Aman Yesuf

Background: In response to the increasing incidence and prevalence of hypertension, Ethiopia has been piloting hypertension control at the primary health care level in selected sentinel sites. However, no evaluation has been conducted and its success and failures have not been ascertained. Objective: This study aimed to evaluate on whether sentinel hypertension surveillance system in Mojo City were operating efficiently and effectively. Methods: A concurrently embedded mixed design (quantitative or qualitative) study was conducted in 2 sentinel health centers in Mojo city, Oromia region of Ethiopia. The usefulness and 9 system attributes were assessed via key informant interviews, observations, and record reviews. The qualitative data were analyzed manually via thematic analysis, whereas quantitative data were analyzed via SPSS Software version 25.0 (IBM Corp). Results: The study invited 14 key informants, and all were willing to participate in the interview. The completeness and timeliness of reports were 98% and 100%, respectively. The sensitivity, positive predictive value, and representativeness were 45.3%, 92.6%, and 22%, respectively. Nearly three-fourths (10/14, 71%) of key informants perceived the system as flexible, while half thought it as unstable due to factors such as inadequate training and lack of supportive supervision and feedback system. Health facilities did not conduct routine data analysis and interpretation, nor did they use for action. Conclusions: The surveillance system in Mojo city was simple, flexible, acceptable, and predictive but less sensitive, unrepresentative, and unstable. There is a need for implementing routine data analysis and use for action, adequate training, and feedback system for optimizing the system’s performance and to ensure its sustainability.

BACKGROUND Hypertension is one of the rising non-communicable diseases in Ethiopia. To achieve optimal hypertension control, and reduce the risk of cardiovascular complications, Ethiopia had initiated a hypertension program in primary healthcare settings whose effectiveness has not yet been ascertained OBJECTIVE This study aimed to determine the effectiveness of a pilot hypertension program in the Amhara region of Ethiopia METHODS A parallel evaluation design guided by the CDC’s Framework of evaluating public health programs was conducted at four pilot and four non-pilot health facilities in the Amhara region of Ethiopia. Data were collected using checklist with a structured questionnaire from face-to face interviews, record reviews and observations. Data were analyzed using SPSS version 25.0. Statistical comparisons were made using chi-square tests, t-tests, 95% confidence intervals, and p < 0.05 RESULTS Opportunistic blood pressure (BP) screening was significantly higher in pilot facilities (91%, 95% CI: 87.8–93.5%) than in non-pilot facilities (74.4%, 95% CI: 71.2–79.7%). Hypertension detection rate was significantly higher in pilot facilities (19.9%, 95% CI: 16.2–24.0%) compared to non-pilot facilities (14.9%, 95% CI: 11.7–18.6%). Half (51.8%) of the hypertensive patients in the pilot facilities and 42.4% in the non-pilot facilities had controlled BP, with a statistically significant difference in BP control rates between facilities (chi-square, X2=0.823; p < 0.001). Overall, pilot facilities showed better performance in the hypertension prevention (72.8% vs 43.6%), treatment (85.3% vs 55.0%) and control domains (49.8% vs 42.4%). The mean performance across the three domains was higher in pilot facilities (76.1%) compared to non-pilot facilities (51.2%) (t = 2.125; p = 0.042) CONCLUSIONS The pilot program in the Amhara region showed promising results in hypertension prevention, treatment, and control. These results support the scale-up of pilot components into nationwide program such as structured approaches in hypertension management, protocol adherence and integration into community level care

Background: Pneumonia is the single largest infectious disease that causes more under-five morbidity and mortality than any other infectious disease in the world, including Ethiopia. The aim of this study is to assess determinants of pneumonia among under-five children in the South West Shewa Zone, Oromia Region, Ethiopia, 2021. Methods: We used an unmatched case-control study design from March 15 to April 30, 2021, in the South West Shewa Zone, Ethiopia. A sample of 398 (199 cases and 199 controls) participated in the study. Trained data collectors through a pre-tested structured questionnaire collected data. We used Epi Info to enter data and analyzed using SPSS version 23. We described our data using descriptive statistics. We identified predictors of pneumonia using logistic regression analysis. We declared predictors of pneumonia at a P-value of 0.05 or less. Results: Breastfeeding for less than 6 months [AOR:3.51, 95%CI:(1.12,11.00)], lack of Vitamin A supplementation [AOR:3.56,95%CI:(1.58, 8.05)], history of URTI [AOR:9.66, 95%CI:(4.69,19.87)], family child care practices [AOR:6.46, 95%CI, (2.83,14.76)], sleeping with three to five persons in a room [AOR:2.90, 9%CI: (1.23,6.84)], having above five persons in a room [AOR: 3.88, 95%CI: 1.02,14.77), use of wood as a source of fuel [AOR = 3.02 95% CI: 1.41,6.46)] and not opening windows [AOR:2.56 95%CI: (1.21,5.41)] were independent factors of pneumonia among under five children. Conclusion: Pneumonia is associated with breastfeeding for less than 6 months, lack of vitamin A supplementation, history of URTI, types of childcare practice, indoor overcrowding, use of wood as a source of fuel, and not opening windows. Therefore, exclusive breastfeeding, improving vitamin A supplementation, early control of respiratory tract infection through promoting good hygiene and ventilation strategies in crowded homes, and promoting how to reduce indoor air pollution through affordable clean stoves will be relevant interventions to reduce under-five pneumonia.

