Tesfa Dejenie Habtewold

Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia

BackgroundThe early initiation of breastfeeding (EIBF), or timely initiation of breastfeeding, is the proportion of children put to the breast within one hour of birth. It is an important strategy for reducing perinatal and infant morbidity and mortality, but it remains under practiced in Ethiopia. The aim of the study was to assess the prevalence and the predicting factors associated with EIBF.MethodsA community based cross-sectional study was conducted in 634 mothers in Dale Woreda, South Ethiopia. Multistage cluster sampling was used to select participating mothers. EIBF was outcome variable whereas sociodemographic characteristics and knowledge and practice of maternal health service were explanatory variables. A face-to-face interview using a pretested semi-structured questionnaire was done from September 2012 to March 2013. To investigate predicting factors, bivariate and multivariate logistic regression analysis was done.ResultsA total of 634 mothers of children under 24xa0months were interviewed. During the time of data collection, 94.3% of the mothers had breastfed. The prevalence of EIBF was 83.7%. Ownership of the house was a significant predicting factor for EIBF. Mothers who lived in rented houses were significantly less likely (60%) to initiate breastfeeding within one hour of birth compared to mothers who owned their own house: Adjusted odds ratio 0.40 (95% Confidence Interval 0.16, 0.97).ConclusionMore than three-fourths of mothers initiated breastfeeding within an hour. Findings from our study suggest that improving the mothers socioeconomic status as reflected by house ownership, being a significant predictor of EIBF, would have a central role in improving EIBF.

Prevalence of Depression among Type 2 Diabetic Outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia

Background. The emotional consequences of diabetes have been scrutinized by a number of investigative teams and there are varying reports about the association of depression with type 2 diabetes mellitus. However, there is limited data about this in Ethiopia. Therefore, the purpose of this study was to assess the prevalence of comorbid depression among type 2 diabetic outpatients. Methods and Materials. Institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients from Black Lion General Specialized Hospital. Systematic random sampling technique was used to get these individual patients from 920 type 2 diabetic outpatients who have an appointment during the data collection period. Patients depression status was measured using Patient Health Questionnaire 9 (PHQ 9). Result. Totally 264 type 2 diabetic outpatients were interviewed with a response rate of 95.6%. The prevalence of depression among type 2 diabetic outpatients was 13%. Based on PHQ 9 score, 28.4% (75) fulfilled the criteria for mild depression, 12.1% (32) for moderate depression, 2.7% (7) for moderately severe depression, and 1.5% (4) for severe depression. But 45.8% (121) of patients had no clinically significant depression. Conclusion. This study demonstrated that depression is a common comorbid health problem in type 2 diabetic outpatients with a prevalence rate of 13%.

Association between diabetes mellitus and multi-drug-resistant tuberculosis: a protocol for a systematic review and meta-analysis

IntroductionMulti-drug-resistant tuberculosis (MDR-TB) has emerged as a challenge to global tuberculosis (TB) control and remains a major public health concern in many countries. Diabetes mellitus (DM) is an increasingly recognized comorbidity that can both accelerate TB disease and complicate its treatment. The aim of this study is to summarize available evidence on the association of DM and MDR-TB among TB patients and to provide a pooled estimate of risks.MethodsAll studies published in English before October 2016 will be searched using comprehensive search strings through PubMed, EMBASE, Web of Science, and WHO Global Health Library databases which have reported the association of DM and MDR-TB in adults with TB (ageu2009>u2009=15). Two authors will independently collect detailed information using structured data abstraction form. The quality of studies will be checked using Newcastle-Ottawa Scale for cohort and case-control studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. Heterogeneity between included studies will be assessed using the I2 statistic. We will check potential publication bias by visual inspection of the funnel plot and Egger’s regression test statistic. We will use the random effects model to compute a pooled estimate.DiscussionIncreases in the burden of non-communicable diseases and aging populations are changing the importance of different risk factors for TB, and the profile of comorbidities and clinical challenges for people with TB. Although classic risk factors and comorbidities such as overcrowding, under-nutrition, silicosis, and HIV infection are crucial to address, chronic conditions like diabetes are important factors that impair host defenses against TB. Thus, undertaking integrated multifaceted approach is remarkably necessary for reducing the burden of DM and successful TB treatment outcome.Systematic review registrationPROSPERO CRD42016045692.

