Publications by authors named "Temesgen Yihunie Akalu"

30 Publications

  • Page 1 of 1

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning.

PLoS Negl Trop Dis 2021 Jul 28;15(7):e0008824. Epub 2021 Jul 28.

Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.
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http://dx.doi.org/10.1371/journal.pntd.0008824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318275PMC
July 2021

Self-Reported Work-Related Musculoskeletal Disorders and Associated Factors among Restaurant Workers in Gondar City, Northwest Ethiopia, 2020.

J Environ Public Health 2021 7;2021:6082506. Epub 2021 Jun 7.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Introduction: Globally, work-related musculoskeletal disorders (WMSDs) have resulted in occupational disability and injury. Of these, restaurant workers are among the high-risk professionals usually affected by WMSDs. In Ethiopia, evidence on the burden of musculoskeletal disorder and contributing factors among restaurant workers were very limited. Therefore, this study was aimed at assessing the prevalence of self-reported WMSDs and contributing factors among restaurant workers in Gondar city, northwest Ethiopia, 2020.

Methods: An institutional-based cross-sectional study was conducted from February 2020 to March 2020 among restaurant workers in Gondar city. A two-stage sampling technique was used to choose 633 study subjects. A structured Nordic questioner was used to collect the data. Data was entered into EpiData version 3.1 and exported to Stata version 14.0 for analysis. Both bivariable and multivariable logistic regression analyses were computed. An adjusted odds ratio with a 95% confidence interval was used to measure the association between WMSDs and independent variables. In the multivariable analysis, a value of <0.05 was used to declare a statistically significant association. To check the goodness of fit, the Hosmer and Lemeshow test was used.

Results: The prevalence of WMSDs among restaurant workers in the past 12 months was 81.5% [95% CI (78.18-84.44)]. Attending primary education [AOR: 2.14, 95% CI (1.17-3.90)], attending secondary education [AOR: 1.71 (1.02-2.86)], and job satisfaction [AOR: 1.90, 95%CI (1.13-3.19)] were significantly associated with WMSDs.

Conclusion: In this study, the prevalence of WMSDs among restaurant workers was high. The upper back, lower back, elbow, and wrist were the most affected body parts. Age above 30 years, educational status being primary and secondary, and being dissatisfied by their job were positively associated with a high prevalence of WMSDs.
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http://dx.doi.org/10.1155/2021/6082506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205578PMC
June 2021

Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study.

Anemia 2021 27;2021:6636043. Epub 2021 Mar 27.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals.

Methods: A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the -value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association.

Results: About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia.

Conclusions: This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.
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http://dx.doi.org/10.1155/2021/6636043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019621PMC
March 2021

Unfavorable Treatment Outcome and Its Predictors Among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study.

Infect Drug Resist 2021 8;14:1343-1355. Epub 2021 Apr 8.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: According to the 2017 global report, Ethiopia is among the top 30 high tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) burden countries. However, studies on MDR-TB treatment outcomes in Southern Ethiopia was very limited. Therefore, the study was aimed at determining the unfavorable treatment outcome and its predictors among patients with multidrug-resistant tuberculosis in Southern Ethiopia MDR-TB treatment centers.

Subjects And Methods: A retrospective follow-up study was conducted in Southern Ethiopia MDR-TB treatment initiating centers. Three hundred sixty-three patients were included in the study. Kaplan-Meier failure curve, median time, and Log rank test were used to present the descriptive findings. Then, a Cox regression analysis was used to identify predictors of unfavorable treatment outcome. The strength of the association was reported using an adjusted hazard ratio (AHR) and a 95% confidence interval (CI). Finally, the Cox Snell residual test was used to check the goodness of fit.

Results: For the entire cohort, the unfavorable treatment outcome was 23.68% (19.29, 28.09). Hospitalization for care (AHR = 2.07; 95% CI = 1.21, 3.63), male sex (AHR = 1.85; 95% CI = 1.002, 3.42), attending tertiary education (AHR = 0.31; 95% CI = 0.11, 0.91), and those with low hemoglobin (AHR = 2.89; 95% CI = 1.55, 5.38) were predictors for unfavorable treatment outcome.

Conclusion: The unfavorable treatment outcome was higher compared with the national goal of END-TB by 2020. Hospitalizations for care, male sex, and low hemoglobin level increased the hazard of the unfavorable treatment outcome. On the other hand, attending territory education decreased the hazard of the unfavorable treatment outcome.
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http://dx.doi.org/10.2147/IDR.S300814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041603PMC
April 2021

Depression, Anxiety, and Stress Symptoms and Its Associated Factors Among Residents of Gondar Town During the Early Stage of COVID-19 Pandemic.

Risk Manag Healthc Policy 2021 15;14:1073-1083. Epub 2021 Mar 15.

Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Purpose: An acute respiratory disease caused by the novel coronavirus disease (COVID) was identified in late 2019. COVID-19 triggered a wide range of psychological problems, such as anxiety, depression, and stress. However, studies on mental health status in developing countries including Ethiopia related to COVID-19 are very limited. Therefore, this study was aimed at determining the magnitude of depression, anxiety, and stress, and their associated factors among Gondar town population during the early stage of the COVID-19 pandemic.

Patients And Methods: A community-based cross-sectional study was conducted among 660 residents of Gondar town in April 2020. A multi-stage sampling technique was employed to select study participants. A 21 item depression, anxiety, and stress scale (DASS-21) was used. Variables with a value <0.05 in the final model were declared as statistically significant. Hosmer and Lemeshow goodness of fit test was used to check the model fitness.

Results: In this study, the prevalence of depression was 32.0% (95% CI: 28.4-35.5), anxiety 25.8% (95% CI: 22.4-29.1), and stress 14.7% (95% CI: 12.0-17.4), respectively. The odds of developing depression was higher among female respondents (AOR=2.30, 95% CI: 1.01, 3.83) and ever smokers (AOR=2.8, 95 CI: 1.23, 6.28) as compared to their counterparts. Besides, history of medical illness and ever smoking increase the odds of anxiety by 2.3 (AOR=2.3; 95% CI: 1.42-3.76), and 2.8 (AOR=2.8; 95% CI: 1.23-3.83), respectively. Furthermore, being unemployed and family size of <5 increase the odds of stress by 2.1 (AOR=2.1; 95% CI: 1.17-3.83) and 1.8 (AOR=1.8; 95% CI: 1.09-2.81), respectively.

Conclusion: In this study, the overall depression, anxiety, and stress were significantly high. There are number of factors associated with depression, anxiety, and stress. Designing and implementing tailored strategies for COVID-19 prevention and control could be supremely important to reduce mental health problems in the community.
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http://dx.doi.org/10.2147/RMHP.S296796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979341PMC
March 2021

Joint Modeling of Incidence of Tuberculosis and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Anti-Retroviral Therapy at Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

HIV AIDS (Auckl) 2021 1;13:239-249. Epub 2021 Mar 1.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Globally, approximately 37.9 million people were living with HIV and one-third of these people are co-infected with tuberculosis (TB). However, little is known about predictors of tuberculosis incidence and its association with viral load. Thus, this study was aimed at assessing the incidence of tuberculosis and its predictors and its association with the longitudinal change in viral load over time among adult HIV/AIDS patients at Zewditu memorial hospital, Addis Ababa Ethiopia.

Methods: A retrospective follow-up study was conducted among 471 HIV patients. The proportional hazard assumption was checked for the survival sub-model and the longitudinal sub-model. Νormality assumption was checked. Then the joint model with time-dependent lagged parameterizations was fitted. The goodness of fit was checked using the Cox-Snell residual test and Akaike Information Criteria (AIC) was used for model selection. Finally, the hazard ratio with a 95% confidence interval (CI) with a corresponding P-value <0.05 was used.

Results: A total of 471 patients were followed for a minimum of 12 and a maximum of 48 months with a median follow-up time of 44 months [IQR (33, 46)]. The incidence rate was 3.08/1000 person-years (PY) with a 95% CI of [0.0023788, 0.003998). Age above 65 years adjusted hazard ratio (AHR) = 2.07, 95% CI: 1.06, 4.06), underweight at baseline (AHR = 2.29, 95% CI: 1.20, 4.35), past opportunistic infection (AHR = 2.98, CI: 1.23, 7.17) and 6th month lagged value of the viral load were significant predictors for being co-infected with TB.

Conclusion: The incidence of TB among HIV/AIDS patients in Zewditu memorial hospital was low. Older age, underweight at baseline, and past opportunistic infection were significant predictors of time to TB co-infection. Thus, addressing significant predictors and strengthening continuous follow-up are highly recommended in the study setting.
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http://dx.doi.org/10.2147/HIV.S291872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935332PMC
March 2021

Low practice of malaria prevention among migrants and seasonal farmworkers in Metema and west Armacheho districts, Northwest Ethiopia.

BMC Infect Dis 2021 Feb 4;21(1):145. Epub 2021 Feb 4.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: More than hundreds and thousands of migrants and seasonal farm workers move from the highlands (relatively low malaria endemicity areas) to the lowlands (higher malaria endemicity areas) for the development of the corridor of the Amhara region during planting, weeding, and harvesting seasons in each year. Seasonal migrant workers are at high risk of malaria infection. Therefore, evidence of their knowledge level and practice in the prevention of malaria during their stay would be important.

Objective: The aims of this study was to assess the knowledge and practice of malaria prevention and associated factors among migrants and seasonal farm workers in Northwest Ethiopia.

Method: A cross-sectional study was conducted from October to November, 2018 in Metema and West Armacheho districts, northwest Ethiopia. A sample of about 950 migrants and seasonal farm workers were included using two stages of cluster sampling technique. Interview administered structured questionnaire was used. Both bi-variable and multivariable binary logistic regressions were applied to identify predictors of malaria prevention.

Result: The overall good knowledge of malaria (those participants who scored more than 60% of correct response for knowledge related questions) was 50.2% with 95% CI (47.0-53.0) and the overall good practice of malaria (those participants who practiced more than 60% for practice related questions) was 27.2% with 95% CI (244.3-29.9). Age (AOR = 0.51(95%CI; 0.33-0.80)), level of education (AOR = 0.55(95%CI; 0.32-0.94)), using mass media as a source of information (AOR = 2.25(95%CI; 1.52-3.32)) and length of stay at the farming site (AOR = 0.59(95%CI; 0.44-0.79)) were significantly associated with knowledge of malaria prevention. Knowledge (AOR = 6.62(95%CI; 4.46-9.83)), attitude (AOR = 2.17(95%CI1.40-3.37), use of mass media (AOR = 1.64(95%CI; 1.30-2.60)) and the length of stay (AOR = 1.93(95%CI; 1.35-2.77)) in the farming area were significantly associated with practice of malaria prevention.

Conclusion: The practice of malaria prevention among migrant and seasonal farm workers was low. The programmers and implementers should design tailored malaria intervention programs and strategies for these hard to reach population.
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http://dx.doi.org/10.1186/s12879-021-05853-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863355PMC
February 2021

Common mental disorders among seasonal migrant farmworkers in Northwest Ethiopia.

BMC Psychiatry 2021 02 2;21(1):69. Epub 2021 Feb 2.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Seasonal migrant farmworkers in Ethiopia are a vulnerable segment of the population facing numerous threats to their mental health. This research aimed to determine the magnitude of common mental disorders (CMDs) and its associated factors among seasonal migrant farmworkers in the northwest of Ethiopia.

Methods: A cross-sectional study was conducted. A total of 950 seasonal migrant farmworkers were selected randomly. CMDs were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect the associated characteristics of socio-demographic data. Data were analyzed using descriptive statistics, bivariate, and multivariable binary logistic regression. The adjusted odds ratio (AOR) with a 95% confidence level was used to declare a statistically significant association with CMDs.

Results: The prevalence of CMDs was found to be 23.05% (219/950; 95% CI 20.47-25.84) among seasonal migrant farmworkers. The prevalence of psychological stress was 74.53% (708/950; 95% CI 71.65-77.20). Having a daily income below USD 5 (AOR = 1.53, 95% CI: 1.10-2.15), moderate perceived stress (AOR = 3.18, 95% CI: 1.18, 5.36), severe perceived stress (AOR = 16.15, 95% CI: 8.96, 29.11), and heat-related illness (AOR = 1.60, 95% CI: 1.11, 2.30) were associated with a higher likelihood of experiencing CMD. On the other hand, those seasonal migrant farmworkers who migrated for the first time (AOR = 0.38, 95% CI: 0.23-0.65) and those who received health related information (AOR = 0.60, 95% CI: 0.42, 0.85) were less likely to have CMDs.

