Facility-based Cross-sectional Study Research Articles

Menopausal symptoms and utilization of menopausal hormone therapy among women aged 40–60 years in Addis Ababa, Ethiopia: a cross-sectional study

BackgroundThe onset of menopause leads to diminished estrogen exposure, resulting in a high morbidity burden related to menopausal symptoms. Menopausal hormonal therapy is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years.ObjectiveThis study aimed to assess the prevalence of menopausal symptoms, identify factors associated with menopausal symptoms, and assess the use of menopausal hormone therapy among women aged 40–60 who visited the gynecological clinics of three hospitals in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted from January 2022 to June 2022 at Gandhi Memorial Hospital, Tikur Anbessa Hospital, and Zewditu Memorial Hospital on 296 middle-aged women. Data were collected using an interviewer-administered structured questionnaire and analyzed for sociodemographic factors, utilization of menopausal hormone therapy, and prevalence of menopausal symptoms using the menopause rating scale. Data were analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to identify independent predictors of each subscale of menopausal symptoms. The strength of the association was measured using odds ratios with 95% confidence intervals, and statistical significance was set at a value of P < 0.05.ResultThe prevalence of menopausal symptoms was 89.9%. According to the menopausal rating scale, the frequency of reported symptoms was hot flushes (54.7%), muscle and joint pain (32.1%) on the somatic subscale; physical and mental exhaustion (55.1%), irritability (48.6%) on psychological subscale; and sexual problems (41.3%), bladder problems (39.2%) on urogenital subscale. This study also showed that the age of women [aOR: 0.317, 95%CI (0.102, 0.990)], and monthly family income [aOR = 0.182, 95% CI (0.041, 0.912)] were significantly associated with somatic menopausal symptoms. There was no utilization of menopausal hormonal therapy to treat menopausal symptoms and to prevent complications.ConclusionThe prevalence of menopausal symptoms is high; however, the utilization of individualized administration of menopausal hormone therapy according to symptoms is negligible. It appears essential for these institutions to work on service availability and delivery of menopausal hormone therapy for those in need of wider benefits for their clients.

Antimicrobial resistance profile and associated factors of hospital-acquired gram-negative bacterial pathogens among hospitalized patients in northeast Ethiopia

BackgroundAntimicrobial resistance is a major global public health issue. Infections caused by resistant species are associated with higher mortality rates, longer hospital stays, medication failure, and rising medical costs. The World Health Organisation has declared multidrug resistance-associated infections as an epidemic of public health concern.ObjectiveThis study aimed to evaluate the antimicrobial resistance profile and associated factors of hospital-acquired Gram-negative bacterial pathogens among hospitalized patients in Northeast Ethiopia.Materials and methodsA health facility-based cross-sectional study was conducted among hospitalized patients from March 2021 to February 2022. About 810 clinical specimens were collected, transported, and processed from admitted patients following the standard bacteriological procedures. The clinical samples were inoculated onto blood agar, MacConkey agar, and chocolate agar. Furthermore, the species identification was done using gram reactions, colony morphology, and color and biochemical tests. Antimicrobial susceptibility tests, extended-spectrum beta-lactamase, and carbapenemase production were performed as per the clinical laboratory standard institute guidelines. For analysis, the information was entered into Epi-data and exported to SPSS. A P value of < 0.05 with a 95% confidence interval was considered as a statistically significant association.ResultsOut of 810 clinical specimens, 285/810 (35.2%) developed bacterial infections. From the isolated bacteria, E. coli was the predominant bacteria accounting for 78/285 (27.4%) followed by K. pneumoniae, 69/285(24.42%), whereas P. vulgaris accounted for the least, 7/285 (2.5%). Overall, 132/285 (46.3%) and 99/285 (34.7%) of culture-positive patients were infected by extended-spectrum beta-lactamase and carbapenemase-producing bacteria. The overall multidrug resistance rate of the isolated bacteria was 89.4%. The highest antibiotic resistance rates were detected for doxycycline (92.9%), amoxicillin-clavulanic acid (83.9%), and ampicillin (93%). The least antibiotic resistance rate was observed for meropenem at 41.1% and amikacin at 1.7%, respectively.Conclusions and recommendationsIn the study area, significant health concerns include a range of hospital-acquired bacterial infections associated with elevated rates of multidrug resistance, Extended-spectrum beta-lactamase (ESBL), and carbapenemase-producing bacterial pathogens. Consequently, it is recommended to conduct drug-susceptibility testing of isolates and molecular detection at a national level to optimize antibiotic usage for treating prevalent bacterial infections in this area.

