Survival and determinants of mortality in adult HIV/Aids patients initiating antiretroviral therapy in Somali Region, Eastern Ethiopia

Introduction: Studies have shown high initial mortality in Antiretroviral Therapy (ART) programs from resource-limited settings. However, there is dearth of evidence on treatment outcomes and associated determinant factors in public hospitals. Therefore, the objective of this study is to assess survival and identify predictors of death in adult HIV-infected patients initiating ART at a public hospital in Eastern  Ethiopia.Methods: A retrospective cohort study was conducted by reviewing baseline and follow-up records of patients who started ART between December 1, 2007 and December 31, 2011 at Kharamara hospital. Time to death was the main outcome measure. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality. Results: A total of 784 patients (58.4% females) were followed for a median of 60 months. There were 87 (11.1%) deaths yielding an overall mortality rate of 5.15/100 PYO (95% CI: 4.73-6.37). The estimated mortality was 8.4%, 9.8%, 11.3%, 12.7% and 14.1% at 6, 12, 24, 36 and 48 months respectively. The independent predictors of death were single marital status (AHR: 2.31; 95%CI: 1.18-4.50), a bedridden functional status (AHR: 5.91; 95%CI: 2.87-12.16), advanced WHO stage (AHR: 7.36; 95%CI:  3.17-17.12), BMI < 18.5 Kg/m2 (AHR: 2.20; 95%CI: 1.18-4.09), CD4 count < 50 cells/BL (AHR: 2.70; 95%CI: 1.26-5.80), severe anemia (AHR: 4.57; 95%CI: 2.30-9.10), and TB co-infection (AHR: 2.30; 95%CI: 1.28-4.11). Conclusion: Improved survival was observed in patients taking ART in Somali region of Ethiopia. The risk for death was higher in patients with advanced WHO stage, low CD4 count, low Hgb, low BMI, and concomitant TB infection. Intensive case management is recommended for patients with the prognostic factors. Optimal immunologic and weight recoveries in the first 6 months suggest increased effort to retain patients in care at this period.Key words: HIV, Aids, antiretroviral therapy, Ethiopi

Prevalence and risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, Eastern Ethiopia; Robust Poisson Regression Analysis

Background: Diarrhea is the second leading cause of under-five mortality in Ethiopia. Information on the prevalence and the impacting factors of diarrhea in the rural suburbs of Dire Dawa is inadequate.Objective: This study was aimed at determining risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, eastern Ethiopia.Methods: A cross-sectional study was conducted from 02 May 2018, to 31 May 2018. The required 1146 children for this study were selected from the rural suburbs of Dire Dawa using multi-stage sampling. Both bi-variable and multivariable Robust Poisson regressions were used for identifying the risk factors. Explanatory variables with a p-value < 0.05 were considered as independently associated with diarrhea.Results: The prevalence of diarrhea among the children was 23% (95% CI: 20.7 - 25.4). The type of house floor (aPR [adjusted prevalence ratio] = 0.89, 95% CI: 0.84 - 0.95) and sharing latrine with neighbours (aPR = 1.18, 95% CI: 1.09 - 1.26) were the significant factors associated with childhood diarrhea.Conclusion: Earthen house floor and shared use of latrine were the risk factors associated with childhood diarrhea. Hence, improving the house floor condition and construction of private latrine together with health education are recommended.Keywords: Prevalence; diarrhea; rural Dire Dawa; Robust Poisson Regression

Comparing the effect of independent and combined interventions of household chlorination and handwashing on diarrhea of under-fives in rural Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial

Introduction: in poorly developed countries, no single intervention is adequate to interrupt diarrhea occurrence in rural households. However, the effect sizes of multiple interventions and participants combined adherence to the interventions are understudied. This study aimed at comparing combined intervention of water sanitation and hygiene (WASH) with each individual intervention in reducing diarrhea among under-five children in rural Dire Dawa. Methods: a cluster randomized controlled factorial trial was conducted between October 2018 and January 2019. Householders in the first, second and third arms received waterguard, soap and both, respectively. However, householders in the control arm were followed with their customary practices. Generalized estimation equations (GEE) with log link Poisson distribution was used to compute adjusted incidence rate ratio and the corresponding 95% CIs. Results: overall, 36% (aIRR =0.64, 95% CI:0.57 - 0.73), 41% (aIRR =0.588, 95% CI:0.53 - 0.65), and 41% (aIRR =0.585, 95% CI:0.53 - 0.65) reduction in incidence of diarrhea was observed in the water treatment, handwashing and combined arms respectively. This study showed no additional benefit of combining the two interventions than the individual intervention. Conclusion: we recommend implementing either household water disinfection using sodium hypochlorite or household handwashing with hand hygiene promotion independently at large scale to vulnerable population to reduce diarrheal morbidity

Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study

Background: Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods: A community-based cross-sectional study design was employed in five rounds of surveys in seven kebeles in slums of Addis Ababa among 472 mothers/caregivers of 472 under-five children with acute diarrhea in reference to Andersen\u2019s behavioral model. Data were entered into EpiData Version 3.1 and analyzed using STATA Version 14.0. Descriptive statistics were used to examine patterns of health facilities utilization and multivariable logistic regression analysis was applied to identify predictors associated with health-seeking behavior. Results: Most mothers/caregivers (70.8%) sought care either at home (14.2%) or health facilities (56.6%), whereas 29.2% reported that they did not seek any care. Of those who consulted health facilities, government health facilities (76.9%) were more utilized than private (18.0%) and informal (5.1%) health facilities. Nearly all (93.9%) of the mothers/caregivers using government health facilities used health centers, and of those who took their children to private health facilities (60.9%) used clinics and 26.1% used pharmacies/drug vendors. Mothers/caregivers visiting health facilities obtained mainly oral rehydration salt (ORS) (39.8%) and home-recommended fluids (HRF) (40.3%), but few of them (11.9%) obtained ORS plus zinc supplementation. Predisposing factors of literacy of mothers/caregivers (adjusted odds ratio (AOR) = 2.4; 95% CI 1.4\u20134. 1) and occupation (AOR = 2.6; 95% CI 1.5\u20134.6), the enabling factors of households monthly income of 50 United States Dollars (US$) and above (AOR = 2.9; 95% CI 1.5\u20135.6) and availability of nearest health facilities within 15 min walking distance (AOR = 3.3; 95% CI 1.7\u20136.6), and the need factors of recognizing danger signs of fever (AOR = 4.3; 95% CI 2.4\u20137.6) and vomiting (AOR = 3.3; 95% CI 1.8\u20135.9) were significantly associated with health-seeking behavior. Conclusions: Increasing the proximity of health facilities in slums and health education and socioeconomic development programs targeting illiterate mothers/caregivers and poor households may promote and increase health-seeking behavior and the accessibility of health facilities for the treatment of acute diarrhea in under-five children in Addis Ababa slums

Erratum to: Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study

Upon publication of the original article [1], it was noticed that the second sentence of Section Methods, sub-section study setting, \u2018Three slum kebeles in Gullele Sub-City\u2019s District (Woreda) 01 and four slum kebeles in Lideta Sub- City\u2019s District 05 were included in the study\u2019 was incorrectly given as \u2018Four slum kebeles in Gullele Sub-City\u2019s District (Woreda) 01 and three slum kebeles in Lideta Sub-City\u2019s District 05 were included in the study\u2019. This has now been acknowledged and corrected in this erratum

Household food insecurity and its association with nutritional status of under five children in Sekela District, Western Ethiopia: a comparative cross-sectional study

BACKGROUND: Food insecurity influences children nutritional status by limiting the quantity and quality of dietary intake. Studies conducted across different parts of the world revealed controversial evidences about the relationship between household food insecurity and child nutritional status. Although child malnutrition and food insecurity are the main problems in Ethiopia, to what extent food insecurity contributes to children nutritional status is not yet well studied. Therefore, this study was conducted to compare children nutritional status in food secure and insecure housholds. METHOD: A community based comparative cross sectional study was conducted in Sekela District,Western Ethiopia from February 5–27, 2014. The total sample size was 576 households having at least one children less than 5 year’s old. Two stage cluster stratified sampling technique was used to select study participants. Data were collected using a pre tested structured questionnaire and anthropometric measurements. Household food insecurity was measured using household food insecurity access scale. Anthropometry indices were calculated using WHO Anthro 3.1.0 and interpreted according to WHO 2006 cutoff points. Data were entered using Epi.Data 3.2. and exported to SPSS 21.0 for analysis. Logistic regression analysis was employed to identify independent predictors of children under nutrition. RESULT: The mean of household food insecurity score was 8.16 ± 6.01 and the prevalence of food insecurity was 74.1%. Of children in food insecure households 38.9% were stunted, 22.6% were underweighted and 12.9% were wasted while the respective prevalence of stunting, underweight and wasting were 31.3%, 11.8% and 7.6% among children in food secure households. Food insecurity had association with children underweight (AOR = 2.25; 95% CI = 1.29, 3.94), but not with stunting and wasting. Children under nutrition had independent association with sex and age of the child, colostrum feeding, upper respiratory infection, fever, and maternal literacy. CONCLUSION: Household food insecurity and child under nutrition were critical problems in the study setting. Socio demographic factors, poor child caring practices, infection and food insecurity had positive association with children under nutrition. Thus, due emphasis should be given for the designing and implementation of multi sectorial community based nutrition interventions and initiation of income generating livelihood to the community to curtail under nutrition and household food insecurity in the locality