Conclusion: In this study, CMDs were found to be prevalent among seasonal migrant farmworkers. These findings highlight the importance of systematic development of community-based mental health services in combination with rural primary health care centers and an integrated approach to the health care of farmworkers such as screening, early identification, and treatment of CMDs of seasonal migrant farmworkers.
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http://dx.doi.org/10.1186/s12888-021-03068-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852114PMC
February 2021

Factors Affecting Under-Five Mortality in Ethiopia: A Multilevel Negative Binomial Model.

Pediatric Health Med Ther 2020 31;11:525-534. Epub 2020 Dec 31.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Purpose: Even though remarkable declines in under-five mortality rates noticed globally, nearly 5.6 million children still die annually before celebrating their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1000 live births died before the fifth birthday. This study aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016.

Materials And Methods: The data were retrieved from the EDHS 2016, and a total weighted number of 11,023 under-five children were included. Descriptive statistics were reported using tables, graphs, and texts. A multilevel negative binomial regression model was fitted, and adjusted incidence rate (ARR) with a 95% confidence interval (CI) and a p-value <0.05 were reported. The deviance test was used to check the goodness of fit.

Results: Mother attained higher education (ARR=0.25, 95% CI: 0.10-0.66), female-headed household (ARR=1.32, 95% CI: 1.05-1.66), age of household head (AIRR=1.07, 95% CI: 1.03,1.11), preceding birth interval ≥48 months (ARR=0.51, 95% CI: 0.42-0.61), child who had history of diarrhea (ARR=1.23, 95% CI: 1.08-1.41), multiple birth type (ARR=1.80, 95% CI: 1.34-2.42), mothers who delivered in health facility (ARR=0.86, 95% CI: 0.73,0.94), residents of Addis Ababa (ARR=0.52, 95% CI: 0.28-0.98), and Amhara region (ARR=1.43, 95% CI: 1.09, 1.88) were statistically significant with the number of under-five mortality.

Conclusion: In this study, under-five mortality remains a public health problem in Ethiopia. Educational status of the mother, women delivered at health institution, preceding birth interval 24-35 and ≥48, and residents of Addis Ababa reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employed, having multiple births, and childhood diarrhea were associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to reduce the burden of under-five mortality.
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http://dx.doi.org/10.2147/PHMT.S290715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781031PMC
December 2020

Low Knowledge and Attitude Towards Visceral Leishmaniasis Among Migrants and Seasonal Farm Workers in Northwest Ethiopia.

Res Rep Trop Med 2020 15;11:159-168. Epub 2020 Dec 15.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objective: Ethiopia has the second highest burden of visceral leishmaniasis (VL) next to Sudan. North West Ethiopia alone accounts for 60% of the national burden. Migrant and seasonal farmworkers were the riskiest groups. Good knowledge and attitude on VL is a precursor for successful control of the disease. Therefore, this study was aimed to determine knowledge and attitude towards VL and its associated factors among migrants and seasonal farmworkers in West Gondar zone, Northwest Ethiopia.

Methods: A community-based cross-sectional study was conducted from October to November 2018 in Metema and West Armachiho districts. Two-stage cluster sampling was used to select 950 migrant and seasonal farmworkers. A binary logistic regression model was fitted and variables having a -value<0.05 were considered to have a significant association with the outcome variable. Odds ratio (OR) with 95% confidence interval (CI) was used as a measure of association. The goodness of fit test was assessed by Hosmer-Lemeshow test.

Results: Of the total participants, 33.2% (95% CI=30.2-36.2) and 30.2% (95% CI=27.4-33.2) were found to have good knowledge and favorable attitude towards VL, respectively. Factors associated with good knowledge include having health information (AOR=3.2, 95% CI=2.3-4.4), previous history of VL (AOR=6.8, 95% CI=3.7-12.8), and higher age (AOR=1.58, 95% CI=1.12-2.23). Moreover, factors associated with favorable attitude include having health information (AOR=2.8, 95% CI=2.0-3.9), previous history of VL (AOR=2.3, 95% CI=1.3-4.1), good knowledge (AOR=2.4, 95% CI=1.7-3.3), and larger number of visits to the farm area (AOR=2.5, 95% CI=1.5-4.1).

Conclusion: In this study, knowledge and attitude of migrants and seasonal farmworkers towards VL were low. Having health information and previous history of VL had increased the odds of both knowledge and attitude. Tailored interventions for the migrant seasonal farmworkers focusing on knowledge and attitude of VL would be supremely important.
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http://dx.doi.org/10.2147/RRTM.S286212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751707PMC
December 2020

Knowledge, Attitudes and Practices Toward Prevention and Early Detection of COVID-19 and Associated Factors Among Religious Clerics and Traditional Healers in Gondar Town, Northwest Ethiopia: A Community-Based Study.

Risk Manag Healthc Policy 2020 20;13:2239-2250. Epub 2020 Oct 20.

School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: COVID-19 control measures efforts are affected by the knowledge, attitudes, and practices of the public, particularly religious clerics and traditional healers, who have close contact and are widely accepted by a significant number of community members.

Methods: A community-based cross-sectional study was conducted to determine knowledge, attitudes and practices towards COVID-19 and its associated factors among religious clerics and traditional healers in Gondar town. Study participants who met our inclusion criteria were selected using a simple random sampling technique. Data were collected by trained data collectors through face-to-face interviews. The reliability of the questionnaire was assessed using Cronbach's alpha. Knowledge, attitudes and practices scores were calculated to give the overall knowledge, attitude and practice score. Binary logistic regression was fitted to identify associated factors and odds ratio was used to measure the strength of the association.

Results: A total of 410 religious clerics and traditional healers were included in the study with a response rate of 97.1%. Of the total participants, 60.7% (95%: CI (56-65%)) had good knowledge, 34.1% (95%: CI (30-39%)) had a positive attitude and 15.6% (95%: CI (12-19%)) had good practices towards prevention and early detection of COVID-19. Less than one third of the participants practiced physical distancing (28%) and facemask use (17.8%). In multivariate logistic regression, age, educational status and marital status were significantly associated with knowledge score. Likewise, age and marital status were significantly associated with the positive attitude score. In addition, age, educational status, and the presence of underlying disease were significantly associated with the good practice score.

Conclusion: Majority of the participants had poor practice and negative attitudes. Therefore, there should be a sensitization program to fill the gap in the knowledge, attitudes and practice measures of COVID-19 especially for elderly and illiterates.
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http://dx.doi.org/10.2147/RMHP.S277846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585854PMC
October 2020

Dietary diversity practice and associated factors among adolescent girls in Dembia district, northwest Ethiopia, 2017.

Public Health Rev 2020 9;41:23. Epub 2020 Oct 9.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Dietary diversity is defined as the number of food groups or items consumed over a reference period, and usually, it is a problem in developing countries including Ethiopia. Inadequate dietary diversity is one of a major public health problem and can result in physical, emotional, and psychological changes among adolescents. However, studies on dietary diversity among school children were very limited. Hence, this study aimed at determining dietary diversity practices and factors among adolescents in Dembia district.

Methods: A school-based cross-sectional study was conducted from March 1 to April 15, 2017, at Dembia district, northwest Ethiopia. A total of 474 study subjects were selected using the multi-stage sampling technique. A structured and pre-tested questionnaire was used to collect the data. Dietary diversity was measured through standard tool adopted from Food and Nutrition Technical Assistance (FANTA) 2016 using the 24-h recall method. A multivariable binary logistic regression model was employed to identify factors associated with a diversified diet.

Result: This study illustrated that 32.3% (95% CI 27.9-36.8) of the adolescents had adequate dietary diversity. Inadequate dietary diversity was significantly associated with being Muslim (AOR = 0.3; 95% CI 0.1-0.7), self-employment (AOR = 0.3; 95% CI 0.1-0.9), middle (AOR = 0.5; 95% CI 0.3-0.8) and high wealth category (AOR = 0.3; 95% CI 0.2-0.6), and underweight (AOR = 3.5; 95% CI 1.3-9.5).

Conclusion: The findings of this study showed that only one-third of adolescent girls have adequate dietary diversity. Low level of dietary diversification suggested points to the need for strengthening efforts targeting to improve the healthy dietary practice of adolescents by giving due attention to poor households and undernourished adolescents.
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http://dx.doi.org/10.1186/s40985-020-00137-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547502PMC
October 2020

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study.

Epidemiol Infect 2020 10 15;148:e258. Epub 2020 Oct 15.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

The burden of multidrug-resistant tuberculosis (MDR-TB) related to mortality in resource-poor countries remains high. This study aimed to estimate the incidence and predictors of death among MDR-TB patients in central Ethiopia. A retrospective follow-up study was conducted at three hospitals in the Amhara region on 451 patients receiving treatment for MDR-TB from September 2010 to January 2017. Data were collected from patient registration books, charts and computer databases. Data were fitted to a parametric frailty model and survival was expressed as an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). The median follow-up time of participants was 20 months (interquartile range: 12, 22) and 46 (10.20%) of patients died during this period. The incidence rate of mortality was 7.42 (95% CI 5.56-9.91)/100 person-years. Older age (AHR = 1.04, 95% CI 1.01-1.08), inability to self-care (AHR = 13.71, 95% CI 5.46-34.40), co-morbidity (AHR = 5.74, 95% CI 2.19-15.08), low body mass index (AHR = 4.13, 95% CI 1.02-16.64), acute lung complications (AHR = 4.22, 95% CI 1.66-10.70) and lung consolidation at baseline (AHR = 5.27, 95% CI 1.06-26.18) were independent predictors of mortality. Most of the identified predictor factors of death in this study were considered to be avoidable if the TB programme had provided nutritional support for malnourished patients and ensured a close follow-up of the elderly, and patients with co-morbidities.
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http://dx.doi.org/10.1017/S0950268820002514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689597PMC
October 2020

Time to Adjuvant Chemotherapy and Its Predictors Among Women with Breast Cancer at the University of Gondar Compressive Specialized Hospital: A Retrospective Follow-Up Study.

Breast Cancer (Dove Med Press) 2020 17;12:97-108. Epub 2020 Sep 17.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.

Background: Early adjuvant chemotherapy improves the outcomes of breast cancer patients by increasing the benefit provided by the cytotoxic systemic therapies. Despite these, the recommended time to adjuvant chemotherapy and its predictors is very limited. Therefore, this study was determining the time to adjuvant chemotherapy and its predictors among women with breast cancer at the University of Gondar Comprehensive Specialized Hospital.

Methods: An institution-based retrospective follow-up study was conducted at the University of Gondar Compressive Specialized Hospital from January 2015 to February 2019 among all women with breast cancer. Stata version 14 was used for data analysis. A stratified Cox regression model was fitted to identify the potential predictors. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of the association. Cox-Snell residual test was used to check the goodness of fit.

Results: In this study, the median time to adjuvant chemotherapy was 67 days with an interquartile range of 34-102 days. More than three-fourth (79.9%) of patients received chemotherapy after 30 days. Of the total, 96.6% of patients with co-morbidity received adjuvant chemotherapy after 30 days. Regarding surgical complications, 97.0% of the patients with a surgical complications were received adjuvant chemotherapy after 30 days. Older patients (AHR= 0.34, 95% CI: 0.16,0.71), presence of co-morbidity (AHR= 0.43, 95% CI: 0.29, 0.62), positive surgical margin (AHR= 0.40, 95% CI: 0.25, 0.64), and presence of surgical complication (AHR= 0.55, 95% CI: 0.34, 0.88) were significantly associated with delayed time to adjuvant chemotherapy.

Conclusion: In this study, time to adjuvant chemotherapy among women was longer. Age, co-morbidity, surgical complications, and margin status were significant predictors of time to adjuvant chemotherapy. Close follow-up is important for women with surgical complications, co-morbidities, elder patients, and patients with a positive margin.
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http://dx.doi.org/10.2147/BCTT.S260341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509314PMC
September 2020

Spatial Pattern and Associated Factors of ANC Visits in Ethiopia: Spatial and Multilevel Modeling of Ethiopian Demographic Health Survey Data.

Adv Prev Med 2020 19;2020:4676591. Epub 2020 Aug 19.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Although there is an increase in having antenatal care (ANC), still many women lack recommended ANC contacts in Ethiopia. Therefore, this study was aimed at determining spatial patterns and associated factors of not having ANC visits using the Ethiopian Demographic and Health Survey (EDHS) 2016 data.

Methods: A two-stage stratified cluster sampling technique was employed based on EDHS data from January 18 to June 27, 2016. A total of 7,462 women were included in the study. ArcGIS version 10.7 software was used to visualize the spatial distribution. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for not having ANC visits in Ethiopia. A multivariable multilevel logistic regression model was used to identify individual- and community-level determinants of not having antenatal care. Model comparison was checked using the likelihood test and goodness of fit was assessed by the deviance test.

