Risk Factors for Cardiovascular Diseases among Diabetic Patients In Southwest Ethiopia

BACKGROUND: Studies on cardiovascular risk factors among diabetic persons in Ethiopia are lacking. The objective of this study was to determine the prevalence of the cardiovascular risk factors (hypertension, obesity, physical inactivity, dyslipidemia and smoking) among diabetic patients at the diabetic clinic of Jimma University Specialized Hospital. METHODS: A cross-sectional study was conducted from October to December 2007. Three hundred one individuals were randomly selected from 950 patients on follow-up. Data were collected using a structured format and appropriate equipments and reagents. Laboratory data were recorded in a separate checklist. The data were entered into SPSS for Windows version 12. Multivariate regression analysis was carried out to identify predictors of hypertension, obesity and dyslipidemia. RESULTS: Two hundred and fifty six (85.1%) of the sample participated in the study. The prevalence of hypertension, obesity, dyslipidemia, physical inactivity and current smoking was 46.5%, 23.4%, 63.5%, 55.1% and 5.5% respectively. Age . 45 years, type 2 diabetes and obesity were predictors of hypertension. Females were less likely to be hypertensive (OR =2.26, 3.37, 3.79 and 0.48 respectively). Type 2 diabetics and females were more while rural diabetics were less likely to be obese. (OR =6.08, 4.17 and 0.37 respectively). Female gender, hypertension and fasting blood glucose . 180mg/dl were predictors of dyslipidemia. Alcohol users were less likely to be dyslipidemic. (OR =4.25, 3.5, 3.56 and 0.39, respectively) CONCLUSION: Hypertension, obesity, dyslipidemia and physical inactivity were common while smoking was uncommon among diabetic patients in Jimma University Specialized Hospital. Type 2 DM was a predictor of hypertension and obesity. Diabetic women were more likely to be obese and dyslipidemic. We recommend screening and management of these risk factors

Knowledge, risk perception and practice regarding tuberculosis transmission among long distance bus drivers in Addis Ababa, Ethiopia: A cross sectional study

 Background: Window opening during bus transportation is recommended as a tuberculosis prevention strategy.Yet, drivers are affected by lack  knowledge and risk perception of passengers and assistants. Boosting  knowledge of and notifying the high risk of tuberculosis transmission for  every passenger could be too costly. However, strategies targeting bus  drivers as key agents unlike targeting all passengers might be less costly for window opening. Method: Data were collected from November 18/2014 to December  21/2014 in inter-region bus stations of Addis Ababa using cross sectional study design. Samples of 306 participants were selected using simple  random sampling, and data were collected through face-to-face interview. Data were entered into Epi-data version 3.1 andanalyzed using IBM SPSS version 21. Result: From a sample of 306 bus drivers, 303 were interviewed. Nine in ten and nearly half of participants believed in the need for opening all  windows and avoiding overcrowding of passengers as TB preventive  measures respectively. Few bus drivers (7.3%) believed that bus drivers and their assistants could be at risk of tuberculosis. The majority (85.7%) of bus drivers opened side window the whole day without precondition. Hearing tuberculosis related information from radio was a promoting factor for tuberculosis preventive measures among bus drivers. Conclusion: Tuberculosis preventive practices and knowledge of bus  drivers seempositive (opportunities), despite their low risk perception  (challenge). Using the opportunity, further empowering bus drivers to  persuade passengers and assistants to open all the rest of the windows is  needed.  Keywords: Tuberculosis, Knowledge, prevention practices, bus drivers, Ethiopi

Knowledge about Obstetric Danger Signs among Pregnant Women in Aleta Wondo District, Sidama Zone, Southern Ethiopia

Background: Raising awareness of women on danger signs of pregnancy, childbirth and the postpartum period is crucial for safe motherhood. In Ethiopia, a country where maternal morbidity and mortality is high little is known about knowledge level of pregnant women on obstetric danger signs. The objective of this study was to assess pregnant women's knowledge about obstetric danger signs in Aleta Wondo district, Sidama Zone, South Ethiopia. Methods: A community based cross-sectional study was conducted from January 18 – February 20, 2007, on a sample of 812 pregnant women selected from, 8 rural and 2 urban Kebeles. A structured pre-tested questionnaire was used to collect quantitative data on socio-demographic characteristics, obstetric history, and knowledge about danger signs of pregnancy, childbirth and post partum period. Qualitative data was collected through focus group discussion with pregnant women and in-depth interview with traditional birth attendants. The collected data were analyzed using SPSS for Windows version 12.0.1. Results: Seven hundred forty three pregnant women participated in the study making a response rate of 92%. Out of the 743 pregnant women who participated in this study 226 (30.4%), 305(41.3%) and 279(37.7%) knew at least two danger signs during pregnancy, childbirth and postpartum period, respectively. Being urban resident was con-sistently found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4). Conclusion: This study indicated that the knowledge level of pregnant women about obstetric danger signs (during pregnancy, childbirth and postpartum period) was low and affected by residential area. Therefore, the identified deficiencies in awareness should be addressed through maternal and child health services by designing an appro-priate strategies including provision of targeted information, education and communication

