Jimma University Specialized Hospital Research Articles

The Cost of Suspected and Confirmed Bacterial Meningitis Cases in Jimma University Specialized Hospital in Southwest Ethiopia.

The Cost of Suspected and Confirmed Bacterial Meningitis Cases in Jimma University Specialized Hospital in Southwest Ethiopia.

Clinicopathological Features of Invasive Breast Cancer: A Five-Year Retrospective Study in Southern and South-Western Ethiopia.

Background: Breast cancer (BC) is the most common type of cancer in Ethiopia. The incidence of BC is also rising, but the exact figure is still poorly known. Therefore, this study was conducted to address the gap in epidemiological data on BC in southern and southwestern Ethiopia. Materials and Methods: This is a five-year (2015-2019) retrospective study. The demographic and clinicopathological data were collected from biopsy reports of different kinds of breast carcinomas in the pathology department of Jimma University Specialized Hospital and Hawassa University Specialized Referral Hospital. Histopathological grades and stages were conducted using Nottingham grading and TNM staging system, respectively. Collected data were entered and analyzed using SPSS Version-20 software. Results: The mean age of patients at diagnosis was 42.27 (SD = 13.57) years. The pathological stage of most BC patients was stage III, and most of them had tumor sizes greater than 5 cm. Most patients had moderately differentiated tumor grade, and mastectomy was the most common type of surgery at the time of diagnosis. Invasive ductal carcinoma was the most common histological type of BC, followed by invasive lobular carcinoma. Lymph node involvement was seen in 60.5% of cases. Lymph node involvement was associated with tumor size (χ2 = 8.55, p = 0.033) and type of surgery (χ2 = 39.69, p < 0.001). Conclusions: This study showed that BC patients in southern and southwestern Ethiopia displayed advanced pathological stages, relatively young age at diagnosis, and predominant invasive ductal carcinoma histological patterns.

Statistical Analysis on Time to Blindness of Glaucoma Patients at Jimma University Specialized Hospital: Application of Accelerated Failure Time Model.

Background Glaucoma is one of the most frequent vision-threatening eye diseases. It is frequently associated with excessive intraocular pressure (IOP), which can cause vision loss and damaged optic nerves. The main objective of this study was to model time to blindness of glaucoma patients by using appropriate statistical models. Study Design. A Retrospective Community-Based Longitudinal Study design was applied. Materials and Procedures. The data were obtained from Ophthalmology Department of JUSH from the period of January 2016 to August 2020. The glaucoma patient's information was extracted from the patient card and 321 samples were included in the study. To discover the factors that affect time to blindness of glaucoma patients', researchers used the Accelerated Failure Time (AFT) model. Results 81.3 percent of the 321 glaucoma patients were blind. Unilaterally and bilaterally blinded female and male glaucoma patients were 24.92 and 56.38%, respectively. After glaucoma disease was confirmed, the median time to the blindness of both eyes and one eye was 12 months. The multivariable log-logistic accelerated failure-time model fits the glaucoma patient's time to blind dataset well. The result showed that the chance of blindness of glaucoma patients who have absolute stage of glaucoma, medium duration of diagnosis, long duration of diagnosis, and IOP greater than 21 mmHg were high with parameters (ϕ = 2.425, p value = 0.049, 95% CI [2.249, 2.601]), (ϕ = 1.505, p value = 0.001, 95% CI [0.228, 0.589]), (ϕ = 3.037, p value = 0.001, 95% C.I [2.850, 3.22]) and (ϕ 0.851, p value = 0.034, 95% C.I [0.702, 0.999]), respectively. Conclusion The multivariable log-logistic accelerated failure time model evaluates the prognostic factors of time to blindness of glaucoma patients. Under this finding, duration of diagnosis, IOP, and stage of glaucoma were a key determinant factors of time to blindness of glaucoma patients'. Finally, the log-logistic accelerated failure-time model was the best-fitted parametric model based on AIC and BIC values.

The Burden of HIV Infection among Pregnant Women Attending Antenatal Care in Jimma University Specialized Hospital in Ethiopia: A Retrospective Observational Study.

