Predictors of regular physical activity among Type 2 diabetes mellitus patients in Wolaita Sodo University teaching hospital using the Trans-Theoretical Model

Background: Globally, 382 million people are estimated to have diabetes. To date there is paucity of evidence regarding predictor of regular physical activity among Type 2 diabetes mellitus patients with application of Trans-theoretical model. Therefore the objective of this study was to determine predictors of regular physical activity among type 2 diabetes mellitus patients in Wolaita Sodo University hospital using the Trans- theoretical model. Method: Institutional based cross-sectional study was conducted on 400 systematic random selected Type 2 diabetes mellitus patients. One-way ANOVA was used to show mean scores differences of processes of change, decisional balance and self-efficacy across stages of change. Multivariable logistic regressions were also conducted.Result: Of the participants, 34.3% were physically active. The processes of change, the pros and the self-efficacy significantly increased from precontemplation to maintenance stage while the cons decreased across the stages (p<0.05). The result of multivariable logistic regression showed that pros, cons, self-efficacy, self-liberation and counter conditioning were predictors of physical activity.Conclusion: Type 2 diabetes mellitus patients’ physical activity was very low. Stage matched intervention should be designed to increase processes of change, pros and self-efficacy from precontemplation to maintenance stages. [Ethiop. J. Health Dev. 2018;32(2):97-103]Key words: Physical activity, Type 2 diabetes mellitus, Transtheoretical mode

Effect of Nutritional Status and Associated Factors on Pneumonia Treatment Outcome among Under-Five Children at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Acute respiratory infection is still a major health problem among under-five children specifically in Ethiopia, where 38% of them are reported as living in the status of under-nutrition. However, there are studies limitation regarding the relationship of nutritional status of under-five children and outcome of pneumonia treatment. Institutional based cross-sectional study design had been employed to see the Effect of nutritional status and associated factors on pneumonia treatment outcome among under-five children in 2015. Data was collected using interview administered structured questionnaires and anthropometric measurement.The study revealed that high probability of poor pneumonia treatment outcome 26(40%) among exposed groups. Those children to house wife mothers 11(16.92%), smoker family member 6(9.23%), non-fully immunized 9(13.85%), less than 500birr spent for a child 26(40%) are observed to be with poor pneumonia treatment outcome. The risk of poor pneumonia treatment outcome was 4 times and 5 times more like among children who lives with smoker family member and exposed groups respectively. But it was 0.075 and 0.05 times less like among Children from urban and whom their monthly budget is 1000 birr or more respectively.Child nutritional status has significant effect on pneumonia treatment outcome among under-five children. Undernourishment, smoker family member, rural residency, monthly budget are among factors impact pneumonia treatment outcome. Nutritional education, Mother education, Employing mothers, Budgeting more than 500 birr per child per month, alleviate smoking among the family member, Limiting family members number per house hold, All children should feed colostrums and Full immunization should be done

Factors Predisposing Out-of-School Youths to HIV/AIDS-related Risky Sexual Behaviour in Northwest Ethiopia

Ethiopia is a developing country with a demographic profile dominated by a young population. Due to biological, psychological, sociocultural and economic factors, young people, particularly those aged 15–24 years, are generally at a high risk of HIV/AIDS and other reproductive health problems. This paper presents results of a cross-sectional descriptive study conducted in Bahir Dar town, northwest Ethiopia, to assess factors that predispose out-of-school youths to HIV/AIDS-related risk behaviours. Both quantitative and qualitative data-collection methods were employed to conduct the study. For quantitative data collection, a household interview survey was conducted among 628 out-of-school youths, aged 15–24 years, within the 17 kebeles (villages) of the town. The number of respondents in each kebeles was assigned proportional to the size of kebeles, and the required numbers of respondents within each kebeles were selected through a systematic random-sampling technique. Qualitative data were collected by conducting five focus-group discussions with 46 participants and in-depth interviews with 10 participants. Institutional ethical clearance and informed verbal consent from the study participants were obtained before undertaking the study. Of the 628 study subjects, 64.8% had experienced sexual intercourse at the time of the survey. The mean age at first sexual commencement was 17.7 (+2) years. Of those sexually active, 33% had sexual intercourse with non-regular partners (the proportions were 40.6% among males and 24.7% among females, suggesting that males tended to be about two times more likely to have sex with non-regular sexual partners than females (odds ratio=1.78, with 95% confidence interval 1.16−2.73). Furthermore, consistent condom-use among those who had sex in exchange for money was low (36%). Alcohol intake, chewing of khat (a green leaf), low educational background, and being male were significantly associated with having sex with either a commercial or a non-regular sexual partner. In view of the magnitude of high-risk sexual behaviours among out-of-school youths that may expose them to HIV/AIDS and other sexually transmitted infections, efforts need to be exerted to deal with the identified predisposing factors and to address the problems of idleness, lack of jobs, and hopelessness

