Effect of preeclampsia on the incidence rate of small-for-gestational-age of the fetuses among pregnant women in selected public hospitals in Tigray, Northern Ethiopia

Background: In low- and middle-income countries, including Ethiopia, small-for-gestational-age of the fetuses is a risk factor for fetal and neonatal mortality and morbidity that is linked to immediate perinatal adverse events and also to adult pathologic conditions in later life. In Ethiopia, particularly in Tigray, there is a paucity of information on the incidence rate and predictors of small-for-gestational-age of the fetuses among pregnant women. Objective: To determine the incidence rate and predictors of small-for-gestational-age of fetuses among pregnant women in selected public hospitals in Tigray, Ethiopia. Methods: A retrospective cohort study was conducted among preeclampsia (n = 239) and normotensive (n = 476) women who were in antenatal care follow-up before 20 weeks in selected hospitals of Tigray, from January 01, 2014, to March 31, 2019, to measure weight for gestational age of the fetuses every two to four weeks. Systematic sampling was used to select preeclampsia and normotensive women from the list in antenatal care logbook by their medical record numbers, using every three and every 25 intervals, respectively. A pre-tested structured checklist was used to extract data, then entered and cleaned using Epi Data version 3.1 and exported to Stata version 14 for analysis. The incidence rate was calculated by dividing all small-for-gestational-age of the fetus cases by the person weeks of follow-up. The Cox proportional hazard model was performed to identify predictors of small for gestational age of the fetuses. Results: The incidence rate of small-for-gestational-age of the fetuses was higher among women with preeclampsia than normotensive women (94.5 versus 24.9 per 1,000 person weeks, Z = 9.42, p < 0.000001). A higher risk of small-for-gestational-age of the fetuses was observed among women with preeclampsia/eclampsia (AHR = 3.92, 95% CI 2.55-6.01), women with a history of low birth weight (AHR = 0.41, 95% CI 0.17-0.94), and women with poor gestational weight gain (AHR = 1.89, 95% CI 1.15-3.1). Conclusions and recommendations: There were significant differences in the incidence rates of small-for-gestational-age of fetuses among preeclampsia, and normotensive women. Preeclampsia, a history of low birth weight and poor weight gain were significant predictors for small-for-gestational-age of the fetuses. It is necessary to strengthen the screening of preeclampsia for optimal fetal growth and to provide counseling on nutrients for adequate gestational weight gain. Further studies would also be beneficial to confirm the predictors at the community level. [Ethiop. J. Health Dev. 2020; 34(3):181-190] Keywords: Small-for-gestational-age, preeclampsia/eclampsia, Tigra

Survival and predictors of breast cancer mortality in South Ethiopia: A retrospective cohort study

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity. Methods: A hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit. Results: The study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7–23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30). Conclusion: Beyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women

The magnitude of anemia and associated factors among adult diabetic patients in Tertiary Teaching Hospital, Northern Ethiopia, 2019, cross-sectional study.

BackgroundPatients with Diabetic Mellitus are at higher risk of different complications. Many previous studies show that anemia among diabetic patients is poorly diagnosed.ObjectiveThis study aimed to assess the magnitude and associated factors of anemia among adult diabetes patients having regular follow up at the diabetic clinic of Ayder Comprehensive Specialized Hospital, Tigray, 2018/19.MethodsThis study was conducted the Diabetic clinic of Ayder comprehensive specialized hospital, Tigray regional state, Northern Ethiopia from January to March 2019. A systematic random sampling technique was used to select study participants. About 5 ml of venous blood was collected by experienced laboratory technologists under a complete aseptic technique. Two ml of the venous blood was used for hemoglobin determination. And three ml of the venous blood was used without any anticoagulant for creatinine determination. The association of variables was assessed using bivariate and multivariable analysis in the logistic regression model with p-value, odds ratio, and 95% CI in the SPSS version 24 software.ResultsFrom a total of 262 diabetes patients, forty-seven (17.9%) were found to be anemic (6.7% males and 11.5% females). Among the related factors, residency (Adjusted Odds Ratio, 7.69, 95% CI, 2.060, 28.69, p = 0.002,), age of the patients (Adjusted Odds Ratio, 4.007, 95%CI, 1.53-10.51, p = 0.005,) and sex (Adjusted Odds Ratio, 3.434, 95% CI, 1.582, 7.458, p = 0.042,) were significantly associated with anemia.ConclusionAccording to this study, the magnitude of anemia is high among diabetic patients. Occupation of the participants, residency, HIV status, being female, and age was significantly associated with anemia

Usage of cervical cancer screening services among HIV-positive women in Southern Ethiopia: a multicentre cross-sectional study