Knowledge and self-care practice among patients with hypertension in tertiary public hospitals of Addis Ababa, Ethiopia: A multicenter cross-sectional study

IntroductionGlobally, hypertension is the leading cause of death due to its related complications. Patients’ knowledge and self-care practice in hypertension is crucial for achieving optimal blood pressure control and prevention of related complications. This study aimed to evaluate the level of knowledge and self-care practice among hypertensive patients in Addis Ababa, Ethiopia. MethodsA facility-based cross-sectional study was conducted among 413 hypertensive patients using simple random sampling methods. A face-to-face interview was administered using a structured questionnaire. Data was analyzed using SPSS version 27.0. Frequency percentage, and mean were calculated. Multivariable logistic regression was used to identify the association between predictors and outcome variables. ResultsOut of 413 respondents, 46.0 % (95 % CI: 40–50 %) and 40.9 % (95 % CI: 36–46 %) had poor knowledge and self-care practice respectively. Being married (AOR = 1.92, 95 % CI:1.19–3.06, P = 0.007), higher education [AOR = 7.38 (95 % CI: 2.29–23.78), P < 0.001); family history (AOR = 3.68, 95 % CI: 2.28–5.94, P < 0.001); getting information from healthcare providers (AOR = 3.17, 95 % CI: 1.46–6.87, P = 0.003) were significantly associated with knowledge of hypertension. Being female (AOR: 0.62,95 % CI: 0.39–0.97, P = 0.033), owing sphygmomanometer (AOR: 4.41,95 % CI: 2.40–8.13, P < 0.001) were associated with self-care practice towards hypertension. ConclusionThe overall knowledge and self-care practice of respondents was low. Gender, marital status, educational level, family history, source of information, and owing sphygmomanometer were determinant factors. Improving patients’ awareness and self-care practice is essential for prevention and control of hypertension.

Assessment of abnormal liver function tests and associated factors among COVID-19-infected patients in Addis Ababa, Ethiopia, 2022: a facility-based comparative cross-sectional study

ObjectiveLiver function test (LFT) abnormalities are higher in patients with severe COVID-19. Most of the studies on this theme were conducted in foreign nations, and the association with LFT abnormalities...

Clinical and hematological profile of patients with pancytopenia at a tertiary medical center in Ethiopia.

Pancytopenia is an important hematological problem encountered in routine clinical practice associated with a multitude of disease states. The possible causes of pancytopenia can be influenced by geography, socioeconomic conditions, and endemic illnesses. Information regarding the underlying clinical conditions and morphologic features of blood cells of pancytopenia is limited and varied across different regions. Thus, this study was designed to assess the peripheral morphologic features of blood cells and the underlying clinical causes of pancytopenia. A facility-based cross-sectional study was conducted at the Jimma Medical Center hematology laboratory from June 13 to November 13, 2022. A total of 3mL of whole blood was collected from each subject for complete blood count analysis and peripheral blood morphology examination. Data on sociodemographic and clinical conditions were collected from medical records using a checklist. The data were analyzed using Statistical Package for the Social Sciences version 26. A total of 163 patients with pancytopenia were identified within the 5 months. Hyper-reactive malarial splenomegaly was the most prevalent cause (29.4%), followed by megaloblastic anemia (20.2%), chronic liver disease (10.4%), and acute leukemia (8.6%). Anisocytosis was the predominant peripheral blood morphology finding (82.2%), along with microcytosis (49.7%), ovalocytosis (31.3%), and macrocytosis (30.7%). Severe anemia was observed in 57% of cases, whereas the majority (92%) exhibited moderate leukopenia. A significant proportion (42.3%) had a platelet count below 50,000/μL. Unlike previous studies conducted in other parts of the world, this study showed that hyperreactive malarial splenomegaly was the leading cause of pancytopenia. This emphasizes the necessity of considering this condition as a possible cause for pancytopenia, particularly in malaria-endemic areas. The findings of the hematological profiles and peripheral blood morphology strongly suggest that early identification and prompt management of patients with pancytopenia require collaboration between clinical and laboratory investigations.

Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana

BackgroundThe incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana.MethodsA facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants’ self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy.ResultsChronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18).ConclusionsWe observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia

IntroductionEmergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. MethodsA facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. ResultsAmong the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. ConclusionNearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

Prevalence of opportunistic intestinal coccidian parasites and associated factors in HIV/AIDS patients attending anti-retroviral therapy (ART) clinic at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study.

A growing number of acquired immunodeficiency syndrome (AIDS) patients suffer from opportunistic intestinal coccidian infections. Instead of human immuno deficiency virus (HIV) infection itself, opportunistic infections like intestinal coccidian parasites cause death of over 80% AIDS patients. Factors like exposed drinking water sources and poverty aid the prevalence of opportunistic intestinal coccidian parasitic infections in HIV/AIDS patients. The goal of this study was to determine the prevalence of intestinal coccidian parasites and associated factors in HIV/AIDS patients. A health facility based cross sectional study was conducted from 140 HIV/AIDS patients attending ART clinic in Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia from September to December 2023. The sociodemographic characteristics were collected through face-to-face interviews. Stool samples were processed with Modified Acid Fast staining technique. Statistical Package for Social Sciences software version 20 was used to analyze the data. Logistic regression was used to assess factors associated with dependent variable and p < 0.05 was considered significantly associated. The total prevalence of opportunistic intestinal coccidian parasites (OICPs) in HIV/AIDS patients was 16.4% (23/140). Drinking surface water [p = 0.015, COR = 3.4] compared to tape water, drinking alcohol [p = 0.001, COR = 18] compared to not drinking alcohol, diarrhea [p = 0.005, COR = 1] compared to non-diarrheic, drug dropout [p = 0.01, COR = 11] compared to regular drug intake and low CD4 count [p = 0.042, COR = 9] compared to CD4 > 500/µL showed significant association with increased prevalence of OICPs in HIV/AIDS patients. OICPs are still the common causes of morbidity and mortality in HIV/AIDS patients. Surface water consumption, alcoholism, interruption of treatment drugs, diarrhea, and reduced CD4+ T-cells significantly contribute to acquisition and prevalence of OICPs in HIV/AIDS patients. Routine screening of OICPs with sensitive diagnostic techniques in HIV/AIDS patients regardless of symptoms is crucial and has to be practiced in health settings.

Proportion and Associated Factors of Adverse Birth Outcomes Among Women Who Gave Birth at Debre Markos General Hospital, East Gojjam Zone, Ethiopia, 2022: A Cross-Sectional Study

Background: Adverse birth outcomes are a common public health problem in the developing world, including Ethiopia. There are several indices of adverse birth outcomes, such as stillbirth, preterm birth, low birth weight, small for gestational age and congenital anomalies. Objective: This study aimed to determine the proportion and associated factors of adverse birth outcomes among women who gave birth at Debre Markos General Hospital. Methods: A health facility-based cross-sectional study was conducted from July 1 to August 1/2022 on laboring women who attended Debre Markos General Hospital. A total of 337 study participants were selected using a systematic sampling method. Data were collected through interviews with a structured questionnaire. Epi Data version 3.1 was used for data entry and analyzed using Statical Package for Social Sciences software. Bivariable and multivariable logistic regression analyses were employed; a P value of less than 0.05 was considered a statistically significant factor. Result: The overall proportion of this study showed that 26.1% of women had adverse birth outcomes; 7.7% stillbirths and 9.2% each preterm and low birth weights. Rural residence, no antenatal care, antepartum hemorrhage, pregnancy-induced hypertension, illiteracy, post term pregnancy, birth interval less than two years, and age less than 20 years were independently associated with adverse birth outcomes. Conclusion: In this study, the overall proportion of adverse birth outcomes was low compared to previous studies. Residence, no antenatal care follow-up, antepartum hemorrhage, pregnancy-induced hypertension, post term pregnancy, birth interval less than two years, illiteracy, and age less than 20 years were associated with adverse birth outcomes.

Level of knowledge and intention to use oral fluid HIV self-testing and associated factors among Ethiopian health care workers in southern Ethiopia

BackgroundThe World Health Organization has recommended a new method for HIV self-testing (HIVST) using oral fluid, intending to increase HIV testing rates, and linking individuals to medical care. Healthcare workers are chief health advocates in the community who need adequate knowledge and intention to use the newly recommended HIVST approach. However, studies on awareness and the intention to use oral fluid for HIV self-testing among Ethiopian healthcare workers are limited. Therefore, this study aimed to assess healthcare workers' knowledge of and intentions to use oral fluid for HIV self-testing in Hadiya Zone public hospitals in southern Ethiopia in 2022.MethodsWe conducted a facility-based cross-sectional study among a sample of 352 healthcare workers from 1 to 30 June 2022. The data were entered into Epidata version 4.2 and exported to SPSS version 23 for analysis. We used a logistic regression model with a 95% confidence interval for the interpretation of adjusted odds ratios (AORs) with P < 0.05.ResultsOf the total participants, 40.3% had good knowledge, and 63.1% intended to use oral fluid (HIVST). Approximately 92% of healthcare workers had not received training, and 48.3% had heard about HIVST. Only 12.3% knew about the availability of the kit in hospitals, and 19.9% had ever used HIVST. Being male (AOR = 2.28; 95% CI 1.33–3.95), receiving support for the implementation of HIVST (AOR = 2.07; 95% CI 1.21–3.56), hearing about HIVST (AOR = 5.05; 95% CI 2.89–8.81), having prior experience using HIVST (AOR = 2.94; 95% CI 1.71–5.05), having a spouse or partner (AOR = 2.78; 95% CI 1.14–6.82), and having multiple sexual partners (AOR = 2.76; 95% CI 1.13–6.78) were associated with good knowledge of oral HIVST. Being aged 25–29 years (AOR = 2.54; 95% CI 1.18, 5.41), perceiving the high cost of the HIVST kit (AOR = 0.37; 95% CI 0.16–0.84), and having poor knowledge (AOR = 1.91; 95% CI 1.13–3.23) were significantly associated with the intention to use the oral fluid for HIVST.ConclusionThis study highlights the need for technical updating training for healthcare workers to increase their knowledge of and intention to use oral fluid for HIVST. Promoting oral fluid HIVST through targeted education, supporting initiatives, and addressing cost concerns related to the testing kit may increase the uptake of oral fluid HIVST among healthcare workers.

