Berihun Megabiaw Zeleke

Non-Adherence to Anti-Tuberculosis Treatment and Determinant Factors among Patients with Tuberculosis in Northwest Ethiopia

Background Non-adherence to anti tuberculosis treatment is one of the crucial challenges in improving tuberculosis cure-rates and reducing further healthcare costs. The poor adherence to anti-tuberculosis treatment among patients with tuberculosis is a major problem in Ethiopia. Hence, this study assessed level of non-adherence to anti-tuberculosis therapy and associated factors among patients with tuberculosis in northwest Ethiopia. Methods An institution based cross-sectional survey was conducted among tuberculosis patients who were following anti-tuberculosis treatment in North Gondar zone from February 20 – March 30, 2013. Data were collected by trained data collectors using a structured and pre-tested questionnaire. Data were entered to EPI INFO version 3.5.3 and analyzed using statistical package for social sciences (SPSS) version 20. Multiple logistic regressions were fitted to identify associations and to control potential confounding variables. Odds ratio (OR) with 95% confidence interval was calculated and p-values<0.05 were considered statistically significant. Results A total of 280 tuberculosis patients were interviewed; 55.7% were males and nearly three quarters (72.5%) were urban dwellers. The overall non-adherence for the last one month and the last four days before the survey were 10% and 13.6% respectively. Non-adherence was high if the patients had forgetfulness (AOR 7.04, 95% CI 1.40–35.13), is on the continuation phase of chemotherapy (AOR: 6.95, 95% CI 1.81–26.73), had symptoms of tuberculosis during the interview (AOR: 4.29, 95% CI 1.53–12.03), and had co-infection with HIV (AOR: 4.06, 95% CI 1.70–9.70). Conclusions Non-adherence to anti-tuberculosis treatment was high. Forgetfulness, being in the continuation phases of chemotherapy, having symptoms of tuberculosis during the interview, and co-infected with HIV were significantly associated with non-adherence to anti-tuberculosis therapy. Special attention on adherence counseling should be given to symptomatic patients, TB/HIV co-infected patients, and those in the continuation phase of the tuberculosis therapy.

Predictors of mortality among children on Antiretroviral Therapy at a referral hospital, Northwest Ethiopia: A retrospective follow up study

BackgroundAn estimated 2.5 million children were living with HIV/AIDS at the end of 2009, 2.3 million (92%) in sub-Saharan Africa. Without treatment, a third of children with HIV will die of AIDS before their first birthday, half dying before two years of age. Hence, this study aimed to assess magnitude and predictors of mortality among children on Antiretroviral Therapy (ART) at a referral hospital in North-West Ethiopia.MethodsInstitution based retrospective follow up study was carried out among HIV-positive children from January 1st, 2006 - March 31st, 2011. Information on relevant variables was collected from patients’ charts and registries. Life table was used to estimate the cumulative survival of children. Log rank tests were employed to compare survival between the different categories of the explanatory variables. Multivariate Cox proportional hazards model was fitted to identify predictors of mortality.ResultsA total of 549 records were included in the analysis. The mean age at initiation of treatment was 6.35 ±3.78 SD years. The median follow up period was 22 months. At the end of the follow up, 41(7.5%) were dead and 384(69.9%) were alive. Mortality was 4.0 deaths per 100 child-years of follow-up period. The cumulative probabilities of survival at 3, 6, 12, 24, and 60 months of ART were 0.96, 0.94, 0.93, 0.92 and 0.83 respectively. Majority (90.2%) of the deaths occurred within the first year of treatment. Absence of cotrimoxazole preventive therapy (adjusted hazard ratio [AHR] = 4.74, 95% CI: 2.17, 10.34), anaemia (haemoglobin level < 10gm/dl) (AHR=2.44, 95% CI: 1.26, 4.73), absolute CD4 cell count below the threshold for severe immunodeficiency (AHR=2.24, 95% CI: 1.07, 4.69) and delayed or regressing developmental milestones at baseline (AHR=6.31, 95% CI: 2.52, 15.83) were predictors of mortality.ConclusionsThere was a high rate of early mortality. Hence, starting ART very early reduces disease progression and early mortality; close follow up of all children of HIV-positive mothers is recommended to make the diagnosis and start treatment at an earlier time before they develop severe immunodeficiency.

Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia

BackgroundAdverse birth outcomes are major public health problems in developing countries. Data, though scarce in developing countries including Ethiopia, on adverse birth outcomes and the risk factors are important for planning maternal and child health care services. Hence, this study aimed to determine the prevalence and associated factors of adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia.MethodsInstitution based cross-sectional study was conducted in February 2013 at Gondar University Hospital. Data were collected by face-to-face interview of 490 women after verbal informed consent using a pretested and structured questionnaire. Gestational age was determined based on the last normal menstrual period. Birth weight was measured following standards. Multiple logistic regressions were fitted and odds ratios with their 95% confidence interval were computed to identify associated factors.ResultsThe mean age of women was 26.2 (±5.2 SD) years. HIV infection among laboring women was 4.8%. About 23% of women had adverse birth outcomes (14.3% preterm, 11.2% low birth weight and 7.1% still births). Women having history of either preterm delivery or small baby (AOR: 3.1, 95% CI 1.1- 8.4) were more likely to have preterm births. Similarly, history of delivering preterm or small baby (AOR: 8.4, 95% CI 2.4- 29.4), preterm birth (AOR: 5.5, 95% CI 2.6- 11.6) and hypertension (AOR: 5.8, 95% CI 1.8- 19.6) were associated factors with low birth weight. Ante partum haemorrhage (AOR: 8.43, 95% CI 1.28- 55.34), hypertension (AOR: 9.5, 95% CI 2.1-44.3), history of perinatal death (AOR: 13.9, 95% CI 3.3- 58.5) and lack of antenatal care follow up (AOR: 9.7, 95% CI 2.7 - 35.8) were significantly associated with still birth.ConclusionsPrevalence of adverse birth outcomes (still birth, preterm birth and low birth weight) were high and still a major public health problem in the area. Histories of perinatal death, delivering preterm or small baby, ante partum hemorrhage, lack of ante natal care follow up and hypertension were associated factors with adverse birth outcomes. Thus, further enhancements of ante natal and maternal care and early screening for hypertension are recommended.

Vasomotor and sexual symptoms in older Australian women: a cross-sectional study

OBJECTIVES To determine the prevalence and severity of vasomotor symptoms (VMS) and sexual symptoms in community-dwelling older women, and to explore factors associated with VMS. DESIGN Population-based cross-sectional study. SETTING Not applicable. PARTICIPANT(S) A total of 1,548 women aged 65-79 years. INTERVENTION(S) None. MAIN OUTCOMES MEASURE(S) The presence and self-rated severity of VMS (hot flashes, night sweats, or sweating), and sexual symptoms (intimacy, desire, and vaginal dryness) were determined with the use of the Menopause Quality of Life (MenQOL) questionnaire. RESULT(S) All items of the vasomotor and the sexual MenQOL domains were completed by 1,532 and 1,361 of the study participants, respectively. Menopausal hormone therapy (MHT) use was reported by 6.2% of the women, and 6.9% reported using vaginal estrogen. Among the 1,426 women not using MHT, at least 1 VMS was reported by 32.8%. The prevalence of VMS rated as moderately to severely bothersome was 3.4%. A total of 54.4% of currently partnered women had sexual symptoms, and 32.5% reported vaginal dryness during intercourse in the past month. In the multivariate analysis, factors significantly associated with VMS were age, obesity, being a caregiver for another person, and bilateral oophorectomy. CONCLUSION(S) VMS and vaginal atrophy symptoms are common in community-dwelling older women, but they are predominantly untreated. The degree of distress caused by sexual symptoms among older women needs further exploration.

Hypoactive sexual desire dysfunction in community-dwelling older women

Objective: To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years. Methods: A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress. Results: The mean ± SD age of the 1,548 women was 71 ± 3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%-17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9%; P < 0.001). Being partnered (adjusted odds ratio [AOR] = 4.21; 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR = 2.37; 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR = 1.92; 95% CI, 1.29-2.92), and having moderate-to-severe depressive symptoms (AOR = 4.15; 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3%; P < 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women. Conclusions: HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire.

Symptomatic pelvic floor disorders in community-dwelling older Australian women

OBJECTIVES To assess the prevalence, and factors associated with, pelvic floor disorders in a representative sample of community-dwelling older Australian women. METHODS 1548 women, aged 65-79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders. RESULTS Among 1517 women (mean age=71.5 ± 4.1 SD years), 47.2% (95% CI, 44.7-49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8-38.6%) having UI, 19.8% (95% CI, 17.8-21.9%) having FI, and 6.8% (95% CI, 5.6-8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both. The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8-11.7%) for nulliparous women, to 45.3% (95% CI, 40.3-59.1%) for 1-2 births, and 52.1% (95% CI, 48.3-55.8%) for ≥ 3 births. Obese women were more likely to have at least one pelvic floor disorder (OR=1.77; 95% CI, 1.36-2.31, p<0.01). CONCLUSION Pelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem.

Trends and causes of maternal mortality in Ethiopia during 1990-2013: Findings from the Global Burden of Diseases study 2013

BackgroundMaternal mortality is noticeably high in sub-Saharan African countries including Ethiopia. Continuous nationwide systematic evaluation and assessment of the problem helps to design appropriate policy and strategy in Ethiopia. This study aimed to investigate the trends and causes of maternal mortality in Ethiopia between 1990 and 2013.MethodsWe used the Global Burden of Diseases and Risk factors (GBD) Study 2013 data that was collected from multiple sources at national and subnational levels. Spatio-temporal Gaussian Process Regression (ST-GPR) was applied to generate best estimates of maternal mortality with 95% Uncertainty Intervals (UI). Causes of death were measured using Cause of Death Ensemble modelling (CODEm). The modified UNAIDS EPP/SPECTRUM suite model was used to estimate HIV related maternal deaths.ResultsIn Ethiopia, a total of 16,740 (95% UI: 14,197, 19,271) maternal deaths occurred in 1990 whereas there were 15,234 (95% UI: 11,378, 19,871) maternal deaths occurred in 2013. This finding shows that Maternal Mortality Ratio (MMR) in Ethiopia was still high in the study period. There was a minimal but insignificant change of MMR over the last 23 years. The results revealed Ethiopia is below the target of Millennium Development Goals (MGDs) related to MMR. The top five causes of maternal mortality in 2013 were other direct maternal causes such as complications of anaesthesia, embolism (air, amniotic fluid, and blood clot), and the condition of peripartum cardiomyopathy (25.7%), complications of abortions (19.6%), maternal haemorrhage (12.2%), hypertensive disorders (10.3%), and maternal sepsis and other maternal infections such as influenza, malaria, tuberculosis, and hepatitis (9.6%). Most of the maternal mortality happened during the postpartum period and majority of the deaths occurred at the age group of 20–29 years. Overall trend showed that there was a decline from 708 per 100,000 live births in 1990 to 497 per 100,000 in 2013. The annual rate of change over these years was -1.6 (95% UI: -2.8 to -0.3).ConclusionThe findings of the study highlight the need for comprehensive efforts using multisectoral collaborations from stakeholders for reducing maternal mortality in Ethiopia. It is worthwhile for policies to focus on postpartum period.

Vasomotor symptoms and urogenital atrophy in older women: a systematic review

Abstract Objective Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years. Methods A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. Results The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, sampling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies. Conclusion Larger and appropriately sampled studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.

