Determinants of podoconiosis, a case control study

Background: Podoconiosis is a non-filarial swelling of lower extremity endemic in tropical regions, North America and India. The etiology and pathophysiology of the disease remain unknown. The objective of this study was to identify the determinants of Podoconiosis.Methods: Unmatched case control study design was conducted. The sample size was calculated using Epi-info soft ware: 95% CI, 85% power, control to case ratio of 2:1, expected frequency of barefoot among controls 50%, odds ratio of 1.5 and non-response rate of 10% yielding 1148 study participants. Binary logistic regression was used to identify the determinants of Podoconiosis.Results: A total of 1113 study participants (379 cases and 734 controls) were included giving for a response rate of 96.95%. Positive family history (AOR, 2.81 [95% CI: 1.7-4.64]), bare foot (AOR, 3.26 [95% CI: 2.03-5.25]), poor foot hygiene (AOR, 2.68 [95 CI: 1.72 - 4.19]) increase the risk of Podoconiosis. Female gender (AOR, 0.26 [95% CI: 0.15-0.44]), good housing condition (AOR, 0.17 [95% CI: 0.1-0.3]), medium income (AOR, 0.12 [95 % CI: 0.07- 0.22]) and primary education (AOR, 0.02 [95% CI: 0.01-0.04]) decrease the risk of Podoconiosis.Conclusion: Podoconiosis control and prevention programmes should involve the low income and uneducated populations.Keywords: Podoconiosis, Determinants, Ethiopi

Nutritional Status and Intestinal Parasite in School Age Children: A Comparative Cross-Sectional Study

Background. The objectives of this study were to determine the burden of underweight and intestinal parasitic infection in the urban and rural elementary school children. Methods. A comparative cross-sectional study design was conducted. Binary logistic regression was used to identify the determinants of malnutrition or intestinal parasites. Two independent samples’ t-test was used to identify the effect of malnutrition on school performance or hemoglobin level. Results. A total of 2372 students were included. Quarters (24.8%) of school children were underweight. Underweight was associated with sex [adjusted odds ratio (AOR) 0.61; 95% CI = 0.47–0.78], age [AOR = 0.21; 95% CI = 0.16–0.28], intestinal parasitic infection [AOR 2.67; 95% CI = 2–3.55], and family size [AOR 23; 95% CI = 17.67–30.02]. The prevalence of intestinal parasite among school children was 61.7% [95% CI = 60%–64%]. Shoe wearing practice [AOR 0.71; 95% CI = 0.58–0.87], personal hygiene [AOR 0.8; 95% CI = 0.65–0.99], availability of latrine [AOR 0.34; 95% CI = 0.27–0.44], age [AOR 0.58; 95% CI = 0.48–0.7], habit of eating raw vegetables [AOR 3.71; 95% CI = 3.01–4.46], and family size [AOR 1.96; 95% CI = 1.57–2.45] were the predictors of intestinal parasitic infection

Epidemiology of Hookworm Infection in the School-age Children: A Comparative Cross-sectional Study

Background: Globally more than 740 million peoples are infected with hookworm. In sub-Saharan Africa, approximately 200 million people have been infected with hookworm, 90 million of them were children. The objective of this study was to identify the prevalence and determinant factors of hookworm infection in urban and rural school-age children’s. Methods: This comparative cross-sectional study design was conducted in Bahir Dar and Mecha district, Bahir Dar, Ethiopia from Mar-May, 2014. Epi-info software was used to calculate the sample size. Multistage sampling technique was used to select the children’s. Blood and stool samples were collected from the children to determine the hemoglobin level and the presence of parasites. Data were entered into the computer using Epi-info software and transferred to SPSS for analysis. Descriptive statistics were used to identify the prevalence of hookworm and binary logistic regression was used to identify the determining factors for hookworm. Results: The prevalence of hookworm was 22.3% [21%-24%]. Hookworm infection was associated with gender (AOR 1.31, 95% CI [1.03-1.66]), wearing shoe (AOR 0.35, 95% CI [0.25-0.48]), hand washing practice (AOR 0.62, 95% CI [0.48-0.79]), personal hygiene (AOR 0.45, 95% CI [0.34-0.61]), age (AOR 0.44, 95% CI [0.34-0.57]) or availability of latrine (AOR 0.08, 95 % CI [0.06-0.1]). Hookworm infection significantly decreases the school performance of children. Conclusion: High prevalence of hookworm infection was observed. The ministry of health and ministry of education should include deworming activity as one strategy to increase quality of education

Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study

BACKGROUND: Globally, 370,000 children became newly infected with HIV and an estimated 42,000-60,000 pregnant woman died because of HIV annually. Pediatric HIV infection in 90% of the cases was acquired from their mothers.METHODS: Comparative cross-sectional study design was implemented. Epi-info software was used to calculate the sample size, and the estimated sample size was 2667 pregnant women. Data were collected using exit interview technique. Descriptive statistical techniques were used to identify the prevalence of PMTCT service utilization and binary logistic regression was used to identify the determinants of PMTCT service utilization.RESULTS: A total of 2615 respondents were included for a response rate of 98.05%. Only 61.3% of the pregnant women attending ANC in the health facility were utilizing PMTCT services [95% CI: 59 %-63 %]. Around 3.22% of tested pregnant women did not receive their result. PMTCT service utilization was affected by knowledge of PMTCT [AOR 1.87, 95 % CI: 1.53-2.28], residence [AOR 0.67, 95 % CI: 0.51-0.89], internal referral system [AOR 3.06, 95% CI: 2.51-3.72], health professional client interaction [AOR 2.18, 95% CI: 1.75 2.76], fear [AOR 1.23, 95% CI: 1.03-1.47], long waiting time [AOR 0.74, 95% CI: 0.58-0.94], number of ANC visit [AOR 1.79, 95% CI: 1.4-2.29], gravidity [AOR 0.55, 95% CI: 0.46-0.66], educational status [AOR 1.43, 95% CI: 1.04-1.96] and involvement in PMTCT services [AOR 2.57, 95% CI: 1.51-4.4].CONCLUSION: PMTCT service utilization was low in the study area. The presence of internal referral system significantly increases PMTCT service utilization

Survival of patients in the intensive care units of referral hospitals in Amhara Region: A prospective cohort study

Background: An intensive care unit (ICU) is a place where critically ill patients are managed using life-saving interventions. Evidence regarding ICUs like average days of stay, and what caused the patients to delay in the ward were scarce in resource-limited settings such as Ethiopia. The objectives of this study were to assess the survival of patients in ICUs, the incidence density for discharge with prognosis, and the determinants of ICU stay in five referral hospitals in Amhara Region. Methods and materials: To implement the prospective cohort study design, baseline data were recorded from patients’ charts at the time of admission to the ICUs of the five referral hospitals. Patients’ status was followed every day for a maximum of nine days. Interviews and chart reviews were used to collect the data. A Kaplan–Meier curve was used to estimate the time of patients’ discharge from the ICU. A Cox proportional hazard model (Weibull) was used to identify the predictors of ICU stay. Results: A total of 2,789 patients were included; the incidence density of discharge with prognosis was 1,962/12,448 person days. The length of ICU stay was determined by patient-to-nurse ratio (AHR = 0.59 [95% CI: 0.56-0.64]), chronic illness (AHR = 0.93 [95% CI: 0.88-0.98]), hemoglobin concentration (AHR = 1.09 [95% CI: 1.05-1.14]), ICU area-to-bed ratio (AHR = 1.14 [95% CI: 1.06-1.22]), nosocomial infection (AHR = 0.47 [95% CI: 0.37-0.59]), tracheotomy (AHR =  1.12 [95% CI: 1.01-1.24]), time of admission (AHR = 0.83 [95% CI: 0.75-0.93]), and formal education (AHR = 0.72 [95% CI: 0.64-0.80]). Conclusions and recommendations: Decision makers in Ethiopia should give high priority to ICU infrastructure and to increasing the number of nurses in ICU wards. [Ethiop. J. Health Dev. 2020; 34(1):30-34] Key words: Critical care, Intensive care, predictors, resource-limited settin

