Effectiveness of trained religious leaders' engagement in maternal health education on improving maternal health service utilizations: Protocol of cluster randomized controlled trial in Hadiya Zone, Southern Ethiopia

BACKGROUND

Despite the many supply- and demand-side interventions aimed at increasing uptake of maternal health service utilizations, the maternal and new-born health service utilizations remains low. Religious leaders have the power to inhibit or facilitate effective adoption of maternal health service utilizations to promote maternal health. However, evidence on the roles of religious leaders in promoting maternal health in developing world is not fully known. Therefore this cluster-randomized trial is designed to evaluate the effects of trained religious leaders' engagement in maternal health education in improving maternal health service utilization and knowledge of obstetric danger signs.

METHODS

A community based cluster randomized control trial in which the study kebeles are randomly assigned into intervention and control groups will be conducted. The sample size is calculated using stata software. Three hundred six pregnant mothers will be enrolled in each group. A baseline study will be conducted before the intervention and post-intervention evaluation will be conducted after four months of intervention. Religious leaders will be selected and trained to lead participatory sessions on maternal health. Data on maternal health service utilizations, knowledge about obstetric danger signs, attitude towards skilled delivery service utilization and perception of pregnancy risk will be collected from a repeated cross sectional household survey. Effect of intervention will be assessed using multivariable logistic regression with generalized estimating equation model. Data will be analyzed using STATA software. For qualitative study, coded transcripts will be further analyzed and summarized in narratives for each theme and sub-themes.

DISCUSSION

This is one of the first trials to evaluate the effectiveness of trained religious leaders' engagement in maternal health education and will provide much needed evidence to policy makers about aspects of functionality and the religious leaders engagement required as they scale-up this programme in Ethiopia.

Nutritional knowledge, nutritional status and associated factors among pregnant adolescents in the West Arsi Zone, central Ethiopia

When pregnancy occur among teenagers; there is a competition for nutrients between the still-growing adolescent mother and her fetus. Pregnant adolescents' nutrition issues are not addressed well and changes are too slow in Ethiopia. This study aimed to study, nutrition knowledge, nutritional status and associated factors among pregnant adolescents in West Arsi , central Ethiopia. We conducted a cross-sectional study of 426 pregnant adolescents between January 1 and January 25, 2023. Data were collected using kobo collect and analyzed using SPSS version 25. We performed linear regression to identify independent predictors of nutritional status and multivariable logistic regression analyses to identify nutritional knowledge. Odds ratios (ORs) with 95% confidence intervals were estimated to show the strength of the association. Magnitude of good nutrition knowledge was 23.7%, 95% CI (21.4-25.3%), and the odds of having good nutrition knowledge was 7.5 times higher among participants whose education level was above college compared with illiterate participants [(AOR = 7.5, 95% CI = (5.27-9.38)],the odds of having good nutrition knowledge was 8 times higher among adolescent who had ANC visits, [(AOR = 8, 95% CI = (3.63-13.85)], and the odds of having good nutrition knowledge was 5 times higher among adolescents who received nutrition education [(AOR = 5, 95% CI = (3.67- 13.53)]. Receiving nutrition education (β = 0.25, P = 0.002) and good nutrition knowledge (β = 0.08, P < 0.001) were positively associated with nutritional status; however, food insecurity (β = - 0.93, P < 0.001) was negatively associated with nutritional status. The nutrition knowledge of pregnant adolescents was suboptimal; educational status, ANC visits and nutrition education were associated with good nutrition knowledge, whereas food insecurity, low nutrition knowledge, and not receiving nutrition education were predictors of poor nutritional status. Nutritional education interventions, increasing utilization of ANC, and interventions for improving food security are strongly recommended.

Screening and characterization of thermostable enzyme-producing bacteria from selected hot springs of Ethiopia

Hot springs are potential sources of diverse arrays of microbes and their thermostable hydrolytic enzymes. Water and sediment samples were collected from three hot springs of Ethiopia and enriched on nutrient and thermus agar media to isolate pure cultures of potential microbes. A total of 252 bacterial isolates were screened and evaluated for the production of amylase, protease, cellulase, and lipase. About 95.23%, 84.12%, 76.58%, and 65.07% of the isolates displayed promising amylase, proteases, cellulase, and lipase activities, respectively. Based on the diameter of the clear zone formed, 45 isolates were further screened and identified to species level using matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry analysis and 16S rRNA gene sequencing. Five of the 45 isolates showed significantly high (P < 0.05) clear zone ratios as compared to others. The identified isolates were categorized under five bacterial species, namely, Bacillus licheniformis, Bacillus cereus, Paenibacillus thiaminolyticus, Paenibacillus dendritiformis, and Brevibacillus borstelensis. The most dominant species (66.7%) was B. licheniformis. It could be concluded that hot springs of Ethiopia are potential sources of thermostable extracellular hydrolytic enzymes for various industrial applications. Further optimization of the growth conditions and evaluation for better productivity of the desired products is recommended before attempting for large-scale production of the hydrolytic enzymes.

IMPORTANCE

Thermostable microbial enzymes play an important role in industries due to their stability under harsh environmental conditions, including extreme temperatures. Despite their huge application in different industries, however, the thermostable enzymes of thermophilic microorganism origin have not yet been fully explored in Ethiopia. Here, we explored thermophilic bacteria and their enzymes from selected hot spring water and sediment samples. Accordingly, thermophilic bacteria were isolated and screened for the production of extracellular hydrolytic enzymes. Promising numbers of isolates were found as producers of the enzymes. The potent enzyme producers were further identified using matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry analysis and 16S rRNA gene sequencing. The findings revealed the presence of potential hydrolytic enzyme-producing thermophilic bacteria in hot springs of Ethiopia and necessitate further comprehensive study involving other extreme environments. Our findings also revealed the potential of Ethiopian hot springs in the production of thermostable enzymes of significant application in different industries, including food industries.

Effect of nutrition counseling on nutritional status and gestational weight gain of pregnant adolescents in West Arsi, Central Ethiopia: a cluster randomized controlled trial

When pregnancy occurs in adolescence, the growth and development of the mother and fetus may be impaired due to strong competition for nutrients between the still-growing adolescent and the fetus. Pregnant adolescents constitute an underserved population; they lack adequate nutritional knowledge. Therefore, this study investigated the effect of nutritional behavior change communication (NBCC) through alliance for development (AFD) on the nutritional status and gestational weight gain (GWG) of pregnant adolescents. A two-arm parallel cluster randomized controlled community trial was conducted in the West Arsi Zone, central Ethiopia, from August 2022 to July 2023. The nutritional status of the pregnant adolescent was assessed using mid-upper arm circumference. Weight was measured at baseline and at the end of the intervention. A total of 207 and 219 pregnant adolescents participated in the intervention and control clusters, respectively. The intervention started before 16 weeks of gestation, and the intervention group attended four NBCC sessions. The NBCC was based on the health belief model (HBM) and was given at the participants' homes with their husbands. The NBCC intervention was delivered by AFDs and community-level health actors. Pregnant adolescents in the control group received routine nutrition education from the health care system. A linear mixed-effects model and difference in difference (DID) were used to measure the intervention effect after adjusting for potential confounders. After the implementation of the trial, the mean mid-upper arm circumference (MUAC) in the intervention arm significantly increased from baseline (p ≤ 0.001), 23.19 ± 2.1 to 25.06 ± 2.9 among intervention group and 23.49 ± 2.1 to 23.56 ± 2.0 among control group and the mean difference in the MUAC (DID) was 1.89 ± 2 cm (p ≤ 0.001); the mean GWG in the intervention arm significantly increased from baseline; 51.54 ± 4.7 to 60.98 ± 4.6 among intervention group and 52.86 ± 5.27 to 58 ± 5.3 among control group; the mean GWG in the intervention group was 9.4 kg, and that in the control group was 5.14 kg, and the difference in difference was 4.23 kg and this was statically significant p ≤ 0.001). This study demonstrated that the use of the HBM for NBCC delivered through the AFD was effective at improving the nutritional status and GWG of pregnant adolescents. These results imply the need for the design of model-based nutritional counseling guidelines.Clinical trial registration: PACTR202203696996305, Pan African Clinical Trials Registry, date of first registration: 16/03/2022.

Leadership Commitment and the Quality of Adolescent-Friendly Sexual Reproductive Health Services in Public Health Facilities Among Pastoral Districts of Guji Zone, Ethiopia

Background

Accessible and high-quality sexual and reproductive health services are essential for adolescents. However, there is a need for more knowledge about the role of leadership and the quality of these services in Ethiopia, where a significant proportion of the population consists of adolescents. Inadequate quality of friendly health services may lead to underutilization and higher rates of unintended pregnancies and sexually transmitted infections. This study aimed to evaluate the leadership role and quality of friendly health services in the pastoral community of East Guji Zone, Ethiopia.

Methods

We implemented in-depth interviews and focus group discussions with eight key informants and fifty participants. Study design: We used a programmatic qualitative research design. Data were collected using 22 semi-structured questions and analyzed using ATLAS.ti7.

Results

The findings indicate significantly less commitment to health sector leadership and substandard quality of adolescent-friendly sexual and reproductive health services. Inadequate achievement of the quality of care frameworks, including accessibility, equitability, availability, acceptability, and appropriateness, contributed to the insufficient quality of friendly health services.

Conclusions and Recommendations

Poor commitment of health facility leaders influenced the quality of adolescent-friendly sexual and reproductive health services in the pastoral community of the East Guji Zone, according to the study. We recommend enhancing organizational and provider readiness, ensuring equitability, and redesigning services through improving leadership commitment, which is crucial to improving the quality of adolescent-friendly health services. The Ministry of Health Ethiopia and relevant stakeholders should consider these recommendations to improve the quality of friendly health services for adolescents in Ethiopia.

Evaluation of microbiome and physico-chemical profiles of fresh fruits of Musa paradisiaca, Citrus sinensis and Carica papaya at different ripening stages: Implication to quality and safety management

INTRODUCTION

The ripening of fleshy fruits is a developmental process that involves changes in color, texture, aroma, nutrients, and diversity of microbiomes. Some microorganisms, specially, bacteria and molds are responsible for postharvest spoilage of fruits. Thus, this study is aimed at evaluating the alterations in microbiome and physico-chemical properties of selected fruits at different ripening stages.

METHODS

Totally, 108 fresh fruit samples of Musa paradisiaca, Citrus sinensis and Carica papaya at three ripening stages were collected and processed in this study. The biochemical methods and MALD-TOF MS were used in identification. The physico-chemical properties of all samples were analyzed using standard methods.

RESULTS

The minimum counts (6.74± 0.48-6.76± 0.42 log CFU/mL) and the maximum count (7.51± 0.43-7.96± 0.34 log CFU/mL) of AMB in all fruit samples was observed at mature green and overripe stages of the fruits, respectively. The ripening stage has significantly affected the microbial counts (P < 0.05) in all fruits, except counts of Enterobacteriaceae in banana and orange, and fungal counts in orange. The bacterial community of all fruits was predominated by B. cereus (33.7%), A. faecalis (17.3%), P. putida (15.2%), M. morganii (11.1%), S. sciuri (6.6%) and S. epidermidis (4.9%); while the fungal microbiome was constituted by Candida spp. (33.9%) followed by Saccharomyces spp. (18.1%) and Aspergillus spp. (16.3%). The ripening stages have also significantly affected the physico-chemical property in all samples. Accordingly, the lowest pH (3.53) and highest content of ascorbic acid (69.87 mg/100g) were observed in mature green oranges and overripe papaya, respectively, while the maximum concentration of total sugar (17.87%) and reducing sugar (14.20%) were recorded in overripe bananas.

CONCLUSION

The presence of some potential human pathogens and spoilage microorganisms in fruit samples could contribute to post-harvest product losses besides the potential health risk associated with consumption of the tainted fruits. Hence, proper safety management practices and preservation mechanisms should be developed and put in place to ensure consumers safety against pathogens besides minimizing product losses through microbial spoilage.

Hematological Parameters of Gasoline Station Workers at Hosanna Town, Southwest Ethiopia: A Comparative Cross-Sectional Study

Background

Human exposure to benzene is associated with many adverse health effects. It is mainly related to impairment of the hematopoietic system and bone marrow suppression, causing abnormalities in hematological parameters. However, the reports obtained from different studies are contradictory, and there are little data regarding the hematological parameters of gas station workers in the study area. Therefore, this study aimed to evaluate the hematological parameters of gas station workers in Hosanna town, southwest Ethiopia, from May 01 to June 15, 2020.

Methods

A comparative cross-sectional study was conducted by involving 180 (60 gas-stations workers and 120 controls) participants. Socio-demographic and related data of the study participants were collected using a pre-tested structured questionnaire through face-to-face-interviews. All phases of quality assurance were maintained, and hematological parameters were determined using Uni-Cel DxH 800 automated hematological analyzer. Independent sample T-test, Mann-Whitney U-test, and one-way ANOVA were used for data analysis. Statistical significance was declared at P<0.05.

Results

Statistically significant difference was observed in hematological parameters of gasoline-workers and control groups. The mean of red blood cell count among gasoline-workers was significantly reduced as compared to control groups (p=0.007). In addition, the median of hemoglobin levels among gasoline-workers was significantly decreased as compared to the control groups (p=0.001). In contrast, a significant increase was observed in median of absolute eosinophil count among the gasoline-workers as compared to control groups (p=0.01). The mean of mean cell volume was significantly decreased with respect to the duration of work experience (p=0.04).

Conclusion

In this study, a statistically significant difference was observed in some hematological parameters of gas station workers compared to the control group. Therefore, medical observation and periodic medical check-ups of the hematological profile should be considered to prevent the development of medical complications.

Nitrogen Defect-Rich Graphitic Carbon Nitride for Highly Sensitive Voltammetric Determination of Tryptophan

Here, a highly sensitive electrochemical sensor for detection of tryptophan (Trp) using a nitrogen defect graphitic carbon nitride-modified glassy carbon electrode (ND-CN/GCE) was introduced. ND-CN/GCE showed a higher oxidation current for Trp than the graphitic carbon nitride-modified glassy carbon electrode (g-CN/GCE) and bare glassy carbon electrode (BGCE). The synthesized nitrogen defect-rich graphitic carbon nitride (ND-CN) was characterized using X-ray photoelectron spectroscopy, X-ray diffraction spectroscopy, Fourier-transform infrared spectroscopy, scanning electron microscopy, and transmission electron microscopy. Electrochemical impedance spectroscopy and cyclic voltammetry were used to further analyze the electrochemical properties of BGCE, g-CN/GCE, and ND-CN/GCE. The oxidation of Trp at ND-CN/GCE is a diffusion-controlled process at pH 3.0. It was calculated that the transfer coefficient, rate constant, and diffusion coefficient of Trp were 0.53, 2.24 × 103 M-1 s-1, and 8.3 × 10-3 cm2 s-1, respectively, at ND-CN/GCE. Trp was detected using square wave voltammetry, which had a linear range from 0.01 to 40 μM at pH 3.0 and a limit of detection of about 0.0034 μM (3σ/m). Analyzing the presence of Trp in a milk and multivitamin tablet sample with a percentage recovery in the range of 97.0-108% satisfactorily demonstrated the practical usability of the electrochemical sensor. The ND-CN/GCE additionally displays good repeatability and reproducibility and satisfactory selectivity.

Exploring dietary perception, beliefs and practices among pregnant adolescents, their husbands and healthcare providers in West Arsi, Central Ethiopia: a phenomenological study

BACKGROUND

The two most physically active stages of life, pregnancy and adolescence, put the pregnant adolescent under a lot of stress. Adolescence is a crucial era in women's nutrition that is frequently overlooked.

OBJECTIVE

This study aimed to explore dietary perceptions, beliefs and practices among pregnant Adolescents in West Arsi, Central Ethiopia.

DESIGN

A qualitative method, specifically, a phenomenological research design, was carried out from February to March 2023.

SETTINGS

This study was conducted in the West Arsi zone, Oromia, Ethiopia, in four randomly selected districts.

PARTICIPANTS

Thirty participants, 12 pregnant adolescents, 8 husbands of pregnant adolescents and 10 healthcare providers were purposefully selected and participated.

METHODS

In-depth and key informant interviews were conducted. To create relevant codes, subthemes and themes, ATLAS.ti V.7.1 software was used. An inductive qualitative data analysis approach was used. The results were presented using respondents' clear verbatim and thematic analysis.

RESULTS

The findings were organised into four major themes: (1) low nutritional awareness, (2) poor dietary practice, (3) barriers to good dietary practice and (4) facilitators for good dietary practice. A low perceived severity (one's belief of the seriousness) of undernutrition and low perceived benefits (one's belief of the benefits) of balanced nutrition have been reported. A monotonous diet (one type food usually cereal based), no change in dietary practices during pregnancy, and low intake of animal food sources (meat, egg and milk) were found under dietary practices. One of the most striking findings to emerge from this study is the Alliance for Development (AFD), the former Women Development Army, which can be a great facilitator of good dietary practice. Husbands' involvement in nutrition education and specific nutrition training for healthcare providers are the other facilitators identified in this study. The lack of nutrition education, misconceptions and economic problems are barriers to dietary practices.

CONCLUSION

This study found a low nutritional awareness and poor dietary practices. Further experimental studies are recommended to assess whether AFD is capable of delivering effective nutrition interventions that improve dietary practice of pregnant.

Potentially inappropriate medicine use and predicting risk factors in hospitalized older adult patients: findings of a prospective observational study from Ethiopia

BACKGROUND

Older patients are fragile and more susceptible to medication-related problems requiring a strict assessment of their medicine list. The present study was conducted with the intention to assess the quality use of medicines in older adult patients by detecting potentially inappropriate medicine use and its predictive risk factors.

METHODS

This prospective cross-sectional study involved 162 older medical patients admitted to Jimma Medical Center. A data abstraction format is employed to capture relevant information. Each patient was assessed for the presence of potentially inappropriate medicine using the 2019 American Geriatrics Associations Beers Criteria. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. A p value < 5% was considered a cutoff point for declaring statistical significance.

RESULTS

Over the hospital stay, 103 (63.6%) participants were on polypharmacy (5-9 concurrent medicines per patient), while 16 (9.9%) were on hyper polypharmacy (≥ 10 concurrent medicines per patient). On medicine use assessment using the Beers criteria, at least one potentially inappropriate medicine was detected in 118 (73%) participants. Overall, 191 potentially inappropriate medicines (range, 0 to 4) were identified, and 27 (14.1%) of these were associated with avoiding recommendations. Furosemide [83 (43%)], tramadol [26 (14.5%)], and spironolactone [22 (11.4%)] were the top three most frequent potentially inappropriate medicines identified. In terms of mode of prescription, 187 (96.9%) potentially inappropriate medicines were prescribed on a scheduled basis. Older adult patients with thrombocytopenia had a lower probability of taking potentially inappropriate medicine, while the odds of potentially inappropriate medicine use were 7.35 times higher in patients diagnosed with heart failure.

CONCLUSIONS

Nearly three-fourths of the participants had potentially inappropriate medicine in their medicine list. Therefore, generating local evidence on the clinical, economic, and humanistic consequences may help in determining whether the Beers criteria should be taken into account when prescribing medicine to older adults. Interventions targeting older adult patients with heart failure might reduce inappropriate medicine use.

Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study

Background

Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies.

Objective

To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia.

Methods and Materials

A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index.

Results

The overall completion rate was 16.1% (CI, 13.8%-18.5%), with significant dropouts observed between the first and the fourth ANC.Factors associated with the completion of MHC included the women's residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women's occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC.

Conclusion and Recommendations

The completion rate of CoC for MHC remains low. Factors influencing completion include women's residence, partners' educational status, women's occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.

Pregnancy Risk Perception, Knowledge of Obstetric Danger Signs and Attitude Towards Skilled Delivery Service Utilization Among Pregnant Mothers in a Rural Setting in South Ethiopia: A Community-Based Cross-Sectional Study

Background

Poor pregnancy risk perception, ignorance of obstetric risk symptoms, and attitudes toward institutional delivery services are factors that prevent pregnant women from choosing to receive emergency obstetric treatment.

Objective

To assess pregnancy risk perception, attitude towards skilled delivery service, and knowledge of obstetric danger signs and associated factors among pregnant mothers.

Methods

A cross-sectional community-based study design was used. The 668 pregnant women who participated in this study were chosen using a multi-stage sampling methodology. Data were gathered using a pretested questionnaire that was presented by an interviewer. To find independent factors, logistic regression analysis was used. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated.

Results

Pregnancy risk perception was shown to have a lower mean score (23) overall. Only 40.9% of the study participants had high pregnancy risk perception. Over 50% (337) of respondents had a positive attitude towards skilled delivery service utilization. In all categories of obstetric danger signs, only 153 respondents (or 22.9%) knew what the obstetric danger signs were. Maternal age (AOR = 1.966, CI: 1.185-3.261), maternal education (AOR = 1.965, 1.002-3.854), and parity (AOR = 0.534, CI: 0.305-0.933) were factors affecting knowledge of obstetric danger signs. Pregnancy risk Perception (AOR = 14.7, CI: 9.849-22.235) and parity (AOR = 2.27, CI: 1.381-3.733) were significantly associated with attitudes on the use of skilled delivery services.

Conclusion

This study found that pregnant women in rural locations had poor levels of knowledge of obstetric danger sign, attitude toward using skilled delivery services, and perception of pregnancy risk. The knowledge of obstetric danger indicators among pregnant women was considerably affected by the mother's age, education, and parity. The perception of pregnancy risk and parity were found to be substantially associated with attitudes towards skilled delivery services.

Isolation of virulent phages against multidrug-resistant Acinetobacter baumannii recovered from inanimate objects of Jimma Medical Center, Southwest Ethiopia

BACKGROUND

Because of the multidrug resistance features of Acinetobacter baumannii, endurance to diverse conditions, and causing health fatalities in healthcare settings, the global health system is looking for the development of new antimicrobials for such bacteria. As the new antimicrobial drugs pipeline is running dry, it is imperative to look for eco-friendly bio-control strategies. In this regard, phages are one to combat the biofilm producer and MDR A. baumannii. Thus, the study aimed to isolate and examine the role of phages against biofilm producers and MDR A. baumannii from inanimate objects at Jimma Medical Center (JMC), Ethiopia.

METHOD

Institution-based cross-sectional study was conducted from June to November 2019. A total of 309 swab samples were collected from inanimate objects and the environment in JMC. Isolation of A. baumannii, antimicrobial susceptibility testing, and biofilm detection were carried out according to standard protocol. Kirby Bauer disk diffusion and microliter plate were methods for AST and biofilm detection, respectively. Specific phage was isolated and characterized from sewage at JMC compound. The data were analyzed by SPSS version 25.0, and chi-square (X2) cross-tabulation was used to determine the correlation of variables. A P-value of < 0.05 was considered a statistically significant association.

RESULT

A. baumannii from inanimate objects and surfaces of different environments at JMC was detected in 6.5% of the samples. From 20 of the isolates, 85% were biofilm producers, and 60% were MDR. The lytic phage isolated specifically against A. baumannii was found host specific, and thermally stable ranging from 10-50°C. The phage was active against 42% of MDR A. baumannii, 40% of both biofilm-producing and MDR A. baumannii (MDRAB), and 35.3% of the biofilm-producing isolates.

CONCLUSION

The good activity of phages towards MDRAB isolates, its biofilm degradation capability, thermal stability, and host specificity in our study encourages viewing the potential use of phages as a bio-control agent besides the routine cleansing agents. Therefore, we recommend isolation of specific phages in the eradication of MDRAB from health facilities with additional efforts to characterize in detail and assess their efficacy in animal models.

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis

BACKGROUND

Neonatal sepsis remains a leading cause of morbidity and mortality in neonates across all regions, including Africa. Compared to developed and some developing countries, there are relatively few epidemiological trends for neonatal sepsis and associated patterns with COVID-19 in Ethiopia. We modeled an epidemiological trend and pattern to aid in the monitoring of changes in neonatal sepsis.

METHODS

Retrospective data were collected from all admissions to the Neonatal Intensive Care Unit (NICU) in Ethiopia at Jimma Medical Center between May 2019 and April 2022. We analyzed the monthly neonatal sepsis incidence, mortality, and case-fatality rates using STATA software. Finally, we modeled a monthly time series of neonatal sepsis incidence trends and patterns associated with the COVID-19-impacted period using Joinpoint software. For all analyses, a P value of 0.05 was considered statistically significant at the 95% confidence interval (CI).

RESULTS

In the 36 months, 6796 cases were admitted to the NICU, with a 9.5% (95% CI: 9.1, 10.0) incidence rate of neonatal sepsis. The overall admission mortality rate was 16.5% (95% CI: 13.6, 19.8), while sepsis-attributed mortality was 7.1% (95% CI: 5.8, 8.5). The data showed an unstable decreasing trend for three Joinpoints (August 2020, December 2020, and August 2021). Notably, a decrease in the incidence trend was observed from May 2019 to August 2020 (MPC, -4.1; 95% CI: -7.6, -0.5; P = 0.03), followed by a sharp increase (MPC, 23.7; 95% CI: -13.8, 77.7; P = 0.24) from August 2020 to December 2020. From December 2020 to August 2021, there was again a decreasing trend (MPC, -13.8; 95% CI: -23.3, -3.5; P = 0.01), followed by a slight increase from August 2021 to April 2022 (MPC, 4.2; 95% CI: -8.4, 18.6; P = 0.52). Finally, the study revealed an association between patterns of neonatal sepsis incidence trends and COVID-19, with a Joinpoint jump model comparability ratio (CR = 0.43) between pre- and COVID-19-impacted periods.

CONCLUSIONS

Neonatal sepsis was prevalent at Jimma Medical Center, but it was on an unstably declining trend. The current results suggest a potential temporal association between the intensity of COVID-19 containment measures and a change in the incidence trend and patterns of neonatal sepsis. However, the quantified contribution of a particular containment measure requires further investigation.

Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia

BACKGROUND

While there have been many previous studies focusing on the adverse effects of khat chewing, attempts to investigate the protective behavioural strategies (PBS) employed by the khat using population are rare. PBS are strategies that substance users employ to minimize or alleviate the possible negative consequences related to the behaviour. This study focuses on the harms that chewers associate with khat use, and the behavioural strategies they practise to prevent or minimize these harms.

METHODS

A community-based qualitative study was conducted using a snowball sampling technique to recruit a diverse sample of khat chewing participants (N = 102) in Jimma city, Ethiopia. Face-to-face in-depth interviews were carried out with the participants.

RESULTS

Participants identified a variety of harms likely to result from chewing khat. These include impacts on their finances, work, social life and health. The PBS that participants employed to avoid or minimize the risks were classified into four themes based on their temporal sequence with khat chewing sessions: prior to chewing, during chewing, after chewing and general PBS covering the whole of their khat chewing career. The PBS enable khat chewers to prevent or minimize the adverse health consequences of chewing, socialize and work without or with fewer difficulties and manage their economy successfully.

CONCLUSION

The study participants believe that khat-related harms are avoidable if khat users implement appropriate strategies prior to, during and after chewing, and if they apply PBS to khat-related factors (e.g. type, amount and frequency), set factors (e.g. reason for using and health behaviour) and setting factors (e.g. place of use, when used, with whom used and social norms) covering the whole of their khat chewing career.

Effect of a school-linked life skills intervention on adolescents' sexual and reproductive health skills in Guji zone, Ethiopia (CRT)-A generalized linear model

Background

Although appropriate life skills are recognized as a fundamental right for adolescents and a critical component of health policy, they are often overlooked and rarely researched in pastoral communities. Life skills encompass the ability to adopt positive behaviors, which enable individuals to effectively deal with the demands and challenges of everyday life. This study aimed to evaluate the effectiveness of a school-linked life skills intervention program on adolescents' sexual and reproductive health skills in the pastoral community of Guji zone.

Methods

A two-arm cluster randomized control trial with a pretest-posttest experimental design was conducted, involving the intervention group (N = 375) and the control group (N = 384). This study assessed the effect of a school-linked adolescent-friendly life skills intervention in comparison to the usual RH curriculum, used as a control arm. Pretest-posttest and posttest-posttest scores of the control group and trial groups were compared, and the data were collected using 27 self-administered questions. The collected data were analyzed using paired-sample independent t-tests and a generalized linear model to examine the relationship between the dependent and independent variables.

Results

Data were collected from 759 adolescents in 15 intervention and 15 control clusters. The findings have shown that the proportion of mean life skills score was significantly higher in the intervention clusters than controls [(375) 70.49% vs. (384) 62.25%, P < 0.001 95% CI (0.06 and 0.1)]. Adolescents who were trained in school-linked life skills (β = 1.915, 95% CI: 1.411-2.418), were confident to make safe and informed decisions (β = 1.999, 95% CI: 1.562-2.436), and had life skills to deal with SRH issues (β = 1.66, 95% CI: 1.233-2.087) were significantly correlated with predicting the relevant life skills. The proportion of adolescents with SRH life skills increased from 384 (52%) at baseline to 375 (70%) at end line in the intervention group compared to 384 (60.31%) at baseline to 384 (62.31%) in control arms, respectively.

Conclusions

The implementation of a school-linked life skills intervention program proved to have a significant effect on SRH life skills development. Furthermore, individual-level and behavioral-level variables were significant in explaining variability in life skills development within the pastoral community. Therefore, we recommend scaling up this intervention in all high schools.

Trial registration

Trial registration PACTR202107905622610, registered on 16 July 2021.

Understanding Gender-Based Perception During Pregnancy: A Qualitative Study

Purpose

Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy.

Methods

A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category.

Results

Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond.

Conclusion

This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.

Challenges in Palliative Care Provision in Ethiopia: An Exploratory Qualitative Study

Background

The prevalence of chronic illnesses is increasing at an alarming rate in Ethiopia. However, the existing palliative care service is not adequate to address the palliative care need of the patients and their families. This demands the need to explore, among other things, the challenges in palliative care provision. Thus, this article aimed to examine the challenges of palliative care provision in Ethiopia.

Methods

The study considered Ethiopia as a case and examined the topic using a qualitative exploratory design. The data used in the study were collected through 29 in-depth interviews and 5 focus group discussions with health professionals and other stakeholders and analyzed using thematic analysis technique with ATLAS-ti 7.0 computer software.

Results

This study explored patient-related, provider-related, health system-related and partnership-related challenges/gaps in palliative care in Ethiopia. Patient-related factors include, delay in seeking medical care, lack of awareness of disease conditions, discontinuation of treatment due to inability to pay, a lack of follow-up care by considering cancer diagnosis as end of life/death and preferring dying at home. Provider-related challenges include lack of awareness of palliative care, lack of pre-service/in-service training for health professionals, absence of palliative care in the curricula of health programs and scarcity of research information on palliative care in Ethiopia. Health-system challenges include lack of drug, reagent shortage, limited chemotherapy and radiotherapy services, and weak facility-community linkage. Finally, lack of collaborators between governmental and non-governmental organizations was seen as a challenge to the provision of palliative care in Ethiopia.

Conclusion

The study revealed that the challenges to palliative care provision in Ethiopia include patient-related factors, provider-related factors, health facility-related factors and partnership-related factors. Therefore, it is vital to take these challenges into account in order to improve the current palliative care service provision in Ethiopia.

Sexual Coercion is Associated with HIV Risk Behavior Among Female Waiters in Jimma Town, Southwest Ethiopia

Background

Female waiters are at higher risk of workplace violence including sexual coercion. Even though there are numerous studies on the prevalence of sexual coercion among students, nurses, adolescents, and young pregnant women, studies on the prevalence of sexual coercion among female waiters are limited. Furthermore, there is no evidence existed that show a relationship between sexual coercion and HIV risk behavior in Ethiopia.

Purpose

The purpose of this study was to examine the relationship between sexual coercion and HIV risk behavior among female waiters in Jimma, southwest Ethiopia.

Patients and Methods

We conducted a cross-sectional survey from 1st April to 30, 2018, among 420 female waiters of reproductive age working in the licensed food and drinking establishments in Jimma town. A structured interviewer-administered questionnaire was used to collect data. Statistical analysis was conducted with SPSS version 21 statistical software. A binary logistic regression model was used to determine the association between independent variables and outcome variables.

Results

The lifetime prevalence of sexual coercion among female waiters was 71.4% (95% confidence interval: 67.1-76.8). More than two-thirds (71.6%) of female waiters engaged in HIV-related risk behaviors. Working in the bar (AOR 4.64, 95% CI: 2.15-10.0), being a substance user (AOR 3.37, 95% CI: 1.7-6.7), experiencing sexual coercion (AOR 7.6, 95% CI: 3.8-15.3) were significantly associated with HIV risk behaviors.

Conclusion

A significant number of female waiters experienced sexual coercion and engaged in HIV-risk behaviors. Workplace, substance use, and sexual coercion were significantly associated with HIV risk behavior. As a result, establishments, town health offices, and other stakeholders should work together to safeguard female waiters from the burdens of sexual coercion, HIV risk behavior, and sexually transmitted infections.

Health risk perceptions of household air pollution and perceived benefits of improved stoves among pregnant women in rural Ethiopia: a mixed method study

OBJECTIVE

Since community perceptions of the risk of biomass smoke and the benefits of improved stoves play a critical role in behaviour change to the uptake and sustainable utilisation of improved stoves, we aimed to assess the level of health risk perception on kitchen smoke and benefits of using improved stoves among pregnant women.

DESIGN

A community-based cross-sectional mixed method study.

SETTING

In six kebeles of a low-income rural community of South Gondar Zone, Northwestern Ethiopia.

PARTICIPANTS

All 455 households with pregnant women aged 18-38 years, in their first-trimester or second-trimester gestation, exclusively use traditional biomass-fuelled or locally modified mud stoves, and the primary cook in her household were included. But completed data were obtained only from 422 households.

RESULT

From 422 completed data, more than half, 63% (95% CI 58% to 68%) had high-level health risk perception of household air pollution, and nearly three-fourths, 74% (95% CI 70% to 79%) of the respondents perceived that using improved stove had benefits for their families. Participants in the 32-38 years age group, rich in asset index, presence of under-five children, being a member of any women group and large family size were positively associated with high-level health risk perception. Whereas respondents in the 18-24 years age group, presence of under-five children, husbands of primary or higher education, high health risk perception and not happy with the current stove were positively associated with perceived benefits of using an improved stove.

CONCLUSION

The observed level of health risk perception of biomass smoke and the benefits of using improved stoves may help to adopt effective intervention measures. This study also suggests that for successful intervention, clean cooking programmes and policies must consider many local factors influencing health risk perception and benefits of using improved stoves.

TRIAL REGISTRATION NUMBER

ACTR202111534227089.

Predictors of College Academic Achievement for Medical Students: The Case of Gondar University, College of Medicine and Health Sciences, Ethiopia

Background

In Ethiopia, the University Entrance Exam (UEE) score is the only criteria for selecting prospective medical students entering the university system, disregarding their career choice motivation.

Methods

A cross-sectional study design was conducted to identify medical students career choice motivation and predictors of college academic achievement at Gondar university, Ethiopia. The study was conducted on 222 medical students enrolled at Gondar University in 2016. A self-administered questionnaire was used to collect data on study participants demographic characteristics, career choice motivation, and informed career choice. Data on the UEE score and student's college academic achievement were collected from the university registrar. Descriptive statistics and regression analysis were used to analyze the data.

Results

Desire to help others as a medical doctor and prevent and cure diseases were mentioned as the first important career choice reasons by 147 (68.2%) and 135 (64.0%) study participants, respectively. The results of regression analysis showed that the UEE score was significantly associated with pre-clinical cumulative GPA (R2=.327, p<.05) and 5th year cumulative GPA (R2=.244, p<.05) respectively. The stepwise multiple regression revealed that UEE score, having prior knowledge about medical profession, positive experience in the medical school, and intrinsic career choice motivation significantly predicted 5th year cumulative GPA (p<.05). The high beta weight of 0.254 and 0.202 confirmed the strongest prediction to come from prior knowledge about the medical profession and positive experience in medical school, respectively.

Conclusion and Recommendation

The UEE score is a significant predictor for medical students' academic achievement, but it should not be the sole admission criterion. We suggest that comprehensive admissions criteria covering both cognitive and non-cognitive factors, as well as informed career choice, be developed to select the best applicants in the future.

COVID-19 Vaccine Hesitancy and Its Associated Factors Among Adolescents

Background

Currently, COVID-19 disease is a major public health issue that affects a large number of people worldwide. The COVID-19 vaccine is one of the best preventative measures. Adolescents between the ages of 12 and 17 are eligible to get the COVID-19 vaccine. The COVID-19 pandemic cannot be stopped if people are reluctant to use this vaccine. However, the extent of COVID-19 vaccine hesitancy and related variables among adolescents are not well understood.

Objectives

To assess the magnitude of COVID-19 vaccine hesitancy and its associated factors among adolescents in Seka Chekorsa town, Jimma, Ethiopia.

Methods

Institutional-based cross-sectional study employing both qualitative and quantitative methods were used. The study participants were selected using a simple random sampling technique. Data were collected using interviewer-administered questions. Data collected was checked for completeness and entered into EPI data version 3.1. Finally, data were exported to SPSS version 25 for further analysis. The bivariate analysis was used to identify variables eligible for multivariate logistic regressions. In a multivariable analysis to identify factors that have statistically significant association, a p value less than 0.05 and a 95% confidence interval were used. The qualitative data were triangulated with quantitative data.

Results

In this study, 379 adolescents were participated, yielding a response rate of 95.2%. The magnitude of COVID-19 vaccine hesitancy among adolescents was 29% (95% CI: 24.3-33.5%). Being female (AOR = 1.89, 95%, 1.81-3.56), primary education (AOR = 2.99, 95% CI: 1.26-3.56), source information from social media (AOR = 2.42, 95% CI: 1.06-5.57), poor knowledge about COVID-19 disease (AOR = 3.18, 95% CI: 1.66-6.12), unfavorable attitude (AOR = 5.2, 95% CI: 2.76-9.79) and poor knowledge towards COVID-19 vaccine (AOR = 5.66, 95% CI, 2.91-11.0) were associated with COVID-19 vaccine hesitancy among adolescents.

Conclusion

This study shows that COVID-19 vaccine hesitancy among adolescents is very high. Being female, poor knowledge towards COVID-19 disease and the vaccine, an unfavorable attitude and social media were factors significantly associated with COVID-19 vaccine hesitancy.

Device for remote and realtime monitoring of neonatal vital signs in neonatal intensive care unit using internet of things: proof-of-concept study

BACKGROUND

Realtime and remote monitoring of neonatal vital signs is a crucial part of providing appropriate care in neonatal intensive care units (NICU) to reduce mortality and morbidity of newborns. In this study, a new approach, a device for remote and real-time monitoring of neonatal vital signs (DRRMNVS) in the neonatal intensive care unit using the internet of things (IoT), was proposed. The system integrates four vital signs: oxygen saturation, pulse rate, body temperature and respiration rate for continuous monitoring using the Blynk app and ThingSpeak IoT platforms.

METHODS

The Wemos D1 mini, a Wi-Fi microcontroller, was used to acquire the four biological biomarkers from sensors, process them and display the result on an OLED display for point of care monitoring and on the Blynk app and ThingSpeak for remote and continuous monitoring of vital signs. The Bland-Altman test was employed to test the agreement of DRRMNVS measurement with reference standards by taking measurements from ten healthy adults.

RESULTS

The prototype of the proposed device was successfully developed and tested. Bias [limits of agreement] were: Oxygen saturation (SpO2): -0.1 [- 1.546 to + 1.346] %; pulse rate: -0.3 [- 2.159 to + 1.559] bpm; respiratory rate: -0.7 [- 0.247 to + 1.647] breaths/min; temperature: 0.21 [+ 0.015˚C to + 0.405˚C] ˚C. The proof-of-concept prototype was developed for $33.19.

CONCLUSION

The developed DRRMNVS device was cheap and had acceptable measurement accuracy of vital signs in a controlled environment. The system has the potential to advance healthcare service delivery for neonates with further development from this proof-of-concept level.

Lifestyle modification and medication use among diabetes mellitus patients attending Jimma University Medical Center, Jimma zone, south west Ethiopia

Diabetes, a non-communicable metabolic disease, causes multiple complications and deaths worldwide. It is a complex, chronic disease that requires continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Ongoing patient education and self-management support are critical for preventing acute complications and reducing the risk of long-term complications. There is ample evidence that healthy lifestyle choices, such as a healthy diet, moderate weight loss, and regular exercise, can maintain normal blood sugar levels and minimize diabetes-related complications. In addition, this lifestyle change has a major impact on controlling hyperglycemia and can help to maintain normal blood sugar levels. This study aimed to assess lifestyle modification and medication use in patients with diabetes mellitus at Jimma University Medical Center. Hospital-based prospective cross-sectional study was conducted from April 1 to September 30, 2021 among DM patients who have follow-up at diabetic clinic of Jimma University Medical Center. Consecutive sampling was used until the required sample size was achieved. Data were checked for completeness, then entered into Epidata version 4.2 software and exported to SPSS version 21.0. Pearson's chi-square test was performed to determine the association between KAP and independent factors. Variables with a p value < 0.05 were considered significant. A total of 190 participants took part in this study with a response rate of 100%. In this study, 69 (36.3%) participants had good knowledge, 82 (43.2%) moderate knowledge and 39 (20.5%) poor knowledge, 153 (85.8%) had positive attitudes, 141 (74.2%) had good practice. Marital status, Occupational status and educational status were significantly associated with knowledge and attitude towards LSM and medication use. Marital status was the only variable that remained significantly associated with knowledge, attitude and practice towards LSM and medication use. The result of this study showed that more than 20% of the participants had poor knowledge, attitude, and practice towards medication use and LSM. Marital status was the only variable which remained to be significantly associated with KAP towards LSM and medication use.

