Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study.

BackgroundThis study aimed to determine the incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy (ART) in public hospitals of Northern Ethiopia.MethodsA retrospective study was conducted from September 1, 2007 to July 30, 2017 on 227 patients. The data were extracted using a retrieval checklist from the patient's charts. The incidence rate of treatment failure was calculated using Kaplan-Meier methods and Cox proportional hazard model was used to assess factors associated with treatment failure.ResultThe study subjects were followed for a total observation of 788.58 person-years with a median follow-up period of 35 (IQR: 17-60) months after switching to second-line ART. About 57 (25.11%) patients developed treatment failure, out of which, 32 (56.14%) occurred during the first two years. The overall incidence of second-line treatment failure was 72.3 per 1000 person years (95%CI: 55.75-93.71) of observation. The Kaplan-Meier estimates of cumulative treatment failure after 1, 2, and around 10 years of follow-up were 12.31% (95%CI: 8.60-17.45%), 14.99% (95%CI: 10.82%-20.57%), and 48.67% (95%CI: 32.45-67.81%) respectively. Age >45 years AHR = 3.33, 95%CI = 1.33-8.31), WHO stage IV (AHR = 3.63, 95%CI = 1.72-7.67), CD4 count ConclusionIncidence of second-line ART treatment failure in the first 2 years of follow-up was high. The rate of second-line ART failure was higher in patients who started second-line ART with poor drug adherence, CD4 count 45 years, and being in WHO stage IV. Therefore, intensive counseling and adherence support should be given along with strong TB screening. Moreover, the government of Ethiopia should consider endorsing third-line ART drugs after careful cost-benefit analysis

Determinants of Anemia in Pregnancy: Findings from the Ethiopian Health and Demographic Survey

In Ethiopia, anemia during pregnancy is a major public health problem and affects both the mother’s and their child’s health. There is a scarcity of community-based evidence on determinants of anemia among pregnant women in the country. Therefore, this study aimed to assess the determinants of anemia among pregnant women in Ethiopia. Method. This study was based on the 2016 Ethiopian Demographic Health Survey (EDHS) that used a two-stage stratified cluster sampling technique. A cross-sectional study was conducted among 3080 pregnant women. Data analysis was done using STATA v.14. Variables with P value <0.05 in the bivariate analysis were candidates for the multivariable analysis to identify independent determinants of anemia among pregnant mothers. Odds ratios (OR) were calculated at 95% confidence interval (CI). Results. The overall prevalence of anemia among pregnant women was 41% of which 20% were moderately anemic, 18%, mildly anemic, and 3%, severely anemic. The following were significantly associated with anemia during pregnancy: an age of 30–39 years, receiving no education (AOR = 2.19; 95% CI 1.45, 2.49), belonging to the poorest wealth quintile (AOR = 1.29; 95% CI 1.22, 1.60), being a Muslim (AOR = 1.59; 95% CI 1.69, 2.65), number of house members being 4–6 (AOR = 1.44; 95% CI 1.05, 1.97), number of under-five children being two (AOR = 1.47; 95% CI 1.10, 1.97), head of the household being a female (AOR = 2.02; 95% CI 1.61, 2.54), current pregnancy wanted later (AOR = 1.75; 95% CI 1.23, 1.63), no terminated pregnancy (AOR = 1.49; 95% CI 1.15, 1.93), and an age of 13–17 years at the first sexual intercourse (AOR = 1.97; 95% CI 1.291, 3.00). Conclusions. The study revealed that more than one-third of the pregnant women in Ethiopia were found anemic. Its prevalence varied among regions in which the highest (62.7%) and the lowest (11.9%) were from Somali and Addis Ababa, respectively. Hence, efforts should be made by concerned bodies to intervene in terms of the identified risk factors

Effectiveness of Anthropometric Measurements for Identifying Diabetes and Prediabetes among Civil Servants in a Regional City of Northern Ethiopia: A Cross-Sectional Study

Back ground. Diabetes mellitus is an emerging noncommunicable disease in Ethiopia. Overlooking an appropriate tool for identifying diabetes and prediabetes would have significant impact for future diabetes and prediabetes projections and its management. Therefore, the study aims to examine the effectiveness of anthropometric measurements for identifying prediabetes and diabetes in Mekelle city, Tigray, Northern Ethiopia. Methods. The study involved a cross-sectional survey carried out from October 2015 to February 2016 among 1504 subjects aged from 18 to 75 years of age. Receiver operating characteristic (ROC) was used to select the most effective anthropometric cut-off point among waist circumference, waist-to-hip ratio, waist-to-height ratio, and BMI for identifying prediabetic and diabetes. Statistical significance was declared at p value of ≤0.05. Results. Waist circumference was found better for identifying diabetes (AUC = 0.69) and prediabetes (AUC = 0.63) in women, respectively. Waist-to-hip ratio was better identifying diabetes (AUC = 0.67) while waist circumference-to-height ratio was better identifying prediabetes (AUC = 0.63) in men compared to body mass index. The optimal cut-off point with maximum sensitivity and specificity of waist circumference for identifying diabetes and prediabetes was 83.5 cm and 82.9 cm in women, respectively. The optimal ut-off point with maximum sensitivity and specificity of waist-to-hip ratio for identifying diabetes and prediabetes was 0.97 and 0.82 in men, respectively. Conclusion. Waist circumference and waist-to-hip ratio exhibited better discriminate performance than BMI for identifying prediabetes and diabetes in women and men, respectively