Results: The primary clusters' spatial window was located in Somalia, Oromia, Afar, Dire Dawa, and Harari regions with the log-likelihood ratio (LLR) of 133.02, at < 0.001 level of significance. In this study, Islam religion (adjusted odds ratio (AOR) = 0.7 with 95% confidence interval (CI) (0.52,0.96)), mother education being primary (AOR = 0.59, 95% CI (0.49,0.71)), distance from health facility being a big problem (AOR = 0.76, CI (0.65,0.89)), second birth order (AOR = 1.35, CI (1.03, 1.76)), richer wealth index (AOR = 0.65, CI (0.51,0.82)), rural residence (AOR = 2.38, CI (1.54,3.66)), and high community media exposure (AOR = 0.68, CI (0.52,0.89)) were determinants of not having antenatal care in Ethiopia.

Conclusion: The spatial distribution of ANC in Ethiopia is non-random. A higher proportion of not having ANC is found in northeast Amhara, west Benishangul Gumuz, Somali, Afar, north, and northeast SNNPR. On the other hand, a low proportion of not having ANC was found in Tigray, Addis Ababa, and Dire Dawa. In Ethiopia, not having antenatal care is affected by both individual- and community-level factors. Prompt attention by the Federal Ministry of Health is compulsory to improve ANC especially in rural residents, uneducated women, poor households, and regions like Oromia, Gambella, and Somalia.
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http://dx.doi.org/10.1155/2020/4676591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453231PMC
August 2020

Flatfoot and associated factors among Ethiopian school children aged 11 to 15 years: A school-based study.

PLoS One 2020 25;15(8):e0238001. Epub 2020 Aug 25.

Department of Physiotherapy, College of Medicine and Health Sciences & Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.

Background: The Foot health of a child plays a pivotal role in their participation in play, locomotive activities, healthy lifestyle, somatic development, and weight management. The burden of flatfoot among children in Ethiopia is not known. The objective of this study was to analyze the structure of the medial foot arch using Staheli plantar arch index and investigate its associated factors among larger sample school children, aged 11-15 years in Ethiopia.

Methods: A school-based cross-sectional study was conducted among children aged 11-15 years from eleven randomly selected primary schools. The sample size was determined proportionally across school strength and governmental and private schools to ensure variety within the sample. Data collection consisted of physical measurements, footprint-based measures whilst full weight-bearing, and a structured questionnaire on foot pain, footwear type, and physical activity. Data were analyzed descriptively and through uni- and multivariate logistic regression model.

Results: A total of 823 children participated. The overall prevalence of flatfoot was 17.6% with a significant difference between age, gender, type of school, BMI, and type of footwear. Being younger (OR 3.3, 95% CI 1.6-6.7), male (OR 1.6, 95% CI 1.0-2.4), experiencing foot pain (OR 1.9, 95% CI 1.0-3.5), wearing closed shoe (OR 4.4, 95% CI 1.6-11.9), overweight (OR 3.8, 95% CI 1.2-8.7), obese (OR 4.2, 95% CI 2.5-10.9), and low level of physical activity (OR 2.1, 95% CI 1.0-4.6) were significantly associated with flatfoot. Children who were overweight, obese, and also experiencing foot pain have a 2.8 (95% CI 1.62-5.94) and 4.1 (95% CI 2.85-8.31) times greater chance of having flatfoot respectively. The prevalence of flatfoot among 560 normal weight children was 17.5%.

Conclusions: The findings of this study demonstrated that the overall prevalence and the prevalence of flatfoot among normal-weight children are almost the same. There is a definite need to develop a screening algorithm for diagnosis and treatment indication for this children's lower extremity disorder.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238001PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447044PMC
October 2020

The role of mass media exposure on tuberculosis knowledge and attitude among migrant and seasonal farmworkers in Northwest Ethiopia.

BMC Infect Dis 2020 Aug 5;20(1):579. Epub 2020 Aug 5.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Globally, tuberculosis (TB) is the 10th leading cause of death. Despite no country achieved its target, the world health organization (WHO) proposed a 90-90-90 approach to fastening the end TB strategy. Improvement and progression of TB control need good knowledge and a favorable attitude towards the disease. However, interventions designed don't take migrants and seasonal farmworkers into account. Therefore, this study aimed at estimating the level of knowledge and attitude on Tuberculosis among migrant and seasonal farmworkers in northwest Ethiopia.

Methods: Community-based cross-sectional study was conducted in the West Gondar zone from October to November 2018. A two-stage cluster sampling was used to select 949 migrant and seasonal farmworkers. Both bivariate and multivariable logistic regression analyses were performed. A p-value of < 0.05 was used to declare statistical significance. The goodness of fit was checked using Hosmer and Lemeshow test.

Results: In this study, (41.8%), (95% CI: 38.73, 45.01) and (50.5%), (95% CI: 47.29, 53.65) of migrants and seasonal farmworkers had good knowledge and a favorable attitude, respectively. The odds of good knowledge among mass media exposed migrants were AOR = 1.42, 95% CI: (1.02, 2.01). Moreover, urban residence and having good knowledge increase the odds of favorable attitude by 1.66, (AOR = 1.7; 95% CI: 1.05, 2.62) and 4.3 (AOR = 4.3, 95%CI: 3.26, 5.75), respectively.

Conclusion: In this study, the overall knowledge and attitude of migrant and seasonal farmworkers on TB were low. Family size and mass media exposure significantly affect knowledge of the migrants on TB. On the other hand, the attitude was affected by urban residence, health information, and having good knowledge. Health promotion interventions, focused on TB cause, mode of transmission, prevention, and treatment are important to migrant and seasonal farmworkers to improve the knowledge and attitude of migrants and seasonal farmworkers.
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http://dx.doi.org/10.1186/s12879-020-05316-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405343PMC
August 2020

Factors affecting infant mortality in the general population: evidence from the 2016 Ethiopian demographic and health survey (EDHS); a multilevel analysis.

BMC Pregnancy Childbirth 2020 May 15;20(1):299. Epub 2020 May 15.

Department of Human Nutrition, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia.

Background: Infant mortality is one of the leading public health problems globally; the problem is even more staggering in low-income countries. In Ethiopia seven in ten child deaths occurred during infancy in 2016. Even though the problem is devastating, updated information about the major determinants of infant mortality which is done on a countrywide representative sample is lacking. Therefore, this study was aimed to identify factors affecting infant mortality among the general population of Ethiopia, 2016.

Methods: A Community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. A total of 10,641 live births were included in the analysis. Data were analyzed and reported with both descriptive and analytic statistics. Bivariable and multivariable multilevel logistic regression models were fitted by accounting correlation of individuals within a cluster. Adjusted odds ratio (AOR) with 95% confidence interval was reported to show the strength of the association and its significance.