Background: Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul’s Hospital Millennium Medical College, 2012 to 2019. Methods: A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual. Results: In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death. Conclusion: The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions.

Background: The introduction of antiretroviral therapy (ART) significantly decreases the incidence of tuberculosis (TB) in people living with human immunodeficiency virus (PLWHIV). However, a considerable proportion is still co-infected with TB after ART initiation. Thus, this study aimed to assess the effect of long-term HAART on the incidence of TB among PLWHIV in Addis Ababa, Ethiopia. Methods: A matched nested case–control study was conducted among PLWHIV who were enrolled in ART clinics in Addis Ababa, Ethiopia from 2013 up to 2018. Cases were HIV-TB co-infected individuals who were taking antiretroviral treatment, while controls were PLWHIV without TB who were taking antiretroviral treatment. The cases and controls are matched exactly in age and sex. Data were entered in Epi Info version 7.1 and analyzed using SPSS version 20. Bi-variable and multivariable conditional logistic regression were employed along with 95% CI. A P-value < 0.05 in the multivariable analysis was considered statistically significant. Results: Fifty-seven cases were compared with 114 controls. Accordingly, previous TB history (X²; 13.790, P < 0.001), baseline functional status (X²; 9.120, P = 0.010), baseline WHO clinical stage (X²; 10.083, P = 0.001), baseline hemoglobin value (X²; 6.985, P = 0.008), baseline body mass index (X²; 3.873, P = 0.049), isoniazid preventive treatment (X²; 8.047, P = 0.005), baseline CD4 value (X²; 12.741, P < 0.001) and length of stay on ART (X²; 53.359, P < 0.001) were associated with developing TB. Length of stay on ART was found to be the statistically significant determinant of TB infection after ART initiation (aOR = 5.925, 95% CI = 2.649– 13.250). Conclusion: Advanced clinical stages at the baseline, previous TB history, and not taking IPT were associated with TB infection. The long-term ART exposure significantly decreases tuberculosis incidence in PLWHIV. Thus, retaining PLWHIV on ART would be important to decrease the incidence of TB in this group of individuals.

Background. Major reasons for malnutrition, particularly among those who live in low- and middle-income countries, are physiological vulnerability and inadequate intake. The objective of the study was to assess the prevalence of undernutrition and associated factors among lactating mothers of Angecha District, Southern Ethiopia. Methods. A community-based cross-sectional study was conducted among randomly selected lactating mothers in Angecha District from March to April 2017. A pretested structured questionnaire was used to assess the prevalence of undernutrition and associated factors among lactating mothers. Undernutrition was defined as the body mass index of less than 18.5 kg/m2. A multivariable logistic regression model was fitted, and the adjusted odds ratio (AOR) at a p value less than 0.05 was used to determine a statistically significant association between predictors and outcome variables. Result. The prevalence of undernutrition among lactating mothers was 21.2% (95% CI: 17.52, 25.46). The odds of undernutrition were higher among lactating mothers in the younger age group (AOR 4.12 (95% CI: 1.25–13.63), compared to 36–49 years group), dietary diversity less than five food groups (AOR 2.4, 95% CI: 1.35–4.36), and not attending antenatal care (ANC) (AOR 2.90 (95% CI: 1.43–5.86), compared to those who attended ANC for 4 or more times). The odds of undernutrition among lactating women from 3rd quantile wealth index households reduced by nearly half (AOR 0.47, 95% CI: 0.23–0.98) compared to lactating mothers from 1st quantile wealth index households. Conclusion. Nearly one in every five lactating mothers was undernourished. Age, dietary diversity score, ANC visit, and wealth index were found to be the associated factors of undernutrition. Therefore, due attention should have to be given to increase the use of ANC.

Hepatitis B is the world’s most common serious liver infection. Infection by hepatitis B virus during pregnancy has high rate of vertical transmission and adverse effect on both the mother and child. Data on seroprevalence and associated factors among pregnant women in Dawuro or surrounding was scarce. Therefore, the aim of this study was to assess prevalence of hepatitis B virus and factors associated among pregnant women in Dawuro Zone. Institution based cross-sectional study was conducted from 1st April to May 31, 2015 in Dawuro zone. Venous blood was collected, plasma was separated and hepatitis B virus surface antigen was screened using rapid test. Logistic regression was employed with 95% CI and p value of <0.05 was used as statistically significant. Data were collected on 289 women. The overall prevalence from this study was (p = 3.5%, 95% CI 1.4–5.6%) multivariate analysis using logistic regression showed multiple sexual partner (AOR = 6.923; 95% CI 1.685–28.441), and abortion history (AOR = 4.975; 95% CI 1.21–20.456), were significantly associated with hepatitis B virus surface antigen (HBsAg) infection. This seroprevalence was categorized as intermediate endemicity according to WHO classification criteria. Health education on sexual transmission of hepatitis B virus and inclusion of screening hepatitis b virus as routine antenatal care service is recommended.

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0–1) in Bahrain and Oman to 471 (95% UI = 245–763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520–989) in Syria to 40,869 (95% UI = 21,540–65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.