SystEmatic review and meta-aNAlysis of infanT and young child feeding Practices (ENAT-P) in Ethiopia : Protocol

Introduction Infant and young child feeding (IYCF) is the cornerstone of infant and child survival, healthy growth and development, healthy future generations and national development. In spite of the importance of optimal nutrition in low- and middle-income countries, there has been no review conducted in Ethiopia. Thus, the aim of this systematic review and meta-analysis is to estimate the national coverage and identify the associated factors of IYCF practices in Ethiopia. Methods PubMed, Scopus, EMBASE, CINHAL, EBSCO, Web of Science and WHO Global Health Library databases will be searched for all available publications from 1 January 2000 to 30 September 2017. All published studies on the timely initiation of breast feeding, exclusive breast feeding and timely initiation of complementary feeding practice in Ethiopia will be screened, selected and reviewed. Bibliographies of identified articles and grey literature will be hand-searched as well. Heterogeneity of studies will be quantified using Higginss method where I2 statistic >80% indicates substantial heterogeneity. Funnel plots and Eggers regression test will be used to assess potential publication bias. The Newcastle–Ottawa Scale (NOS) will be used to assess the quality of evidence and risk of bias. Meta-analysis and meta-regression will be carried out to estimate the pooled national prevalence rate and an OR of each associated factor of IYCF practices. Narrative synthesis will be performed if meta-analysis is not feasible due to the substantial heterogeneity of studies. Ethics and dissemination Ethical clearance is not required for this study because primary data will not be collected. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal and presented at an (inter)national research symposium. Systematic review registration This systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017056768.

Comorbidity of depression and diabetes: an application of biopsychosocial model

BackgroundType 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors.MethodsInstitution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis.ResultsTotal of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (meanxa0±xa0SD) was 98.9xa0±xa011.1xa0cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score.ConclusionBiopsychosocial variables including marital status, negative life event in the last 6xa0months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms.

Occupational exposure to sharps injury among healthcare providers in Ethiopia regional hospitals

BackgroundSharps injury is a penetrating stab wound from a needle, scalpel, or another sharp object that may result in exposure to blood or other body fluids. According to World Health Organization pooled estimate, the annual incidence of sharps injury in Africa was ranged from 2.10 to 4.68 per person per year, but research data in Ethiopia is limited. The aim of the study was to investigate sharps injury prevalence and associated risk factors.MethodsInstitution based cross-sectional study was conducted with 200 healthcare providers (HCP) in Northeast Ethiopia. Proportionate stratified sampling was used to select HCP. Sharps injury during the last 12xa0months was an outcome variable whereas demographic characteristics, behavioral attributes, and job environment characteristics were independent variables. Data was collected from April to May 2016 using self-administered questionnaire; which was adapted from World Health Organization best practices for injections and related procedures toolkit. Bivariate and multivariate logistic regression analysis was carried out to identify sharps injury associated risk factors. Epi Info version 3.5.1 software package was used for data coding and entry whereas Statistical Package for Social Sciences (SPSS) version 20 software package was used for analysis.ResultsIn total, 195 HCP participated with a response rate of 97.5%. The prevalence of sharps injury was 32.8%. Following adjustment for covariates, lack of in-service job training and previous exposure to sharps injury were statistically significant risk factors for sharps injury. HCP who had no in-service job training were 4.7 times more likely sustained sharps injury compared with those who had in-service job training (pu2009<u20090.001, ORu2009=u20094.7, 95% CIu2009=u20092.05–10.56). HCP who had previous exposure to sharps injury were 3.7 times more likely sustained sharps injury compared with those who were not exposed (p-valueu2009=u20090.002, ORu2009=u20093.7, 95% CIu2009=u20091.62–8.27).ConclusionsThis study revealed 32.8% or at least three out of ten HCP exposed to sharps injury. This was found statistically significant among HCP who had no in-service job training and who had previous exposure to sharps injury. Thus, training HCP perhaps increase their skill andxa0curiosity to reduce exposure to sharps injury.

