Nega Assefa

Wealth Status, Mid Upper Arm Circumference (MUAC) and Antenatal Care (ANC) Are Determinants for Low Birth Weight in Kersa, Ethiopia

Background Low Birth Weight (LBW) is one of the major risk factor for death in early life. However, little is known about predictors of LBW in sub-Saharan Africa. Therefore, the aim of this study was to measure the incidence and determinants of LBW in a rural population of Ethiopia. Methods An observational cohort study on pregnant women was conducted from December 2009 to November 2010. During the study period 1295 live birth were registered and the weights of 956 children were measured within 24 hours after birth. Socio-demographic, economic, maternal and organizational factors were considered as a predicators of LBW, defined as birth weight below 2500g. Logistic regression was used to analyze the data, odds ratio (OR) and confidence intervals (CI) are reported. Result The incidence of LBW was 28.3%. It is significantly associated with poverty [OR 2.1; 95% CI: 1.42, 3.05], maternal Mid Upper Arm Circumference (MUAC) less than 23 cm [OR 1.6; 95% CI: 1.19, 2.19], not attending ANC [OR 1.6; 95% CI: 1.12, 2.28], mother’s experience of physical violence during pregnancy [OR 1.7; 95% CI: 1.12, 2.48], and longer time to walk to health facility [OR 1.6; 95% CI: 1.11, 2.40]. Conclusion and Recommendation The incidence of LBW was high in Kersa. Babies born to women who were poor, undernourished, experienced physical violence during pregnancy and who had poor access to health services were more likely to be LBW in this part of the country. In this largely poor community where ANC coverage is low, to reduce the incidence of LBW, it is essential to improve access for maternal health care. The involvement of husbands and the community at large to seek collective action on LBW is essential.

HDSS Profile: The Kersa Health and Demographic Surveillance System

Abstract Kersa HDSS was established in 12 sub-districts of Kersa district, Eastern Hararge, Oromia Region, Ethiopia. The site is principally rural with two small towns (Kersa and Weter). The baseline census was conducted in 2007 and since then has been updated every 6 months, with registration of demographic and health events. Data are entered into the HRS-2 relational database. At baseline a total of 10 085 houses, 10 522 households and 50 830 people were registered. The sex ratio and number of persons per household were 1.0 and 5.1, respectively. At the end of 2013, the population was 60 694. Up to the end of 2013, 12 571 births and 3143 deaths were registered, respectively. Over 85% of births and deaths occurred at home. The annual net population growth ranges from 0.06 to 1.6. The majority of the population in Kersa are not working age group; hence the dependency ratio in most of the years is below 1. The total fertility rate ranges from 4.0 to 5.3. A reduction in neonatal, infant and under-five mortalities was observed. For all deaths, verbal autopsies were done. Tuberculosis is the leading cause of death among adults and malnutrition is the leading cause of death among children aged under 5 years. Kersa HDSS is ready to collaborate with interested researchers on health and demographic issues. For further details please visit: [ http://www.haramaya.edu.et/research/projects/kds-hrc/ ].

Pregnancy rates and pregnancy loss in Eastern Ethiopia

To determine pregnancy, pregnancy loss and fertility rates in a rural community of Ethiopia.

In Rural Eastern Ethiopia Hearing Loss Is the Most Frequent Disability during Childhood: A Community Based Survey

Background The type and extent of childhood disability in Ethiopia is unknown due to lack of accurate and reliable data. This study tried to assess the magnitude and types of disabilities among children 0–14 years of age in eastern Ethiopia. Methods We conducted a cross-sectional community-based study among households that are under demographic and health surveillance in eastern Ethiopia. The study population consisted of all children aged 0–14 year. A structured questionnaire was used to assess the type and severity of the disability. Results A total of 21,572 children in the age group 0–14 were screened for disability. Of which 586 (2.7%; 95% CI = 2.5%, 2.9%) had at least one kind of disability at the time of the survey. The proportion of disability increased as children were older; measured by the extended Mantel-Haenszel (M-H) chi square for linear trend (M-H = 48.74; P<0.001). Hearing impairment was the most common reported disability; 417 (71.2%; 95% CI = 67.5%, 74.9%). Among children with a disability, 179 (31.0%; 95% CI = 27.3%, 34.7%) had a combination of multiple disabilities and about a third, 200 (34.1%; 95% CI = 30.3%, 37.9%) had developed the disability during infancy. Magnitude of disability was higher among boys 335 (2.98%; 95% CIs = 2.66%, 3.30%) compared to girls 251 (2.44%; 95% CIs = 2.14%, 2.74%). Conclusion Childhood disability is a health challenge in the study area and is already common at an early age. Permanent disability among children may be prevented by an early screening program in the routine child health services and adequate care, especially for hearing impairment.