BURDEN AND DETERMINANT FACTORS OF ANEMIA AMONG ELEMENTARY SCHOOL CHILDREN IN NORTHWEST ETHIOPIA: A COMPARATIVE CROSS SECTIONAL STUDY

Background: Anemia is an indicator of both poor nutrition and health. In low-income countries like Ethiopia, the prevalence of anemia remains high due to several determinant factors. There is a lack of regular surveillance system to determine the magnitude of anemia among school age children. The aim of this study was to determine the burden and determinant factors of anemia among school children. Materials and Methods: A comparative cross-sectional study was conducted from March 2014 to May 2014 among elementary school children in Northwest Ethiopia. Multi stage and simple random sampling techniques were used to select the schools and the study subjects. Standard questionnaire was employed to assess the socioeconomic status of study participants. Intestinal parasitosis infections and hemoglobin level were determined by formula ether concentration technique and automated hematology analyzer, respectively. Descriptive statistics were used to determine the burden of anemia. Stepwise logistic regression was used to identify the determinants of anemia. Results: Among 2,372 elementary school children, the prevalence of anemia was 7.6% (95 % CI: 7% - 9%). The mean hemoglobin level was 11.6 g/dl ranging from 10 g/dl to 13g/dl. The magnitude of hookworm infection was 530 (22.3%). In multivariate analysis anemia was found associated with residence, source of water, availability of latrine, maternal education, family size and hookworm infection. Conclusion: Anemia still remains as a major public health problem among the school children in the study area. Residence, source of water, availability of latrine, maternal education, family size and hookworm infection are also the major determinant factors for the high prevalence of anemia. Therefore, health education, iron supplement and deworming should be given to school age children

Knowledge and practice on magnitude, diagnosis, treatment and prevention strategies of Hepatocellular Carcinoma in Ethiopia: A Systematic Review

Introduction: In Ethiopia, hepatocellular carcinoma (HCC) is the most common cancer with 100% fatality rate. HCC cases in low income countries die within few months following diagnosis. There is lack of information on the burden, risk factors, diagnosis modalities, surveillance strategies and treatment approaches to HCC in Ethiopia.Objective: To analyze the existing evidence related to burden, risk factors, diagnosis modalities, surveillance strategies, and treatment and prevention strategies of HCC in Ethiopia.Methods: All studies done on HCC in Ethiopian irrespective of year of publication and study types were included. Literatures were retrieved from electronic database of PubMedand Cochrane library during September/2016 to January 2/2017. Key words and mesh terms such as ‘hepatocellular carcinoma’, ‘hcc’, ‘hepatoma’, ‘malignant hepatoma’, ‘hepatocarcinoma’ were used to search for documents. Besides, we searched for articles, guidelines and reviews from world health organizations, lancet and Google scholar sites. Each of the retrieved studies was assessed by two authors for inclusion based on the eligibility criteria, and for quality using the critical appraisal checklist. Qualitative data were synthesized for analyzing the theories of studies. Medley reference manager was used to manage citations.Results: A total of 1448 literatures were retrieved. Eight studies fulfill the eligibility criteria, however, only three were full-fledged articles. HCC is clinically characterized by exhaustion, loss of appetite, rapid loss of weight, epigastric pain, right upper abdominal quadrant pain with a rapidly growing mass, jaundice, and ascites with or without hepatomegaly and splenomegaly. Data on HCC proportion among liver disease patients lies between 16.1%-19.2%. Cirrhosis followed by hepatotoxic indigenous drugs and viral hepatitis were found to be as major risk factor for HCC. In Ethiopia, there is no surveillance activity and no standard staging systems. Furthermore, there was no policy frame -work for management of HCC.Conclusion: As compared to other countries, Ethiopia is far behind in addressing HCC. There is no national policy framework and guideline for the management of HCC. Moreover, HCC is a neglected cancer that is considered as a death penalty by the community. Health professionals working in health facilities and health offices should share the data they have to the scientific community and policy makers, for further searching solutions and informed decision, respectively. An intensified public health strategy on health education and early case detection is of critical importance. In addition concerted effort should be made to develop HCC prevention and treatment modality.Key words: Hepatocellular Carcinoma, Ethiopi

Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors). Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population. Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)). Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.publishedVersio

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe