Demewoz Haile

Khat Chewing Practice and Associated Factors among Adults in Ethiopia: Further Analysis Using the 2011 Demographic and Health Survey

Background Khat chewing has become a highly prevalent practice and a growing public health concern in Ethiopia. Although there have been many small scale studies, very limited national information has been available in the general population. This study aimed to identify factors associated with khat chewing practice among Ethiopian adults. Methods The study used the 2011 Ethiopian demographic and health survey data. The survey was cross-sectional by design and used a multistage cluster sampling procedure. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to quantify the predictors. Results The overall khat chewing prevalence was 15.3% (95% CI: 14.90–15.71). Regional variation was observed with the highest in Harari [(53.2% (95% CI: 43.04–63.28)] and lowest in Tigray regional state [(1.1% (95% CI: 0.72–1.66)]. Multivariable analysis showed that Islam followers were 23.8 times more likely to chew khat as compared to Orthodox followers. Being a resident in Oromiya, South Nation, Nationalities and People (SNNP), Gambella, Harari and Dire Dawa regions had 1.9, 1.6, 3.1, 5.2 and 3.5 times higher odds of chewing khat as compared to Addis Ababa residents, respectively. Adults in the age group 45–49 years were 3.6 times more likely to chew khat as compared to 15–19 years. The middle and richest wealth quintiles were 1.3 and 1.5 times more likely to chew khat, respectively, as compared to the poorest category. Rural residents had 1.3 odds of chewing khat than urban residents. Those individuals who had occupation in sales, agriculture, service sector, skilled and unskilled manual workers were 1.6, 1.3, 2.4, 1.7 and 2.3 times more likely to chew khat, respectively, as compared to those who have no occupation. Females were 77% less likely to chew khat as compared to males. Formerly married and those experienced in child death had 1.4 and 1.2 times higher odds to chew khat as compared with those never married and never had child death, respectively. Those who attended mass media were 1.4 times more likely to chew khat compared with not attended. Conclusion Khat chewing is a public health concern in Ethiopia. The highest wealth quintiles, older age group, rural residence, child death, formerly married, males, regions of Oromiya, SNNP, Gambella, Harari and Dire Dawa and Islamic followers had statistically significant association with khat chewing. Due attention needs to be given for these factors in any intervention procedures.

Factors Associated with Colostrum Avoidance Among Mothers of Children Aged less than 24 Months in Raya Kobo district, North-eastern Ethiopia: Community-based Cross-sectional study

Background: UNICEF and WHO recommend colostrum as newborns’ perfect food that should be initiated within the first hour after birth. Objective: To assess colostrum avoidance practices and associated factors among mothers of children aged <24 months in Raya Kobo district, North-eastern Ethiopia. Methods: A quantitative community-based cross-sectional study supplemented by qualitative method was used. Descriptive statistics, binary and multivariable logistic regression analyses were used in the statistical analysis. Results: Colostrum avoidance was practiced by 13.5% (95% confidence interval: 10.99–16.33) of mothers having children aged <24 months. In multivariable logistic regression analysis, giving birth at home, mother-heading households, lack of awareness on the advantages of colostrum and late initiation of breastfeeding remained statistically significant factors associated with colostrum avoidance practices. Conclusion: Promoting institutional delivery, timely initiation of breastfeeding and creating awareness on the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance.

Predictors of Mortality among Adult Antiretroviral Therapy Users in Southeastern Ethiopia: Retrospective Cohort Study

Background. Although efforts have been made to reduce AIDS-related mortality by providing antiretroviral therapy (ART) services, still people are dying while they are on treatment due to several factors. This study aimed to investigate the predictors of mortality among adult antiretroviral therapy (ART) users in Goba Hospital, Southeast Ethiopia. Methods. The medical records of 2036 ART users who enrolled at Goba Hospital between 2007 and 2012 were reviewed and sociodemographic, clinical, and ART-related data were collected. Multivariable Cox proportional hazards regression model was used to measure risk of death and identify the independent predictors of mortality. Results. The overall mortality incidence rate was 20.3 deaths per 1000 person-years. Male, bedridden, overweight/obese, and HIV clients infected with TB and other infectious diseases had higher odds of death compared with their respective counterparts. On the other hand, ART clients with primary and secondary educational level and early and less advanced WHO clinical stage had lower odds of death compared to their counterparts. Conclusion. The overall mortality incidence rate was high and majority of the death had occurred in the first year of ART initiation. Intensifying and strengthening early ART initiation, improving nutritional status, prevention and control of TB, and other opportunistic infections are recommended interventions.