Results: A total of 10,641 live-births from the Ethiopian demographic and health survey (EDHS) data were included in the analysis. Being male infant (AOR = 1.51; 1.25, 1.82), Multiple birth (AOR = 5.49; 95% CI, 3.88-7.78), Preterm (AOR = 8.47; 95% CI 5.71, 12.57), rural residents (AOR = 1.76; 95% CI; 1.16, 2.67), from Somali region (AOR = 2.07; 1.29, 3.33), Harari (AOR = 2.14; 1.22, 3.75) and Diredawa (AOR = 1.91; 1.04, 3.51) were found to be statistically significantly associated with infant mortality.

Conclusion: The study has assessed the determinants of infant mortality based on EDHS data. Sex of the child, multiple births, prematurity, and residence were notably associated with infant mortality. The risk of infant mortality has also shown differences across different regions. Since infant mortality is still major public health problem interventions shall be done giving more attention to infants who were delivered multiple and who are preterm.
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http://dx.doi.org/10.1186/s12884-020-03002-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229626PMC
May 2020

Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis.

BMC Pregnancy Childbirth 2020 Apr 28;20(1):251. Epub 2020 Apr 28.

University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Department of Epidemiology and Biostatistics, Gondar, Ethiopia.

Background: Antenatal depression is a serious problem worldwide that has devastating consequences not only for the mother but also for the child and family. The pooled evidence regarding the prevalence and associated factors of antenatal depression is rare in Africa. Hence this review aimed to investigate the prevalence and associated factors of antenatal depression in Africa.

Methods: We searched CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases for English written observational studies conducted in Africa from 2007 to 2018.Quality of studies was assessed using the Newcastle Ottawa Scale (NOS), and studies with good quality were included in the final review. Heterogeneity across studies was assessed using the I and Higgins test. Publication bias was checked using Funnel plot symmetry, and Egger's regression test and adjustment was made by using Duval and Tweedie's Trim and Fill analysis. A random effect Meta-analysis was employed to determine the pooled estimates with 95% confidence interval (CI). Stata 14 was used for analysis. The review protocol has been registered in PROSPERO number CRD42018106717.

Result: Of the 175 studies identified, 28 studies with an overall sample size of 17,938 were included. According to the random effect model following trim and fill analysis, the pooled prevalence of antenatal depression in Africa was 26.3% (95%CI: 22.2, 30.4%). Economic difficulties [POR = 1.87;95%CI:1.25,2.78,I = 88.1%], unfavorable marital condition [POR = 4.17;95% CI:1.75, 9.94, I = 81.2%], poor support from relatives [POR = 1.36;95% CI:1.18, 1.56, I = 78.0%], bad obstetric history [POR = 2.30;95% CI:1.81, 2.92), I = 81.7%], and history of mental health problem [POR = 2.97; 95% CI:1.74, 5.06, I = 92.0%]were the factors associated with antenatal depression.

Conclusion: The prevalence of antenatal depression is high in Africa, which showed that one in four pregnant women had depression. Pregnant mothers who had economic difficulties, bad obstetric history, poor support from relatives, previous mental health problems, and unfavorable marital conditions were at higher risk of antenatal depression. Therefore these factors should be considered while designing mental health care services for pregnant mothers.
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http://dx.doi.org/10.1186/s12884-020-02929-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189721PMC
April 2020

Epidemiology of postnatal depression and its associated factors in Africa: A systematic review and meta-analysis.

PLoS One 2020 28;15(4):e0231940. Epub 2020 Apr 28.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia.

Introduction: Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of postnatal depression is high. However, it is under-investigated hence under-treated. To fill this information gap and to advise further interventions, we aimed at analyzing its epidemiology in Africa.

Methods: We searched observational studies conducted in Africa and published in between 01/01/2007 and 30/06/2018 in CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases. We assessed the quality of the studies using the Newcastle Ottawa Scale (NOS) and included studies with good quality. We evaluated the heterogeneity using the Higgins I2 statistics. We used a random-effects model to pool estimates. We assessed publication bias using the funnel plot and Egger's test statistics and adjusted using Tweedie's and Duval Trim and Fill analysis. The protocol has been registered in the PROSPERO (Protocol No. CRD42018100461).

Results: Nineteen studies involving 40,953 postnatal mothers were part of this systematic review and meta-analysis. The overall pooled prevalence of PND was 16.84% (95% CI: 14.49% -19.19%). The odds of having PND was higher among women with a poor obstetric condition (POR = 2.11; 95% CI: 1.11-4.01) and history of adverse birth and infant health outcomes (POR = 2.85; 95% CI: 1.29-6.25). Having a history of common mental health disorders (POR = 2.47; 95% CI: 1.51-4.04), poor social support (POR = 2.06; 95% CI: 1.05-4.05), lower economic status (POR = 2.38; 95% CI: 1.75-3.23), and those who had exposure to a different form of intimate partner violence (POR = 2.87; 95% CI: 1.60-5.16) had higher odds of PND.

Conclusion: While robust prevalence studies are scarce, our review indicated a high prevalence rate of postnatal depression. The analysis also identified postpartum women at increased risk of PND. Therefore, there is a need to design and escalate comprehensive strategies to decrease its burden, focusing on those women at risk of PND.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231940PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188237PMC
July 2020

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia.

BMJ Open 2020 02 13;10(2):e034583. Epub 2020 Feb 13.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objectives: This study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia.

Design: An institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016.

Setting: Selected government health institutions in the Amhara region, Ethiopia.

Participants: Children treated in therapeutic feeding units for SAM were included.

Outcome Measures: Time to recovery from SAM.

Results: One thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11-28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery.

Conclusions: The time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.
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http://dx.doi.org/10.1136/bmjopen-2019-034583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045195PMC
February 2020

Factors affecting current khat chewing among male adults 15-59 years in Ethiopia, 2016: a multi-level analysis from Ethiopian Demographic Health Survey.

BMC Psychiatry 2020 01 14;20(1):21. Epub 2020 Jan 14.

Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Regular khat chewing causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems. Based on the Ethiopian Demographic and Health Survey (EDHS) 2016, 12% of women and 27% of men have reported having ever chewed khat. Even though khat addiction is a major public health problem, studies that consider both individual level and community level factors are limited. Therefore, this study aimed to determine the prevalence and factors affecting current khat chewing among male adults in Ethiopia.

