Time to development of surgical site infection and its predictors among general surgery patients admitted at specialized hospitals in Amhara region, northwest Ethiopia: a prospective follow-up study

Abstract Background Surgical site infection is an infection occurring within 30 days after surgery. It is recently reported that evidence-based information on the specific time when the majority of surgical site infections would develop is a key to early detect the infection as well as to preventing and early intervene against their pressing and fatal complications. Therefore, the current study aimed to determine the incidence, predictors, and time to development of surgical site infection among general surgery patients at specialized hospitals in the Amhara region. Method An institution-based prospective follow-up study was conducted. The two-stage cluster sampling procedure was used. A systematic sampling technique with a K interval of 2 was applied to prospectively recruit 454 surgical patients. Patients were followed up for 30 days. Data were collected using Epicollect5 v 3.0.5 software. Post-discharge follow-up and diagnosis were done by telephone call follow-up. Data were analyzed using STATA™ version 14.0. Kaplan–Meier curve was used to estimate survival time. Cox proportional regression model was used to determine significant predictors. Variables with a P-value less than 0.05 in the multiple Cox regression models were independent predictors. Result The incidence density was 17.59 per 1000 person-day-observation. The incidence of post-discharge Surgical site infection was 70.3%. The majority of surgical site infections were discovered after discharge between postoperative days 9 to 16. Being male (AHR: 1.98, 95% CI: 1.201 – 3.277, diabetes Mellitus (AHR: 1.819, 95% CI: 1.097 – 3.016), surgical history (AHR: 2.078, 95% CI: 1.345, 3.211), early antimicrobial prophylaxis (AHR: 2.60, 95% CI: 1.676, 4.039), American Society of Anesthesiologists score ≥ III AHR: 6.710, 95% CI: 4.108, 10.960), duration of the surgery (AHR: 1.035 95% CI: 1.001, 1.070), Age (AHR: 1.022 95% CI: 1.000, 1.043), and the number of professionals in the Operation Room (AHR: 1.085 95% CI: 1.037, 1.134) were found to be the predictors of time to development of Surgical site infection. Conclusion The incidence of surgical site infection was higher than the acceptable international range. The majority of infections were detected after hospital discharge between 9 to 16 postoperative days. The main predictors of Surgical site infection were Age, Sex, Diabetes Mellitus, previous surgical history, the timing of Antimicrobial prophylaxis, American Society of Anesthesiologists score, pre-operative hospital stay, duration of surgery, and the number of professionals in the operation room. Hence, hospitals should give great emphasis on pre-operative preparation, post-discharge surveillance, modifiable predictors, and high-risk patients, as they found in this study

Spatial distribution and determinants of limited access to improved drinking water service among households in Ethiopia based on the 2019 Ethiopian Mini Demographic and Health Survey: spatial and multilevel analyses

IntroductionSafe and easily accessible drinking water service generates substantial benefits for public health and the economy. Approximately 10% of the global burden of disease worldwide could be prevented with improved access to drinking water. The death of ~ 30% of children younger than 5 years in developing countries is attributable to inadequate access to improved drinking water. Despite the presence of abundant water sources in Ethiopia, uneven distribution and waste pollution coupled with unprecedented population growth, rapid urbanization, and climate change are hindering the country's ability to maintain the balance between the demand and supply of accessible and improved drinking water services. The importance of up-to-date evidence for actions regarding the distribution of access to improved drinking water services is indicated by the Ethiopian Ministry of Water and Energy. Therefore, this study aimed to explore the spatial distribution and determinants of limited access to improved drinking water service among households in Ethiopia.MethodsThis study used the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The data were weighted using sampling weight to restore the representativeness and to obtain valid statistical estimates. After excluding ineligible households, a total weighted sample of 5,760 households was included in the final analysis. The analysis was performed using STATA version 14.2, ArcGIS Pro, and SaTScan version 10.1 software. To find significant determinants with limited access to improved drinking water service, we used a multilevel logistic regression model. A P-value of <0.05 was used to declare statistical significance.ResultsThis study found that in Ethiopia, 16.1% (95% CI: 15.2, 17.1) of households have limited access to improved drinking water services. The spatial distribution of households with limited access was identified to be clustered across a few regions of the country (Moran's I = 0.17, p-value < 0.01). The most likely significant primary clusters with highly limited access were seen in the Somali region (RR = 4.16, LLR = 162.8), the border between Amhara and Afar region (RR = 4.74, LLR = 41.6), the border between Oromia and Afar region (RR = 5.21, LLR = 13.23), and the northeastern Tigray region (RR = 2.52, LLR = 9.87). The wealth index, the age of household head, residence, and region were significantly associated with limited access to improved drinking water service. A high rate of limited access to improved drinking water service is predicted in the southwestern part of Gambella, the northeastern part of Oromia, the southwestern part of South Nation Nationalities and Peoples' region, and part of the Oromia region that surrounds Addis Ababa.ConclusionLimited access to improved drinking water service in Ethiopia varies across regions, and inequality in the service provision exists in the country. Prioritization and extra level of efforts should be made by concerned government and non-government organizations as well as other stakeholders for those underprivileged areas and groups of the population as they are found in the study

Correction: Spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis.

[This corrects the article DOI: 10.1371/journal.pone.0296123.]