Editorial: Methodological implications of longitudinal studies in public health research: examples from Jimma longitudinal family survey of youth

No Abstrac

Factors associated with utilization of long acting and permanent contraceptive methods among married women of reproductive age in Mekelle town, Tigray region, north Ethiopia

Background: Ethiopia is the second most populous country in Sub-Saharan Africa. Total Fertility Rate of Ethiopia is 5.4 children per women, population growth rate is estimated to be 2.7% per year and contraceptive prevalence rate is only 15% while the unmet need for family planning is 34%. Overall awareness of Family Planning methods is high, at 87%. The prevalence of long acting and permanent contraceptive methods (LAPMs) in Tigray region was very low which accounts for 0.1% for implants and no users for intra-uterine contraceptive device (IUCD) and female sterilization. Moreover almost all modern contraceptive use in Ethiopia is dependent on short acting contraceptive methods. The objective of this study was to assess factors associated with utilization of long acting and permanent contraceptive methods (LAPM) among married women of reproductive age group in Mekelle town. Methods: A cross sectional community based survey was conducted from March 9-20, 2011. Multistage sample technique was used to select the participants for the quantitative methods whereas purposive sampling was used for the qualitative part of the study. Binary descriptive statistics and multiple variable regressions were done. Results: The study consisted of quantitative and qualitative data. From the quantitative part of the study the response rate of the study was 95.6%. Of the qualitative part two FGDs were conducted for each married women and married men. 64% of the married women heard about LAPMs. More than half (53.6%) of the married women had negative attitude towards practicing of LAPMs. The overall prevalence of LAPMs use was 12.3% however; there were no users for female or male sterilization. The main reason cited by the majority of the married women for not using LAPMs was using another method of contraception 360 (93.3%). Mothers who had high knowledge were 8 times more likely to use LAPMs as compared with those who had low knowledge (AOR = 7.9, 95% CI of (3.1, 18.3). Mothers who had two or more pregnancies were 3 times more likely to use LAPM as compared with those who had one pregnancy (AOR = 2.7, 95% CI of (1.4, 5.1). Conclusion: A significant amount of the participants had low knowledge on permanent contraceptive particularly vasectomy. More than half (53.6%) of married women had negative attitude towards practicing of LAMPs. Few of married women use female sterilization and none use of female sterilization and or vasectomy. Positive knowledge of LAMPs, women who had two and above pregnancies and women who do not want to have additional child were significantly associated. Information education communication should focus on alleviating factors hinder from practicing of LAPMs

Seasonality and determinants of child growth velocity and growth deficit in rural southwest Ethiopia

Background: Ethiopia faces cyclic food insecurity that alternates between pre- and post-harvest seasons. Whether seasonal variation in access to food is associated with child growth has not been assessed empirically. Understanding seasonality of child growth velocity and growth deficit helps to improve efforts to track population interventions against malnutrition. The aim of this study was assess child growth velocity, growth deficit, and their determinants in rural southwest Ethiopia. Method: Data were obtained from four rounds of a longitudinal household survey conducted in ten districts in Oromiya Region and Southern Nations, Nationality and Peoples Region of Ethiopia, in which 1200 households were selected using multi-stage cluster sampling. Households with a child under 5 years were included in the present analyses (round 1 n = 579, round 2 n = 674, round 3 n = 674 and round 4 n = 680). The hierarchical nature of the data was taken into account during the statistical analyses by fitting a linear mixed effects model. A restricted maximum likelihood estimation method was employed in the analyses. Result: Compared to the post-harvest season, a higher length and weight velocity were observed in pre-harvest season with an average difference of 6.4 cm/year and 0.6 kg/year compared to the post-harvest season. The mean height of children in post-harvest seasons was 5.7 cm below the WHO median reference height. The mean height of children increased an additional 3.3 cm [95% CI (2.94, 3.73)] per year in pre-harvest season compared to the post-harvest season. Similarly, the mean weight of children increased 1.0 kg [95% CI (0.91, 1.11)] per year more in the pre-harvest season compared to the post-harvest season. Children who had a low dietary diversity and were born during the lean season in both seasons had a higher linear growth deficit. Being member of a highly food insecure household was negatively associated with higher weight gain. Having experienced no illness during the previous 2 weeks was positively associated with linear growth and weight gain. Conclusion: Child growth velocities and child growth deficits were higher in the pre-harvest season and post-harvest season respectively. Low dietary diversity and being part of a highly food insecure household were significantly risk factors for decreased linear growth and weight gain respectively

Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia

Background: In resource limited settings, many People Living with HIV/AIDS (PLWHA) lack access to sufficient quantities of nutritious foods, which poses additional challenges to the success of antiretroviral therapy (ART). Maintaining adequate food consumption and nutrient intake levels and meeting the special nutritional needs to cope up with the disease and the ART are critical for PLWHA to achieve the full benefit of such a treatment. Objective: To determine the prevalence and correlates of food insecurity among HIV-infected individuals receiving highly active antiretroviral therapy in resource-limited settings. Methods: A cross sectional study was carried out from January 1, 2009 to March 3, 2009 at ART clinic at Jimma University specialized hospital (JUSH) in Ethiopia. We used multivariable logistic regression model to compare independent risk factors by food insecurity status among 319 adult PLWHA (>= 18 years) attending ART Clinic. Results: A total of 319 adult PLWHA participated in the study giving a response rate of 100%. Out of 319 PLWHA the largest numbers of participants, 46.4% were in the age group of 25-34 years. The overall 201(63.0%) PLWHA were food insecure. Educational status of elementary or lower [OR = 3.10 (95%CI; (1.68-5.71)], average family monthly income < 100 USD [OR = 13.1 (95%CI; (4.29-40.0)] and lower food diversity [OR = 2.18 (95%CI; (1.21-3.99)] were significantly and independently associated with food insecurity. Conclusion: Food insecurity is a significant problem among PLWHA on HAART. Lower educational status and low family income were the predictors of food insecurity. Food security interventions should be an integral component of HIV/AIDS care and support programs. Special attention need to be given to patients who have lower educational status and are members of households with low income

Trends of HIV Seropositivity among Blood Donors over Six Years Period (1995-2000) in Jimma Zone, Southwest Ethiopia

Background: Since few years back HIV/AIDS has become a threat to globaldevelopment. Developing countries especially those in the sub-Saharan area are highly victimized by the tolls of its morbidity and mortality. Circumstantial evidences and reports from sentinel studies indicate that the problem is progressing from time to time. However, there is no adequate information in Ethiopia as to what the trend of the infection looks like in healthy population over a period of time. The objective of this study was to determine the trend of HIV positivity among blood donors at the Jimma Hospital Blood Bank. Methods: A retrospective cross-sectional study was carried out among blood donors during the period of January 1995 to December 2000 at Jimma hospital blood bank, Jimma zone, Southwest of Oromiya, to determine the trend of HIV seropositivity and associated factors. All subjects who donated their blood at Jimma hospital blood bank during the specified period were included in the study. Data on socio-demographic variables, and serologic status of the subjects were abstracted from their records using structured questionnaire. The data were cleaned edited and entered in to computer and analysis was done using SPSS version 7.5. Results: A total of 3394 subjects donated blood over the last six years, 3020 were male and 360 were female. The prevalence of seropositivity tended to decrease from 1995 some how until 1999 and started to rise in 2000 this difference in the prevalence of seropositivity was statistically significant (P&lt;0.05). The study revealed that 189 (5.6%) donors were positive for HIV upon screening by ELISA method. The sex specific prevalence of HIV infection was 9.3% for females and 5.8% for males. This difference in the sex specific prevalence of HIV infection was statistically significant (P=0.002, OR = 0.565, 95%CI =0.395-0.810). There is also a statistically significant difference in the prevalence of HIV infection along the years (P =0.003). The age specific prevalence is highest in the age group of 18-30 followed by that of the age group of 31-40 as compared to other age groups, this difference was statistically significant (P =0.028). Single subjects showed the highest (5.8%) prevalence followed by Married ones (5.6%), the difference was not statistically significant (P&gt;0.05). Pertaining the literacy status, the highest prevalence (7.2%) was observed in those subjects who attended Junior secondary and high school followed by those who attended grades 1-6(5.4%), the difference was not statistically significant (P&lt;0.05). Seropositivity was higher(6.9%) among Christians as compared to Muslims (4.1%) and the difference was statistically significant (P &lt;0.001, OR =1.68, 95%CI=1.25-1.27). Conclusion: Based on the results of the study, appropriate recommendations were made.Ethiop J Health Sci Vol. 11, No. 2 July 200