Work-related stress among nurses: a comparative cross-sectional study of two government hospitals in Ghana

BackgroundOccupational stress is increasing globally and affecting all workplaces and countries’ health professionals. Despite its significant impact on healthcare delivery, limited studies have actually compared the prevalence, causes, effects, and coping strategies of stress among nurses working in hospitals with variation in capacity and function in Ghana. We, therefore, examined and compared the prevalence, causes, effects and coping strategies of occupational stress among nurses working in a secondary care and tertiary hospital in Ghana.MethodsWe conducted a health facility-based cross-sectional study among 248 nurses from two hospitals (Volta Regional Hospital [VRH] and Ho Teaching Hospital [HTH]). The Perceived Stress Scale (PSS) and Weiman Occupational Stress Scale (WOSS) were used to measure the nurses’ stress levels and causes of occupational stress respectively. A self-reported checklist was used to measure both the effects of stress and strategies. Descriptive analyses and t-tests were performed, and statistical significance was measured at the 0.05 level.ResultsThe majority of nurses 77.8% experienced a moderate level of perceived stress. The total individual mean scores of the nurses from the two hospitals (VRH = 3.02 and HTH = 3.09) were 34% and 37% respectively higher than the established WOSS individual average of 2.25. Nursing difficult patients (t=-1.1196, p = 0.037), Unfriendly relationships with superiors, colleagues, and subordinates (t=-2.3333, p = 0.020), working with incompetent staff (t=-1.3129, p = 0.037) were the statistically significant stressors among nurses in the HTH. Whereas, long work hours (t = 2.0841, p = 0.038) and needle-stick injuries (t = 2.6669, p = 0.008) were the statistically significant stressors among nurses from the VRH. Headache (VRH = 73.8% and HTH = 97.9%), Fatigue (VRH = 68.9% and HTH = 83.5%), Frustration VRH = 50.5% and HTH = 68.3%) and Lack of Concentration (VRH = 81.6% and HTH = 80.0%) were most common effects of occupational stress reported.ConclusionThe majority of nurses reported moderate levels of stress, with the two institutions’ stressors differing. Key causes of stress were needle stick injuries, long hours, dealing with challenging patients and strained interpersonal relationships. Common side effects were headaches, exhaustion, irritability, and trouble focusing. To accelerate progress towards achieving the sustainable development goal (SDG) 3.4 of promoting mental health and well-being by 2030, the 2012 Mental Health Act of Ghana and the Occupational Health and Safety Regulations, should fully and effectively be implemented in health facilities across the country.

Factors associated with uptake of isoniazid preventive therapy among children living with HIV in Mwanza region, Tanzania: a cross-sectional study

BackgroundTuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania.MethodsThis was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers’ demographics, caregivers’ health related information and children’s clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0.ResultsA total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5–8). The uptake of IPT was 91% (n = 377). The majority of children’s caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87–1.00] .ConclusionsThe uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV.

Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia

BackgroundIn low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital’s four NCD clinics using systematic random sampling. Patients’ direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study’s findings, while logistic regression was used to examine the associations between variables.ResultsA study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41–16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold.Conclusion and recommendationThis study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.

Practice of district health information data for decision making and associated factors among performance monitoring team at Hadiya Zone Public Health Facilities SNNPR, Ethiopia.

Evidence based practice is a key tool to increase effectiveness and efficiency of healthcare providers worldwide and using health facility data at all levels is vital. But, it is poorly practiced in developing countries including Ethiopia. As a result, the purpose of this study was to evaluate the level of practice of District Health Information for decision making and associated factors among performance monitoring teams in Hadiya Zone public health facilities, South Nation Nationality People Republic, Ethiopia, in 2022. A facility based-cross sectional study was employed from May 3 to June 3, 2022. To obtain data, a pre-tested structured questionnaire with qualitative was employed. A multistage random sampling technique was employed to select performance monitoring team from public health facilities. Data was entered into a computer using Epi data version 4.6, and analyzed using SPSS version 25. Bivariable and multivariable analyses were used to identify determinants related to practice of district health information. For the qualitative section, thematic analysis was used. The practice of district health information for decision making among performance monitoring team in this study was 48% (95% CI: [42.3, 54.1]). having standard sets of indicators [AOR = 4.055; 95% CI: (1.67, 9.86)], Being trained [AOR = 3.12; 95%CI: (1.385, 7.023)], having internet access [AOR = 3.23; 95% CI: (1.52, 6.9)], having positive attitudes [AOR = 2.667; 95% CI: (1.28, 5.56)], having low motivation [AOR = 0.202; 95% CI: (0.081, 0.504)], Sufficient skill [AOR = 3.239: 95%CI; (1.328, 8.164)] and having knowledge [AOR = 6.227; 95% CI: (2.12, 12.8)] were significantly associated with practice of District health information for decision making. In general, this study found that the performance monitoring team at health facilities poorly practiced district health information. It requires major improvement to provide a consistent set of indicators, training, internet access, user attitudes, motivation, and necessary skills and knowledge, as well as to raise users' confidence in DHIS2.

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study

BackgroundTuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections.ObjectiveThis study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia.MethodsThe study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05.ResultsIntestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth –co-infection.ConclusionHelminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

Dietary adherence and associated factors among hypertensive patients in governmental hospitals of Guji zone, Oromia, Ethiopia

BackgroundThe Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure in hypertensive adults, but there is limited information available on dietary adherence and related factors among hypertensive patients in the study area. Hence, the current study aimed to assess dietary adherence and associated factors among hypertensive patients aged greater than or equal to 18 years old in governmental hospitals of Guji zone, Oromia region, Ethiopia.MethodsA facility-based cross-sectional study was conducted between June 5, 2023, and August 30, 2023. For this study, patients with a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher on two separate occasions were classified as hypertensive. Thus, the study involved 399 hypertensive patients who were selected using systematic random sampling methods. The level of knowledge regarding hypertension was measured through the use of hypertension knowledge-level scale (HK-LS) questionnaires, while the reliability and validity of the questionnaire were assessed using the Cronbach’s alpha test (α ≥ 0.70).The association between factors was analyzed using adjusted odds ratio (AOR) and a 95% confidence interval. Variables with p-values below 0.05 were considered statistically significant.ResultsAmong the respondents, only 28.30% (CI: 23.9, 33) of participants were found to be adherent to the recommended diet. Factors like participation in nutritional education, level of knowledge, respondents’ ages, and length of time since hypertension diagnosis showed a strong association with adherence to recommended dietary guidelines.ConclusionsThe research findings indicated that the level of compliance with the prescribed diet was generally subpar among individuals with hypertension in comparison to the Dietary Approaches to Stop Hypertension (DASH) diet recommendations. So, it is essential to offer hypertensive patients an education focused on health and nutrition in order to enhance their adherence to dietary guidelines and promote a healthier dietary routine. The results of this research will also be valuable in increasing awareness among policymakers and the general public about the dietary adherence and its associated factors, thus aiding in the development and execution of suitable interventions.

The odds of having obesity in Egyptian children with autism spectrum disorders is higher than stunting compared to healthy developing peers: a national survey

BackgroundThe nutritional status and growth of children with Autism spectrum disorders (ASD) is influenced significantly by two factors; food selectivity behaviors due to their consumption of a limited variety of food and the high incidence of gastrointestinal (GIT) disorders.AimThis study aimed to assess the nutritional adequacy and growth pattern of ASD children aged three to twelve years compared to their healthy developing peers.MethodsA national comparative, facility-based cross-sectional study was conducted in eight Egyptian governorates on 285 Egyptian children diagnosed with ASD and 224 children who are their relatives as healthy developing peers. Anthropometric measurements were obtained, including weight, height, head circumference, and mid-upper arm circumference. Body Mass Index (BMI) was calculated and all numbers were plotted on WHO growth charts. Assessment of food preferences, and nutrient intake adequacy of children was done using the Food preference questionnaire, and the Dietary Reference Intakes (DRIs) of Egyptian children.ResultsCalorie-dense food and sugar intake were higher among ASD children than their healthy developing peers. ASD children omit some important protein sources such as dairy (COR = 5.2, 95% CI:2.7–9.9), meat, and poultry (COR = 2.7, 95% CI: 1.6–4.7), and a lower intake of fruits and vegetables than their healthy developing peers. For children with ASD in all age groups, a deficiency in the range of 50–60% was detected for vitamins (C, D, B6, thiamine, riboflavin, niacin) and minerals (iron). A deficiency in the range of 60–70% was detected for folate and calcium. A deficiency of vitamin C calcium and iron was also detected for both children with ASD and their healthy developing relatives aged 6 to 12 years. GIT disorders were common among ASD children compared to healthy developing peers (COR = 2.8 to 10.3). Children with ASD had four-fold higher odds of stunting (COR = 4.1, CI: 1.7–10.1), threefold higher odds of being overweight (COR = 3.3, CI: 1.48–7.32), and nearly eleven-fold higher odds of obesity (COR = 11.4, CI: 4.05–32.17) compared to their healthy developing peers.ConclusionASD children are prone to overweight and protein malnutrition. Their intake of fruits and vegetables is inadequate and hence their intake of vitamins and minerals is insufficient, contributing to stunting.

Association between oral hygiene knowledge and practices among older dental patients attending private dental clinics in Addis Ababa, Ethiopia

BackgroundEnsuring optimal oral hygiene is crucial for preserving the well-being of hard and soft tissues within the oral system. A lack of proper oral hygiene can have a detrimental impact on an individual’s health, leading to conditions such as caries and periodontitis. Therefore, this study investigated the association between the knowledge and practices of older patients in oral hygiene in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was carried out on 111 older patients who presented at purposively selected dental clinics in Addis Ababa. A convenience sampling method was used to recruit study participants. The data were collected using a pretested structured questionnaire. The questionnaire included information related to the patient’s knowledge and practices related to oral hygiene. The data were analyzed using SPSS version 23. Descriptive statistics were used to analyze the data. Multivariate logistic regression was performed to investigate the associations between independent and dependent variables. Adjusted odds ratios with 95% confidence intervals (95% CIs) were estimated, and variables with a p value < 0.05 in the multivariate analysis were considered significant.ResultsThe median age of the study participants was 70.31 years (65–100). Inadequate oral hygiene knowledge was found in 53.15% of the participants, while more than three-quarters (83.78%) of the older participants practiced poor oral hygiene. Older patients with good oral hygiene knowledge were 7.6 times more likely to practice good oral hygiene practices (AOR, 7.6; 95% CI (2.05–27.9)).ConclusionsPoor oral health is significantly associated with various health problems, particularly in older people. This study examined the relationship between oral health knowledge and practices in older dental patients and revealed insufficient knowledge and practices among participants. The results showed a notable link between oral health knowledge and practices in this demographic group, highlighting the need for support to improve oral health status. Organizations should increase awareness among older patients to improve their oral health status.

Asymptomatic malaria in pregnancy and associated risk factors in Majang Zone, Gambella Region, Southwest Ethiopia: a hard-to-reach malaria hotspot