Common mental disorder and its association with academic performance among Debre Berhan University students, Ethiopia

BackgroundCommon mental disorder (CMD) is prevalent in industrialized and non-industrialized countries. The prevalence of CMD among university students was 28.8–44.7% and attributed to several riskxa0factors, such as schooling. The aim of this study was to assess the prevalence and risk factors of CMD. In addition, the association between CMD and academic performancexa0was tested.MethodsInstitution based cross-sectional study was conducted with 422 students at Debre Berhan university from March to April 2015. CMD was the primary outcome variable whereas academic performance was the secondary outcome variable. Kessler psychological distress (K10) scale was used to assess CMD. Bivariate and multiple logistic regression analysis were performed for modeling the primary outcome variable; independent samples T test and linear regression analysis were carried out for modeling the secondary outcome variable. The strength of association was interpreted using odds ratio and regression coefficient (β) and decision on statistical significance was made at a p value of 0.05. Data were entered using EPI-data version 3.1 software and analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.01 software.ResultsThe prevalence of CMD was 63.1%. Field of study (pxa0=xa00.008, ORxa0=xa00.2, 95% CI 0.04–0.61), worshiping (pxa0=xa00.04, ORxa0=xa01.8, 95% CI 1.02–3.35), insomnia (pxa0<xa00.001, ORxa0=xa03.8, 95% CI 2.21–6.57), alcohol drinking (pxa0=xa00.006, ORxa0=xa02.7, 95% CI 1.33–5.66), and headache (pxa0=xa00.02, ORxa0=xa02.1, 95% CI 1.10–3.86) were identified risk factors for CMD. The mean cumulative grade point average of students with CMD was lower by 0.02 compared to those without CMD, but not statistically significant (pxa0=xa00.70, βxa0=xa0−0.02, 95% CI −0.15 to 0.10).xa0CMD explained only 0.8% (r2xa0= 0.008) of the difference in academic performance between students.ConclusionsAt least three out of five students fulfilled CMD diagnostic criteria. The statistically significant risk factors were field of study, worshiping, insomnia, alcohol drinking, and headache. Moreover, there was no statistically significant association between CMD and academic performance. Undertaking integrated evidence-based intervention focusing on students with poor sleep quality, poor physical health, and who drink alcohol is essentialxa0if the present finding confirmed by a longitudinal study.

What is the impact of gender of new-born, antenatal care and postnatal care on breastfeeding practices in Ethiopia? A systematic review and meta-analysis

Objective The aim of this systematic review and meta-analysis was to investigate the association of gender of new-born, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breastfeeding (TIBF) and exclusive breastfeeding (EBF) practice in Ethiopia. Design Systematic review and meta-analysis Methods PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases systematically searched and complemented by manual searches to retrieve all available literature. Newcastle-Ottawa Scale (NOS) was used for quality assessment of included studies. Egger’s regression test at p-value threshold ≤ 0.01 was used to examine publication bias. Cochran’s Q X2 test, τ2, and I2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity respectively. A meta-analysis using a weighted inverse variance random-effects model was performed. The trend of evidence over time was evaluated by performing a cumulative meta-analysis. Furthermore, mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Results Of 523 articles retrieved, 17 studies (N = 26,146 mothers) on TIBF and 27 studies (N = 17,819 mothers) on EBF were included in the final analysis. ANC (OR = 2.24, 95% CI 1.65 -3.04, p <0.001, I2 = 90.9%), PNC (OR = 1.86, 95% CI 1.41 - 2.47, p <0.001, I2 = 63.4%) and gender of new-born (OR = 1.31, 95% CI 1.01 - 1.68, p = 0.04, I2 = 81.7%) significantly associated with EBF. In addition, ANC (OR = 1.70, 95% CI 1.10 - 2.65, p = 0.02, I2 = 93.1%) was significantly associated with TIBF but not gender of new-born (OR = 1.02, 95% CI 0.86 -1.21, p = 0.82, I2 = 66.2%). Conclusions In line with our hypothesis, gender of new-born, ANC and PNC significantly associated with EBF. Likewise, ANC significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breastfeeding. This meta-analysis study provided evidence on breastfeeding practices and its associated factors in Ethiopian context, which can be useful for cross-country and cross-cultural comparison and for breastfeeding improvement initiative in Ethiopia. Protocol registration and publication: CRD42017056768 and 10.1136/BMJOPEN-2017-017437 Strengths and limitations of this study This systematic review and meta-analysis was conducted based on the registered and published protocol. Since it is the first study in Ethiopia, the information could be helpful for future researchers, public health practitioners, and healthcare policymakers. Almost all included studies were observational which may hinder causality inference. Perhaps the results may not be nationally representative given that studies from some regions are lacking. Based on the conventional methods of the heterogeneity test, a few analyses suffer from high between-study variation.