Anaemia prevalence and associated factors among lactating mothers in Ethiopia: evidence from the 2005 and 2011 demographic and health surveys

Objective To identify factors associated with anaemia in lactating mothers in Ethiopia. Design A cross-sectional secondary analysis of data pooled from two rounds of the 2005 and 2011 Ethiopian Demographic and Health Survey (EDHS) was used. A multivariate logistic regression model was applied to determine the factors associated with anaemia. Population A total of 7332 lactating mothers (2285 from EDHS 2005 and 5047 from EDHS 2011) were included from 11 administrative states of Ethiopia. Main outcome measures Lactating mothers considered anaemic if haemoglobin level <12 g/dL. Results The overall prevalence of anaemia among lactating mothers was 22.1% (95% CI 21.13% to 23.03%). The highest prevalence was 48.7% (95% CI 40.80% to 56.62%) found in the Somali region, followed by 43.8% (95% CI 31.83% to 56.87%) in the Afar region. The multivariate statistical model showed that having a husband who had attended primary education (adjusted OR (AOR) 0.79; 95% CI 0.68 to 0.91), working during the 12 months preceding the survey (AOR 0.71; 95% CI 0.63 to 0.80), having a normal maternal body mass index (18.5–24.99 kg/m2) (AOR 0.78; 95% CI 0.68 to 0.89), being in the middle wealth quintile (AOR 0.83; 95% CI 0.71 to 0.98) or rich wealth quintile (AOR 0.83; 95% CI 0.70 to 0.98), having ever used family planning (AOR 0.68; 95% CI 0.57 to 0.80), having attended antenatal care (ANC) for the indexed pregnancy four times or more (AOR 0.73; 95% CI 0.59 to 0.91), having experienced time variation between the two surveys (AOR 0.73; 95% CI 0.64 to 0.85), and breastfeeding for 2 years (AOR 0.76; 95% CI 0.66 to 0.87) were factors associated with lower odds of having anaemia in lactating mothers. Conclusions Anaemia is highly prevalent among lactating mothers, particularly in the pastoralist communities of Somali and Afar. Promoting partner education, improving maternal nutritional status, and creating behavioural change to use family planning and ANC services at health facilities are recommended interventions to reduce the prevalence of anaemia among lactating mothers in Ethiopia.

Infant feeding practices among HIV exposed infants using summary index in Sidama Zone, Southern Ethiopia: a cross sectional study

BackgroundCombining various aspects of child feeding into an age-specific summary index provides a first answer to the question of how best to deal with recommended feeding practices in the context of HIV pandemic. The objective of this study is to assess feeding practices of HIV exposed infants using summary index and its association with nutritional status in Southern Ethiopia.MethodsFacility based cross-sectional study design with cluster random sampling technique was conducted in Sidama Zone, Southern Ethiopia. Bivariate and multivariable linear regression analyses were performed to assess the association between summary index (infant and child feeding index) (CS-ICFI) and nutritional status.ResultsThe mean (±standard deviation (SD)) cross-sectional infant and child feeding index (CS-ICFI) score of infants was 9.09 (±2.59), [95% CI: 8.69-9.49]). Thirty seven percent (36.6%) of HIV exposed infants fell in the high CS-ICFI category while 31.4% of them were found in poor feeding index tertile. About forty two percent (41.6%) of urban infants were found in the high index tertile but only 24% of the rural infants were found in high index tertile. Forty six percent (46%) of the rural infants were found in low (poor) feeding index category. The CS-ICFI has a statistically significant association with weight for age z score (WAZ) (ß = 0.168, p = 0.027) and length for age z score (LAZ) (ß = 0.183 p = 0.036). However CS-ICFI was not significantly associated with weight for height z score (WLZ) (p = 0.386).ConclusionMajority of HIV exposed infants had no optimum complementary feeding practices according to cross-sectional infant and child feeding index. CS-ICFI was statistically associated especially with chronic indicators of nutritional status (LAZ and WAZ). More rural infants were found in poor index tertile than urban infants. This may suggest that rural infants need more attention than urban infants while designing and implementing complementary feeding interventions.

Predictors of Breastfeeding Cessation among HIV Infected Mothers in Southern Ethiopia: A Survival Analysis

