Incidence and Predictors of Mortality among Severe Acute Malnourished Under Five Children Admitted to Dilla University Referal Hospital: A Retrospective Longitudinal Study

Background: Many developing countries continue to experience high mortality of children with severe acute malnutrition that receive treatment in inpatient set ups associated to either co-morbidity or due to poor adherence to the World Health Organization therapeutic guidelines for the management of severe acute malnutrition. Objective: To assess incidence and predictors of mortality among severe acute malnourished under five children admitted to Dilla university referral hospital from 2013 to 2015 Methods: A 36 month retrospective cohort study was conducted among 450 under five children admitted to stabilization centers in Dilla university referral hospital between 2013 and 2015. The data was collected from a randomly selected chart after getting ethical clearance from the Institutional review board of Arba Minch University by trained professionals. Data was entered and cleaned by Epi Info version 7 and analyzed by STATA version 11. Life table was used to estimate the cumulative incidence of death and Log rank tests to compare probability of hazard between variables. Bivariate and multivariate Cox proportional hazards model were used to identify predictors. Significance was considered at P-value < 0.05 in the multivariate analysis. Model was built by forward step wise procedure; compared by likely hood ratio test and Harrell’s concordance and fitness checked by cox-snell residual plot.Result: A total of 450 children were followed for 7389 person-day of observation; during the follow up period 56(12.4) died making overall incidence density rate of 7.57 (CI=5.83-9.84) per 1000 Person day. Survival at the end of 1st, 2nd and 3rd week was 95%, 88% and 84% respectively and overall mean survival time was 47(95%CI=45-48.6) day. Presence of Altered pulse rate [AHR =5.85, 95% CI= 2.55-13.4], altered body temperature [AHR= 6.94 (95 % CI [2.94-16.4], Shock (AHR=3.15 (95 % CI [1.5-6.5]), IV infusion (AHR=3.24 (95 % CI [1.54-6.8]) and septicemia/meningitis (AHR=2.88(95 % CI [1.413-5.9]) were independent predictors of mortality. Conclusion and recommendation: The incidence of death and treatment outcomes was in acceptable ranges. Intervention to further reduce deaths has to focus on children with comorbidities and altered general conditions. Key words: Severe acute malnutrition, Incidence, Under-five children, Dilla, Hospita

Predictors of Neonatal mortality among Neonates who admitted in Neonatal intensive Care Unit at Arba Minch General Hospital

Introduction: The neonatal period refers to the first 28 days of life. Newborns are particularly vulnerable to death. The predictors associated with neonatal mortality need to be addressed, as identifying the predictors will contribute to reducing the rates of neonatal morbidity and mortality.Method: A facility-based retrospective cohort study was conducted of 332 records of neonates who were admitted to the neonatal intensive care unit at Arba Minch General Hospital. Data were collected from randomly selected neonate records using computer-generated random numbers. Data were entered into Epi-info version 3.5.1 and exported to SPSS v.23 for analysis. Crude hazard ratios, adjusted hazard ratios and 95% confidence intervals were used to assess the strength of association and statistical significance. The incidence density rate of death with respect to ‘person time at risk’ was calculated. Variables which had a p-value of ≤ 0.25 in bivariate analysis were considered as candidates for multivariate regression analysis; variables that had a p-value of ≤0.05 in the multivariate analysis were considered as independent predictors of neonatal mortality in the final Cox regression analysis.Result: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days. The neonatal mortality predictors were 5th-minute APGAR score ≤5 (AHR: 1.9; 95%CI: 1.02,3.54); 2nd to 4th birth order (AHR:13; 95%CI: 5.1,33.4); 5th birth order (AHR:24; 95%CI: 10.5,55.2); history of two to four live births(AHR: 0.16; 95%CI: 1.07,3.63); history of ≥5 live births (AHR: 0.18; 95%CI: 0.06,0.51); and not initiating exclusive breastfeeding within the first hour of delivery (AHR: 1.8: 95%CI: 1.03,3.18).Conclusion: The incidence density rate of neonatal mortality was 31.6 per 1,000 neonate days, and maternal age, APGAR score, birth order, parity, and exclusive breastfeeding initiation were independent predictors of neonatal mortality. [Ethiop.J. Health Dev. 2019; 33(1):46-52]Key words: Neonatal mortality; Predictors; Arba Minch General hospita

Incidence and Predictors of Tuberculosis Among Adult PLWHA at Public Health Facilities of Hawassa City

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important

Prevalence and Associated Factors of Hypertension Among Civil Servants Working in Arba Minch Town, South Ethiopia

