Determinants of Anemia Among Pregnant Women Attending Antenatal Care Clinic at Public Health Facilities in Kacha Birra District, Southern Ethiopia

BACKGROUND

Anemia is accountable for 20% of maternal death globally, and it is associated with premature birth, low birth weight, and infant death. According to the WHO report of 2008, 57.1% of pregnant women were anemic in Africa. In Ethiopia, anemia among pregnant women is 62.7%. There were no data in the study area that identified the determinants of anemia.

OBJECTIVE

To identify the determinants of anemia among pregnant mothers attending ANC clinic in public health facilities in Kacha Birra District, Southern Ethiopia.

METHODS

An institutional-based unmatched case-control study was conducted among pregnant women attending antenatal care clinics in public health facilities in Kacha Birra District, Southern Ethiopia, from February 1/2019-May 30/2019. An aggregate of 117 cases and 227 controls were involved in the study. Data were collected using interviewer-administered questionnaires. Controls were pregnant ladies whose blood hemoglobin level was 11 g/dl and above at their first antenatal care clinic, and cases were pregnant ladies whose hemoglobin level less than 11 g/dl. Both bivariate and multivariable logistic regression models were used to isolate independent predictors of anemia.

RESULTS

An overall of 344 respondents (117 cases and 227controls) were included in this study with a response rate of 100%. On multivariable logistic regression models, significant predictors of anemia were: rural residence [AOR= 2.9,95% CI:1.18-5.84], previous history of heavy menstrual blood flow [AOR=2.75, 95% CI: 2.66-28.53], age of mother [AOR=4.013, 95% CI: 1.08-14.90], parasitic infection [AOR=6.39, 95% CI: 1.226-33.362], food taboo (aversion) [AOR= 3.92, CI: 95% 2.08-7.35], drinking tea/coffee instantly after meal [AOR=18.49, 95% CI:6.89-40.64].

CONCLUSION

Residence, previous heavy menstrual flow, age, parasitic infection, food taboo, and tea/coffee consumption immediately after meals were significant predictors of anemia among pregnant women. So, anemia prevention and control policy should include the promotion of counseling on the consumption of diversified and iron-enriched foods during pregnancy, prevention of parasitic infection as well as mass deworming, awareness creation on cultural norms that makes food aversion during pregnancy.

Dried Blood Spot Test for HIV Exposed Infants and Children and Their Anti-Retro Viral Treatment Status in Selected Hospitals in Ethiopia

BACKGROUND

Infants and children living with HIV receive antiretroviral treatment often late, are exposed to opportunistic infection and quickly develop AIDS. Few hospitals are providing ART service after Dried Blood Spot (DBS)test.The objective of this study is to assess the status of infants and children linked to ART.

METHODS

Descriptive cross-sectional study was conducted in hospitals. Data of 138 infants and children exposed to HIV were collected from registration books and data bases from 2009 to 2011. Data were analyzed using SPSS version 16. Chi-squared test and p-value were computed. In-depth interviews were conducted with key informants.

RESULT

Ninety-eight (71%) infants and children exposed to HIV were diagnosed for HIV infection of which 68(69.4%) initiated ART. Twenty four (35.3%) initiated ART one month after HIV screening results. Thirty-three (50.0%) and 23(35.3%) infants and children dropped from and adhered to ART respectively. Eleven (16.2%) of them who initiated ART died within the study period. HIV infection status (p-value=0.003), dropping from ART (p-value=0.002) and death after ART initiation (p-value=0.010) showed significance with mothers' PMTCT service status.

CONCLUSION

Seven in ten HIV-exposed infants and children were diagnosed with HIV, and almost all of them initiated ART. The overall turnaround time was 10 days. Based up on mothers' PMTCT service status, there was a significant difference among HIV-exposed infants and children in acquiring HIV infection from mothers during pregnancy (p-value=0.003) and dropping from ART (p-value=0.010). There were challenges in sample collection and transportation. Early HIV screening during pregnancy and PMTCT service should be strengthened.

Household dietary diversity and Animal Source Food consumption in Ethiopia: evidence from the 2011 Welfare Monitoring Survey

Background

It is imperative to track dietary quality and progress in nutritional outcomes in a population to develop timely interventions. Dietary diversity is a commonly used proxy to assess dietary quality in low-income countries. This study identified predictors of household dietary diversity in Ethiopia and pattern of consumption of animal source food (ASF) among households.

Methods

Secondary data were analyzed from the 2011 Ethiopian Welfare Monitoring Survey (WMS). This survey used a structured questionnaire to collect socio-demographic and economic data. Dietary data were collected using a dietary diversity questionnaire measuring dietary diversity over the past 1 week. A Household Dietary Diversity Score (HDDS) was constructed according to the Food and Agricultural Organization (FAO) guidelines. Consumption of ASFs is described by its distribution among the regions and by HDDS. Multiple logistic regression analysis was fitted to identify independent predictors for HDDS.

Results

A total of 27,995 households were included in the analyses. A little over half of the study households (52.2%) had more than four household members, and 75% of households were male headed. The mean HHDS was five food groups. Cereals were the most commonly (96%) consumed food groups. Fish, egg and fruits, on the other hand, were the least consumed food groups. ASFs were consumed in greater proportion among households with higher HDDS. Being part of the higher and middle socio economic strata (P < 0.001), literacy (P < 0.01), urban residence (P < 0.01), male headed household (P < 0.01), larger family size (P <0.01) and owning livestock (P < 0.01) were positively associated with higher HDDS.

Conclusions

Considering these findings, nutrition sensitive interventions which address the problem through economic and educational empowerment and modern technologies supporting agricultural practices need to be designed to increase both local production and increased consumption.

Use of Occult Blood Detection Cards for Real-Time PCR-Based Diagnosis of Schistosoma Mansoni Infection

Background

In Schistosoma mansoni infection, diagnosis and control after treatment mainly rely on parasitological stool investigations which are laborious and have limited sensitivity. PCR methods have shown equal or superior sensitivity but preservation and storage methods limit their use in the field. Therefore, the use of occult blood detection cards (fecal cards) for easy sampling and storage of fecal samples for further PCR testing was evaluated in a pilot study.

Methodology

Stool specimens were collected in a highly endemic area for S. mansoni in Ethiopia and submitted in an investigator-blinded fashion to microscopic examination by Kato-Katz thick smear as well as to real-time PCR using either fresh frozen stool samples or stool smears on fecal cards which have been stored at ambient temperature for up to ten months.

Principal Findings

Out of 55 stool samples, 35 were positive by microscopy, 33 and 32 were positive by PCR of frozen samples and of fecal card samples, respectively. When microscopy was used as diagnostic “gold standard”, the sensitivity of PCR on fresh stool was 94.3% (95%-CI: 86.6; 100) and on fecal cards 91.4% (95%-CI: 82.2; 100).

Conclusions

The use of fecal cards proved to be a simple and useful method for stool collection and prolonged storage prior to PCR based diagnosis of S. mansoni infection. This technique may be a valuable approach for large scale surveillance and post treatment assessments

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

Background

Multi-drug-resistant Enterococci colonizing the intestinal tract of hospitalized patients are the major source of infection as well as nosocomial spread. Despite worldwide increasing rate of multidrug resistant Enterococci colonization and infection among hospitalized patients, there is scarcity of data from resource limited setting. The present study aimed at determining the antimicrobial resistance profile of Enterococcus species from intestinal tracts of hospitalized patients in Jimma, Ethiopia.

Methods

The study was conducted among hospitalized patients at Jimma University Specialized Hospital, from January to July 2013. Fecal samples were collected and processed for bacterial isolation and susceptibility testing to antimicrobial agents. Stool samples were inoculated onto enterococcus selective media (Bile Esculin azide agar plate) with and without 6 µg/ml of vancomycin. The isolates were identified to genus and species level by cultural characteristics, Gram’s stain, catalase test, growth in 6.5% NaCl broth, growth at 45°C, motility test and by using API 20 Streptococcus system. Sensitivity testing was done using Kirby–Bauer disk diffusion method. Minimum inhibitory concentrations for vancomycin were determined using E-test strips.

Result

Overall, Enterococci were isolated from 114 (76%) of the study subjects. The isolates were Enterococcus faecium (35.1%) followed by Enterococcusfaecalis (29.8%), Enterococcus gallinarum (17.5%), Enterococcuscasseliflavus (8.8%) and Enterococcusdurans (8.8%). Among 114 tested Enterococci isolates, 41 (36%) were resistant to ampicillin, 62 (54.4%) to streptomycin and 39 (34.2%) to gentamycin. Other alternative antibiotics to treat mixed nosocomial infection caused by Enterococci also showed high rate of resistance in vitro: ciprofloxacin (50% of resistance), norfloxacin (49.1%), erythromycin (63.2%), tetracycline (64.9%), chloramphenicol (34.2%), and nitrofrantoin (32.4%). Multiple drug resistance was observed among 89.5% of E. faecium and E. faecalis. Vancomycin resistant Enterococci were observed in 5% of E. faecium isolates.

Conclusion

This study reveals high rate of fecal colonization by multidrug-resistant Enterococci and prevalence of vancomycin resistance strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance and to prevent the spread of antibacterial-resistant strains.