Mass Psychogenic Illness in Haraza Elementary School, Erop District, Tigray, Northern Ethiopia: Investigation to the Nature of an Episode

Background. Mass psychogenic illness has been documented for more than 600 years in a variety of cultural, ethnic, and religious settings. We aimed to assess the nature and characteristics of mass psychogenic illness and to evaluate community awareness and perception about the treatment they practiced in Haraza Elementary School, Erop district, Tigray, Northern Ethiopia. Methods. A school-based cross-sectional study was conducted in Haraza Elementary School from January to February, 2020. Students who were victims of an episode were subjects of the study. A total of twelve students were investigated using a semistructured questionnaire for a quantitative study. Seven key informant interviews were conducted using a guiding questionnaire. Quantitative data was analyzed using XL sheet while qualitative data were analyzed manually. Results. The mean age of study participants was 14 years (SD±1.3). The majority (87%) were teenage female students. The incident was an unspecified disease with psychiatric disorder, migraine, and syncope with no plausible organic causes. An important feature of migraine and syncope was their comorbidity with mass psychogenic illness. The community perceived that evil devil force and blaming the being as an evil eye were common causes of the occurrence of an episode. Conclusion. Lack of empirical knowledge and awareness about its management and prevention among community members and health professionals resulted exaggerated rumor that would perceive as newly emerging disease that affected school activities. Integrating MPI in PHEM package at health facility level, advocacy workshops for media, and other relevant stakeholders will minimize its impact for the future

Knowledge, Attitude, and Practices on Water, Sanitation, and Hygiene among Rural Residents in Tigray Region, Northern Ethiopia

Background. Poor hygienic practices, inadequate water supply, and poor sanitary conditions play a major role in the spread of infectious diseases. Lack of knowledge, attitude, and practices (KAP) on WASH is one of the most imperative causes for transmission of infectious diseases. Therefore, the aim of this study was to assess knowledge, attitude, and practice of rural residents on water, sanitation, and hygiene in Tigray, Ethiopia. Methods. A community-based cross-sectional study was conducted from June to July 2018. Multistage cluster sampling technique was used to collect data from 759 households in Tigray region, Northern Ethiopia. A standardized questionnaire was used to collect data on knowledge, attitude, and practice on water, sanitation, and hygiene (WASH). Descriptive data analysis was done to present the study findings. Results. The response rate was 99.6%, and 574 (75.9%) of the respondents were females. Good knowledge, favorable attitude, and good practice on WASH were observed in 42.2% (95% CI: 38.7%, 45.7%), 48.5% (95% CI: 44.9%, 52.0%), and 49.2% (95% CI: 45.6%, 52.7%) of the respondents, respectively. Conclusions. Poor knowledge, unfavorable attitude, and poor practice on WASH were common amongst the residents in rural Tigray, Northern Ethiopia. Therefore, the health extension programs at primary health care should be revitalized in a way that can enhance the interventional measures to improve knowledge, attitude, and practice on WASH

High manifestations of food insecurity and hunger among pregnant and lactating women during post-conflict in Tigray, Ethiopia: a community-based study

Abstract Background Food insecurity is a state or condition in which people have limited or uncertain physical, social, and economic access to safe, sufficient, and nutritious food to meet their dietary needs. Since no thorough evaluation was carried out to determine the degree of household food insecurity in Tigrayan communities in the aftermath of the conflict. This study aims to describe household-level food insecurity status among pregnant and lactating women during the post-armed conflict in Tigray, Ethiopia. Method Descriptive research was designed to assess household food insecurity. A multi-stage sampling technique was used for this study. One thousand two hundred forty-nine households were selected systematically following a list of food insecure households. Descriptive statistical values, including frequency counts, percentages, minimum values, maximum values, and averages, were calculated to quantify the indicators under study. Household food insecurity and hunger Scale measurement using the standardized Food and Agriculture Organization standard. Results The mean age (± SD) of the mothers was 28.35 ± 5.91 years. More than three fourth of the participants 1010(80.93%) were rural residents. The survey result showed that 88.8% of the pregnant and lactating were food insecure. Half (50.1%) of the households were hungry,one month before the study, 78.5% of the families expressed concern about running out of food and 6.4% had severe hunger. Conclusions The food insecurity levels and hunger prestige of the study communities were excessively high. This is in the context of a region affected by intense armed conflict. It is commended that the study communities need to be safeguarded from the direct and long-term consequences of armed conflict-caused household food insecurity

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience

BACKGROUND: Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P \u3c .001), repeated runs and long cardiopulmonary bypass time (P \u3c .001), and aortic cross-clamp time (P \u3c .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention