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Background Bacteremia is a major cause of morbidity and mortality worldwide. Children infected with HIV present with patterns of bacteremia that are generally associated with poor prognosis. In Mozambique, data on bacteremia are sparce, with most studies describing the epidemiology of pediatric bacteremia limited to patients near the capital city of Maputo, in the south. Methods We conducted an observational study of HIV-infected and HIV-exposed uninfected children, aged 0-59 months, that were hospitalized with fever between April 1, 2016 and February 28, 2019. A single blood specimen for bacterial culture was collected at admission. Descriptive statistics were used to summarize microorganisms detected and antibiotic susceptibility testing. Results A total of 808 HIV-infected (90%) and HIV-exposed uninfected (10%) children aged 0-59 months were enrolled in our study. The blood culture positivity rate was 12% (95% CI: 9.9%-14.4%). Five organisms accounted for most cases, with Staphylococcus Aureus being most common (37%), followed by Klebsiella spp (11%), Salmonella spp (11%), Escherichia Coli (9%) and Micrococcus (7%). Antibiotic resistance was common. Nearly 70% of Staphylococcus Aureus isolates were methicillin-resistant and roughly 50% of Klebsiella isolates had ESBL production. Conclusion Community-acquired bacteremia was common in HIV-infected and HIV-exposed uninfected children hospitalized in Mozambique with a febrile illness. A high rate of MRSA and ESBL producing organisms has implications for the empiric antibiotic choices utilized in Mozambique. Longitudinal data on the prevalence and antimicrobial resistance patterns of important pathogens are badly needed to guide national policy for drug formulary expansion and antibiotic prescription guidelines.

Background Wheeze and allergic sensitization are the strongest early-life predictors of childhood asthma development; the molecular origins of these early-life phenotypes are poorly understood. Objectives We sought to identify metabolites associated with early-life wheeze, allergic sensitization, and childhood asthma. Methods We conducted a nested case-control study using Environmental influences on Child Health Outcomes Program cohorts for discovery and independent replication. Wheeze and allergic sensitization were defined by number of wheeze episodes and positive specific IgE at age 1 year, respectively. Asthma was defined as physician diagnosis of asthma at age 5 or 6 years. We used untargeted metabolomics, controlling for observed and latent confounding factors, to assess associations between the plasma metabolome and early-life wheeze, allergy, and childhood asthma. Results Eighteen plasma metabolites were associated with first-year wheeze in the discovery cohort (n = 338). Z,Z unconjugated bilirubin (UCB) and its related metabolites exhibited a dose-response relationship with wheeze frequency; UCB levels were 13% (β = 0.87; 95% CI, 0.74-1.02) and 22% (β = 0.78; 95% CI, 0.68-0.91) lower in children with 1 to 3 and 4+ wheeze episodes compared with those who never wheezed, respectively. UCB levels were also associated with childhood asthma (β = 0.82; 95% CI, 0.68-0.98). Similar trends were observed in 2 independent cohorts. UCB was significantly negatively correlated with eicosanoid- and oxidative stress–related metabolites. There were no significant associations between metabolites and allergic sensitization. Conclusions We identified a novel inverse, dose-dependent association between UCB and recurrent wheeze and childhood asthma. Inflammatory lipid mediators and oxidative stress byproducts inversely correlated with UCB, suggesting that UCB modulates pathways critical to the development of early-life recurrent wheeze and childhood asthma.

Background While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women’s are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad. Method Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15–49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). Results Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, − 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: − 3.21, − 1.34) and relative (PAF = − 91.9, 95% CI: − 129.58, − 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures. Conclusion The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders’ priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

Background Underweight is one of the largest contributors to child morbidity and mortality and is considered to be the largest contributor to the global burden of diseases in low-and middle-income countries. In Mauritania, where one-fifth of children are underweight, there is a dearth of evidence on socio-economic, sex and geographic disparities in childhood underweight. As a result, this study aimed at investigating the socio-economic, sex and geographic disparities in childhood underweight in Mauritania. Methods Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Mauritania Multiple Indicator Cluster Surveys (MICSs) conducted between 2007 and 2015 were analysed. Childhood underweight was disaggregated by five equity stratifiers: education, wealth, residence, region and sex. In addition, absolute and relative inequality measures, namely difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF) were calculated to understand inequalities from wider perspectives. Corresponding 95% confidence intervals (CIs) were computed to measure statistical significance. Results Substantial absolute and relative socio-economic, sex and geographic disparities in underweight were observed from 2007 to 2015. Children from the poorest households (PAR=−12.66 [95% CI −14.15 to −11.16]), those whose mothers were uneducated (PAF=−9.11 [95% CI −13.41 to −4.81]), those whose mothers were rural residents (R=1.52 [95% CI 1.37 to 1.68]), residents of HodhCharghy (PAF=−66.51 [95% CI −79.25 to −53.76]) and males (D=4.30 [95% CI 2.09 to 6.52]) experienced a higher burden of underweight. Education-related disparities decreased from 2007 to 2015. The urban–rural gap in underweight similarly decreased over time with the different measures showing slightly different reductions. Wealth-driven disparities decreased marginally from 2011 to 2015. The sex-based and regional disparities increased, at least on average, over the 8-y intersurvey period. Conclusions The burden of underweight was significantly higher among children from disadvantaged subpopulations, those with uneducated and poorest/poor mothers, those living in rural areas and those living in HodhCharghy. Special nutrition intervention and efforts focused on these deprived subpopulations are required to reduce childhood morbidity and mortality associated with underweight and help achieve the Sustainable Development Goals.

Background. Food insecurity is the shortage of both the quantity and quality of food and a negative impact on the overall nutritional and health status of people with human immunodeficiency virus (HIV). Ethiopia is intensely affected by food insecurity which is about 87.4% of adult people living with human immuno deficiency virus (HIV) are still facing shortage to have access to safe, sufficient, and nutritious food for themselves and their family. However, there is no concrete scientific evidence established at the national level in Ethiopia. Hence, this review gave special emphasis on adult people with human immunodeficiency virus (HIV) to estimate the pooled prevalence of food insecurity and its associated factor at the national level in Ethiopia. Methods. Studies were retrieved from selected electronic data bases, including PubMed/Medlin, Cochrane library, Sciences Direct, Google, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled prevalence of food insecurity and its associated factors at 95% confidence interval with odds ratio (OR) using statistical R -software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias was checked using the funnel symmetry test, and heterogeneity was checked using forest plot and inverse variance square ( I 2 ). The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search. Result. A total of 650 articles were identified through the initial search of which 20 studies were included in the final review yielding a total sample size of 7,797 adult people with human immunodeficiency virus (HIV). The pooled prevalence of food insecurity was 52% (95% CI, 40%, 63%). Cluster of differentiation 4 CD 4 count < 350 cell / m m 3 [ AOR = 1.29 (95% CI, 1.08, 1.54)], develop opportunistic infection [ AOR = 4.09 (95% CI, 2.47, 6.78)], rural residence [ AOR = 1.59 (95% CI, 1.09, 2.34)], and World Health Organization (WHO) clinical stages III and IV [ AOR = 1.98 (95% CI, 1.23, 3.19)] was among the significantly associated factors. Conclusion. In this review, there was a high prevalence of food insecurity among adult people with human immunodeficiency virus. Therefore, the responsible stockholders should strengthen the system and procedure for early diagnosis of opportunistic infection, under nutrition, screening of underlying problems.

BACKGROUND Childhood asthma is a common chronic disease that likely has prenatal origins. Gestational diabetes alters maternal physiology and may influence fetal risk for childhood-onset disease. However, the association between gestational diabetes and child asthma is not well characterized. OBJECTIVE To investigate the association between gestational diabetes and wheeze/asthma at approximately 4 years of age in a racially diverse US cohort. METHODS We studied mother-child dyads enrolled prenatally in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. Gestational diabetes was determined by medical chart review. At approximately 4 years of age, we assessed child respiratory outcomes including parent report of physician-diagnosed asthma (ever), current wheeze (symptoms within the past 12 months), and current asthma (physician diagnosis and/or medication or symptoms within the past 12 months). We used the modified Poisson regression to assess associations between gestational diabetes and child respiratory outcomes, adjusting for maternal age, race, prenatal smoking, pre-pregnancy body mass index, parity, asthma history, socioeconomic status, and infant sex. RESULTS Among 1107 women, 66% were African American/Black. Six percent (n = 62) had gestational diabetes documented during pregnancy. Gestational diabetes was associated with increased risk of physician-diagnosed asthma (adjusted risk ratio (RR) [95% Confidence Interval]: 2.13 [1.35, 3.38]; prevalence: 14%), current wheeze (RR: 1.85 [1.23, 2.78]; prevalence: 19%), and current asthma (RR: 2.01 [1.30, 3.10]; prevalence: 16%). CONCLUSIONS Gestational diabetes was associated with increased risk of asthma and wheeze outcomes. Additional studies are needed to elucidate modifiable pathways underlying this association.

Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

Edosa Kebede,1 Gashaw Getnet,2 Getie Enyew,3 Daniel Gebretsadik1 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Department of Medical Laboratory Science, Family Guidance Association of Ethiopia, Dessie Branch, Dessie, Ethiopia; 3Department of Medical Laboratory Science, Dr. Mehretie Children’s Speciality Clinic, Gondar, EthiopiaCorrespondence: Edosa Kebede Tel +251913811305Email edexkebede@gmail.comBackground: The prevalence of transfusion transmitted infections (TTIs) among blood donors varies across different geographical populations. Establishing the sero-prevalence of the disease among blood donors is important to informing the direction of preventive and control strategies.Objective: The aim of this study was to determine the sero-prevalence of transfusion transmitted infections among voluntarily blood donors at Dessie Blood Bank, North East Ethiopia.Methods and Materials: A cross-sectional study was conducted from November 10 to December 12, 2018. A total of 384 blood donors were conveniently included in this study. Socio-demographic data and other factors were collected using a pre-tested structured questionnaire. Five milliliters of venous blood was collected using a sterile test tube from each blood donor and the blood was allowed to clot; then, serum was separated by centrifugation for laboratory investigation. Serum samples from blood donors were tested by enzyme-linked immunosorbent assays (ELISA) for the presence of hepatits B surface antigen (HBsAg), and antibodies to human immunodeficiency virus (HIV-1/2), hepatits C virus (HCV), and Treponema pallidum. Logistic regression was used to explore risk factors associated with each transfusion transmissible infection.Results: From a total of 384 blood donors, 24 (6.25%) of them had serological evidence for at least one infection. The overall sero-prevalence rates of HBV, HCV, HIV, and syphilis among blood donors were 4.2%, 0%, 0.26%, and 1.82%, respectively. Educational status was significantly associated with HBV infection. Multiple sexual behaviors had statistically significant association with syphilis.Conclusion: In conclusion, 6.25% of blood donors still harbor transfusion transmissible infections despite recent blood donation safety improvements with the greater majority (4.2%) of cases caused by HBV infection.Keywords: transfusion transmitted infections, HBV infection, syphilis, HCV infection, HIV infection, Ethiopia

Background Globally, hypertension is the most important public health issue and is a increasing health problem in Ethiopia. Blood pressure (BP) control is an ultimate therapeutic goal of hypertensive patients in reducing early complications of hypertension. Hence, this study was sought to examine the magnitude of uncontrolled BP, left ventricular hypertrophy (LVH), and treatment practice. Predictors of uncontrolled BP and LVH were also investigated. Methods A hospital-based cross-sectional study was conducted among 223 outpatients with hypertension on follow-up at Ayder Comprehensive Specialized Hospital (ACSH). Hypertensive patients with ≥18 years old who had been on follow-up care for at least 3 months were included in the study. Severely ill patients requiring urgent medical care and wheelchair-bound individuals or persons who had difficulty standing steady and pregnant women were excluded. Data were collected using a structured questionnaire and patients' chart review. Data were entered and analyzed using SPSS version 22.0. To identify predictors, binary logistic regression model analysis was performed. Statistical significance was set at P-value of 140/90mmgH) and LVH was found to be 31.4% and 39.5%, respectively. More than half (53%) of participants were on at least two antihypertensive drug combinations of different classes. Uncontrolled BP was significantly associated with poor adherence to salt reduction in meal (Adjusted Odds Ratio (AOR) =8.552, 95% CI: 2.853, 15.638, P

Summary Background Although a positive association has been established, it is unclear whether lower respiratory tract infections (LRTIs) with respiratory syncytial virus (RSV) cause chronic wheezing illnesses. If RSV-LRTI were causal, we would expect RSV-LRTI prevention to reduce the incidence of chronic wheezing illnesses in addition to reducing acute disease. We aimed to evaluate the strength of evidence for a causal effect of RSV-LRTI on subsequent chronic wheezing illness to inform public health expectations for RSV vaccines. Methods We did a systematic review and meta-analysis of observational studies evaluating the association between RSV-LRTI and subsequent wheezing illness (exposure studies) and studies evaluating the association between RSV immunoprophylaxis and subsequent wheezing illness (immunoprophylaxis studies). Exposure studies were included if the exposure group members had an LRTI with laboratory-confirmed RSV and if the exposure ascertainment period began before 2 years of age and ended before 5 years of age. We required a wash-out period of more than 30 days between the index RSV-LRTI and the outcome measurement to allow for resolution of the acute illness. Comparisons between RSV-LRTI and non-RSV-LRTI were not included. Immunoprophylaxis studies were included if they measured the association with subsequent wheezing illness relative to a control group, either in a randomised controlled trial (RCT) or an observational design. For the immunoprophylaxis drugs in question, we required evidence of efficacy in targeting RSV-LRTI from at least one RCT to ensure biological plausibility. All variations of wheezing illness were combined into a single outcome that refers broadly to asthma or any other respiratory illness with wheezing symptoms. Ovid MEDLINE and Embase databases were searched from inception up to Aug 28, 2018. We evaluated whether data from exposure studies could provide evidence against the most viable non-causal theory that RSV-LRTI is a marker of respiratory illness susceptibility rather than a causal factor. Additionally, we tested whether RSV immunoprophylaxis reduces the odds of subsequent wheezing illnesses. We used a random-effects modelling framework and, to accommodate studies providing multiple correlated estimates, robust variance estimation meta-regressions. Meta-regression coefficients (b) quantify differences between exposure and comparator groups on the loge odds ratio (loge OR) scale. Findings From 14 235 records we identified 57 eligible articles that described 42 studies and provided 153 effect estimates. 35 studies estimated the direct effect of RSV-LRTI on wheezing illnesses (exposure studies) and eight evaluated the effect of RSV immunoprophylaxis (immunoprophylaxis studies). Exposure studies that adjusted for genetic influences yielded a smaller mean adjusted OR estimate (aOR+ 2·45, 95% CI 1·23–4·88) compared with those that did not (4·17, 2·36–7·37), a significant difference (b 0·53, 95% CI 0·04–1·02). Infants who were not protected with RSV immunoprophylaxis tended to have higher odds of subsequent wheezing illness, as we would expect if RSV-LRTI were causal, but the effect was not significant (OR+ 1·21, 95% CI 0·73–1·99). There was generally a high threat of confounding bias in the observational studies. Additionally, in both the observational studies and immunoprophylaxis RCTs, there was high risk of bias due to missing outcome data. Interpretation Our findings, limited to exposure and immunoprophylaxis studies, do not support basing policy decisions on an assumption that prevention of RSV-LRTI will reduce recurrent chronic wheezing illnesses. Funding Bill & Melinda Gates Foundation.

Background. Children are highly susceptible to Mycobacterium tuberculosis infection, and about 70% of children living in the same households with pulmonary tuberculosis-positive patients will become infected. However, pulmonary positive tuberculosis is a common phenomenon and the implementation of the recommended contact screening and initiation of isoniazid preventive therapy is very low. Therefore, this study is aimed at assessing contact screening practice and initiation of isoniazid preventive therapy of under-five children among pulmonary tuberculosis-positive patients in Bahir Dar, northwest Ethiopia. Methods. A facility-based cross-sectional study was conducted from March 1 to 30, 2016. A total of 267 pulmonary tuberculosis-positive patients were included in this study. To identify independent predictors of contact screening and isoniazid preventive therapy initiation, we performed multivariable logistic regression analyses using SPSS version 20 with CI of 95% at p value < 0.05. Results. A total of 230 (90.2%) pulmonary tuberculosis-positive patients had single contacts with their under-five children. One hundred nine (64.8%) children were screened. From those screened, 11 (7.4%) developed tuberculosis disease and started antituberculosis treatment. Forty-four (31.9%) children started isoniazid preventive therapy. Sex of the participants, place of service delivery, relationship with contacts, HIV status, and attitude of PTB+ cases were significant predictors of contact screening (p<.05). Participant’s knowledge, attitude of participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation (p<0.05). Conclusion. Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant’s knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.

Background Breast cancer affects the overall quality of life (QOL) among its survivors. Limited evidence is available about the QOL among cases. Therefore, this study was intended to assess the quality of life of breast cancer patients attending the cancer treatment center at Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia. Methods An institution-based cross-sectional study was conducted among breast cancer patients attending cancer treatment at the Hawassa University Comprehensive Specialized Hospital between April and June, 2019. All breast cancer patients attending treatment the center were included in the study by universal sampling. Data were collected using a structured questionnaire containing demographic data, patient clinical factors and Quality of Life Instrument (WHOQOL)-BREF version 3.0. The collected data were entered into EpiData software version 3.1 and analyzed using SPSS Version 20.0. Descriptive statistics were presented in tables. Results A total of 259 respondents with a mean age of (SD) 44.89 (12.56) participated in study. The mean score of overall global health scale was 75.3 (SD±17.1) with the mean health satisfaction was 12.43 (SD±3.98). The highest mean score was observed in environmental domain, 93.31 (SD±19.76), despite social domain being very low, 36.69 (SD±7.62). Most of the participants were highly satisfied with the health care service that was provided, with a mean score of 16.1 (SD±3.1). In contrast, the majority of study participants were disappointed with the need for any medical treatment, body appearance, luxurious activities, and sexual life, with mean scores of 8.93 (SD±3.68), 8.74 (SD±4.26), 9.1 (SD±4.22), and 8.1 (SD±4.14), respectively. Conclusion Breast cancer patients in southern Ethiopia suffered from poor social and psychological support that, in turn, highly affected their life value. Therefore, due attention should be given to enhance social and psychological support for breast cancer patients as a whole.