Despite Hypertension is a global public health challenge and a leading modifiable risk factor for cardiovascular disease and death attention was not given in developing countries. Therefore measuring the prevalence and identifying predictors of Hypertension is very important. Institution based cross sectional study design was employed from March–April, 2016 by taking 319 randomly selected civil servants working in in Arba Minch town. Data was collected using structured questionnaire and standardized instruments for physical examination by 5 trained nurses. SPSS version 20 was used for data analysis. Bi-variable and Multivariate logistic regression was employed for analysis of risk factors. The mean SBP and DBP of study participants were 120.87 + 14.15 mmHg and 80.28 + 8.8 mmHg, respectively. The prevalence of hypertension was found to be 27.8% (95% CI = 22.9-32.7%). Civil servants of age 50 years and above [AOR = 13.3], age 40-49 years [AOR = 5], age 30-39 years [AOR = 3.5], abdominal obesity [AOR=12.2], general obesity [AOR = 4.2], stress status [AOR = 12.3], current alcohol drink [AOR = 3.3], ex-drinker [AOR = 8.9] and family history of hypertension [AOR = 5.6] were found to be significantly associated with hypertension. The prevalence indicates that it is hidden epidemic in this population; therefore for screening and risk reduction program are needed

Prevalence and Associated Factors of Hypertension among Civil Servants Working in Arba Minch Town, South Ethiopia

Despite Hypertension is a global public health challenge and a leading modifiable risk factor for cardiovascular disease and death attention was not given in developing countries. Therefore measuring the prevalence and identifying predictors of Hypertension is very important. Institution based cross sectional study design was employed from March–April, 2016 by taking 319 randomly selected civil servants working in in Arba Minch town. Data was collected using structured questionnaire and standardized instruments for physical examination by 5 trained nurses. SPSS version 20 was used for data analysis. Bi-variable and Multivariate logistic regression was employed for analysis of risk factors. The mean SBP and DBP of study participants were 120.87 + 14.15 mmHg and 80.28 + 8.8 mmHg, respectively. The prevalence of hypertension was found to be 27.8% (95% CI = 22.9-32.7%). Civil servants of age 50 years and above [AOR = 13.3], age 40-49 years [AOR = 5], age 30-39 years [AOR = 3.5], abdominal obesity [AOR=12.2], general obesity [AOR = 4.2], stress status [AOR = 12.3], current alcohol drink [AOR = 3.3], ex-drinker [AOR = 8.9] and family history of hypertension [AOR = 5.6] were found to be significantly associated with hypertension. The prevalence indicates that it is hidden epidemic in this population; therefore for screening and risk reduction program are needed

Risky Sexual Behavior and Associated Factors Among High School Students in Gondar City, Northwest Ethiopia

According to World Health Organization (WHO), youth are young people within 15-24 years old. Studies reported that more than half of all new HIV infections occur among people between the ages of 15 and 24 years. Institution based quantitative cross-sectional study was conducted among high school students in Gondar city. Multistage sampling technique was employed to recruit study participants. Data were collected using pretested structured self-administered questionnaire. Data were entered in Epi Info version 7 and analyzed using SPSS version 21. Descriptive statistics were computed to describe important variables in relation to the outcome variable, Binary and multivariable logistic regressions were used to identify independent predictors of the outcome variable. The overall prevalence of risky sexual behavior was 12.8%. Two out of five sexually active respondents ever had unprotected sexual intercourse. Ever used alcohol ((AOR, 3.53 95% CI (1.73-7.19)), had no parental monitor (AOR, 12.21 95% CI (6.55-22.78), ever watched pornographic film (AOR, 2.24 95% CI (1.15-4.35), had no parental discussion on sexual and reproductive health issues (AOR, 2.57 95% CI (1.36-4.85) and peer pressure (AOR,2.50, 95%CI (1.20-5.21), were factors which significantly increases the odds of risky sexual behavior among youth. Risky sexual behavior among high school students in Gondar city administration was very high and worrisome; so that collaborated effort is needed from parents, schools, health facilities and health policy makers to bring healthy sexual behavior among school youth

Non-communicable diseases in Ethiopia: policy and strategy gaps in the reduction of behavioral risk factors