Demand for long acting contraceptive methods and associated factors among family planning service users, Northwest Ethiopia: a health facility based cross sectional study

BackgroundDemand for long acting contraceptive methods is one of the key factors for total fertility rate and reproductive health issues. Increased demand for these methods can decline fertility rate through spacing and limiting family size in turn improving maternal and family health and socioeconomic development of a country. The aim of this study was to assess demand for long acting contraceptives and associated factors among family planning users in Debre-Tabor Town, Northwest Ethiopia.MethodsFacility based cross-sectional study was conducted from July to August 2013. Data was collected on 487 current family planning users through face to face interview using structured questionnaire. Study participants were selected by systematic sampling method. Data were entered in to Epi Info and analyzed by using SPSS version 20. Bi-variable and multi-variable regression analyses were done to identify factors associated with demand for long acting contraceptive methods. Odds ratio with 95% CI was used to assess the association between the independent variables and demand for long acting family planning methods.ResultsThe study showed that, demand for long acting contraceptives was 17%. Only 9.2% of the women were using long acting contraceptive methods (met need). About 7.8% of women were using short acting methods while they actually want to use long acting methods (unmet need). Demand for LACMs was positively associated 3with being a daily labour (AOR = 3.87, 95% CI = [1.06, 14.20]), being a student (AOR = 2.64, 95% CI = [1.27, 5.47]), no future birth intensions (AOR = 2.17, 95% CI = [1.12, 4.23]), having five or more children (AOR = 1.67, 95% CI = [1.58, 4.83]), deciding together with husbands for using the methods (AOR = 2.73, 95% CI = [1.40, 5.32]) and often having discussion with husband (AOR = 3.89, 95% CI = [1.98, 7.65]). Clients treated poorly by the health care providers during taking the services was negatively associated with demand for LACMs (AOR = 0.42, 95% CI = [0.24, 0.74]).ConclusionDemand for long acting family planning methods was observed to be lower as compared to other studies. There were also significant proportion of women having unmet need for long acting methods – women using short acting method while actually wanting long acting methods. Therefore, it is necessary to create and increase awareness and advocacy on demand for long acting contraceptive methods considering women and their husbands. Moreover, emphasis should be given to service provision of the methods.

Vasomotor symptoms are associated with depressive symptoms in community-dwelling older women

Objective: To assess the prevalence of, and factors associated with, moderate-to-severe depressive symptoms in community-dwelling older Australian women. Methods: A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on the electoral roll. Depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) tool. Vasomotor symptoms (VMS), vulvovaginal atrophy (VVA), and pelvic floor symptoms were assessed using validated questionnaires. Women were provided a comprehensive list of psychotropic medications (antidepressants, benzodiazepines, antipsychotics, and mood stabilizers) to identify their use over the preceding month. Results: In all, 1,534 women completed the BDI-II. Overall, 34.2% (95% confidence interval [CI] 31.8%-36.7%) of women had VMS, 6.3% (95% CI 5.2%-7.7%) had moderate-to-severe depressive symptoms (BDI-II score ≥20), 26.8% (95% CI 24.6%-29.1%) had used any psychotropic medication in the previous month, and 17.5% (95%CI: 15.6-19.5%) had taken an antidepressant. Moderate-to-severe depressive symptoms were more common among women using antidepressants compared with nonusers (16.6% vs 4.3%; P < 0.001). Obesity (adjusted odds ratio [AOR] 2.18, 95% CI 1.17-4.04), living in financially insecure housing (AOR 3.84, 95% CI 2.08-8.08), being a caregiver to another person (AOR 2.39, 95% CI 1.36-4.19), being a smoker (AOR 2.28, 95% CI 1.12-4.66), having VMS (AOR 1.67, 95% CI 1.03-2.62), having pelvic floor dysfunction (AOR 1.78, 95% CI 1.08-2.94), and having vaginal dryness during intercourse (AOR 1.84, 95% CI 1.06-3.22, P < 0.05) were positively and independently associated with moderate-to-severe depressive symptoms. Being currently partnered (AOR 0.57, 95% CI 0.33-0.97) and employed (AOR 0.38, 95% CI 0.16-0.92) were associated with a lower likelihood of depressive symptoms. Conclusions: In older women, depressive symptoms are common and are associated with social and financial insecurity, and with VMS.