Synthesis of Nickel Oxide Nanoparticles and Copper-Doped Nickel Oxide Nanocomposites Using Phytolacca dodecandra L'Herit Leaf Extract and Evaluation of Its Antioxidant and Photocatalytic Activities

Nanotechnology research is emerging as cutting-edge technology, and nanoparticles (NPs) and nanocomposites (NCs) have played a significant role in the bioremediation and treatment of polluted water by organic and nonorganic materials. Nanoparticles produced by plant extracts are more stable and biocompatible in comparison with those produced by physical and chemical methods. This research focuses on the synthesis of NiO NPs and Cu-NiO NCs using Phytolacca dodecandra L'Herit (P.d) leaf extract and evaluation of their antioxidant and photocatalytic activities. Cu-NiO NCs were synthesized using 50 mL of 0.1 M nickel(II) nitrate hexahydrate, 10 mL of 0.1 M copper(II) nitrate trihydrate, and 20 mL of leaf extract. The synthesized nanoparticles were characterized by UV-vis, X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR), and scanning electron microscopy (SEM) analyses to study the energy band gap, average crystallite size, functional groups, and morphology of the samples, respectively. The UV-vis analysis showed a red shift after copper doping, indicating a decrease in the optical band gap values. FT-IR characterization confirms the presence of various functional groups in samples. Crystallite sizes of the formed particles were obtained to be 14.18 and 16.10 nm from the XRD data for NiO NPs and Cu-NiO NCs, respectively. SEM showed the crystallinity of particles with a cubic structure. The photocatalytic degradation of methylene blue (MB) was found to be 78.3 and 97.8% by NiO NPs and Cu-NiO NCs, respectively. In the antioxidant test, NiO NPs and Cu-NiO NCs prevented the oxidation of 50% of the H₂O₂ molecules at a concentration of 363.96 and 350.29 μg/mL, respectively. Finally, the synthesized samples showed good photocatalytic and antioxidant activities.

Development of constructs to measure client satisfaction with pharmacy services in resource-limited settings. A multicenter cross-sectional study

BACKGROUND

Satisfaction with pharmacy services has many implications, including the degree of interaction with health care providers, the type and quality of service provided, and the extent to which needs and desires are met. This study aimed to identify the dimensions of pharmacy services and quantify client satisfaction with them.

METHODS

A quantitative cross-sectional study was employed to guide this study. Data were entered into Epi Data, exported to SPSS 26.0, and analyzed using exploratory factor analysis to identify the underlying dimensions of pharmacy service. The study was conducted between 14th August 2020 and 28th December 2020. For standardization and comparison purposes, items loaded onto each dimension were computed and rescaled, and descriptive statistics were used to summarize the results. Stepwise linear regression was performed to quantify the contribution of each dimension to overall satisfaction and to identify determinant variables for overall satisfaction. A 95% CI, and a P-value of < 0.05 were used for the declaration of statistical significance.

RESULTS

The mean overall satisfaction with pharmacy service was found to be (21.62±6.74)/30. There were eight dimensions of pharmacy service identified, and poor customer satisfaction was recorded for the premises and supply dimensions, with mean satisfaction of (12.08±8.49)/30 and (13.66±10.06)/30, respectively. The highest mean satisfaction was recorded with waiting time (24.24±6.54). Of the emergent dimensions, only four (supply, compassion and care, privacy, and premises) were predictors of overall satisfaction (P<0.05). The supply component was the strongest predictor of overall satisfaction, accounting for 20% of the variance in overall satisfaction. The number of prescribed and dispensed pharmaceuticals, marital status, and gender of participants also predicted overall satisfaction (P<0.05).

CONCLUSION

The survey uncovered eight underlying aspects of pharmacy services that influence client satisfaction. A significant gap was recorded with premises and supply chain-related components. These dimensions' contributions to total satisfaction were substantial in terms of practical relevance. As a result, improving the availability of pharmaceuticals and the infrastructure surrounding pharmacy services may enhance consumer satisfaction considerably. Stakeholders must work on addressing supply related and premises difficulties to increase client satisfaction.

Depression among people with dyspepsia and H. pylori infection: A community based cross-sectional study in Ethiopia

BACKGROUND

Depression is the most common mental health problem, and frequently associated with physical illnesses. A link between depression, dyspepsia and Helicobacter pylori (H. pylori) infection has previously been reported. However, there is limited data regarding the association between these conditions from sub-Saharan Africa where they are highly prevalent.

OBJECTIVE

This study aimed at elucidating the potential associations between depression, dyspepsia and H. pylori infection in Ethiopia.

METHODS

We conducted a community based cross-sectional study involving urban and rural residents aged 13 years or older in Jimma Zone, southwest Ethiopia. A total of 871 participants were evaluated using a structured case reporting format for symptoms of dyspepsia and the patient health questionnaire (PHQ-9) for depression. Additionally, participants were assessed for H. pylori infection using stool antigen and serology tests. A multivariate logistic regression was used to identify the association between depression, dyspepsia and H. pylori infection after controlling for potential confounders.

RESULTS

The prevalence of PHQ-9 scores indicative of probable case of depression among all participants was 10.9%. The prevalence of probable case of depression among patients who had at least one symptom of dyspepsia was 13.3% (X2 = 15.1 = p-value<0.001), while it was 11.9% (X2 = 1.23, p-value = 0.26) among patients who had H. pylori infection. Out of patients who took medications for their heartburn in the past 30 days, 14.9% (X2 = 3.6, p-value = 0.06) had probable case of depression. Dyspepsia symptoms such as epigastric discomfort (aOR = 2.59, 95%CI = 1.14, 5.87), postprandial fullness (aOR = 1.70, 95%CI = 1.48, 5.51), nausea (aOR = 1.71, 95%CI = 1.04, 2.82) excessive belching (aOR = 0.53, 95%CI = 0.31, 0.92) were associated with probable case of depression. However, being H. pylori test positive, gender, and age were not associated with probable case of depression.

CONCLUSIONS

There was an increased prevalence of probable case of depression among patients who had dyspepsia symptoms and H. pylori infection. Longitudinal studies are needed to examine possible further determinants of association between symptoms of dyspepsia and probable case of depression.

Pharmaceutical Supply Chain Practices and Its Associated Factors in Public Health Facilities, West Gojjam Zone, Ethiopia: Cross-Sectional Study

Background: Effective pharmaceutical supply chain practices help to minimize stockout, losses due to expiry, and pilferage. Besides, it helps to ensure the availability of the pharmaceutical in an adequate quantity and improving the quality of services provided. This study aimed to assess the status of the pharmaceutical supply chain practices and associated factors from the healthcare professional's perspective in public health facilities. Methods: A descriptive cross-sectional study design, complemented with a qualitative study, was conducted in public health facilities between April 30 and June 30, 2018. The data were collected with self-administering questionnaires and face-to-face interviews. Epidata and SPSS version 20 was utilized for quantitative data entry and analysis, respectively. Simple and multiple linear regressions were done. A variable with a P-value less than .05 was considered as significantly associated. Twenty-seven key informants were interviewed for qualitative study and the data were analyzed using the thematic analysis method. Result: A total of 425 questionnaires were distributed to respondents and 413 questionnaires were filled and returned successfully. Supplier relationship management and information sharing and technology were underperformed supply chain practices with a mean value of 2.64 and 2.39, respectively. On the contrary, inventory management was a better-performed supply chain practice with a mean of 3.22. The linear regression analysis revealed that the Integrated Pharmaceutical Logistics System [IPLS] skill of the staff and management support were the factors significantly associated with the performance of most supply chain practices. Additional, in-depth interviews exposed that the shortage of budget, poor management support, and lack of staff commitment were the major challenges for most supply chain practices. Conclusion: Generally, the study revealed that most of the supply chain practices were poorly executed in public health facilities. Besides, the pharmaceutical supply chain practices were compromised by budget constraints, staff ignorance, and lack of administrative support.

Quality of multiple-choice questions in medical internship qualification examination determined by item response theory at Debre Tabor University, Ethiopia

BACKGROUND

Assessment of cognitive competence is a major element of the internship qualification exam in undergraduate medical education in Ethiopia. Assessing the quality of exam items can help to improve the validity of assessments and assure stakeholders about the accuracy of the go/no decision to the internship. However, we know little about the quality of exam items utilized to ascertain fitness to join the medical internship. Therefore, this study aimed to analyze the quality of multiple-choice questions (MCQs) of the qualification exam administered to final-year medical students at Debre Tabor University (DTU), Ethiopia.

METHODS

A psychometric study was conducted to assess the qualities of 120 randomly selected MCQs and 407 distractors. Item characteristics were estimated using the item response theory (IRT) model. T-test, one-way ANOVA, and chi-square tests were run to analyze the univariate association between factors. Pearson's correlation test was done to determine the predictive validity of the qualification examination.

RESULT

Overall, 16, 51, and 33% of the items had high, moderate, and low distractor efficiency, respectively. About two-thirds (65.8%) of the items had two or more functioning distractors and 42.5% exhibited a desirable difficulty index. However, 77.8% of items administered in the qualification examination had a negative or poor discrimination index. Four and five option items didn't show significant differences in psychometric qualities. The qualification exam showed a positive predictive value of success in the national licensing examination (Pearson's correlation coefficient = 0.5).

CONCLUSIONS

The psychometric properties of the medical qualification exam were inadequate for making valid decisions. Five option MCQs were not better than four options in terms of psychometric qualities. The qualification examination had a positive predictive validity of future performance. High-stakes examination items must be properly created and reviewed before being administered.

Evaluation of mass treatment with ivermectin program reach and survey coverage for onchocerciasis elimination in selected endemic areas of Ethiopia

Currently, national governments of onchocerciasis endemic African countries are working towards the elimination of the disease using mass drug administration (MDA) with ivermectin as a primary strategy. Attainment of this goal requires implementation of prolonged high MDA coverage in all endemic areas, and vigilant monitoring and evaluation of the program. This study was thus conducted with the purpose of i) providing estimate of ivermectin coverage, ii) validating the MDA coverage reported through community drug distributors (CDDs), iii) determining the factors associated with MDA coverage, and iv) estimating the difference between MDA program reach and survey coverage rates following MDA campaign carried out in May 2017 in Asosa and Yeki districts in Ethiopia. A community-based cross-sectional study was conducted among 2,824 study participants in Asosa and Yeki districts. A total of 50 kebeles (smallest administrative units) were randomly selected from the two districts. A systematic sampling was employed to select study households from the 50 kebeles. Then, a household member was randomly selected for the interview. Univariate and multivariate logistic regression analysis were used to determine the odds ratio and to observe the associations between the MDA survey coverage and the variables used. Eighty-seven percent (2458/2824) of the respondents from both districts responded that they were offered ivermectin during the May 2017 MDA campaign. At the district level, 1182 individuals from Yeki and 1276 from Asosa, received the drug, that indicate 88.5% and 85.8% MDA program reach in Yeki and Assosa districts, respectively. Whereas, a total of 366 individuals were not offered ivermectin in both study districts. Of these, 47(12.8%), 143(39.1%), and 176(48.1%) did not receive the drug because of program implementation-related reasons, ineligibility criteria, and personal issues, respectively. Of the 1488 and 1336 respondents in Asosa and Yeki, 1272 and 1182 participants took the drug, resulting in survey coverage rate of 85.5% (95% CI: 83.6–87.2%) and 88.5% (95% CI: 86.7–90.1%), respectively. Multivariable logistic regression analysis revealed significantly low survey coverage rate in females (AOR = 0.5, 95%CI: 0.3–0.6; p<0.001) and in those whose age ranges between 15–24 years (AOR = 0.5, 95%CI: 0.3–0.8; p = 0.007) and 25–34 years (AOR = 0.5, 95%CI: 0.3–0.9; p = 0.021) in Asosa. The researchers believe that the current study generated operational evidence on MDA program reach and coverage rates in two study districts in Ethiopia. The survey coverages were lower than the recommended 90% minimum threshold for success. Only Yeki district reached the 90% threshold survey coverage. Both districts had reported higher coverages than the survey estimates (even outside the 95% CI), thus, were not validated. The majority (60.9%) of the reasons for not receiving the drug were related to program implementation and recipients`personal issues. Efforts must therefore be directed to enhance MDA coverage in future rounds via proper MDA planning and implementation, such as allocating adequate time to the MDA activities, health education, and mobilizing of all segments of the population, including adolescents and the youth. The researchers also recommend such studies to be extended to other MDA programs for other neglected tropical diseases (NTDs).

Urogenital schistosomiasis prevalence and diagnostic performance of urine filtration and urinalysis reagent strip in schoolchildren, Ethiopia

Background

Urogenital schistosomiasis has been known to be endemic in several lowland areas of Ethiopia. It is caused by Schistosoma haematobium and causes considerable public health problems to schoolchildren. Ethiopia, after mapping the distribution of the disease (2013 to 2015), launched school-based mass deworming program to treat schoolchildren for schistosomiasis and soil-transmitted helminthiasis (STH) across the country since 2015. However, there is no recent information about the prevalence of the disease among schoolchildren in the current study areas. Diagnostic performance of urine filtration method and urinalysis reagent strip is also lacking. Therefore, this study aimed to determine the prevalence of urogenital schistosomiasis in schoolchildren, and to evaluate diagnostic performance of urine filtration and urinalysis reagent strip in Amibara, Kurmuk and Abobo districts, Ethiopia.

Methods

Across-sectional study was conducted involving 1,171 schoolchildren in Abobo, Amibara and Kurmuk districts from October, 2020 to January, 2021. The study participants were selected using random sampling technique. From each study participant, 10 ml urine samples were collected and examined using urine filtration method and urinalysis reagent strip. Data obtained from the survey were entered into Microsoft Excel 2010 and analysed with SPSS version 20.0. Data was summarized using descriptive statistics. Chi-square, bivariate and multivariable logistic regression and Pearson correlation test were used to measure associations between urogenital schistosomiasis, age, sex and haematuria. Odds ratio was used to measure strengths of association between variables. Agreement between urine filtration method and urinalysis reagent strip was determined using Kappa statistics. P-value < 0.05 at 95% CI was considered as statistically significant.

Results

Among the 1,171 urine samples from schoolchildren examined by urine filtration method, 143 (12.2%) were S.haematobium egg positive. Out of 143 positive children 126(88.1%) were lightly infected and 17 (11.9%) were heavily infected. Among the total of 1,171 urine samples tested by dipstick, 264(22.5%) were positive for haematuria. Prevalence of urogenital schistosomiasis by both urine filtration and urinalysis reagent strip method was higher in Abobo than Hassoba (Amibara) and Kurmuk (P< 0.001). The number of egg counts (intensity of infections) were significantly correlated with intensity of haematuria (r = 0.6, P < 0.001). Egg-positive children had significantly higher risk of having haematuria compared to S. haematobium egg negative children (OR; 6.96; 95%CI: 4.98, 8.940). Compared to urine filtration method, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of urinalysis reagent strip were 99.3%, 88.1%, 53.8% and 99.8%, respectively. Furthermore, its positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 8.34 and 0.008, respectively. The accuracy index and diagnostic odds ratio (DOR) of reagent strip were 0.89 and 1054, respectively. The agreement level between urine filtration methods and urinalysis reagent strip for detecting urogenital schistosomiasis was substantial (Kappa = 0.64).

Conclusion

This study showed that urogenital schistosomiasis was prevalent in schoolchildren in Abobo, Hassoba and Kurmuk districts. Urogenital schistosomiasis prevalence in Hassoba-bure and Kurmuk falls under low category whereas moderate in Abobo and is almost four times compared to Kurmuk and Hassoba-bure. Chemotherapy is needed in schoolchildren in such endemic areas and other measures like access to safe water, improved sanitation, hygiene, and health education should be implemented to control and prevent schistosomiasis effectively. The sensitivity, specificity, positive and negative predictive values of urinalysis reagent strip were higher and could serve as alternative for mass screening of urogenital schistosomiasis, for surveillance and evaluation of schistosomiasis intervention programs.

Developing a desktop application for drug-drug interaction checker ordered for chronic diseases in Ethiopian hospitals pharmacy

BACKGROUND

Drug-drug interactions are a major cause of morbidity worldwide and are a leading source of treatment inefficacy. They are classified based on their pharmacological action on the body as major, moderate, and minor. Currently, it is a tedious process to remember the drug-drug interactions by the pharmacist during dispensing of the prescribed drugs for the patients. Therefore, there is a need for technology that assists the pharmacist in checking the drug-drug interaction for prescribed drugs. Therefore, in this work, a desktop-based application that can automatically identify the drug-drug interactions for prescribed drugs that could operate offline for those found in low-resource setting hospitals has been developed. To do this, around 3000 drugs along with their major and moderate interaction points were collected from Ethiopian Pharmaceutical Supply Agency. The developed system included two main parts; the database part that comprises all the drugs collected along with their major and moderate interaction points, and a patient registration platform to register the patients' history. The system was developed by using C sharp programing language.

RESULTS

The developed system has both drug-drug interaction checking as well as patient registration platform. Registration of the patient's history will be done by the pharmacist and during dispensing of the drugs to the patient, the developed system will check the interaction between the drugs prescribed. The system was tested to operate the above functions, and finally, it was able to display the major and moderate interaction points of all inserted drugs automatically and accurately. For those drugs which have no either major or moderate interaction, the system was displayed as 'unknown'.

CONCLUSIONS

The developed system assisted the pharmacist in knowing the drug-drug interaction, and enabled the patients for the resubscription of drugs with the same functional. The system would help to increase the efficiency of the pharmacist in low resource settings to do their tasks without any difficulty, and tiredness. In the future, it is recommended to include all drugs for all disease types rather than focusing only on chronic disease drugs.

Photoluminescence processes in τ-phase Ba1.3Ca0.7-x-y SiO4:xDy 3+/yTb3+ phosphors for solid-state lighting

The τ-phase Ba_1.3Ca_0.7-x-y SiO₄:xDy ³⁺/yTb³⁺ phosphors co-doped with Dy ³⁺ (x = 0.03) and Tb³⁺ (y = 0.01-0.05) trivalent rare-earth ions were prepared by the gel-combustion method. The structure-property relation of the samples was examined by X-ray diffraction, scanning electron microscopy and spectrophotometer. Here, the effect of Tb³⁺'s concentration on the spectroscopic properties of Ba_1.3Ca_0.7-x-y SiO₄:xDy ³⁺/yTb³⁺ phosphors was explored by using the photoluminescence excitation, emission and decay curves. Importantly, the photonic energy transfer from (Dy ³⁺:⁴F_9/2 + Tb³⁺:⁷F₆) to (Dy ³⁺:⁶H_15/2 + Tb³⁺:⁵D₄) was observed, in which the Dy ³⁺ ions act as a light-emitting donor whereas the Tb³⁺ ions as a light-absorbing acceptor, resulting in an enhanced emission from the co-doped Ba_1.3Ca_0.7-x-y SiO₄:xDy ³⁺/yTb³⁺ (x = 0.03 and y = 0.01-0.05) phosphors. Finally, the chromaticity coordinates were determined from the measured emission spectra, locating at the green and white light regions. This observation indicates that the characteristic emission colour could be tuned from white to green by varying Tb³⁺ concentrations under ultraviolet light.

Development of Low-Cost and Portable Pulse Oximeter Device with Improved Accuracy and Accessibility

Purpose

Methods

Results

Conclusion

Indoor Pool Game and Substance Abuse as Trajectories to Students' Academic Procrastination: The Mediation Role of Self-Regulation

Background

Over the last decade, indoor pool games (IPGs) and substance abuse (SA) became a remarkable emerging addictive behavior among adolescent university students. With the failure of educational quality and retention of learners, boomerangs around the university local environment in line with the students' learning culture were not considered in many countries including Ethiopia. Thus, this study aimed to examine the trajectory and contribution of an IPG and SA to students' academic procrastination (AP) as determinants of quality education.

Methods

A sequential explanatory mixed-methods design was employed. Self-reporting questionnaires, interview guides, and an observation checklist were used to collect data. All self-reporting items were adapted from previous scales. By using simple random sampling techniques, 237 undergraduate university students were selected for obtaining the quantitative data, and using purposive sampling, 12 interviewees were selected to collect the qualitative data. The SPSS AMOS version 25 was used to compute the multiple mediation path analysis. The Hayes PROCESS macro model was used. Furthermore, the thematic content analysis method was employed for the qualitative data.

Results

A direct path analysis was established between IPG, SA, and AP. The path analysis model indicated that IPG did not significantly predict AP. Moreover, SA significantly predicted AP. In addition, SR had a partial mediating effect on the relationship between IPG, SA, and AP.

Conclusion

The study concluded that IPG and substances available around the university local environment found trajectories to students' AP, which in turn affects the quality of education.

Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study

BACKGROUND

Globally, hypertension is a major public health problem and a strong predictor of cardiovascular disease complications. To reduce and prevent complications from hypertension, it is important to adapt self-care behaviors. This study aimed to assess the self-care practices of adult hypertensive patients at a tertiary teaching hospital in Ethiopia.

METHODS

A health facility-based prospective cross-sectional study was conducted at Jimma Medical Center in Ethiopia between February 2021 and July 2021. Binary and logistic regression was performed to assess the strength of associations between independent and dependent variables. Data entry and analysis were done using Statistical Package for social science (SPSS) software version 22.0. A p-value < 0.05 was considered to declare statistical significance.

RESULTS

From a total of 422 respondents included to the study, male accounted 55.7% and the mean ± SD age of the respondents was 58.7 ± 9.75 years. About 53.1% of patients had poor self-care practices toward hypertension. Not attending formal education [AOR = 2.15; 95% CI (1.74, 6.39); p ≤ 0.001], uncontrolled blood pressure [AOR = 2.14 95% CI (1.27, 3.61); p = 0.003], chronic disease co-morbidity [AOR = 1.48; 95% CI (0.25, 7.73); p ≤ 0.001], unfavorable attitude toward hypertension[AOR = 3.13; 95% CI (1.95, 7.52); p ≤ 0.001], and poor social support [AOR = 2.75; 95% CI (1.45, 6.43); p ≤ 0.001] were independent predictors of poor self-care practice.

CONCLUSION

The level of self-care practices for hypertension in the study area was low. In particular, the level of adherence to the DASH diet, exercise, and weight control was very low. Patient-specific targeted interventions are required to improve self-care practices for hypertension.

Knowledge and attitude of health extension workers regarding mental health problems in Jimma Zone, Ethiopia: a cross-sectional study

OBJECTIVE

Health extension workers' (HEWs') knowledge and attitude regarding mental health problems are vital for integrating mental healthcare into primary healthcare services. However, information in this context is scarce in Ethiopia. So, this study aimed to assess HEWs' knowledge and attitude towards mental health problems in Jimma, Ethiopia.

DESIGN

A cross-sectional study.

SETTING

Five districts in Jimma Zone, Ethiopia, 2020.

PARTICIPANTS

A total of 259 HEWs working in selected five districts were included in the study.

OUTCOME

The knowledge and attitude status of HEWs towards mental health problems.

RESULTS

Nearly half of the respondents had inadequate knowledge (122,47.1%) and an unfavourable attitude (125, 48.3%). Most (139, 53.7%) described mental illness as due to evil spirits' possession. Almost all (240, 92.7%) of the respondents reported talking or laughing alone as a manifestation of mental illness. Almost two-thirds (157, 60.6%) of the respondents reported people with mental illness are dangerous. About a quarter (63, 24.3%) of the participants stated witch doctors should manage mental illnesses.

CONCLUSIONS

A significant proportion of the study respondents had poor knowledge and attitude towards mental health problems. Short-term and long-term mental health training is needed to improve their perception level and to provide effective community mental health services.

Utilisation of immediate postpartum family planning among postpartum women at public hospitals of North Shoa Zone, Ethiopia: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence of immediate postpartum family planning utilisation and the associated factors among postpartum women at public hospitals of North Shoa Zone, Ethiopia.

DESIGN AND METHODS

A facility-based cross-sectional study was conducted in 1-30 May 2020. Systematic random sampling technique was used to select the participants. Data were collected through a face-to-face interview using a structured and pretested questionnaire. Univariate and multivariable logistic regression analyses were employed. In multivariable logistic regression analysis, p<0.05 and adjusted OR (AOR) with 95% CI were used to declare statistically significant factors.

SETTING AND PARTICIPANTS

The study was conducted at public hospitals of North Shoa Zone, Ethiopia. A total of 394 postpartum women within 48 hours after giving birth before discharge from the selected hospitals were enrolled in the study.

OUTCOME

Immediate postpartum family planning utilisation (used or not used).

RESULTS

Of the total 394 participants, 84 (21.3%) used immediate postpartum family planning. The factors associated with immediate postpartum family planning utilisation were women's age (30-34 years) (AOR: 0.118; 95% CI 0.023 to 0.616), planning status of pregnancy (AOR: 3.175; 95% CI 1.063 to 9.484), reproductive intention (AOR: 5.046; 95% CI 1.545 to 16.479), partner support (AOR: 4.293; 95% CI 1.181 to 15.61), attitude towards family planning (AOR: 2.908; 95% CI 1.081 to 7.824) and maternal satisfaction with intrapartum care (AOR: 6.243; 95% CI 2.166 to 17.994).

CONCLUSION

In the study area, only less than a quarter of postpartum women used immediate postpartum family planning. Therefore, enhancing immediate postpartum family planning utilisation, strengthening community awareness to develop a favourable attitude towards family planning, promoting partner involvement in family planning and ensuring maternal satisfaction during intrapartum care are essential.

Combination of Xpert® MTB/RIF and DetermineTM TB-LAM Ag improves the diagnosis of extrapulmonary tuberculosis at Jimma University Medical Center, Oromia, Ethiopia

BACKGROUND

Ethiopia is one of the high burden countries for extrapulmonary tuberculosis (EPTB); however, the prompt diagnosis of EPTB remains challenging. This study is aimed to evaluate the diagnostic performance of Xpert MTB/RIF and DetermineTM TB-LAM Ag (TB-LAM) for the prompt diagnosis of EPTB in Ethiopia.

METHODS

A total of 147 presumptive EPTB patients, including 23 HIV- positive participants were enrolled. Extra-pulmonary samples were collected from all presumptive EPTB cases and tested for Mycobacterium tuberculosis complex (MTBC) using fluorescent microscopy, Xpert MTB/RIF, and culture. Additionally, urine samples were also collected from 126 participants and were tested by DetermineTM TB-LAM Ag (Alere Inc, Waltham, USA). The Sensitivity and specificity of Xpert and TB- LAM tests were calculated by comparing with a composite reference standard (CRS), which comprises smear microscopy, culture and response to empirical anti-TB treatment.

RESULTS

Of 147 patients, 23 (15.6%) were confirmed EPTB cases (culture-positive), 14 (9.5%) were probable EPTB (clinically, radiologically or cytologically positive and received anti-TB treatment with good response), and 110 (74.8%) were classified as "non- TB" cases. Compared to the composite reference standard (CRS), the overall sensitivity and specificity of Xpert MTB/RIF were 43.2% and 100%, respectively with the highest sensitivity for Lymph node aspirate (85.7%) and lower sensitivity for pleural fluid (14.3%) and 100% specificity for all specimen types. The sensitivity and specificity of TB-LAM were 33.3% and 94.4% respectively with the highest sensitivity for HIV co-infected participants (83.3%). The sensitivity of the combination of Xpert MTB/RIF and TB-LAM tests regardless of HIV status was 61.1% whereas the sensitivity was improved to 83.3% for HIV-positive cases.

CONCLUSION

TB-LAM alone has low sensitivity for EPTB diagnosis; however, the combination of TB-LAM and Xpert MTB/RIF improves the diagnosis of EPTB particularly for countries with high EPTB and HIV cases.

Biosynthesis, characterisation and antimicrobial activity of zinc oxide and nickel doped zinc oxide nanoparticles using Euphorbia abyssinica bark extract

Biosynthesis of metallic oxide nanoparticles is being used and preferred over physical and chemical methods of synthesis since it is simple, inexpensive, environmentally friendly, and green. The aim of this study was to synthesise ZnO and nickel doped ZnO nanoparticles using Euphorbia abyssinica bark extract for antimicrobial activity studies via agar disk diffusion method against some selected microbes. The synthesised nanoparticles were characterised using X-ray diffraction (XRD), ultraviolet-visible spectroscopy, and Fourier transform infrared spectroscopy. The study results revealed that the biosynthesised nanoparticles had good crystalline nature, with crystal sizes in the range of nanoparticles and structures of hexagonal wurtzite. Both undoped ZnO and nickel doped ZnO nanoparticles demonstrated antibacterial and antifungal activity against four bacterial strains and two fungal genus. Generally, nickel doped ZnO NPs were found to possess more antimicrobial activities than undoped ZnO NPs. Specially, 4% and 5% nickel doped ZnO NPs showed significantly enhanced activity against Enterococcus faecalis, Staphylococcus aureus, Aspergillus and Fusarium.

Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study

Background

Many studies conducted in the past focused on patients’ sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians’ adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians’ prescribing patterns, patients’ medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center.

Methods

A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients’ specific data was collected with a face-to-face interview and from their medical charts. Clinicians’ related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients’ adherence. P-Values of less than 0.05 were considered statically significant.

Results

From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients’ medication adherence was 46.6%, while clinicians’ guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence.

Conclusion

The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.

Heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in Southwest, Ethiopia: Unmatched case-control study

BACKGROUND

The burden of hypertension is more devastating in low-and middle-income countries, including sub-Saharan Africa than in high-income countries. Among the modifiable risk factors, dyslipidemia and khat chewing were expanding at an alarming rate in Ethiopia but were still underestimated. Thus, this study aimed to assess heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in the southwest, Ethiopia.

METHODS

A facility-based case-control study was conducted among 136 cases and 270 controls from May 15 to July 30, 2017. A consecutive sampling technique was used in this study. Epi data version 3.1.1 and SPSS version 21 were used for data entry and analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Both crude and adjusted odds ratios and 95% confidence intervals were reported.

RESULTS

The majority of the cases had a total cholesterol to high-density lipoprotein ratio of >5 (72.1%). The odds of hypertension increased among participants who had attended no formal education [AOR = 2.25, 95% CI: (1.05-4.82)], history of alcohol consumption [AOR = 5.93,95% CI:(3.11-11.30)], moderate khat chewing [AOR = 3.68, 95% CI:(1.69,8.01)], heavy khat chewing [AOR = 18.18, 95% CI: (3.56-92.89)], mild intensity physical activity [AOR = 3.01, 95% CI: (1.66-5.47)], type of oil used for food preparation [AOR = 2.81, 95% CI: (1.49-5.28)], and dyslipidemia [AOR = 6.68, 95% CI: (2.93-15.23)].

CONCLUSION

The study showed that modifiable risk factors were the major factors associated with the development of hypertension. The findings of this study highlighted that health education is needed to focus on physical exercise, quitting excess alcohol consumption, quitting khat chewing by giving special emphasis to those who had no formal education. In addition, consideration should be given to a healthy diet free of cholesterol and unhealthy behavior.

Effect of food insecurity on mental health of patients with tuberculosis in Southwest Ethiopia: a prospective cohort study

OBJECTIVE

The objective of this study is to investigate the effect of food insecurity on the mental health of patients with tuberculosis (TB) in Ethiopia.

DESIGN

A prospective cohort study.

SETTING

Health centres and hospitals located in Jimma zone, Southwest Ethiopia.

PARTICIPANTS

Patients with TB who had recently been diagnosed with TB and started directly observed treatment in the selected 26 health institutions from October 2017 to October 2018. A total of 268 patients were followed for 6 months and data were collected at recruitment and two follow-up visits (at 2 and 6 months). Patients with multidrug-resistant TB were not included in the study.

MAIN OUTCOME MEASURES

Mental distress was measured by the Self-Reporting Questionnaire-20 while food insecurity was assessed by using the Household Food Insecurity Access Scale.

RESULTS

A total of 268 patients were recruited and there was no lost to follow-up. The prevalence of food insecurity at baseline, first and second follow-up was 49.3%, 45.9% and 39.6%, respectively. Of these, 28.0% of them reported severe food insecurity at baseline which declined to 23.5% at the end of the sixth month. Likewise, the prevalence of mental distress at baseline was 61.2% but declined to 22.0% at the second follow-up. At baseline, 77.3% of patients with mental distress reported severe food insecurity but declined to 46.0% at second follow-up. In the final model, severe food insecurity (OR 4.7, 95% CI 2.4 to 9.4) and being a government employee (adjusted odds ratio (aOR) 0.3, 95% CI 0.1 to 0.9) were associated with mental distress.

CONCLUSION

In this study, food insecurity was associated with mental distress over the course of follow-up. Likewise, there is a high prevalence of food insecurity and mental distress among patients with TB on treatment. Therefore, early assessment and interventions for food insecurity may improve the mental health of patients with TB on treatment.

Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study

Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.

Determinants of instructors' educational ICT use in Ethiopian higher education

ICT can address concerns about access and quality of higher education in developing countries like Ethiopia. The crucial role of ICT in education has become more evident than ever during the COVID 19 crisis. Despite its role in addressing educational quality and access issues, evidence about the educational use of ICT in developing countries is scarce. Many previous studies on determinants of educational ICT focus on higher education in developed countries, while it remains unclear whether existing models explain ICT use by instructors in developing countries. This study reports the findings of a qualitative study conducted in three public universities of Ethiopia in order to elaborate determinants of instructors' educational use of ICT. First, it presents a conceptual framework of factors that explain instructors' ICT use based on literature. Second, based on empirical evidence collected from instructors, it assesses their experiences and opinions in relation to the proposed framework components. In-depth data were collected through focus group discussions from twenty-one instructors. The data were analyzed thematically with ATLAS.ti software. The results confirmed that the institutional, individual and infrastructure-related determinants of the framework are perceived to be relevant in determining instructors' ICT use. Moreover, the study revealed the necessity of extending the proposed framework through aspects of management support, course-related factors, students' ICT competence and access to ICT infrastructure as new determinants of instructors' educational ICT use. Implications for theory-building are discussed and follow-up research is proposed.

Hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia: A comparative cross-sectional study

BACKGROUND

Diabetes is a global public health problem and associated with metabolic, cellular, and blood disturbances. Hematological changes have been reported in diabetes and play a major role in diabetes-associated complications. However, reports are contradicting and data on hematological parameters of type 2 diabetic patients in the study area are scarce. Therefore, the aim of this study was to assess the hematological parameters of type 2 diabetic adult patients at Debre Berhan Referral Hospital, Northeast Ethiopia from May 01 to June 30, 2020.

METHODS

A comparative cross-sectional study was conducted on 268 (134 type 2 diabetic patients and 134 controls) study participants selected by systematic random sampling technique. Socio-demographic, behavioral, and clinical data were collected using a structured questionnaire and checklist. Ethical approval was obtained from Jimma University. All phase of quality assurance was maintained. Hematological parameters and blood glucose levels were determined using UniCel DxH 800 (Beckman Coulter, USA) and Biosystems A25 (Costa Brava, Spain) analyzers, respectively. Independent t-test, Mann-Whitney U-test, correlation, and logistic regression were used during data analysis. P-value <0.05 was considered as statistically significant.

RESULTS

The current study found that total white blood cell count, absolute counts of neutrophil, lymphocyte, eosinophil, and basophil, red blood cell distribution width, platelet count, and mean platelet volume were significantly higher in type 2 diabetic patients as compared to the control group (P<0.05). On the other hand, the mean hemoglobin was significantly lower in type 2 diabetic patients than the control group (P = 0.007). Anemia was found in 17.9% of type 2 diabetic patients. Longer duration of diabetes (AOR = 3.05, 95% CI = 1.12-8.34) and milk consumption (AOR = 4.60, 95% CI = 1.50-14.00) were significantly associated with anemia.

CONCLUSION

This study showed a statistically significant variation in some hematological parameters of type 2 diabetic patients compared to control group. Anemia among type 2 diabetic patients was found to be a mild public health problem. Therefore, routine screening of hematological parameters should be considered for proper management of type 2 diabetic patients. Close attention should also be given to the duration of diabetes and dietary practice.

Renal Function Impairment and Associated Factors Among Adult HIV-Positive Patients Attending Antiretroviral Therapy Clinic in Mettu Karl Referral Hospital: Cross-Sectional Study

BACKGROUND

Human immunodeficiency virus (HIV) affects every organ system in the body through impairment or by rendering the patient vulnerable to opportunistic infections. The kidney is the vital organ in the excretion of waste products and toxins (urea, creatinine and uric acid), and regulation of extracellular fluid volume, serum osmolality and electrolyte concentrations. The risk of kidney disease is greater in HIV-infected individuals than in the general population. This study aimed to assess the magnitude of renal function impairment and its associated factors among adult HIV-positive patients attending an ART clinic in Mettu Karl Referral Hospital, Mettu town, south-west Ethiopia.

METHODS

The institution-based, cross-sectional quantitative study was conducted from March 8 to May 30, 2020. A total of 352 clients participated and a systematic sampling technique was used to allocate study participants. Data were entered into Epi data and exported to SPSS version 22 for analysis. Bivariate analysis was conducted to identify candidate variables for multivariate analysis at P <0.25. Multivariable logistic regression analysis was conducted to determine the predictors of renal function impairment with ART. P value < 0.05 was considered to indicate statistical significance.

RESULTS

A total of 352 HIV-infected patients participated in this study with a response rate of 98.1%. Out of 352 HIV patients on ART, 73 (20.7%) were found to have renal function impairment. Cigarette smoking [AOR = 9.60, 95% CI: 4.73-19.48], diabetes mellitus [AOR = 6.16, 95% CI: 2.79-13.59], hypertension [AOR = 4.71, 95% CI: 1.98-11.17] and low CD4 count [AOR = 6.47, 95% CI: 3.31-12.64] were found to be independent predictors of renal function impairment among adult HIV positive patients.

CONCLUSION

The prevalence of renal function impairment among HIV patients on ART is high. Hypertension, diabetes, cigarette smoking and low CD4 count were associated factors of renal function impairment. HIV patients on ART should be regularly screened for early diagnosis and management of renal function impairment.

Patient-Centered Care and Associated Factors at Public and Private Hospitals of Addis Ababa: Patients' Perspective

BACKGROUND

Patient-centered care is a practice of caring for patients in ways that are valuable to the individual patient and families. Implementation of the practice is a common problem worldwide. In Ethiopia, the available information is limited and is largely skewed to certain dimensions of the practice.

OBJECTIVE

To assess the patient-centered health care practice and associated factors among public and private general hospitals of Addis Ababa 2020.

METHODS

An institution-based comparative cross-sectional study was conducted in two public, and seven private general hospitals located in Addis Ababa from April 08 to May 20, 2020. A multistage sampling technique was employed to select the study participants. Data were collected using an interviewer-administered structured questioner, then entered into Epi-data version 3.1, and finally analyzed using SPSS version 25. Multivariable logistic regression was used to identify independent predictors of clients' perceived patient-centered care. Statistical significance was declared at p-value <0.05 and adjusted odds ratio with 95% confidence interval.

RESULTS

A total of 570 patients were involved with 99.8% response rate. About 49% (95% CI: 45.0-53.1) of patients rated the practice as good. It was 27.8% (95% CI: 22.5-33.1), and 70.2% (95% CI: 64.6-75.4) for public, and private hospitals, respectively Hospital type (AOR:0.21; 95% CI: 0.13-0.35), service easiness (AOR:3.3; 95% CI: 2.0-5.8), hospital attractiveness (AOR:2.3; 95% CI: 1.2,4.5), privacy to access care (AOR:2.0; 95% CI: 1.1,4.1), information on plan of care (AOR:2.3; 95% CI; 1.1,4.6), information on medication (AOR:3.1; 95% CI; 1.5,6.3), and perceived intimacy with the provider (AOR: 0.4; 95% CI;0.2,0.8) were the factors associated with the practice.

CONCLUSION

Even though providing patient-centered care has been the focus of quality improvement in Ethiopia, this study showed it is mostly being implemented from the traditional provider-centered approach and public hospitals were lower in practice than private hospitals.

Functional Health Literacy in Patients with Cardiovascular Diseases: Cross-Sectional Study in Ethiopia

OBJECTIVE

This study assessed functional health literacy and associated factors among adult patients with cardiovascular diseases (CVDs) in Ethiopia.

METHODS

A cross-sectional study was conducted on 410 respondents from May 1 to July 1, 2020, using a functional health literacy questionnaire consisting of 14 items that covers three conceptually distinct functional health literacy domains: having sufficient information to manage my health, ability to find good health information and understand health information well enough to know what to do. Data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 23. Data were collected by exit face-to-face interview using an interviewer administered and pre-tested questionnaire. Statistical significance of associated variables had been declared based on the adjusted odds ratio (AOR) with its 95% CI and p-value <0.05.

RESULTS

Adequate functional health literacy was determined in 55.4% of CVD patients understanding health information whereas inadequate functional health literacy was determined in 53.9% participants for finding health information and in 50.5% of them having sufficient information to manage my health. Educational status was found to have a statistically significant association across the three domains.

CONCLUSION

The functional health literacy level of CVD patients varied by domain. Educational status of the participant is significantly associated with the three domains of functional health literacy whereas household monthly income and number of information sources are significantly associated with having sufficient information and the ability to find good health information. The findings indicate the need to streamline medical communication that improves the functional health literacy of CVD patients.