Determinants of Desire for Children among HIV-Positive Women in the Afar Region, Ethiopia: Case Control Study.

Introduction The desire for a child in Ethiopian society is normal. Among HIV positive women, due to the risk of MTCT, it is imperative to understand factors influencing women’s desire for children. This study aimed at assessing factors associated with desire for children among HIV-positive women in two selected hospitals of Afar Regional State, Ethiopia. Methods A facility based case-control study was conducted among 157 cases (with a desire) and 157 controls of HIV positive individuals registered in the selected health facilities. The participants were selected by random sampling technique. Data were collected using face-to-face interview and was analyzed using logistic regression. Result Factors found to be independently associated with desire for children were age categories of 20–24 years (OR = 6.22, 1.29–10.87) and 25–29 years (OR = 14.6, 3.05–21.60), being married (OR = 5.51, 2.19–13.54), Afar ethnicity (OR 6.93, 1.19–12.14), having HIV-positive children (OR 0.23, 0.09–0.63), duration on ART more than one year (3.51, 1.68–9.05), CD4 count greater than 350 (OR 4.83, 1.51–7.27) and discussion of reproductive health issues with health providers (OR 0.31, 0.12–0.51). Conclusion Women who were young, married, Afar, those who received ART more than one year, and had CD4 count >350 were more likely to have a desire for children. Recommendation Health care workers at ART clinic should openly discuss about the reproductive options for the women living with HIV/AIDS.

Sharp Injury and Exposure to Blood and Body Fluids among Health Care Workers in Health Care Centers of Eastern Ethiopia

Background: Health care workers are facing certain occupational hazards because of sharp injury and exposure to human blood and body fluids as a result of handling wastes. Though much attention is paid for the protection of these workers, the number of exposures and injuries do not show a sign of decline from time to time. Objective: To examine the occurrence of sharp injury and exposure to blood and body fluids in health care workers in health care centers in Ethiopia. Methods: In a case-control study, a randomly selected sample of 65 health facilities with 391 cases and 429 controls were studied. Data were collected through a self-administered questionnaire. Detailed analysis of exposure among the health care workers was done by logistic regression analysis with generalized estimating equations model to control correlation effects of responses within the cluster of health facilities. Results: The number of health care workers who got sharp injury was 217 (26.5%). 296 (36.1%) had exposure to blood and body fluids. Working at Harari region (adjusted OR 0.44, 95% CI 0.26 to 0.75) and East Hararghea (adjusted OR 0.61, 95% CI 0.40 to 0.94), being male (adjusted OR 0.56, 95% CI 0.44 to 0.91), and a being nurse (adjusted OR 0.188, 95% CI 0.06 to 0.63) were independent risk factors of the exposure. Conclusion: Regardless of the anticipated low self-reporting for exposure status, the number of health care workers reported having sharp injury and exposure to blood and body fluids was high. Such high exposures indicate that health care workers are at high risk of acquiring blood-borne viral infections such as hepatitis B, hepatitis C, and HIV.

Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review

BackgroundEvidence from the global burden of diseases show that psychiatric disorders are a growing public health concern. Maintaining adherence to medication is the most essential, but challenging course in the pharmacological treatment modality for major psychiatric disorders. Nevertheless, there is a paucity of abridged evidence on the level of psychotropic medication non-adherence and associated factors. Therefore, we aim to systematically summarize existing primary studies finding to estimate the level and identify associated factors of psychotropic medication non-adherence among adult patients with major psychiatric disorders.MethodsWe will search studies using computerized search engines, main electronic databases and other relevant sources. PubMed (Medline), EMBASE, CINAHL, PsycINFO, Web of Science, WHO Global Health Library, and direct Google search will be searched to retrieve studies written in English language before December 2017. Observational studies (cross-sectional, case-control, cohort or longitudinal, survey and surveillance reports) on major psychiatric disorders (schizophrenia, major depressive and bipolar disorders) among adult patients will be eligible. Data will be extracted independently by two authors. Data synthesis and statistical analysis will be carried out. Pooled estimate will be done to quantify the level of psychotropic medication non-adherence using Comprehensive Meta-Analysis software.DiscussionPsychiatric disorders remain a public health, social and economic concern worldwide. Management of major psychiatric disorders is highly affected by medication non-adherence. Thus, undertaking an integrated and multifaceted approach is necessary to reduce the burden of medication non-adherence, and enhance the quality of patients’ life. Evidence is required to design appropriate intervention to prevent psychotropic medication non-adherence.Protocol registrationPROSPERO: 2017: CRD42017067436.