Healthcare facility water, sanitation, and hygiene service status and barriers in Addis Ababa, Ethiopia

Inadequate water, sanitation, and hygiene (WASH) practices within healthcare facilities heighten the likelihood of hospital-acquired infections. Therefore, this study aimed to assess the status of WASH services and barriers at public healthcare facilities in Addis Ababa. A converging parallel mixed design was conducted among 86 public health care facilities and 16 key informants. A stratified sampling technique was used to select health care facilities. Quantitative data was collected using a semi-structured checklist, and qualitative data was collected using key informant interviews. Thematic data analysis was done to identify the barriers. Independent analysis of the healthcare WASH domain revealed that 86% and 14% of healthcare facilities had access to basic and limited water services, respectively; 100% had limited access to sanitation services; and 88.4% had limited hand hygiene services. While 97.7% and 29% did not have environmental cleaning or waste management services, respectively. Lack of WASH service infrastructure, resource availability, governance and collaborative work, capacity and awareness building, and a framework for monitoring and evaluation were found to be barriers to WASH services. Lack of basic WASH service access and existing challenges at healthcare facilities hinder efforts towards infection prevention and control. HIGHLIGHTS 100% of healthcare facilities had limited access to sanitation service.; 88.4%, and 3.5% of healthcare facilities had limited, and no service access for hand hygiene, respectively.; 97.7% and 29% of healthcare facilities had not environmental cleaning service and waste management service respectively.; Lack of access to basic WASH services, combined with multiple existing challenges at healthcare facilities in Addis Ababa, hinders efforts towards pandemic and healthcare-acquired infection prevention and control.

Sero-prevalence of transfusion-transmittable infections and associated factors among blood donors in Eastern Ethiopia: an Institutional-based cross-sectional study

Background: Blood transfusion saves millions of lives each year globally. But, it was associated with certain risks which can lead to adverse consequences. However, there is paucity of information regarding to the sero-prevalence and risk factor of transfusion-transmittable infections among blood donors in Eastern Ethiopia. Objective: The aim of this study was to determine the sero-prevalence of transfusion-transmittable infections and associated factors among blood donors in Eastern Ethiopia from February to March 2018. Methods: An institutional-based cross-sectional study was conducted among 500 blood donors in Eastern Ethiopia. Data were collected using a structured questionnaire and laboratory blood screening. Data were analyzed using Statistical Package for Social Sciences version 20. Statistically significance was considered at p < 0.05. Results: The overall sero-prevalence of transfusion-transmittable infections was 12.4% (95% confidence interval: 9.5, 15.3). Hepatitis B virus (6.6%) and syphilis (3.4%) were found at high magnitude. Those with family having human immunodeficiency virus or hepatitis (adjusted odd ratio = 2.91; 95% confidence interval: 1.33, 6.33), giving care for human immunodeficiency virus or hepatitis patient (adjusted odd ratio = 3.24; 95% confidence interval: 1.49, 7.07), multiple sex partner (adjusted odd ratio = 2.56; 95% confidence interval: 1.21, 5.19), unsafe sex (adjusted odd ratio = 2.99; 95% confidence interval: 1.51, 5.92), dental procedure (adjusted odd ratio = 2.75; 95% confidence interval: 1.20, 6.28), and had no formal education (adjusted odd ratio = 2.46; 95% confidence interval: 1.24, 4.86) were significantly associated with transfusion-transmittable infections. Conclusion: The prevalence of transfusion-transmittable infections in this study was relatively high compared to studies conducted earlier in Ethiopia. Factors such as unsafe sex, multiple sex partner, dental procedure, and family with human immunodeficiency virus or hepatitis, provide health care for human immunodeficiency virus–infected or hepatitis patients, donor type, and educational level were significantly associated with transmission-transmittable infections. Thus, health promotion about prevention and control transmission-transmittable infections should be given to the community by considering the identified risk factors. Each of the blood banks and regional health bureaus in the study area should mobilize community for increasing repeated voluntary donors through promotion of blood bank activity