Background The HIV (human immunodeficiency virus) epidemic enters its fifth decade amid a global pandemic. Nearly 61% of the people newly infected with HIV live in sub-Saharan Africa (SSA). The virus is transmitted from mother to child during pregnancy, labour, delivery, and breastfeeding, warranting routine counselling at antenatal care (ANC). Hence, this study aimed to determine the prevalence and trend of HIV infection among pregnant women on ANC follow-up at Jimma University Specialized Hospital (JUSH) in Ethiopia from November 2018 to 2021. Methods A retrospective cross-sectional study was conducted from June 25, 2021, to November 30, 2021. A total of 634 mothers were sampled by systematic random sampling, and the data were analyzed by descriptive statistics package of SPSS software. A chi-square test was employed to assess an association between variables. Analyses outputs were summarized and presented in tables and figures. Results Among the sampled women (634), 96.1% received counselling services on the prevention of maternal-to-child transmission of HIV/AIDS. Around 83.1% of the mothers refused to consult their partners and were unable to persuade their surrogate or afraid to discuss HIV serostatus tests. The overall prevalence of HIV infection among pregnant mothers was 7.1% and no significant decrease in the trends of HIV prevalence over the three years study period (p value >0.05). The seroprevalence is high in urban residents (4.4%) and age group of 25–29 years (38.9%) (p value <0.05). Residence, level of education attained, and marital status of women were significantly associated (p value <0.05) with seropositivity. Conclusion HIV burden among ANC attendees in JUSH is high as compared to the national figure and its trend over three years is steady. Accordingly, mandatory early screening tests and community-based education are mandatory for all women and adolescent girls in the reproductive age group.

Determination of the indoor air bacterial profile in Jimma University Specialized Hospital, Southwest Ethiopia.

Objective:Microorganisms are one of the main indoor air contaminants. In a hospital setting, a range of hospital-acquired infectious diseases are caused due to indoor air pollution. Studies conducted on hospital patients and healthcare workers revealed that indoor air pollution is causing more severe health problems than outdoor air pollution. Thus, this study aimed to determine the bacterial indoor air quality in Jimma University Specialized Hospital in southwest Ethiopia.Method:An institution-based cross-sectional study was conducted from late May to October 2020. Indoor air samples were collected through a passive method by exposing prepared sample plates for prescheduled exposure time, and bacterial species were identified using morphology and biochemical tests.Result:Based on the findings, neither of the wards showed a similar microbial concentration. Among the studied wards, the minimum and the maximum bacterial distribution ranged from 280 to 6369 cfu/m3, respectively. Staphylococcus aureus, coagulase-negative spp., Klebsiella spp., Escherichia coli, Bacillus spp., Proteus spp., and Streptococcus spp. were bacterial isolates. Statistically, the concentration of the bacteria in all the studied wards was tested significantly different (p ⩽ 0.001).Conclusion:Among studied wards, the emergency outpatient ward showed a maximum bacterial concentration in contrast to the minor operating room. Based on the criteria of the World Health Organization on hospital-acquired infections, studied wards were highly contaminated.

Challenges in Procurement of Pharmaceuticals in the Ethiopian Health Institutions

Public procurement is crucial to government service delivery. Procurement of Pharmaceuticals in public hospitals has faced challenges that affect service delivery. Public procurement is a key tool to the overall achievements of development goals such as reducing poverty and providing health, infrastructure, education and other services hence immensely contribute to best utilization of public resources. The limited public resources should be properly managed to get the most out of these resources. Despite its importance, limited scientific research has been undertaken to examine the Challenges of procurement in public institutions in the case of Health institutions. This study aimed to describe challenges in procurement of pharmaceuticals in Jimma University Specialized Hospital (JUSH). Specifically, the study sought to describe challenges in regards to the procurement process, procurement planning, staff competency, and information communication technology and procurement organization structure. The study was conducted through a descriptive design of research. The targeted respondents were 146 and comprise of Administration Officers and functional head that are members of tender committee and/or directly/indirectly involved in pharmaceutical procurements, Supply Chain and pharmaceuticals professionals, and pharmacy service professionals, Department heads of service delivery units and nurse heads of service delivery units in Jimma University Specialized Hospital. A structured questionnaire and interview as a data collection instrument were used. The field data were statistically analyzed using descriptive statistics and narrative summary analyses. Findings indicate that lengthy pharmaceuticals procurement process, lack of employee competency ,poor culture of pharmaceuticals procurement planning are the most serious challenges in pharmaceuticals procurement and fully centralization of pharmaceuticals procurement activities and in efficient use of information communication technology are the next most serious challenges in pharmaceuticals procurement Jimma University specialized Hospital. Keywords: Procurement, Challenges, pharmaciuticals, Ethiopia, Health institutions, procurement Organizational structure DOI: 10.7176/IEL/11-2-01 Publication date: June 30 th 2021

