Prevalence and associated factors of treatment failure among children on ART in Ethiopia: A systematic review and meta-analysis

BACKGROUND

As the use of antiretroviral therapy (ART) increases, the issue of treatment failure is still a global challenge, particularly in a resource limited settings including Ethiopia. The results of former studies in Ethiopia were highly variable and inconsistent across studies. Thus, this systematic review and meta-analysis intended to provide the pooled estimation of treatment failure and associated factors among children on antiretroviral therapy.

METHODS

We searched international databases (i.e., PubMed, Google Scholar, Web of Science, Ethiopian Universities' online repository library, Scopus, and the Cochrane Library) during the period of February 30 to April 7, 2021. All identified observational studies reporting the proportion of treatment failure among HIV positive children in Ethiopia were included. Heterogeneity of the studies was checked using I2 test and Cochrane Q test statistics. We run Begg's regression test to assess publication bias. A random-effects meta-analysis model was performed to estimate the pooled prevalence of treatment failure.

RESULTS

The estimated pooled prevalence of treatment failure among children in Ethiopia was 12.34 (95%CI: 8.59, 16.10). Subgroup analysis of this review showed that the highest prevalence was observed in Addis Ababa (15.92%), followed by Oromia region (14.47%). Poor ART adherence (AOR = 2.53, CI: 2.03, 4.97), advanced WHO clinical staging (AOR = 1.66, CI: 1.24, 3.21), and opportunistic infections (AOR = 2.64 CI: 2.19, 4.31 were found to be significantly associated factors with childhood treatment failure.

CONCLUSIONS

This study revealed that treatment failure among children on ART was high in Ethiopia. Poor ART adherence, advanced WHO clinical staging, opportunistic infections, and low level of CD4 cell counts increased the risk of treatment failure.

Behavioral intention and its predictors toward COVID-19 vaccination among people most at risk of exposure in Ethiopia: applying the theory of planned behavior model

Acceptance of a vaccine or hesitancy has great public health implications as these partly determine the extent to which people are exposed to infections that could have otherwise been prevented. There is a high need for a more updated understanding of the behavioral intention of the public toward COVID-19 vaccines and associated factors in light of the COVID-19 pandemic to give appropriate public health messages or actions. Thus, the study aimed to assess behavioral intention and its predictors toward COVID-19 vaccine among people most at risk of exposure in Ethiopia. A population-based anonymous online survey was conducted on individuals aged greater than 18 years from May 01, 2021 to June 30, 2021. The data were collected using a convenient sampling method through an online self-administered, structured questionnaire that was created onto Google survey tool (Google Forms) and disseminated to the public on different social media channels through online sharable platforms. Descriptive statistics were done. Bivariateand multivariable logistic regression was done to show the association of behavioral intention toward the COVID-19 vaccine. The associations of variables were declared with the use of 95% CI and P-value. A total of 1080 participants were included in this survey. Seven hundred one (64.9%) of the respondents had a behavioral intention to receive the COVID-19 vaccine. Males (AOR = 1.41 (95% CI = 1.004-2.53)), degree in level of education (AOR = 0.815 (95% CI = 0.254-0.916)), good knowledge (AOR = 4.21 (95% CI = 2.871-6.992)), attitude (AOR = 2.78 (95% CI = 1.654-4.102)), subjective norm (AOR = 1.214 (95% CI = 1.008-4.309)) and perceived behavioral control (AOR = 3.531 (95%CI = 1.689-5.201)) were found to be significantly associated with behavioral intention toward COVID-19 vaccine. Generally, the prevalence of behavioral intention in Ethiopia is low. Males, degree level of education, knowledge about vaccine, attitude toward vaccine subjective norm and perceived behavioral control were found to be significantly associated with intention to receive COVID-19 vaccine. Health education and communication from government sources are very crucial methods to alleviate the negative attitude, poor knowledge, and action need to improve or change the attitude and behavior of influential people within the community or organization to improve intention to take the vaccine.

Under-nutrition and associated factors among children on ART in Southern Ethiopia: a facility-based cross-sectional study

BACKGROUND

Malnutrition is very common in HIV-infected individuals. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of the nutritional status of HIV-infected children. Hence, this study aims to assess the nutritional status and associated factors among children on antiretroviral therapy.

METHODS

An institutional-based cross-sectional study was conducted among 383 HIV-positive children in Southern Ethiopia. Data were collected using an interviewer-administered questionnaire and anthropometry measurement. Data were coded and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25. Bi-variable and multi-variable binary logistic regression models were used to identify factors associated with nutritional status and variables with p-values <0.05 in multi-variable logistic regression were considered as statistically significant.

RESULTS

The prevalence of wasting among HIV-positive children in Southern Ethiopiaselected Hospitals was 36.3% (95% CI, 31.6-41.0) while stunting on the same study population was 5.5% (95% CI, 3.4-7.8). Rural residence, lack of maternal education, low CD4 counts (< 500), using an unprotected water source, having a non-biological mother and recurrent oral lesion were significantly associated with wasting. Furthermore, history of hospital admission, recurrent oral lesion, low CD4 counts (< 500), advanced WHO clinical stage were statically associated with stunting with p-value < 0.05.

CONCLUSION

This study found that the prevalence of under-nutrition among HIV-positive children in Ethiopia was significantly high. Therefore, timely identification and monitoring of nutritional problems should be necessary to enhance the effectiveness of ART treatment and to prevent further related complications.