One in five women suffer from pelvic floor disorders in Kersa district Eastern Ethiopia: a community-based study

BackgroundHundreds of millions of women suffer from pelvic floor disorders globally, often in silence. Women in developing countries do not disclose their problems due to associated social stigma or lack of access to services. Thus, the extent of the problem remains largely unknown. This study was conducted to assess the magnitude of pelvic floor disorders in Kersa district Eastern Ethiopia.MethodWe conducted a community-based cross-sectional study among ever married women who reside in Kersa district, Eastern Ethiopia. The study subjects were selected through stratified multistage probability sampling. The data were collected using a structured questionnaire through face-to-face interviews. The prevalence of various pelvic floor disorders are presented along with the 95% Confidence Intervals (CI).ResultsA total of 3432 women participated in the study, of which 704 (20.5%; 95% CI; 19.2, 21.8) reported at least one type of pelvic floor disorder and 349 (49.6%; 95% CI: 46.0, 53.0) reported two or more pelvic floor disorders. The most common pelvic floor disorders included an over active bladder (15.5%; 95% CI: 14.4, 16.8), pelvic organ prolapse (9.5%; 95% CI: 8.5,10.4), stress urinary incontinence (8.3%; 95% CI: 7.4, 9.2) and anal incontinence (1.9%; 95% CI: 1.5, 2.4). More than two-thirds of the women with pelvic floor disorders (68.0%; 95% CI:64.4, 71.3) reported having severe distress but had never sought health care.ConclusionsThe magnitude of the health problem and the low level of health seeking behavior indicates the silent suffering of many women in the study area. Extrapolating these figure to national statistics would indicate the staggering number of women suffering from pelvic floor disorders in the country. This calls for urgent action to improve prevention, diagnosis and treatment services to mitigate the suffering of women from pelvic floor disorders.

Small area clustering of under-five children's mortality and associated factors using geo-additive Bayesian discrete-time survival model in Kersa HDSS, Ethiopia

BACKGROUND Child mortality reflects a countrys level of socio-economic development and quality of life. In Ethiopia, limited studies were conducted on under-five mortality and almost none of them tried to identify the spatial effect on mortality. Thus, this study explored the small area clustering of under-five mortality and associated factors in Kersa HDSS, Eastern Ethiopia. METHODS The study population included all children under the age of five years during the time September, 2008-august 31, 2012 which are registered in Kersa Health and Demographic Surveillance System (Kersa HDSS). A flexible Bayesian geo-additive discrete-time survival mixed model was used. RESULTS Some of the factors that are significantly associated with under-five mortality, with posterior odds ratio and 95% credible intervals, are maternal educational status 1.31(1.13,-1.49), place of delivery 1.016(1.013-1.12), no of live birth at a delivery 0.35(0.23,1.83), low household wealth index 1.26(1.10 1.43) middle level household wealth index 0.95 (0.84 1.07) pre-term duration of pregnancy 1.95(1.27,2.91), post-term duration of pregnancy 0.74(0.60,0.93) and antenatal visit 1.19(1.06, 1.35). Variation was noted in the risk of under-five mortality by the selected small administrative regions (kebeles). CONCLUSION This study reveals geographic patterns in rates of under-five mortality in those selected small administrative regions and shows some important determinants of under-five mortality. More importantly, we observed clustering of under-five mortality, which indicates the importance of spatial effects and presentation of this clustering through maps that facilitates visuality and highlights differentials across geographical areas that would, otherwise, be overlooked in traditional data-analytic methods.

Medical Waste Collectors in Eastern Ethiopia are Exposed to High Sharp Injury and Blood and Body Fluids Contamination

Background: Health facilities generate different types of wastes which are characterized as hazardous, most of which are toxic, harmful, carcinogenic and infectious. Waaste collectors face massive exposure to hazardous wastes and occupational accidents as a result of manual handling of healthcare waste and working under unfavourable conditions. Methodology: The study employed a cross-sectional study design on 253 medical wastes collectors interviewed using questionnaire from 65 health facilities. With an observational checklist, the healthcare waste management system of these health facilities was also assessed. For data analysis, factors associated with exposure to sharp injuries and blood and body fluids were identified by a binary logistic regression with Generalized Estimating Equation model to control the effect of clustering. Result: For the last one year, there were 75 (30%) waste collector who were exposed to any sharp material and 121 (43.8%) had exposure to blood and body fluid while handling healthcare wastes. Factors such as not wearing glove (AOR=3.5, CI=1.17-4.92, p=0.003), being uneducated AOR=1.55, CI=1.18-2.65, p=0.03) and not taking training (AOR=1.39, CI=1.27-2.48, p=0.01) were found to be associated with exposure to sharp injury and blood and body fluids. Conclusion: Medical waste collectors are exposed to high sharp injury and blood and body fluid. Adequate training before employment and on job, provision of personal protective devices and routine exposure reporting mechanism, testing, medication and post exposure prophylaxis and establishment of therapeutic centers are recommended