Unmatched Case-control Study Research Articles

Determinants of pediatrics emergency mortality at comprehensive specialized hospitals of South nation nationalities and people region, Ethiopia, 2022: unmatched case-control study

BackgroundGlobally, child mortality is remaining high, especially in sub-Saharan African countries like Ethiopia. Mortality which happens within 24 hours of admission is preventable. However, in Ethiopia little is known regarding pediatric emergency mortality. Therefore, this study was aimed to identify determinants of pediatric emergency mortality at compressive specialized hospitals found in South Nation Nationalities and people region, Southern Ethiopia.MethodsA facility-based unmatched case-control study was conducted on 344 children (115 cases and 229 controls) at comprehensive specialized hospitals of South Nation Nationalities and people region, Ethiopia. The data collection checklist was checked for its consistency. Data were entered and cleaned for missed values by using Epi Data3.1, then exported to Stata version 14.1 for analysis. Logistic regression was done to identify the significant determinants for pediatric emergency mortality. Finally, AORs at 95% CI and P-value < 0.05 were used to declare statistical significance.ResultA total of 344 charts were reviewed, of which 333 (97%) (112 cases and 221 controls) charts fulfilled the inclusion criteria.. In multivariable analysis, delayed diagnosis and treatment [AOR = 2.088, 95% of CI (1.128, 3.864)], acute respiratory distress syndrome [AOR = 2.804, 95% of CI (1.487, 5.250)], dehydration [AOR = 3.323, 95% of CI (1.260, 8.761)], meningitis [AOR = 5.282, 95% of CI (2.707, 10.310)], sepsis [AOR = 4.224, 95% of CI (2.220, 8.040)], accidental injury [AOR = 3.603, 95% of CI (1.877, 6.916)] and duration of sign/symptoms [AOR = 5.481, 95% of CI (2.457, 12.230)] were significantly associated with pediatric emergency mortality.ConclusionIn the current study, delayed diagnosis and treatment, acute respiratory distress syndrome, dehydration, sepsis, meningitis, accidental injury and duration of signs/symptoms were significantly associated with pediatric emergency mortality. Healthcare professionals should identify and treat patients early at an emergency department and provide attention to patients with the above diseases. Furthermore, quality care should be provided.

Association between obesity and cervical intraepithelial neoplasia: results from a case control study in south western Uganda

BackgroundThough obesity has been said to be associated with a number of malignancies including cervical cancer, its association with cervical intraepithelial neoplasia (CIN) is still a contentious issue. This study was designed to determining the prevalence and association between obesity and CIN.MethodsThis was an unmatched case control study, involving women with cervical intraepithelial neoplasia (cases) and those negative for intraepithelial lesions or malignancy (controls) at the cervical cancer clinic of Mbarara Regional Referral Hospital, in south-western Uganda, between April and November 2022. Cases and controls provided written informed consent and were recruited in a ratio of 1:1. Cases were identified by visual inspection with acetic acid (VIA) and subsequent confirmation with cytology and/or histology. Demographic information was collected using an enrolment form and height, weight and waist circumference were recorded. We calculated body mass index (BMI) and identified obese women as those with body mass index of ≥ 30 kg/m2 from both case and control groups. Central obesity was defined as waist: height ration of ≥ 0.5. Data was analysed using STATA version 17. Categorical variables were analysed using proportions, chi-square and logistic regression analysis to determine association between obesity and CIN. Our level of statistical significance was set at ≤ 0.05.ResultsThe prevalence of general and central obesity among cases was 25.5% (24/94) and 0% (0/94) respectively while the prevalence of general and central obesity among controls was 33.3% (37/111) and 0% (0/111) respectively. There was an increased prevalence of general obesity among women with low grade squamous intraepithelial lesions (LSIL). However, there was no statistically significant association between general obesity and CIN. Factors associated with general obesity included residing in Mbarara city (AOR 2.156, 95%CI 1.085–4.282, P-value 0.028), age group of 31–45 years (AOR 2.421, 95%CI 1.577–9.705, P-value 0.003) and ≥ 46 years (AOR 1.971, 95%CI 1.022–11.157, P-value 0.046).ConclusionWe observed an increased prevalence of general obesity among women with LSIL. However, there was no association between obesity and CIN. Factors associated with general obesity included residing in Mbarara city, and being in the age groups of 31–40 and ≥ 46 years. This highlights the need to rethink management of CIN to control other non-communicable diseases that could arise due to general obesity.

Determinants of Female Genital Mutilation Among Under Five-Year Children in Motta Town, Northwest Ethiopia, 2022: Unmatched Case Control Study.

Female genital mutilation is the removal of a woman's external genitalia in whole or in part for a non-obvious medical reason. Female genital mutilation causes short- and long-term complications like bleeding, pain, infection and exposes girls to sexually transmitted diseases. The determinants of female genital mutilation among children under the age of five have received less attention. As a result, the purpose of this study was to determine the factors that influence female genital mutilation in children under the age of five. A community-based unmatched case control study design was used. The study participants were chosen using computer-generated simple random sampling technique. With a ratio of 1:4 between cases and controls, 323 participants were recruited. Data were collected using an interviewer-administered questionnaire. The association between each independent variable and the dependent variable was determined using binary logistic regression. In a multivariable analysis, variables were considered statistically significant if they had a P-value of less than 0.05 at a 95% confidence interval. In this study, mothers' circumcision status (AOR = 4.6; 95% CI: 2.29-9.25), mothers who had an unfavorable attitude (AOR = 4.15; 95% CI: 1.96-8.82), households in the poorest wealth quintile (AOR = 3.65; 95% CI: 1.2-11.54), mothers who had inadequate knowledge (AOR = 3.31; 95% CI: 1.51-7.25) and antenatal care visit of mothers (AOR = 2.46; 95% CI: 1.03-5.83) were found to be determinant factors of female genital mutilation. Mothers' circumcision status, mother's attitude, wealth quintile, knowledge of mothers, and number of antenatal care visits were factors associated with female genital mutilation. Regular awareness-building on the impacts of the practice and special attention to the mother's attitude are important to eliminate female genital mutilation.

Determinants of premature rupture of membrane among pregnant women in Harar town, Eastern Ethiopia: A case-control study

IntroductionPremature rupture of membrane is a disruption of fetal membrane followed by passage of watery fluid gush before the onset of labor any time beyond 28 weeks of gestation. It is a significant cause of perinatal morbidity and mortality. Many studies were conducted on the pre-labor rupture of membrane, yet limited evidence is available on its determinants. This study aimed to identify determinants of premature rupture of membrane among pregnant women in Harar Town, Eastern Ethiopia. Methodology; Hospital-based unmatched case control study was conducted on 115 cases and 230 controls from 15th May to 15th July 2021. The study was conducted on two public hospitals in Harar town. All cases admitted at the time of data collection were included until the required sample size was obtained and controls were selected by using simple random sampling among all non -cases. Data were collected using interviewer-guided semi-structured questionnaires. The data were entered into Epi-data version 3.1 and exported to SPSS version 22.0 for analysis. Binary logistic regression was used to identify determinants of the outcome and statistical significance declared at a p-value less than 0.05. Multicollinearity was checked and model fitness was assessed by Hosmer Lemeshow test. ResultsAbnormal vaginal discharge [AOR 2.15 (2.53, 22.46), history of cesarean delivery [AOR 2.06 (1.11, 6.78)], history of premature rupture of membrane [AOR 4.62 (2.06, 11.52)] and history of abortion [AOR 2.81 (1.04, 6.23)] increase the odds of the outcome. ConclusionBad obstetric histories in the current and previous pregnancies are related to premature rupture of membrane. Therefore, it is recommended that health care providers should take attention to women with past and current pregnancy complications.

Determinants of post-traumatic stress disorder among survivors of road traffic accidents in dessie comprehensive specialized hospital North-East Ethiopia

BackgroundPost-traumatic stress disorder is the most common mental disorder occurring among survivors of road traffic accidents. However, it remains under-explored and is not taken into account in the health policies of Ethiopia. Therefore, this study aimed to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia.MethodsA facility-based unmatched case–control study design was employed from February 15 to April 25, 2021, in Dessie Comprehensive Specialized Hospital, with a total sample size of 139 cases and 280 controls selected by using a simple random sampling technique. Data were collected by pretested, interview with a structured questionnaire. The data were entered using Epi-Info, then exported and analyzed using STATA. The bi-variable and multivariable binary logistic regression model was used to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident. Adjusted odds ratio with a 95% confidence level was used as a measure of association. Variables with a p-value less than 0.05 were considered as statistically significant.ResultA total of 135 cases and 270 controls participated in this study, with a response rate of 97% and 96%, respectively. In the final multivariable analysis, being male [AOR = 0.43, 95% CI: 0.32–0.99], primary educational status [AOR = 3.4, 95% CI: 1.04–11], presence of personal psychiatric history [AOR = 2.12, 95% CI: 1.17–3.92], presence of fracture [AOR = 2.41, 95% CI: 1.2–4.8], witness of death [AOR = 2.25, 95% CI: 1.26–4.30], presence of comorbidity [AOR = 2.29, 95% CI: 1.28–4], good social support [AOR = 0.71, 95% CI: 0.12–0.68] were significantly associated with post-traumatic stress disorder among survivors of road traffic accident patients.ConclusionPTSD following road traffic accidents is common. A multi-disciplinary approach was therefore essential in the management of road traffic accident survivors at the orthopedic and trauma clinics. Patients with poor social support, bone fracture, witnessed death, comorbidity, and females should be routinely screened for post-traumatic stress disorder in all road traffic accident survivors.