Objectives To assess the usage of cervical cancer screening services and associated factors among HIV-positive women on antiretroviral treatment in Southern Ethiopia in 2020.Design A multicentre cross-sectional study.Setting The study was conducted in Wolaita Sodo University Teaching Referral Hospital and Sodo Health Centre, Southern Ethiopia, from 1 July 2020 to 30 September 2020.Participants Four hundred and seventeen HIV-positive women on antiretroviral treatment attending public health facilities were approached during the study period. A multivariable binary logistic regression model was carried out to identify independent factors associated with the usage of cervical cancer screening services, and a p value<0.05 was used to declare statistical significance.Results The uptake of cervical cancer screening services among HIV-positive women was 27.8% with a 95% CI of 24.2% to 33.1%. Married women and women reporting a high level of perceived barriers were 75% and 66% less likely to receive cervical cancer screening services, adjusted OR (AOR)=0.25; 95% CI: 0.07 to 0.93, and AOR=0.34; 95% CI: 0.12 to 0.98, respectively. Whereas, being a government employee, AOR=3.85; 95% CI: 1.31 to 11.3, sexual debut before the age of 20, AOR=2.39; 95% CI: 1.09 to 5.26, using modern contraceptives, AOR=2.43; 95% CI: 1.05 to 5.65, having a high perceived self-efficacy, AOR=4.42; 95% CI: 1.79 to 10.89 and having a high perceived benefit of cervical cancer screening services, AOR=12.23; 95% CI: 2.22 to 67.35 were significantly associated with the usage of cervical cancer screening services.Conclusions The usage of cervical cancer screening services among HIV-positive women remains low in this setting. Married HIV-positive women and those with a high perceived barrier were associated with low uptake of cervical cancer screening services. Being a government employee, having an early sexual experience, using modern contraceptives, having a high perceived self-efficacy and having a high perceived benefit were identified as factors associated with increased uptake of cervical cancer screening services

Household knowledge, practice and treatment seeking behaviors towards cutaneous leishmaniasis in the endemic rural communities of Ganta- afeshum district, Tigrai, northern Ethiopia, 2019: a cross-sectional study

Abstract Background Cutaneous leishmaniasis is endemic to Ethiopia. However, the prevention and control efforts of leishmaniasis remain unfocused with clear knowledge and practice gaps within the country. Thus, a house to house survey has been carried out to assess the knowledge, practice and treatment-seeking behavior of households towards cutaneous leishmaniasis in the rural communities of Tigrai region, northern Ethiopia. Methods A community-based cross-sectional house-to-house survey was conducted in two selected rural villages of Ganta-afeshum district, Tigrai, northern Ethiopia in 2019. A simple random sampling technique was employed to select the participants. Household heads were interviewed using a pre-tested semi-structured questionnaire. Epi info version 7.0 was used for data entry and the data were imported to SPSS version 23 for analysis. Chi-square test (χ2) was used to test the association between the independent variables and the knowledge and practice status of the study participants. P-value < 0.05 was used to declare a statistically significant association among the variables. Results In our study, most of the participants (78%) stated that cutaneous leishmaniasis is a health problem in the area. Three hundred eighty (99.5%) participants responded that the most common clinical presentation of cutaneous leishmaniasis is a lesion on the face. All of the study participants did not know the mode of cutaneous leishmaniasis transmission, and had never heard of the sand fly. A majority of the participants were unaware of the main prevention methods for cutaneous leishmaniasis. Lastly, traditional medicine was used in 90% of the study households with a previous history for cutaneous leishmaniasis. Conclusion There is a lack of awareness regarding the transmission of cutaneous leishmaniasis in Ganta-afeshum, Ethiopia, where the majority of individuals are unfamiliar with the sand fly vector. Prevention methods for cutaneous leishmaniasis were unavailable among the community. Therefore, health education programs concerning cutaneous leishmaniasis transmission, prevention, and treatment in the area should be rigorously implemented

Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia

Background. Despite the significant public health impact of neonatal jaundice on neonatal survival, local epidemiologic data are scarce. Methods. A multi-centered, unmatched case-control study was conducted among 180 consecutively admitted neonates (60 cases and 120 controls). The independent determinants of newborn jaundice were determined using a multivariable binary logistic regression model, and a P -value of <0.05 was used to indicate statistical significance. Results. Maternal medical complications during the index pregnancy (AOR = 2.45; 95% CI 1.01-5.97), rural residence (AOR = 3.1; 95% CI 1.02-9.42), being a low birthweight neonate (AOR = 3.42; 95% CI 1.12-10.41), neonatal B blood group (AOR = 10.19; 95% CI 2.89-35.9), neonatal O blood group (AOR = 2.99; 95% CI 1.04-8.59), and a longer duration of hospital stay (AOR = 9.83; 95% CI 3.11-31.02) were the independent determinants of neonatal jaundice. Conclusions. Early assessment of high-risk neonates might reduce the long-term neurodevelopmental consequences