Pattern of trauma admission and outcome among patients presented to Jimma University Specialized Hospital, south-western Ethiopia

BackgroundTrauma is an ever evolving world problem that needs close attention and devising means to prevent and treat. The aim of the study is to identify the main reason for...

Prevalence and pattern of severe malaria among adults in Jimma University Specialized Hospital, Jimma, Southwest Ethiopia: A three years retrospective study

Severe malaria is a protozoan disease of human caused mainly by plasmodium falciparum (P.falciparum) but sometimes by Plasmodium vivax and mixed infections. The objective was to assess the prevalence, pattern and trends of severe and complicated malaria among adults admitted to the Medical wards of Jimma University Specialized Hospital (JUSH), South West Ethiopia, from May 1, 2013 to April 30, 2016. A retrospective medical record review study was conducted from May 1, 2013 to April 30, 2016 to assesses the files and registries of patients’ with severe malaria admitted to Medical wards of JUSH. The prevalence of confirmed sever and complicated malaria in JUSH from May 1, 2013 to April 30, 2016 was 2.6 % (144) out of the total admission of 5590 patients cards in the three years to JUSH medical ward. Out of the confirmed severe and complicated malaria case mortality was 0.6 %( 32) with case fatality rate was 22.2 %( 32/144). Adult severe malaria cases showed slightly declining pattern during the study period: 90 %( 58) in 2013/14, 3.82% (33) in 2014/15 and 1.64% (53) in 2015/16. Distribution of cases over months showed bimodal pattern for all of the years with the two peaks during the months of May to July and during November to January. P. falciparum accounted for 91.6% of severe malaria causative agent. Patients with co-morbid infections account 33% of cases of severe and complicated malaria. The commonest co-morbid infection was meningitis. More than 80% of the cases were presented to the hospital after 24 hours of malaria episode, which may contributed to increased case fatality rate. Delayed hospital visit was significantly associated with average annual case fatality rate of 5.32 %(15.97% for all the study years) (X2=33.75, P=0.001).This study has shown that trend of malaria admission over three years showed marked decline from 2013/14 to 2015/16. Delay in presentation to the health facility is associated with poorer prognosis, hence early recognition and treatment would decrease mortality. Though declining pattern of malaria s being observed adult severe malaria transmission was active over the studied years even at the end of the first phase of Roll Back Malaria Initiative. Therefore, the efficiency of malaria control and treatment programs should be investigated to fill gaps.

Drug-Therapy Problems and Predictors among Hospitalized Heart-Failure Patients: A Prospective Observational Study.

BackgroundHeart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients.MethodsThis hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems.ResultsA total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance.ConclusionPatients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.

Depression, Anxiety and Stress among COPD Patients: A Comparative Cross Sectional Study

