Burnout Status at Work among Health Care Professionals in aTertiary Hospital

Background: Burnout is a physical, physiological and psychological stress reaction syndrome Caused by long-term exposure to intense work-related emotional and interpersonal pressures. There is no evidence on the issue in Ethiopian setting.Methods: An institution based cross-sectional study design was conducted on 403 health care providers. Burnout was detected using Copenhagen’s burnout inventory tool. Other structured questionnaire on work-related condition and substance use habits was used to collect data. Binary logistic regression was used to identify the associated factors of burnout at work.Result: Of all the study participants, 36.7% scored above the mean level of burnout. Highest prevalence (82.8%) of burnout status was found among nurses. The least prevalence of burnout was observed among laboratory technicians which was 2.8% (n=4). Job insecurity, history of physical illness, low interest in profession, poor relationship status with managers, worry of contracting infection or illness and physical/verbal abuse were found to be predictors of burnout.Conclusion: The prevalence of burnout at work was found to be high. The predictors were job insecurity, history of physical illness, low interest in profession, poor relationship status with managers, worry of contracting infection or illness and physical/verbal abuse.Keywords: Burnout, Health professionals, Occupational health, Work related factor

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence

IntroductionChild marriage and teen pregnancy have negative health, social and development consequences. Highest rates of child marriage occur in sub-Saharan Africa (SSA) and 40% of women in Western and Central Africa got married before the age of 18. This systematic review was aimed to fill a gap in evidence of effectiveness to reduce teen pregnancy and child marriage in SSA.MethodsWe considered studies conducted in sub-Saharan Africa that reported on the effect of interventions on child marriage and teen pregnancy among adolescent girls for inclusion. We searched major databses and grey literature sources.ResultsWe included 30 articles in this review. We categorized the interventions reported in the review into five general categories: (a) Interventions aimed to build educational assets, (b) Interventions aimed to build life skills and health assets, (c) Wealth building interventions, and (d) Community dialogue. Only few interventions were consistently effective across the studies included in the review. The provision of scholarship and systematically implemented community dialogues are consistently effective across settings.ConclusionProgram designers aiming to empower adolescent girls should address environmental factors, including financial barriers and community norms. Future researchers should consider designing rigorous effectiveness and cost effectiveness studies to ensure sustainability.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022327397

Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

Objectives .In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia. Design. Prospective cohort study. Settings. Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia. Participants. This study was conducted among 268 patients with TB, aged 18–80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions. Main outcome measure. Adherence to anti-TB medications. Results. Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications. Conclusion. Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services

Substance use disorder and associated factors among prisoners in a correctional institution in Jimma, Southwest Ethiopia: a cross-sectional study

Background: Substance use disorder is an important public health problem and one of the major causes of disability worldwide. Substance use and criminal behavior are closely related and there is a significant association between substance misuse and crime, but little is known about substance use disorder among prisoners, in particular in low-income countries. Therefore, we investigated substance use disorder and associated factors in inmates of a correctional institution in Jimma, Southwest Ethiopia. Methods: We used a cross-sectional study design to collect data from 336 prisoners from June 5 to July 5, 2017. Study participants were selected from the total of 1460 prisoners eligible for the study by a systematic random sampling technique, i.e., one participant was randomly selected from every four consecutive admissions in the registration book. Alcohol use disorder, nicotine dependence, khat abuse, cannabis use disorder, psychopathy, adverse traumatic life events, and social support were assessed. Data were entered into EpiData version 3.1 and analyzed in bivariate and multivariable logistic regression models with the Statistical Package for Social Science version 21. Variables with a P value < 0.05 in the final fitting model were declared to be associated with the outcome variable. Results: The overall prevalence of substance use disorder was 55.9%. The prevalence of khat abuse was 41.9%;alcohol use disorder, 36.2%;nicotine dependence, 19.8%;and cannabis use disorder, 3.6%. Poor social support, living in urban areas, psychopathy, and a family history of substance use were positively associated with substance use disorder. Conclusions: Substance use disorder is prevalent among prisoners. The increased morbidity and unpleasant psychosocial consequences associated with substance use disorder, together with our finding that 66.3% of prisoners with substance use disorder were interested in obtaining treatment, suggest a need to establish prison-based treatment in this correctional institution in Jimma

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap. METHODS From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors. RESULTS The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis. CONCLUSION A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Alcohol use disorders and associated factors among people living with HIV who are attending services in south west Ethiopia

Background: Alcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa. Methods: Across-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization’s Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol (‘alcohol use disorders’). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value <0.25 were included in the final multivariable model. Results: The overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respectively. There was no significant difference in the prevalence of AUDs in persons receiving antiretroviral treatment compared to those who were antiretroviral therapy naïve (32.6% vs. 38.6%). AUDs were identified in 26.0% and 44.1% of females and males, respectively. Male gender, smoking cigarettes and psychological distress were positively associated independently with AUDs. Conclusion: The high prevalence of AUDs detected in our facility-based survey of PLHIV in Ethiopia highlights the need to integrate delivery of effective and feasible interventions for AUDs into HIV care.Matiwos Soboka, Markos Tesfaye, Garumma Tolu Feyissa, and Charlotte Hanlo