Background The occurrence of uterine rupture has dropped significantly in high income countries. It continues, however, to be a major public and clinical health problem in low income countries including Ethiopia. Aim of this study was to assess management outcomes of uterine rupture and associated factors in Yirgalem General and Teaching Hospital in South Ethiopia. Methods Institution-based cross-sectional study was conducted to examine medical records of women with uterine rupture between January 1, 2012, and Decem”ber 31, 2017. Data were collected based on a checklist. Descriptive statistics and logistic regression analyses were performed. Results Incidence of uterine rupture was 345 in 13,500 live births (25.5 in 1000 live births) in the study period. Of these, 331 cases were included. Poor maternal outcome occurred in 224 (67.7%) women. There were 13 (3.7%) maternal deaths and 320 (96.7%) stillbirths. Wound site infection (131; 39.6%) and anemia (129; 39%) were the most common post-operative complications. Prolonged duration of labor (more than 24 h) (adjusted odds ratio (aOR) 3.6; 95% CI 1.7–7.4), women with sepsis on admission (aOR 2.9; 95% CI 1.4–6.1), hemoglobin level Conclusion Poor maternal outcome of uterine rupture was high in the study area as compared to other studies. Proper management of anemia, prompt surgical treatment, proper labor progress monitoring, surgical skills, improved infection prevention, maximizing blood transfusion availability and improving the quality of maternal healthcare all play a significant role in reducing uterine rupture and enhancing the chance of good outcomes.

Background Atopic dermatitis is a common childhood disease, potentially influenced by prenatal nutritional exposures such as polyunsaturated fatty acids (PUFAs). Objective In a racially diverse cohort, we hypothesized that childhood atopic dermatitis would be associated with higher prenatal omega-6 (n-6) and lower omega-3 (n-3) PUFAs. Methods We included mother-child dyads, births 2006 to 2011, enrolled in the University of Tennessee Health Sciences Center Conditions Affecting Neurocognitive Development in Early Childhood cohort. Primary exposures included second trimester plasma n-3 and n-6 PUFA status and the ratio of the two (n-6:n-3). We assessed child current atopic dermatitis symptoms in the previous 12 months at age approximately 4 to 6 years. We investigated the association between PUFA exposures and atopic dermatitis using multivariable logistic regression, adjusting for potential confounders. We assessed for effect modification by maternal prenatal smoking, atopic disease history, and child sex. Results Among 1131 women, 67% were African American and 42% had an atopic disease history; 17% of children had atopic dermatitis. Higher prenatal n-6 PUFAs were associated with increased relative odds of child atopic dermatitis (adjusted odds ratio: 1.25; confidence interval: 1.01-1.54 per interquartile range difference), and interaction models demonstrated that this association was seen in dyads in which the women had a history of atopic disease. Neither prenatal n-3 PUFAs nor n-6:n-3 were associated with child atopic dermatitis. Conclusion In this racially diverse cohort, higher second trimester n-6 PUFAs were associated with atopic dermatitis in children of women with atopy. PUFAs may represent a modifiable risk factor for atopic dermatitis, particularly in individuals with a familial predisposition.

Background The potential for prenatal antibiotic exposure to influence asthma risk is not clear. We aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. Methods We conducted a population-based cohort study of 84 214 mother–child dyads to examine the association of prenatal antibiotic exposure and childhood asthma using multivariable logistic regression models. Results Sixty-four percent of pregnant women received antibiotics. Prenatal antibiotic exposure was associated dose-dependently with increased odds of childhood asthma (adjusted odds ratio [aOR] for interquartile increase of 2 courses [interquartile range, 0–2], 1.26 [95% confidence interval {CI}, 1.20–1.33]). Among children exposed to at least 1 course in utero, the effect of timing at the first course was moderated by total maternal courses. Among pregnant women receiving a single antibiotic course, timing of exposure had no effect on childhood asthma risk. Among women receiving > 1 course, early exposure of the first course was associated with greater childhood asthma risk. Compared to narrow spectrum–only antibiotic use, broad spectrum–only antibiotic exposure was associated with increased odds of asthma (aOR, 1.14 [95% CI, 1.05–1.24]). There were effect modifications (P Conclusions Increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk. Our study provides important evidence supporting judicious prenatal antibiotic use, particularly timing of use and choice of antibiotics, in preventing subsequent childhood asthma.

Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6–59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7–9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in high-burden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one’s anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non–disease specific approaches to pediatric anemia management and should include improved access to blood culture.

Background The roles of systemic and airway-specific epithelial energy metabolism in altering the developmental programming of airway epithelial cells (AECs) in early life are poorly understood. Objective Our aim was to assess carbohydrate metabolism in developing AECs among children with and without wheeze and test the association of infant plasma energy biomarkers with subsequent recurrent wheeze and asthma outcomes. Methods We measured cellular carbohydrate metabolism in live nasal AECs collected at age 2 years from 15 male subjects with and without a history of wheeze and performed a principal component analysis to visually assess clustering of data on AEC metabolism of glycolitic metabolites and simple sugars. Among 237 children with available year 1 plasma samples, we tested the associations of year 1 plasma energy biomarkers and recurrent wheeze and asthma by using generalized estimating equations and logistic regression. Results Children with a history of wheeze had lower utilization of glucose in their nasal AECs than did children with no wheeze. Systemically, a higher plasma glucose concentration at year 1 (within the normal range) was associated with decreased odds of asthma at age 5 years (adjusted odds ratio = 0.56; 95% CI = 0.35-0.90). Insulin concentration, glucose-to-insulin ratio, C-peptide concentration, and leptin concentration at year 1 were associated with recurrent wheeze from age 2 years to age 5 years. Conclusion These results suggest that there is significant energy metabolism dysregulation in early life, which likely affects AEC development. These pertubations of epithelial cell metabolism in infancy may have lasting effects on lung development that could render the airway more susceptible to allergic sensitization.

OBJECTIVE: Pregnant women with asthma have increased frequency of respiratory viral infections and exacerbations. Because of these risks, women with asthma may be subject to increased surveillance during pregnancy and may, therefore, be at increased risk of antibiotic receipt. The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. METHODS: We included women who delivered a singleton, term, non-low birthweight, and otherwise healthy infant enrolled in the Tennessee Medicaid Program. Maternal asthma and prenatal antibiotic fills were ascertained from healthcare encounters and outpatient pharmacy claims. We examined the association between maternal asthma and prenatal antibiotic fills using modified Poisson regression. RESULTS: Our study population included 168354 pregnant women, 4% of whom had asthma. Women with asthma had an increased risk of filling at least one prenatal antibiotic prescription (adjusted risk ratio [aRR] 1.27, 95% confidence interval [CI] 1.25–1.28) and had an increased number of fills during pregnancy (aRR 1.54, 95% CI 1.51–1.57) compared to women without asthma. Among those who filled at least one antibiotic prescription, women with asthma had earlier first prenatal antibiotic prescription fill and increased likelihood of filling at least one course of broad-spectrum antibiotics during pregnancy (versus narrow-spectrum). CONCLUSIONS: Pregnant women with asthma had more outpatient antibiotic prescription fills than pregnant women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy, providing data that may inform antibiotic stewardship.

Background: Balneotherapy and hydrotherapy offer interesting treatment alternatives and are commonly used as additional interventions in the management of musculoskeletal disorders and pain management. Therefore, the aim of this study was to assess the effect of balneotherapy on musculoskeletal disorder pain and its perceived improvement among users of hot spring water in Southern Ethiopia. Methods: A single-arm cohort study and convenient sampling method were used to select 1337 study participants from four hot springs in Southern Ethiopia. A structured questionnaire, a physical examination, and laboratory blood tests were used to collect data. Data were entered using Epi data and transferred to SPSS 25 for cleaning and analysis. Descriptive analysis was made. Results: A total of 1279 participants were included in the study, giving a response rate of 96%. The majority of these patients have multiple health problems. Of all, 1137 (88.9%) of the patients were visiting the hot springs for joint pain followed by muscle pain 669 (52.2). Out of all cases of joint pain, 132 (11.6%) were clinically diagnosed with rheumatoid arthritis, and 5.3% were confirmed as having the disease based on a laboratory test. Of the total number of study participants, 1064 (83.2%) reported complete relief from the complaints they had at the start of the bath. Conclusions: Hot spring baths for three and more days have significant therapeutic effects on patients with musculoskeletal disorders, including rheumatoid arthritis. Physicians who are currently working in the area of diagnosis and treatment of patients in government and public facilities of the southern region should consider hot spring bath treatment for those patients with complaints of musculoskeletal pain, nonspecific arthritis, and rheumatoid arthritis. A hot spring bath is beneficial for everyone because it is a natural treatment with few side effects and a low cost.

Artículo con numerosos autores, sólo se mencionan el primero, los de la UAM y grupo colectivo, A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of, This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation awarded to S.I.H.

BackgroundThyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.MethodsAn institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared atp ResultsMean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89–38.16,p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04–7.15,p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery.ConclusionsIn developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.

Objectives This study aimed to determine the unfavorable outcomes and to assess factors contribute to the unfavorable management outcomes after cesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. Results The unfavorable maternal management outcomes were Adhesion 28 (8.3%), excessive blood loss and blood transfusion 19 (5.6%), cesarean hysterectomy 10 (3%), relaparotomy 5 (1.5%), wound infection and wound dehiscence 23 (6.8%). Unfavorable fetal outcomes were were stillbirth 9 (2.6%), early neonatal death 8 (2.4%), low birth weight 58 (17.2%). women who did not book for Antenatal Care and having a history of previous cesarean delivery were found to be associated with unfavorable maternal outcomes and indications of cesarean delivery as obstructed labor was associated with unfavorable fetal outcomes.

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility–based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting.What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths.What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems. What is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting. What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths. What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.

Background Viral bronchiolitis is a common respiratory infection that often affects term, otherwise healthy infants. A small literature suggests maternal stress during pregnancy is associated with bronchiolitis. However, the association between maternal exposure to lifetime traumatic stress, including traumatic events occurring in childhood or throughout the life course, and bronchiolitis has not been studied previously. Objectives To investigate the association between maternal exposure to total lifetime and childhood traumatic stress events and infant bronchiolitis. Methods We studied mother-infant dyads enrolled in a prospective prenatal cohort, recruited 2006-2011, and Tennessee Medicaid. During pregnancy, we assessed maternal lifetime exposure to types of traumatic events by questionnaire. We captured bronchiolitis diagnoses in term, non-low birthweight infants' first 12 months using linked Medicaid data. In separate models, we assessed the association of maternal lifetime traumatic events (0 to 20 types) and a subset of traumatic events that occurred during childhood (0 to 3: family violence, sexual, and physical abuse) and infant bronchiolitis using multivariable log-binomial models. Results Of 629 women, 85% were African American. The median count (interquartile range) of lifetime traumatic events was 3 (2, 5); 42% reported ≥1 childhood traumatic event. Among infants, 22% had a bronchiolitis diagnosis (0 to 2 lifetime traumatic events: 24%; 3 events: 20%; 4 to 5 events: 18%; 6 or more events: 24%). Total maternal lifetime traumatic events were not associated with bronchiolitis in multivariable analyses. For maternal childhood traumatic events, the risk of infant bronchiolitis increased with number of event types reported: adjusted Risk ratios were 1.12 (95% confidence interval [CI] 0.80, 1.59), 1.31 (95% CI 0.83, 2.07), and 2.65 (95% CI 1.45, 4.85) for 1, 2, and 3 events, respectively, vs none. Conclusions Infants born to women reporting multiple types of childhood trauma were at higher risk for bronchiolitis. Further research is needed to explore intergenerational effects of traumatic experiences.

Background: Diabetic ketoacidosis (DKA) is the most severe acute complication of type 1 diabetes mellitus which results in increased risk of morbidity and mortality especially in developing countries. Objective: To assess prevalence and associated factors of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in hospitals of the Tigray region, Ethiopia. Methods: A facility based retrospective observational study design was conducted in newly diagnosed type 1 diabetic children and adolescents up to the age of 18 years who were registered in 13 general and two referral hospitals from January 1, 2013 to December 30, 2017. The diagnosis of diabetic ketoacidosis was made with the criteria below, Children presenting with polysymptoms, weight loss, vomiting, dehydration, and also the indirect signs or effects of acidosis on respiratory and central nervous systems like Kussmaul breathing, lethargy or coma and biochemically random blood sugar level >11 ml/L, glucosuria and urine ketone >+1 and diagnosed with type 1 diabetes for the first time. Descriptive, Mann-Whitney U and logistic regression analysis were carried out to describe and identify the associated factors with diabetic ketoacidosis. Results: More than three-quarters, 258/328 (78.7%) of the newly diagnosed type 1 diabetes patients, presented with diabetic ketoacidosis at initial diagnosis. Median age of diabetic ketoacidosis patients was 11 years. The patients with diabetic ketoacidosis were younger than nondiabetic ketoacidosis patients (11 vs 13 years, P=0.002). The mortality rate of diabetic ketoacidosis was 4.3%. Young age, presence of precipitating factors and symptoms of DKA/diabetes were found to be highly associated with diabetic ketoacidosis at initial diagnosis. Conclusions: The prevalence of diabetic ketoacidosis was alarmingly high. Young age group patients, precipitating factors and the presence of symptoms of diabetes/DKA like excessive drinking, vomiting and fatigue were highly associated with diabetic ketoacidosis.

Background. Globally, more than 830 maternal deaths happen daily, and nearly, all of these occur in developing countries. Similarly, in Ethiopia, maternal mortality is still very high. Studies done in pastoralist women are almost few. Therefore, the objective of this study was to assess the determinant factors of maternal death in the pastoralist area of Borena zone, Oromia region, Ethiopia. Methods. Community-based unmatched case-control study was conducted on 236 mothers (59 maternal deaths (cases) and 177 controls). The sample included pregnant women aged 15–49 years from September 2014 to March 2017. Data were collected using a structured questionnaire adapted from Maternal Death Surveillance and Response Technical Guideline, entered into the EpiData, exported into SPSS for analyses. Odds ratios (ORs) and 95% confidence interval (CI) were computed to determine contributing factors of maternal death and control potential confounding variables. Results. About 51 (86%) of all maternal deaths were due to direct obstetric causes. Of this, hemorrhage (45%), hypertensive disorders of pregnancy (23%), and obstructed labor (18%) were the leading direct causes of maternal deaths. Husbands who had no formal education were 5 times higher compared with their counterparts (AOR = 5.1, 95% CI: 1.6–16). Mothers who were not attending ANC were 5 times more at risk for death than those who attend (AOR 5.3, 95% CI 2.3–12.1). Mothers who gave birth at home/on transit were twice to die compared to health facility delivery (AOR 2.6, 95% CI 2.4–6) that were contributing factors of maternal deaths. Conclusions. Husband’s level of education, lack of antenatal care, and home delivery were the factors contributing to maternal deaths in the zone. Frequent and tailored antenatal care, skilled delivery, and access to education also need due attention.

There is growing evidence suggesting that young people in school are practicing risky sexual behaviors. Ethiopian people aged 10 to 24 years have emerged as the segments of the population most vulnerable to a broad spectrum of serious sexual health problems. Therefore, the main aim of this study was to assess risky sexual behaviors and associated factors among preparatory school students in Arba Minch, Southern Ethiopia. An institution based cross sectional study was conducted among 465 study participants from April 20 to June 2, 2018. A self-administered pre-tested questionnaire was used to collect the data. Bivariate and multivariate analysis was done using binary logistic regression. In this study, 22.4% (95%CI: 18.6%, 26.2%) of study participants had risky sexual behaviors. Marital status, education and occupational status of the father, occupation of the mother, watching pornographic movies, drinking alcohol, using hashish/shisha and knowledge about HIV/AIDS were significantly associated with odds (AOR=3.28, 95%CI: 1.24, 8.70), (AOR=5.96, 95%CI: 1.35, 26.25), (AOR=0.33, 95%CI: 0.12, 0.93), (AOR=0.22, 95%CI: 0.09, 0.51), (AOR=8.80, 95%CI: 4.04, 19.17), (AOR=2.71, 95%CI: 1.35, 5.46), (AOR=14.88, 95%CI: 4.52, 48.96) and (AOR=2.89, 95%CI: 1.42, 5.88), respectively. This finding noted that significant numbers of students were engaged in risky sexual behaviours. Those students had multiple sexual partners, used condoms inconsistently, had sex with risky individuals, and an early sexual start. Watching pornographic movies, substance abuse and a knowledge gap on HIV/AIDS were some of the significant factors. Awareness creation for youths to reduce substance abuses, HIV/AIDS and sexual and reproductive health in the school community is recommended. Key words: Risky sexual behaviors, sexual and reproductive health problems, youths

Background Few studies have examined longitudinal asthma incidence rates (IRs) from a public health surveillance perspective. Objective Our aim was to calculate descriptive asthma IRs in children over time with consideration for demographics and parental asthma history. Methods Data from 9 US birth cohorts were pooled into 1 population covering the period from 1980 to 2017. The outcome was earliest parental report of a doctor diagnosis of asthma. IRs per 1,000 person-years were calculated. Results The racial/ethnic backgrounds of the 6,283 children studied were as follows: 55% European American (EA), 25.5% African American (AA), 9.5% Mexican-Hispanic American (MA) and 8.5% Caribbean-Hispanic American (CA). The average follow-up was 10.4 years (SD = 8.5 years; median = 8.4 years), totaling 65,291 person-years, with 1789 asthma diagnoses yielding a crude IR of 27.5 per 1,000 person-years (95% CI = 26.3-28.8). Age-specific rates were highest among children aged 0 to 4 years, notably from 1995 to 1999, with a decline in EA and MA children in 2000 to 2004 followed by a decline in AA and CA children in 2010 to 2014. Parental asthma history was associated with statistically significantly increased rates. IRs were similar and higher in AA and CA children versus lower but similar in EA and MA children. The differential rates by sex from birth through adolescence principally resulted from a decline in rates among males but relatively stable rates among females. Conclusions US childhood asthma IRs varied dramatically by age, sex, parental asthma history, race/ethnicity, and calendar year. Higher rates in the 0- to 4-year-olds group, particularly among AA/CA males with a parental history of asthma, as well as changes in rates over time and by demographic factors, suggest that asthma is driven by complex interactions between genetic susceptibility and variation in time-dependent environmental and social factors.

Bedilu Deribe,1 Mohammed Ayalew,1 Dereje Geleta,2 Lalisa Gemechu,3 Netsanet Bogale,4 Kurabachew Mengistu,4 Anteneh Gadissa,4 Dubale Dula,5 Girma Ababi,6 Achamyelesh Gebretsadik2 1Hawassa University School of Nursing, Hawassa, Ethiopia; 2Hawassa University School of Public Health, Hawassa, Ethiopia; 3Hawassa University Department of Environmental Health, Hawassa, Ethiopia; 4Hawassa University Faculty of Medicine, Hawassa, Ethiopia; 5Hawassa University Department of Midwifery, Hawassa, Ethiopia; 6Yanet Medical Center, Hawassa, EthiopiaCorrespondence: Bedilu DeribeHawassa University School of Nursing, Hawassa, South Ethiopia, EthiopiaTel +251933220151Email bediluderibe2002@gmail.comBackground: Cancer has become one of the most common and the second leading cause of death. According to grounded theory, quality care is meeting all the needs of the patients. Low-quality nursing care relates omission of nursing care required to meet patients’ need. Quality of nursing care in oncologic setting was nursing practice area where studies are limited.Objective: The aim of the study was to assess the perceived quality of nursing care among patients with cancer attending Hawassa University comprehensive specialized Hospital.Methods: A quantitative Cross-sectional study was conducted. Among the proposed 422 patients with cancer, using a simple random sampling technique 415 patients were included in this study. Seven data were discarded due to incompleteness and inconsistency between collected data and patient medical record. Data were collected using structured questionnaires and Quality of Oncology Nursing Care Scale. We carried out statistical analysis using SPSS V-20. We used descriptive analysis to examine the quality of oncology nursing care.Results: The mean age of patients was 42.51 (± 14.24) years, among patients diagnosed with cancer more than one-third 148 (35.70%) had breast cancer. The majority of patients with cancer 173 (41.70%) were in stage-III. Nearly two-third 266 (64.10%) of patients were on chemotherapy. Among study participants on treatment, 249 (60.00%) perceived they received good quality of nursing care. The mean score related to the domain of support and confirmation is 62.73 ± 7.26. In terms of spiritual care, the mean score is 21.03 ± 5.37.Conclusion: The perceived quality of nursing care was high however not all domains of oncology care were achieved. We recommend Detail and focused study to explore important predictors’ quality nursing care.Keywords: cancer, Hawassa, patents with cancer, quality of nursing care

Background. Iron-folate supplementation for a pregnant mother is a cost-effective intervention to reduce iron deficiency anemia during pregnancy. The aim of this study was to assess the iron-folic acid supplements and associated factors among pregnant women attending antenatal clinics in the public health center of Shalla district, Southwest Ethiopia. Methods. Institutional-based cross-sectional study design was conducted among 402 randomly selected pregnant mothers between February and April 2019. Data were collected using an interviewer-administered structured questionnaire from pregnant mothers attending antenatal care and using iron-folate supplements. Descriptive and multivariate logistic regression analyses were employed. Results. Pill count compliance rate was found to be (154) 38.3%. Pregnant mothers who had anemia in their previous pregnancy [(AOR = 11.35, 95% CI: 4.76–27.03)], counseling on iron-folate supplements [(AOR = 11.39, 95% CI: 5.09–27.03)], awareness of the benefit of the iron-folate supplements [(AOR = 2.22, 95% CI: 1.18–3.92)], and being a member of the Health Development Army [(AOR = 2.11, 95% CI: (1.2, 3.9)] were significantly associated with compliance with iron-folate supplement. Conclusion. Compared to the World Health Organization cut-off point, the pill count compliance rate of iron-folate supplementation among pregnant women in the study area was very low. Previous history of anemia and lack of knowledge about its benefit were some of the factors associated with it. Therefore, the healthcare providers should give continuous awareness creation and counseling services focusing on the benefit of iron-folate supplementation for pregnant mothers and their neonates.

Background. Periodic vitamin A supplementation to children is a cost-effective strategy to avert vitamin A deficiency. However, few pieces of evidence are available about the coverage of vitamin A supplementation at the community level in the study area. Therefore, the aim of this study was to assess vitamin A supplementation coverage and prevalence of ocular signs of vitamin A deficiency among children aged 6–59 months. Methods. Community-based cross-sectional study design was conducted using a two-stage stratified random sampling method. Data were collected from mothers with children aged 6–59 months using a structured pretested questionnaire. A total of 665 children aged 6 to 59 months were examined for clinical signs and symptoms of vitamin A deficiency by trained clinical health professionals. Descriptive statistics and logistic regression were done. Result. Vitamin A supplementation coverage in the study area was 36.2% (95% CI: 32.6–39.9). Overall, the prevalence of xerophthalmia was 2.7%. Age group 6–23 months (AOR: 2.1, 95% CI: 1.4–2.9), good maternal knowledge (AOR: 1.5, 95% CI: 1.2–2.1), children with high wealth status (AOR: 2.3, 95% CI: 1.4–3.8), precampaign health education on vitamin A (AOR: 3.4,95% CI: 2.1–5.6), member of Health Development Army (AOR: 2.7, 95% CI: 1.7–4.2), and access to health facility within

Background Individuals with metabolic syndrome are five times more susceptible to chronic diseases. Assessment of its magnitude, components, and risk factors is essentials to deploy visible interventions needed to avoid further complications. The study aimed to assess magnitude, components, and predictors of metabolic syndrome in Tigray region northern Ethiopia, 2016. Methods Data were reviewed from Tigray region NCDs STEPs survey data base between May to June 2016. A total of 1476 adults aged 18–64 years were enrolled for the study. Multi-variable regression analysis was performed to estimate the net effect of size to risk factors associated with metabolic syndrome. Statistical significance was declared at p-value of ≤0.05 at 95% confidence interval (CI) for an adjusted odds ratio (AOR). Results The study revealed that unadjusted and adjusted prevalence rate of Metabolic Syndrome (MetS) were (CPR = 33.79%; 95%CI: 31.29%–36.36%) and (APR = 34.2%; 95% CI: 30.31%–38.06%) respectively. The most prevalent MetS component was low HDL concentration (CPR = 70.91%; 95%CI: 68.47%–73.27%) and (APR = 70.61; 95%CI; 67.17–74.05). While; high fasting blood glucose (CPR = 20.01% (95%CI: 18.03–22.12) and (APR = 21.72; 95%CI; 18.41–25.03) was the least ones. Eating vegetables four days a week, (AOR = 3.69, 95%CI; 1.33–10.22), a salt sauce added in the food some times (AOR = 5.06, 95%CI; 2.07–12.34), overweight (AOR = 24.28, 95%CI; 10.08–58.47] and obesity (AOR = 38.81; 12.20–111.04) had strong association with MetS. Conclusion The magnitude of metabolic syndrome was found to be close to the national estimate. Community awareness on life style modification based on identified MetS components and risk factors is needed to avoid further complications.

BackgroundEthiopia has set a goal to eliminate malaria by 2030; Artemether–lumefantrine (AL) is put as one of the cornerstone strategies for uncomplicatedplasmodium falciparummalaria treatment. However, only focusing on prescribing of the treatment without assessing patients’ adherence could lead to the resistance of the drug. In Ethiopia, there is limited evidence about patients’ adherence to AL and its influencing factors. Therefore, this study aimed at addressing this information gap.MethodsA health facility based cross-sectional study was employed. Participants were selected using simple random sampling technique from registration books of the public health facilities in AsgedeTsimbla. Data were collected from March 24th to April 30th, 2018. We interviewed participants using a pre-tested structured questionnaire, and the blister pack was also inspected at their homes on day 4. Data were entered into Epi-Info and analyzed using SPSS 21. Odds ratios with 95% Confidence Intervals were estimated and the level of significance was declared at p-value ≤ 0.05.ResultsA total of 384 study participants were interviewed with a response rate of 95.5%. The overall AL adherence was 53.6% (95% CI 48.4–58.3%). Children aged ConclusionAL adherence was low. Children aged

Gebremedhin Gebreegziabher Gebretsadik,1 Hailay Gebretnsae,2 Mulu Ftwi,1 Afewerki Tesfahunegn3 1Department of Midwifery, College of Health Science, Adigrat University, Adigrat, Tigray, Ethiopia; 2Tigray Health Research Institute, Mekelle, Tigray, Ethiopia; 3Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, EthiopiaCorrespondence: Gebremedhin Gebreegziabher Gebretsadik Email gebremedhingebretsad@gmail.comBackground: Option B plus antiretroviral therapy (ART) is an approach used to eliminate new Human Immune Deficiency Virus (HIV) infections among infants. Considering the high adherence on Option B plus ART in HIV positive mothers is a crucial part in preventing mother-to-child transmission HIV. Therefore, this study was performed to assess the status of adherence and factors related to Option B plus ART.Methods: A cross-sectional study design was conducted in Eastern zone of Tigrai Region from January to February 2017. Data were collected by using pre-tested structured interviewer-administered questionnaire from 350 participants selected using simple random sampling. Descriptive and binary logistic regression was done during analysis.Results: The overall good adherence status of Option B plus ART among pregnant and lactating motherswas 67.3% [62.3– 72.3%]. Attending formal education (AOR=2.78, 95% CI 1.52– 5.07), traveling for < 1 hour to reach health facility (AOR=2.03, 95% CI 1.19– 3.44), (CD4) count < 350 cells/mm3 (AOR=2.3, 95% CI 1.33– 3.95), starting their Option B plus during pregnancy (AOR= 2.08, 95% CI 1.08– 3.97), taking one pill per day (AOR=2.12, 95% CI 1.25– 3.58), using a clock as a reminder (AOR=2.51, 95% CI 1.3– 4.86), and having good male involvement (AOR=2.91, 95% CI 1.64– 5.16) were associated with good level of adherence for Option B plus ART treatment.Conclusion: Our study revealed that the level of good adherence is low compared with the national target. Therefore, addressing the low adherence of Option B plus ART requires a policy response, such as efforts to enhance male partner involvement and better service accessibility in Prevention of Mother-to-Child Transmission (PMTCT) program. Moreover, health care providers and policymakers need to maximaze their efforts on HIV positive pregnant and lactating mothers using a clock as a reminder.Keywords: adherence, Option B plus ART, Prevention of Mother-to-Child Transmission program; PMTCT, Ethiopia

Background The risk factors determining short- and long-term morbidity following acute respiratory infection (ARI) due to respiratory syncytial virus (RSV) in infancy remain poorly understood. Objectives Our aim was to examine the associations of the upper respiratory tract (URT) microbiome during RSV ARI in infancy with the acute local immune response and short- and long-term clinical outcomes. Methods We characterized the URT microbiome by 16S ribosomal RNA sequencing and assessed the acute local immune response by measuring 53 immune mediators with high-throughput immunoassays in 357 RSV-infected infants. Our short- and long-term clinical outcomes included several markers of disease severity and the number of wheezing episodes in the fourth year of life, respectively. Results We found several specific URT bacterial-immune mediator associations. In addition, the Shannon ⍺-diversity index of the URT microbiome was associated with a higher respiratory severity score (β =.50 [95% CI = 0.13-0.86]), greater odds of a lower ARI (odds ratio = 1.63 [95% CI = 1.10-2.43]), and higher number of wheezing episodes in the fourth year of life (β = 0.89 [95% CI = 0.37-1.40]). The Jaccard β-diversity index of the URT microbiome differed by level of care required (P = .04). Furthermore, we found an interaction between the Shannon ⍺-diversity index of the URT microbiome and the first principal component of the acute local immune response on the respiratory severity score (P = .048). Conclusions The URT microbiome during RSV ARI in infancy is associated with the acute local immune response, disease severity, and number of wheezing episodes in the fourth year of life. Our results also suggest complex URT bacterial-immune interactions that can affect the severity of the RSV ARI.

Ataklti Gebretsadik Woldegebriel,1 Gebremedhin Gebreegziabiher Gebrehiwot,2 Abraham Aregay Desta,1 Kiros Fenta Ajemu,1 Asfawosen Aregay Berhe,1 Tewolde Wubayehu Woldearegay,1 Nega Mamo Bezabih1 1Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia; 2Department of Human Nutrition, School of Public Health, Adigrat University, Adigrat, Tigray, EthiopiaCorrespondence: Ataklti Gebretsadik WoldegebrielTigray Health Research Institute, Mekelle, Tigray, 1547, EthiopiaEmail atakltigebertsadik@gmail.comBackground: Anemia is the most common nutritional problem and a widespread micronutrient-deficiency disorder on a global scale. In Ethiopia, childhood anemia is highly prevalent and a major public health concern. This study aimed to identify factors associated with anemia among children aged 6– 59 months in Ethiopia.Methods: Data weres extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). We found records for 8,603 children aged 6– 59 months in the data set. After 448 had been excluded due to incomplete records, 8,155 children were included in the final analysis. Pearson’s χ2 was used to assess associations between each factor and categorical outcome variables. Multivariate logistic regression analyses were done to determine factors associated with anemia, and significant associations were declared at p≤ 0.05 for the final model.Results: More than half (51.5%) the children were male and the overall mean age was 31.85± 15.66 months. Mean hemoglobin concentration was 10.37± 17.55 g/dL. The overall prevalence of anemia was 56.6%: 3.7%, 30.4%, and 22.5% severe, moderate, and mild anemia, respectively. Increased child age, decreased maternal age, lowest rung on wealth index, mother living alone, mother engaged in outside work, increased birth order, decreased birth interval, one antenatal care visit, severe stunting, and severe underweight were significantly associated with anemia.Conclusion: The prevalence of anemia in this study was the highest of all EDHS reports. It had increased since the preceding report (EDHS 2011), and remains the main public health concern in Ethiopia. Comprehensive intervention strategies should be put in place and tailored to different levels of government (national, regional, and district) including household- and individual-level interventions for combating childhood anemia by focusing on the identified risk factors.Keywords: anemia, associated, children, EDHS 2016, Ethiopia

Background Worldwide cervical cancer is the third most common malignancy in women. It usually arises from the cervical area which is susceptible to Human Papilloma virus induced malignancy changes. In low-resource setting visual inspection with acetic acid (VIA) is an alternative sensitive cervical screening method. Therefore the aim of this study was to assess the magnitude and associated factors of VIA positive test results for Cervical Cancer screening among Eritrean refugee women aged 25–49 years in northern Ethiopia refugee camps. Methods A community based cross-sectional study was conducted among 412 Eritrean refugee women aged 25–49 years from august 10 to September 25, 2018. Study subjects were selected by simple random sampling method. Data were collected using pretested structured questioner through Face-to-face interview and cervical examination. Data were coded and entered to Epi info software version 7 and then exported to Statistical package for Social Science (SPSS) version 21 for analysis. Bivariable and multivariable logistic regression analysis was made to test the association between the independent variables and the outcome variable. P-value of less than 0.05 with 95% CI was considered to declare statistical significance. Result In this study the magnitude of VIA positive precancerous cervical lesions was 9% (95% CI: 6.3–11.8%). Previous history of sexually transmitted infections (STI) [AOR (95%CI) = 2.84(1.07–7.53)] and presence of STI during cervical examination [AOR (95%CI) =3.97(1.75–9.00)] were found significantly associated with VIA positive precancerous cervical lesions. Conclusions In this study the magnitude of VIA positive precancerous cervical lesions was high. Previous history of sexually transmitted infections (STI) and presence of STI during cervical examination were found associated with VIA positive precancerous cervical lesions. Efforts such as early screening for sexually transmitted disease shall be done to prevent precancerous cervical lesions.

BackgroundCytopenias affect the outcomes of highly active anti-retroviral therapy that results in higher morbidity, mortality, and impaired quality of life. The purpose of this study was to assess the prevalence of cytopenia and its associated factors among HIV infected adults on highly active antiretroviral therapy at Mehal Meda Hospital, North Shewa Zone, Ethiopia.MethodA cross-sectional health facility based study was conducted among 499 consecutively selected adult HIV infected patients taking HAART for at least six months from January to April 2018. The study participant's socio-demographic and clinical information was collected using a pre-tested questionnaire and reviewing of medical records by trained clinical nurses. Complete blood count and CD4 T cell count were determined by Sysmex KX-21 N and BD FACS count respectively. Bivariate and multivariate analysis was performed to identify the independently associated factors of cytopenia and prevalence ratios and their 95% confidence intervals were estimated using Poisson regression model with robust error variance to quantify the strength of statistical association. In all cases, a P value less than 0.05 was considered statistically significant.ResultOut of the total study participants, 39.9% had at least one form of cytopenia, 23.2% had anemia, 13.8% had leukopenia, 12.4% had thrombocytopenia, 11.62% had bi-cytopenias, and only 1% had pancytopenia. In multivariate analysis, cytopenia was independently associated with older age groups, male gender, ZDV based regimen, and CD4 count less than 200 cells/mm3.ConclusionsIn this study, the magnitude of any cytopenia was 40% among adult HIV infected patients taking highly active antiretroviral therapy and the prevalence increased as the CD4 count decreases. Therefore, these warrant the need for monitoring hematological parameters of HIV infected patients on HAART to reduce morbidity and mortality.

Mekuanent Alemu,1 Melaku Ashagrie Belete,2 Solomon Gebreselassie,3 Assefa Belay,1 Daniel Gebretsadik2 1Department of Medical Laboratory Science, Dessie Health Science College, Dessie 1212, Amhara, Ethiopia; 2Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie 1145, Ethiopia; 3Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa 1176, EthiopiaCorrespondence: Melaku Ashagrie BeleteDepartment of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie 1145, EthiopiaTel +251- 913867849Fax +251 333115250Email melakuashagrie@gmail.comPurpose: To determine the bacterial profile with its associated risk factors and to identify extended spectrum beta-lactamase producing Gram-negative bacterial uropathogens among diabetic patients at Dessie Referral Hospital, Northeastern Ethiopia.Materials and Methods: A hospital-based cross-sectional study was conducted from May to September 2018. A total of 336 diabetic patients were included using a simple random sampling technique. A structured questionnaire was used to collect socio-demographic and risk factor-related data. A 10-mL mid-stream urine specimen was collected and transported to the microbiology laboratory for culture, antimicrobial susceptibility testing, and detection of ESBL-producing bacteria. The data were entered into SPSS version 22, and descriptive statistics, bivariate and multivariate logistic regression analyses were performed. A p-value ≤ 0.05 with a 95% confidence interval was considered for statistical significance.Results: Among 336 diabetic patients, the overall prevalence of UTI was 11.6%. The predominant bacterial isolate was Escherichia coli 12/39 (30.8%), followed by Klebsiella pneumoniae 11/39 (28.2%) and coagulase-negative staphylococci 7/39 (17.9%). Gram-negative isolates showed 100% resistance to ampicillin, whereas Gram-positive isolates showed a high level of resistance to penicillin and tetracycline. Moreover, MDR was observed among 18 (46.2%) of the isolates and 2 of the isolated Gram-negative bacteria were ESBL producers. Being illiterate (AOR=7.226, 95% CI: (1.478, 35.340), p< 0.015), having current symptoms of UTI (AOR = 2.702, 95% CI: (1.102, 6.624), p=0.030), and blood glucose level ≥ 126 mg/dl (AOR = 2.940, 95% CI: (1.080, 8.005), p=0.035) were significantly associated with the occurrence of bacterial UTI.Conclusion: The overall prevalence of significant bacteriuria (11.6%) in this study was comparable with some studies in Ethiopia and relatively lower than others. A moderately higher rate of resistance to the commonly used antimicrobial agents was noticed for both Gram-negative and Gram-positive isolates. Health information dissemination should be given about UTI, glycemic control, and habit of drug use for diabetes mellitus patients.Keywords: urinary tract infection, diabetes mellitus, bacterial profile, antimicrobial susceptibility pattern, risk factors, ESBL

Background Altered mental status (AMS) is a priority presenting sign that must be assessed in HIV-infected, febrile children, yet diagnosis is difficult in areas with limited diagnostic capacity. Malaria and bacterial meningitis have been reported as the most common causes of AMS in febrile children presenting to the hospital in sub-Saharan Africa. However, in an HIV-infected child, central nervous system manifestations are diverse. Methods We conducted a clinical observational study of HIV-infected febrile children, aged 0–59 months, hospitalized in Mozambique and prospectively followed. Within this cohort, a nested study was designed to characterize children admitted with AMS and to assess factors associated with mortality. Univariate and multivariable analysis were performed comparing characteristics of the cohort by AMS status and evaluated demographic and clinical factors by in-hospital mortality outcome. Results In total, 727 children were enrolled between April 2016 and February 2019, 16% had AMS at admission. HIV-infected, febrile children, who presented with AMS and who had a diagnosis of bacteremia, had a 4-fold increased relative odds of in-hospital mortality, and children who presented with neurologic symptoms on admission had a roughly 8-fold higher odds of in-hospital mortality relative to children without presenting neurologic findings. Conclusions Mozambique has a pressing need to expand local diagnostic capacity. Our results highlight the critical need for clinicians to incorporate a broader differential into their potential causes of AMS, and to develop a Ministry of Health approved diagnostic and management algorithm, which is standardly used, to manage patients for whom reliable and relevant diagnostic services are not available.

ObjectiveThis study aimed to identify determinants of immunological recovery following highly active antiretroviral therapy (HAART) among severely immunosuppressed patients at enrolment to care in Northern Ethiopia.MethodsA retrospective study.SettingThe study was done in Tigray Region, Northern Ethiopia.ParticipantsThe study was done among severely immunosuppressed (3) individuals at initial enrolment to care and whose samples were sent for viral load determination from April 2015 to March 2019 in Tigray Health Research Institute.Main outcomesThe main outcome variable was immunological recovery, modelled using binary logistic regression.ResultsAmong the 9687 patients with severe immunosuppression at enrolment, 2746 (28.35%, 95% CI 27.45% to 29.26%) had immunological recovery following HAART for at least 6 months. Male gender (adjusted OR (AOR)=0.50, pConclusionsImmunological recovery following HAART was low among severely immunosuppressed individuals at enrolment to care. Gender, age, WHO stage III and viral non-suppression were determinants of immunological recovery. Male patients, adolescents and virally non-suppressed patients should be identified as groups at higher risk for immunological failure. Therefore, greater support and intensive counselling should be prioritised among adolescents, men and virally non-suppressed patients for better immunological recovery.

BackgroundAnemia is the most common nutritional problem and a wide spread micronutrient deficiency disorder even at global scale. In Ethiopia, child hood anemia is the most prevalent and a serious public health problem. The aim of this study is to assess determinants of anemia among children 6–59 months in Ethiopia, Ethiopia Demographic and Health Survey, 2016.MethodThis study was based on the 2016 Ethiopian Demographic Health Survey (EDHS).A community-based cross-sectional with a two-stage stratified cluster sampling technique was implemented at national level. Total of 7689 children were included in the analysis. Descriptive, bivariate and multivariable logistic regression analysis was employed.ResultThe prevalence of anemia among 6–59 months old children was 56.6% and highest among 6–11 months age groups. Child age 6–23 months, maternal age 20–29 and 30–39 years, poorest wealth index, mothers not currently living with husband, Birth order of the child eighth and, birth interval, one times, stunted children and underweight were significantly associated with anemiaConclusionsThe prevalence of anemia in this study was the highest from all EDHS reports. Itwas skyrocketed from the preceding report (EDHS 2011) and remains the main public health problem in Ethiopia. Comprehensive intervention strategies should be in place tailored to different government hierarchies (national, regional and district level) including household and individual level interventions for combating child hood anemia by giving an emphasis on the identified variables.

In Ethiopia, anemia during pregnancy is a major public health problem and affects both the mother’s and their child’s health. There is a scarcity of community-based evidence on determinants of anemia among pregnant women in the country. Therefore, this study aimed to assess the determinants of anemia among pregnant women in Ethiopia. Method. This study was based on the 2016 Ethiopian Demographic Health Survey (EDHS) that used a two-stage stratified cluster sampling technique. A cross-sectional study was conducted among 3080 pregnant women. Data analysis was done using STATA v.14. Variables with P value Results. The overall prevalence of anemia among pregnant women was 41% of which 20% were moderately anemic, 18%, mildly anemic, and 3%, severely anemic. The following were significantly associated with anemia during pregnancy: an age of 30–39 years, receiving no education (AOR = 2.19; 95% CI 1.45, 2.49), belonging to the poorest wealth quintile (AOR = 1.29; 95% CI 1.22, 1.60), being a Muslim (AOR = 1.59; 95% CI 1.69, 2.65), number of house members being 4–6 (AOR = 1.44; 95% CI 1.05, 1.97), number of under-five children being two (AOR = 1.47; 95% CI 1.10, 1.97), head of the household being a female (AOR = 2.02; 95% CI 1.61, 2.54), current pregnancy wanted later (AOR = 1.75; 95% CI 1.23, 1.63), no terminated pregnancy (AOR = 1.49; 95% CI 1.15, 1.93), and an age of 13–17 years at the first sexual intercourse (AOR = 1.97; 95% CI 1.291, 3.00). Conclusions. The study revealed that more than one-third of the pregnant women in Ethiopia were found anemic. Its prevalence varied among regions in which the highest (62.7%) and the lowest (11.9%) were from Somali and Addis Ababa, respectively. Hence, efforts should be made by concerned bodies to intervene in terms of the identified risk factors.

Background. Vitiligo is not a well-studied disease in Ethiopia. Therefore, this study assessed its clinico-epidemiological profile and treatment patterns. Methods. An institutional-based cross-sectional study was conducted in conveniently selected dermatologic clinics of Mekelle city, Ethiopia. A two-phased study was conducted, in which the first was to determine prevalence of vitiligo while the second phase was to describe the clinico-epidemiological profile and treatment pattern of vitiligo. Four-hundred three randomly selected dermatological patients were included in the first phase study. The second phase study included vitiligo cases from the first phase study and additional vitiligo cases found in a two months period prospective study. Results. Of the 403 randomly selected dermatological patients who presented in the year 2017 to 2019, the prevalence of vitiligo was 13.15%. Of the 79 cases with vitiligo, nearly two-thirds (50, 63.3%) were males with five years as the median age at onset of the disease. Positive family history of vitiligo was recorded in about one-third (25, 31.6%) of the cases. Limbs (48, 44.5%) followed by the head and neck (26, 24%) were the most commonly affected parts of the body at the onset of the disease. The most prevalent clinical form of vitiligo was vulgaris (39.2%) followed by the focal type (26.6%). Emotional upset (24, 33.8%) and physical traumas (23, 32.4%) were the frequently reported triggering factors of vitiligo. Three-fourths (75.5%) of the cases had prescriptions of topical corticosteroids, and 24.5% of them had prescriptions of sun screen lotion. Conclusion. The prevalence of vitiligo was found to be high. The clinico-epidemiological profile of vitiligo in Ethiopia was similar with that found globally. However, treatment options of vitiligo were very limited in Ethiopia.

Background Nutrition and dietary patterns are modifiable factors that can be utilized to prevent or slow the progression of Chronic kidney disease (CKD). Adherence to current dietary recommendations can reduce the incidence, or slow the progression of CKD and reduce mortality. The objectives of this study was to compare the dietary nutrient intake of CKD patients (CKD above stage 3 including hemodialysis) to dietary recommendations and to assess the correlations of those dietary nutrient intakes with each other and with chosen laboratory measurements. Methods A hospital-based cross-sectional study was conducted among 100 patients with CKD. A consecutive 7 days dietary record supplemented with interviews for data completion was used to assess dietary intake. Recent clinical laboratory measurements were obtained from patients’ medical records. The obtained dietary data were analyzed by the Ethiopian food composition database and the nutrisurvey software. Dietary energy and nutrients intake were compared with recommendations for CKD patients. Results The dietary energy intake (DEI) of almost all patients was below recommended levels. The average Dietary protein intake (DPI) was above the recommended levels (0.95 ± 0.27 g/kg/day) for about 60% of the respondents. Besides, 38% and only two of the respondents had their dietary phosphorus and potassium intakes above recommended levels, respectively. Estimated Glomerular filtration rate (eGFR) was positively correlated with both total and animal protein intakes while blood levels of creatinine and urea were negatively correlated with animal protein intake. Conclusion Patients with CKD are not well adhered to dietary recommendations and some nutrients showed correlation with chosen clinical laboratory measurements. Besides, DEI and DPI were below and above recommended levels, respectively, for most patients. Besides, more than one-third of the participants had phosphorus intakes above recommendation. These non-optimal dietary nutrient intakes may contribute to fast clinical deterioration and mortality.

Background: Fatigue is one of the most common and devastating Human Immuno-deficiency Virus (HIV) - related symptoms, with a varying prevalence in different study areas. In Ethiopia, there is a paucity of information on the magnitude and factors associated with fatigue among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients. This may lead to under-diagnosis and eventually under-management of the symptom. Objectives: This study assessed the prevalence and factors associated with fatigue among adults living with HIV/AIDS attending antiretroviral therapy at health facilities of Mekelle city, Tigray, North Ethiopia, 2019. Methods: Institution based cross-sectional study design was conducted among 609 HIV/AIDS patients who were selected by using a systematic random sampling method. Data were collected by using interviewer administered structured questionnaire. Level of fatigue was measured by Fatigue Severity Scale. Results: The prevalence of fatigue was found to be 51.7%. The factors associated with fatigue were: Parity [AOR= 2.01; 95% CI: 1.09-3.71], CD4 count 200-499 cells/mm3 [AOR= 2.81; 95% CI: 1.58-4.99], anemia [AOR= 4.90 95% CI: 2.40-9.97], co-morbidities [AOR= 3.65; 95% CI: 1.71-7.78], depression [AOR= 3.68 95% CI: 1.99-6.79], not being physically active [AOR= 3.20 95% CI: 1.50-6.81], clinical stage II or IV HIV [AOR= 3.11; 95% CI: 1.51-6.40] and [AOR= 4.08; 95% CI: 1.37-12.14], respectively. Conclusion: The finding of this study revealed that fatigue is a common health problem among adult People Living with HIV (PLHIV). Factors associated with fatigue included: Parity, CD4 count 200-499 cells/mm3, Clinical Stage II or IV HIV, anemia, co-morbidities, depression, and not being physically active. The health care service needs to address the predisposing factors by provision integrated care including timely detection and treatment of comorbidities, mental health problems, and promote physical activity to slow down disease progression and then reduce exposure to fatigue. Keywords: Fatigue, HIV/AIDS, Associated factors, Prevalence, Ethiopia

Background Delayed treatment initiation of tuberculosis (TB) increases disease progression and development of complications which may lead to a higher level of infectiousness, clinical severity and increased mortality. But published evidences that investigated the effect of delayed initiation of treatment on clinical severity and level of infectiousness of pulmonary tuberculosis patients is scarce in Tigray, Northern Ethiopia. Objective To investigate the association of delayed treatment initiation of new adult Pulmonary Tuberculosis patients with clinical severity and level of infectiousness. Methods In this cross-sectional study design, a total of 875 newly diagnosed adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities and study participants were selected by a simple random sampling method. Data were collected using questionnaires through face-to-face interviews of patients within the first 2 weeks of treatment initiation. Clinical severity was assessed by Bandim tuberculosis score and level of infectiousness was assessed by smear positivity or lung cavitations. Data were analyzed using SPSS version 21 software program. Logistic regression analysis was used to ascertain the association of delay with clinical severity and level of infectiousness. P-BMC Public Health of less than 0.05 was reported as being statistically significant. Results Those who had initiated treatment without delay and those who have initiated treatment after a medium delay of 31 to 60 days were significantly associated with decreased clinical score compared to those who initiated treatment after a delay of more than two months. Compared with patients who have initiated treatment within one month, the level of infectiousness was greater for delay of 30–60 days and above 60 days. Patients having more than 3 family members have higher level of infectiousness as compared to those who have a maximum of 3 family members. Whereas, patients having at least two rooms and being HIV negative had lower levels of infectiousness compared to their counter patients. Conclusion Narrowing the gap between their initial occurrence of TB symptoms and treatment initiation is the way forward to improve clinical courses of TB patients and to reduce the level of infectiousness of TB to other people from these patients.

Daniel Gebretsadik,1 Nuru Ahmed,2 Edosa Kebede,1 Miftah Mohammed,1 Melaku Ashagrie Belete1 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Ataye District Hospital, Ataye, EthiopiaCorrespondence: Daniel Gebretsadik Email gebretsadikd@gmail.comBackground: Tuberculosis is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide, and the leading cause of death from a single infectious agent, even ranking above human immuno-deficiency virus (HIV/AIDS).Objective: To assess the prevalence and associated risk factor of Mycobacterium tuberculosis among pulmonary tuberculosis (PTB) suspects attending at Ataye District Hospital from October 1, 2018, to February 30, 2019.Methodology: A facility-based cross-sectional study was conducted among 423 presumptive tuberculosis patients at Ataye District Hospital. Sputum was processed by MTB/RIF Xpert assay. Data were entered into EpiData 3.1 software and exported to SPSS version 20.0 (SPSS, Chicago, IL, USA) for analysis. Univariate and multivariate analyses were used to examine the relationship between the dependent and independent variables. Variables that show significance at P-value of 0.3 during univariate analysis were selected for multivariable analysis. A P-value of less than or equal to 0.05 was used to indicate statistical significance.Results: Out of the total study participants, about 60% were male, and 39% were aged between 18 and 24 years. Of the total 423 PTB suspected patients, 38 (8.98%) of them were identified as having PTB by GeneXpert and 2/38 (5.3%) were resistant to rifampicin and 3/38 (7.89%) patients were co-infected with HIV. Participant age between 18 and 24 years and between 25 and 34 years, weight loss, chest pain, having contact history with confirmed PTB cases, utilization of congested transportation, and a history of imprisonment were significantly associated with the prevalence of PTB.Conclusion: A considerable prevalence of PTB in the area was observed and the magnitude of MDR-TB was low. PTB is still a public health problem in Ethiopia and there is a need for collaborative prevention and control activities in the study area.Keywords: PTB, Ataye, MTB/RIF Xpert assay, Ethiopia