Overview of biomedical and public health reviews in Ethiopia from 1970 to 2018: trends, methodological qualities, gaps and future directions

Introduction Globally, there has been a dramatic increment of narrative reviews, systematic reviews and overview publication rates. In Ethiopia, only small number of reviews are published and no overviews conducted in biomedical and public health disciplines. Therefore, we aimed to (1) assess the trend of narrative and systematic reviews in Ethiopia, (2) examine their methodological quality and (3) suggest future directions for improvement. Methods PubMed, EMBASE, Web of Science, SCOPUS, CINHAL, WHO Global Index Medicus, Cochrane Library and PsycINFO electronic databases were searched and supplemented by hand searching as well. All narrative reviews and systematic reviews with or without a meta-analysis from 1970 to April 2018 were included. The International Narrative Systematic assessment (INSA) for narrative reviews and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) for systematic reviews with or without a meta-analysis were used for quality appraisal. Fisher’s exact test at the p-value threshold of 0.05 was used to compare the differences in methodological quality. Results Of the 2,201 initially identified articles, 106 articles published from 1970 to 2018 were eligible for full-text review. Among included reviews, 50.9% were narrative reviews, 16% were systematic reviews and 33.1% were systematic reviews with meta-analyses. Twenty-nine percent were published in Ethiopia and 43.4% were published after 2015. 85.1% of narrative reviews poorly described the characteristics of included studies and 63.8% did not report a conflict of interest. In systematic reviews, 89.6%, 91.7%, and 100% did not register/publish the protocol, justifying the selection of the study designs for inclusion and report sources of funding for the primary studies respectively. Overall, 55.3% of narrative reviews and 75% of systematic reviews with or without meta-analysis had poor methodological quality. Conclusions Although publication rate of narrative and systematic reviews have risen in Ethiopia, half of the narrative reviews and three-quarters of the systematic reviews had poor methodological quality. We recommend authors to strictly follow standardized quality assessment tools during conducting reviews. Moreover, immediate interventions such as providing methodological training and employers, editors and peer-reviewers should carefully evaluate all reviews before submission or publication. What is new? Key findings The publication rate of narrative and systematic reviews have risen in Ethiopia. Almost half of narrative reviews and three-fourths of systematic reviews with or without meta-analysis had poor scientific methodological quality. What this adds to what is known To our knowledge, this is the first overview of its kind providing insight into the publication trend of narrative and systematic reviews, and their methodological rigor in Ethiopia. What is the implication, what should change now Our review shows that the methodological quality of reviews in biomedical and public health discipline in Ethiopia is substantially low and urges immediate intervention. We recommended authors to strictly follow standardized quality assessment tools during designing, conducting and reporting (systematic)reviews.

Association of age and colostrum discarding with breastfeeding in Ethiopia: systematic review and meta-analyses

Introduction Even though optimal breastfeeding is important, significantly low percentage of mothers’ initiate breastfeeding timely and maintain exclusive breastfeeding for 6 months. The aim of this meta-analyses and systematic review was to investigate whether maternal/caregivers’ age, infant age (0-6 months) and discarding colostrum affects timely initiation of breastfeeding (TIBF) and exclusive breastfeeding (EBF) in Ethiopia. Methods A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all English published articles from 2000 to January 2018, supplemented by manual search of identified articles and grey literatures bibliographies. Two reviewers independently screened, extracted and graded the quality studies using Newcastle–Ottawa Scale (NOS). Heterogeneity was assessed using the I2 and Cochran Chi-square statistics. A weighted inverse variance random-effects model meta-analysis was done. Result A total of 37 articles (i.e., 14 studies on TIBF and 23 on EBF) were included. TIBF was associated with colostrum discarding (Odds ratio (OR) = 0.38, 95% CI = 0.21-0.68) but not with maternal/caregivers’ age (OR = 0.98, 95% CI = 0.83-1.15). In addition, colostrum discarding (OR = 0.56, 95% CI = 0.37-0.84) and infant age (OR = 1.86, 95% CI = 1.45-2.39) were significantly associated with EBF but not maternal/caregivers’ age (OR = 1.07, 95% CI = 0.81-1.40). Conclusion This meta-analyses indicated absence of association between maternal/caregivers’ age and breastfeeding practice. Colostrum discarding was associated with both EBF and TIBE. This evidence could be helpful to counsel all reproductive age mothers and who discard colostrum.