BackgroundAsymptomatic malaria in pregnancy (AMiP) is a daunting public health problem with multifaceted adverse outcomes for mothers, fetuses, newborns and beyond. This study aimed to assess the prevalence and risk factors of AMiP and anaemia in Majang Zone, Gambella, Southwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 425 pregnant women attending the antenatal care (ANC) clinics of five health facilities in the Majang Zone from November 2022 to February 2023. Sociodemographic, obstetric, and anti-malarial intervention data were collected using an interviewer-administered questionnaire. A capillary blood specimen was collected to diagnose malaria and anaemia as well as determine the blood group. Malaria was diagnosed by rapid diagnostic test (RDT), microscopy, and quantitative polymerase chain reaction (qPCR). Statistical analyses were done by Statistical Package for Social Science (SPSS) version 26.0. The association between dependent and independent variables was assessed by multivariable binary logistic regression, considering P < 0.05 statistically significant. The magnitude of associations was quantified with the adjusted odds ratio (AOR) along with the corresponding 95% confidence interval (CI).ResultsThe overall prevalence of AMiP was 15.3% (95% CI 12.1, 18.9). It was 11.3% (95% CI 8.4, 14.7) by RDT, 11.8% (95% CI 8.9, 15.2) by microscopy and 17.6% (95% CI 11.7, 24.9) by qPCR. Plasmodium falciparum, moderate parasitaemia and submicroscopic infection accounted for 55.4% of the AMiP prevalence, 50.8% of the parasite density, and 41.6% of the qPCR-positive AMiP, respectively. Nearly 32.3% of pregnant women with AMiP carried gametocytes. Risk factors of AMiP were: not utilizing insecticide-treated net (ITN) within the previous week (AOR: 9.43 95% CI 1.57, 56.62), having a history of malaria within the previous year (AOR: 2.26 95% CI 1.16, 4.42), lack of indoor residual spraying (IRS) within the previous year (AOR: 3.00 95% CI 1.50, 6.00), and ANC contact below two rounds (AOR: 4.28 95% CI 2.06, 8.87). The prevalence of anaemia was 27.7% (95% CI 23.6, 32.1), and it was higher among AMiP-positives (56.9%) than the negatives (22.5%) (P: 000).ConclusionThe prevalence of AMiP and anaemia was high, and remained as a critical public health problem in the study area. Focus on the identified risk factors and introduction of more sensitive diagnostic tools should be considered to mitigate AMiP in the study area.

Disparities in satisfaction among insured and uninsured adult outpatient department service users in Southern Ethiopia, 2022: a comparative cross-sectional study

BackgroundPatient satisfaction is a critical measure of the quality of healthcare services provided by healthcare facilities. However, very few studies, particularly in Ethiopia, which includes the study area, have specifically examined these discrepancies among people who use outpatient care. In this study, satisfaction levels and associated factors were compared between insured and uninsured patients receiving outpatient services at public health institutions in Hadiya Zone, southern Ethiopia.MethodsA facility-based comparative cross-sectional study design was employed on 630 patients using multistage and systematic random sampling. Data were collected using a pretested and structured interviewer-administered questionnaire. Results of the analysis were presented in text, tables, and graphs as appropriate. Multivariable logistic regression was used to predict associations between predictors and the outcome variable. Statistical significance was declared at p-value < 0.05.ResultsOverall, 344(55.48%) patients were satisfied with the service they received, of which 206(65.8%) out of 313 with a 95% CI [60.7–71.2%] were insured and 138(44.95%) out of 307 with a 95% CI [39.4–5.1%] were uninsured. Among insured patients, factors associated with higher satisfaction included having a family size less than five members [AOR = 3.3, 95% CI; 1.5, 7.4], perceived fair waiting time to be seen[AOR = 2.35, 95% CI; 1.02, 5.5], perceived short waiting time to be seen[AOR = 8.12, 95% CI; 1.6, 41.3], having all ordered laboratory tests available within the facility[AOR = 7.89, 95% CI; 3.5, 17.5], having some ordered laboratory tests within the facility[AOR = 2.97, 95% CI; 1.25, 7.01] having all prescribed medications available within the facility[AOR = 16.11, 95% CI; 6.25, 41.5], having some prescribed medications available within the facility[AOR = 13.11, 95% CI; 4.7, 36.4]. Among non-insured patients, factors associated with higher satisfaction included urban residency, a fair and short perceived time to be seen, having ordered laboratory tests within the facility, and having prescribed drugs within the facility.ConclusionThis study identified lower overall satisfaction, particularly among uninsured patients. Enrollment in the CBHI program significantly impacted satisfaction, with both groups reporting lower levels compared to enrollment periods. Access to essential services, wait times, and socio-demographic factors identified as associated factors with patient satisfaction regardless of insurance status.