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Adequate micronutrient status during adolescence can break the inter-generational cycle of malnutrition. This study evaluated the effect of community-based weekly iron-folic acid supplementation (WIFAS) on serum ferritin (SF), serum folate (SFol) and hemoglobin concentration (Hb) among adolescent girls. A community-based, individually randomized-controlled trial (RCT) was conducted in four villages of Wolaita and Hadiya zones. Adolescent girls (n = 226) aged 10–19 years were recruited and randomly assigned (n = 113/group) into: (i) WIFAS and (ii) control (no intervention) groups. Anthropometry, Hb concentration, and serum ferritin (SF), SFol, and C-reactive protein (CRP) was analyzed at baseline and endline. Baseline Hb, SF, SFol and CRP concentrations were similar in both groups (P > 0.05). About 47–49% of adolescents had marginal iron store ( 15 µg/l) was slightly higher in the WIFAS than in the control group (P = 0.06). After adjusting for confounding factors in the multiple linear regression model, a three-months WIFAS intervention was associated with an improvement of 4.10 ng/ml in serum folate, 39.1 μg/l in serum ferritin, and 1.2 g/dl in hemoglobin concentration relative to the control group (P

Background Burden of caregivers of people with mental illness (PWMI) is considered to be a negative impact of the care provided by the family to the patient. However, little is known about the extent of the burden among caregivers of PWMI in Ethiopia. The aim of this study, therefore, is to assess the magnitude and associated factors of burden among caregivers of PWMI at Jimma University Medical Center, 2017. Methods Institution-based cross-sectional study design was employed among 406 conveniently selected caregivers of PWMI and interviewed using a structured questionnaire. Family burden interview schedule (FBIS) was used to assess burden of caregivers. Bivariate and multivariable linear regression analyses were performed to determine the predictors of burden among caregivers. Results Nearly two-thirds [264 (65.0%)] of the participants were male with a mean age of 38.45 ± 12.03 years. The mean score for burden among caregivers on family burden interview schedule was 23.00 ± 10.71. Age of the caregivers (β = 0.18, p

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi‐experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in‐person ECC meetings supplemented with audio‐recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p‐value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.

Objective:To explore influences on adolescent diet and physical activity, from the perspectives of adolescents and their caregivers, in Jimma, Ethiopia.Design:Qualitative design, using focus group discussions (FGD).Setting:A low-income setting in Jimma, Ethiopia.Participants:Five FGD with adolescents aged 10–12 years and 15–17 years (n 41) and three FGD with parents (n 22) were conducted.Results:Adolescents displayed a holistic understanding of health comprising physical, social and psychological well-being. Social and cultural factors were perceived to be the main drivers of adolescent diet and physical activity. All participants indicated that caregivers dictated adolescents’ diet, as families shared food from the same plate. Meals were primarily determined by caregivers, whose choices were driven by food affordability and accessibility. Older adolescents, particularly boys, had opportunities to make independent food choices outside of the home which were driven by taste and appearance, rather than nutritional value. Many felt that adolescent physical activity was heavily influenced by gender. Girls’ activities included domestic work and family responsibilities, whereas boys had more free time to participate in outdoor games. Girls’ safety was reported to be a concern to caregivers, who were fearful of permitting their daughters to share overcrowded outdoor spaces with strangers.Conclusions:Adolescents and caregivers spoke a range of social, economic and cultural influences on adolescent diet and physical activity. Adolescents, parents and the wider community need to be involved in the development and delivery of effective interventions that will take into consideration these social, economic and cultural factors.

BackgroundIn sub-Saharan countries, one in five children and one in three women experiences emotional and behavioural problems (EBPs) and depression, respectively. While various factors were reported to affect the mental health of children, little is known about the impact of maternal depression on the offspring. Moreover, the magnitude of children’s EBPs is barely known in Ethiopia.AimTo determine the magnitude of child EBPs and its association with maternal depression in Jimma town, southwest Ethiopia.MethodsA quantitative cross-sectional study was conducted among 734 mother–child pairs in Jimma town from January to June, 2019. EBP was assessed by using the parent version of Strengths and Difficulties Questionnaire (SDQ) with cut-off score of ≥14. Maternal depression was assessed using Patient Health Questionnaire-9 with a cut-off score of ≥10. Data were entered into Epidata V.3.1 and exported to SPSS V.24 for analysis. Multivariable logistic regression was fitted to identify the strength of association between exposure and outcome variables.ResultsOf the 734 participants, 146 (19.9%, 95% CI: 16.9% to 22.9%) met EBP criteria based on parent version of SDQ. Maternal depression had significant association with child EBP (adjusted OR=2.38, 95% CI: 1.55 to 3.66). In addition, children aged 7–10 years, family size categories of ≤3 and 4–6, maternal intimate partner violence and maternal khat use had significant association with child EBP.Conclusions and recommendationsA significant number of children suffer from EBP in Jimma town. Maternal depression is found to be a predictor of children’s EBPs. Thus, there is a need to design and implement an integrated maternal and child mental health programme. The maternal and child health section at the national level should integrate and cascade routine maternal and child mental health screening and intervention modalities down to the family healthcare system.

Young maternal age during pregnancy is linked with adverse birth outcomes. This study examined the role of maternal nutritional status in the association between maternal age and small for gestational age (SGA) delivery and birth length. We used data from a birth cohort study in Ethiopia, involving women who were 15-24 years of age and their newborns. A mediation analysis was fitted in a sample of 1,422 mother infant dyads for whom data on birth length were available, and 777 dyads for whom gestational age and birth weight was measured. We used commands, medeff for the mediation analysis and medsens for sensitivity analysis in STATA 14. Maternal nutritional status, measured by mid-upper arm circumference, mediated 21% of the association between maternal age and birth length and 14% of the association with SGA delivery. The average direct effect (ADE) of maternal age on birth length was (beta = 0.45, 95% CI [0.17, 0.99]) and the average causal mediated effect (ACME) was (beta = 0.12, 95% CI [0.02, 0.15]). We also found an ADE (beta = 0.31, 95% CI [0.09, 0.47]) and an ACME of (beta = 0.05, 95% CI [0.003, 0.205]) of maternal age on SGA delivery. The sensitivity analysis suggests an unmeasured confounder with a positive correlation of 0.15 and 0.20 between the mediator and the outcome could explain the observed ACME for birth length and SGA, respectively. We cannot make strong causal assertions as the findings suggest the mediator partly explained the total effect of maternal age on both outcomes.

Objective This retrospective cohort study is aimed to assess reasons and predictors of regimen change from initial highly active antiretroviral therapy among 1533 Human Immunodeficiency virus-infected adult patients at the Jimma University Tertiary Hospital. Results One in two (47.7%) adults changed their antiretroviral therapy regimen. Patients who were above the primary level of education [Hazard ratio (HR) 1.241 (95% CI 1.070–1.440)] and with human immunodeficiency virus/tuberculosis co-infection [HR 1.405 (95% CI 1.156–1.708)] had the higher risk of regimen change than their comparator. Individuals on Efavirenz [HR 0.675 (95% CI 0.553–0.825)] and non-stavudine [HR 0.494 (95% CI 0.406–0.601)] based regimens had lower risk of regimen change.

Objective. The study is aimed to assess the determinants of low birth weight among term neonates born in the health facilities of Kambata Tembaro Zone, Ethiopia. Methods. An Institution-based case control study was conducted. Term neonates born with birth weight less than 2500.00 g (LBW) were grouped into cases, and those term neonates with weight greater or equal to 2500.00 g were grouped as controls. A total of 282 participants (57 cases and 225 controls) were included with controls to cases ratio of 4:1. Binary logistic regression was done to get candidate variables. An adjusted odd ratio (aOR) was estimated from multivariable analysis with corresponding confidence interval to assess the strength of the association and statistical significance between the independent and the outcome variable. Results. A total of 282 term neonates (57 cases and 225 controls) comprised the study participants. The mean birth weight of the neonates was 2041.23 g (standard deviation-SD 339.00) for cases and 376.00 g (438.572) for controls. Among mothers of neonates 38 (66.7%) cases' and 146 (64.9%) controls' were age > 24 years old. Household food insecu­rity (aOR=6.74; 95% confidence interval-CI 2.78-16.36), gen­der of neonates (aOR=2.74, 1.24-6.05), iron supplementation (aOR=9.71, 3.51-26.88), additional food during pregnancy (aOR=5.49, 2.49-12.11) and anemia (aOR=3.51, 1.56-7.85) were significantly associated with LBW at term. Conclusion. Neonatal, maternal and dietary factors are mu­tually associated with low birth weight among term neonates included in our study.

Background The migration of young Ethiopian men and women to the Middle East countries was mainly for economic reasons. The migration was largely irregular that posed a wide range of unfavorable life conditions for some of the migrants. The overall objective is to assess common mental disorders and its associated factors for Ethiopian migrants returned from the Middle East countries and to describe mental health care services targeting these migrants. Methods The study employed a mixed-methods approach. For the quantitative part, a systematic random sampling technique was used to select a sample of 517 returnees. An interviewer-administered questionnaire based on Self Report Questionnaire-20 was used to collect data from respondents. The qualitative study employed a phenomenological study design to describe mental health care services. Key informant interviews and non-participant observation techniques were used to collect qualitative data. Results The prevalence of common mental disorder among Ethiopian migrants returned from the Middle East countries was found to be 29.2%. education (AOR=2.90 95%CI: 1.21, 6.94), physical abuse (AOR=12.17 95%CI: 5.87, 25.22), not getting salary properly and timely (AOR=3.35 95%CI: 1.47, 7.63), history of mental illness in the family (AOR=6.75 95%CI: 1.03, 43.95), detention (AOR=4.74 95%CI: 2.60, 8.62), guilty feeling for not fulfilling goal (AOR=9.58 95%CI: 4.43, 20.71), and denial of access to health care (AOR=3.20 95%CI:1.53, 6.67) were significantly associated with a common mental disorder. Shelter based and hospital-based mental health care services were rendered for a few return migrants with mental disorders. The services were primarily targeted, female return migrants. Conclusion The prevalence of common mental disorder was high among migrants returned from the Middle East countries. Despite the high burden of mental distress, only a small proportion of return migrants with mental illness is getting mental health care services.

Undernutrition is a major public health concern due to its association with the mortality and disease burden of women and children. This study aimed at identifying the extent and determinants of undernutrition among young pregnant women in Ethiopia. A multivariable regression analysis was fitted to identify determinants of undernutrition and anaemia in a sample of 1,393 pregnant women. Risk ratios (RRs) with 95% confidence interval (CI) were estimated. All the analyses were performed using STATA version 14 and adjusted for clustering. The study revealed that 38% of the women were undernourished and 22% were anaemic. Improved maternal education, RR = 0.94, 95% CI [0.89, 0.98]; higher wealth status, RR = 0.72, 95% CI [0.47, 0.95]; higher minimum dietary diversity for women, RR = 0.87, 95% CI [0.77, 0.98]; increased maternal height, RR = 0.96, 95% CI [0.94, 0.98]; and protected water source, RR = 0.93, 95% CI [0.86, 0.96], have decreased the risk of undernutrition while using unimproved toilet, RR = 1.31, 95% CI [1.06, 1.63], and depression, RR = 1.33, 95% CI [1.14, 1.55], increased the risk of anaemia. Animal source food consumption decreased both the risk of undernutrition, RR = 0.85, 95% CI [0.77, 0.94], and anaemia, RR = 0.91, 95% CI [0.85, 0.95]. The burden of undernutrition is still high. Although improved socio-economic status and dietary practices decreased the risk of undernutrition, poor health and environmental conditions were still significant risk factors. These findings suggest the need to target this set of important determinants to significantly decrease the burden of undernutrition among young pregnant women.

The world has faced a public health emergency due to the emergence of the COVID-19 pandemic. A cross-sectional study with mixed methods was conducted to review the status of maternal and child health care and nutrition service delivery during the early months of the pandemic in woredas (districts) targeted by the Growth through Nutrition Activity, a multi-sectoral nutrition project, in Ethiopia. Comparison to the previous year showed some decline in key maternal and child health and nutrition services, with more pronounced effects during the early months of March and April before coordinated effort and standard guidance were well established. A recovery of most services was likely due in no small part to a range of mitigation interventions implemented by respective health workers and institutions, supervising government organizations, and through support from non-governmental organizations., Findings from a crossectional, mixed method study reviewing status of maternal and child health and nutrition service delivery in select areas of Ethiopia during the COVID-19 pandemic.

Abdulhalik Workicho,Wondwosen Kassahun,Fessahaye Alemseged Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia Background: Multidrug-resistant tuberculosis (MDR-TB) did not receive major attention until recently in sub-Saharan Africa where the tuberculosis incidence and risk factors are highest. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies for national programs. The objective of this study was to identify the risk factors for MDR-TB among tuberculosis patients. Methods: A case-control study was conducted to assess sociodemographic, behavioral and clinical risk factors using a structured questionnaire and clinical record reviewing. The data were entered and analyzed using SPSS windows version 16. Descriptive analysis was done to generate summary values for the variables and those significant variables in the bivariate analysis at p-value less than 0.25 were entered to multivariable logistic regression to identify independent determinants. Statistical significance was declared at p-value less than or equal to 0.05. Results: A total of 90 cases and 90 controls were included in the study. Age of respondents (adjusted odds ratio [AOR] =7; 95% confidence interval [CI]: 2.6–24.5), living in a household with only one room (AOR=5; 95%CI: 1.68–15.38), history of previous treatment (AOR=21; 95% CI: 17.8–28) and being HIV infected (AOR=3.1; 95%CI: 1.02–9.4) were found to be independent predictors of MDR-TB. Conclusion: In light of these findings, the strategies in controlling MDR-TB should emphasize on patients with HIV coinfection, young patients, those who have a history of previous treatment, and those living in crowded places. Keywords: MDR-TB, risk factors, case-control study, St. Peter’s TB Specialized Hospital, Ethiopia

Background Diabetic nephropathy is the most serious complication of diabetes which leads to end-stage renal failure and other complication of diabetes mellitus. Determinants of Diabetic nephropathy are not consistent in different studies and associated factors to chronic complications of diabetes are not specific and there are limited studies specific to diabetic nephropathy. Thus, the aim of this study is to identify determinants of diabetic nephropathy in Ayder Referral Hospital, Northern Ethiopia. Methods A case-control study was conducted from February 14 to May 8 2016. Diabetic patients who developed nephropathy in the last two years were the cases and diabetic patients free of nephropathy were controls. Cases and controls were identified detailed review of the chronic care follow up chart. Then simple random sampling was used to select sample of 420 (with control to case ratio of 4:1) resulting in 84 cases and 336 controls. Record review and interviewer administered questionnaire were used to collect data. Data was coded and entered in to Epi-Data version 3.1 and then exported to STATA 12 for analysis. Variables with P-values< 0.25 in Bivariate logistic regression were selected for multiple logistic regressions to determine independent determinants of diabetic nephropathy. OR was calculated with 95% CI to show strength of association. Result The mean age (±Standard deviation) for the cases and the controls were 52(SD: ±1.34) and 42.4(SD: ±0.8) respectively. In multiple logistic regressions age of patient (AOR: 1.037 95%CI: 1.01–1.064), duration of diabetes after diagnosis (AOR for one year increase: 1.09 95%CI: 1.036–1.15), not-adhered to blood glucose measurement at home (AOR: 6.81 95%CI: 1.15–40.24), having Systolic Hypertension (AOR;2.13 (1.002–4.51), poor glycemic control (AOR;2.71 95%CI: (1.49–4.95), being overweight(AOR;2.7(1.47–4.96) were the independent predictors of diabetic nephropathy. Conclusion In the light of these findings, targeted interventions should be designed at the follow up clinic to address the risk of developing diabetic nephropathy among the risk groups.

Background: Peripheral arterial disease (PAD) is defined as an ankle-brachial index (ABI) ≤ 0.90 in individuals aged 40 years or over. So far, the prevalence of PAD in Ethiopia is not known. We assessed the prevalence of PAD among Ethiopians using ABI and thus evaluated its applicability as a screening tool at the community level. Methods: A cross-sectional community based survey was conducted on 178 sampled individuals aged 40 years and above in Jimma town, Southwest Ethiopia from June 15 to July 15, 2011. Conventional cardiovascular risk factors and intermittent claudication (with Edinburgh Claudication assessment tool) were assessed using a structured questionnaire. Blood pressure was measured using a mercury sphygmomanometer and a hand held Doppler flow detector at arm and ankle respectively. The ABI was calculated from the ratio of higher ankle systolic blood pressure and the higher of the two brachial systolic pressure measurements. Descriptive statistics and chi-square or Fischer’s exact test, were used for data analysis and interpretation. Predictors of PAD were estimated using univariate and multivariate regression models. Results: The overall prevalence of peripheral arterial disease was 10.8%. But, none of the participants with peripheral arterial disease fulfilled the criteria for claudication. The traditional risk factors identified were; hypertension, diabetes mellitus, and current cigarette smoking accounting for 29.5%, 6.8% and 12.5% of participants respectively. Female sex, current smoking and diabetes mellitus were significantly associated with increased risk of PAD. Conclusion: Peripheral arterial disease is common among Ethiopians aged 40 years and above. Intermittent claudication was found to be insensitive in the detection of peripheral arterial disease. Female sex, current smoking and diabetes mellitus were predictors of PAD.

BackgroundHealth-related quality of life (HRQOL) has become an important measure for evaluating patient treatment with non-curable chronic disease. The aim of the study was to assess HRQOL and its associated factors among patients with type II diabetes.MethodsThis is an institution-based, cross-sectional study conducted from March 13 to May 9, 2018. A total of 267 patients with type II diabetes who visited the clinic for follow-up for at least 3 months and who were 18 years or older were included in the study. The WHO Quality of Life-BREF was used to assess quality of life. Multivariable linear regression was employed to identify associated factors with HRQOL among patients with type II diabetes.ResultsThe mean score for overall HRQOL was 51.50±15.78. The mean scores for physical health, psychological, environmental and social relationship domains were 49.10±18.14, 53.51±19.82, 49.72±16.09 and 53.68±17.50, respectively. Age, disease duration and fasting blood glucose level were inversely associated with all domains of HRQOL (pConclusionThe findings from this study indicated that all dimensions of HRQOL of patients with diabetes in this study setting were compromised. The study also identified important predictors such as age, duration of disease and level of fasting blood sugar. This entails the need to intervene in improving the HRQOL of patients with diabetes beyond the provision of standard treatments.

Khalid Ali,1 Abdulhalik Workicho,2 Esayas Kebede Gudina3 1Department of Internal Medicine, Dire Dawa University, Dire Dawa, 2Department of Epidemiology, 3Department of Internal Medicine, Jimma University, Jimma, Ethiopia Background: Hyponatremia is a common electrolyte abnormality in patients with heart failure (HF). It is independently associated with increased short-term and long-term morbidity and mortality. The main objective of this study was to assess patterns of hyponatremia and its association with discharge outcomes in patients with HF admitted to a teaching hospital in Ethiopia.Patients and methods: This is a descriptive, prospective, hospital-based cohort study of patients with HF admitted to Jimma University Hospital, Ethiopia, between ­November 1, 2013 and July 31, 2014. A structured questionnaire was used to collect information on sociodemographic characteristics, clinical profile at admission, and outcomes at discharge. Plasma sodium concentration was analyzed at admission for all patients. The relationship between hyponatremia at admission and in-hospital mortality, as well as length of hospital stay, was assessed using both bivariate analysis and multivariable logistic regressions. The level of statistical significance was set at P

Background Despite different strategies designed to rapidly identify HIV infected individuals, majority of HIV-infected people are unaware of their sero-status in developing countries. The objective of this study was to assess predictors of provider-initiated HIV testing and counseling (PITC) refusal by outpatient department (OPD) clients in Wolaita zone, Southern Ethiopia. Methods Facility based unmatched case control study was conducted on outpatient department clients in randomly selected seven health facilities in Wolaita zone, Southern Ethiopia in February 2012. A total of 291 participants (97 cases and 194 controls) were included in our study. Cases were patients who refused HIV test while controls were patients who tested for HIV after provider-initiated HIV testing and counseling (PITC) recommendation by outpatient department (OPD) clinicians. We used both quantitative and qualitative methods of data collection. Pretested interviewer administered questionnaires were used to collect quantitative data by trained nurses, and in-depth interview with 14 OPD clinicians was conducted by principal investigator to supplement quantitative findings. Bivariate and multivariate analyses were done to identify independent predictors of provider-initiated HIV testing and counseling refusal by OPD clients. Result Study participants who had stigmatizing attitude [AOR = 6.09, (95 % CI: 1.70, 21.76)], who had perceived risk for HIV infection [AOR = 5.23, (95 % CI: 2.22, 12.32)], who did not perceive the benefits of provider-initiated HIV testing and counseling [AOR = 4.64, (95 % CI: 1.79, 12.01)], who did not get minimum recommended pretest information from their providers [AOR = 2.98, (95 % CI: 1.06, 8.35)], who ever not heard of provider-initiated HIV testing and counseling service [AOR = 2.41, (95 % CI: 1.14, 5.09)], and who were from urban area [AOR = 2.40, (95 % CI = 1.26, 4.57)] were more likely to refuse provider-initiated HIV testing and counseling service than their counterparts. Conclusion Knowledge on HIV/AIDS, attitude towards people living with HIV/AIDS and perceived risk for HIV infection by clients were the major barriers for provider-initiated HIV testing and counseling acceptance. Health professionals working at outpatient department should give due attention to overcome these barriers so as to enhance HIV testing acceptance by their clients.