Khat use in people living with HIV:A facility-based cross-sectional survey from South West Ethiopia

Background: Khat is an evergreen plant with leaves containing the amphetamine-like compounds cathinone and cathine. Many people in the Horn of Africa use khat on a regular basis. Adverse health and social consequences of khat use have been described but little is known about the use of khat in people living with Human Immunodeficiency Virus (PLHIV) in Ethiopia. This study aimed to assess the prevalence of khat use and factors associated with khat use among PLHIV who are in contact with HIV services in a hospital in south-west Ethiopia. Methods: A cross-sectional study was conducted among 389 PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. A structured questionnaire, translated into the local languages, was used to ask about the frequency of khat use and potential risk factors and consequences of khat use in this patient group. Logistic regression analysis was used for bivariate and multivariable analysis. Results: The overall prevalence of current khat use among people living with HIV was 23.0%. The prevalence was 18.3% in females and 33.6% in males. Christians were less likely to use khat when compared to Muslims (adjusted Odds Ratio (aOR) 0.26, 95% CI = 0.13, 0.55). There was a positive association between khat use and mental distress (aOR 1.84, 95% CI = 1.01, 3.36), smoking cigarettes (aOR 21.21, 95% CI = 7.19, 62.51), alcohol use disorders (aOR 2.16, 95% CI = 1.10, 4.21), CD4 count ≤200 cells/mm3 (aOR 3.46, 95% CI = 1.60, 7.50) and missing at least one dose of antiretroviral medication in the preceding month (ART) (aOR 4.2, 95% CI = 1.80, 5.75). Conclusion: In this study there was a high prevalence of khat use among people living with HIV which was associated with poorer adherence to ART. There is a need to adapt and evaluate feasible and acceptable interventions to reduce khat use in people living with HIV.Matiwos Soboka, Markos Tesfaye, Garumma Tolu Feyissa, and Charlotte Hanlo

Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study

Abstract Background Psychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH). Methods Data were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value <0.25 in the bivariate analyses were entered into multivariate logistic regression and variables with P-value < 0.05 in the final model were declared to be significantly associated with the outcome variable. Results The prevalence of relapse among patients with psychotic disorder was 24.6 % (n = 95). Of this, 25.4 and 22.4 % were males and females respectively. The odds of developing psychotic relapse among patients living with family was 72 % lower than that of patients living alone (aOR = 0.28, 95 % CI = 0.08, 0.93). The odds of developing psychotic relapse among patients compliant to medication was 69 % lower than that of patients who were not compliant to medications (aOR = 0.31, 95 % CI = 0.12, 0.80). The odds of developing psychotic relapse among patients having high score on social support score was 48 % lower than that of patients who were compliant to medications (aOR = 0.52, 95 % CI = 0.28, 0.95). The odds of developing psychotic relapse among patients reporting to have sought religious support was 45 % lower than that of patients who have not sought religious support (aOR = 0.55, 95 % CI = 0.31, 0.96). On the other hand, the odds of developing psychotic relapse among participants who have experienced medication side effects was 1.83 times higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31). Conclusions The high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services

Tobacco dependence among people with mental illness: a facility-based cross sectional study from Southwest Ethiopia

Abstract Background Tobacco smoking is a health care issue in developed as well as in developing countries. Tobacco smoking among people with mental illness is significantly higher than in the general population. Tobacco smoking has negative effects on physical, mental and financial well-being of people with mental illness but little is known about tobacco dependence among mental health service users in sub-Saharan African countries, including Ethiopia. Therefore, this study attempted to assess the prevalence of tobacco dependence and associated factors among mental health service users at Jimma University teaching hospital. Methods A cross-sectional study was conducted among 305 male and 117 female mental health service users at Jimma University teaching Hospital in 2014. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess tobacco dependence. Logistic regression analysis was used for bivariate and multivariate analysis. Variables with a P value of <0.05 were considered to be associated with tobacco dependence in the final model. Results The prevalence of current tobacco dependence among the study participants was 18.5%. Amongst people with tobacco dependence, 57.7, 29.5 and 12.8% had moderate, high and very high level of tobacco dependence respectively. All mental health service users with tobacco dependence were males. There was a significant association between tobacco dependence and high school education (AOR 3.02, 95% CI 1.07, 8. 48), alcohol use disorder (AOR 4.14, 95% CI = 1.54, 11.11), daily khat chewing (AOR 13.51, 95% CI = 4.27, 42.74), chewing khat 2–3 times per week (AOR 5.09, 95% CI = 1.37,18.95), chewing khat once a week (AOR 4.31, 95%CI = 1.04,17.78), having friends who smoke tobacco (AOR 4.88, 95% CI = 2.12, 11.25) and being diagnosed with schizophrenia compared to a diagnosis of major depression (AOR 5.26, 95% CI = 2.07, 13.37). However, daily attendance at a place of worship (AOR 0.46, 95% CI = 0.22, 0.95) was associated negatively with tobacco dependence. Conclusion In this study, there was a high prevalence of tobacco dependence among mental health services users. There is a pressing need to increase availability of psychological and pharmacological interventions to reduce tobacco dependence and tobacco-related medical illness in this vulnerable group