Clinical epidemiology of COVID-19 among hospitalized children in rural western Kenya

The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection

Identifying opportunities to reduce cervical cancer prevention disparities in Western Washington

Thesis (Ph.D.)--University of Washington, 2023Cervical cancer screening (CCS) and human papillomavirus (HPV) vaccination are at the heart of the global cervical cancer elimination movement. However, in the United States (US), less than two thirds of age-eligible adolescents are up to date for HPV vaccination, and screening coverage among minorities and immigrants is still low. This dissertation addressed critical knowledge gaps in CCS adherence among East African immigrants and the association of maternal screening adherence with adolescent HPV vaccination. In addition, it predicted the impact of screening by self-sampling on the burden of cervical cancer among East African immigrants in Washington State. The first chapter examined cervical cancer screening adherence and its correlates among 1,664 East African immigrant females aged 25-65 years with ≥1 primary care clinic visit(s) between 2017 and 2018, using electronic health record (EHR) data from University of Washington (UW) Medicine. It also included an analysis of the screening uptake of overdue women who were retrospectively followed for 12 months. Adherence to cervical cancer screening was 63%, and older age, longer duration of care, higher visit frequency, index visit in an obstetrics and gynecology clinic, having an assigned primary care provider, and breast and colorectal cancer screening adherence were associated with higher CCS adherence. Low body mass index was associated with lower screening adherence. Only 9% of overdue women were screened within 12 months of follow-up, and having commercial health insurance compared to having Medicare/Medicaid was associated with higher screening uptake. The second chapter also used EHR data and assessed the association between maternal CCS and adolescent HPV vaccination among adolescent-mother pairs who had ≥1 primary care visit at UW Medicine between 2018 and 2020. It also assessed the associations between maternal breast cancer screening adherence and HPV vaccination, and maternal receipt of a recent wellness visit with HPV vaccination. For the association of maternal CCS and adolescent HPV vaccination, effect modifications by adolescent sex, maternal language interpreter use, and provider characteristics were further evaluated. Of 4,121 identified adolescents, 3,395 (82%) initiated HPV vaccination, and 2,020 (49%) completed the series. CCS adherence and recent maternal wellness visit were associated with higher HPV vaccination. There was no statistically significant association between maternal breast cancer screening and HPV vaccination. The associations of maternal CCS and adolescent HPV vaccination were stronger for male vs. female adolescents, adolescents with a primary care provider with a specialty in Family Practice vs. Pediatrics, and adolescents with the same primary care provider as their mother’s vs. not. The third chapter estimated the impact of screening by self-sampling relative to primary HPV testing via provider collection as the standard of care on cervical cancer incidence and mortality among East African immigrants using a Markov cohort state-transition model for the natural history of high-risk HPV. A hypothetical cohort of 10,000 East African immigrant women aged 25 years was followed until age 80, and outcomes for various scenarios of screening coverage and colposcopy adherence were compared across the screening strategies. Keeping the colposcopy adherence for self-sampling lower than the standard of care based on empirical evidence balanced out the potential gains in screening coverage; cancer incidence and mortalitywere not significantly different across the strategies except when self-sampling coverage increased to 100%. Screening by self-sampling yields lower incidence and mortality of cervical cancer relative to the standard of care when both strategies have equal colposcopy adherence. Overall, cervical cancer screening adherence among East African immigrants was lower than the national average of 80%, and patients with frequent and long-term connections to the health system had higher screening coverage. As our model predicted, self-sampling can be a better alternative for CCS if followed by increased screening coverage and high compliance for follow-up testing. Nevertheless, it can still be an option for under-screened people who could not get screened otherwise. More importantly, since maternal adherence to cervical cancer screening along with attendance to wellness visits had a positive association with HPV vaccination, leveraging healthcare encounters in addition to designing culturally tailored interventions could potentially improve both CCS adherence and adolescent HPV vaccination

Prevalence of unintended pregnancy and associated factors among married women in west Belessa Woreda, Northwest Ethiopia, 2016

Abstract Background Unintended pregnancies can have adverse physical, mental, social, and economic outcomes. Illegal abortions and associated complications often follow unintended pregnancies and claim the lives of many women in developing countries. To better understand how unintended pregnancy impacts married women, this study aimed to assess the prevalence of unintended pregnancies and associated factors among married pregnant women in West Belessa woreda, Ethiopia. Methods A community-based cross-sectional study was conducted from August to September 2015.. A multistage stratified sampling technique was used to select nine kebeles, to participate in the study. A total of 619 married pregnant women were selected from these kebeles by the simple random sampling technique and data were collected with a structured questionnaire. Binary logistic regression analysis was used to identify factors associated with the unintended pregnancies. A p-value of < 0.05 in the multi-variable model was used to identify significance. Result A total of 592 married pregnant women were surveyed regarding their intention to become pregnant. The prevalence of unintended pregnancy was 13.7%. Age at pregnancy (AOR: 15.2, 95% CI (1.9, 125.2)), history of stillbirth (AOR: 3.3, 95% CI (1.4, 7.9)), discussing pregnancy related issues with husbands (AOR: 2.3, 95% CI (1.1, 5.0)), making family planning decisions on their own (AOR: 0.4, (0.2, 0.8)), and making family planning decisions with their husbands (AOR: 95% CI 0.2 (0.1, 0.4)) were significantly associated with unintended pregnancies in this group. Conclusion The magnitude of unintended pregnancy in the study area was low. Age at pregnancy, history of stillbirth and involvement of partners in making reproductive health choices were associated with unintended pregnancies. Empowering women to make family planning decisions and increasing partner involvement in reproductive health could decrease unintended pregnancies

Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling.

INTRODUCTION:Loss to follow up after the initiation of antiretroviral therapy (ART) is common in Africa, particularly in Ethiopia and it is a considerable obstacle for the effectiveness of the ART program. Mortality is a competing risk of loss to follow up but it is often overlooked and there is limited evidence about the incidence and predictors of loss to follow up in the presence of competing events. OBJECTIVE:To assess the Incidence and predictors of loss to follow up among adult HIV patients on ART in University of Gondar Comprehensive Specialized Hospital between January 1, 2015, and December 31, 2018. METHODS:Institution based retrospective follow up study was conducted in University of Gondar Comprehensive Specialized Hospital. A Gray's test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow up. Bivariable and multivariable competing risk regression models were fitted to identify the predictors of lost to follow up and those variables with p-value <0.05 in the multivariable analysis was considered as significant predictors of lost to follow up. RESULT:A total of 531 adult HIV patients on ART were included in the analysis. The incidence rate of loss to follow up in this study was 10.90 (95% CI: 8.9-13.2) per 100 person years. Being age group 15-30 years (aSHR = 2.01; 95%CI;1.11-3.63), being daily laborer(aSHR = 2.60; 95%CI;1.45-4.66), not receiving cotrimoxazole preventive therapy (aSHR = 2.66; 95%CI;1.68-4.21), not receiving isoniazid preventive therapy(aSHR = 4.57; 95% CI;1.60-13.08), ambulatory functional status (aSHR = 1.61; 95% CI; 1.02-2.51) and taking AZT-3TC-NVP medication at start of ART(aSHR = 2.01; 95% CI; 1.16-3.78) were significant predictors of lost to follow up. CONCLUSION:In this study the incidence of lost to follow up was high. Young people, daily laborer, ambulatory patients and those taking AZT-3TC-NVP as well as those who did not take opportunistic prophylaxis were at higher risk of loss to follow up. Therefore, giving special attention to the high-risk groups for lost to follow up highlighted in this study could decrease the rate of LTFU

Treatment outcomes in patients with multidrug-resistant tuberculosis in north-west Ethiopia

Objective: Multidrug-resistant tuberculosis (MDR-TB) is an emerging public health problem in Ethiopia. The aim of this study was to assess MDR-TB treatment outcomes and determine predictors of poor treatment outcomes in north-west Ethiopia. Methods: A retrospective cohort study was conducted using all MDR-TB patients who were enrolled at Gondar University Hospital since the establishment of the MDR-TB programme in 2010. A Cox proportional hazard model was used to identify the predictors of time to poor treatment outcomes, which were defined as death or treatment failure. Results: Of the 242 patients who had complete records, 131 (54%) were cured, 23 (9%) completed treatment, 31 (13%) died, four (2%) experienced treatment failure, 27 (11%) were lost to follow-up, six (2%) transferred out, and 20 (8%) were still on treatment at the time of analysis. The overall cumulative probability survival of the patients at the end of treatment (which was 24 months in duration) was 80% (95% CI: 70%, 87%). The proportion of patients with poor treatment outcomes increased over time from 6% per person-year (PY) during 2010–2012, to 12% per PY during 2013–2015. The independent predictors of time to poor treatment outcome were being anaemic [AHR = 4.2; 95% CI: 1.1, 15.9] and being a farmer [AHR = 2.2; 95% CI: 1.0, 4.9]. Conclusions: Overall, in north-west Ethiopia, the MDR-TB treatment success rate was high. However, poor treatment outcomes have gradually increased since 2012. Being a farmer and being anaemic were associated with poor treatment outcomes. It would be beneficial to assess other risk factors that might affect treatment outcomes such as co-infection with malaria, poverty and other socio-economic and biological risk factors

Coping Strategies for Adverse Effects of Antiretroviral Therapy among Adult HIV Patients Attending University of Gondar Referral Hospital, Gondar, Northwest Ethiopia: A Cross-Sectional Study

