common opportunistic infections in those with advanced HIV disease. Thus, this study aimed to assess the predictors of current CD4⁺ T-cell count among women of reproductive age on antiretroviral therapy in public hospitals, southwest Ethiopia.

Methods

A cross-sectional study was conducted from February to April 2018. A total of 422 participants in the three public hospitals were selected using a systematic random sampling method. Linear regression analyses were used to determine the important predictors of current CD4⁺ T-cell count at p-values of <0.05.

Results

A total of 422 women with a median age of 37.00 years participated in this study. More than one in ten (12.8%) respondents experienced immunological failure. An increased current CD4⁺ T-cell count was observed among patients with a tertiary level of education [β = 56.45, 95% CI (3.5, 109.4)], baseline WHO clinical stage II [β = 44.06, 95% CI (5.3, 82.9)], initial regimen of AZT+3TC+EFV [β = 167.23, 95% CI (100.4, 234.1)], with increased baseline CD4⁺ T-cell count [β = 0.35, 95% CI (0.2, 0.5)], and with increased time duration on ART [β = 14.36, 95% CI (6.304, 22.4)]. On the other hand, the current CD4⁺ T-cell count was lowered among patients with poor baseline adherence, opportunistic infection, and viral load of ≥1000 by 181.06 cells/mm³, 101.62 cells/mm³, and 137.53 cells/mm³ compared to good baseline adherence, no opportunistic infection and undetectable viral load, respectively.

Conclusion

The immunological failure was relatively low. Maintaining adherence, early identification and treatment of opportunistic infections, and minimizing viral load to undetectable levels may further decrease immunological failure.

Prevalence and Associated Factors of Burnout syndrome among Nurses in Public Hospitals, Southwest Ethiopia

BACKGROUND

The Burnout syndrome has been defined as a response to the chronic work-related stress typically found in professionals working in care service organizations. Therefore, this study aimed at assessing the prevalence of burnout syndrome and factors associated with burnout syndrome among nurses in public hospitals, Southwest Ethiopia, 2018.

METHOD

An institutional-based cross-sectional study was conducted from February 1st, 2018 to April 1st, 2018. Total number of nurses who fulfill the inclusion criterias were enrolled. Data was collected using the predesigned tool. Data were entered using EPI INFO version 7 and was exported to statistical packages for social science (SPSS) version 21.0 for analysis. Logistic regression was employed and odds ratio with a 95% confidence interval was used. Variables with a P value of less than 0.05 was considered statistically significant.

RESULTS

A total of 282 eligible nurses were enrolled in the study with a mean age of 28.71 [SD ±7.047]. The prevalence of burnout syndrome among nurses was 96(34%). Predictor variables like; educational status, job title, work experience, fatigue, and social support were found to be strong predictor variables for burnout syndrome.

CONCLUSION

This study revealed that a considerable proportion of nurses had burnout syndrome. Therefore, improved educational status and strong social support should be encouraged among nurses working in the health setting for the betterment of health care services, job satisfaction and quality of care in general.

Factors Associated with Coronavirus Disease 2019 Prevention Practices in Three Zones of Southwest Ethiopia: Community-Based Cross-Sectional Study

BACKGROUND

The cases of coronavirus disease 2019 (COVID-19) and related deaths are increasing exponentially in Ethiopia. Prevention is currently available effective management, and its implementation has not been assessed adequately. This study aimed to identify the factors associated with COVID-19 prevention practices in three zones of southwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted in the Bench Sheko, Kafa, and West Omo zones. A multistage sampling technique was employed to select 845 study participants. The data collection tool was adapted from the WHO resources and related literature. Independent factors were identified using binary logistic regression and a p-value less than 0.05 was used to declare the level of statistical significance.

RESULTS

In this study, 803 participants participated. About two-thirds (64.7%) of the respondents had a history of going to crowded places, while only 30.3% of the participants had a history of wearing a mask when leaving home. Two-thirds of the respondents had a history of maintaining their distance at 2 meters (64.4%) and washing their hands with soap and water or using alcohol-based hand sanitizers (64.8%). Generally, less than two-thirds (59.4%) of study participants had a good prevention practices of COVID-19. Urban residence (AOR [adjusted odds ratio] =2.34; 95% CI=1.39, 3.94), highest family size (AOR=2.95; 95% CI=1.56, 5.57), good knowledge (AOR=1.74; 95% CI=1.10, 2.77), positive attitude (AOR=1.86; 95% CI=1.27, 2.73), intention to seek care (AOR=1.73; 95% CI=1.13, 2.63), and perceived mortality (AOR=2.20; 95% CI=1.50, 3.08) were positively associated with good prevention practices.

CONCLUSION

The proportion of individuals who had good COVID-19 prevention practices was inadequate. For such highly infectious diseases, prevention should be the priority intervention, and improving its implementation needs further effort. Community-based interventions such as risk communication and mass education should center on scaling up community knowledge and practice by prioritizing vulnerable groups such as rural residents.