Background Mother-to-child transmission (MTCT) of Human immunodeficiency virus (HIV) through breastfeeding remains the most significant route infection among children. Although the current guideline is recommending continued breastfeeding for HIV exposed infants, significant proportion of infants have been subjected to early weaning to prevent HIV transmission. However the predictors of breastfeeding cessation among HIV positive mothers were not documented in Ethiopia. Therefore the objective of this study was to determine the predictors of breastfeeding cessation among HIV-infected women in Southern Ethiopia. Methods A facility based cross sectional study was conducted in Southern Ethiopia. The samples were selected by cluster sampling technique. The Kaplan-Meier curve was used to describe the survival time of breastfeeding and a step-wise multivariable Cox-proportional hazards regression model were used to identify the predictors of breastfeeding cessation. Both crude and adjusted hazard ratio were determined and p<0.05 was considered as statistically significant. Result The mean duration of breastfeeding among HIV positive mothers was 13.79 [95% CI: (12.97–14.59)] months. The Kaplan-Meier estimate showed that proportions of women who were breastfeeding at 6, 9, 12 and 17 months were 89.3%, 75.3%, 66% and 17%, respectively. Those mothers having a monthly income of ≤500 ETB [AHR = 0.16, 95% CI :(0.03–0.76)], having a family size of three and below [AHR = 0.12, 95%CI: (0.02–0.68), four and above [AHR = 0.07, 95%CI: (0.01–0.35)] and bottle feeding [AHR = 3.95, 95%CI: (1.64–9.51)] were also independent factors associated with breastfeeding cessation. Conclusion Above one third of HIV positive mothers stopped breastfeeding before 12 months. Monthly income, bottle feeding and family size were the independent predictors of breastfeeding cessations. Strengthening the current counseling and promotion modality on avoidance of bottle feeding and continued breastfeeding is recommended for improved HIV free survival.

Stability of infant and child feeding index over time and its association with nutritional status of HIV exposed infants in Sidama Zone, Southern Ethiopia: A longitudinal study

BACKGROUND Even though many studies showed that infant and child feeding index has a statistically significant association with nutritional status, there is paucity of studies on stability of infant and child feeding index over time and its association with nutritional status of HIV exposed infants. AIMS This study aimed to investigate the stability of infant and child feeding index over time that is developed based on the current recommendations and its association with nutritional status of HIV exposed infants in Sidama Zone, Southern Ethiopia. STUDY DESIGN A panel study design was conducted in health institutions in Sidama Zone from February to July, 2012. Three repeated measurements of data were collected from each HIV exposed infant aged 6-17 months over the 6 month follow-up period approximately per 2 month interval. RESULTS The cross-sectional index was found stable overtime with the repeatability coefficient of 0.802 which differed significantly from zero (95% CI: 0.75-0.85). A longitudinal infant and child feeding index (L-ICFI) has a statistically significant association with length for age Z scores (LAZ) and weight for age Z scores (WAZ) at visit three (β=0.262, p=0.007; β=0.226, p=0.017), respectively. But the longitudinal index has no statistically significant association with WLZ score (p=0.552). There was no significant difference in change of LAZ and WAZ over time between L-ICFI tertiles for both female and male HIV exposed infants. CONCLUSION The index is stable overtime at individual level even though one third of the index components were not stable. The L-CFI was associated with LAZ and WAZ but not with WLZ. However there was no significant difference in change of HAZ and WAZ over time between L-ICFI tertiles for both female and male HIV exposed infants.

Adherence to WHO breastfeeding guidelines among HIV positive mothers in Southern Ethiopia: implication for intervention

Background Breastfeeding reduces major causes of infant mortality and morbidity. On the other hand, it is a major mode of vertical HIV transmission. In developing countries like Ethiopia, HIV positive mothers are advised to continue breastfeeding up to 12 months. But there is scarce literature regarding the mothers’ adherence to continued breastfeeding recommendations. Therefore, the objective of this study is to assess HIV positive mothers’ adherence to the infant feeding recommendations of the new World Health Organization (WHO) guidelines for HIV-exposed infants aged ≥6 months. Methods A cross-sectional study was conducted in health institutions with antiretroviral therapy and prevention of mother to child transmission facilities in Sidama Zone, Southern Ethiopia. Health institutions were considered as clusters and cluster sampling technique was employed. A total of 184 HIV positive mothers with their infants registered at respective health institutions were recruited and assessed for their infant breastfeeding practices. Descriptive statistics (frequency, mean, median, and standard deviation) were computed to describe the breastfeeding practices of HIV positive mothers. Result Almost all (181 [98.4%]) of the HIV-exposed infants were “ever breastfed”. Among those mothers who had ever breastfed, 158 (87.3%) initiated breastfeeding within an hour of delivery and 157 (85.8%) had fed their babies colostrum while 31 (16.8%) gave prelacteal food to their infants. The prevalence of continued breastfeeding at 1 year was (54.5%) (46.9% for urban mothers and 75% for rural mothers). Seventy-one percent (70.9%) of HIV positive mothers practiced “on demand” breastfeeding. Twenty nine percent of infants aged 6–11 months and 47.8% of infants aged ≥12 months were no longer breastfed. The mean (± standard deviation) duration of breastfeeding was 7.8 (±3.1) months (95% confidence interval: 6.9–8.7). Conclusion The 2010 WHO guidelines and recommendations on breastfeeding duration for HIV positive mothers was not adhered to after 6 months of age. Promotion and counseling of optimal breastfeeding practice for HIV positive mothers based on the updated WHO guideline is an appropriate intervention. However, further research is recommended to evaluate the acceptance of the new 2010 WHO guideline by the health professionals and HIV positive mothers.