Household Fuel Use and Acute Respiratory Infections in Children Under Five Years of Age in Gondar city of Ethiopia

Acute respiratory infections (ARI) are the leading cause of childhood illness and death worldwide, accounting for an estimated 6.5% of the entire global burden of disease.  This study investigated the association between household use of biomass fuels for cooking and acute respiratory infections in preschool age children (< 5 years) in Gondar city of Ethiopia. This cross sectional study was based on 715 children age 0–59 months included in three clusters randomly selected from 12 administrative areas of Gondar city. Children who suffered from cough accompanied by short, rapid breathing during the two weeks preceding the survey were defined as having suffered from ARI. Logistic regression was used to estimate the odds of suffering from ARI among children from households using biomass fuels (wood, dung or straw) relative to children from households using cleaner fuels (liquid petroleum gas (LPG), or electricity) after controlling for potentially confounding factors. More than half of the children (54.7%) lived in households using biomass fuels from which 26.3% suffered from ARI during the 2 weeks preceding the survey interview. Children in households using wood, dung, or straw for cooking were 3.89 times more likely to have suffered from ARI as compared to children from households using LPG or electricity (OR = 3.89; 95% CI: 1.54, 28.25). Household’s use of high pollution biomass fuels is significantly associated with ARI in preschool age children in Gondar city, Ethiopia. The relationship needs to be further investigated using more direct measures of smoke exposure and clinical measures of ARI. Keywords: Acute respiratory illness, Indoor air pollution, Biomass combustion, Gondar cit

Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies

Background: The effectiveness of antiretroviral therapy (ART) depends on the choice of regimens during initiation. Most evidences from developed countries indicated that there is difference between efavirenz (EFV) and nevirapine (NVP). However, the evidences are limited in resource poor countries particularly in Africa. Thus, this systematic review and meta-analysis was carried out to summarize reported long-term treatment outcomes among people on first line therapy in sub-Saharan Africa. Methods: Observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio to compare risk of treatment failure among HIV/AIDS patients who initiated ART with EFV versus NVP were systematically searched. Searches were conducted using the MEDLINE database within PubMed, Google Scholar, HINARI, and Research Gates between 2007 and 2016. Information was extracted using standardized form. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effect, generic inverse variance method. Result: A total of 6394 articles were identified, of which, 29 were eligible for review and abstraction in sub-Saharan Africa. Seventeen articles were used for the meta-analysis. Of a total of 121,092 independent study participants, 76,719 (63.36%) were females. Of these, 40,480 (33.43%) initiated with NVP containing regimen. Two studies did not report the median CD4 cell counts at initiation. Patients who have low CD4 cell counts initiated with EFV containing regimen. The pooled effect size indicated that treatment failure was reduced by 15%, 0.85 (95%CI: 0.75–0.98), and non-nucleoside reverse transcriptase inhibitor (NNRTI) switch was reduced by 43%, 0.57 (95%CI: 0.37–0.89). Conclusion: The risk of treatment failure and NNRTI switch were lower in patients who initiated with EFV than NVP-containing regimen. The review suggests that initiation of patients with EFV-containing regimen will reduce treatment failure and NNRTI switch

Factors Predisposing Out-of-School Youths to HIV/AIDS-related Risky Sexual Behaviour in Northwest Ethiopia