Risky sexual behavior and predisposing factors among students of Jimma University, Ethiopia

BACKGROUND: Students of higher institutions are assumed to be exposed to many risky sexual behaviors. However, little has been explored about the magnitude of risky behavior and predisposing factors in the context of higher education institutions in Ethiopia. Thus, the objective of this study was to assess the pattern of risky sexual behaviors and predisposing factors among Jimma University students. METHODS: This cross-sectional study was conducted in November 2009 involving quantitative and qualitative methods. The quantitative study was conducted on 1010 students selected by multistage cluster sampling technique. The data were collected using self-administered questionnaire and analyzed using SPSS V.16.0. Multi-variate logistic regression was used to see association between variables. The qualitative part involved 10 focus group discussions and 17 key-informant interviews selected purposively. The qualitative data were analyzed by thematic areas. RESULTS: Among the respondents, 267(26.9%) ever had sexual intercourse. The mean age at first sexual intercourse was 17.7±2.7 years. Most, 75.6%, started sexual intercourse during secondary school. Among whoever had sex, 51.0% had sex in the last 12 months and 28.3% had multiple sexual partners. Consistent condom use with non-regular partner in the last 12 months was 69.1%. Lack of parental control, substance use, peer pressure, campus and outside environment were identified as predisposing factors. CONCLUSION: Risky sexual behaviour such as having multiple sexual partner and sexual practice without condom with non- regular partner exists. The university and local health bodies should work together to address the identified risky behaviours with particular focus on Behaviour change communication.Keywords: risky behaviour, Jimma University, University students, predisposing factors, HIV/AIDSEthiopian Journal of Health Sciences vol 22 (3) 201

Assessment of potential drug-drug interactions among outpatients receiving cardiovascular medications at Jimma University specialized hospital, South West Ethiopia

Background: The quality of pharmacotherapy is highly dependent on the process of choosing a drug in relation to nature of the disease. Several factors should be considered in choosing optimal pharmacotherapeutics strategy including efficacy, safety, availability and cost of the drugs. The objective of this study was to assess potential drug-drug interactions and risk factors in outpatients taking cardiovascular drugs at Jimma University specialized hospital.Methods: A cross-sectional study was conducted from Feb. to April, 2011on patients visiting the cardiac clinic of Jimma University Specialized hospital. A sample of 332 outpatients who were taking cardiovascular medications at study clinic was studied. MicroMedex software was used to screen drug-drug interactions and SPSS for windows software versions-16.0 was used for data analysis.Results: A total of 1249 drugs with average of 3.76 drugs per prescription were prescribed for the 332 patients. The frequency of potential DDIs was found to be 241 (72.6%). Among these 200 (67.3%) were of "moderate" severity and 164 (55.2%) were delayed in onset. The most common potential DDI observed was between Enalapril and Furosemide (20%). Patients who prescribed many drugs (AOR=4.09; P=0.00) by medical intern had a higher risk of developing potential DDIs (AOR=4.6; P=0.00).Conclusions: Patients with cardiovascular disorders are subjected to high risk of potential drug-drug interactions and the number of drugs prescribed and educational level of the prescribers has a high significantly associated with the occurrence of potential drug-drug interactions. Therefore, it is imperative that further studies need to be conducted to identify reasons for and tackle the problem and provide appropriate mechanisms for management

Incidence, Causes and Outcome of Obstructed Labor in Jimma University Specialized Hospital

BACKGROUND: Obstructed labor is one of the common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Africa has the highest maternal mortality in the world, estimated at an average of about 1,000 deaths per 100,000 live births. This study was conducted to assess the incidence, causes and outcome of obstructed labor in Jimma University Specialized Hospital. METHODS: Hospital-based, cross-sectional study was conducted on all mothers who were admitted and delivered in the labor ward of Jimma University Specialized Hospital from November 1, 2008 to April 30, 2009. Data was collected using structured questionnaire and checklist, and then analyzed using SPSS for windows version 16.0. RESULTS: The incidence of obstructed labor was 12.2%. Out of these 61.5% did not have antenatal care follow-up. Most of the cases, accounting for 145(81.0%), 160 (89.4%) and 170 (93.9%) were referred from health centers, visited the hospital after at least 12 hours of labor and came from a distance of more than 10 kilometers, respectively. The causes of obstructed labor were cephalo-pelvic disproportion in 121(67.6%) and malpresentation in 50 (27.9%) of the cases. The commonest maternal complications observed were uterine rupture in 55 (45.1%) and sepsis in 48 (39.3%) of the cases with complications. Forty-five point eight percent of fetuses were born alive and all had low first minute APGAR score. CONCLUSION: The incidence of obstructed labor was high with high rate of complications. The antenatal care follow-up practice was also found to be low. Improved antenatal care coverage, good referral system, and availing comprehensive obstetric care in nearby health institution are recommended to prevent obstructed labor and its complications

Parents' Perception, Students' and Teachers' attitude towards School Sex Education