Predictors of Mortality Among Post-COVID-19 Discharged Patients in Northern India: A Case-Control Study.

Introduction The post-discharge all-cause mortality of COVID-19 disease is known, but predictors for the same have not been studied as much. The objective of this study was to develop an understanding of predictors of mortality to guide in prioritizing patient care and preventive approaches. Methods This current research is a single-center unmatched case-control study conducted at a tertiary care center in northern India, between April and September 2022. The data were extracted retrospectively from the hospital's electronic medical records of patients with the assistance of trained physicians using a standardized data extraction sheet. Results A total of 184 patients were enrolled and were segregated into two groups, cases and control, with 92 in each. The mean age of patients was 49.3 ± 17.53 years. The mortality group had a higher mean age (53.24 ± 18.53 yrs) as compared to the control group (45.37 ± 15.58 yrs, p=0.002). Bivariate analysis revealed a significant difference in the two groups with respect to O2 saturation at the time of admission (case - 91.12 ± 12.49 %, control - 95.46 ± 5.01 %, p=0.003); maximum O2 flow rate (L/min) (case - 11.01 ± 22.2, control - 6.41 ± 13.31, p=0.04); ICU need (p=0.005), cancer (p=0.001), O2 requirement at discharge (p=0.001) and acute kidney injury (AKI; p=0.007). On multiple regression analysis, cancer (adjusted odds ratio (aOR) - 2.469; 95% CI1.183-5.150, p=0.016), ICU admission (aOR - 2.446; 95% CI1.212-4.938, p=0.013), oxygen at discharge (aOR - 2.340; 95% CI0.971-5.640, p=0.0586) and AKI (aOR - 5.6; 95% CI2.351- 13.370, p=0.00) only found to be significant. Conclusion Among the patients released from the hospital post-COVID-19 treatment, the following aspects oxygen requirement (2.3 times), malignancy (2.4 times), ICU admission (2.4 times), and AKI (5.6 times) are risk factors of mortality. The presence of these variables would warrant a close follow-up for these patients in order to decrease post-COVID mortality.

Partner Notification and Associated Factors among People Living with Human Immunodeficiency Virus in Bushenge Hospital, Rwanda

IntroductionPartner notification is among strategies adopted by WHO to identify people at risk of HIV infection among sexual partners with people living with HIV to achieve the 90-90-90 target. There is still a gap in Sub-Saharan Africa.ObjectiveTo assess the determinants of partner notification among people infected with HIV in Bushenge hospital.MethodsAn unmatched case control study was conducted, 141 people who successfully notified their sexual partners as controls and 141 who did not as cases were selected to identify the factors associated with partner notification. Data were analyzed with Stata V13.ResultsMost cases were female 81(58%); 91(64.5%) of cases and 97(68.8.5%) of controls were in couple, 40(28.8%)of cases and 67(48%) of controls had multiple partner. Thirty-five 35(25%) of cases and 51(36%) of controls were newly diagnosed; 73(74%) of cases and 78(86.6%) suppressed the viral load. Notification approach was associated with partner notification, aOR = 9, CI[2.8, 29].ConclusionPartner notification as one of the strategies to reach the first 90 requires more efficient and effective efforts. Different initiatives are needed especially in partner notification approach.Rwanda J Med Health Sci 2022;5(3):53-60

Effect of facemask, handwashing, and social distancing on contracting COVID-19 infection in Saudi Arabia: a case-control study

Background: This study aimed to evaluate the impact of self-preventive measures (handwashing, mask-wearing, and social distancing) on preventing the Coronavirus Disease-2019 (COVID-19) infection in Saudi Arabia (KSA). Methods: An unmatched case-control study (1 to 1 ratio) was conducted with a sample size of 1102. The researchers used descriptive, bivariate, and multivariate analyses to determine the effect of handwashing, mask-wearing behavior, and social gatherings on COVID-19 infection. Results: The results evinced that participants who believed that the facemask was important for preventing COVID-19 infection were more likely protected against the disease (OR=0.450; 0.320—0.631). Using a facemask during social visits and shopping indicated a lower protective effect than using it at work (OR=1.299; 1.011—1.668). The type of mask (disposable versus cloth; OR=0.929; 0.590—0.1.462) and its wearing period (1&lt; dayversus ≤1 day; OR=0.907; 0.662—1.243) showed an almost neutral statistical association with acquiring the infection. Contrarily, handwashing time for ≥20 seconds, compared to a shorter time, had a statistically significant protective association with the infection even after adjusting the odds ratio (OR=0.616; 0.4763—0.796). It was also noted that gathering with relatives and friends ≥4 times per month exhibited a higher and statistically significant association with the infection compared to the lower times (OR=1.347; 1.046—1.734). Furthermore, people who prayed five times a day at the mosque showed a higher risk of infection than those who prayed less than five times (adjusted OR=1.740; 1.152—2.626). Conclusions: This study suggested that handwashing for more than 20 seconds is the most important preventive factor among all considerations investigated. Moreover, it was noticed that disposable and cloth facemasks may have the same effect regardless of the wearing period or sterilization status. Furthermore, gathering with relatives and friends, as well as praying five times a day at the mosque, were ascertained as significant social factors in acquiring the COVID-19 infection.

Determinants of puerperal sepsis among postpartum women at public hospitals of Hawassa city, Southern Ethiopia: Institution-based unmatched case-control study

BackgroundWorld health organization reported that from 358,000 maternal deaths occurring during labor and childbirth about 15% were attributed to puerperal sepsis. In Ethiopia, puerperal sepsis is the fourth leading direct cause of maternal death next to hemorrhage, obstructed labor, and pregnancy-induced hypertension. Early recognition and management of the contributing factors would help to modify the problem. Therefore, this study was aimed to identify the determinants of puerperal sepsis among postpartum women at Hawassa city public hospitals in South Ethiopia. Methods& materials: Institution-based unmatched case-control study was conducted among 305 postpartum women (61 cases & 242 controls; with a ratio of 1:4) at Hawassa city public hospitals from June 17 to August 20/2021. Cases were all postpartum women admitted with puerperal sepsis and controls were randomly selected postpartum women admitted with other cases. A pre-tested interviewer-administered questionnaire was used to collect the data. Data were entered into Epi data version 4.6 and then exported to STATA version 14 for analysis. Bivariable analysis was performed and variables having a p-value <0.25 made candidates for the multivariable logistic regression model. Adjusted Odds ratio (AOR) with 95% confidence interval was computed to identify the presence and strength of association and statistical significance was declared at p-value <0.05. ResultIn this study, a total of 61 cases & 242 controls were included. Cesarean section delivery (AOR = 2.85; 95% CI; 1.36–5.98), manual removal of placenta (AOR = 6.0; 95% CI = ; 0.39–26.26), ≥5 times Per-vaginal Examination during labor (AOR = 4.53; 95% CI; 2.10–9.80), presence Gestational Diabetes Mellitus (AOR = 8.50; 95% CI; 1.99–36.33) & prolonged labor (AOR = 3.43; 95% CI; 1.20–9.76) were identified as determinants of puerperal sepsis. ConclusionIn this study, cesarean delivery, Per-vaginal Examination ≥5 times during labor, manual removal of placenta, Gestational Diabetes Mellitus & prolonged labor were factors that significantly increased the odds of developing puerperal sepsis among postpartum women. So, labor & delivery procedures should be conducted as per labor & delivery management protocols.

Risk Factors for Influenza Disease in Shai-Osudoku and Ningo-Prampram Districts in the Greater Accra Region of Ghana

Aims: This study sought to determine the risk factors of Influenza by investigating the characteristics of patients with Acute Respiratory Infections (ARIs). Study Design: An unmatched case-control study. Place and Duration of Study: This was conducted among residents of Shai-Osudoku (SO) and Ningo-Prampram (NP) Districts from April to November 2016. Methods: Prospective cases of ARIs from a facility-based sentinel surveillance on respiratory illnesses were screened for Influenza-Like-Illnesses (ILIs). Respiratory samples were obtained from those meeting the case definition for ILI and investigated. A total of 147 samples were influenza virus-positive and selected as case-patients. Another 294 patients were selected as control-patients from the pool of influenza negative tests. These two groups were used to assess the risk factors of influenza. Crude and adjusted odds ratios were calculated. A purposive selection logistic regression was used for the adjusted modelling. Results: The study identified Influenza A(H3N2) and Influenza B as the predominant circulating influenza viruses. Study participants had poor knowledge on the causes and prevention of acute respiratory illness. After the multivariate analysis, ILI patients presenting with Chills had 4 times odds (aOR:4.57; 95%CI: 1.51 – 13.76) of having influenza as compared with the controls. In addition, ILI patients with recent travel history in past 2 weeks had 3 times odds (aOR:3.05; 95%CI: 1.07 – 8.73) of being infected with the influenza virus compared with controls with no history of travel. Conclusion: The study provided clues for increasing the index of suspicion of clinicians in identifying patients with respiratory signs who could be at risk of influenza infection. Communication of the significant risk factors identified in the study to all health workers should be prioritized as an action. This important knowledge about factors associated with influenza among ILIs will inform early detection and appropriate health interventions to reduce the burden influenza disease.

Factors associated with poor glycemic control among adult patients with type 2 diabetes mellitus in Gamo and Gofa zone public hospitals, Southern Ethiopia: A case-control study.

Diabetes mellitus is a serious global public health problem that affects the whole life of people in terms of their biological, psychological, and social effects. Complications and death from diabetes occur from poorly controlled blood glucose levels. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess factors associated with poor glycemic control among type2 diabetes patients in public hospitals of Gamo and Gofa zone southern, Ethiopia, 2021. An institution-based unmatched case-control study was employed among 312 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identify factors associated with poor glycemic control using IBM SPSS version 25. The strength of association was assessed by using an Adjusted odds ratio (AOR) with a 95% confidence interval (CI). Factors associated with poor glycemic control based on multivariable analysis were, having comorbidity (AOR = 2.35, 95% CI (1.39-3.95)), adhering to dietary recommendations (AOR = 0.31, 95% CI (089-0.51)), poor social support (AOR = 3.31, 95% CI (1.59-6.85)), physical exercise (AOR = 1.86 95% CI (1.11-3.12)), and having poly-pharmacy (AOR = 2.83, 95% CI (1.39-5.74)). This study indicated a significant association of comorbidity, physical exercise, poly-pharmacy, low social support, and adherence to dietary recommendations with poor glycemic control. We suggest that the health care providers and concerned bodies encourage patients to have regular check-ups and work on providing necessary social support.

Community Scabies Outbreak Investigation and Risk Factors in Katondo Health Post, Kasenengwa District of Eastern Province: Unmatched Case Control Study

Scabies is a parasitic infestation caused by <i>Sarcoptes scabiei var hominis</i> which is a microscopic mite that burrows into the skin and lays eggs. Prevalence of the condition range from 0.2% to 71% globally. This study was therefore conducted to investigate the suspected community scabies outbreak in Katondo Health Post of Kasenengwa District and bring out the significant associated factors. Unmatched case control study was conducted (1:2 case control ratio). Suspected outbreak was identified through weekly notifiable report. Desk review of the Out Patient Register (OPD) was done to determine additional suspected cases. Structured questionnaire was administered to collect risk factors data. Total study participants were therefore cases with clinical signs of symptoms unmatched to controls within the area. Frequency tables were used to present demographic variables. Attack rate was used to measure morbidity. Odds Ratio (OR) with 95% confidence interval (CI) was used to determine risk factors. Total of 64 clinical scabies cases were recorded giving an attack rate of 1/100 people. Mandondo zone which was the index case zone recorded the highest attack rate of 3/100 people. Mean age of the cases was 18 with range of 11-56 years. Statistically significant factors associated with the outbreak were Low education ((OR=4.9, 95% CI=1.34-6.45, P-Value=0.014), record of exchanging clothes (OR=2.1, 95%CI=1.45-5.34, P value 0.001), Skin contact with suspected case (OR=2.5, 95% CI=0.74-8.68, P Value=0.012), bathing less than 3 times per week (OR=5.4, 95% CI=2.38-14.43, P value: 0.000). Protective factors were, use of soap for bathing (OR=0.34, 95% CI=0.21-2.71, P value=0.003), family member less than 5 (OR=0.12, 95% CI= 0.12-0.06, P Value=0.000). From the results, it can be deduced that scabies outbreak occurred in Katondo Health Facility. Low education, record of exchanging clothes, bathing less than 3 times per week, and skin contact with the suspected case were the risk factors associated with outbreak. Epidemic protective factors were, use of soap for bathing and belonging to a household with family members less than 5. Providing risk factors-based health education on prevention and controls especially, at health facility and community level were recommended.

Cholera outbreak in some communities in North-East Nigeria, 2019: an unmatched case–control study

BackgroundCholera, a diarrheal disease caused by the bacterium Vibrio cholerae, transmitted through fecal contamination of water or food remains an ever-present risk in many countries, especially where water supply, sanitation, food safety, and hygiene are inadequate. A cholera outbreak was reported in Bauchi State, North-eastern Nigeria. We investigated the outbreak to determine the extent and assess risk factors associated with the outbreak.MethodsWe conducted a descriptive analysis of suspected cholera cases to determine the fatality rate (CFR), attack rate (AR), and trends/patterns of the outbreak. We also conducted a 1:2 unmatched case–control study to assess risk factors amongst 110 confirmed cases and 220 uninfected individuals (controls). We defined a suspected case as any person > 5 years with acute watery diarrhea with/without vomiting; a confirmed case as any suspected case in which there was laboratory isolation of Vibrio cholerae O1 or O139 from the stool while control was any uninfected individual with close contact (same household) with a confirmed case. Children under 5 were not included in the case definition however, samples from this age group were collected where such symptoms had occurred and line-listed separately. Data were collected with an interviewer-administered questionnaire and analyzed using Epi-info and Microsoft excel for frequencies, proportions, bivariate and multivariate analysis at a 95% confidence interval.ResultsA total of 9725 cases were line-listed with a CFR of 0.3% in the state. Dass LGA had the highest CFR (14.3%) while Bauchi LGA recorded the highest AR of 1,830 cases per 100,000 persons. Factors significantly associated with cholera infection were attending social gatherings (aOR = 2.04, 95% CI = 1.16–3.59) and drinking unsafe water (aOR = 1.74, 95% CI = 1.07–2.83).ConclusionAttending social gatherings and drinking unsafe water were risk factors for cholera infection. Public health actions included chlorination of wells and distribution of water guard (1% chlorine solution) bottles to households and public education on cholera prevention. We recommend the provision of safe drinking water by the government as well as improved sanitary and hygienic conditions for citizens of the state.

An outbreak of acute neurological illness associated with drinking water source following a cyclone in Eluru, West Godavari district, Andhra Pradesh, India, December 2020

BackgroundIn December 2020, over 500 residents of Eluru City were hospitalised with seizures and sudden loss of consciousness (LOC) resembling the neurotoxic effects of organochlorine poisoning after a flooding event during the last week of November 2020. We described the epidemiological investigation of outbreak and identified risk factors. MethodsWe performed descriptive analysis followed by 1:1 unmatched case-control study. Cases were identified through house-to-house search and review of medical records at district hospital. A case defined as sudden onset LOC or new-onset seizures in an Eluru resident aged ≥1 year, December 1–15, 2020 and a control as absence of neurological symptoms in a person aged ≥1 year selected randomly from same administrative division of the case. We compared cases and controls for possible risk factors and calculated adjusted odds ratio (aOR) with 95% confidence interval (CI). Biological and environmental samples were tested for contaminants. ResultsWe identified 545 cases (56% males), including one death. Seizures were reported in 491 (90%) cases. Median age was 27 years (interquartile range: 17–37 years) and 480 (88%) cases resided in urban area. Cases were clustered in administrative divisions supplied by municipal water reservoirs. Cases were more likely than controls to use municipal water as primary source of drinking water (aOR = 4.6, 95% CI = 1.6–13.0). High levels (average: 14.6 mg/l) of organochlorine compounds were detected in all municipal water samples (acceptable limit: <0.001 mg/l). ConclusionThis investigation highlights water ingestion as an exposure pathway for environmental contaminants (organochlorines) in the community after largescale flooding. We recommended strengthening safe water surveillance in natural disaster response contingency plans in Eluru.

Malaria Outbreak Investigation in Nensebo District, West Arsi Zone, Southeast Ethiopia: A case-control study

Background: Malaria-related morbidity and mortality are 94% concentrated in Africa. Ethiopia is one of ten African countries affected by malaria, with 60% of the population living in malaria-risk areas. Recently, seasonal outbreaks have been reported in all regions, including previously malaria-free areas. Nationally, the Nensebo district of the west Arsi zone is classified as having very low transmission. During the 21st WHO week of 2021, Melka Denbi kebele reported an unusually high number of malaria cases to this district. The purpose of this study was to look into the magnitude of the malaria outbreak and the factors that contributed to it. Methods: A descriptive study was followed by an unmatched case-control study on 86 cases and 172 controls who were chosen at random. Malaria cases were those who were confirmed positive by rapid diagnostic test (RDT) and were line-listed at a health facility, while controls were those who lived nearby and were confirmed negative by RDT. At a p-value of 0.05 and a 95% confidence interval, logistic regression was used to identify malaria contracting factors.Results: With a mean age of 22 (12.31SD), the overall attack rate was 20.2/1000. Plasmodium vivax (PV) 105 (52.8%) was the most common. Staying out at night (AOR=3.94; 95%CI: 2.18-7.37) and stagnant water/intermittent river within 1 km of the vicinity were risk factors. Screened houses were protective (AOR=0.49; 95%CI: 0.27-0.89), as was knowledge of malaria transmission (AOR=0.51; 95%CI: 0.28-0.93) and prevention and control methods (AOR=0.50; 95%CI: 0.27-0.93).Conclusion: The illness was caused primarily by PV species known for their relapsing characteristics. Risk factors included stagnant water near homes and sleeping outside at night. Malaria screening centers and increased public awareness reduce the risk of contracting the disease. Our recommendations included regular environmental monitoring, behavioral change communication, ensuring radical cure, and further research with a detailed entomological survey and climate variables.

Predictors of death among severe COVID-19 patients admitted in Hawassa City, Sidama, Southern Ethiopia: Unmatched case-control study.

Since COVID-19 was announced as a worldwide pandemic, the world has been struggling with this disease. In Ethiopia, there is some information on the epidemiological characteristics of the disease and treatment outcomes of COVID-19 patients. But, there is limited evidence related to predictors of death in COVID-19 patients. To assess the predictor of death among severely ill COVID-19 patients admitted in Hawassa city COVID-19 treatment centers. An institution-based unmatched case-control study was conducted at Hawassa city COVID-19 treatment centers from May 2021 to June 2021. All severe COVID-19-related deaths from May 2020 to May 2021 were included in the case group whereas randomly selected discharged severe COVID-19 patients were included in the control group. Extracted information was entered into Epi-data 4.6 and exported to SPSS 25 for analysis. Multivariable binary logistic regression was run to assess predictors. The result was presented as an adjusted odds ratio with a 95% confidence interval. Variables with a 95% confidence interval which not included one were considered statistically significant. A total of 372 (124 cases and 248 controls) patients were included in the study. Multivariable analysis revealed age ≥ 65 years (AOR = 2.62, 95% CI = 1.33-5.14), having shortness of breath (AOR = 1.87, 95% CI = 1.02-3.44), fatigue (AOR 1.78, 95% CI = 1.09-2.90), altered consciousness (AOR 3.02, 95% CI = 1.40, 6.49), diabetic Mellitus (AOR = 2.79, 95% CI = 1.16-6.73), chronic cerebrovascular disease (AOR = 2.1, 95% CI = 1.23, 3.88) were found to be predictors of death. Older age, shortness of breath, fatigue, altered consciousness, and comorbidity were predictors of death in Severe COVID-19 patients.

Food Poisoning in a Senior High School in Kumasi an Unmatched Case Control Study

Food poisoning is when a person or a group of persons consume food that may be contaminated with microbes, toxins, or chemicals. Most cases are accidental and may arise from contamination of ingredients, an overdose of additives, or contamination of utensils. Globally, 600 million cases and 420,000 deaths are reported annually. In Ghana, 1914 cases were reported between 2013 and 2021, with 36 deaths. We investigated a case of food poisoning among students of a Girls SHS in the Kumasi Metropolis to estimate the burden, identify the cause, and implement control measures. An unmatched case-control study (119 cases, 347 controls) was conducted after descriptive epidemiology, to test for an association between the suspected exposure and the outcome. Medical records were reviewed. Active case search was conducted in classes. Our outbreak Case Definition was ‘Any person who developed diarrhoea and or abdominal pains from March 5-8, 2022 within the school’. Confidentiality was ensured by excluding the name of the school. A total of 119 boarders, out of 982 (attack rate 12.1%) were affected, but 18 hospitalised. The mean age was 17.4 (range 15-20, SD±0.92). Onset of index case was March 5, 2022. Symptoms included abdominal pains (84/119), diarrhoea (95/119) without mortality. A total 109 (91.6%) cases ate rice and stew, 6 (5%) ate tea and bread, 7 (5.8%) ate banku and groundnut soup, 4 (3.3%) ate rice balls and 1 (0.8%) ate porridge prior to incident. Odds ratio was 9.9 for consumption of rice-and-stew. A point source outbreak was concluded. The odds ratio indicated very strong association between the consumption of the rice-and-stew and the outbreak. We recommended screening for food-vendors and education on food hygiene.

Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study.

Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions. A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR). In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53). Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.

Risk factors of primary postpartum hemorrhage among postnatal mothers in the public hospital of southern Tigray, Ethiopia, 2019: A case-control study.

Postpartum hemorrhage is the most common direct cause of maternal mortality and morbidity; among them, primary postpartum hemorrhages are an enormous element. Although it has an incredible impact on maternal lifestyle, this is the most neglected area in Ethiopia and there is a lack of studies achieved within the study area. So this study aimed to identify the risk factors of primary postpartum hemorrhage among postnatal mothers in public hospitals in southern Tigray, Ethiopia, 2019. Institution-based unmatched case-control study design was conducted on 318 (106 case and 212 controls) postnatal mothers in public hospitals of Southern Tigray from January to October 2019. We used a pretested, structured interviewer-administered questionnaire and a chart review to collect the data. Bivariate and multivariable logistic regression models were used to identify the risk factors. P-value ≤ 0.05 was considered statically significant for both steps and an odds ratio with a 95% confidence level was used to see the strength of association. Abnormal third stage of labor [adjusted odds ratio = 5.86, 95% confidence interval (2.55-13.43), P = 000], cesarean section [adjusted odds ratio = 5.61, 95% confidence interval (2.79-11.30), P = 0.000], lack of active management of third-stage labor [adjusted odds ratio = 3.88; 95% confidence interval (1.29-11.60), P = 0.015], absence of labor monitoring by partograph [adjusted odds ratio = 3.82, 95% confidence interval (1.31-11.09), P = 0.014], lack of antenatal care [adjusted odds ratio = 2.76, 95% confidence interval (1.13-6.75), P = 0.026] and complications during pregnancy [adjusted odds ratio = 2.79, 95% confidence interval (1.34-5.83), P = 0.006] were found to be risk factors for primary postpartum hemorrhage. In this study complications and lack of maternal health interventions in the course of the antepartum and the intrapartum period were found to be risk factors for primary postpartum hemorrhage. A strategy for improving essential maternal health services and detecting and handling complications in a timely manner will help to prevent primary postpartum hemorrhage.

Livelihood activities, human mobility, and risk of malaria infection in elimination settings: a case–control study

BackgroundLivelihood activities and human movements participate in the epidemiology of vector-borne diseases and influence malaria risk in elimination settings. In Saudi Arabia, where malaria transmission intensity varies geographically, it is vital to understand the components driving transmission within specific areas. In addition, shared social, behavioural, and occupational characteristics within communities may provoke the risk of malaria infection. This study aims to understand the relationship between human mobility, livelihood activities, and the risk of malaria infection in the border region of Jazan to facilitate further strategic malaria interventions. In addition, the study will complement and reinforce the existing efforts to eliminate malaria on the Saudi and Yemen border by providing a deeper understanding of human movement and livelihood activities.MethodsAn unmatched case–control study was conducted. A total of 261 participants were recruited for the study, including 81 cases of confirmed malaria through rapid diagnostic tests (RDTs) and microscopy and 180 controls in the Baish Governorate in Jazan Provinces, Saudi Arabia. Individuals who received malaria tests were interviewed regarding their livelihood activities and recent movement (travel history). A questionnaire was administered, and the data was captured electronically. STATA software version 16 was used to analyse the data. Bivariate and multivariate analyses were conducted to determine if engaging in agricultural activities such as farming and animal husbandry, recent travel history outside of the home village within the last 30 days and participating in spiritual gatherings were related to malaria infection status.ResultsA logistical regression model was used to investigate components associated with malaria infection. After adjusting several confounding factors, individuals who reported travelling away from their home village in the last 30 days OR 11.5 (95% CI 4.43–29.9), and those who attended a seasonal night spiritual gathering OR 3.04 (95% CI 1.10–8.42), involved in animal husbandry OR 2.52 (95% CI 1.10–5.82), and identified as male OR 4.57 (95% CI 1.43–14.7), were more likely to test positive for malaria infection.ConclusionHuman movement and livelihood activities, especially at nighttime, should be considered malaria risk factors in malaria elimination settings, mainly when the targeted area is limited to a confined borderland area.