Ethiopia is a developing country with a demographic profile dominated by a young population. Due to biological, psychological, sociocultural and economic factors, young people, particularly those aged 15-24 years, are generally at a high risk of HIV/AIDS and other reproductive health problems. This paper presents results of a cross-sectional descriptive study conducted in Bahir Dar town, northwest Ethiopia, to assess factors that predispose out-of-school youths to HIV/AIDS-related risk behaviours. Both quantitative and qualitative data-collection methods were employed to conduct the study. For quantitative data collection, a household interview survey was conducted among 628 out-of-school youths, aged 15-24 years, within the 17 kebeles (villages) of the town. The number of respondents in each kebele was assigned proportional to the size of kebele, and the required numbers of respondents within each kebele were selected through a systematic random-sampling technique. Qualitative data were collected by conducting five focus-group discussions with 46 participants and in-depth interviews with 10 participants. Institutional ethical clear\uadance and informed verbal consent from the study participants were obtained before undertaking the study. Of the 628 study subjects, 64.8% had experienced sexual intercourse at the time of the survey. The mean age at first sexual commencement was 17.7 (\ub12) years. Of those sexually active, 33% had sexual intercourse with non-regular partners (the proportions were 40.6% among males and 24.7% among females, suggest\uading that males tended to be about two times more likely to have sex with non-regular sexual partners than females (odds ratio=1.78, with 95% confidence interval 1.16-2.73). Furthermore, consistent condom-use among those who had sex in exchange for money was low (36%). Alcohol intake, chewing of khat (a green leaf), low educational background, and being male were significantly associated with having sex with ei\uadther a commercial or a non-regular sexual partner. In view of the magnitude of high-risk sexual behaviours among out-of-school youths that may expose them to HIV/AIDS and other sexually transmitted infections, efforts need to be exerted to deal with the identified predisposing factors and to address the problems of idleness, lack of jobs, and hopelessness

Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study.

BACKGROUND: Maternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions. METHODS: A cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13-49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*. RESULTS: Of the 6321women included in the study, 714 had a live birth in the 12 months before the survey. One-third of the women (30, 95% CI 26-34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43-51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40-57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37-45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron's I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron's I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women's age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone. CONCLUSIONS: This study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage

Caregivers' and Health Extension Workers' Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia: A Qualitative Study.

INTRODUCTION: Ethiopian Health Extension Workers provide facility-based and outreach services, including home visits to manage sick children, aiming to increase equity in service coverage. Little is known about the scope of the outreach services and caregivers' and health workers' perceptions of these services. We aimed at exploring mothers' and health extension workers' perceptions and experiences of the outreach services provided for the management of childhood illnesses. METHODS: Four focus groups and eight key informant interviews were conducted. A total of 45 community members participated. Interviews were recorded, transcribed verbatim, and translated into English. We applied thematic content analysis, identified challenges in providing outreach services, and suggestions for improvement. We balanced the data collection by selecting half of the participants for interview and focus group discussions from remote areas and the other half from areas closer to the health posts. RESULTS: Mothers reported that health extension workers visited their homes for preventive services but not for managing childhood illnesses. They showed lack of trust in the health workers' ability to treat children at home. The health extension workers reported that they provide sick children treatment during outreach services but also stated that in most cases, mothers visit the health posts when their child is sick. On the other hand, mothers considered distance from home to health post not to be a problem if the quality of services improved. Workload, long distances, and lack of incentives were perceived as demotivating factors for outreach services. The health workers called for support, incentives, and capacity development activities. CONCLUSIONS: Mothers and health extension workers had partly divergent perceptions of whether outreach curative services for children were available. Mothers wanted improvements in the quality of services while health workers requested capacity development and more support for providing effective community-based child health services

The Burden of Internal Conflict on Expanded Programs on Immunization in Northwest Ethiopia: Implementation Science Study

AbstractBackground: Despite the rapid progress in immunization service delivery systems worldwide, populations in areas of conflict often have limited or no access to lifesaving vaccines. Hence, evidence generation and translation for context-specific strategies and tailored action would be important, before, during and after an acute humanitarian emergency.Aim: To explore factors affecting immunization service delivery during and after conflict among internally displaced communities in Northwest Ethiopia.Methods: Qualitative and quantitative (record review) methods were applied, phenomenological study design and in-depth interviews were applied to collect the lived experiences of participants in the affected areas. Transcribed and translated data were analyzed and thematized using open code software. A Twenty-four-month record review of quantitative data was analyzed descriptively using an excel sheet to develop immunization coverage trends for tracer antigens.Results: We found that the immunization program had seriously deteriorated during and after the conflict in the study area. The monthly EPI service report in the affected areas showed a decline with the lowest records in December and January when the internal conflict was peak. Security problems, displacement of health workers, destruction of health infrastructures, mixing of the displaced community in the host community and poor coordination among stakeholders and partners, clients having other emergent needs and shortages of resources were important factors for immunization services.Conclusion: Vaccination service delivery was found to have significantly declined in the study area. Security problems affected not only the service utilizers but also the service providers’ wing as well. Coordination of stakeholders and strong leadership systems are crucial in maintaining optimum vaccination service delivery even at the time of conflict. [Ethiop. J. Health Dev. 2021; 35(SI-3):39-48]Key words: Conflict, internally displaced, Immunization service