Chronic Kidney Disease and Associated Factors Among HIV/AIDS Patients on HAART in Ethiopia

Background

In developing countries, both opportunistic infections and chronic diseases account a high HIV-associated mortality and morbidity. Chronic kidney disease (CKD) associated with HIV infection has got increased attention in sub-Saharan Africa as a result of the high HIV prevalence and due to the late diagnosis and initiation of HAART. Thus, this study was conducted to assess CKD and associated factors among HIV patients on HAART in Ethiopia.

Methods

A hospital-based cross-sectional study with a secondary data review was conducted on 336 on HIV/AIDS patients on HAART from February to July 2017 at University of Gondar Referral Hospital. The study participants were selected using a systematic random sampling technique. Socio-demographic and clinical data were collected using a semi-structured questionnaire at their follow-up date with interview and chart review. Three to five milliliters of venous blood and five milliliters of urine specimen were collected for serum creatinine and urine albumin determination, respectively. Data were entered into SPSS version 20 for analysis. Glomerular filtration rate was estimated using the CKD-EPI estimator. Bivariate and multivariate logistic regression was employed and p-value <0.2 and < 0.05, respectively, was considered statistically significant.

Results

The prevalence of CKD on the study participants was 54 (16.1%) (95% CI, 12.2–20.4%). By stage, about 27 (8.0%) had stage 1 (persistent proteinuria with eGFR ≥ 90 mL/min/1.73 m²), 16 (4.8%) had stage 2 (persistent proteinuria with eGFR of 60–89.9 mL/min/1.73 m²), 6 (1.8%) had stage 3 (eGFR 30–59.9 mL/min/1.73 m² with or without proteinuria) and 5 (1.5%) had stage 5 ((kidney failure), eGFR<15mL/min/1.73 m² with or without proteinuria). With multivariate logistic regression analysis, being male (AOR=2.05 (1.03–4.09), p=0.04), being merchant (AOR=2.91 (1.00–8.48), p=0.049) and having viral load≥1000 copies/mm³ (AOR=3.1 (1.38–7.00), P<0.01) were significantly associated with CKD.

Conclusion

The prevalence of CKD among HIV patients on HARRT is high. Being male, merchant and having viral load ≥1000 copies/mm³ were associated factors of CKD. Patients should be regularly monitored and screened for early diagnosis and management of CKD. Those patients who have being merchant with high viral load and male patients should require close monitoring.

Immunological Response During HAART and Determinants of Current CD4+ T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia

PURPOSE

After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4+ count. Several factors affect the CD4+ T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4+ T-cell count among HIV/AIDS patients on HAART.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p-value <0.2 in the bivariate analysis were entered in the multiple regression models. p-Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4+ T-cell count.

RESULTS

The mean CD4+ T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4+ T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [β=185.5, 95% CI (8.8, 362.2)] (p=0.040), with increased baseline CD4+ T-cell count [β=0.468, 95% CI (0.342, 0.594)] (p<0.0001), and with long duration on HAART [β=18.0, 95% CI (9.9, 26.1)] (p<0.0001), whereas a decreased level of current CD4+ T-cell count was observed among males [β=-72.7, 95% CI (-114.5, -30.9)]) (p<0.0001) and those with poor baseline adherence [β=-108.9, 95% CI (-210.9, -7.0)] (p=0.036) and viral load >1000 copies [β=-189.2, 95% CI (-243.5, -134.9)] (p<0.0001).

CONCLUSION

The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4+ count, viral load, and duration on HAART were independent determinants of current CD4+ count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.

The epidemiology of syphilis in Ethiopia: a protocol for systematic review and meta-analysis covering the last three decades

BACKGROUND

Several individual epidemiological studies in Ethiopia suggest that syphilis is a public health problem. However, to the best of our knowledge, there is no synthesized and meta-analysis data on the epidemiology of syphilis in Ethiopia. This systematic review and meta-analysis aimed to summarize and synthesize existing data on the prevalence of syphilis in Ethiopia.

METHOD

Studies reporting the prevalence of syphilis will be identified from major databases and gray literature. The major databases (MEDLINE/PubMed, EMBASE, Web of Science, CINAHL, The Cochrane Library, Lilacs, and African journal online) and gray literature (Google Scholar search engine, official WHO and CDC websites, the online library of academic and governmental institutions in Ethiopia) will be searched. Studies published/reported from 1 January 1990 to 1 January 2019 will be included to have a contemporary estimation. A random-effect meta-analysis of prevalence will be used after stabilizing the variance of included studies using a single arc transformation. The quality of the included studies will be assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments. Heterogeneity and publication bias will be assessed. If significant heterogeneity is detected, subgroup analysis will be done using study region, study population, diagnostic assay/syphilis screening tool, median sample size, year of data collection, study sites, sampling method, and methodological quality as grouping variables.

DISCUSSION

This systematic review and meta-analysis intend to contribute an improved knowledge on the epidemiology of syphilis in Ethiopia. Knowledge about the epidemiology of syphilis may help policymakers and other stakeholders to allocate resources and target interventions for the prevention and elimination of syphilis.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018116231.