Introduction: Non-communicable diseases (NCDs) are the leading cause of death worldwide. Over 80% of NCD deaths occur in developing countries. Four modifiable behaviors, namely tobacco use, consumption of unhealthy diet, physical inactivity, and the harmful use of alcohol, contribute to 80% of the NCD burden. Studies show that the vast majority of NCDs can be prevented through behavioral risk-reduction interventions. Properly executed, the interventions could lead to a decrease in the burden of NCDs, ranging from a 30% drop in the prevalence of cancer to a 75% reduction in cardiovascular diseases. This study examined the policy and strategy gaps in the reduction of the modifiable NCD behavioral risk factors in Ethiopia to inform and guide policy-makers and other stakeholders. Methodology: This study used a data triangulation methodology with a sequential, explanatory, mixed-method design conducted in two stages. The authors carried out quantitative analysis on the prevalence and distribution of behavioral risk factors from the Ethiopia NCD STEPwise approach to surveillance (STEPS) survey. Qualitative data on national policies and strategies complemented the analysis of the progress made so far and the existing gaps. Results and Discussion: Ethiopia has made substantial progress in responding to the NCD epidemic by developing a health sector NCD strategic action plan, generating evidence, and setting time-bound national targets on NCD behavioral risk factors. Activities mainly aimed at reducing tobacco use, such as implementation of the ratified WHO Framework Convention on Tobacco Control (FCTC), using evidence of the Global Adult Tobacco Survey (GATS), and the articulation of legislative measures are ongoing. On this paper our analysis reveals policy and strategy gaps, status in law enforcement, social mobilization, and awareness creation to reduce the major behavioral risk factors. Conclusions: NCDs share common risk factors and risk reduction strategies creates an opportunity for an effective response. However, the national response still needs more effort to have a sufficient impact on the prevention of NCDs in Ethiopia. Thus, there is an urgent need for the country to develop and implement targeted strategies for each behavioral risk factor and design functional, multisectoral coordination. There is also a need for establishing sustainable financial mechanisms, such as increasing program budgets and levying ‘sin taxes,’ to support the NCD prevention and control program. Ethiop. J. Health Dev. 2019; 33(4):259-268] Key words: NCDs, behavioral risk factors, policy, strategy, multisectoral coordination, Ethiopi

Non-communicable Diseases in Ethiopia: Disease burden, gaps in health care delivery and strategic directions.

Abstract Introduction: In Ethiopia, non-communicable diseases (NCDs) cause 42% of deaths, of which 27% are premature deaths before 70 years of age. The Disability Adjusted Life Years (DALYs) increased from below 20% in 1990 to 69% in 2015. With no action, Ethiopia will be the first among the most populous nations in Africa to experience dramatic burden of premature deaths and disability from NCDs by 2040. However, the national response to NCDs remains fragmented with the total health spending per capita for NCDs still insignificant. The focus of this paper is highlighting the burden of NCDs in Ethiopia and analyzing one of the two major WHO recommended policy issues; the status of integrated management of NCDs, in Ethiopia. NCDs are complex conditions influenced by a range of individual, social and economic factors, including our perceptions and behavior. Also, NCDs tend to be easily overlooked by individuals and policy makers due to their silent nature. Thus, effectively addressing NCDs requires a fresher look into a range of health system issues, including how health services are organized and delivered.Methods: A mixed method approach with quantitative and qualitative data was used. Quantitative data was obtained through analysis of the global burden of diseases study, WHO-STEPs survey, Ethiopian SARA study and the national essential NCD drug survey. This was supplemented by qualitative data through review of a range of documents, including the national NCD policies and strategies and global and regional commitments.Results and discussion: In 2015, NCDs were the leading causes of age-standardized death rate (causing 711 deaths per 100,000 people (95% UI: 468.8–1036.2) and DALYs. The national estimates of the prevalence of NCD metabolic risk factors showed high rates of raised blood pressure (16%), hyperglycemia (5.9%), hypercholesterolemia (5.6%), overweight (5.2%) and Obesity (1.2%). Prevalence of 3-5 risk factors constituting a metabolic syndrome was 4.4%. Data availability on NCD morbidity and mortality is limited. While there are encouraging actions on NCDs in terms of political commitment, lot of gaps as shown by limited availability of resources for NCDs, NCD prevention and treatment services at the primary health care (PHC) level. Shortage of essential NCD drugs and diagnostic facilities and lack of treatment guidelines are major challenges. There is a need to re-orient the national health system to ensure recognition of the NCD burden and sustain political commitment, allocate sufficient funding and improve organization and delivery of NCD services at PHC level. [Ethiop. J. Health Dev. 2018;32 (3):00-000]Key words: Non-communicable diseases, health-system re-orientation, NCD burden, metabolic risk factors, Service delivery, Primary Health Car