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with depression, anxiety and stress, which are the commonest disorders resulting in significant morbidity and mortality. There is paucity of information regarding the association between depression, anxiety, and stress and chronic obstructive pulmonary disease in the present setup. This comparative cross-sectional study was designed to determine the magnitude of Depression, Anxiety and Stress and associated factors among COPD patients. Methods: Sixty five COPD patients and equal number of age and sex matched healthy individuals were included in the study. The study was conducted at Jimma University Specialized Hospital JUSH), from March 01 to April 30/2016. Spirometric assessment was done to evaluate severity of COPD. Depression, anxiety and stress scale (DASS 21) was used for the assessment of severity of depression, anxiety and stress. Chi-square test, independent t-test, Fisher’s exact test, one way ANOVA and linear regression were carried out to determine the association between independent and outcome variables and variables with p<0.05 were considered as significant. Results: Statistically significant difference between COPD patient and healthy controls was recorded on the prevalence of depression, anxiety and stress (47.7%, 49.2 %, and 56.9% respectively, p< 0.001). Depression score was significantly associated with severity of COPD (p<0.01). Duration of hospital admission was a common positive predictor for depression, anxiety and stress scores (β =0.156, 0.144 and 0.123 respectively, p<0.001), while FEV1 was a negative predictor of depression (β =-4.209) and stress score (β =-3.003), p <0.001. Higher educational level was a negative predictor of depression (β=-7.100) and anxiety scores (β = -5.15, p<0.05). Income was a negative predictor of stress score (β = -0.002, p <0.05). Cigarette smoking was a positive predictor of both depression (β=13.39, p<0.01) and anxiety scores (β=6.75, p <0.05), while khat chewing was positive predictor of only depression score (β=5.28, p<0.05). Conclusion: The present study showed that the prevalence of depression, anxiety and stress among COPD patients were significantly high. Educational status, duration of admission, FEV1, current khat chewing and cigarette smoking were predictors of depression score. At the same time educational status, cigarette smoking, history and duration of admission were predictors of anxiety score. The severity of depression, anxiety and stress was correlated with the severity of COPD. Therefore, appropriate intervention should be given by the concerned body to treat DAS among COPD patients.

Hospitalization and Predictors of Inpatient Mortality among HIV-Infected Patients in Jimma University Specialized Hospital, Jimma, Ethiopia: Prospective Observational Study.

Despite the number of patients enrolled in ART is increased, HIV/AIDS continues to constitute a significant proportion of medical admissions and risk of mortality in low- and middle-income countries. As one of these countries, the case in Ethiopia is not different. The aim of this study was thus to assess reasons for hospitalization, discharge outcomes, and predictors of inpatient mortality among people living with HIV (PLWH) in Jimma University Specialized Hospital (JUSH), Jimma, Southwest Ethiopia. Prospective observational study was conducted in medical wards of JUSH from February 17th to August 17th, 2017. In this study, 101 PLWH admitted during the study period were included. To identify the predictors of mortality, multiple logistic regression analysis was employed. Of the 101 hospitalized PLWH, 62 (61.4%) of them were females and most of them (52.5%) were between 25 and 34 years of age. A majority (79.2%) of the study participants were known HIV patients, before their admission. Tuberculosis (24.8%), infections of the nervous system (18.8%), and pneumonia (9.9%) comprised more than half of the reasons for hospitalization. Moreover, drug-related toxicity was a reason for hospitalization of 6 (5.9%) patients. Outcomes of hospitalization indicated that the overall inpatient mortality was 18 (17.8%). The median CD4 cell counts for survivors and deceased patients were 202 cells/μL (IQR, 121–295 cells/μL) and 70 cells/μL (IQR, 42–100 cells/μL), respectively. Neurologic complications (AOR = 13.97; 95% CI: 2.32–84.17, P = 0.004), CD4 count ≤ 100 cells/μl (AOR = 16.40; 95% CI: 2.88–93.42, P = 0.002), and short hospital stay (AOR = 12.98, 95% CI: 2.13–78.97, P = 0.005) were found to be significant predictors of inpatient mortality. In conclusion, opportunistic infections are the main reason of hospitalization in PLWH.

A traveling fellowship to build surgical capacity in Ethiopia: the Jimma University specialized hospital and operation smile partnership

A lack of trained providers is an important contributor to the unmet burden of surgical disease treatment in low- and middle-income countries. The World Health Organization’s Commission on the International Recruitment of Health Personnel lays out guiding principles for addressing this workforce crisis. However, for surgical subspecialties such as plastic surgery, in-country training opportunities remain limited and there is a clear need for effective strategies to retain providers and develop sustainable solutions. We report the design and early implementation of a traveling fellowship in plastic surgery for providers at Jimma University Specialized Hospital in Jimma, Ethiopia. This fellowship is supported by Operation Smile and its network of international surgical volunteers. Since its inception, the program has trained 2 general surgeons with a commitment to helping train a total of 6 surgeons to establish a self-sustaining service. Key innovations include multiple international sites to facilitate broad subspecialty training, commitment of participants to return to Jimma upon completion of the program to establish a local training service, and coordination with national governing bodies to ensure program recognition and support. Ongoing challenges include physical resource limitations and coordination with a wide array of stakeholders. Nongovernmental organizations also have a role to play in supporting the Ministries of Health in scaling up human resources for improved health within their countries. Operation Smile’s traveling fellowship demonstrates a feasible method of addressing the health workforce crisis by providing specialized training and facilitating the development of surgical teaching programs capable of sustainably serving local communities.

Language as a Barrier to Health Care for Oromo Speaking Patients in Hospitals: A Case Study on Jimma and Wollega Public Hospitals

A language concordance between doctors and their patients is very important to exchanging information, expressing emotion, instructing patients, and providing health education. But when they are mutually unintelligible because they don’t have common language between them, language has become to be a barrier rather than serving at the arena they need it. When language is a barrier, it can interfere with wrong scheduling appointments, hinder the compilation of an accurate medical history, or block understanding of a health provider’s instructions and so on and so forth. The aim of this study is to explore language as a barrier to health care for Afaan Oromoo speaking patients in Jimma University Specialized Hospital and Wollaga University Referral Hospital. The study was a qualitative research method and data were collected from patients, patients’ family/guardian, and health serves providers through interview method. Focus group discussion was conducted with health service providers and the hospital managements. The findings of the study has revealed that there is no common language between much patients and their health serves providers and/or no professional interpreters between them as well and therefore, the patients and their family or guardians were exposed to delaying treatment, compromising their well-being, leaving the hospital without getting medication being disappointed, and losing their life where the situation is to the worst. It is advisable that if hospitals consider establishing a centralized program and committee with executive level to coordinate services relating to language as a part of the organization’s commitment to language sensitive health care. It is better if financial incentives are created to promote, develop and maintain accessibility to qualified health serves and professional interpreters.

Level of Self-care Practice and Associated Factors Among Hypertensive Patients in Jimma University Specialized Hospital, South West Ethiopia

Globally hypertension is a major public health problem and leading cause of mortality in developing countries. Self-care practice encourage hypertensive patients to have better quality of life by preventing complication and decrease health care expenditure. The aim of this study is to assess Self-care practice and associated factors among hypertension patients in Jimma university specialized hospital, south west Ethiopia. An institution based Cross sectional study was employed on 322 adult hypertensive patients using simple random sampling procedure between March to May, 2016. Data was analyzed using SPSS version 20.0. A p-value of <0.05 was considered as statistically significant. Adjusted odds ratio at 95% CI was considered to declare the independent effect of independents variables on the outcome. In this study, the overall participants with the recommended level of self-care practice were found to be 44.7%. Being employed [AOR = 2.032, 95% Confidence Interval [CI]: (1.162, 3.552), educational attainment (AOR = 3.730, 95% CI: (1.837, 7.576) and Presence of co morbidity diseases (AOR = 0.502, 95% CI: 0.2886, 0.8850) were factors significantly associated with self-care practice. This study revealed level of self-care practice were low among hypertensive patients. Occupation, educational status and comorbidity were factors significantly associated with Self-care practice. Hypertensive patients with low socioeconomic status, no formal educational attainment and with co-morbidity needs special attention to improve their self-care practice.

Care Provider’s Knowledge and Attitude Toward Organ Donation in Jimma Town, Ethiopia: Cross-Sectional Study

IntroductionEthiopia is a country in sub-Saharan Africa with a population of 100 million people. The incidence and prevalence of end-stage organ failure seems to be a growing health problem in the country. Transplant legislation was drafted years ago by the federal minster of health in Ethiopia, but the number of donors is still low. Thus, we aimed to assess care providers’ knowledge and attitude toward organ donation so they will be volunteer advocates for the public to increase organ donation in the country. MethodA cross-sectional survey was conducted at 3 main higher private clinics and at Jimma University Specialized Hospital (JUSH) in Ethiopia from February 25, 2018, to June 21, 2018. Knowledge measuring questions had 2 possible answers (yes or no). The attitudes domain was measured with an “Agree” and “Disagree” categorical response scale. Data was entered to Epi-Data version 3.1 and exported to SPSS version 21 for Windows (IBM-SPSS Statistics 21, IBM, Armonk, NY) for data analysis. Descriptive statistics and a generalized linear model were used to analyze the data. ResultsIn total, 326 care providers were involved in the study. The mean age and service year of the participants were 29.68 (± 4.877) and 4.28 (± 4.561), respectively. The overall weighted knowledge and practices scores were 4.344 (4.214, 4.473) and 5.64 (5.39, 5.89), respectively. Majority care providers had an understanding about brain death and the definition of organ donation. Over half of the care providers agreed to donate organs in the future; additionally, they believed there was no strict association between religion and organ donation. Furthermore, many care providers believed in the advertisement and promotion of organ donation to raise public awareness. ConclusionCare providers showed good knowledge and attitudes toward organ donation. The findings may encourage health care workers to provide better counseling to improve organ donation.

Prevalence of Dental Caries of Streptococcus mutans among Diabetic Patients Who are Attending Jimma University Specialized Hospital Dental Clinic, South-West, Jimma, Ethiopia

Prevalence of Dental Caries of Streptococcus mutans among Diabetic Patients Who are Attending Jimma University Specialized Hospital Dental Clinic, South-West, Jimma, Ethiopia

Predictors of therapeutic communication between nurses and hospitalized patients

BackgroundTherapeutic communication is a purposeful interaction between health professionals and patients that helps to achieve positive health outcomes. There is a pressing need for research examining factors influencing effective implementation of therapeutic communication in relation to patient-centered care and satisfaction. ObjectiveThis study was aimed at determining the effective implementation of therapeutic communication and its predictors. MethodsInstitution based cross-sectional study was conducted at the Jimma University Specialized Hospital from March 21 to April 9, 2016. One hundred ninety two patients were recruited using stratified sampling. A questionnaire was used to collect data. One-way ANOVA for mean difference by socio-demographic characteristics, simple and multivariable linear regressions were conducted. ResultsThe study revealed that 67(34.9%) of the patients rated high level of therapeutic communication. Significant predictors of therapeutic communication implementation were educational status (β = 5.87, P = 0.011), language difference (β = -6, P = 0.014), education difference (β = 5.21, P = 0.010) and perceived patient view score (β = 3.57, P˂0.001). ConclusionTherapeutic communication was poorly implemented. Education, language difference, education difference and perceived patient view scores were significant predictors of therapeutic communication.

Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial

BackgroundThe World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM.MethodChildren with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital.The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations.ResultsThe intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes.ConclusionPsychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available.Trial registrationThe trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) # NCT03036176.

Relationship between nurses\u2019 perception of ethical climates and job satisfaction in Jimma University Specialized Hospital, Oromia region, south west Ethiopia

BackgroundThe ethical climate is one aspect of an organization which refers to the shared perceptions of ethically correct behaviors and way of handling ethically deviated behaviors. Increased awareness of the complexity of ethical issues in the health care setting has fueled interest in nursing ethics. However; there is limited information on the relationship between nurses’ perception of ethical climate and job satisfaction globally and no study was done on this issue particularly in Ethiopia. Therefore, this study was aimed to assess the relationship between nurses’ perception of ethical climates and job satisfaction in Jimma University Specialized Hospital, southwest Ethiopia, 2016.MethodsInstitutional based cross-sectional study was conducted on 266 nurses in Jimma University Specialized Hospital from March to April 2016. The study participants were invited by using simple random sampling method. Data were collected using self-administered questionnaires and were entered into Epidata 3.1 and analyzed using SPSS Version 20.0. Pearson’s correlation was used to assess the correlation between each dimension of the hospital ethical climate and job satisfaction of nurses. Variables significant at bivariate analysis (P < 0.25) were considered as a candidate for the multivariable linear regression analysis. All analyses were conducted at the 0.05 significance level.ResultsThe percentage mean score for ethical climate and job satisfaction were 53.4 and 51.3% respectively. Law and code climate significantly influenced job satisfaction (β = 1.53, p = 0.000). Caring climate also significantly influenced nurses job satisfaction (β = 0.99, p = 0.000). The result also showed that an independence climate significantly influenced job satisfaction (β = 0.62, p = 0.041). On the other hand, rule climate and instrumental climate did not significantly affect job satisfaction (β = 0.380, p = 0.409 and β = − 0.208, p = 0.290 respectively). The adjusted R square was 0.601, indicating that 60.1% of the variations in job satisfactions was explained by ethical climate variables.ConclusionThe different dimensions of ethical climates have a negative or positive impact on nurses’ job satisfaction and maintaining a positive ethical climate is key to increasing nurses’ job satisfaction.

Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years: The Ethiopian iABC birth cohort study.

BackgroundAccelerated growth in early childhood is an established risk factor for later obesity and cardiometabolic disease, but the relative importance of fat mass (FM) and fat-free mass (FFM) accretion is not well understood. We aimed to study how FM and FFM at birth and their accretion during infancy were associated with body composition and cardiometabolic risk markers at 5 years.Methods and findingsHealthy children born at term were enrolled in the Infant Anthropometry and Body Composition (iABC) birth cohort between December 2008 and October 2012 at Jimma University Specialized Hospital in the city of Jimma, Ethiopia. FM and FFM were assessed using air displacement plethysmography a median of 6 times between birth and 6 months of age. In 507 children, we estimated individual FM and FFM at birth and their accretion over 0–3 and 3–6 months of age using linear-spline mixed-effects modelling. We analysed associations of FM and FFM at birth and their accretion in infancy with height, waist circumference, FM, FFM, and cardiometabolic risk markers at 5 years using multiple linear regression analysis. A total of 340 children were studied at the 5-year follow-up (mean age: 60.0 months; girls: 50.3%; mean wealth index: 45.5 out of 100; breastfeeding status at 4.5 to 6 months post-partum: 12.5% exclusive, 21.4% almost exclusive, 60.6% predominant, 5.5% partial/none). Higher FM accretion in infancy was associated with higher FM and waist circumference at 5 years. For instance, 100-g/month higher FM accretion in the periods 0–3 and 3–6 months was associated with 339 g (95% CI: 243–435 g, p < 0.001) and 367 g (95% CI: 250–484 g, p < 0.001) greater FM at 5 years, respectively. Higher FM at birth and FM accretion from 0 to 3 months were associated with higher FFM and cholesterol concentrations at 5 years. Associations for cholesterol were strongest for low-density lipoprotein (LDL)–cholesterol, and remained significant after adjusting for current FM. A 100-g higher FM at birth and 100-g/month higher FM accretion from 0 to 3 months were associated with 0.16 mmol/l (95% CI: 0.05–0.26 mmol/l, p = 0.005) and 0.06 mmol/l (95% CI: 0.01–0.12 mmol/l, p = 0.016) higher LDL-cholesterol at 5 years, respectively. Higher FFM at birth and FFM accretion in infancy were associated with higher FM, FFM, waist circumference, and height at 5 years. For instance, 100-g/month higher FFM accretion in the periods 0–3 and 3–6 months was associated with 1,002 g (95% CI: 815–1,189 g, p < 0.001) and 624 g (95% CI: 419–829 g, p < 0.001) greater FFM at 5 years, respectively. We found no associations of FM and FFM growth with any of the other studied cardiometabolic markers including glucose, HbA1c, insulin, C-peptide, HOMA-IR, triglycerides, and blood pressure. Non-attendance at the 5-year follow-up visit was the main limitation of this study, which may have introduced selection bias and limited the power of the regression analyses.ConclusionsFM accretion in early life was positively associated with markers of adiposity and lipid metabolism, but not with blood pressure and cardiometabolic markers related to glucose homeostasis. FFM accretion was primarily related to linear growth and FFM at 5 years.