Background: Sex education is described as education about human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, family planning, body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods. This study was conducted to explore perception of parents about school sex education and assess the attitude of teachers and students towards school sex education.Methods: A cross-sectional quantitative and qualitative study was conducted on randomly selected 386 students, total census of 94 teachers and 10 parents in Merawi Town from March 13-27, 2011. Data were collected using self-administered structured questionnaire and in-depth interview guideline. Multiple linear regression analysis was performed using total score to determine the effect of the independent variables on the outcome variable and thematic analysis was used to analyze the qualitative data.Results: All study participants have favourable attitude towards the importance of school sex education. They also agreed that the content of school sex education should include abstinence-only and abstinence-plus based on mental maturity of the students. That means at early age (Primary school) the content of school sex education should be abstinence-only and at later age (secondary school) the content of school sex education should be added abstinence-plus. The students and the teachers said that the minimum and maximum introduction time for school sex education is 5 year and 25 year with mean of 10.97(SD±4.3) and 12.36(SD±3.7) respectively. Teacher teaching experiences and field of studies have supportive idea about the starting of school sex education. Watching romantic movies, reading romantic materials and listening romantic radio programs appear to have a contribution on the predictor of students’ attitude towards the starting time of school sex education.Conclusion: All study participants have a need to start sex education at school. All study participants said that at early age (Primary school) the content of school sex education is abstinence-only and at later age (secondary school) is added abstinence-plus. School Sex education should be under considers the need of students, teachers and parents.Keywords: Sex education, Attitude, perceptionEthiop J Health Sci. Vol. 22, No. 2 July 201

Health workforce acquisition, retention and turnover in southwest Ethiopian health institutions

Background: Skill mix of health professionals, staff acquisition and turnover rate are among the major challenges for the delivery of quality health care. This study  assessed the health workforce acquisition, retention, turnover rate and their  intention to leave.Methods: A cross-sectional survey with quantitative and qualitative data collection methods was conducted in Jimma Zone health institutions. Five years records (September 2009-August 2014) were reviewed to determine the turnover rate. A total of 367 health professionals were included for the quantitative study. For the qualitaive study, all available and relevant health managers and administrative records in the selected health institutions were included. Descriptive and inferential analyses were done for the quantitative study. Thematic analysis was used for the qualitative component.Results: A total of 367 health workers were incorporated for the quantitative study making a response rate of 87%. The overall health workers’ satisfaction was neutral (mean 3.3). In five years period, 45.9% staffs had left for a cause; 59.4% health professionals intended to leave. Being male (AOR =1.6, 95%CI: 1.001-2.5), not knowing their overall satisfaction (AOR=0.5, 95%CI: 0.2-0.8), below mean score of institutional satisfaction (AOR =1.7, 95%CI: 1.06-2.7) and below mean score of organizational satisfaction (AOR=1.8, 95%CI: 1.08-2.8) were independent predictors for intention to leave.Conclusions: The overall health workers’ satisfaction was marginally neutral. A considerable number of staffs had left, and more than half of the current staffs had an intention to leave. Thus, it is recommended that the responsible authorities should design strategies to improve the situation.Keywords: Health workforce, acquisition, retention, turnover, Ethiopi

Prevalence of lipodystrophy and metabolic syndrome among HIV positive individuals on Highly Active Anti-Retroviral treatment in Jimma, South West Ethiopia

Introduction: Use of highly active antiretroviral therapy has led to significant reductions in morbidity and mortality rates. However, these agents had also given rise to the metabolic and morphologic abnormalities which are modifiable risk factors for cardiovascular diseases. Evidences elsewhere indicate growing in prevalence of these problems but studies are lacking in Ethiopia. This study was conducted to determine the prevalence of HIVassociated lipodystrophy and metabolic syndrome in patients taking highly active antiretroviral therapy. Methods: A cross-sectional study was conducted in 2010 on a sample of 313 patients taking highly active antiretroviral therapy in Jimma University specialized hospital. Structured questionnaire was used to assess patients' sociodemographic characteristics and clinical manifestations of metabolic abnormalities. Checklists were used for reviewing charts about clinical manifestations of metabolic abnormalities and immunologic profile of patients. Data was cleaned, entered in and analyzed using SPSS for windows version 16.0. Results: Metabolic syndrome was detected in 21.1% and HIV-lipodystrophy was detected 12.1% of patients. The factors found to be independently associated with metabolic syndrome were taking the antiretroviral therapy for more than 12 months (AOR=4.2; 95% CI=1.24-14.23) and female sex (AOR= 2.30; 95% CI=1.0-5.27) and the factor found to be independently associated with HIV-lipodystrophy was taking the antiretroviral therapy (AOR=3.59; 95% CI=1.03-12.54) for more than 12 months. Conclusion: Metabolic abnormalities were relatively common in the study population. The problems were higher among those who took anti-retroviral treatment for longer duration. Therefore, regular screening for and taking action against the metabolic abnormalities is mandatory.Pan African Medical Journal 2012; 13:4

Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1-2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care