Chronic Malnutrition Among Under Five Children of Ethiopia May Not Be Economic. A Systematic Review and Meta-Analysis

Background: Ethiopia is one of the four low income countries in achieving MDG4, however, minimizing child undernutrition became critical undertaking thus far. This review aimed at identifying the predictors of under-5 children nutrition in Ethiopia.Methods: Databases searched were Med Line, HINARY, MedNar and Embase. Furthermore, gray literatures were also sought. All papers selected for inclusion in the review were subjected to a rigorous critical appraisal using standardized critical appraisal instruments from the Joanna Briggs Institute. Quantitative papers were pooled for statistical analysis and narrative synthesis. Odds ratios and their 95% confidence intervals were calculated for analysis. Papers of optimal quality but without optimal data set for meta-analysis were subjected for narrative synthesisResults: Nonadherence towards Optimal feeding recommendations was the most reported predictor of stunting and wasting, while, maternal education and ‘Water, Sanitation and Hygiene’ factors were the second. The findings of the Meta-analysis showed no evidence of association between household income/wealth and stunting of children in Ethiopia (OR=1.14, 95% CI= 0.97, 1.34), heterogeneity test:i2 = 92%, df = 20, (P &lt; 0.00001). On the other hand, children in low income/wealth group were 1.73 times more likely to have wasting compared to children of the higher income/wealth households (OR=1.73, 95% C I= 1.51, 1.97) heterogeneity test: i2 = 71%, df = 20, (P &lt; 0.00001).Conclusion: An over-reliance on macroeconomic growth as a solitary factor towards undernutrition should not be the way forward. Supplementary and more focused nutrition specific and sensitive interventions are needed in Ethiopia

The Prevalence of Anaemia Among Children Age 6 to 59 Months and Association Factors in Central Highland Region of Ethiopia, Community Based Cross Sectional Design, Initial Assessment for BCC Intervention

Behavioral change communication (BCC) to prevent iron deficiency anaemia had lacked attention in our country. Considerably, children are the most vulnerably group for iron deficiency anaemia (IDA). This study aimed to assess prevalence of anaemia and associated factors among children age 6 to 59 months. Methods: Community based Cross sectional study design was used for initial assessment for BCC intervention in Central Highland of Ethiopia. Multistage sampling method was used to select 8 districts, 16 clustered Kebeles (smallest unit of administration) and 1012 mothers/care givers and their pair children age 6 to 59 months by considering feature BCC intervention. Dietary behaviour, anthropometric measurements and blood samples data were collected. Binary and linear logistic regressions were analysed using IBM SPSS Statistics software version 21. Results: The prevalence of anaemia among study subjects was 184 (18.4 %.), but higher (24.1%) among group of age 6 to &lt;24 months. The mean Hb concentration was 12.55+ 1.73 and stunted growth (411 (40.6%)). Being consuming cow milk as major complementary food (Adjusted Odds Ratio (AOR) =4.54, 95% CI =3.14, 6.56), age 6 to &lt;24 months (AOR=1.4, CI=1.10, 2.94) were considered as independent predictors of risk for having anaemia among children. In linear logistic regression analysis, being increasing age (Bcoefficient ((B) = 0.172, CI=0.01, 0.33) and increasing height (B=0.170, CI=0.14, 0.329) were potentially increase haemoglobin concentration by 0.170 mg/dl. Also, Height for age (HAZ) (B =0.105, CI=0.02, 0.144) change Hb concentration by 0.105mg/dl. Conclusions: The magnitude of anaemia was moderate among young children. Cow milk consumption and young children related to poor dietary intake behaviour increased the risk of anaemia and high proportion of inadequate growth (stunting) among study subjects considerable for BCC intervention to improve iron intake for children growth

Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia

Introduction: The period from birth to two years of age is a "critical window" of opportunity for the promotion of optimal growth, health and behavioral development of children. Poor child feeding patterns combined with household food insecurity can lead to malnutrition which is a major public health problem in developing countries like Ethiopia. Methods: A community based cross-sectional study that involved 575 participants from rural Sidama was conducted from February to March 2011. A two-stage stratified sampling procedure was employed to select the required households. Multivariable logistic regression analyses were performed to compare stunting by feeding patterns and other characteristics. Results: Only 14.4% of mothers fed their children optimally. Prevalence of stunting was higher for infants aged 6 to 8 months (43%) than for those in 0-5 months (26.6%) or 9-23 months (39%) category. Women who did not receive antenatal care(ANC) during pregnancy were 1.5 times more likely to practice pre-lacteal feeding and 2.8 and 1.9 times more likely to feed their children below minimum dietary diversity and minimum meal frequency, respectively (P=0.01). Mothers older than 18 years during the birth of index child were 86% less likely to feed their child below minimum meal frequency than their younger counterparts (P=0.01). Children who started complementary food either before or after the recommended 6 months time, were more likely to be stunted (P=0.01). Conclusion: The feeding practices of most mothers did not meet WHO recommendations. Behavior change communication about the importance of optimal complementary feeding and ANC attendance should be strengthened through extensive use of the Health Extension Workers to reduce the level of child stunting in the study area.Pan African Medical Journal 2013; 14: 7

Surgical Site Infection Rate and Risk Factors Among Obstetric Cases of Jimma University Specialized Hospital, Southwest Ethiopia

BACKGROUND: Surgical Site infections are the second most frequently reported infections of all nosocomial infections among hospital patients. Among surgical patients in obstetrics, Surgical Site Infections were the most common nosocomial infections and the rate is higher in sub-Saharan Africa. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to determine the surgical site infection rate among women having surgery for delivery in obstetrics of Jimma University Specialized Hospital (JUSH) from April 1, 2009 to March 31, 2010. METHODS: A prospective descriptive study design was conducted with the aim of determining the surgical site infection rate on all 770 women who had surgery for delivery from April 1, 2009 to March 31, 2010 in obstetric ward of the Hospital. Data on history of the patient, patient specific demographic information on potential risk factors and the occurrence of Surgical Site infections in the first 30 days following surgery were collected using pretested data collection form. In addition, relevant data were also abstracted from the operation logbook of the cases. Then data were cleaned, edited and fed to computer and analyzed using SPSS for window version 16.0. Finally Statistical test for significance was employed using chi-squared (X 2) where appropriate at 5% level of significance. RESULTS: The mean (±SD) of the subjects’ age was 26(±7) years and the majority of the women were from the rural areas (72.7%). The overall surgical site infection rate was 11.4%. Of those who had surgical site infections, 64.8% had clean-contaminated wound and 35.2% had contaminated /dirty wounds. Wound class at time of surgery has a statistically significant association with Surgical Site infections (p < 0.001).The Surgical Site infections rate was similar for cesarean section and abdominal hysterectomy but higher for destructive delivery under direct vision. Majority of the operations were made for emergency Obstetric conditions (96.6%) and the Surgical Site Infections rate was two times higher compared to that of elective surgery. Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections. CONCLUSION: it has been revealed that Surgical Site Infections rates are higher than acceptable standards indicating the need for improving Antenatal care, increasing the number of skilled birth attendants at the local clinics, increasing basic and comprehensive emergency obstetric care services, applying improved surgical techniques and improving infection prevention practices to decrease infection rate to acceptable standard. KEYWORDS: surgical site infection, antenatal care, chorioamnionitis, meconium