Methods: Data from EDHS, a community-based cross-sectional study conducted from January 18, 2016, to June 27, 2016, was used. A multistage stratified cluster sampling technique was used to select participants. Both descriptive and analytical statistics were done. Bi-variable and multivariable multilevel logistic regression analyses were performed to determine factors affecting current khat chewing. Adjusted Odds ratio (AOR) with 95% Confidence Interval (CI) for variables with P-value < 0.05 was used as a measure of association.

Result: A total of 12,595 male adults were included. The prevalence of current khat chewing was 23.61% (95% CI: 22.87, 24.36). Age 20-24 years; (AOR = 2.68, 95% CI: 2.02, 3.56), being uneducated (AOR = 1.62, 95% CI: 1.10, 2.39), professional/technical/managerial job (AOR = 3.59, 95% CI: 2.18, 5.91), Muslim religion (AOR = 18.30, 95% CI: 13.54, 24.74), poorest wealth index (AOR = 0.67, 95% CI: 0.51, 0.89), being divorced (AOR = 0.38, 95% CI: 0.21, 0.69), history of alcohol drinking in the last 30 days (AOR = 2.15, 95% CI: 1.69, 2.73), and history of cigarette smoking in the last 30 days (AOR = 14.92, 95% CI: 10.88, 20.47), and Amhara region (AOR = 0.07, 95% CI: 0.04, 0.14) were significantly associated with khat chewing.

Conclusion: Khat chewing remains high in Ethiopia with certain regional variations. The uneducated, older age, Alcohol and cigarette users, Muslims, and professional workers were at higher risk of khat chewing whereas the poorest wealth index and being divorced reduced its risk. Policymakers should consider a multi-faceted policy approach that accounts for regional variation and the identified risk factors to alleviate the problem.
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http://dx.doi.org/10.1186/s12888-020-2434-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961402PMC
January 2020

Time to recovery and determinants of severe acute malnutrition among 6-59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study.

Ital J Pediatr 2019 Nov 4;45(1):136. Epub 2019 Nov 4.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia.

Objective: This study was aimed at finding the time to recovery and determinants among 6-59 months children with severe acute malnutrition treated at an outpatient therapeutic programme in North Gondar zone, northwest Ethiopia.

Methods: Facility based prospective follow up study was conducted from March 24 to May 24, 2017. A total of 408 children with the age of 6-59 months were included in the study. Structured interviewer administered questionnaire was used. Anthropometric measurements were conducted every week. The median time of recovery, Kaplan Meier (KM) curve, and log rank test were computed. Both bi-variable and multivariable Cox regression model was fitted. To establish an association between time to recovery and its determinants 95% confidence interval (CI) and p-value < 0.05 were used. Proportional hazard assumption was checked graphically and using Schoenfeld residual test.

Results: Out of 389 children, 254 (65.3%) recovered. The median time to recovery was 38.5 ± IQR of 14 days. Children with diarrhoea AHR = 0.81 with 95% CI (0.73, 0.99), children taken amoxicillin AHR = 2.304 with 95% CI (1.68-3.161), and had vomiting at admission AHR = 0.430 with 95% CI (0.205, 0.904) were significant predictors of time to recovery.

Conclusions And Recommendations: The overall time to recovery has not met the minimum sphere international standard which was lower than 75%. It is advisable to give emphasis to patients with diarrhoea and vomiting.
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http://dx.doi.org/10.1186/s13052-019-0732-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829982PMC
November 2019

Factors affecting neonatal mortality in the general population: evidence from the 2016 Ethiopian Demographic and Health Survey (EDHS)-multilevel analysis.

BMC Res Notes 2019 Sep 23;12(1):610. Epub 2019 Sep 23.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Objective: This study was aimed to identify factors affecting neonatal mortality in Ethiopia.

Results: According to the multilevel multivariable logistic regression analysis, the odds of neonatal mortality was significantly associated with husbands with no education (AOR = 2.30, 95% CI 1.10, 4.83), female birth (AOR = 0.57, 95% CI 0.39, 0.83), twin birth (AOR = 13.62, 95% CI 7.14, 25.99), pre-term birth (AOR = 15.07, 95% CI 7.80, 29.12) and mothers with no antenatal care (ANC) visit during pregnancy (AOR = 1.90 95% CI 1.11, 3.25).
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http://dx.doi.org/10.1186/s13104-019-4668-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757386PMC
September 2019

Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia.

BMC Infect Dis 2019 Sep 13;19(1):804. Epub 2019 Sep 13.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Globally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia.

Methods: A community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association.

Results: In this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child's age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease.

Conclusion: There was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.
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http://dx.doi.org/10.1186/s12879-019-4445-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743097PMC
September 2019

Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia.

BMC Infect Dis 2019 May 31;19(1):489. Epub 2019 May 31.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia.

Methods: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay.

Results: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays.

Conclusion: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.
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http://dx.doi.org/10.1186/s12879-019-4112-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544973PMC
May 2019

Spatial distribution and determinants of acute respiratory infection among under-five children in Ethiopia: Ethiopian Demographic Health Survey 2016.

PLoS One 2019 22;14(4):e0215572. Epub 2019 Apr 22.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Childhood acute respiratory infection remains the commonest global cause of morbidity and mortality among under-five children. In Ethiopia, it remains the highest burden of the health care system. The problem varies in space and time, and exploring its spatial distribution has supreme importance for monitoring and designing effective intervention programs.

Methods: A two stage stratified cluster sampling technique was utilized along with the 2016 Ethiopian Demographic and Health Survey (EDHS) data. About 10,006 under-five children were included in this study. Bernoulli model was used to investigate the presence of purely spatial clusters of under-five acute respiratory infection using SaTScan.ArcGIS version 10.1 was used to visualize the distribution of pneumonia cases across the country. Mixed-effect logistic regression model was used to identify the determinants of acute respiratory infection.

Result: In this study, acute respiratory infection among under-five children had spatial variations across the country (Moran's I: 0.34, p < 0.001). Acute respiratory infection among under-five children in Tigray (p < 0.001) and Oromia (p < 0.001) National Regional States clustered spatially. History of diarrhoea (Adjusted Odds Ratio (AOR) = 4.71, 95% CI: (3.89-5.71))), 45-59 months of age (AOR = 0.63, 95% CI: (0.45-0.89)), working mothers (AOR = 1.27, 95% CI: (1.06-1.52)), mothers' secondary school education (AOR = 0.65; 95% CI: (0.43-0.99)), and stunting (AOR = 1.24, 95% CI: (1.00-1.54)) were predictors of under-five acute respiratory infection.

Conclusion And Recommendation: In Ethiopia, acute respiratory infection had spatial variations across the country. Areas with excess acute respiratory infection need high priority in allocation of resources including: mobilizing resources, skilled human power, and improved access to health facilities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215572PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476529PMC
January 2020

Incidence and predictors of major adverse drug events among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara regional state public hospitals; Ethiopia: a retrospective cohort study.

BMC Infect Dis 2019 Mar 27;19(1):286. Epub 2019 Mar 27.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia.

Background: Second line anti-tuberculosis drugs are substantially complex, long term, more costly, and more toxic than first line anti-tuberculosis drugs. In Ethiopia, evidence on the incidence and predictors of adverse drug events has been limited. Thus, this study aimed at assessing incidence and predictors of major adverse drug events among drug resistant tuberculosis patients on second line tuberculosis treatment in Amhara Regional State public hospitals, Ethiopia.

Methods: A multi-center retrospective cohort study was conducted on 570 drug resistant tuberculosis Patients. Data were entered in to EPI-Data version 4.2.0.0 and exported to Stata version 14 for analysis. Proportional hazard assumption was checked. The univariate Weibull regression gamma frailty model was fitted. Cox-Snell residual was used to test goodness of fit and Akaike Information Criteria (AIC) for model selection. Hazard ratio with 95% CI was computed and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors for adverse drug event.

Results: A total of 570 patients were followed for 5045.09 person-month (PM) observation with a median follow-uptime of 8.23 months (Inter Quartile Range (IQR) =2.66-23.33). The overall incidence rate of major adverse drug events was 5.79 per 100 PM (95% CI: 5.16, 6.49). Incidence rate at the end of 2nd, 4th, and 6th months was 13.73, 9.25, 5.97 events per 100 PM observations, respectively. Age at 25-49 (Adjusted Hazard Ratio (AHR) = 3.36, 95% CI: 1.36, 8.28), and above 50 years (AHR = 5.60, 95% CI: 1.65, 19.05), co-morbid conditions (AHR = 2.74 CI: 1.12, 6.68), and anemia (AHR = 3.25 CI: 1.40, 7.53) were significant predictors of major adverse drug events.

Conclusion: The incidence rate of major adverse drug events in the early 6 months of treatment was higher than that of the subsequent months. Age above 25 years, base line anemia, and co-morbid conditions were independent predictors of adverse drug events. Thus, addressing significant predictors and strengthening continuous follow-ups are highly recommended in the study setting.
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http://dx.doi.org/10.1186/s12879-019-3919-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437856PMC
March 2019

Prevalence and associated factors of underweight among children 6-59 months of age in Takusa district, Northwest Ethiopia.

Int J Equity Health 2018 07 24;17(1):106. Epub 2018 Jul 24.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.

Background: Most of the nearly 104 million underweight children in the world lived in South East Asia and sub-Saharan Africa in 2010. According to the 2014 Ethiopian Demographic and Health Survey (EDHS) report, 24 and 7% of children aged 6-59 months were underweight and severely underweight, respectively. Although appropriate child feeding and nutritional interventions reduce child illness and death, malnutrition remains a leading public health problem in Ethiopia. As literature on the issue is scarce in northwest Ethiopia, this study aimed at determining the prevalence of under-weight and associated factors in children 6-59 months of age in Takusa district, northwest Ethiopia.

Methods: A community based cross-sectional study was conducted from January to February, 2017, at Takusa district, northwest Ethiopia. A total of 645 subjects were selected using the multi-stage sampling technique. Anthro software version 2.02 was used to determine the nutritional status of the children. A multivariable logistic regression analysis was used to investigate factors associated with underweight. Adjusted Odds Ratios (AOR) with the corresponding 95% Confidence Interval (CI) were used to show the strength of associations, and variables with P-values of < 0.05 were considered statistically significant.

Results: In this study, the overall prevalence of underweight was 19.5% (95% CI: 16.4-22.8). According to the multivariate analysis, urban residence (AOR = 0.60; 95% CI: 0.38-0.95), no antenatal care (ANC) follow up (AOR = 1.59; 95% CI 1.01-2.52), and mothers age (over 35 years) (AOR = 0.62; 95% CI: 0.38-0.99) were significantly associated with lower odds of underweight.

Conclusion: In the study community, the prevalence of underweight was lower than the findings of different studies in Ethiopia. Advanced maternal age (> 35 years), no antenatal follow up during pregnancy, and rural residence were significantly associated with underweight. Therefore, interventions targeting community management of acute malnutrition might be appropriate to manage the problem of underweight; efforts should also be intensified to reduce under-weight by focusing on identified determinants.
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http://dx.doi.org/10.1186/s12939-018-0816-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057034PMC
July 2018

Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study.

PLoS One 2018 21;13(6):e0199320. Epub 2018 Jun 21.

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: In Ethiopia, Multi-drug resistant Tuberculosis (MDR-TB) is one of the major public health problems that need great attention. Time to sputum culture conversion is often used as an early predictive value for the final treatment outcome. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Ethiopia. This study was aimed at determining the time to sputum culture conversion and the determinants among MDR-TB patients at public Hospitals of the Amhara Regional State.

Methods: A retrospective follow up study was conducted between September 2010 and December 2016. Three hundred ninety two MDR-TB patients were included in the study. Parametric frailty models were fitted and Cox Snell residual was used for goodness of fit, which the Akaike's information criteria was used for model selection. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of association.

Result: Out of the 392 participants, sputum culture changed for 340(86.7%) during the follow up period. The median culture conversion time in this study was 65 (60-70 days). Alcohol drinking (AHR = 3.79, 95%CI = 1.65-8.68), sputum smear grading +2 (AHR = 0.39, 95%CI 0.19-0.79), smear grading +3 (AHR = 0.30, CI = 0.14-064), cavitations (AHR = 0.36, 95%CI = 0.19-0.68), and consolidation (AHR = 0.29, CI = 0.13-0.69) were the determinants of time to sputum culture conversion.

Conclusion: In this study, time to sputum culture was rapid as compared to 4 months WHO recommendation. Alcohol drinking, sputum smear grading, cavitations and consolidations were found to be the determinants of time to sputum culture conversion. Therefore, providing a special attention to patients who had baseline radiological finding is recommended, high bacillary load and patients with a history of alcohol intake at baseline should be given priority.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199320PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013102PMC
April 2019
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