Determinants of First Line Antiretroviral Treatment Failure in Public Hospitals of Addis Ababa, Ethiopia: Unmatched Case Control Study

Background: The identification and management of first-line antiretroviral therapy failure is a key challenge for human immune deficiency virus programs in resource-limited settings. Ethiopia being one of the resource-limited countries has limited resources available for diagnosing treatment failure and monitoring patient response with viral load, which is the gold standard, is not feasible in this limited setting. Patients initiate treatment with very advanced disease. However, factors lead to treatment failure is not well understood and well-studied. Objective: To identify determinants of first line antiretroviral treatment failure in public hospitals of Addis Ababa Methods: An unmatched case control study was conducted at Addis Ababa public hospitals using record review. Total sample size was 309 (103 cases and 206 controls). Bivariate analysis was done and all explanatory variables associated with first line treatment failure with P<.05 were entered in to multivariable logistic regression analysis using back ward stepwise likely hood ratio method to identify independent predictors. Result: One hundred three cases and two hundred six controls were included in the study. Treatment interruption (Adjusted odds ratio 5.4, 95% confidence interval 2.33 to 12.13), base line clusters of differentiation cell count <50 cells/?l (Adjusted odds ratio 2.7, 95% confidence interval 1.24 to 5.64), pulmonary Tuberculosis treatment (Adjusted odds ratio 2.9, 95% confidence interval 1.55 to 5.34) and history of gastric problem (Adjusted odds ratio 6.6, 95% confidence interval 2.33 to 18.87) were all independently associated with first line antiretroviral treatment failure. Conclusion and Recommendation: Base line lower clusters of differentiation cell count <50 cell/?l, treatment interruption, history of pulmonary Tuberculosis treatment during follow up time and chronic gastric problem were the independent predictors of first line antiretroviral treatment failure. There for Health professionals should pay special attention for the risk group identified. Keywords: antiretroviral therapy, case control study, treatment failure, highly activ

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high‐impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron‐folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability

Experience of Research Undertaking among Women Academia at Addis Ababa University: a Qualitative Study

AbstractBackground: As a pioneer University in the Country, Addis Ababa University engages itself in collaborative and local research undertakings along with teaching, community engagements and technology transfer. Despite its long engagement in research, the participation of women academia in research is limited as manifested by their low research productivity in terms of publication in peer-reviewed scientific journals. However, the reasons for their low research participation are less known and needs further exploration. Objective: To explore the experience of research undertakings among women academia at Addis Ababa University. Method: We conducted an exploratory qualitative study using a phenomenological approach among women academia. Eight women who have been working in the University with a rank of a lecturer having at least two years participated in in-depth interviews. We used NVivo10 software to code and categorize the transcripts. Result: Our study revealed that only a few senior informants with more than 10 years of stay at the University had a better experience in applying for national and international research grants. Although all the participants said they had ever undertaken research, their publication track in peer-reviewed journals is limited. Social and economic factors, lack of networking, low salary and family responsibility, limited internet and library access, and lack of research skill among young faculty were raised as impediments to undertake research. Conclusion: This study has indicated that women in academia had limited research engagement in terms of grant application and publication in peer reviewed scientific journals. Balancing work and family life, low salary, lack of access to common University facilities were some of the challenges. While structural change ensures gender equality at a long time, addressing the gender gap in research is the responsibility of AAU. [Ethiop. J. Health Dev. 2021; 35(SI-2):22-29]Keywords: Addis Ababa University, experience of research, women in academi

Female Academic Career Development and Administrative Positions at Addis Ababa University: a Mixed-Method Study

AbstractBackground: In Ethiopia, the number of female in academia in general and in administrative positions and higher university ranks in specific is very small as compared to men. A slight change has been seen in recent years, where a few women have come to male-dominated administrative positions as university presidents, vice presidents, deans and directors with still insignificant increase in the number of full professors. Objective: This study assessed female faculty member's career development and involvement in administrative positions and explored challenges. Method: We used a sequential mixed-method study starting with a cross-sectional quantitative study among 888 faculty members. The quantitate data were analysed using descriptive statistics and regression models to identify independent predictors of administrative involvement using SPSS version 25 software. An exploratory qualitative study was done among eight purposively selected female faculty. NVivo10 data management software was used to code and categorize the transcripts. Result: We found that male faculty members were more likely to involve in administrative positions than their female counterparts [AOR (95%CI) 1.6(1.1, 2.4)]. Those who were provided housing facility by AAU [AOR (95%CI) 2.29 (1.61, 3.23)] and assistant professors and above [AOR (95%CI) 1.495 (1.01, 2.220)] were more likely to involve in an administrative position than their counterparts. The qualitative findings indicated that the low salary faculty earns, lack of networks and family responsibility have deterred females from taking administrative positions. Conclusion: Female faculty involvement in the university administrative position and career development is very low. Both structural and personal factors such as gender roles affected their professional enhancement in academic ranks and hence positions. Creating a conducive platform for female faculty development is recommended to increase their involvement in administrative positions. [Ethiop. J. Health Dev. 2021; 35(SI-2):30-39]Keywords: Addis Ababa University, administrative positions, career development, female academician, female facult

Gender Difference in Research Productivity and its Associated factors in Addis Ababa University: a Cross-Sectional study

AbstractBackground: Gender equity movements have increased the number of women going to higher institutions. However, the number of women participating in research is limited in creating a critical mass. Objective: To assess the gender gap in research and its associated factors determinants among faculty at Addis Ababa University. Method: We conducted a cross-sectional study from October 2018 to March 2019 using a structured self-administered questionnaire. University faculty who was lecturers and above level who served the University for more than a year were invited to participate in the study. Faculty were approached by data collection facilitators with graduate degrees and the secretory of the respective departments. We used descriptive and multivariate statistical methods to analyse the data. Result: Of the 888 study participants, 161 (18.1%) females faculty participated in the study. It was found that three hundred ninety-seven male academics (54.6%) and 50 female academics (31.1%) had ever published articles in peer-reviewed journals (p<0.001). Male faculty were more likely to publish in peer-reviewed journals than their female counterparts [AOR and (95% CI) [2.55 (1.68, 3.86)]. Faculty with a rank of assistant professors and above [AOR (95% CI) 3.47(2.31, 5.21)], those who have a Ph.D. as highest degree [AOR (95% CI) 2.98 (2.11, 4.19) and those who have affiliation with other institutions [AOR (95% CI) 2.59 (1.98, 3.56)], were more likely to publish in peer-reviewed journals than their counterparts. Conclusion: Female faculty were less likely to be involved in research than men counterparts. The University needs to narrow the gender gap in research by designing and implementing an appropriate intervention strategy. [Ethiop. J. Health Dev. 2021; 35(SI-2):15-21]Keywords: Addis Ababa University, female faculty, gender difference, publication, researc

Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research

Abstract Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high‐impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron‐folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability

Development and validation of a simplified risk prediction model for preterm birth: a prospective cohort study in rural Ethiopia

Abstract Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer–Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the “Youden index” to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer–Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications

Chronic aflatoxin exposure during pregnancy is associated with lower fetal growth trajectories : a prospective cohort from the Butajira Nutrition, Mental Health, and Pregnancy (BUNMAP) Study in rural Ethiopia

Background Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed. Objectives In the present study, we examined the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia. Methods In a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 wk of gestation. Serum aflatoxin B-1-lysine concentration was measured using LC-tandem MS. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean +/- SD gestational age weeks of 19.1 +/- 3.71, 28.5 +/- 3.51, and 34.5 +/- 2.44. Estimated fetal weight was expressed in centiles using the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B-1-lysine concentration above or equal to the limit of detection) and unexposed mothers in the study. Results Mothers had a mean +/- SD age of 26.0 +/- 4.58 y. The median (25th, 75th percentile) serum aflatoxin B-1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the females enrolled provided at least 2 ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational-age centile than the unexposed group (ss = -0.92; 95% CI: -1.77, -0.06 centiles/week; P = 0.037). Conclusions Chronic maternal aflatoxin exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development