Background. Adverse effects from antiretroviral therapy (ART) have an impact on quality of life and medication adherence. There is no clear understanding of how people manage the adverse effects of ART. The individual taking medications which cause serious adverse effects may choose to stop or reduce the medications to relieve the adverse effects. Hence, this study was aimed at assessing coping strategies for adverse effects of ART among adult human immunodeficiency virus (HIV) patients. Methods. A cross-sectional study was conducted at HIV clinic of University of Gondar Referral Hospital (UoGRH). A total of 394 study participants were recruited by systematic random sampling. Data were collected through interviewing patients. Data were entered to Epi-Info 3.5.4 and analyzed using SPSS-20.0. Descriptive statistics were used to summarize patient’s sociodemographic data and the adverse effects of their ART regimen. Binary and multivariate logistic regressions were used to investigate the potential predictors of nonadherence coping strategies. Results. The majorities of study participants were females (66%) and aged between 35 and 44 years (38.1%). The major adverse effects reported by the participants were headache (48.2%) followed by fatigability (18%) and loss of appetite (17.5%). Coping strategies used by HIV patients for adverse effect of ART were positive emotion coping strategy (91.1%), social support seeking (76.6%), taking other medications (76.6%), information seeking (48.7%), and nonadherence (35.5%). Younger age (AOR = 29.54, 95% CI = 2.49–35.25, p = 0.007), low level of education (AOR = 5.70, 95% CI = 2.16-15.05, p < 0.001), and living far from the health institution (AOR = 2.68, 95% CI = 1.29–5.57, p = 0.008) were associated with nonadherence coping strategy to relieve the adverse effects of ART. Conclusion. The present study revealed that positive emotion coping was the most commonly used strategy. Age, level of education, and distance from health institution were the predictors of nonadherence coping strategy

Treatment outcomes in patients with multidrug‐resistant tuberculosis in north‐west Ethiopia

Objective: Multidrug-resistant tuberculosis (MDR-TB) is an emerging public health problem in Ethiopia. The aim of this study was to assess MDR-TB treatment outcomes and determine predictors of poor treatment outcomes in north-west Ethiopia. Mehtods: A retrospective cohort study was conducted using all MDR-TB patients who were enrolled at Gondar University Hospital since the establishment of the MDR-TB programme in 2010. A Cox proportional hazard model was used to identify the predictors of time to poor treatment outcomes, which were defined as death or treatment failure. Results: Of the 242 patients who had complete records, 131 (54%) were cured, 23 (9%) completed treatment, 31 (13%) died, four (2%) experienced treatment failure, 27 (11%) were lost to follow-up, six (2%) transferred out, and 20 (8%) were still on treatment at the time of analysis. The overall cumulative probability survival of the patients at the end of treatment (which was 24 months in duration) was 80% (95% CI: 70%, 87%). The proportion of patients with poor treatment outcomes increased over time from 6% per person-year (PY) during 2010-2012, to 12% per PY during 2013-2015. The independent predictors of time to poor treatment outcome were being anaemic [AHR = 4.2; 95% CI: 1.1, 15.9] and being a farmer [AHR = 2.2; 95% CI: 1.0, 4.9]. Conclusions: Overall, in north-west Ethiopia, the MDR-TB treatment success rate was high. However, poor treatment outcomes have gradually increased since 2012. Being a farmer and being anaemic were associated with poor treatment outcomes. It would be beneficial to assess other risk factors that might affect treatment outcomes such as co-infection with malaria, poverty and other socio-economic and biological risk factors

Chronic energy deficiency and associated factors among adults living with HIV in Gondar University Referral Hospital northwest Ethiopia

BACKGROUND: Human Immunodeficiency Virus (HIV) infection and chronic energy deficiency are bidirectional and multifaceted. HIV can cause or worsen chronic energy deficiency by increasing energy requirements, reducing food intake and nutrient absorption. Chronic energy deficiency weakens the immune system, increase the susceptibility to infections and worsening the disease impact. Studies on the magnitude and factors associated with chronic energy deficiency among adults living with HIV are limited. The aim of this study was to assess the prevalence of chronic energy deficiency and associated factors among adults living with HIV in Gondar University Referral Hospital, northwest Ethiopia. METHODS: An institution based cross-sectional study was conducted and systematic random sampling was used to select study subjects. A total of 317 study subjects were enrolled in the study. Structured and pretested questionnaire was used to collect socio-demographic, economic and diet related variables. Weight and height measurement were taken and medical charts were reviewed. Laboratory analysis for CD4 count and anemia was done. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy deficiency. RESULTS: A total of 317 patients provide complete information with response rate of 99.4%. The overall prevalence of chronic energy deficiency was 18.3% (95%CI: 14.5%–22.7%). The prevalence of mild, moderate and severe chronic energy deficiency was 11.4, 3.5 and 3.5% respectively. No formal education (AOR = 2.05,95%CI:1.01,4.21), being in the WHO clinical stage three and four (AOR = 3.84,95%CI:1.39,10.61) and history of diarrhea in the last two weeks prior to the survey (AOR = 4.43,95%CI:1.83,10.72) were significantly associated with chronic energy deficiency. CONCLUSION: The prevalence of chronic energy deficiency among adults living with HIV was medium public health problem. Educational status, WHO clinical stage, and history of diarrhea in the last two weeks prior to the survey were risks for chronic energy deficiency. Integration of nutritional management with HAART, early diagnosis and treatment of diarrheal disease would be supreme important

Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study

Background There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. Methods This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. Result Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. Conclusion The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151804/1/Gashaye etal_PlosOne_2019.pdfDescription of Gashaye etal_PlosOne_2019.pdf : Main articl